Exhaled Breath Condensate pH in Lung Cancer, the Impact of Clinical Factors

Preliminary results from the EMoLung clinical study showing early lung cancer detection by the LC score

BACKGROUND

Lung cancer (LC) causes more deaths worldwide than any other cancer type. Despite advances in therapeutic strategies, the fatality rate of LC cases remains high (95%) since the majority of patients are diagnosed at late stages when patient prognosis is poor. Analysis of the International Association for the Study of Lung Cancer (IASLC) database indicates that early diagnosis is significantly associated with favorable outcome. However, since symptoms of LC at early stages are unspecific and resemble those of benign pathologies, current diagnostic approaches are mostly initiated at advanced LC stages.

METHODS

We developed a LC diagnosis test based on the analysis of distinct RNA isoforms expressed from the GATA6 and NKX2-1 gene loci, which are detected in exhaled breath condensates (EBCs). Levels of these transcript isoforms in EBCs were combined to calculate a diagnostic score (the LC score). In the present study, we aimed to confirm the applicability of the LC score for the diagnosis of early stage LC under clinical settings. Thus, we evaluated EBCs from patients with early stage, resectable non-small cell lung cancer (NSCLC), who were prospectively enrolled in the EMoLung study at three sites in Germany.

RESULTS

LC score-based classification of EBCs confirmed its performance under clinical conditions, achieving a sensitivity of 95.7%, 91.3% and 84.6% for LC detection at stages I, II and III, respectively.

CONCLUSIONS

The LC score is an accurate and non-invasive option for early LC diagnosis and a valuable complement to LC screening procedures based on computed tomography.

Surface-enhanced electrochemiluminescence combined with resonance energy transfer for sensitive carcinoembryonic antigen detection in exhaled breath condensates

The detection of biomarkers in exhaled breath condensates (EBCs) is regarded as a promising non-invasive diagnostic approach. However, the ultralow concentration of biomarkers in EBCs is a great challenge. Herein, a sensitive dual signal amplification strategy was developed based on surface-enhanced electrochemiluminescence (SEECL) combined with resonance energy transfer (RET). Gold nanoparticles-functionalized graphite-like carbon nitride nanohybrids (Au-g-C₃N₄ NHs) could be used as an energy transfer donor because of the good overlap between its emission peak and the absorption peak of tris(2,2'-bipyridine)ruthenium dichloride (Ru(bpy)₃Cl₂) at 460 nm. Gold-silicon dioxide core-shell nanoparticles doped with Ru(bpy)₃²⁺(Au@SiO₂-Ru) were employed as an energy transfer acceptor emitting at 620 nm. Moreover, the signals at 620 nm emitted by Ru (bpy)₃²⁺ were enhanced by 5 times, attributed to the localized surface plasmon resonance (LSPR) of gold nanoparticles (Au NPs). The detection of carcinoembryonic antigen (CEA) was performed by using two aptamers as the recognition unit; whereby aptamer 1 (Apt1) was modified on the surface of Au-g-C₃N₄ NHs, and aptamer 2 (Apt2) was banded on the surface of Au@SiO₂-Ru. In the presence of CEA, a sandwich structure was formed between Au-g-C₃N₄ NHs-Apt1-CEA and Apt2-Au@SiO₂-Ru, which resulted in an ultrasensitive detection of CEA. The proposed electrochemiluminescence sensor showed a wide linear relationship with the CEA concentration in the range from 1.0 pg mL^-1 to 5.0 ng mL^-1, with a limit of detection (LOD) of 0.3 pg mL^-1. Finally, the practicality of the proposed sensor was demonstrated to detect CEA in EBCs, and the obtained results were in good agreement with the enzyme-linked immunosorbent assay (ELISA) method.

Development of Optimized, Inhalable, Gemcitabine-Loaded Gelatin Nanocarriers for Lung Cancer

BACKGROUND

Aerosol delivery of chemotherapeutic nanocarriers represents a promising alternative for lung cancer therapy. This study optimized gemcitabine (Gem)-loaded gelatin nanocarriers (GNCs) cross-linked with genipin (Gem-GNCs) to evaluate their potential for nebulized lung cancer treatment.

METHODS

Gem-GNCs were prepared by two-step desolvation and optimized through Taguchi design and characterized for physicochemical properties. Particle size and morphology were confirmed by scanning and transmission electron microscopy. In vitro release of Gem from Gem-GNCs performed in Dulbecco's phosphate-buffered saline and simulated lung fluid was evaluated to determine release mechanisms. Particle size stability was assessed under varying pH. Differential scanning calorimetry and powder X-ray diffraction were used to determine the presence and stability of Gem-GNC components and amorphization of Gem, respectively. Gem-GNC efficacy within A549 and H460 cells was evaluated using MTT assays. Mucus rheology upon treatment with Gem-GNCs, lactose, and normal saline control was measured. Andersen cascade impaction identified the aerodynamic particle size distribution of the nebulized formulation.

RESULTS

Gem-GNCs had particle size, zeta potential, entrapment efficiency, and loading efficiency of 178 ± 7.1 nm, -18.9 mV, 92.5%, and 9.1%, respectively. The Gem and formulation excipients where molecularly dispersed and configured amorphously. Gem-GNCs were stable at pH 5.4-7.4 for 72 hours. Gem release from Gem-GNCs was governed by non-Fickian controlled release due to diffusion/erosion from a matrix-based nanocarrier. Gem-GNCs elicited a 40% reduction of the complex viscosity η*(1 Hz) of human bronchial epithelial cell mucus containing 3 wt% solids to mimic mild airway disease. The nebulized Gem-GNCs had a mass median aerodynamic diameter (MMAD) of 2.0 ± 0.16 μm, geometric standard deviation (GSD) of 2.7 ± 0.16, and fine particle fraction (FPF) of 75.2% ± 2.4%. The Gem-GNC formulation did not outperform the Gem solution in A549 cells. However, in H460, Gem-GNCs outperformed the Gem IC50 reduction by ∼5-fold at 48 and 10-fold 72 hours.

CONCLUSION

Stable, effective, and sustained-release Gem-GNCs were developed. The nebulized Gem-GNCs had satisfactory MMAD, GSD, and FPF and the formulation reduced the dynamic complex viscosity of mucus consistent with increased mobility of nanoparticles.