循环肿瘤DNA突变检测方法研究进展

循环肿瘤DNA(Circulating Tumor DNA,ctDNA)含有肿瘤的遗传信息,与肿瘤组织具有高度的一致性,可代替肿瘤组织用于肿瘤的早期诊断,预后监测和药物疗效监测,是一种具有良好临床应用前景的液体活检标记物。但血液中的ctDNA片段化程度高,含量稀少,且与野生型DNA混合存在(约1%甚至更低),并会随着患者肿瘤分期等情况动态变化,造成了ctDNA检测困难,需要高灵敏度高特异性的突变检测方法,才能够从大量的野生型DNA中检测出微量突变型ctDNA。目前,灵敏度和特异性能够满足ctDNA检测需求的方法主要有扩增阻滞突变系统PCR(Amplification Refractory Mutation System PCR,ARMS-PCR)、钳制PCR(Clamping-PCR)、数字化PCR(Digital-PCR)、西格诺公司的质谱分辨技术(Sequenom UltraseekTM)和高通量测序技术。本文对这些方法的原理、特点、最新进展和应用前景进行了综述,为研究人员选择合适的ctDNA检测方法提供理论依据。     

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。     

循环肿瘤DNA的检测技术及在癌症诊疗中的应用价值

循环肿瘤DNA（ctDNA）来源于肿瘤,能很好地反映肿瘤的基因信息,并且会随着肿瘤的进展发生相应的改变。近年来,ctDNA独特的能力备受人们关注并被广泛研究,本文在总结ctDNA的来源、性质和样品处理的基础上,对ctDNA的检测技术及在癌症诊疗中的应用进行综述,阐述了ctDNA标准物质在二代测序中的作用及重要性,并指出ctDNA样品的收集、存储、定量检测以及数据分析等各个流程中建立统一标准及规范的迫切性。     

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.     

Cell:新型血检技术或可扩大液体活检的范围

正当细胞死亡后,其并不会消失地无影无踪,相反其会以游离DNA的形式留下一下"指纹"痕迹,而在人类机体中,这些小型的DNA片段就会在血液中被发现;近些年来游离DNA的研究领域应运而生了一种称之为"液体活检"的新技术,该技术可以诊断并且监测某些癌症,鉴别出胎儿机体异常,并且评估移植器官的健康性,进行这些操作仅需要简单的抽血就可以完成,尽管这些检测潜力巨大,但目前其所检测的范围却非常有限。发表在Cell上的一篇报道中,华盛顿大学的科学家就表示他们开发了一种新方法可以克服当前液体活检技术的局限性,从而就以帮助鉴别     

非编码RNA在肿瘤液体活检中的研究进展

液体活检是一种基于分析体液样本中的生物标志物来诊断疾病、监测疾病进展和评估疗效的非侵入性的新型微创诊断技术。液体活检主要包括探查和检测循环肿瘤细胞、ctDNA、非编码RNAs和细胞外囊泡等。非编码RNA之前被认为是一类无功能的RNA,但近年来研究表明它们在肿瘤的发病机制中扮演着重要的角色。它们构成了基因调控的一个重要层面,其表达水平在多种癌种中呈现失调势态,这提示了它们作为肿瘤生物学标志物的临床应用潜力。飞速发展的高通量测序技术使得在泛癌领域建立非编码RNA表达谱的分子表征成为可能。该文系统阐述了非编码RNA作为非侵入性肿瘤标志物的研究进展,评估了其作为肿瘤生物标志物的适用性,同时总结了近期的检测技术突破对肿瘤分子标志物发展的影响。     

表观遗传学标志物在肿瘤液体活检中的研究进展

与传统组织活检相比,液体活检具有无创、实时动态监测、克服肿瘤异质性等诸多优势,是极具潜力的肿瘤早筛早诊工具。肿瘤的发生发展伴随着异常的表观遗传学的改变,如DNA甲基化、组蛋白修饰、非编码RNA调控等。通过液体活检检测这些表观遗传标志物的变化已被应用于肿瘤的早诊早筛、复发监测、肿瘤亚型鉴定以及对治疗反应和结果预测等方面,并展现出极大的应用前景。该文就目前表观遗传学标志物检测在肿瘤液体活检中的研究进展进行综述。     

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。     

循环肿瘤DNA检测技术的研究进展

循环肿瘤DNA(circulating tumor DNA,ct DNA)检测,即所谓的"液体活检"。与传统的组织活检技术相比,"液体活检"能够更加全面地反映肿瘤的特征。随着ct DNA研究的逐渐深入,其检测技术的灵敏度和特异性都得到了很大的提升,而其中最具代表性的检测技术有数字PCR(digital PCR,d PCR)技术、流式技术的磁珠乳液扩增方法(bead,emulsion,amplification and magnetic,BEAMing)、标记扩增深度测序(tagged-amplicon deep sequencing,TAm-Seq)等,这些技术的发展有望开启精准医疗的新时代。     

DNA甲基化标志物的无创性检测在肺癌早期诊断中的应用

肺癌居癌症死亡率之首,寻找有效的无创性早期检测手段,对提高肺癌患者5年生存率至关重要。目前DNA甲基化标志物用于癌前或早期病变的研究逐渐系统深入。该文重点讨论肺癌患者体液中的DNA甲基化标志物,探讨无创性检测DNA甲基化标志物在肺癌早期诊断中的应用前景。     

肿瘤液态活检的研究进展及其临床应用

液态活检是一类新兴的病理检测手段,其研究内容包括肿瘤循环细胞、肿瘤循环DNA、外泌体等物质,其中的信息为肿瘤患者的个性化医疗提供有力的依据。它凭借无创、便捷等优势在临床应用中展现出广大前景。近年来,随着液态活检研究内容的扩大及其捕获与检测技术的发展,液态活检在临床中的应用日益广泛。本文旨在探讨近年来液态活检的主要研究对象、检测技术以及在临床应用中的发展前景与所面临的挑战,以期为肿瘤患者获得更佳的治疗,推动肿瘤精准医学的发展。     

Current and emerging applications of liquid biopsy in pan-cancer

Cancer morbidity and mortality are growing rapidly worldwide and it is urgent to develop a convenient and effective method that can identify cancer patients at an early stage and predict treatment outcomes. As a minimally invasive and reproducible tool, liquid biopsy (LB) offers the opportunity to detect, analyze and monitor cancer in any body fluids including blood, complementing the limitations of tissue biopsy. In liquid biopsy, circulating tumor cells (CTCs) and circulating tumor DNA (ctDNA) are the two most common biomarkers, displaying great potential in the clinical application of pan-cancer. In this review, we expound the samples, targets, and newest techniques in liquid biopsy and summarize current clinical applications in several specific cancers. Besides, we put forward a bright prospect for further exploring the emerging application of liquid biopsy in the field of pan-cancer precision medicine.     

DNA methylation signatures in circulating cell-free DNA as biomarkers for the early detection of cancer

Detecting cell-free DNA(cfDNA) or circulating tumor DNA(ctDNA) in plasma or serum could serve as a "liquid biopsy", which would be useful for numerous diagnostic applications. cfDNA methylation detection is one of the most promising approaches for cancer risk assessment. Here, we reviewed the literature related to the use of serum or plasma circulating cell-free DNA for cancer diagnosis in the early stage and their power as future biomarkers.     

Genetic profiling of cancer with circulating tumor DNA analysis

Circulating cell-free tumor DNA(ctDNA) in the blood is DNA released from apoptotic, circulating, and living tumor cells. ctDNA is about 140 nt in length and has a half-life of about 1.5 h. ctDNA analysis provides a noninvasive means to assess the genetic profile of cancer in real time. With the advent of molecular technologies, including digital PCR and massively parallel sequencing(MPS), ctDNA analysis has shown promise as a highly sensitive and specific alternative to conventional tissue biopsy in cancer detection, longitudinal monitoring, and precision therapy. This review provides an overview of the latest development in our understanding of the biologic characteristics, detection methodologies, and potential clinical implications of ctDNA, as well as the challenges in translating ctDNA analysis from the research arena to patient care.     

Neueste technologische Entwicklungen für die Analyse von zirkulierender Tumor-DNA

The analysis of circulating tumor DNA (ctDNA) and circulating tumor cells, often known as liquid biopsy, is a rapidly developing field of medical research. Although it has taken decades since the discovery of cell-free DNA for it to be recognized as a suitable biomarker, the clinical benefit of ctDNA with regard to monitoring therapy response, the identification of resistance mechanisms, and novel emerging actionable targets, in addition to the detection of minimal residual disease, has recently been proven in numerous studies.Owing to the great variability of ctDNA in the circulation, together with the high degree of fragmentation, ctDNA is a challenging analyte. However, in recent years technological advances have contributed to a variety of routine applications of ctDNA analysis becoming a reality, given that a number of additional regulatory hurdles can be overcome.     

Overview of the role of liquid biopsy in cancer management

With the emergence of novel targeted therapeutic options in early-stage and advanced-stage malignancies, researchers have shifted their focus on developing personalized treatment plans through molecular profiling. Circulating tumor DNA (ctDNA) is a cell-free DNA (ctDNA) fragment, originating from tumor cells, and circulating in the bloodstream as well as biological fluids. Over the past decade, many techniques were developed for liquid biopsies through next-generation sequencing. This alternative non-invasive biopsy offers several advantages in various types of tumors over traditional tissue biopsy. The process of liquid biopsy is considered minimally invasive and therefore easily repeatable when needed, providing a more dynamic analysis of the tumor cells. Moreover, it has an advantage in patients with tumors that are not candidates for tissue sampling. Besides, it offers a deeper understanding of tumor burden as well as treatment response, thereby enhancing the detection of minimal residual disease and therapeutic guidance for personalized medicine. Despite its many advantages, ctDNA and liquid biopsy do have some limitations.This paper discusses the basis of ctDNA and the current data available on the subject, as well as its clinical utility. We also reflect on the limitations of using ctDNA in addition to its future perspectives in clinical oncology and precision medicine.     

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.     

Liquid Biopsies

In oncology, “liquid biopsy” refers to the analysis of circulating tumor cells (CTCs) or of circulating tumor DNA (ctDNA), to establish non-invasively from the peripheral blood the characteristics of a tumor genome in cancer patients. Liquid biopsies have tremendous potential for future developments in personalized medicine and for the application of targeted therapies. In this review we show that many unresolved issues need to be addressed before liquid biopsies can be routinely used. A particular challenge is the fact that, depending on the analysis performed, the results can have implications reaching far beyond the analysis of the tumor genome originally intended. All of these issues can best be addressed in a multidisciplinary setting with human geneticists, oncologists, pathologists, bioinformaticians and bioethicists participating.     

Methylated DNA/RNA in Body Fluids as Biomarkers for Lung Cancer

DNA/RNA methylation plays an important role in lung cancer initiation and progression. Liquid biopsy makes use of cells, nucleotides and proteins released from tumor cells into body fluids to help with cancer diagnosis and prognosis. Methylation of circulating tumor DNA (ctDNA) has gained increasing attention as biomarkers for lung cancer. Here we briefly introduce the biological basis and detection method of ctDNA methylation, and review various applications of methylated DNA in body fluids in lung cancer screening, diagnosis, prognosis, monitoring and treatment prediction. We also discuss the emerging role of RNA methylation as biomarkers for cancer.     

Liquid biopsy in pancreatic cancer – Current perspective and future outlook

Pancreatic cancer is a lethal condition with a rising incidence and often presents at an advanced stage, contributing to abysmal five-year survival rates. Unspecific symptoms and the current lack of biomarkers and screening tools hamper early diagnosis. New technologies for liquid biopsies and their respective evaluation in pancreatic cancer patients have emerged over recent years. The term liquid biopsy summarizes the sampling and analysis of circulating tumor cells (CTCs), small extracellular vesicles (sEVs), and tumor DNA (ctDNA) from body fluids. The major advantages of liquid biopsies rely on their minimal invasiveness and repeatability, allowing serial sampling for dynamic insights to aid diagnosis, particularly early detection, risk stratification, and precision medicine in pancreatic cancer. However, liquid biopsies have not yet developed into a new pillar for clinicians' routine armamentarium. Here, we summarize recent findings on the use of liquid biopsy in pancreatic cancer patients. We discuss current challenges and future perspectives of this potentially powerful alternative to conventional tissue biopsies.