Prospective assessment of the role of five tumour markers in breast cancer

Summary Retrospective analysis previously identified significant elevation of five tumour markers, carcinoembryonic antigen (CEA), ferritin, orosomucoid,C-reactive protein and erythrocyte sedimentation rate (ESR), in patients with systemic breast cancer and showed that changes in each of these markers individually correlated significantly with therapeutic response. In this study we have prospectively tested these findings. None of the five markers was significantly elevated in primary breast cancer compared to normal control or benign breast disease groups. They therefore appear to have no role either in screening or in the differential diagnosis of breast cancer. There was a significant elevation of all five markers in patients with systemic breast cancer (P <0.0001; analysis of variance) but sequential changes in CEA and ESR only correlated significantly with the UICC-assessed response. Prospective confirmation of the correlation between changes in serum CEA and ESR provides the basis for using these markers in the assessment of response to therapy in patients with systemic breast cancer.     

Hypoxia inhibition of apoptosis induced by tumor necrosis factor-related apoptosis-inducing ligand (TRAIL)

Hypoxia is a common environmental stress. Particularly, the center of rapidly growing solid tumors is easily exposed to hypoxic conditions. Thus, tumor cell response to hypoxia plays an important role in tumor progression as well as tumor therapy. However, little is known about hypoxic effect on apoptotic cell death. To examine the effects of hypoxia on TRAIL-induced apoptosis, human lung carcinoma A549 cells were exposed to hypoxia and treated with TRAIL protein. Hypoxia significantly protected A549 cells from apoptosis induced by TRAIL. Western blotting analysis demonstrated that hypoxia increased expression of antiapoptotic proteins such as Bcl-2, Bcl-XL, and IAP family members. The increase of these antiapoptotic molecules is believed to play an hypoxia-mediated protective role in TRAIL-induced apoptosis. Our findings suggest that an increase of antiapoptotic proteins induced by hypoxia may regulate the therapeutic activity of TRAIL protein in cancer therapy.     

肺癌肿瘤标志物的临床意义及研究进展

肺癌血清肿瘤标志物在肺癌的早期筛查、诊断、疗效评价、复发及预后预测等方面有重要的指导意义。本研究对目前临床常用的癌胚抗原（CEA）、神经元特异性烯醇化酶（NSE）、细胞角蛋白19片段抗原（CYFRA21—1）、鳞状细胞癌相关抗原（SCC—Ag）、乳酸脱氢酶（LDH）5种肺癌相关血清肿瘤标志物的临床意义及研究进展进行综述。     

Genetic Defects as Tumor Markers

Carcinogenesis is long-term multistep accumulation of defects of genes responsible for cell division, DNA repair, and apoptosis. The functions of these genes are known both for norm and for pathologies caused by their damage and resulting in asocial cell behavior. Owing to the recent progress in studying the mechanisms of carcinogenesis, some genetic defects may be considered from the applied point of view (as tumor markers rather than as pathogenetic factors) and employed in diagnostics. Thus detection of mutant alleles in biological fluids (e.g., beyond the tumor) suggests higher risk of carcinogenesis. Genetic defects are a new class of tumor markers and have a substantial diagnostic potential. In contrast to known protein markers (-fetoprotein, etc.) used in clinical practice, DNA markers are oncospecific (as these are in direct cause-and-effect relationships with carcinogenesis) and universal (as there is not a single tumor cell without a genetic defect). Analysis of DNA markers may be employed not only in diagnostics or tumor growth monitoring (assessment of treatment efficiency, early detection of recurrence or metastasis), but also (prospectively) in screening (tumor detection at the presymptomatic stage, identification of high-risk groups). Theoretical grounds, prospects, problems, and methods of this new field are considered.     

奥拉帕利维持治疗对铂敏感复发性卵巢癌患者血清肿瘤标志物和凋亡因子的影响

摘要 目的：观察奥拉帕利维持治疗对铂敏感复发性卵巢癌患者血清凋亡因子、肿瘤标志物的影响。方法：按照随机数字表法,将2020年1月到2022年1月期间我院收治的80例铂敏感复发性卵巢癌患者分为对照组（n=40）和观察组（n=40）。两组患者均经二线含铂化疗后,经评估达到临床缓解或部分缓解后,对照组患者不予特殊药物处理,观察组则在化疗结束8周内开始口服奥拉帕利作为维持治疗,直至疾病进展或发生不可接受的毒性反应。对比两组的血清肿瘤标志物和凋亡因子水平情况,观察两组不良反应发生率和预后情况。结果：两组治疗后癌胚抗原（CEA）、糖类抗原（CA）125、人附睾蛋白4（HE4）均下降（P<0.05）,且观察组低于对照组（P<0.05）。两组治疗后B淋巴细胞瘤-2（Bcl-2）、可溶性细胞凋亡因子（sFas）和Bcl-2结合抗凋亡基因-1（Bag-1）均下降,Bcl-2相关X蛋白（Bax）升高（P<0.05）,观察组治疗后Bcl-2、sFas、Bag-1低于对照组,Bax高于对照组（P<0.05）。两组治疗期间各项不良反应发生率对比未见统计学差异（P>0.05）。两组治疗后认知能力、情感健康、社会功能、躯体功能、行为功能评分升高,且观察组的改善幅度大于对照组（P<0.05）。结论：奥拉帕利维持治疗铂敏感复发性卵巢癌患者,可有效改善血清肿瘤标志物和凋亡因子水平,提高患者生存质量,预后良好。     

Identification of novel tumor antigens with patient-derived immune-selected antibodies

The identification of tumor antigens capable of eliciting an immune response in vivo may be an effective method to identify therapeutic cancer targets. We have developed a method to identify such antigens using frozen tumor-draining lymph node samples from breast cancer patients. Immune responses in tumor-draining lymph nodes were identified by immunostaining lymph node sections for B-cell markers (CD20&CD23) and Ki67 which revealed cell proliferation in germinal center zones. Antigen-dependent somatic hypermutation (SH) and clonal expansion (CE) were present in heavy chain variable (VH) domain cDNA clones obtained from these germinal centers, but not from Ki67 negative germinal centers. Recombinant VH single-domain antibodies were used to screen tumor proteins and affinity select potential tumor antigens. Neuroplastin (NPTN) was identified as a candidate breast tumor antigen using proteomic identification of affinity selected tumor proteins with a recombinant VH single chain antibody. NPTN was found to be highly expressed in approximately 20% of invasive breast carcinomas and 50% of breast carcinomas with distal metastasis using a breast cancer tissue array. Additionally, NPTN over-expression in a breast cancer cell line resulted in a significant increase in tumor growth and angiogenesis in vivo which was related to increased VEGF production in the transfected cells. These results validate NPTN as a tumor-associated antigen which could promote breast tumor growth and metastasis if aberrantly expressed. These studies also demonstrate that humoral immune responses in tumor-draining lymph nodes can provide antibody reagents useful in identifying tumor antigens with applications for biomarker screening, diagnostics and therapeutic interventions.     

Aptamer directly evolved from live cells recognizes membrane bound immunoglobin heavy mu chain in Burkitt's lymphoma cells

The identification of tumor related cell membrane protein targets is important in understanding tumor progression, the development of new diagnostic tools, and potentially for identifying new therapeutic targets. Here we present a novel strategy for identifying proteins that are altered in their expression levels in a diseased cell using cell specific aptamers. Using an intact viable B-cell Burkitt's lymphoma cell line (Ramos cells) as the target, we have selected aptamers that recognize cell membrane proteins with high affinity. Among the selected aptamers that showed different recognition patterns with different cell lines of leukemia, the aptamer TD05 showed binding with Ramos cells. By chemically modifying TD05 to covalently cross-link with its target on Ramos cells to capture and to enrich the target receptors using streptavidin coated magnetic beads followed by mass spectrometry, we were able to identify membrane bound immunoglobin heavy mu chain as the target for TD05 aptamer. Immunoglobin heavy mu chain is a major component of the B-cell antigen receptor, which is expressed in Burkitt's lymphoma cells. This study demonstrates that this two step strategy, the development of high quality aptamer probes and then the identification of their target proteins, can be used to discover new disease related potential markers and thus enhance tumor diagnosis and therapy. The aptamer based strategy will enable effective molecular elucidation of disease related biomarkers and other interesting molecules.     

早期胃癌患者外周血清差异蛋白表达谱的建立及其生物学分析

目的:分析早期胃癌患者外周血中低丰度蛋白的表达差异,以筛选诊断早期胃癌血清多肽或蛋白标志物。方法:应用高通量的AAH-BLG-1000蛋白芯片分别检测3例早期胃癌患者和3例正常对照成人的外周血清,建立早期胃癌患者外周血清差异蛋白表达谱,分析其相关生物学信息,以筛选早期胃癌的血清肿瘤标志物。结果:与正常对照组比较,早期胃癌患者外周血清中有10种蛋白表达显著上调(P0.05),52种蛋白表达显著下调(P0.05)。生物信息学分析发现差异蛋白质集中于血管生成、信号调控,免疫调节、酶联受体蛋白信号,细胞凋亡等生物进程,而差异蛋白中的VEGI、CD40L、SMAD7、PLUNC、NTN、LTβR和HEVM7个差异蛋白的特征性改变有望成为早期胃癌血清学的肿瘤标志物。结论:应用蛋白芯片技术所得的早期胃癌患者血清中的差异表达蛋白有望成为诊断早期胃癌的血清肿瘤标志物。     

Sustained activation of DNA damage response in irradiated apoptosis-resistant cells induces reversible senescence associated with mTOR downregulation and expression of stem cell markers

Cells respond to genotoxic stress by activating the DNA damage response (DDR). When injury is severe or irreparable, cells induce apoptosis or cellular senescence to prevent transmission of the lesions to the daughter cells upon cell division. Resistance to apoptosis is a hallmark of cancer that challenges the efficacy of cancer therapy. In this work, the effects of ionizing radiation on apoptosis-resistant E1A + E1B transformed cells were investigated to ascertain whether the activation of cellular senescence could provide an alternative tumor suppressor mechanism. We show that irradiated cells arrest cell cycle at G₂/M phase and resume DNA replication in the absence of cell division followed by formation of giant polyploid cells. Permanent activation of DDR signaling due to impaired DNA repair results in the induction of cellular senescence in E1A + E1B cells. However, irradiated cells bypass senescence and restore the population by dividing cells, which have near normal size and ploidy and do not express senescence markers. Reversion of senescence and appearance of proliferating cells were associated with downregulation of mTOR, activation of autophagy, mitigation of DDR signaling, and expression of stem cell markers.     

CEACAM6 as a novel target for indirect type 1 immunotoxin-based therapy in pancreatic adenocarcinoma

Immunotoxins are a potentially powerful approach for targeted anticancer therapy. We evaluated a novel immunotherapeutic strategy targeting the immunoglobulin superfamily member carcinoembryonic antigen-related cell adhesion molecule 6 (CEACAM6). Using pancreatic adenocarcinoma as a model, we show that crosslinking CEACAM6 induces its cytoplasmic accumulation and that this effect can be utilized to increase the efficacy of antibody-mediated delivery of the ribosomal inhibitory protein saporin. Exposure of cells to anti-CEACAM6 antibody, followed by secondary saporin-conjugated immunoglobulin (IgG), induced marked cytotoxicity, via caspase-mediated apoptosis, in vitro. In an in vivo nude mouse xenograft model, this immunotherapeutic approach markedly suppressed pancreatic adenocarcinoma tumor growth and enhanced tumor apoptosis. Given the prevalence of CEACAM6 overexpression among human malignancies, immunological targeting of this tumor antigen may have therapeutic applicability.     

三维适形放疗与调强放疗对晚期非小细胞肺癌患者血清肿瘤标志物及剂量学参数比较研究

目的:对比晚期非小细胞肺癌患者经三维适形放疗(3D-CRT)与调强放疗(IMRT)后,其血清肿瘤标志物及剂量学参数的变化。方法:选择2015年1月-2016年12月期间我院收治的非小细胞肺癌患者120例,根据放疗方案将其分为IMRT组60例与3D-CRT组60例。比较两组临床疗效、药物毒副反应、1年内的生存率、放射剂量参数,以及治疗前与治疗后血清肿瘤标志物的变化。结果:IMRT组治疗的总有效率与3D-CRT组对比差异无统计学意义(P0.05)。IMRT组血小板减少、Ⅲ度放射性食管炎、Ⅲ度消化道反应、Ⅲ度放射性肺炎、Ⅲ度白细胞减少的发生率均低于3D-CRT组(P0.05)。IMRT组1年内的生存率90.00%,高于3D-CRT组的75.00%(P0.05)。IMRT组CI值与HI值均高于3D-CRT组(P0.05),IMRT组与3D-CRT组平均剂量对比差异无统计学意义(P0.05)。治疗后两组鳞状细胞癌抗原(SCC)、细胞角蛋白19片段抗原21-1(CYFRA21-1)与肿瘤特异性生长因子(TSGF)水平均显著降低,且IMRT组低于3D-CRT组(P0.05)。结论:IMRT与3D-CRT对于晚期非小细胞肺癌患者的临床疗效相当,但IMRT药物毒副反应少、放射剂量低,可能通过控制肿瘤来降低肿瘤标志物水平。     

Proteomic characterization of the interstitial fluid perfusing the breast tumor microenvironment: a novel resource for biomarker and therapeutic target discovery

Clinical cancer proteomics aims at the identification of markers for early detection and predictive purposes, as well as to provide novel targets for drug discovery and therapeutic intervention. Proteomics-based analysis of traditional sources of biomarkers, such as serum, plasma, or tissue lyzates, has resulted in a wealth of information and the finding of several potential tumor biomarkers. However, many of these markers have shown limited usefulness in a clinical setting, underscoring the need for new clinically relevant sources. Here we present a novel and highly promising source of biomarkers, the tumor interstitial fluid (TIF) that perfuses the breast tumor microenvironment. We collected TIFs from small pieces of freshly dissected invasive breast carcinomas and analyzed them by two-dimensional polyacrylamide gel electrophoresis in combination with matrix-assisted laser desorption/ionization time-of-flight mass spectrometry, Western immunoblotting, as well as by cytokine-specific antibody arrays. This approach provided for the first time a snapshot of the protein components of the TIF, which we show consists of more than one thousand proteins--either secreted, shed by membrane vesicles, or externalized due to cell death--produced by the complex network of cell types that make up the tumor microenvironment. So far, we have identified 267 primary translation products including, but not limited to, proteins involved in cell proliferation, invasion, angiogenesis, metastasis, inflammation, protein synthesis, energy metabolism, oxidative stress, the actin cytoskeleton assembly, protein folding, and transport. As expected, the TIF contained several classical serum proteins. Considering that the protein composition of the TIF reflects the physiological and pathological state of the tissue, it should provide a new and potentially rich resource for diagnostic biomarker discovery and for identifying more selective targets for therapeutic intervention.     

Proteomic detection of prostate-specific antigen using a serum fractionation procedure: potential implication for new low-abundance cancer biomarkers detection

One of the major obstacles in proteomic analysis of biological fluids is the presence of highly abundant proteins such as albumin and immunoglobulins, which can interfere with the resolution and sensitivity of the proteome profiling techniques used. In this paper, we describe an anion exchange fractionation procedure for serum using denaturating conditions allowing protein-protein interaction disruption before analysis by surface-enhanced laser desorption/ionization and by two-dimensional electrophoresis. This method simplifies the serum proteome into subproteomes and markedly increases resolution and sensitivity without any loss of minor proteins. To confirm the applicability of this method, fractionated serum of a patient with prostate cancer was analyzed for the presence of the prostate-specific antigen (PSA) which is a low-abundance tumor marker protein. The results demonstrate that PSA can be detected by two-dimensional electrophoresis only in serum following fractionation. Hence, this procedure may facilitate the identification of other, so far unknown, tumor markers in patient sera.     

Serum markers in small cell lung cancer: Opportunities for improvement

Lung cancer is one of the leading causes of death from malignancy worldwide. In particular small cell lung cancers, which comprise about 15–20% of all lung cancers, are extremely aggressive and cure rates are extremely low. Therefore, new treatment modalities are needed and detection at an early stage of disease, as well as adequate monitoring of treatment response is essential in order to improve outcome. In this respect, the use of non-invasive tools for screening and monitoring has gained increasing interest and the clinical applicability of reliable, tumor-related substances that can be detected as tumor markers in easily accessible body fluids is subject of intense investigation. Some of these indicators, such as high LDH levels in serum as a reflection of the disease, have been in use for a long time as a general tumor marker. To allow for improved monitoring of the efficacy of new therapeutic modalities and for accurate subtyping, there is a strong need for specific and sensitive markers that are more directly related to the biology and behavior of small cell lung cancer. In this review the current status of these potential markers, like CEA, NSE, ProGRP, CK-BB, SCC, CgA, NCAM and several cytokeratins will be critically analyzed with respect to their performance in blood based assays. Based on known cleavage sites for cytoplasmic and extracellular proteases, a prediction of stable fragments can be obtained and used for optimal test design. Furthermore, insight into the synthesis of specific splice variants and neo-epitopes resulting from protein modification and cleavage, offers further opportunities for improvement of tumor assays.     

特罗凯靶向治疗联合培美曲塞和顺铂对非小细胞肺癌患者血清肿瘤标志物、免疫球蛋白和T淋巴细胞亚群的影响

摘要 目的：探讨特罗凯靶向治疗联合培美曲塞和顺铂对非小细胞肺癌（NSCLC）患者血清肿瘤标志物、免疫球蛋白和T淋巴细胞亚群的影响。方法：选取2018年2月~2020年2月期间我院接收的NSCLC患者80例,采用抽签法分为对照组、观察组两组,各40例。对照组给予培美曲塞和顺铂化疗方案治疗,观察组在对照组基础上联合特罗凯靶向治疗,对比两组总有效率、血清肿瘤标志物、免疫球蛋白、T淋巴细胞亚群及不良反应发生率。结果：对比两组不良反应无差异（P>0.05）。治疗3个疗程后,对照组、观察组的临床总有效率分别为37.50%、60.00%,观察组的总有效率高于对照组（P<0.05）。治疗3个疗程,观察组CD3⁺、CD4⁺、CD4⁺/CD8⁺高于对照组,CD8⁺低于对照组（P<0.05）。治疗3个疗程,观察组免疫球蛋白G（IgG）、免疫球蛋白A（IgA）、免疫球蛋白M（IgM）高于对照组（P<0.05）。治疗3个疗程,观察组细胞角蛋白19片段（CYFRA21-1）、糖类抗原50（CA50）、癌胚抗原（CEA）低于对照组（P<0.05）。结论：特罗凯靶向治疗联合培美曲塞和顺铂治疗NSCLC患者,疗效较好,可能与该方案可降低患者血清肿瘤标志物含量、调节免疫应答等因素有关。     

The role of radiation-induced apoptosis as a determinant of tumor responses to radiation therapy

Ionizing radiation is an effective means of killing tumor cells. Approximately 50% of all American cancer patients are treated with radiotherapy at some time during the course of their disease, making radiation one of the most widely used cytotoxic therapies. Currently, much effort is focused on understanding the molecular pathways that regulate tumor cell survival following radiotherapy, with the long term goal of developing novel therapeutic strategies for specifically sensitizing tumors to radiation. At present, there is particular interest in the role of tumor cell apoptotic potential as a regulator of both intrinsic and extrinsic determinants of the response of tumors to radiation therapy. Here we review what is currently known about the role of apoptosis as a mechanism of tumor cell killing by ionizing radiation and the relative contribution of apoptosis to cellular radiosensitivity and the ability to control human cancers using radiotherapy. The following topics will be discussed: (1) radiation-induced apoptosis in normal and malignant cells, (2) clinical findings with respect to apoptosis in human cancers treated with radiotherapy, (3) the contribution of apoptosis to intrinsic radiosensitivity in vitro, (4) the relevance of apoptosis to treatment outcome in experimental tumor models in vivo and (5) the potential of exploiting apoptosis as a means to improve the therapeutic efficacy of radiotherapy.     

Cell cycle checkpoints and their impact on anticancer therapeutic strategies

Cells contain numerous pathways designed to protect them from the genomic instability or toxicity that can result when their DNA is damaged. The p53 tumor suppressor is particularly important for regulating passage through G1 phase of the cell cycle, while other checkpoint regulators are important for arrest in S and G2 phase. Tumor cells often exhibit defects in these checkpoint proteins, which can lead to hypersensitivity; proteins in this class include ataxia-telangiectasia mutatated (ATM), Meiotic recanbination 11 (Mre11), Nijmegen breakage syndrome 1 (Nbs 1), breast cancer susceptibility genes 1 and 2 (BRCA1), and (BRCA2). Consequently, tumors should be assessed for these specific defects, and specific therapy prescribed that has high probability of inducing response. Tumors defective in p53 are frequently considered resistant to apoptosis, yet this defect also provides an opportunity for targeted therapy. When their DNA is damaged, p53-defective tumor cells preferentially arrest in S or G2 phase where they are susceptible to checkpoint inhibitors such as caffeine and UCN-01. These inhibitors preferentially abrogate cell cycle arrest in p53-defective cells, driving them through a lethal mitosis. Wild type p53 can prevent abrogation of arrest by elevating levels of p21(waf1) and decreasing levels of cyclins A and B. During tumorigenesis, tumor cells frequently loose checkpoint controls and this facilitates the development of the tumor. However, these defects also represent an Achilles heel that can be targeted to improve current therapeutic strategies.     

Conventional pluripotency markers are unspecific for bovine embryonic-derived cell-lines

Bovine embryonic stem cells are of potentially big value in transgenic research and studies of lineage commitment and development. Nevertheless, key aspects of the establishment of bovine embryonic stem cells such as the identification of specific pluripotency markers need to be clarified to achieve successful results. Bovine blastocysts were produced in vitro and cultured for 8 days up to the expanded or hatched stage. The trophectoderm, the inner cell mass and its embryonic stem cell-derived lines, all showed a common positive immunocytochemical staining for stage-specific embryonic antigen-4, tumour-rejection antigen gp96 and NANOG proteins. The antigenic profile obtained partially agrees with previous data from bovine and other species. Until a validated pluripotent bovine stem cell marker can be identified, it might be advisable to combine the use of epiblast and trophoblast-specific markers to rule out the presence of early committed trophectoderm cells in bovine embryonic stem cell cultures.