血浆游离DNA检测在心血管系统疾病诊断中的应用

心血管疾病发病率和病死率居高不下,寻求敏感性高的生物学指标帮助早期诊断和改善预后意义重大。血浆游离DNA(cell-free DNA, cfDNA)是一类存在于血浆、尿液及其他体液中游离于细胞之外的双链DNA片段。血浆cfDNA水平在心血管疾病的早期明显升高,提示其可能是心血管疾病的潜在生物标志物。为了更深入理解cfDNA在心血管疾病中的研究进展,本文就cfDNA的生物学特性、在心血管疾病中的作用和应用进展进行了总结。     

HER2基因组DNA标准物质互通性研究

采用实验室建立的数字PCR方法 (ddPCR)和荧光定量PCR (qPCR)方法研究HER2基因组DNA标准物质的互通性,评价HER2基因组DNA标准物质与临床样本的互通性,为临床实验室检测提供具有互通性的可溯源标准物质.将研制的5个水平标准物质随机穿插于29例临床样本间,使用ddPCR方法与qPCR方法同时进行检测.参考美国临床实验室标准化协会(CLSI)指南文件EP30和中华人民共和国卫生行业标准基质效应与互通性评估指南WS/T356-2011的推荐,采用Deming回归法评价标准物质的互通性.结果显示,5种标准物质与临床样本之间具有良好的互通性,可以用于临床实验室对HER2基因拷贝数变异检测方法的方法验证和质量控制.     

癌症液体活检新思路：数字PCR检测DNA甲基化

癌症的早期诊断可提高患者生存率.微创采集人体体液的液体活检方法可避免传统肿瘤组织活检方法侵入性和异质性的问题,逐渐成为癌症诊断的新方式.另外,DNA甲基化作为预测癌症发生发展的标志物,引起了越来越多研究者的关注.但传统DNA甲基化的检测方法灵敏度不高,且容易出现假阳性.近年来,数字PCR技术因其超高的检测灵敏度和精确度、无需标准曲线即可进行核酸绝对定量检测的优势,被用于DNA甲基化的定量检测中.本文首先介绍了DNA甲基化与癌症发生发展的关系,总结了传统DNA甲基化检测方法及其在癌症临床诊断中的应用,阐述了基于不同核酸样本分散方法的数字PCR技术及其在微量DNA甲基化检测中的优势,总结了采用数字PCR技术检测癌症患者体液中DNA甲基化的具体步骤,列举了数字PCR技术在癌症DNA甲基化检测中的研究成果及应用进展,最后提出了数字PCR技术检测癌症DNA甲基化未来可能面临的挑战,并对数字PCR技术在癌症液体活检方面的应用前景进行了展望.     

扩增子测序技术应用于乳腺癌循环游离DNA无创性检测的研究

目的:应用扩增子测序方法检测乳腺癌循环游离DNA肿瘤相关突变。方法:军事医学科学院附属医院的10例HER2阳性晚期乳腺癌患者血样入组,应用扩增子测序技术检测血细胞和血浆中的循环游离DNA(cfDNA),筛选出肿瘤相关基因突变,即循环肿瘤DNA(ctDNA)。结果:检测10例晚期乳腺癌患者外周循环血50个基因,共检出11个突变基因,其中PIK3CA、ERBB4的阳性检出率均达到100%,AKT、TP53的阳性检出率为90%。结论:检测覆盖度及深度均良好,结果提示11个基因的热点突变区域出现单核苷酸的多态性基因突变,突变基因与PI3K-AKT-m TOR通路、Ras-Raf-MEK-ERK通路明显相关。扩增子测序技术和筛选方法可以用于乳腺癌ctDNA的无创性检测。     

基于级联核酸侵入反应的real-time PCR法检测咽拭子样本中UGT1A1*6基因多态性

伊立替康(irinotecan)不良反应与UGT1A1*6单核苷酸多态性相关,目前应用的单核苷酸多态性检测方法具有耗时长、开盖易污染、操作繁琐等缺点,因此需建立一种操作简便且不易污染的适合临床应用的新方法。本研究利用3种已知基因型的DNA样本建立基于级联核酸侵入反应的real-time PCR法检测UGT1A1*6多态性的最佳反应体系,并对其检测口腔咽拭子样本的灵敏度和准确性进行了考察。结果显示,本文成功建立了基于级联核酸侵入反应的UGT1A1*6基因多态性检测方法,可用于咽拭子样本的分型检测,其灵敏度达到6 ng DNA,分型准确性达到100%。因其取样方便对人体无创,单管闭管检测不易产生交叉污染,具有用于临床检测伊立替康的个体化用药相关UGT1A1*6基因多态性的潜力。     

血浆循环DNA水平与血常规指标的关联分析

目的:通过观察血浆循环DNA(cfDNA)浓度与血常规指标间的关系,探索cfDNA的来源。方法:用实时荧光定量PCR测定选定人群的血浆cfDNA浓度,用ADVIA120血细胞分析仪测定血常规指标,用双变量关联分析和逻辑回归分析血浆cfDNA浓度与性别、年龄及血常规指标间的相关性。结果:男性的血浆cfDNA浓度(23.23±3.186)略高于女性(18.55±2.037),但差异无显著性(P=0.2183);在各年龄段中,61~70岁年龄段的cfDNA浓度(23.20±4.274)最高,其次为70岁以上年龄段(20.92±2.089),51~60岁年龄段最低(15.81±1.747),但三者之间的差异没有显著性(P=0.3276);双变量关联分析表明血浆cfDNA浓度与过氧化物酶活性指数、血红蛋白及红细胞比积呈正相关(P<0.05),与性别、年龄及其他血常规指标无关;逻辑回归分析提示血浆cfDNA浓度升高只与平均血小板浓度和过氧化物酶活性指数呈正相关(P<0.05)。结论:血浆cfDNA增加可能与平均血小板浓度升高及过氧化物酶含量或活性有关,血小板前体细胞(即巨核细胞)可能是cfDNA的一个重要来源。     

支原体检测多重定量PCR方法的建立及应用

目的:建立一种快速、准确的方法检测支原体,这不仅可以有效地减少和预防支原体污染,还能为科研工作者提供一定的指导价值。方法:利用荧光定量PCR(TaqMan探针法)检测支原体,反应体系中同时存在标记两种颜色TaqMan探针及相关引物,分别检测支原体DNA和参考基因模板。根据支原体16S核糖体RNA保守区和参考基因TOP3A保守区设计引物和探针。通过对引物浓度、探针浓度和退火温度等反应条件的优化,建立了TaqMan探针多重定量PCR方法,并对该方法的特异性、敏感性和重复性进行了验证。结果:建立的双色荧光探针定量PCR方法的标准曲线相关系数r2和扩增效率分别为0.995和113.36%;该方法最低检测限为10 copies/μL;组内及组间变异系数均小于1%,证明该检测方法高效。利用该方法对随机挑选90例细胞抽提DNA样本进行检测,结果有60例为支原体阳性样本,阳性率67%,阳性率与相关研究报道一致。检测3个细胞培养上清样本,结果 1例支原体阳性,2例支原体阴性。从检测的样本中随机选择3个阳性样本及2个阴性样本使用普通PCR支原体检测试剂盒检测,结果一致;将其测序,测序结果比对正确。结论:本研究建立的多重定量PCR支原体检测方法能够应用于细胞抽提DNA及细胞培养上清的支原体检测,可以实现高效、快速检测支原体污染。     

牛绝对端粒长度测定及DNA提取造成的影响

目的：端粒是真核生物染色体末端的一种高度保守的负责维持染色体稳定的特殊结构,其DNA序列长度即端粒长度,会随着年龄增长或疾病发生发展而逐渐缩短,检测端粒长度可以为评估机体衰老和健康状况提供参考,但目前缺乏测定微量牛DNA样本绝对端粒长度的方法;通过实时荧光定量PCR(real-time quantitative PCR, qPCR)实现微量牛DNA样本绝对端粒长度的测定并评估DNA提取方法对牛绝对端粒长度测定结果的影响,为进行端粒长度研究时选择合适的DNA提取方法和端粒长度分析方法提供参考。方法：利用标准曲线对检测样本的端粒和内参Ct值进行转换,通过qPCR测定牛端粒长度绝对值;采用膜吸附法、苯酚-氯仿法和磁珠法3种方法分别提取相同样本的DNA,分别用端粒末端限制性片段(terminal restriction fragment, TRF)分析法和qPCR法分析端粒长度,比较不同DNA提取方法对牛绝对端粒长度测定的影响。结果：(1)qPCR可以测定纳克级别DNA样本的绝对端粒长度,检测结果重复性良好,并且和“金标准”TRF测定结果的相关性良好。(2)不同方法提取的DNA用TRF分析法和...     

DNA甲基化分析中重亚硫酸盐处理DNA转化效率的评估方法

为建立一种评估重亚硫酸盐处理DNA样本后胞嘧啶转化效率的有效方法,以两组不同的TaqMan qPCR检测梯度稀释的重亚硫酸盐处理和未处理的DNA标准品,建立转化与未转化的DNA Ct值以及对应的DNA拷贝数的标准曲线。使用相同的探针定量检测重亚硫酸盐处理后的DNA样本评估转化效率。结果显示该方法应用两组探针,根据相应的标准曲线,精确评估样本经重亚硫酸盐处理的转化效率。使用已知转化和未转化拷贝数的混合DNA作为模板,证实了该方法的可靠性。同时也对不同重亚硫酸盐试剂盒处理DNA的转化效率进行了评估,结果显示,该方法能够有效地评估DNA样品重亚硫酸盐的转化效率,为DNA甲基化准确分析提供了可靠快捷的方法。     

血浆游离DNA全基因组甲基化测序的实用稳定性评估

随着液体活检技术的发展,血浆游离DNA成为当前的研究热点之一。血浆游离DNA的全基因组甲基化测序被认为在癌症检测等医学应用拥有巨大潜力,但目前尚缺乏针对该实验流程的实用稳定性评估。文中利用两名志愿者在不同时间采样的血浆游离DNA,在不同实验平台分别进行DNA甲基化的重亚硫酸盐转化前建库(Pre-BS)、转化后建库(Post-BS)和常规DNA建库,获取多因素影响下的测序数据样本。在此基础上,建立了一套血浆游离DNA测序数据分析的质量控制参考流程,综合评估了血液采集提取、游离DNA建库测序过程的实用稳定性,为血浆游离DNA全基因组甲基化测序应用于临床液体活检提供实用性的基础参考。     

The diverse origins of circulating cell‐free DNA in the human body: a critical re‐evaluation of the literature

Since the detection of cell‐free DNA (cfDNA) in human plasma in 1948, it has been investigated as a non‐invasive screening tool for many diseases, especially solid tumours and foetal genetic abnormalities. However, to date our lack of knowledge regarding the origin and purpose of cfDNA in a physiological environment has limited its use to more obvious diagnostics, neglecting, for example, its potential utility in the identification of predisposition to disease, earlier detection of cancers, and lifestyle‐induced epigenetic changes. Moreover, the concept or mechanism of cfDNA could also have potential therapeutic uses such as in immuno‐ or gene therapy. This review presents an extensive compilation of the putative origins of cfDNA and then contrasts the contributions of cellular breakdown processes with active mechanisms for the release of cfDNA into the extracellular environment. The involvement of cfDNA derived from both cellular breakdown and active release in lateral information transfer is also discussed. We hope to encourage researchers to adopt a more holistic view of cfDNA research, taking into account all the biological pathways in which cfDNA is involved, and to give serious consideration to the integration of in vitro and in vivo research. We also wish to encourage researchers not to limit their focus to the apoptotic or necrotic fraction of cfDNA, but to investigate the intercellular messaging capabilities of the actively released fraction of cfDNA and to study the role of cfDNA in pathogenesis.     

Blood-based DNA methylation signatures in cancer: A systematic review

DNA methylation profiles are in dynamic equilibrium via the initiation of methylation, maintenance of methylation and demethylation, which control gene expression and chromosome stability. Changes in DNA methylation patterns play important roles in carcinogenesis and primarily manifests as hypomethylation of the entire genome and the hypermethylation of individual loci. These changes may be reflected in blood-based DNA, which provides a non-invasive means for cancer monitoring. Previous blood-based DNA detection objects primarily included circulating tumor DNA/cell-free DNA (ctDNA/cfDNA), circulating tumor cells (CTCs) and exosomes. Researchers gradually found that methylation changes in peripheral blood mononuclear cells (PBMCs) also reflected the presence of tumors. Blood-based DNA methylation is widely used in early diagnosis, prognosis prediction, dynamic monitoring after treatment and other fields of clinical research on cancer. The reversible methylation of genes also makes them important therapeutic targets. The present paper summarizes the changes in DNA methylation in cancer based on existing research and focuses on the characteristics of the detection objects of blood-based DNA, including ctDNA/cfDNA, CTCs, exosomes and PBMCs, and their application in clinical research.     

The dark side of circulating nucleic acids

Free circulating or cell‐free DNA (cfDNA), possibly from dying cells that release their contents into the blood as they break down, have become of major interest as a source for noninvasive diagnostics. Recent work demonstrated the uptake of human cfDNA in mouse cells in vitro and in vivo, accompanied by the activation of a cellular DNA damage response (DDR) and the appearance of apoptotic proteins in the host cells. By acting as a source of mobile genetic elements, cfDNA could be a continuous source of DNA mutagenesis of healthy cells in the body throughout life, promoting progressive cellular aging in vivo. As such, cfDNA may causally contribute to multiple aging‐related diseases, such as cancer, diabetes, and Alzheimer's disease.     

基于微滴式数字PCR检测肠癌病人游离环状DNA KRAS突变的新方法

基于微滴式数字聚合酶链式反应(Droplet digital polymerase chain reaction,dd PCR)设计一种检测肠癌游离循环DNA(Circulating cell free DNA,cf DNA)中KRAS(V-Ki-ras2 Kirsten ratsarcoma viral oncogene homolog)基因突变的新方法并评估其灵敏度和准确性。根据肠癌病人KRAS基因的突变类型设计并合成,采用dd PCR扩增并评估其灵敏度和准确性;根据AMRS-PCR引物设计原理设计KRAS基因的实时定量PCR扩增引物并评估其准确性,进而比较dd PCR和q PCR二者之间的优缺点;最后针对52例肠癌病人的cf DNA采用dd PCR进行检测,研究dd PCR在cf DNA KRAS基因突变检测的应用。成功使用dd PCR和q PCR两种方法对KRAS野生型及7种突变型建立检测方法,使用质粒标准品及实际样品验证该两种方法可行并对其假阳性率、线性范围及检测下限等性能进行了评价,最后成功对52例临床患者和20例正常人的血浆cf DNA样本进行检测,临床灵敏度为97.64%,临床特异性为81.43%。dd PCR的检测性能优于q PCR,LOD达到个位数DNA拷贝,最低可确认突变浓度达到0.01%–0.04%。样本提取效率在方法学建立中也十分重要,直接影响到灵敏度和Cut Off值的判定。临床患者检测结果显示其KRAS突变率接近报道水平。     

Associations of genome-wide cell-free DNA fragmentation profiles with blood biochemical and hematological parameters in healthy individuals

Cell-free DNA (cfDNA), as a non-invasive approach, has been introduced in a wide range of applications, including cancer diagnosis/ monitoring, prenatal testing, and transplantation monitoring. Yet, studies of cfDNA fragmentomics in physiological conditions are lacking. In this study, we aim to explore the correlation of fragmentation patterns of cfDNA with blood biochemical and hematological parameters in healthy individuals. We addressed the impact of physiological variables and abnormal blood biochemical and hematological parameters on cfDNA fragment size distribution. We also figured and validated that hematological inflammation markers, including leukocyte, lymphocyte, neutrophil, and platelet distribution width as well as aspartate transaminase levels were significantly correlated with the genome-wide cfDNA fragmentation pattern. Our findings suggest that cfDNA fragmentation profiles were associated with physiological parameters related to cardiovascular risk factors, inflammatory response and hepatocyte injury, which may provide insights for further research on the potential role of cfDNA fragmentation in diagnosis and monitor of several disease.     

Influence of Plasma Processing on Recovery and Analysis of Circulating Nucleic Acids

Circulating nucleic acids (CNAs) are under investigation as a liquid biopsy in cancer. However there is wide variation in blood processing and methods for isolation of circulating free DNA (cfDNA) and microRNAs (miRNAs). Here we compare the extraction efficiency and reproducibility of 4 commercially available kits for cfDNA and 3 for miRNA using spike-in of reference templates. We also compare the effects of increasing time between venepuncture and centrifugation and differential centrifugation force on recovery of CNAs. cfDNA was quantified by TaqMan qPCR and targeted deep sequencing. miRNA profiles were assessed with TaqMan low-density arrays and assays. The QIAamp^® DNA Blood Mini and Circulating nucleic acid kits gave the highest recovery of cfDNA and efficient recovery (>90%) of a 564bp spike-in. Moreover, targeted sequencing revealed overlapping cfDNA profiles and variant depth, including detection of HER2 gene amplification, using the Ion AmpliSeq™Cancer Hotspot Panel v2. Highest yields of miRNA and the synthetic Arabidopsis thaliana miR-159a spike-in were obtained using the miRNeasy Serum/Plasma kit, with saturation above 200 µl of plasma. miRNA profiles showed significant variation with increasing time before centrifugation (p<0.001) and increasing centrifugation force, with depletion of platelet associated miRNAs, whereas cfDNA was unaffected. However, sample replicates showed excellent reproducibility on TaqMan low density arrays (ρ = 0.96, p<0.0001). We also successfully generated miRNA profiles for plasma samples stored > 12 years, highlighting the potential for analysis of stored sample biobanks. In the era of the liquid biopsy, standardisation of methods is required to minimise variation, particularly for miRNA.     

Comparative analysis of 12 different kits for bisulfite conversion of circulating cell-free DNA

Blood circulating cell-free DNA (cfDNA) is becoming popular in the search of promising predictive and prognostic biomarkers. Among these biomarkers, cfDNA methylation markers have especially gained considerable attention. A significant challenge in the utilization of cfDNA methylation markers is the limited amount of cfDNA available for analyses; reportedly, bisulfite conversion (BSC) reduce cfDNA amounts even further. Nevertheless, few efforts have focused on ensuring high cfDNA conversion efficiency and recovery after BSC. To compare cfDNA recovery of different BSC methods, we compared 12 different commercially available BSC kits. We tested whether DNA recovery was affected by the molecular weight and/or quantity of input DNA. We also tested BSC efficiency for each kit. We found that recovery varied for DNA fragments of different lengths: certain kits recovered short fragments better than others, and only 3 kits recovered DNA fragments of <100 bp well. In contrast, DNA input amount did not seem to affect DNA recovery: for quantities spanning between 820 and ～25,000 genome equivalents per BSC, a linear relation was found between input and recovery amount. Overall, mean recovery ranged between 9 and 32%, with BSC efficiency of 97–99.9%. When plasma cfDNA was used as input for BSC, recovery varied from 22% for the poorest and 66% for the best performing kits, while conversion efficiency ranged from 96 to 100% among different kits. In conclusion, clear performance differences exist between commercially available BSC kits, both in terms of DNA recovery and conversion efficiency. The choice of BSC kit can substantially impact the amount of converted cfDNA available for downstream analysis, which is critical in a cfDNA methylation marker setting.     

Circulating Differentially Methylated Amylin DNA as a Biomarker of β-Cell Loss in Type 1 Diabetes

In type 1 diabetes (T1D), β-cell loss is silent during disease progression. Methylation-sensitive quantitative real-time PCR (qPCR) of β-cell-derived DNA in the blood can serve as a biomarker of β-cell death in T1D. Amylin is highly expressed by β-cells in the islet. Here we examined whether demethylated circulating free amylin DNA (cfDNA) may serve as a biomarker of β-cell death in T1D. β cells showed unique methylation patterns within the amylin coding region that were not observed with other tissues. The design and use of methylation-specific primers yielded a strong signal for demethylated amylin in purified DNA from murine islets when compared with other tissues. Similarly, methylation-specific primers detected high levels of demethylated amylin DNA in human islets and enriched human β-cells. In vivo testing of the primers revealed an increase in demethylated amylin cfDNA in sera of non-obese diabetic (NOD) mice during T1D progression and following the development of hyperglycemia. This increase in amylin cfDNA did not mirror the increase in insulin cfDNA, suggesting that amylin cfDNA may detect β-cell loss in serum samples where insulin cfDNA is undetected. Finally, purified cfDNA from recent onset T1D patients yielded a high signal for demethylated amylin cfDNA when compared with matched healthy controls. These findings support the use of demethylated amylin cfDNA for detection of β-cell-derived DNA. When utilized in conjunction with insulin, this latest assay provides a comprehensive multi-gene approach for the detection of β-cell loss.