1
|
Liu T, Li S, Xia C, Xu D. TERT promoter mutations and methylation for telomerase activation in urothelial carcinomas: New mechanistic insights and clinical significance. Front Immunol 2023; 13:1071390. [PMID: 36713366 PMCID: PMC9877314 DOI: 10.3389/fimmu.2022.1071390] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 12/28/2022] [Indexed: 01/15/2023] Open
Abstract
Telomerase, an RNA-dependent DNA polymerase synthesizing telomeric TTAGGG sequences, is primarily silent in normal human urothelial cells (NHUCs), but widely activated in urothelial cell-derived carcinomas or urothelial carcinomas (UCs) including UC of the bladder (UCB) and upper track UC (UTUC). Telomerase activation for telomere maintenance is required for the UC development and progression, and the key underlying mechanism is the transcriptional de-repression of the telomerase reverse transcriptase (TERT), a gene encoding the rate-limiting, telomerase catalytic component. Recent mechanistic explorations have revealed important roles for TERT promoter mutations and aberrant methylation in activation of TERT transcription and telomerase in UCs. Moreover, these TERT-featured genomic and epigenetic alterations have been evaluated for their usefulness in non-invasive UC diagnostics, recurrence monitoring, outcome prediction and response to treatments such as immunotherapy. Importantly, the detection of the mutated TERT promoter and TERT mRNA as urinary biomarkers holds great promise for urine-based UC liquid biopsy. In the present article, we review recent mechanistic insights into altered TERT promoter-mediated telomerase activation in UCs and discuss potential clinical implications. Specifically, we compare differences in senescence and transformation between NHUCs and other types of epithelial cells, address the interaction between TERT promoter mutations and other factors to affect UC progression and outcomes, evaluate the impact of TERT promoter mutations and TERT-mediated activation of human endogenous retrovirus genes on UC immunotherapy including Bacillus Calmette-Guérin therapy and immune checkpoint inhibitors. Finally, we suggest the standardization of a TERT assay and evaluation system for UC clinical practice.
Collapse
Affiliation(s)
- Tiantian Liu
- Department of Pathology, School of Basic Medical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Shihong Li
- Department of Pathology, Maternal and Child Health Hospital of Liaocheng, Liaocheng, China
| | - Chuanyou Xia
- Department of Urology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China,*Correspondence: Chuanyou Xia, ; Dawei Xu,
| | - Dawei Xu
- Department of Medicine, Bioclinicum and Center for Molecular Medicine (CMM), Karolinska Institutet and Karolinska University Hospital Solna, Stockholm, Sweden,*Correspondence: Chuanyou Xia, ; Dawei Xu,
| |
Collapse
|
2
|
Yahyazadeh R, Bashash D, Ghaffari P, Kord S, Safaroghli-Azar A, Ghaffari SH. Evaluation of hTERT, KRT7, and survivin in urine for noninvasive detection of bladder cancer using real-time PCR. BMC Urol 2021; 21:64. [PMID: 33874920 PMCID: PMC8054358 DOI: 10.1186/s12894-021-00838-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 04/15/2021] [Indexed: 12/30/2022] Open
Abstract
Background Transitional cell carcinoma (TCC) of the bladder is the second most common genitourinary malignancy. Because of the low sensitivity of urinary cytology and the invasiveness and expense of frequent cystoscopies for the detection of low-grade superficial lesions, we aim to establish a sensitive molecular approach to detect bladder cancer noninvasively. Methods Voided urine samples were collected from 80 patients with bladder cancer at the time of diagnosis, in addition to 30 patients with non-bladder cancer urological diseases and 20 healthy volunteers. The level of hTERT, KRT7, and survivin (SVV) mRNAs were analyzed using a qRT-PCR assay. Results The optimal threshold values for hTERT, KRT7, and SVV in urine were calculated by ROC curves analysis. The overall sensitivity was 81.3%, 91.3%, and 68.8% for hTERT, KRT7, and SVV, respectively, which were significantly higher than urine cytology (22.2%, p < 0.001). A higher positive ratio was obtained using multi-marker detection in comparison to single marker detection. The combined use of markers increased the sensitivity of cytology from 22.2 to 100%. In contrast with the urine cytology method, the sensitivity of these biomarkers was not correlated with the grades and stages of the bladder tumors. Conclusions Our data indicate that urinary hTERT, KRT7, and SVV have superior sensitivities over cytology. The combined use of these markers offers a powerful potential assay and promising tool for a sensitive, noninvasive, and highly specific diagnostic method and follow-up of low-grade TCC of the bladder.
Collapse
Affiliation(s)
- Reza Yahyazadeh
- Department of Urology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Davood Bashash
- Department of Hematology and Blood Banking, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parisa Ghaffari
- Hematology, Oncology and Stem Cell Transplantation Research Center, School of Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Saeid Kord
- Hematology, Oncology and Stem Cell Transplantation Research Center, School of Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ava Safaroghli-Azar
- Department of Hematology and Blood Banking, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed H Ghaffari
- Hematology, Oncology and Stem Cell Transplantation Research Center, School of Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
3
|
Casadio V, Bravaccini S. Telomerase Activity Analysis In Urine Sediment for Bladder Cancer. METHODS IN MOLECULAR BIOLOGY (CLIFTON, N.J.) 2021; 2292:133-141. [PMID: 33651358 DOI: 10.1007/978-1-0716-1354-2_12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Bladder cancer with an incidence of 15 cases per 100,000 persons in the global population is the most common tumor of the urinary tract. Imaging techniques, cytoscopy, and cytology are not sufficiently accurate to detect early stage tumors, and the need for new diagnostic markers is still an urgency. Among the biomarkers most recently proposed to improve diagnostic accuracy and especially sensitivity, increasing attention has been focused on the role of the ribonucleoprotein, telomerase. Previous studies have shown that the quantitative telomerase repeat amplification protocol (TRAP) assay performed in voided urine is an important noninvasive tool for the diagnosis of bladder tumors since it has very high sensitivity and specificity, even for early stage and low-grade tumors. Telomerase activity in urine determined by TRAP seems to be marker of great potential, even more advantageous in cost-benefit terms when used in selected symptomatic patients or professionally high-risk subgroups. Here we report the real-time PCR protocol to detect telomerase activity in urine sediment for bladder cancer.
Collapse
Affiliation(s)
- Valentina Casadio
- Biosciences Laboratory, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Sara Bravaccini
- Biosciences Laboratory, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy.
| |
Collapse
|
4
|
Peng L, Li J, Meng C, Li J, Tang D, Guan F, Xu P, Wei T, Li Y. Diagnostic Value of Telomerase Activity in Patients With Bladder Cancer: A Meta-Analysis of Diagnostic Test. Front Oncol 2020; 10:570127. [PMID: 33344230 PMCID: PMC7744937 DOI: 10.3389/fonc.2020.570127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 11/04/2020] [Indexed: 11/13/2022] Open
Abstract
Background This study aimed to evaluate the diagnostic value of telomerase activity (TA) for bladder cancer (BC) by meta-analysis. Methods We conducted a systematic search of studies published on PubMed, Embase, and Web of Science up to June 1, 2019. We used Stata 15 and Review Manager 5.3 for calculations and statistical analysis. Results To evaluate the diagnostic value of TA for BC, we performed a meta-analysis on 22 studies, with a total of 2,867 individuals, including sensitivity, specificity, positive and negative likelihood ratio (PLR, NLR), diagnostic odds ratio (DOR), and 95% confidence intervals (CIs). The pooled parameters were calculated from all studies, and we found a sensitivity of 0.79 (95% CI: 0.72-0.84), a specificity of 0.91 (95% CI: 0.87-0.94), a PLR of 8.91 (95% CI: 5.91-13.43), an NLR of 0.24 (95% CI: 0.15-0.37), a DOR of 37.90 (95% CI: 23.32-61.59), and an AUC of 0.92 (95% CI: 0.90-0.94). We also conducted a subgroup analysis based on the different stages and grades of BC. Results from the subgroup analysis showed that there was no significant difference in TA in either high and low stages of BC, but that low-grade tumors had a lower TA than high-grade tumours. Conclusions TA can be used as a potential biomarker for the diagnosis of bladder cancer with its high specificity. Rigorous and high-quality prospective studies are required to verify our conclusion.
Collapse
Affiliation(s)
- Lei Peng
- Department of Urology, Nanchong Central Hospital, The Second Clinical College, North Sichuan Medical College (University), Nanchong, China
| | - Jinze Li
- Department of Urology, Nanchong Central Hospital, The Second Clinical College, North Sichuan Medical College (University), Nanchong, China
| | - Chunyang Meng
- Department of Urology, Nanchong Central Hospital, The Second Clinical College, North Sichuan Medical College (University), Nanchong, China
| | - Jinming Li
- Department of Urology, The Affiliated Hospital of Medical College, North Sichuan Medical College (University), Nanchong, China
| | - Dandan Tang
- Department of Cardiothoracic Surgery, Shenzhen People's Hospital, Affiliated Hospital of Jinan University, Shenzhen, China
| | - Fangxue Guan
- Internal Medicine, People's Hospital of Yanyuan, Xichang City, China
| | - Peng Xu
- Department of Cardiology, The Affiliated Hospital of Medical University, Guizhou Medical University, Guizhou, China
| | - Tangqiang Wei
- Department of Urology, Nanchong Central Hospital, The Second Clinical College, North Sichuan Medical College (University), Nanchong, China
| | - Yunxiang Li
- Department of Urology, Nanchong Central Hospital, The Second Clinical College, North Sichuan Medical College (University), Nanchong, China
| |
Collapse
|
5
|
Cheng D, Liang B, Li Y. Clinical value of vascular endothelial growth factor and endostatin in urine for diagnosis of bladder cancer. TUMORI JOURNAL 2018; 98:762-7. [DOI: 10.1177/030089161209800614] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims and background The aim of the study was to determine whether urinary VEGF and endostatin predict the presence of bladder cancer, and whether these noninvasive biomarkers provide clinically useful information in the bladder cancer patient as well. Methods and study design Voided urine samples were collected from 239 patients (109 bladder cancers, 81 urological disorders, 49 healthy controls). The urine levels of VEGF and endostatin were determined with the sandwich enzyme immunoassay technique. Results Urine levels of VEGF and endostatin were higher in patients with bladder cancer than those in patients with urological disorders and healthy controls (P <0.01). The difference between patients with urological disorder and healthy controls was significant only for VEGF (P <0.01). Urine level of VEGF was related to the tumor grade, and urine level of endostatin was related to tumor stage, tumor size and tumor number (P <0.05). The optimal cutoffs for VEGF and endostatin were calculated by the ROC curves as 860 pg/ml for VEGF, and 350 pg/ml for endostatin. The five-year survival rate was 60.0% in patients with low level of endostatin (<350 pg/ml) and 7.69% in patients with high level of endostatin (≥350 pg/ml) in the bladder cancer group. Patients with a high level of endostatin had a shorter survival time, whereas patients with a low level of endostatin had a longer survival time (P <0.05). Conclusions Urine levels of VEGF and endostatin may be a clinically useful aid in the diagnosis of bladder cancer, and endostatin but not VEGF is a supplementary prognostic marker for predicting tumor progression.
Collapse
Affiliation(s)
- Daye Cheng
- Department of Transfusion, The First Hospital of China Medical University, Shenyang
| | - Bin Liang
- High Vocational Technological College, China Medical University, Shenyang
| | - Yunhui Li
- Department of Clinical Laboratory, No. 202 Hospital, Shenyang, PR China
| |
Collapse
|
6
|
Casadio V, Bravaccini S, Gunelli R, Nanni O, Zoli W, Amadori D, Calistri D, Silvestrini R. Accuracy of urine telomerase activity to detect bladder cancer in symptomatic patients. Int J Biol Markers 2018; 24:253-7. [DOI: 10.1177/172460080902400406] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Telomerase activity assessment in voided urine is an important noninvasive tool for bladder cancer diagnosis. In a previous case-control study we verified that this method can detect tumor cells in urine with high sensitivity and specificity, but few data are still available on its accuracy to detect tumors in patients with symptomatic urinary tract diseases. Following recently published guidelines on bladder cancer, we aimed to define the diagnostic accuracy of urine telomerase levels in symptomatic patients. Telomerase activity, expressed in arbitrary enzymatic units (AEUs), was evaluated in urine collected from 515 patients: 197 with urinary tract symptoms and 318 with a first diagnosis of bladder cancer. Telomerase repeat amplification protocol (TRAP) sensitivity ranged from 93% to 61% and specificity varied from 42% to 88% at the different AEU cutoff values. At the cutoff of 50, the sensitivity was 87% (95% CI 83–91), the specificity was 70% (95% CI 63–75), and the overall accuracy, in terms of true positives and true negatives, was 80%. Sensitivity did not vary in relation to tumor grade or stage at diagnosis, or to patient age. Our results indicate that urine telomerase activity is a good marker for the early diagnosis of bladder tumors in symptomatic patients, a subset which represents an “at-risk” population requiring close surveillance.
Collapse
Affiliation(s)
- Valentina Casadio
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Meldola (Forlì-Cesena)
| | - Sara Bravaccini
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Meldola (Forlì-Cesena)
| | - Roberta Gunelli
- Department of Urology, Morgagni-Pierantoni Hospital, Forlì - Italy
| | - Oriana Nanni
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Meldola (Forlì-Cesena)
| | - Wainer Zoli
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Meldola (Forlì-Cesena)
| | - Dino Amadori
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Meldola (Forlì-Cesena)
| | - Daniele Calistri
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Meldola (Forlì-Cesena)
- These Auhors contributed equally to the work
| | - Rosella Silvestrini
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Meldola (Forlì-Cesena)
- These Auhors contributed equally to the work
| |
Collapse
|
7
|
Atala A. Re: TERT Promoter Mutations and Telomerase Reactivation in Urothelial Cancer. J Urol 2015; 194:848. [PMID: 26292896 DOI: 10.1016/j.juro.2015.06.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Indexed: 11/29/2022]
|
8
|
Wang K, Liu T, Liu C, Meng Y, Yuan X, Liu L, Ge N, Liu J, Wang C, Ren H, Yan K, Hu S, Xu Z, Fan Y, Xu D. TERT promoter mutations and TERT mRNA but not FGFR3 mutations are urinary biomarkers in Han Chinese patients with urothelial bladder cancer. Oncologist 2015; 20:263-9. [PMID: 25657201 DOI: 10.1634/theoncologist.2014-0391] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The TERT promoter and FGFR3 gene mutations are two of the most common genetic events in urothelial bladder cancer (UBC), and these mutation assays in patient urine have been shown to be promising biomarkers for UBC diagnosis and surveillance. These results were obtained mainly from studies of patients with UBC in Western countries, and little is known about such information in Han Chinese patients with UBC. In the present study, we addressed this issue by analyzing tumors from 182 Han Chinese patients with UBC and urine samples from 102 patients for mutations in the TERT promoter and FGFR3 and TERT mRNA expression in tumors and/or urine. TERT promoter and FGFR3 mutations were identified in 87 of 182 (47.8%) and 7 of 102 (6.7%) UBC cases, respectively. In 46 urine samples from patients with TERT promoter mutation-carrying tumors, the mutant promoter was detected in 24 (52%) prior to operation and disappeared in most examined urine samples (80%) taken 1 week after operation. TERT mRNA was detected in urine derived from 46 of 49 patients (94%) that was analyzed before operation independently of the presence of TERT promoter mutations. Collectively, FGFR3 mutations occur at a very low rate in Han Chinese UBC and cannot serve as diagnostic markers for Chinese patients. Han Chinese patients with UBC have relatively low TERT promoter mutation frequency compared with patients in Western countries, and simultaneous detection of both mutant TERT promoter and TERT mRNA improves sensitivity and specificity of urine-based diagnosis.
Collapse
MESH Headings
- Adenocarcinoma/genetics
- Adenocarcinoma/pathology
- Biomarkers, Tumor/genetics
- Biomarkers, Tumor/urine
- Carcinoma, Transitional Cell/genetics
- Carcinoma, Transitional Cell/pathology
- China/ethnology
- Female
- Humans
- Male
- Mutation
- Neoplasm Recurrence, Local
- Polymerase Chain Reaction
- Promoter Regions, Genetic
- RNA, Messenger/genetics
- Receptor, Fibroblast Growth Factor, Type 3/genetics
- Receptor, Fibroblast Growth Factor, Type 3/urine
- Sensitivity and Specificity
- Sequence Analysis, DNA
- Telomerase/genetics
- Telomerase/urine
- Urinary Bladder Neoplasms/genetics
- Urinary Bladder Neoplasms/pathology
Collapse
Affiliation(s)
- Kun Wang
- Departments of Urology and General Surgery, Qilu Hospital, Department of Pathology, School of Medicine, and Department of Urology, Second Hospital, Shandong University, Jinan, People's Republic of China; Department of Medicine, Division of Hematology and Center for Molecular Medicine, Karolinska University Hospital Solna and Karolinska Institutet, Stockholm, Sweden
| | - Tiantian Liu
- Departments of Urology and General Surgery, Qilu Hospital, Department of Pathology, School of Medicine, and Department of Urology, Second Hospital, Shandong University, Jinan, People's Republic of China; Department of Medicine, Division of Hematology and Center for Molecular Medicine, Karolinska University Hospital Solna and Karolinska Institutet, Stockholm, Sweden
| | - Cheng Liu
- Departments of Urology and General Surgery, Qilu Hospital, Department of Pathology, School of Medicine, and Department of Urology, Second Hospital, Shandong University, Jinan, People's Republic of China; Department of Medicine, Division of Hematology and Center for Molecular Medicine, Karolinska University Hospital Solna and Karolinska Institutet, Stockholm, Sweden
| | - Yan Meng
- Departments of Urology and General Surgery, Qilu Hospital, Department of Pathology, School of Medicine, and Department of Urology, Second Hospital, Shandong University, Jinan, People's Republic of China; Department of Medicine, Division of Hematology and Center for Molecular Medicine, Karolinska University Hospital Solna and Karolinska Institutet, Stockholm, Sweden
| | - Xiaotian Yuan
- Departments of Urology and General Surgery, Qilu Hospital, Department of Pathology, School of Medicine, and Department of Urology, Second Hospital, Shandong University, Jinan, People's Republic of China; Department of Medicine, Division of Hematology and Center for Molecular Medicine, Karolinska University Hospital Solna and Karolinska Institutet, Stockholm, Sweden
| | - Li Liu
- Departments of Urology and General Surgery, Qilu Hospital, Department of Pathology, School of Medicine, and Department of Urology, Second Hospital, Shandong University, Jinan, People's Republic of China; Department of Medicine, Division of Hematology and Center for Molecular Medicine, Karolinska University Hospital Solna and Karolinska Institutet, Stockholm, Sweden
| | - Nan Ge
- Departments of Urology and General Surgery, Qilu Hospital, Department of Pathology, School of Medicine, and Department of Urology, Second Hospital, Shandong University, Jinan, People's Republic of China; Department of Medicine, Division of Hematology and Center for Molecular Medicine, Karolinska University Hospital Solna and Karolinska Institutet, Stockholm, Sweden
| | - Jikai Liu
- Departments of Urology and General Surgery, Qilu Hospital, Department of Pathology, School of Medicine, and Department of Urology, Second Hospital, Shandong University, Jinan, People's Republic of China; Department of Medicine, Division of Hematology and Center for Molecular Medicine, Karolinska University Hospital Solna and Karolinska Institutet, Stockholm, Sweden
| | - Chang Wang
- Departments of Urology and General Surgery, Qilu Hospital, Department of Pathology, School of Medicine, and Department of Urology, Second Hospital, Shandong University, Jinan, People's Republic of China; Department of Medicine, Division of Hematology and Center for Molecular Medicine, Karolinska University Hospital Solna and Karolinska Institutet, Stockholm, Sweden
| | - Hongbo Ren
- Departments of Urology and General Surgery, Qilu Hospital, Department of Pathology, School of Medicine, and Department of Urology, Second Hospital, Shandong University, Jinan, People's Republic of China; Department of Medicine, Division of Hematology and Center for Molecular Medicine, Karolinska University Hospital Solna and Karolinska Institutet, Stockholm, Sweden
| | - Keqiang Yan
- Departments of Urology and General Surgery, Qilu Hospital, Department of Pathology, School of Medicine, and Department of Urology, Second Hospital, Shandong University, Jinan, People's Republic of China; Department of Medicine, Division of Hematology and Center for Molecular Medicine, Karolinska University Hospital Solna and Karolinska Institutet, Stockholm, Sweden
| | - Sanyuan Hu
- Departments of Urology and General Surgery, Qilu Hospital, Department of Pathology, School of Medicine, and Department of Urology, Second Hospital, Shandong University, Jinan, People's Republic of China; Department of Medicine, Division of Hematology and Center for Molecular Medicine, Karolinska University Hospital Solna and Karolinska Institutet, Stockholm, Sweden
| | - Zhonghua Xu
- Departments of Urology and General Surgery, Qilu Hospital, Department of Pathology, School of Medicine, and Department of Urology, Second Hospital, Shandong University, Jinan, People's Republic of China; Department of Medicine, Division of Hematology and Center for Molecular Medicine, Karolinska University Hospital Solna and Karolinska Institutet, Stockholm, Sweden
| | - Yidong Fan
- Departments of Urology and General Surgery, Qilu Hospital, Department of Pathology, School of Medicine, and Department of Urology, Second Hospital, Shandong University, Jinan, People's Republic of China; Department of Medicine, Division of Hematology and Center for Molecular Medicine, Karolinska University Hospital Solna and Karolinska Institutet, Stockholm, Sweden
| | - Dawei Xu
- Departments of Urology and General Surgery, Qilu Hospital, Department of Pathology, School of Medicine, and Department of Urology, Second Hospital, Shandong University, Jinan, People's Republic of China; Department of Medicine, Division of Hematology and Center for Molecular Medicine, Karolinska University Hospital Solna and Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
9
|
Calistri D, Casadio V, Bravaccini S, Zoli W, Amadori D. Urinary biomarkers of non-muscle-invasive bladder cancer: current status and future potential. Expert Rev Anticancer Ther 2014; 12:743-52. [DOI: 10.1586/era.12.50] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
|
10
|
Woo Kim K, Shin Y, Promoda Perera A, Liu Q, Sheng Kee J, Han K, Yoon YJ, Kyoung Park M. Label-free, PCR-free chip-based detection of telomerase activity in bladder cancer cells. Biosens Bioelectron 2013; 45:152-7. [DOI: 10.1016/j.bios.2013.02.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Revised: 01/30/2013] [Accepted: 02/01/2013] [Indexed: 10/27/2022]
|
11
|
Urine telomerase for diagnosis and surveillance of bladder cancer. Adv Urol 2012; 2012:693631. [PMID: 22888342 PMCID: PMC3410307 DOI: 10.1155/2012/693631] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Revised: 05/31/2012] [Accepted: 06/04/2012] [Indexed: 12/18/2022] Open
Abstract
Bladder cancer has increased incidence during last decades. For those patients with nonmuscle involved tumors, noninvasive diagnosis test and surveillance methods must be designed to avoid current cystoscopies that nowadays are done regularly in a lot of patients. Novel urine biomarkers have been developed during last years. Telomerase is important in cancer biology, improving the division capacity of cancer cells. Even urinary telomerase could be a potentially useful urinary tumor marker; its use for diagnosis of asymptomatic and symptomatic patients or its impact during surveillance is still unknown. Moreover, there will need to be uniformity and standardization in the assays before it can become useful in clinical practice. It does not seem to exist a real difference between the most classical assays for the detection of urine telomerase (TRAP and hTERT). However, the new detection methods with modified TeloTAGGG telomerase or with gold nanoparticles must also be taken into consideration for the correct development of this diagnosis method. Maybe the target population would be the high-risk groups within screening programs. To date there is no enough evidence to use it alone and to eliminate cystoscopies from the diagnosis and surveillance of these patients. The combination with cytology or FISH is still preferred.
Collapse
|
12
|
Chen CH, Chen RJ. Prevalence of telomerase activity in human cancer. J Formos Med Assoc 2011; 110:275-89. [PMID: 21621148 DOI: 10.1016/s0929-6646(11)60043-0] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2010] [Revised: 10/30/2010] [Accepted: 12/01/2010] [Indexed: 12/13/2022] Open
Abstract
Telomerase activity has been measured in a wide variety of cancerous and non-cancerous tissue types, and the vast majority of clinical studies have shown a direct correlation between it and the presence of cancerous cells. Telomerase plays a key role in cellular immortality and tumorigenesis. Telomerase is activated in 80-90% of human carcinomas, but not in normal somatic cells, therefore, its detection holds promise as a diagnostic marker for cancer. Measurable levels of telomerase have been detected in malignant cells from various samples: tissue from gestational trophoblastic neoplasms; squamous carcinoma cells from oral rinses; lung carcinoma cells from bronchial washings; colorectal carcinoma cells from colonic luminal washings; bladder carcinoma cells from urine or bladder washings; and breast carcinoma or thyroid cancer cells from fine needle aspirations. Such clinical tests for telomerase can be useful as non-invasive and cost-effective methods for early detection and monitoring of cancer. In addition, telomerase activity has been shown to correlate with poor clinical outcome in late-stage diseases such as non-small cell lung cancer, colorectal cancer, and soft tissue sarcomas. In such cases, testing for telomerase activity can be used to identify patients with a poor prognosis and to select those who might benefit from adjuvant treatment. Our review of the latest medical advances in this field reveals that telomerase holds great promise as a biomarker for early cancer detection and monitoring, and has considerable potential as the basis for developing new anticancer therapies.
Collapse
Affiliation(s)
- Chi-Hau Chen
- Department of Obstetrics and Gynecology, National Taiwan University College of Medicine and National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan
| | | |
Collapse
|
13
|
Bravaccini S, Casadio V, Gunelli R, Bucchi L, Zoli W, Amadori D, Silvestrini R, Calistri D. Combining cytology, TRAP assay, and FISH analysis for the detection of bladder cancer in symptomatic patients. Ann Oncol 2011; 22:2294-8. [DOI: 10.1093/annonc/mdq740] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
14
|
Abstract
The role telomeres and telomerase play in the initiation and progression of human cancers has been extensively evaluated. Telomeres are nucleoprotein complexes comprising the hexanucleotide DNA repeat sequence, TTAGGG and numerous telomere-associated proteins, including the six member Shelterin complex. The main function of the telomere is to stabilize the ends of the chromosomes. However, through multiple mechanisms, telomeres can become dysfunctional, which may drive genomic instability leading to the development of cancer. The majority of human cancers maintain, or actively lengthen, telomeres through up-regulation of the reverse transcriptase telomerase. Because there are significant differences in telomere length and telomerase activity between malignant and non-malignant tissues, many investigations have assessed the potential to utilize these molecular markers for cancer diagnosis. Here, we critically evaluate whether measurements of telomere lengths and telomerase levels may be clinically utilized as diagnostic markers in solid tumours, with emphasis on breast and prostate cancer as representative examples. Future directions focusing on the direct detection of dysfunctional telomeres are explored. New markers for telomere dysfunction may eventually prove clinically useful.
Collapse
Affiliation(s)
- Christopher M Heaphy
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA.
| | | |
Collapse
|
15
|
Bravaccini S, Casadio V, Amadori D, Calistri D, Silvestrini R. The current role of telomerase in the diagnosis of bladder cancer. Indian J Urol 2011; 25:40-6. [PMID: 19468427 PMCID: PMC2684324 DOI: 10.4103/0970-1591.45535] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Bladder cancer has an incidence of 15 cases per 100,000 persons in the global population and is the most common tumor of the urinary tract. Imaging techniques, cytoscopy, and cytology are either invasive or not sufficiently accurate to detect early stage tumors, and the need for new diagnostic markers still remains. Among the markers most recently proposed to improve diagnostic accuracy and especially sensitivity, increasing attention has been focused on the role of the ribonucleoprotein, telomerase. Relevant papers on the etiology, diagnosis, and evaluation of bladder cancer using telomerase in urine were searched for and considered. The PubMed search was performed using the text terms "bladder cancer", "diagnosis", and "telomerase". Previous studies have shown that the quantitative Telomerase Repeat Amplification Protocol (TRAP) assay performed in voided urine is an important non-invasive tool for the diagnosis of bladder tumors since it has very high sensitivity and specificity, even for early stage and low grade tumors. The main limitation of this test is the rate of false positive results due to the presence of inflammatory or non-tumor cells (i.e., epithelial cells from the lower genital tract), which express telomerase activity (TA). Consequently, an in situ analysis would seem to be important to identify the nature of telomerase-positive cells. Immunocytochemical detection of the hTERT subunit by a specific antibody seemed to open up the possibility to identify different cellular components of urine. However, the lack of a strict relationship between hTERT protein expression and telomerase activity has, to a certain extent, made this approach less relevant. In conclusion, telomerase activity in urine determined by TRAP seems to be marker of great potential, even more advantageous in cost/benefit terms when used in selected symptomatic patients or professionally high-risk subgroups.
Collapse
Affiliation(s)
- Sara Bravaccini
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (I.R.S.T.), Via Piero Maroncelli 40, 47014 Meldola (FC), Italy
| | | | | | | | | |
Collapse
|
16
|
Hashim AAA, Youns M, Soltan AAAR, Ali SAEM. Nuclear Matrix Protein-22 and Telomerase Reverse Transcriptase Are Diagnostic Markers for Bladder Carcinoma in Egypt. JOURNAL OF CANCER THERAPY 2011; 02:646-653. [DOI: 10.4236/jct.2011.25086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
|
17
|
Mezzasoma L, Antognelli C, Del Buono C, Stracci F, Cottini E, Cochetti G, Talesa VN, Mearini E. Expression and biological-clinical significance of hTR, hTERT and CKS2 in washing fluids of patients with bladder cancer. BMC Urol 2010; 10:17. [PMID: 20920335 PMCID: PMC2959011 DOI: 10.1186/1471-2490-10-17] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2010] [Accepted: 10/04/2010] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND at present, pathogenesis of bladder cancer (BC) has not been fully elucidated. Aim of this study is to investigate the role of human telomerase RNA (hTR), human telomerase reverse transcriptase (hTERT) and CDC28 protein kinase regulatory subunit 2 (CKS2) in bladder carcinogenesis and their possible clinical significance; METHODS the transcript levels of hTR, hTERT and CKS2 were quantified by Real time reverse transcriptase chain reaction in exfoliated cells from bladder washings of 36 patients with BC and 58 controls. The statistical significance of differences between BC bearing patients and control groups, in the general as well as in the stratified analysis (superficial or invasive BC), was assessed by Student's t test. Non parametric Receiver Operating Characteristics analysis (ROC) was performed to ascertain the accuracy of study variables to discriminate between BC and controls. The clinical value of concomitant examination of hTR, hTERT and CKS2 was evaluated by logistic regression analysis; RESULTS a significant decrease in hTR and a significant increase in hTERT or CKS2 gene expression were found between BC bearing patients and controls, as well as in the subgroups analysis. The area under the curve (AUC) indicated an average discrimination power for the three genes, both in the general and subgroups analysis, when singularly considered. The ability to significantly discriminate between superficial and invasive BC was observed only for hTR transcript levels. A combined model including hTR and CKS2 was the best one in BC diagnosis; CONCLUSIONS our results, obtained from a sample set particularly rich of exfoliated cells, provide further molecular evidence on the involvement of hTR, hTERT and CKS2 gene expression in BC carcinogenesis. In particular, while hTERT and CKS2 gene expression seems to have a major involvement in the early stages of the disease, hTR gene expression, seems to be more involved in progression. In addition, our findings suggest that the studied genes have a clinical role in discriminating between BC and controls in the general as well as in the stratified analysis, when singularly considered. A combined model improved over the single marker BC diagnosis.
Collapse
Affiliation(s)
- Letizia Mezzasoma
- Department of Experimental Medicine, Division of Cell and Molecular Biology, University of Perugia, and Didactic and Scientific District of Terni, Santa Maria General Hospital, Via Del Giochetto 06122 Perugia, Italy.
| | | | | | | | | | | | | | | |
Collapse
|
18
|
Morii A, Komiya A, Okumura A, Fuse H. Telomerase activity in bladder cancer tissue. Exp Ther Med 2010; 1:85-88. [PMID: 23136598 DOI: 10.3892/etm_00000015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2009] [Accepted: 09/04/2009] [Indexed: 02/01/2023] Open
Abstract
Telomerase is a ribonucleoprotein enzyme that maintains telomeric DNA repeats at the end of chromosomes. Telomerase activity has been reported in many human cancers. The present study evaluated telomerase activity in bladder cancer tissue and investigated whether this activity is associated with tumor characteristics and prognosis in bladder cancer patients. Telomerase activity was investigated using the telomeric repeat amplification protocol (TRAP) in bladder tissue specimens from 81 patients, including 75 patients with bladder carcinoma and 6 patients with dysplasia or an inflammatory bladder lesion. Forty-nine of the 75 bladder cancer patients were found to be telomerase-positive, while 1 out of the 6 control specimens without carcinoma was telomerase-positive. Telomerase activity was correlated with lower grade and lower stage bladder cancer, but was not significantly associated with cancer-specific survival in the total population of bladder cancer patients. However, telomerase-positive patients among the patients with invasive and grade 3 tumors had an improved prognosis. Telomerase activity was observed in early-stage bladder cancer, and may be an indicator of prognosis in bladder cancer patients with advanced-stage and high-grade tumors.
Collapse
Affiliation(s)
- Akihiro Morii
- Department of Urology, Graduate School of Medicine and Pharmaceutical Sciences for Research, University of Toyama, Toyama 930-0194, Japan
| | | | | | | |
Collapse
|
19
|
Vrooman OPJ, Witjes JA. Molecular markers for detection, surveillance and prognostication of bladder cancer. Int J Urol 2009; 16:234-43. [PMID: 19298346 DOI: 10.1111/j.1442-2042.2008.02225.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Many markers for the detection of bladder cancers have been tested and almost all urinary markers reported are better than cytology with regard to sensitivity, but they score lower in specificity. Currently molecular and genetic changes play an important role in the discovery of new molecular markers for detection, prognostication and surveillance. The purpose of this review is to highlight the most important urinary molecular biomarker developments that have been studied and reported recently. In the current review we have summarized the most recent and relevant published reports on molecular urinary markers. The results of this review show that the first generation of urinary markers did not add much to urinary cytology. The current generation of markers is better, but additional clinical trials are needed. Our knowledge of molecular pathways in bladder cancer is growing and new methods of marker development emerge, but the perfect marker is still to be found. Currently, there are not clinically usable molecular markers that can guide us in diagnosis or surveillance, nor guide us in lowering the frequency of urethrocystoscopy in bladder cancer.
Collapse
Affiliation(s)
- Olaf P J Vrooman
- Department of Urology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | | |
Collapse
|
20
|
Shirodkar SP, Lokeshwar VB. Bladder tumor markers: from hematuria to molecular diagnostics--where do we stand? Expert Rev Anticancer Ther 2008; 8:1111-23. [PMID: 18588456 DOI: 10.1586/14737140.8.7.1111] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Bladder cancer is a common malignancy in the USA. Currently, the detection of initial tumors and recurrent disease is based on evaluation of voided urinary specimens, often followed by cystoscopy. With the high rate of recurrence, cystoscopies are regularly repeated with the aim of halting progression of the disease. For patients, this process is fraught with anxiety, pain and high cost. As a result, intense work is being done in the field of bladder tumor markers with the goal of identifying bladder cancer earlier, both in the initial diagnosis and in recurrences of known tumor. The possibility of identifying a marker that could noninvasively differentiate benign and malignant causes of hematuria, and identify recurrences prior to their pathologic progression is the objective of this area of research. Currently, a large number of tumor markers exist, each scrutinized in both the laboratory and in clinical trials. Here we present many of the most widely used and tested markers. Background details are provided as to the mechanism of detection of malignant cells, the results of recent trials and future directions of study. Some novel modalities for tumor detection are also presented. The next few years will no doubt bring newer markers and lead to the elimination of others. Studies continue to refine the role of these markers in clinical practice, but their ultimate efficacy will need to be borne out in large-scale clinical trials in a multitude of settings.
Collapse
Affiliation(s)
- Samir P Shirodkar
- Department of Urology (M-800), Miller School of Medicine University of Miami, P.O. Box 016960, Miami, Florida 33101, USA.
| | | |
Collapse
|
21
|
Vrooman OPJ, Witjes JA. Urinary markers in bladder cancer. Eur Urol 2007; 53:909-16. [PMID: 18162285 DOI: 10.1016/j.eururo.2007.12.006] [Citation(s) in RCA: 134] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2007] [Accepted: 12/04/2007] [Indexed: 12/29/2022]
Abstract
OBJECTIVES Many markers for the detection of bladder cancers have been tested. Almost all urinary markers reported are better than cytology with regard to sensitivity, but they score lower in specificity. The purpose of this review is to highlight the most important urinary biomarkers studied and reported recently. METHODS Literature on bladder cancer markers has been reviewed regularly in the last few years. In the current review we have tried to summarise the most recent literature of urinary markers. RESULTS The results of this review show that the first-generation urinary markers did not add much to urinary cytology. The current generation of markers is promising but larger clinical trails are needed. The future of marker development is bright with new techniques emerging, but the perfect marker is still to be found. CONCLUSION Currently, no single marker can yet guide us in surveillance and lower the frequency of urethrocystoscopy.
Collapse
Affiliation(s)
- Olaf P J Vrooman
- Department of Urology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | | |
Collapse
|