Alpha1-antitrypsin deficiency carriers, serum alpha 1-antitrypsin concentration, and non-small cell lung cancer survival

Alpha-1 antitrypsin deficiency and risk of lung cancer: A systematic review

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Alpha-1 antitrypsin deficiency (AATD) may increase the risk of lung cancer.

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The lung cancer histological types most frequently associated with AATD are squamous carcinoma and adenocarcinoma.

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No differences in lung cancer survival have been found acording to the carrier stuatus of alpha 1 antitrypsin deficient alleles.

Introduction

Alpha-1 antitrypsin deficiency (AATD) is an inherited genetic disorder associated with a risk of developing lung and liver disease. Several studies have examined its possible association with an increased risk of lung cancer.

Materials and Methods

Systematic review of the scientific literature on studies analyzing the risk of LC associated with AATD, as well as its impact on the histological type and survival. The information was located in the Medline (PubMed), Cochrane, and EMBASE databases.

Results

Six studies including a total of 4 038 patients with LC met the inclusion criteria. Most studies included seem to indicate that AATD increases the risk of developing LC, particularly of the squamous and adenocarcinoma types. This risk increases with exposure to tobacco smoke and the diagnosis of chronic obstructive pulmonary disease (COPD). Only one study analyzed the survival of LC patients without finding differences between AATD and non-AATD patients.

Conclusions

These results suggest that AATD may increase the risk of developing LC, particularly of the squamous and adenocarcinoma histological types, but no impact on patient survival has been demonstrated. However, the low quality of the included studies makes it necessary to carry out more studies with a larger sample size and preferably of a prospective nature to confirm these results.

Proteomic and genomic biomarkers for Non-Small Cell Lung Cancer: Peroxiredoxin, Haptoglobin, and Alpha-1 antitrypsin

Background

The development of lung cancer is a multifactorial process that involves the environmental and genetic factors. The mortality rate of this cancer is higher than breast, colorectal, and prostate cancers. In this study, we try to analyze the proteome of patients with Non‐Small Cell Lung Cancer (NSCLC) and compare it with the healthy samples.

Methods

This study has compared 30 lung tissue samples from patients with NSCLC and 30 healthy samples using proteomics and RT‐PCR. Hence, tissue samples were obtained from the surgical ward in sterile conditions, and then, protein extraction applied to them. At the next stage, two‐dimensional electrophoresis and mass spectrometry LCMS/MS were performed for protein isolation and sequencing, respectively.

Results

The proteome analysis identified more than 40 differences in proteomic pattern of normal lung tissues compared to lung tissues with NSCLC. Peroxiredoxin, Haptoglobin, and Alpha‐1 antitrypsin proteins were identified. Molecularly, it has also been shown that the two main proteins of Peroxiredoxin‐2 and Alpha‐1 antitrypsin were upregulated, and the expression of Haptoglobin protein was downregulated in cancer tissue.

Conclusion

The results of this study showed that there are some differences in term of protein content between the normal and cancerous lung tissues. Further studies are needed to evaluate these proteins that investigate whether these proteins can candidate as biomarkers to use in the early diagnosis of patients with NSCLC.

Evaluation of alpha-1-antitrypsin levels in blood serum of patients with chronic obstructive pulmonary disease

INTRODUCTION

Chronic obstructive pulmonary disease (COPD) is a disease that causes obstructed air flow from the lungs. The disease also has a dramatic role in increasing rate of mortality and morbidity in recent years. Air pollution, long-term exposure to particulate matter and irritating gases, especially cigarette smoke, genetic inheritance which has an impact on the initial forced expiratory volume one in second (FEV1), and alpha-1-antitrypsin (AAT) deficiency are among common COPD risk factors. The objective of this study is to evaluate parameters and serum AAT levels in COPD patients.

MATERIALS AND METHODS

Having taken the approval of local ethical committee, this cross-sectional study was performed with adult patients diagnosed with COPD, whose serum AAT levels were measured through nephelometric analysis in Kars Harakani State Hospital where secondary health care is served. The study evaluated ATT levels in patients' serum in relation to their age, gender, body mass (BMI), exposure to cigarette smoke, FEV1 percentage, hospitalization in pulmonology or intensive care unit through a year, mortality status, white blood cell (WBC), c-reactive protein (CRP) and blood gases.

RESULTS

The average age of the 243 patients included in the study was 68.41±11.52 and 160 (65.8%) of them were male. The age and BMI of the female patients were higher. Of the all patients only a single patient's serum AAT level was below the reference value. AAT levels were similar in both genders irrespective of their being exposed to cigarette smoke or being discharged or being exitus at their first admission to hospital, being exitus in the first year of disease diagnose, and being hospitalized in intensive care unit. AAT levels were reasonably correlated with WBC and CRP in a positive way (p<0.001 r=0.289 for WBC; p<0.001, r=0.295 for CRP). AAT levels were seen to significantly increase along with COPD stages which go up with FEV1 percentages (p<0.001). CRP was watched to have increased to Stage III COPD (severe COPD). However, it was watched to have decreased in Stage IV (very severe COPD) (p =0.179).

CONCLUSION

In the study, AAT serum levels of COPD patients were examined. The levels and their relations in various parameters of the patients were evaluated.

α1-antitrypsin promotes lung adenocarcinoma metastasis through upregulating fibronectin expression

α1-antitrypsin (AAT) has been recognized to be associated with lung adenocarcinoma metastasis. However, the mechanisms by which AAT promotes tumor metastasis remain to be investigated. Herein, we first examined AAT expression in a panel of formalin-fixed paraffin-embedded tumor tissues from 88 lung adenocarcinoma patients undergoing curative resection, using immunohistochemical methods. Lung adenocarcinoma patients with high AAT expression showed a significantly shorter overall survival compared to those with low AAT expression by Kaplan-Meier method (P=0.008). High AAT expression was also identified as an independent prognostic factor by Cox regression analysis (adjusted hazard ratio: 2.05; P=0.04). Second, the role of AAT in lung adenocarcinoma cell migration was evaluated in vitro using wound healing and Transwell assays, by transfecting the lentivirus vector with interfering sequence or coding sequence of AAT. The migration property of A549 and SPC-A1 cells was significantly diminished by downregulating AAT expression. Conversely, the migration of both cell lines was significantly increased through upregulating AAT. Furthermore, AAT could increase the expression of fibronectin (FN). FN down-regulation reversed AAT-induced promotion of adenocarcinoma cell migration. Third, a cancer cell/endothelial cell co-culture model was established to investigate the effect of AAT on adenocarcinoma cell adhesion using immunofluorescence examination. The results showed that downregulation of AAT inhibited adhesion between lung adenocarcinoma cells and human umbilical vein endothelial cells whereas upregulation of AAT promoted adhesion, which may attribute to interactions between FN and integrin α5. Finally, AAT also showed the regulation effect on the metastatic behavior of lung adenocarcinoma cells in a mouse model, which may be through regulating FN expression. This study suggested that high AAT expression might be a negative prognostic marker for lung adenocarcinoma. AAT promoted lung adenocarcinoma metastasis, whose functional target may be FN. Our findings provide new insight into the mechanisms of lung adenocarcinoma metastasis.

A panel of glycoproteins as candidate biomarkers for early diagnosis and treatment evaluation of B-cell acute lymphoblastic leukemia

BACKGROUND

Acute lymphoblastic leukemia is the most common malignant cancer in childhood. The signs and symptoms of childhood cancer are difficult to recognize, as it is not the first diagnosis to be considered for nonspecific complaints, leading to potential uncertainty in diagnosis. The aim of this study was to perform proteomic analysis of serum from pediatric patients with B-cell acute lymphoblastic leukemia (B-ALL) to identify candidate biomarker proteins, for use in early diagnosis and evaluation of treatment.

METHODS

Serum samples were obtained from ten patients at the time of diagnosis (B-ALL group) and after induction therapy (AIT group). Sera from healthy children were used as controls (Control group). The samples were subjected to immunodepletion, affinity chromatography with α-d-galactose-binding lectin (from Artocarpus incisa seeds) immobilized on a Sepharose(TM) 4B gel, concentration, and digestion for subsequent analysis with nano-UPLC tandem nano-ESI-MS(E). The program Expression (E) was used to quantify differences in protein expression between groups.

RESULTS

A total of 96 proteins were identified. Leucine-rich alpha-2-glycoprotein 1 (LRG1), Clusterin (CLU), thrombin (F2), heparin cofactor II (SERPIND1), alpha-2-macroglobulin (A2M), alpha-2-antiplasmin (SERPINF2), Alpha-1 antitrypsin (SERPINA1), Complement factor B (CFB) and Complement C3 (C3) were identified as candidate biomarkers for early diagnosis of B-ALL, as they were upregulated in the B-ALL group relative to the control and AIT groups. Expression levels of the candidate biomarkers did not differ significantly between the AIT and control groups, providing further evidence that the candidate biomarkers are present only in the disease state, as all patients achieved complete remission after treatment.

CONCLUSION

A panel of protein biomarker candidates has been developed for pre-diagnosis of B-ALL and also provided information that would indicate a favorable response to treatment after induction therapy.

High percentage of α1-globulin in serum protein is associated with unfavorable prognosis in non-small cell lung cancer

The association of the percentage composition of serum protein in patients undergoing lung resections for non-small cell lung cancer (NSCLC) with overall survival and recurrence-free survival has never been investigated. Patients were selected consecutively from the database of the Bio-Bank of Shandong Provincial Hospital. We retrospectively examined the impact of preoperative percentage composition of serum protein detected by serum protein electrophoresis on survival. Furthermore, we investigated the relationships between the potential prognostic biomarkers and clinicopathological factors. A total of 390 patients were evaluated. The higher percentage of α1-globulin in serum protein was significantly associated with histology type (p<0.001), worse tumor status (p<0.001) and higher pathological stage (p=0.004). The α1-globulin percentage composition was an independent prognostic factor for overall survival (hazard ratio 1.52, 95% CI 1.04-2.23, p=0.03). High percentage of α1-globulin in serum protein was also related to short recurrence survival (hazard ratio 1.56, 95% CI 1.14-2.13, p=0.005). Our results showed that the percentage of α1-globulin in serum protein may be an independent prognostic factor in NSCLC.

Serum concentration of alpha-1 antitrypsin is significantly higher in colorectal cancer patients than in healthy controls

Background

The association between alpha-1 antitrypsin (AAT) deficiency and colorectal cancer (CRC) is currently controversial. The present study compares AAT serum concentrations and gene frequencies between a group of CRC patients and a control group of healthy unrelated people (HUP).

Methods

267 CRC subjects (63% males, 72 ± 10 years old) were enlisted from a Hospital Clinic setting in Asturias, Spain. The HUP group comprised 327 subjects (67% males, mean age 70 ± 7.5 years old) from the same geographical region. Outcome measures were AAT serum concentrations measured by nephelometry, and AAT phenotyping characterization by isoelectric focusing.

Results

Significantly higher serum concentrations were found among CRC (208 ± 60) than in HUP individuals (144 ± 20.5) (p = 0.0001). No differences were found in the phenotypic distribution of the Pi*S and Pi*Z allelic frequencies (p = 0.639), although the frequency of Pi*Z was higher in CRC (21%) than in HUP subjects (15%).

Conclusions

The only statistically significant finding in this study was the markedly higher AAT serum concentrations found in CRC subjects compared with HUP controls, irrespective of whether their Pi* phenotype was normal (Pi*MM) or deficient (Pi*MS, Pi*MZ and Pi*SZ). Although there was a trend towards the more deficient Pi* phenotype the more advanced the tumor, the results were inconclusive due to the small sample size. Consequently, more powerful studies are needed to reach firmer conclusions on this matter.

Alpha-1 Antitrypsin Blood Levels as Indicator for the Efficacy of Cancer Treatment

Background

Alpha-1 antitrypsin (α₁-AT) is a member of the serine protease inhibitors (serpins) family. Liver cells are the major source of synthesis and secretion of (α₁-AT) into the blood. Moreover, it has been demonstrated that α₁-AT is expressed and secreted by many types of malignant cells. Studies have indicated that serum levels of (α₁-AT) increase in a good number of malignant diseases. In addition, a significant correlation between serum levels and cancer stage has also been reported. In this work we aimed to test how α₁-AT levels behave at the third week after treatment with chemotherapy.

Methods

The α₁-AT blood levels were measured using commercially available radial immunodiffusion kit (Kent Laboratory Inc, Bellinham, Washigton) following manufacturer instructions.

Results

The α₁-AT blood levels were significantly decreased after treatment compared with those before the treatment started. The mean difference (before - after) treatment was 127.82 and 137.37 mg/dL with 95% CI of difference 109.06 - 146.57 and 116.08 - 158.65 mg/dL in lung and prostate cancer respectively. When we compared these levels according to the stage of cancer, we found that the mean difference (before - after) treatment was also highly significant as indicated by P-value and the 95% CI of these differences.

Conclusion

Obtained data strongly indicate the value of testing α₁-AT blood levels as one of the important indicators for the efficacy of cancer treatment.

Genetic variants associated with the risk of chronic obstructive pulmonary disease with and without lung cancer

Chronic obstructive pulmonary disease (COPD) is a strong risk factor for lung cancer. Published studies about variations of genes encoding glutathione metabolism, DNA repair, and inflammatory response pathways in susceptibility to COPD were inconclusive. We evaluated 470 single-nucleotide polymorphisms (SNP) from 56 genes of these three pathways in 620 cases and 893 controls to identify susceptibility markers for COPD risk, using existing resources. We assessed SNP- and gene-level effects adjusting for sex, age, and smoking status. Differential genetic effects on disease risk with and without lung cancer were also assessed; cumulative risk models were established. Twenty-one SNPs were found to be significantly associated with risk of COPD (P < 0.01); gene-based analyses confirmed two genes (GCLC and GSS) and identified three additional genes (GSTO2, ERCC1, and RRM1). Carrying 12 high-risk alleles may increase risk by 2.7-fold; eight SNPs altered COPD risk without lung cancer by 3.1-fold and 4 SNPs altered the risk with lung cancer by 2.3-fold. Our findings indicate that multiple genetic variations in the three selected pathways contribute to COPD risk through GCLC, GSS, GSTO2, ERCC1, and RRM1 genes. Functional studies are needed to elucidate the mechanisms of these genes in the development of COPD, lung cancer, or both.