The role of human epididymis protein 4 in the diagnosis of epithelial ovarian cancer

Exploring the relationship between preeclampsia and human epididymis protein 4

Background/Aim: The level of human epididymis protein 4 (HE4), a glycoprotein and protease inhibitor, increases under many malignancies and inflammatory conditions. HE4 is also associated with cell invasion, migration, and adhesion. In this study, we compared the HE4 protein levels in pregnant patients with preeclampsia to healthy pregnant and non-pregnant individuals with the aim of finding a biomarker that can be used to recognize preeclampsia. Methods: Our study is a prospective case control study and included 20 pregnant women with preeclampsia, 20 pregnant women without preeclampsia, and 20 healthy non-pregnant women (the control). The participants’ serum HE4 levels were analyzed statistically. Results: Data analysis revealed that the mean HE4 levels were significantly lower in the preeclampsia group than in the other two groups (P = 0.002). Mean HE4 protein levels were also lower in the non-pregnant women than in the pregnant women without preeclampsia; however, this difference was not significant. Conclusion: It is difficult to predict preeclampsia, and there is not any sensitive or specific biomarker for determining the condition. This study may support that HE4 protein may be useful and significant in predicting preeclampsia. The results we achieved provide proof that HE4 levels could be a potential biomarker for preeclampsia. Many more comprehensive studies are needed to support the association between HE4 protein and preeclampsia.

The Association between Human Epididymis Secretory Protein 4 and Metabolic Syndrome

Individuals with metabolic syndrome (MetS) are known to have an increased risk of carcinogenesis. Human epididymis protein 4 (HE4) is a tumor marker and prognostic factor for epithelial ovarian carcinoma (EOC) patients. However, no studies have evaluated the association between MetS and HE4 levels. This study aimed to evaluate the relationship between HE4 levels and MetS in the National Health and Nutrition Examination Survey (NHANES 2001−2002). This cross-sectional analysis assessed all five components of MetS and HE4 levels in 2104 females (age ≥20 years) from the NHANES dataset. MetS was defined according to the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATPIII) criteria. The analysis indicated MetS in 593 individuals, and the β coefficient of their HE4 levels was 0.097 (95% CIs, 0.028−0.166, p = 0.006). Specifically, the β coefficients of the HE4 levels of participants with 1, 2, 3, and ≥4 features of MetS were 0.072 (95% confidence interval (CI): −0.015−0.159), 0.125 (95% CI: 0.030−0.220), 0.161 (95% CI: 0.053−0.270), and 0.242 (95% CI: 0.117−0.368), respectively, and all p values were <0.001. The p-value for the trend was <0.001. There was a significant association between the presence of MetS and HE4 levels. There were positive relationships between HE4 levels and an increased number of MetS components (with 1, 2, 3, and ≥4 features of MetS, all p values <0.001). Among the MetS components, low high-density lipoprotein levels and high triglyceride levels were independently associated with HE4 levels.

May human epididymis 4 protein play a role in the etiopathogenesis of hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome?

AIM

Hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome is an extremely advanced form of preeclampsia. Currently, there is no parameter or marker to predict this syndrome; however, it is emphasized that vascular endothelial damage and abnormal immune responses can be the possible etiologies of HELLP syndrome. It is known that human epididymis protein 4 (HE4) is a protease inhibitor and previous studies have shown that HE4 protein levels are increased in many malignancies and inflammatory conditions. Considering that metalloproteinases may also play a role in endothelial damage, which is thought to be involved in the etiopathogenesis of HELLP syndrome, we thought that HE4 protein, which is a protease inhibitor, may be associated with vascular damage. We aimed to investigate the relationship between HELLP syndrome and HE4 protein and to identify a biomarker that can be utilized in the diagnosis of HELLP syndrome.

STUDY DESIGN

In this study, 40 patients with HELLP syndrome and 40 healthy pregnant women with similar characteristics without HELLP syndrome were compared.

RESULTS

When the results were evaluated, no statistically significant difference was found between serum HE4 protein levels in patients with HELLP syndrome and patients without HELLP syndrome in this study (p: 0.29).

CONCLUSION

HE4 protein has no field of use in obstetrics yet. In our study, we aimed to find a new biomarker to identify patients with HELLP syndrome. However, we could not find any statistically significant difference in terms of HE4 protein levels between patients with and without HELLP syndrome. Our study is an important study as it is the first study aiming to use HE4 protein in obstetrics.

Low-fouling and highly sensitive fluorescence immunoassay of protein in serum based on the antifouling magnetic beads

Aim: A low-fouling and highly sensitive fluorescence immunoassay for protein detection in serum was proposed, and IgG was used as a model protein. Materials & methods: SH-PEG-NH2 serving as antifouling coating was conjugated with carboxyl Fe3O4 nanoparticles, and then, the thiol groups were conjugated with antibody via the covalent binding. IgG was captured through magnetic immunoreaction. Highly fluorescent quantum dots modified with streptavidin (SA-QDs) were united with biotin modified IgG antibody to form the sandwich structure. Results & conclusion: The fluorescence immunoassay was able to detect IgG with a detection limit of 3.89 ng/ml in buffer and 5.0 ng/ml in serum with satisfying selectivity and acceptable reproducibility, which demonstrated its potential application in quantitative analysis of real patient serum samples.

Diagnostic Accuracy of the Risk of Ovarian Malignancy Algorithm in Clinical Practice at a Single Hospital in Korea

Background

The risk of ovarian malignancy algorithm (ROMA) is used for assessing ovarian cancer risk in women with a pelvic mass. Its diagnostic accuracy is variable. We investigated whether the clinically acceptable minimal sensitivity of >80.0% could be obtained with the suggested cutoff of 7.4%/25.3% for pre/postmenopausal women and with adjusted cutoffs set to a specificity of ≥75.0% or a sensitivity of 95.0%, in a hospital with a lower ovarian cancer (OC) prevalence than previously reported.

Methods

ROMA scores were calculated from measurements of human epididymis protein 4 and cancer antigen 125 in blood specimens from 443 patients with a pelvic mass. The ROMA-based risk group was compared against biopsy (N=309) or clinical follow-up with imaging (N=134) results. The ROMA sensitivity and specificity for predicting epithelial OC (EOC) and borderline ovarian tumor (BOT) were calculated for the suggested and adjusted cutoff values.

Results

When targeting BOT and EOC, the prevalence was 7.4% and sensitivity and specificity at the suggested cutoff were 63.6% and 90.7%, respectively. Sensitivity was 81.8% at the 4.65%/13.71% cutoff set to a specificity of 75.0%. When targeting only EOC, the prevalence was 4.1% and sensitivity and specificity at the suggested cutoff were 77.8% and 89.4%, respectively. Sensitivity was 88.9% at the 4.78%/14.35% cutoff set to a specificity of 75.0%.

Conclusions

The sensitivity of ROMA was lower than expected when using the suggested cutoff. When using the adjusted cutoff, its sensitivity reached 80.0%.

Potential association between elevated serum human epididymis protein 4 and renal fibrosis: A systemic review and meta-analysis

BACKGROUND

Human epididymis protein 4 (HE4), a matrix metalloprotease 2 (MMP2), and a matrix metalloprotease 9 (MMP9) inhibitor, promotes renal fibrosis by inhibiting the degradation of type I collagen. However, the predictive value of HE4 for renal fibrosis remains controversial, even though it has been identified as one of the most upregulated genes in cultured fibrosis-associated myofibroblasts. This systematic review and meta-analysis was conducted to investigate the potential association between circulating HE4 and renal fibrosis.

METHODS

Original and review articles published until January 2017 that analyzed the performance of serum HE4 in renal fibrosis were systematically searched for in PubMed (1966-2017.1), Cochrane Library, Web of Science, EMBASE (1980-2017.1), China National Knowledge Infrastructure, Wanfang Database, and VIP (Weipu Database). The meta-analysis was performed using RevMan 5.3 version. Pertinent studies were reviewed and the standardized mean difference (SMD) with 95% confidence interval was extracted. A total of 5 studies reporting 460 participants were included in the final analysis. Subgroup and sensitivity analyses were performed to explore the potential sources of between-study heterogeneity.

RESULTS

The results demonstrated that elevated serum HE4 favored the diagnosis of renal fibrosis across all trials (SMD = 1.41; 95% confidence interval, 0.82-2.01; P < .001). The bubble graph indicated statistically robust result. The pooled SMD was similar after removing any single study for sensitivity analysis.

CONCLUSION

The present study suggests a positive association between circulating HE4 and renal fibrosis. Further studies are needed to investigate the effects of interventions on HE4, and the value of HE4 as a biomarker.

Slide cover glass immobilized liquid crystal microdroplets for sensitive detection of an IgG antigen

Slide cover glass immobilized AIgG conjugated LC microdroplets for optical detection of rabbit IgG antigen through interfacial antibody–antigen interactions.

Validation of a Novel Biomarker Panel for the Detection of Ovarian Cancer

BACKGROUND

Ovarian cancer is the most lethal gynecological malignancy. Our integrated -omics approach to ovarian cancer biomarker discovery has identified kallikrein 6 (KLK6) and folate-receptor 1 (FOLR1) as promising candidates but these markers require further validation.

METHODS

KLK6, FOLR1, CA125, and HE4 were investigated in three independent serum cohorts with a total of 20 healthy controls, 150 benign controls, and 216 ovarian cancer patients. The serum biomarker levels were determined by ELISA or automated immunoassay.

RESULTS

All biomarkers demonstrated elevations in the sera of ovarian cancer patients compared with controls (P < 0.01). Overall, CA125 and HE4 displayed the strongest ability (AUC 0.80 and 0.82, respectively) to identify ovarian cancer patients and the addition of HE4 to CA125 improved the sensitivity from 36% to 67% at a set specificity of 95%. In addition, the combination of HE4 and FOLR1 was a strong predictor of ovarian cancer diagnosis, displaying comparable sensitivity (65%) to the best-performing CA125-based models (67%) at a set specificity of 95%.

CONCLUSIONS

The markers identified through our integrated -omics approach performed similarly to the clinically approved markers CA125 and HE4. Furthermore, HE4 represents a powerful diagnostic marker for ovarian cancer and should be used more routinely in a clinical setting.

IMPACT

The implications of our study are 2-fold: (i) we have demonstrated the strengths of HE4 alone and in combination with CA125, lending credence to increasing its usage in the clinic; and (ii) we have demonstrated the clinical utility of our integrated -omics approach to identifying novel serum markers with comparable performance to clinical markers. Cancer Epidemiol Biomarkers Prev; 25(9); 1333-40. ©2016 AACR.

Ultrasensitive Detection of Low-Abundance Protein Biomarkers by Mass Spectrometry Signal Amplification Assay

A mass spectrometry signal amplification method is developed for the ultrasensitive and selective detection of low-abundance protein biomarkers by utilizing tag molecules on gold nanoparticles (AuNPs). EpCAM and thrombin as model targets are captured by specific aptamers immobilized on the AuNPs. With laser desorption/ionization time-of-flight mass spectrometry (LDI-TOF MS), the mass tag molecules are detected to represent the protein biomarkers. Benefiting from the MS signal amplification, the assay can achieve a limit of detection of 100 aM. The method is further applied to detect thrombin in fetal bovine serum and EpCAM in cell lysates to demonstrate its selectivity and feasibility in complex biological samples. With the high sensitivity and specificity, the protocol shows great promise for providing a new route to single-cell analysis and early disease diagnosis.

Human epididymis protein 4 expression positively correlated with miR-21 and served as a prognostic indicator in ovarian cancer

Ovarian cancer is the most common cause of gynecological malignancy-related mortality. Human epididymis protein 4 (HE4) is a useful biomarker for ovarian cancer when either used alone or in combination with carbohydrate antigen 125 (CA125). What is more, aberrant expression of microRNA-21 (miR-21) has been shown to be involved in oncogenesis, but the relationship between miR-21 and HE4 in ovarian cancer is not clear. Tumor and adjacent tumor tissues from 43 patients with ovarian cancer were examined. Real-time polymerase chain reaction (RT-PCR) was used to detect the expression of HE4 in the carcinoma and adjacent tissues. The associations between HE4 and tumor biological characters were discussed. TaqMan(®) MicroRNA (miRNA) assays were employed to detect the expression of miR-21 in the ovarian carcinoma. In ovarian cancer, the expression of HE4 messenger RNA (mRNA) in cancer tissues was higher than adjacent tumor tissues (P < 0.0001), which was 1.299-fold of adjacent tumor tissues. And, the expression of miR-21 was also up-regulated which was significantly different in the ovarian cancer (the positive rate was 76.74 %). There was a significantly positive correlation between miR-21 and HE4 expression (r = 0.283 and P = 0.066 for HE4 mRNA, r = 0.663 and P < 0.0001 for serum HE4). There was also a significant correlation between miR-21 and tumor grade (r = 0.608, P < 0.0001). Significantly, patients with recent recurrence (less than 6 months, n = 17) have a higher miR-21 expression than those with no recent recurrence. Therefore, HE4 and miR-21 may play an important role in the development and progression of ovarian cancer and they may serve as prognostic indicators in ovarian cancer.