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Usui H, Mikiya A, Katayama E, Nakamura N, Sato A, Matsui H, Shozu M, Koga K. Total human chorionic gonadotropin is a more suitable diagnostic marker of gestational trophoblastic diseases than the free β-subunit of human chorionic gonadotropin. Pract Lab Med 2023; 37:e00343. [PMID: 38025990 PMCID: PMC10661586 DOI: 10.1016/j.plabm.2023.e00343] [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: 09/22/2023] [Accepted: 10/30/2023] [Indexed: 12/01/2023] Open
Abstract
Objectives Human chorionic gonadotropin (hCG) levels are essential for the management of trophoblastic diseases. This study aimed to compare the sensitivities and relationships of two hCG measurement methods (total hCG and the free β-subunit of hCG) in managing gestational trophoblastic disease (GTD). Design and Methods We analyzed data from patients treated for GTD at Chiba University Hospital between 2008 and 2019. We focused on cases where both total hCG (mIU/mL) and the free β-subunit of hCG (ng/mL) were measured on the same day. Results Out of 80 patients (mean age 38.9 ± 11.7 years) and 158 measurements, 26 had values below the sensitivity threshold for both tests. Fifty-nine measurements were positive for total hCG but below the sensitivity threshold for the free β-subunit of hCG, whereas only two showed the opposite. Seventy-one measurements were positive for both total hCG and the free β-subunit of hCG. There was a significant correlation between total hCG and the free β-subunit of hCG with both positive values, (r = 0.94, p < 0.001; Spearman's correlation test). Of the 85 measurements with undetectable free β-subunit levels, 26 also had undetectable total hCG levels. However, total hCG was detectable in 59 patients from these cases, with a median value (interquartile range) of 2.9 (1.75-4.9) mIU/mL. Conclusions In the management of GTD, the use of the free β-subunit system alone cannot be recommended.
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Affiliation(s)
- Hirokazu Usui
- Department of Reproductive Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan
- Department of Gynecology, Chiba University Hospital, Chiba University, Chiba, Japan
| | - Atsuko Mikiya
- Department of Gynecology, Chiba University Hospital, Chiba University, Chiba, Japan
| | - Eri Katayama
- Department of Gynecology, Chiba University Hospital, Chiba University, Chiba, Japan
| | - Natsuko Nakamura
- Department of Gynecology, Chiba University Hospital, Chiba University, Chiba, Japan
| | - Asuka Sato
- Department of Gynecology, Chiba University Hospital, Chiba University, Chiba, Japan
| | - Hideo Matsui
- Department of Reproductive Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Makio Shozu
- Department of Reproductive Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan
- Department of Gynecology, Chiba University Hospital, Chiba University, Chiba, Japan
| | - Kaori Koga
- Department of Reproductive Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan
- Department of Gynecology, Chiba University Hospital, Chiba University, Chiba, Japan
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Pretorius CJ, Wilgen U, Klingberg S, Zournazi A, Sanders L, Ungerer JPJ. Comparison between free β subunit of human chorionic gonadotropin (hCG) and total hCG assays in adults with testicular cancer. Clin Chem Lab Med 2023; 61:1841-1849. [PMID: 37078204 DOI: 10.1515/cclm-2022-1240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 04/11/2023] [Indexed: 04/21/2023]
Abstract
OBJECTIVES We tested the hypothesis that the free-β subunit (βhCG) is diagnostically more sensitive with total hCG assays (hCGt) not detecting all tumours secreting βhCG. The effects of sex, age, and renal failure were investigated as secondary objectives. METHODS We compared βhCG with hCGt in 204 testicular cancer patients (99 seminomas, 105 non-seminonatous germ cell tumours). The effects of sex and age were determined in 125 male and 138 female controls and that of renal failure was investigated in 119 haemodialysis patients. Biochemical assessment of gonadal status was performed with LH, FSH, oestradiol and testosterone. RESULTS Discordant results were common with isolated increases of hCGt observed in 32 (15.7 %) and βhCG in 14 (6.9 %) patients. Primary hypogonadism was the most common cause of isolated hCGt increases. After therapeutic interventions βhCG decreased below its upper reference more rapidly than hCGt. We observed unequivocal false negative results in two patients with non-seminomatous germ cell tumours. Both occurred in patients with clinical tumour recurrences; in one instance we observed a false negative hCGt while in the second false negative βhCG's were documented in serial samples. CONCLUSIONS The similar false negative rates did not support the hypothesis that βhCG will detect more patients with testicular cancer than hCGt. In contrast to hCGt, βhCG was unaffected by primary hypogonadism which is a predictably frequent complication in testicular cancer patients. We therefore recommend βhCG as the preferred biomarker in testicular cancer.
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Affiliation(s)
- Carel J Pretorius
- Chemical Pathology, Pathology Queensland, Herston, QLD, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Urs Wilgen
- Chemical Pathology, Pathology Queensland, Herston, QLD, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Sandra Klingberg
- Chemical Pathology, Pathology Queensland, Herston, QLD, Australia
| | - Anna Zournazi
- Chemical Pathology, Pathology Queensland, Herston, QLD, Australia
| | - Linda Sanders
- Chemical Pathology, Pathology Queensland, Herston, QLD, Australia
| | - Jacobus P J Ungerer
- Chemical Pathology, Pathology Queensland, Herston, QLD, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
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Franks CE, Li J, Martinez M, Farnsworth CW, Jones PM, Grenache DG, Meng QH, Gronowski AM. Utility of Commercially Available Quantitative hCG Immunoassays as Tumor Markers in Trophoblastic and Non-Trophoblastic Disease. Clin Chem 2023:7173311. [PMID: 37205831 DOI: 10.1093/clinchem/hvad045] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 03/23/2023] [Indexed: 05/21/2023]
Abstract
BACKGROUND The use of quantitative human chorionic gonadotropin (hCG) as a tumor marker is widely accepted despite lack of FDA-approval for oncology. Differences in iso- and glycoform recognition among hCG immunoassays is well established, exhibiting wide inter-method variability. Here, we assess the utility of 5 quantitative hCG immunoassays for use as tumor markers in trophoblastic and non-trophoblastic disease. METHODS Remnant specimens were obtained from 150 patients with gestational trophoblastic disease (GTD), germ cell tumors (GCT), or other malignancies. Specimens were identified by review of results from physician-ordered hCG and tumor marker testing. Five analyzer platforms were used for split specimen analysis of hCG: Abbott Architect Total, Roche cobas STAT, Roche cobas Total, Siemens Dimension Vista Total, and Beckman Access Total. RESULTS Frequency of elevated hCG concentrations (above reference cutoffs) was highest in GTD (100%), followed by GCT (55% to 57%), and other malignancies (8% to 23%). Overall, the Roche cobas Total detected elevated hCG in the greatest number of specimens (63/150). Detection of elevated hCG in trophoblastic disease was nearly equivalent among all immunoassays (range, 41 to 42/60). CONCLUSIONS While no immunoassay is likely to be perfect in all clinical situations, results for the 5 hCG immunoassays evaluated suggest that all are adequate for use of hCG as a tumor marker in gestational trophoblastic disease and select germ cell tumors. Further harmonization of hCG methods is needed as serial testing for biochemical tumor monitoring must still be performed using a single method. Additional studies are needed to assess the utility of quantitative hCG as a tumor marker in other malignant disease.
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Affiliation(s)
- Caroline E Franks
- Department of Pathology & Immunology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Jieli Li
- Department of Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Magen Martinez
- TriCore Reference Laboratories, Albuquerque, NM, United States
| | - Christopher W Farnsworth
- Department of Pathology & Immunology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Patricia M Jones
- Department of Pathology, University of Texas Southwestern Medical Center and Children's Medical Center, Dallas, TX, United States
| | | | - Qing H Meng
- Department of Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Ann M Gronowski
- Department of Pathology & Immunology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
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Chen C, Wang K, Luo L. AuNPs and 2D functional nanomaterial-assisted SPR development for the cancer detection: a critical review. Cancer Nanotechnol 2022. [DOI: 10.1186/s12645-022-00138-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
AbstractCancer ranks as a leading cause of death and a huge obstacle to rising life expectancy. If cancers are spotted early there's a high chance of survival. The conventional methods relying on the phenotypic features of the tumor are not powerful to the early screening of cancer. Cancer biomarkers are capable of indicating specific cancer states. Current biochemical assay suffers from time and reagents consuming and discontinuous monitoring. Surface plasmon resonance (SPR) technology, a refractive index-based optical biosensor, has significant promise in biomarker detection because of its outstanding features of label-free, sensitivity, and reliability. The nanomaterial features exotic physical and chemical property work on the process of transferring biorecognition event into SPR signal and hence is functioned as signal enhancer. In this review, we mainly discussed the mechanism of gold nanoparticles (AuNPs) and two-dimensional (2D) functional nanomaterial for improving the SPR signal. We also introduced AuNPs and 2D nanomaterial assisted SPR technology in determining cancer biomarker. Last but not least, we discussed the challenges and outlooks of the aforementioned reformative SPR technology for cancer biomarker determination in the clinical trial.
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Zauner T, Heidler S, Lusuardi L, Albrecht W, Wimpissinger F. Does Determining Tumor Markers from the Testicular Vein Enable Better Diagnosis and Prognosis? Urol Int 2020; 105:264-268. [PMID: 33333530 DOI: 10.1159/000511649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 09/16/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION β-HCG has been the only tumor marker evaluated in testicular vein (VT) blood until now. OBJECTIVE To evaluate the correlation between the tumor markers β-HCG, AFP, PLAP, and LDH from the VT and peripheral blood as well as their significance in predicting tumor recurrence and tumor stage. METHODS Patients with testicular cancer undergoing orchiectomy were studied retrospectively over a period of 20 years. Tumor stage, tumor histology, time to tumor recurrence, and tumor markers from VT and peripheral blood were analyzed. Minimal follow-up was 2 years. Statistical analysis was performed by means of Cox- and logistic regression models and Spearman rank correlation coefficients. RESULTS A total of 172 patients with an average follow-up of 9.9 years were investigated. The overall recurrence rate was 18% (seminoma patients 20.8%, nonseminoma patients 14.5%). Marker values measured from VT blood were higher than in peripheral blood and correlated strongly with the peripherally measured values. AFP obtained from peripheral blood was the only tumor marker allowing a statement on the recurrence probability. Tumor markers from VT blood showed no correlation with tumor stage. DISCUSSION/CONCLUSION Tumor markers from VT blood are significantly higher than in peripheral blood. Tumor markers obtained from VT blood do not provide clinical advantage in terms of assessing tumor stage and recurrence probability.
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Affiliation(s)
- Thomas Zauner
- Department of Urology, Krankenhaus Rudolfstiftung, Vienna, Austria
| | - Stefan Heidler
- Department of Urology, Krankenhaus Mistelbach, Mistelbach, Austria,
| | - Lukas Lusuardi
- Department of Urology, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Walter Albrecht
- Department of Urology, Krankenhaus Mistelbach, Mistelbach, Austria
| | - Florian Wimpissinger
- Department of Urology, Krankenhaus Rudolfstiftung, Vienna, Austria.,Department of Urology, Krankenhaus Mistelbach, Mistelbach, Austria
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Chiu NF, Kuo CT, Chen CY. High-affinity carboxyl-graphene oxide-based SPR aptasensor for the detection of hCG protein in clinical serum samples. Int J Nanomedicine 2019; 14:4833-4847. [PMID: 31308661 PMCID: PMC6613200 DOI: 10.2147/ijn.s208292] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 06/17/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The use of functionalized graphene oxide (fGO) has led to a new trend in the sensor field, owing to its high sensitivity with regards to sensing characteristics and easy synthesis procedures. METHODS In this study, we developed an ultra-sensitive carboxyl-graphene oxide (carboxyl-GO)-based surface plasmon resonance (SPR) aptasensor using peptides to detect human chorionic gonadotropin (hCG) in clinical serum samples. The carboxyl-GO based SPR aptasensor provided high affinity and stronger binding of peptides, which are great importance to allow for a non-immunological label-free mechanism. Also, it allows the detection of low concentrations of hCG, which are in turn considered to be important clinical parameters to diagnose ectopic pregnancies and paraneoplastic syndromes. RESULTS The high selectivity of the carboxyl-GO-based SPR aptasensor for hCG recombinant protein was verified by the addition of the interfering proteins bovine serum albumin (BSA) and human serum albumin (HSA), which did not affect the sensitivity of the sensor. The carboxyl-GO-based chip can enhance the assay efficacy of interactions between peptides and had a high affinity binding for a ka of 17×106 M-1S-1. The limit of detection for hCG in clinical serum samples was 1.15 pg/mL. CONCLUSION The results of this study demonstrated that the carboxyl-GO-based SPR aptasensor had excellent sensitivity, affinity and selectivity, and thus the potential to be used as disease-related biomarker assay to allow for an early diagnosis, and possibly a new area in the field of biochemical sensing technology.
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Affiliation(s)
- Nan-Fu Chiu
- Laboratory of Nano-Photonics and Biosensors, Institute of Electro-Optical Engineering, National Taiwan Normal University, Taipei11677, Taiwan
| | - Chia-Tzu Kuo
- Laboratory of Nano-Photonics and Biosensors, Institute of Electro-Optical Engineering, National Taiwan Normal University, Taipei11677, Taiwan
| | - Chen-Yu Chen
- Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei City10449, Taiwan
- Department of Medicine, Mackay Medical College, Taipei252, Taiwan
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Yoshimura K, Nakashima Y, Sugiyama K, Kohei N, Takizawa A. Supposed pituitary-production of human chorionic Gonadotropin induced by androgen deprivation therapy. Int Braz J Urol 2018; 45:38-44. [PMID: 29757577 PMCID: PMC6442121 DOI: 10.1590/s1677-5538.ibju.2017.0654] [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: 12/17/2017] [Accepted: 04/04/2018] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The main cause of slightly elevated human chorionic gonadotropin (HCG) after successful treatment of male germ cell tumors is considered to be pituitary-derived HCG. It is well known that pituitary-derived HCG is frequently detected in postmenopausal women. We evaluated the status of serum HCG in men with elevated gonadotropins, which were induced by androgen deprivation therapy, using commercially available assays. MATERIALS AND METHODS We enrolled 44 patients with prostate cancer, who underwent luteinizing-hormone releasing hormone agonist treatment. We measured serum follicle-stimulating hormone (FSH), serum luteinizing hormone (LH), serum total HCG, serum free HCG-β subunit, and urine total HCG 3 times per patient, on the day of treatment initiation, the next day, and 3 months after. RESULTS On the day after treatment initiation, serum and urine HCG was detected in 61% and 73% of patients, respectively. Markedly strong correlations were observed between serum/urine HCG and FSH/LH. In particular, receiver operating characteristic curve analysis indicated excellent area under the curve (0.977, 95% confidence interval 0.951-1.003)) for serum HCG-detectable LH. At the cutoff value of 21.07 mIU/mL for serum HCG-detectable LH, the sensitivity and specificity were 96.7% and 95.3%, respectively. Serum HCG-β was not detectable at any times in any patients. CONCLUSIONS Suggested pituitary-derived HCG can be frequently detected in patients with elevated gonadotropins, and there is a firm association between HCG detection and gonadotropin levels.
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Affiliation(s)
- Koji Yoshimura
- Department of Urology, Shizuoka General Hospital, Shizuoka, Japan
| | | | - Kyohei Sugiyama
- Department of Urology, Shizuoka General Hospital, Shizuoka, Japan
| | - Naoki Kohei
- Department of Urology, Shizuoka General Hospital, Shizuoka, Japan
| | - Akitoshi Takizawa
- Department of Urology, International Goodwill Hospital, Yokohama, Japan
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8
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Ferraro S, Trevisiol C, Gion M, Panteghini M. Human Chorionic Gonadotropin Assays for Testicular Tumors: Closing the Gap between Clinical and Laboratory Practice. Clin Chem 2018; 64:270-278. [DOI: 10.1373/clinchem.2017.275263] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Accepted: 09/14/2017] [Indexed: 11/06/2022]
Abstract
Abstract
BACKGROUND
Clinical practice guidelines recommend the measurement of human chorionic gonadotropin (hCG) and/or hCGβ in serum for management of testicular germ cell tumors (GCTs). These guidelines, however, disregard relevant biochemical information on hCG variants to be detected for oncological application. We set out to provide a critical review of the clinical evidence together with a characterization of the selectivity of currently marketed hCG immunoassays, identifying assays suitable for management of GCTs.
CONTENT
Evidence sources in the available literature were critically appraised. Most instances of misdiagnosis and mismanagement of testicular GCTs have been associated with hCG results. According to the clinical evidence, 36% of patients with seminoma show an exclusive hCGβ increase, and 71% of patients with nonseminomatous GCTs (NSGCTs) show an increase of intact hCG and/or hCG + hCGβ, whereas the hCGβ increase in NSGCTs is variable according to the tumor stage and histology.
SUMMARY
hCG + hCGβ assays that display an equimolar recognition of hCG and hCGβ, or at least do not overtly underestimate hCGβ, may be employed for management of testicular GCTs. Assays that underestimate hCGβ are not recommended for oncological application. In addition to the hCG + hCGβ assay in service, an additional assay with broader selectivity for other hCG variants should be considered when false-negative or false-positive results are suspected on the basis of clinical data.
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Affiliation(s)
- Simona Ferraro
- Department of Biomedical and Clinical Sciences “Luigi Sacco,” University of Milan, and Clinical Pathology Laboratory, ASST Fatebenefratelli-Sacco, Milan, Italy
| | | | - Massimo Gion
- Regional Center and Program for Biomarkers, Department of Clinical Pathology and Transfusion Medicine, Venice, Italy
| | - Mauro Panteghini
- Department of Biomedical and Clinical Sciences “Luigi Sacco,” University of Milan, and Clinical Pathology Laboratory, ASST Fatebenefratelli-Sacco, Milan, Italy
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9
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Takizawa A, Kawai K, Kawahara T, Kojima T, Maruyama S, Shinohara N, Akamatsu S, Kamba T, Nakamura T, Ukimura O, Jikuya R, Kishida T, Kakimoto K, Nishimura K, Harabayashi T, Nagamori S, Yamashita S, Arai Y, Sawada Y, Sekido N, Kinoshita H, Matsuda T, Nakagawa T, Homma Y, Nishiyama H. The usefulness of testosterone administration in identifying false-positive elevation of serum human chorionic gonadotropin in patients with germ cell tumor. J Cancer Res Clin Oncol 2017; 144:109-115. [DOI: 10.1007/s00432-017-2520-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 09/11/2017] [Indexed: 11/30/2022]
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Caldeira J, Bustos J, Peabody J, Chackerian B, Peabody DS. Epitope-Specific Anti-hCG Vaccines on a Virus Like Particle Platform. PLoS One 2015; 10:e0141407. [PMID: 26516771 PMCID: PMC4627648 DOI: 10.1371/journal.pone.0141407] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 10/08/2015] [Indexed: 11/18/2022] Open
Abstract
The possibility of a contraceptive vaccine targeting human chorionic gonadotropin has long been recognized, but never fully realized. Here we describe an epitope-specific approach based on immunogenic display of hCG-derived peptides on virus-like particles of RNA bacteriophage. A number of recombinant VLPs were constructed, each displaying a different hCG-derived peptide. Some were taken from the disordered C-terminal tail of the hormone, another came from an internal loop, and yet another was an epitope mimic produced by affinity-selection on an hCG-neutralizing antibody target. Immunization of mice with some VLPs yielded antisera that bound the hormone and neutralized hCG biological activity.
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Affiliation(s)
- Jerri Caldeira
- Department of Molecular Genetics and Microbiology, University of New Mexico School of Medicine, Albuquerque, New Mexico 87131, United States of America
| | - Jeremiah Bustos
- Department of Molecular Genetics and Microbiology, University of New Mexico School of Medicine, Albuquerque, New Mexico 87131, United States of America
| | - Julianne Peabody
- Department of Molecular Genetics and Microbiology, University of New Mexico School of Medicine, Albuquerque, New Mexico 87131, United States of America
| | - Bryce Chackerian
- Department of Molecular Genetics and Microbiology, University of New Mexico School of Medicine, Albuquerque, New Mexico 87131, United States of America
| | - David S. Peabody
- Department of Molecular Genetics and Microbiology, University of New Mexico School of Medicine, Albuquerque, New Mexico 87131, United States of America
- * E-mail:
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Prise en charge des séminomes sécrétants de l’hormone chorionique gonadotrope. Prog Urol 2011; 21:308-13. [DOI: 10.1016/j.purol.2010.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2010] [Revised: 08/24/2010] [Accepted: 12/22/2010] [Indexed: 11/21/2022]
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12
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Lempiäinen A, Stenman UH, Blomqvist C, Hotakainen K. Free β-Subunit of Human Chorionic Gonadotropin in Serum Is a Diagnostically Sensitive Marker of Seminomatous Testicular Cancer. Clin Chem 2008; 54:1840-3. [DOI: 10.1373/clinchem.2008.108548] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Background: We studied whether measurement of the free β subunit of human chorionic gonadotropin (hCGβ) in serum offers additional diagnostic information compared to determination of intact hCG alone in testicular cancer.
Methods: We determined hCG and hCGβ with ultrasensitive assays in 94 serum samples obtained preoperatively, 22 samples obtained during relapse, and 3687 samples obtained during routine follow-up of 351 patients with testicular tumors.
Results: In preoperative samples, isolated increases of hCGβ were seen in 40% of the samples from seminoma patients (n = 42) and in 8% of those from patients with nonseminomatous testicular cancer (NSGCT) (n = 51). Both markers were increased in 12% of the seminoma and 71% of the NSGCT patients and were within reference intervals in 43% of the seminoma and 20% of the NSGCT patients. Specific determination of hCGβ increased the frequency of marker-positive seminomas from 17% to 57% and of marker-positive relapses from 32% to 59% (n = 22). Theoretically, about 40% of marker-positive seminomas and relapses would have been missed with an assay measuring hCG and hCGβ together. Preoperative hCG and hCGβ concentrations correlated with stage, tumor histology, and disease-related mortality. Additionally, hCGβ correlated with tumor size.
Conclusions: hCGβ is a diagnostically sensitive marker for testicular cancer. In patients with seminomatous testicular cancer, hCGβ is superior to hCG, and in some NSGCT patients it provides additional information.
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Affiliation(s)
| | | | - Carl Blomqvist
- Oncology Helsinki University Central Hospital and Helsinki University, Helsinki, Finland
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de Medeiros S, Norman R. Human choriogonadotrophin protein core and sugar branches heterogeneity: basic and clinical insights. Hum Reprod Update 2008; 15:69-95. [DOI: 10.1093/humupd/dmn036] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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14
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Gilligan T, Kantoff PW. Testis Cancer. Oncology 2007. [DOI: 10.1007/0-387-31056-8_49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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15
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Lempiäinen A, Hotakainen K, Blomqvist C, Alfthan H, Stenman UH. Increased human chorionic gonadotropin due to hypogonadism after treatment of a testicular seminoma. Clin Chem 2007; 53:1560-1. [PMID: 17644799 DOI: 10.1373/clinchem.2007.088518] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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17
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Stenman UH, Tiitinen A, Alfthan H, Valmu L. The classification, functions and clinical use of different isoforms of HCG. Hum Reprod Update 2006; 12:769-84. [PMID: 16877746 DOI: 10.1093/humupd/dml029] [Citation(s) in RCA: 137] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
HCG is composed of two subunits, HCGalpha and HCGbeta. During early pregnancy, HCG stimulates progesterone production in the corpus luteum, and injection of HCG is widely used to induce ovulation in assisted reproduction treatment (ART). Under experimental conditions, the free subunits have been shown to exert functions other than those of HCG, but the relevance of these remains to be determined. Intact HCG, free subunits and degraded forms of these occur in biological fluids, and determinations of these are important for diagnosis and monitoring of pregnancy, pregnancy-related disorders and several types of cancer. Development of optimal methods for the various forms has been hampered by lack of appropriate standards and expression of the concentrations of the various forms in units that are not comparable. Furthermore, the nomenclature for HCG assays is confusing and in some cases misleading. These problems can now be solved; a uniform nomenclature has been established, and new standards are available for HCG, its subunits HCGalpha and HCGbeta, the partially degraded or nicked forms of HCG and HCGbeta, and the beta-core fragment. This review describes the biochemical and biological background for the clinical use of determinations of various forms of HCG. The clinical use of HCG and studies on HCG vaccines are briefly reviewed.
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Affiliation(s)
- Ulf-Håkan Stenman
- Department of Clinical Chemistry, Helsinki University Central Hospital, Helsinki, Finland.
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Trojan A, Joller-Jemelka H, Stahel RA, Jacky E, Hersberger M. False-positive human serum chorionic gonadotropin in a patient with a history of germ cell cancer. Oncology 2004; 66:336-8. [PMID: 15218303 DOI: 10.1159/000078336] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2003] [Accepted: 10/03/2003] [Indexed: 11/19/2022]
Abstract
Tumor markers, including the beta-subunit of human chorionic gonadotropin (beta-hCG), and radiological imaging methods are commonly used for the diagnosis and monitoring of testicular cancer. We report of a patient with a history of classical seminoma stage I who had elevated serum levels of beta-hCG suggesting relapse 5 years after initial treatment. Radiological evaluation revealed a pericardial cyst, which was surgically removed. Histological evaluation did not demonstrate malignant tissue, suggesting a false-positive beta-hCG. Further workup confirmed this suspicion as we could demonstrate false-positive test results due to heterophilic antibodies detectable in the patient's serum. This case stresses the need for verification of beta-hCG levels in patients where clinical results are not in line with laboratory results.
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Affiliation(s)
- Andreas Trojan
- Clinic and Policlinic of Oncology, University Hospital Zurich, Zurich, Switzerland.
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Affiliation(s)
- Vikas Kundra
- Department of Radiology and Experimental Diagnostic Imaging, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA
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Abstract
Human chorionic gonadotropin (hCG) is mainly used for detection and monitoring of pregnancy and pregnancy-related disorders but it is also an extremely sensitive and specific marker for trophoblastic tumors of placental and germ cell origin. Thus treatment of relapsing choriocarcinomas and testicular germ cell tumors is often initiated on the basis of rising hCG levels even in the absence of clinical or histological evidence of a relapse. While these tumors mostly produce the intact heterodimeric hormone consisting of an alpha (hCGalpha), and a beta subunit (hCGbeta), many nontrophoblastic tumors produce only hCGbeta This is usually a sign of aggressive disease and elevated serum levels of hCGbeta are strongly associated with poor prognosis. Elevated serum levels are observed in 45-60% of patients with biliary and pancreatic cancer and in 10-30% of most other cancers. Methods that detect hCG and hCGbeta together are mainly used for measurement of hCG-like immunoreactivity in serum. However, the reference range for hCG is 5-8 fold higher than that for hCGbeta and thus moderately elevated levels can be identified only with a specific and sensitive hCGbeta assay.
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Affiliation(s)
- Ulf-Håkan Stenman
- Department of Clinical Chemistry, Helsinki University Central Hospital, Helsinki University, Biomedicum, PB 63 FIN-00014, Finland.
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Saboor-Yaraghi AA, Ghods R, Gharagozlou S, Roohi A, Khoshnoodi J, Towfighi F, Jeddi-Tehrani M, Shokri F. Identification of Cross-Reactive and Restricted Epitopes Localized on Human Chorionic Gonadotropin Beta-Subunit by Monoclonal Antibodies. ACTA ACUST UNITED AC 2004; 23:101-7. [PMID: 15165483 DOI: 10.1089/153685904774129702] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Human chorionic gonadotropin (hCG) belongs to the family of glycoprotein hormones. All members of the family are composed of an identical alpha subunit and structurally related beta subunit which confers biological specificity. Specific quantification and functional analysis of hCG require the use of monoclonal antibodies recognizing different epitopes of hCGbeta. This study describes the production and characterization of monoclonal antibodies (MAbs) to hCGbeta with no cross-reactivity to other glycoprotein hormones. Spleen cells from Balb/c mice immunized with hCG were fused with mouse SP2/0 myeloma cells. Fused cells were grown in hypoxanthine, aminopterine, and thymidine (HAT) selective medium and cloned by limiting dilution assay. Antibody-secreting cells were screened by enzyme-linked immunosorbent assay (ELISA) and the specificity of secreted MAbs was further analyzed, using a panel of highly purified and recombinant glycoprotein hormones, their subunits and peptides representing the C-terminal end of hCGbeta (hCGbeta-CTP) by ELISA and immunoblotting. The affinity constant (K(aff)) was also determined by ELISA. Three murine hybridomas designated G5M1, B12M2 and F4M3 were obtained that secrete MAbs specific for hCGbeta. The G5M1 MAb reacts only with hCGbeta, hCGbeta-CTP and intact hCG with no detectable cross-reaction with hCGalpha or any of the other glycoprotein hormones. The specificity of B12M2 MAb is very similar to G5M1, but it does not react with hCGbeta-CTP. The F4M3 MAb also has similar specificity to G5M1 and B12M2, but it strongly cross-reacts with hLH. The affinity constant (Kaff) of G5M1, B12M2 and F4M3 was found to be 4.28 x 10(9), 5.2 x 10(8), and 1.97 x 10(9) M(-1), respectively. Our results indicate that G5M1 and B12M2 MAbs are specific for hCG and recognize epitopes restricted to hCGbeta, but F4M3 recognizes a common epitope expressed both on hCGbeta and hLHbeta.
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Affiliation(s)
- A A Saboor-Yaraghi
- Department of Immunology and Department of Nutrition and Biochemistry, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Abstract
Ultrasonography (US) with a high-frequency (7.5-10-MHz) transducer has become the imaging modality of choice for examination of the scrotum. US examination can provide information valuable for the differential diagnosis of a variety of disease processes involving the scrotum that have similar clinical manifestations (eg, pain, swelling, or presence of mass). The pathologic condition that may be at the origin of such symptoms can vary from testicular torsion to infection to malignancy. The ability of color and power Doppler US to demonstrate testicular perfusion aids in reaching a specific diagnosis in patients with acute scrotal pain. This review covers the anatomy of the scrotum and the scanning protocol for scrotal US, as well as detailed descriptions of disease processes and their US appearances. Newly described conditions such as intratesticular varicoceles and other benign intratesticular cystic lesions are also discussed.
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Affiliation(s)
- Vikram S Dogra
- Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University, 11100 Euclid Ave, Cleveland, OH 44106, USA.
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HOSHI SENJI. Editorial comment. Int J Urol 2002. [DOI: 10.1046/j.1442-2042.2002.t01-1-00440.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Suzuki K, Hoshi S, Orikasa S. Recurrence pattern of metastatic testicular cancers after chemotherapy. TOHOKU J EXP MED 2001; 194:17-22. [PMID: 11556730 DOI: 10.1620/tjem.194.17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Recurrence pattern of metastatic testicular cancer after the initial treatment was investigated. Seventy-seven patients with metastatic testicular cancer were treated by cisplatin-based chemotherapy. Patients with residual masses after chemotherapy and whose tumor markers were normalized underwent surgical resections. Of the 77 patients, 61 achieved cancer free status and 4 who did not need the study criteria excluded. Recurrences were detected in 12 (21.1%) patients, 2 (7.1%) patients among 28 stage II patients; 10 (34.5%) patients among 29 stage III patients; none (0%) patients among 14 seminoma patients and 12 (27.9%) patients among 43 non-seminoma patients. All recurrences were detected within 17 months (median, 3) after the initial treatment. Of the 12 patients experiencing recurrence, 4 died of cancer. The recurrence rate of the patients in stage III was significantly higher than that in stage II. No recurrence was detected in patients with seminoma. Follow-up studies after treatment should include serum tumor markers and computed tomographic scanning of lung, abdomen and pelvis at defined intervals. Intensive follow-up will be needed especially for the patients in stage III and with non-seminoma. Follow-up within the first two years is especially important in detecting recurrence after chemotherapy.
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Affiliation(s)
- K Suzuki
- Department of Urology, Tohoku University School of Medicine, Sendai.
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