Circulating suPAR in autoimmune liver diseases: advancing global noninvasive fibrosis and immune profiling

The soluble urokinase-type plasminogen activator receptor (suPAR) is a biologic marker of systemic immune activation and fibrotic burden in chronic inflammatory disorders. Recent studies have shown that suPAR has shown potential to distinguish autoimmune liver diseases (AILD) from other liver disorders, and is associated with non-invasive fibrosis indices and immunologic activity. This commentary outlines the evidence for analytical, clinical, and translational potential of suPAR in patients with AILDs. The assay variability and differentiation between liver and systemic inflammation are discussed. Recommendations are made for the establishment of standardized cutoffs for suPAR in diverse populations. Gaps that exist in the current literature regarding suPAR include a lack of histological verification, no long-term data, and no stratification of AILD subtypes. A four-phase innovation model is presented that emphasizes analytic standardization, composite biomarker models, trajectory-based tracking, and equitable global application of suPAR testing. Collectively, these considerations support suPAR as a potential adjunct biomarker with translational relevance in hepatology and immunology, warranting further validation before broader clinical adoption.