异柠檬酸脱氢酶-1 突变及MGMT 甲基化在脑胶质瘤的诊断及治疗研究进展

异柠檬酸脱氢酶-1(Isocitrate dehydrogenase-1,IDH1)突变是脑胶质瘤中基因突变所导致的代谢物生成异常,突变型胶质瘤与普通型胶质瘤具有不同的分子生物学特征,并常与患者良好预后相关。MGMT(O6-methylguanine-DNA methyltransferase)启动子甲基化能够降低胶质瘤中DNA修复蛋白MGMT的表达,提高患者对化疗药物烷化剂治疗的敏感性。IDH1突变和MGMT启动子甲基化在胶质瘤的生长过程中存在关联,二者的联合检测对胶质瘤的预后及治疗方式具有一定的提示作用,在胶质瘤的分子病理学诊断方面具有很大的应用前景。目前IDH1突变和MGMT启动子甲基化的检测已逐渐应用于临床,但其诊断方式及治疗指导意义有待进一步研究探讨。本文就IDH1基因突变及MGMT启动子甲基化在胶质瘤诊断及治疗方面的研究进展进行综述。     

基因启动子异常甲基化及其作为肿瘤生物标志物的研究进展

基因启动子异常甲基化与肿瘤的发生关系密切,它可导致抑癌基因或其它肿瘤相关基因的表达失活。研究显示基因启动子异常甲基化是肿瘤形成过程中的一个早期、频发事件,广泛存在于几乎所有种类的人类肿瘤中,因此,基因启动子区异常甲基化是一个高灵敏度的肿瘤生物标志物,检测外周血血清或肿瘤累及器官体液中肿瘤相关基因的甲基化状态将为肿瘤的早期诊断、疗效观察及预后判断提供非常有价值的信息。     

人脑胶质瘤中的IDH1/2突变

胶质母细胞瘤的基因组突变分析中发现的异柠檬酸脱氢酶(isocitrate dehydrogenase,IDH1)突变对胶质瘤的认识具有突破性意义。随后,在胶质瘤中发现了IDH1的R132碱基和IDH2的R172碱基突变。IDH1突变较多的发生在WHOII-III级胶质瘤和继发胶质母细胞瘤中。这种突变改变了异柠檬酸脱氢酶的结构,从而使将异柠檬酸转化为a-酮戊二酸的能力丧失,而获得将a-酮戊二酸转化为2-羟基戊二酸这一新的酶活性。在临床中,IDH1和IDH2突变已经显示对胶质瘤患者有诊断和预后意义。同时,现今也发展了一些检测方法。     

脑胶质瘤患者组织和血清MGMT、hMLH1和hMSH2基因启动子甲基化状态检测

目的探讨脑胶质瘤患者组织和血清中MGMT、hMLH1和hMSH2基因启动子CpG岛甲基化发生率及相关性。方法甲基化特异性PCR（MSP）检测39例脑胶质瘤组织样本及32例预处理的脑胶质瘤血清样本中MGMT、hMLH1和hMSH2基因启动子区的甲基化状态。结果脑胶质瘤组织MGMT、hMLH1和hMSH2基因启动子区甲基化发生率分别为46．2％、10．3％和20．5％,肿瘤组织中至少有一种基因甲基化的发生率为64．1％（25／39）;在脑胶质瘤患者外周循环血液中检测到了相关基因甲基化系列,并且与组织中基因甲基化发生率明显相关。结论MGMT、hMLH1和hMSH2基因启动子甲基化是脑胶质瘤发生过程中常见的分子事件,血清中相关基因DNA甲基化检测有可能为脑胶质瘤诊断和个体化化疗提供一种稳定的无创性检测指标。     

IDH1基因突变在胶质瘤中的研究进展

胶质瘤是颅内最常见的恶性肿瘤,发病率逐年增高。越来越多的证据表明IDH1基因突变与胶质瘤密切相关。本文就近年来有关胶质瘤与IDH1基因突变的研究作一综述。IDH1基因编码胞浆内NADP依赖的异柠檬酸脱氢酶,后者能够对异柠檬酸进行催化生成α-酮戊二酸。在40%的胶质瘤中存在IDH1突变,在继发性胶质母细胞瘤中变异率最高。作为一种代谢的关键酶,IDH1突变后可以将α-KG转变成2-HG,后者具有促进细胞增殖和促进肿瘤发生的作用。而且,IDH1突变可以导致胶质瘤代谢和表观遗传学方面的改变。同时,IDH1突变可以通过增加HIF-1α水平及活性增加血管生成。目前在不同级别的胶质瘤当中,IDH1突变已经成为一个与预后密切相关的独立预测因素。对IDH1突变的研究有助于深入了解胶质瘤病因及干预措施的具体机制,有助于胶质瘤的分子水平分类和治疗。     

骨关节炎相关生物标志物

骨关节炎（osteoarthritis）是关节软骨进展的退化性疾病,并累及周围组织结构的病变,是致老年人伤残主要原因之一。目前,以临床表现和影像学诊断为主,缺乏早期检测和预后评估的有效方法。生物标志物的检查是具有前景的研究方向,在关节软骨结构改变之前,各种生物标志物代谢发生变化,其能帮助诊断和预测骨关节炎的发生发展及其预后。然而,生物标志物在临床诊断和治疗相关的应用仍需加以证实。通过广泛查阅近年有关骨关节炎相关分子生物诊断的相关文献,有助于了解生物标志物对于骨关节炎的早期诊断意义和临床应用前景。本文就关节软骨、骨和滑膜等不同组织类型相关的生物标志物进行综述。     

急性肾损伤生物标志物的研究进展

正急性肾损伤(acute kidney injury,AKI)是常见的临床综合征,特别是在重症监护病房等单元。临床上血肌酐增高的程度和尿量变化是目前AKI的诊断指标,但肌酐不是反映肾功能变化的可靠指标,临床局限性较大,因此通过基础研究和临床研究发现理想的生物标志物势在必行,这对AKI的诊断、治疗、判断预后及预防极其重要。近年来的研究发     

急性肾损伤早期诊断生物标志物研究进展

急性肾损伤(Acute kidney injury,AKI)可发生于各临床科室其临床经过常见并严重,ICU的重症患者AKI的发病率和死亡率更高。早期诊断对AKI的预后影响重大,能否找到临床实用的早期预测AKI的生物学标志物尽早采取干预措施是改善其预后的关键。本文就近年来研究的几种具有潜力的生物标志物作一综述。     

脑胶质瘤神经干细胞治疗研究进展

脑胶质瘤是神经外科最常见的恶性肿瘤, 发病率约占全身肿瘤的5％,占儿童肿瘤的70％,且呈逐年上升的趋势。脑胶质瘤恶性程度高,生长迅速,５ 年生存率很低,其中高级别胶质瘤具有极强的侵袭能力,目前尚缺乏很有效的根治方法。手术切除肿瘤的难度很大,术后极易复发,预后比较差,对人类健康乃至生命的危害极大。随着分子生物学的发展以及相关生物技术的应用,从基因水平揭示脑胶质瘤的发生发展机制,并寻求有效的基因治疗方法成为人类研究肿瘤治疗新的研究方向。Reynolds 和Richards等先后从成年小鼠的纹状体中分离出能够不断增殖且具有多向分化潜能的细胞群,并提出了神经干细胞（neural stem cell, NSC）的概念。NSC具有高度增殖和自我更新的能力,且有迁移功能以及与正常脑组织良好融合的特性,这为基因治疗胶质瘤提供了良好的基础。     

脑胶质瘤神经干细胞治疗研究进展

脑胶质瘤是神经外科最常见的恶性肿瘤,发病率约占全身肿瘤的5%,占儿童肿瘤的70%,且呈逐年上升的趋势。脑胶质瘤恶性程度高,生长迅速,5年生存率很低,其中高级别胶质瘤具有极强的侵袭能力,目前尚缺乏很有效的根治方法。手术切除肿瘤的难度很大,术后极易复发,预后比较差,对人类健康乃至生命的危害极大。随着分子生物学的发展以及相关生物技术的应用,从基因水平揭示脑胶质瘤的发生发展机制,并寻求有效的基因治疗方法成为人类研究肿瘤治疗新的研究方向。Reynolds和Richards等先后从成年小鼠的纹状体中分离出能够不断增殖且具有多向分化潜能的细胞群,并提出了神经干细胞(neural stem cell,NSC)的概念。NSC具有高度增殖和自我更新的能力,且有迁移功能以及与正常脑组织良好融合的特性,这为基因治疗胶质瘤提供了良好的基础。     

Epigenetic biomarkers of T-cells in human glioma

Immune factors are thought to influence glioma risk and outcomes, but immune profiling studies to further our understanding of the immune response are limited by current immunodiagnostic methods. We developed a new assay to capture glioma immune biology based on quantitative methylation specific PCR (qMSP) of two T-cell genes (CD3Z: T-cells, and FOXP3: Tregs). Flow cytometry of T-cells correlated well with the CD3Z demethylation assay (r = 0.93; p < 2.2 × 10^?16), demonstrating the validity of the assay. Furthermore, there was a high correlation between qMSP and immunohistochemistry (IHC) in quantifying tumor infiltrating T-cells (r = 0.85; p = 3.4 × 10^?11). Applying our qMSP methods to archival whole blood from 65 glioblastoma multiforme (GBM) cases and 94 non-diseased controls, GBM cases had highly statistically significantly lower T-cells (p = 1.7 × 10^?9) as well as Tregs (p = 5.2 × 10^?11) and a modestly lower ratio of Tregs/T-cells (p = 0.024). Applying the methods to 120 excised glioma tumors, we observed that tumor infiltrating CD3+ T-cells were positively correlated with glioma tumor grade (p = 5.7 × 10^?7), and that Tregs were enriched in tumors compared with peripheral blood indicating active chemoattraction of suppressive Tregs into the tumor compartment. Poorer patient survival was correlated with higher levels of tumor infiltrating T-cells (p = 0.01) and Tregs (p = 0.04). DNA methylation based immunodiagnostics represent a new generation of powerful laboratory tools offering many advantages over conventional methods that will facilitate large clinical epidemiologic studies and capitalize on stored archival blood and tissue banks.     

Epigenetic biomarkers of T-cells in human glioma

Immune factors are thought to influence glioma risk and outcomes, but immune profiling studies to further our understanding of the immune response are limited by current immunodiagnostic methods. We developed a new assay to capture glioma immune biology based on quantitative methylation specific PCR (qMSP) of two T-cell genes (CD3Z: T-cells, and FOXP3: Tregs). Flow cytometry of T-cells correlated well with the CD3Z demethylation assay (r = 0.93; p < 2.2 × 10⁻¹⁶), demonstrating the validity of the assay. Furthermore, there was a high correlation between qMSP and immunohistochemistry (IHC) in quantifying tumor infiltrating T-cells (r = 0.85; p = 3.4 × 10⁻¹¹). Applying our qMSP methods to archival whole blood from 65 glioblastoma multiforme (GBM) cases and 94 non-diseased controls, GBM cases had highly statistically significantly lower T-cells (p = 1.7 × 10⁻⁹) as well as Tregs (p = 5.2 × 10⁻¹¹) and a modestly lower ratio of Tregs/T-cells (p = 0.024). Applying the methods to 120 excised glioma tumors, we observed that tumor infiltrating CD3+ T-cells were positively correlated with glioma tumor grade (p = 5.7 × 10⁻⁷), and that Tregs were enriched in tumors compared with peripheral blood indicating active chemoattraction of suppressive Tregs into the tumor compartment. Poorer patient survival was correlated with higher levels of tumor infiltrating T-cells (p = 0.01) and Tregs (p = 0.04). DNA methylation based immunodiagnostics represent a new generation of powerful laboratory tools offering many advantages over conventional methods that will facilitate large clinical epidemiologic studies and capitalize on stored archival blood and tissue banks.     

5-Aza-CdR对胶质瘤细胞生长及LRRC4基因异常甲基化的影响

LRRC4是一个新发现的胶质瘤抑瘤基因,它在多种胶质瘤细胞系和胶质瘤组织表达缺失或下调,前期研究结果表明胶质瘤细胞和组织中LRRC4的编码区未发生突变、缺失或重排．为了获得LRRC4作为胶质瘤抑瘤基因的进一步证据,采用去甲基化制剂5-Aza-CdR处理LRRC4表达缺失的SF126和SF767胶质瘤细胞,MSP和RT-PCR检测表明,LRRC4的启动子在表达缺失的SF126和SF767细胞存在完全的甲基化,而5-Aza-CdR能逆转LRRC4启动子的甲基化状态,恢复LRRC4的表达．MTT法测定显示,5-Aza-CdR使SF126和SF767胶质瘤细胞增殖受到明显抑制,并呈时间和剂量的依赖性．同时流式细胞仪检测显示,5-Aza-CdR使SF126和SF767胶质瘤细胞周期阻滞于G0/G1期．因此,5-Aza-CdR能抑制胶质瘤细胞SF126和SF767增殖并干扰其细胞周期,LRRC4启动子异常甲基化是其在胶质瘤细胞中表达缺失的重要机制,5-Aza-CdR能逆转LRRC4基因的甲基化,恢复LRRC4的表达,为LRRC4作为胶质瘤去甲基化治疗的靶标提供了科学依据．     

A novel approach to the discovery of survival biomarkers in glioblastoma using a joint analysis of DNA methylation and gene expression

Glioblastoma multiforme (GBM) is the most aggressive of all brain tumors, with a median survival of less than 1.5 years. Recently, epigenetic alterations were found to play key roles in both glioma genesis and clinical outcome, demonstrating the need to integrate genetic and epigenetic data in predictive models. To enhance current models through discovery of novel predictive biomarkers, we employed a genome-wide, agnostic strategy to specifically capture both methylation-directed changes in gene expression and alternative associations of DNA methylation with disease survival in glioma. Human GBM-associated DNA methylation, gene expression, IDH1 mutation status, and survival data were obtained from The Cancer Genome Atlas. DNA methylation loci and expression probes were paired by gene, and their subsequent association with survival was determined by applying an accelerated failure time model to previously published alternative and expression-based association equations. Significant associations were seen in 27 unique methylation/expression pairs with expression-based, alternative, and combinatorial associations observed (10, 13, and 4 pairs, respectively). The majority of the predictive DNA methylation loci were located within CpG islands, and all but three of the locus pairs were negatively correlated with survival. This finding suggests that for most loci, methylation/expression pairs are inversely related, consistent with methylation-associated gene regulatory action. Our results indicate that changes in DNA methylation are associated with altered survival outcome through both coordinated changes in gene expression and alternative mechanisms. Furthermore, our approach offers an alternative method of biomarker discovery using a priori gene pairing and precise targeting to identify novel sites for locus-specific therapeutic intervention.     

A novel approach to the discovery of survival biomarkers in glioblastoma using a joint analysis of DNA methylation and gene expression

Glioblastoma multiforme (GBM) is the most aggressive of all brain tumors, with a median survival of less than 1.5 years. Recently, epigenetic alterations were found to play key roles in both glioma genesis and clinical outcome, demonstrating the need to integrate genetic and epigenetic data in predictive models. To enhance current models through discovery of novel predictive biomarkers, we employed a genome-wide, agnostic strategy to specifically capture both methylation-directed changes in gene expression and alternative associations of DNA methylation with disease survival in glioma. Human GBM-associated DNA methylation, gene expression, IDH1 mutation status, and survival data were obtained from The Cancer Genome Atlas. DNA methylation loci and expression probes were paired by gene, and their subsequent association with survival was determined by applying an accelerated failure time model to previously published alternative and expression-based association equations. Significant associations were seen in 27 unique methylation/expression pairs with expression-based, alternative, and combinatorial associations observed (10, 13, and 4 pairs, respectively). The majority of the predictive DNA methylation loci were located within CpG islands, and all but three of the locus pairs were negatively correlated with survival. This finding suggests that for most loci, methylation/expression pairs are inversely related, consistent with methylation-associated gene regulatory action. Our results indicate that changes in DNA methylation are associated with altered survival outcome through both coordinated changes in gene expression and alternative mechanisms. Furthermore, our approach offers an alternative method of biomarker discovery using a priori gene pairing and precise targeting to identify novel sites for locus-specific therapeutic intervention.     

基于单细胞转录组的多级别胶质瘤异质性及免疫微环境分析揭示了潜在的预后生物标志物

脑胶质瘤(glioma)是中枢神经系统最常见的内在肿瘤,具有发病率高、预后较差等特点。本研究旨在鉴定多形性胶质母细胞瘤(glioblastoma multiforme,GBM)和低级别胶质瘤(lower-grade gliomas, LGG)之间的差异表达基因(differentially expressed genes, DEGs),以探讨不同级别胶质瘤的预后影响因素。从NCBI基因表达综合数据库中收集了胶质瘤的单细胞转录组测序数据,其中包括来自3个数据集的共29 097个细胞样本。对于不同分级的人脑胶质瘤进行分析,经过滤得到21 071个细胞,通过基因本体分析、京都基因与基因组百科全书途径分析,从差异表达基因中筛选出70个基因,我们通过查阅文献,聚焦到delta样典型Notch配体3 (delta like canonical Notch ligand 3,DLL3)这个基因。基于TCGA的基因表达谱交互分析(gene expression profiling interactive analysis, GEPIA)数据库用于探索LGG和GBM中DLL3基因的表达差异,采用基因表达...     

Promoter methylation as biomarkers for diagnosis of melanoma: A systematic review and meta-analysis

Melanoma is one of the most common skin cancer that is characterized by rapid growth, early metastasis, high malignant, and mortality. Accumulating evidence demonstrated that promoter methylation of tumor-suppressor genes is implicated in the pathogenesis of melanoma. In the current study, we performed a meta-analysis to identify promising methylation biomarkers in the diagnosis of melanoma. We carried out a systematic literature search using Pubmed, Embase, and ISI web knowledge database and found that gene promoter methylation of 50 genes was reported to be associated with the risk of melanoma. Meta-analysis revealed that hypermethylation of claudin 11 (CLDN11; odds ratio [OR], 16.82; 95% confidence interval [CI], 1.97–143.29; p = 0.010), O-6-methylguanine-DNA methyltransferase (MGMT; OR, 5.59; 95% CI, 2.51–12.47; p < 0.0001), cyclin-dependent kinase inhibitor 2A (p16; OR, 6.57; 95% CI, 2.19–19.75; p = 0.0008), retinoic acid receptor β (RAR-β2; OR, 24.31; 95% CI, 4.58–129.01; p = 0.0002), and Ras association domain family member (RASSF1A; OR, 9.35; 95% CI, 4.73–18.45; p < 0.00001) was significantly higher in melanoma patients compared with controls. CLDN11 (OR, 14.52; 95% CI, 1.84–114.55; p = 0.01), MGMT (OR, 8.08; 95% CI, 1.84–35.46; p = 0.006), p16 (OR, 9.44; 95% CI, 2.68–33.29; p = 0.0005), and RASSF1A (OR, 7.72; 95% CI, 1.05–56.50; p = 0.04) hypermethylation was significantly increased in primary melanoma compared with controls. Methylation frequency of CLDN11 (OR, 25.56; 95% CI, 2.32–281.66; p = 0.008), MGMT (OR, 4.64; 95% CI, 1.98–10.90; p = 0.0004), p16 (OR, 4.31; 95% CI, 1.33–13.96; p = 0.01), and RASSF1A (OR, 10.10; 95% CI, 2.87–35.54; p = 0.0003) was significantly higher in metastasis melanoma compared with controls. These findings indicated that CLDN11, MGMT, p16, RAR-β2, and RASSF1A hypermethylation is a risk factor and a potential biomarker for melanoma. CLDN11, MGMT, p16, and RASSF1A promoter methylation may take part in the development of melanoma and become useful biomarkers in the early diagnosis of the disease.