Allogeneic hematopoietic stem cell transplantation and the risk for transmission of heritable malignancy

Allogeneic transplantation and the risk for transmission of genetic disease: the heritable cancer disorders

With the development of new approaches to transplantation therapy, such as those building upon the potential found in stem cells, it is vital to pursue a clear understanding of transplantation risks. Allogeneic transplantation presents risk for the transmission of disease of various types, including genetic disease. Predisposition to develop cancer is a feature of numerous genetic disorders, and it may be transmissible by transplantation. Some genetic disorders predisposing to cancer are remarkably common, either worldwide or in specific populations, and they could pose significant risk. Hence, to reduce risk to recipients, there is reason to exclude from donation those potential donors (including embryos) harboring certain germ-line mutations. However, the frequent absence of readily identifiable features might confound the effort to exclude those who harbor mutation. Thus, it is also important to consider the magnitude of risk that they represent. For some disorders, life-threatening cancer is highly likely to develop in those individuals born with germ-line mutation, but whether recipients would face the same risk from transplanted mutation is not always evident. Given the diversity of pathways that lead to cancer, there may be diverse factors that impact the likelihood for cancer to develop in the recipient, with some factors decreasing and others increasing the risk. One factor of special concern is the possibility that manipulation of donor cells, prior to transplantation, might introduce additional genetic or epigenetic abnormality, thereby increasing the risk.

Genomic screening and complications of hematopoietic stem cell transplantation: has the time come?

The occurrence of toxic complications following hematopoietic stem cell transplantation (HSCT) is highly variable and dependent on a multitude of host, donor, and treatment factors. The increasingly broad indications for HSCT and the need to provide this treatment option to older and/or more debilitated patients emphasizes the importance of refining our methods of predicting and ameliorating these toxicities. Late complications (occurring after day 100) also pose a threat to quality of life after HSCT. Genetic polymorphisms in key molecular pathways in the host are likely to contribute significantly to the observed variability in the development HSCT-associated complications. Hepatic veno-occlusive disease and acute lung injury, two of the most serious organ toxicities that occur, represent useful paradigms for the identification of genetic polymorphisms in enzyme systems that modulate local and systemic responses to oxidant stress during transplant conditioning therapy. Ongoing studies in this area are providing clues to the prevention of adverse clinical outcomes based on the genetic milieu. This review of studies in HSCT that explore genetic risk factors for transplant complications indicates that significant progress is being made in this rapidly evolving area. However, further large-scale clinical and translational studies are needed before genomic screening can be widely used to individualize treatment.

Recognition of malignant processes with neural nets from ESR spectra of serum albumin

Cancer diseases are the focus of intense research due to their frequent occurrence. It is known from the literature that serum proteins are changed in the case of malignant processes. Changes of albumin conformation, transport efficiency, and binding characteristics can be determined by electron spin resonance spectroscopy (ESR). The present study analysed the binding/dissociation function of albumin with an ESR method using 16-doxyl stearate spin probe as reporter molecule and ethanol as modifier of hydrophobic interactions. Native and frozen plasma of healthy donors (608 samples), patients with malignant diseases (423 samples), and patients with benign conditions (221 samples) were analysed. The global specificity was 91% and the sensitivity 96%. In look-back samples of 27 donors, a malignant process could be detected up to 30 months before clinical diagnosis. To recognise different entities of malignant diseases from the ESR spectra, Artificial neural networks were implemented. For 48 female donors with breast cancer, the recognition specificity was 85%. Other carcinoma entities (22 colon, 18 prostate, 12 stomach) were recognised with specificities between 75% and 84%. Should these specificity values be reproduced in larger studies, the described method could be used as a new specific tumour marker for the early detection of malignant processes. Since transmission of cancer via blood transfusion cannot be excluded as yet, the described ESR method could also be used as a quality test for plasma products.