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Ebersole JL, Hasturk H, Huber M, Gellibolian R, Markaryan A, Zhang XD, Miller CS. Realizing the clinical utility of saliva for monitoring oral diseases. Periodontol 2000 2024. [PMID: 39010260 DOI: 10.1111/prd.12581] [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: 03/18/2024] [Revised: 05/01/2024] [Accepted: 05/16/2024] [Indexed: 07/17/2024]
Abstract
In the era of personalized/precision health care, additional effort is being expended to understand the biology and molecular mechanisms of disease processes. How these mechanisms are affected by individual genetics, environmental exposures, and behavioral choices will encompass an expanding role in the future of optimally preventing and treating diseases. Considering saliva as an important biological fluid for analysis to inform oral disease detection/description continues to expand. This review provides an overview of saliva as a diagnostic fluid and the features of various biomarkers that have been reported. We emphasize the use of salivary biomarkers in periodontitis and transport the reader through extant literature, gaps in knowledge, and a structured approach toward validating and determine the utility of biomarkers in periodontitis. A summation of the findings support the likelihood that a panel of biomarkers including both host molecules and specific microorganisms will be required to most effectively identify risk for early transition to disease, ongoing disease activity, progression, and likelihood of response to standard periodontal therapy. The goals would be to develop predictive algorithms that serve as adjunctive diagnostic tools which provide the clinician and patient important information for making informed clinical decisions.
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Affiliation(s)
- Jeffrey L Ebersole
- Department of Biomedical Sciences, School of Dental Medicine, University of Nevada Las Vegas, Las Vegas, Nevada, USA
| | - Hatice Hasturk
- Immunology and Inflammation, Center for Clinical and Translational Research, The ADA Forsyth Institute, Cambridge, Massachusetts, USA
| | - Michaell Huber
- Department of Comprehensive Dentistry, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | | | | | - Xiaohua D Zhang
- Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, Kentucky, USA
| | - Craig S Miller
- Department of Oral Health Practice, College of Dentistry, University of Kentucky, Lexington, Kentucky, USA
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Chu LJ, Chang YT, Chien CY, Chung HC, Wu SF, Chen CJ, Liu YC, Liao WC, Chen CH, Chiang WF, Chang KP, Wang JS, Yu JS. Clinical validation of a saliva-based matrix metalloproteinase-1 rapid strip test for detection of oral cavity cancer. Biomed J 2024; 47:100594. [PMID: 37044249 PMCID: PMC10821597 DOI: 10.1016/j.bj.2023.04.002] [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: 03/16/2022] [Revised: 09/14/2022] [Accepted: 04/07/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND We previously identified matrix metalloproteinase-1 (MMP-1) as one of the most promising salivary biomarkers for oral squamous cell carcinoma (OSCC) and developed a sensitive ELISA for MMP-1 with good performance in detection of OSCC using a cohort of 1160 saliva samples. METHODS A time-saving rapid strip test (RST) for MMP-1 was developed in this study and its diagnostic performance compared with ELISA using saliva samples from a new cohort of 603 subjects (171 healthy controls, 236 patients with oral potentially malignant disorders, and 196 OSCC patients). RESULTS Salivary MMP-1 levels measured using RST and ELISA were highly comparable and both assays could effectively distinguish between OSCC and non-cancerous groups. Similar to ELISA, receiver operating characteristic curve analysis of the MMP-1 RST was effective in identifying patients with OSCC at different oral cavity sites and stages. CONCLUSIONS Salivary MMP-1 can be sensitively detected using both RST and ELISA methods. Our newly developed point-of-care MMP-1 RST is a promising in vitro diagnostic device (IVD) that may serve as a novel auxiliary tool in the routine clinical detection and monitoring of OSCC.
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Affiliation(s)
- Lichieh Julie Chu
- Molecular Medicine Research Center, Chang Gung University, Taoyuan, Taiwan; Graduate Institute of Biomedical Sciences, Chang Gung University, Taoyuan, Taiwan; Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
| | | | - Chih-Yen Chien
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hui-Ching Chung
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shu-Fang Wu
- Molecular Medicine Research Center, Chang Gung University, Taoyuan, Taiwan
| | | | - Yen-Chun Liu
- Molecular Medicine Research Center, Chang Gung University, Taoyuan, Taiwan
| | - Wei-Chao Liao
- Molecular Medicine Research Center, Chang Gung University, Taoyuan, Taiwan; Department of Pediatrics, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Chien-Hua Chen
- Molecular Medicine Research Center, Chang Gung University, Taoyuan, Taiwan
| | - Wei-Fan Chiang
- Department of Oral and Maxillofacial Surgery, Chi-Mei Medical Center, Liouying, Tainan, Taiwan; School of Dentistry, National Yang Ming University, Taipei, Taiwan
| | - Kai-Ping Chang
- Molecular Medicine Research Center, Chang Gung University, Taoyuan, Taiwan; Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Jun-Sheng Wang
- National Applied Research Laboratories, Taiwan Instrument Research Institute, Zhubei City, Hsinchu, Taiwan
| | - Jau-Song Yu
- Molecular Medicine Research Center, Chang Gung University, Taoyuan, Taiwan; Graduate Institute of Biomedical Sciences, Chang Gung University, Taoyuan, Taiwan; Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan; Research Center for Food and Cosmetic Safety, College of Human Ecology, Chang Gung University of Science and Technology, Taoyuan, Taiwan.
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3
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Adeoye J, Su YX. Artificial intelligence in salivary biomarker discovery and validation for oral diseases. Oral Dis 2024; 30:23-37. [PMID: 37335832 DOI: 10.1111/odi.14641] [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: 03/17/2023] [Revised: 05/19/2023] [Accepted: 05/28/2023] [Indexed: 06/21/2023]
Abstract
Salivary biomarkers can improve the efficacy, efficiency, and timeliness of oral and maxillofacial disease diagnosis and monitoring. Oral and maxillofacial conditions in which salivary biomarkers have been utilized for disease-related outcomes include periodontal diseases, dental caries, oral cancer, temporomandibular joint dysfunction, and salivary gland diseases. However, given the equivocal accuracy of salivary biomarkers during validation, incorporating contemporary analytical techniques for biomarker selection and operationalization from the abundant multi-omics data available may help improve biomarker performance. Artificial intelligence represents one such advanced approach that may optimize the potential of salivary biomarkers to diagnose and manage oral and maxillofacial diseases. Therefore, this review summarized the role and current application of techniques based on artificial intelligence for salivary biomarker discovery and validation in oral and maxillofacial diseases.
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Affiliation(s)
- John Adeoye
- Division of Oral and Maxillofacial Surgery, Faculty of Dentistry, University of Hong Kong, Hong Kong SAR, China
| | - Yu-Xiong Su
- Division of Oral and Maxillofacial Surgery, Faculty of Dentistry, University of Hong Kong, Hong Kong SAR, China
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López-Jornet P, Olmo-Monedero A, Peres-Rubio C, Pons-Fuster E, Tvarijonaviciute A. Preliminary Evaluation Salivary Biomarkers in Patients with Oral Potentially Malignant Disorders (OPMD): A Case-Control Study. Cancers (Basel) 2023; 15:5256. [PMID: 37958429 PMCID: PMC10650598 DOI: 10.3390/cancers15215256] [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: 08/03/2023] [Revised: 10/27/2023] [Accepted: 10/31/2023] [Indexed: 11/15/2023] Open
Abstract
INTRODUCTION Oral potentially malignant disorders (OPMD) are lesions associated with an increased risk of transformation (MT) into cancer. OBJECTIVE A study was made of the salivary levels of adenosine deaminase (ADA), ferritin (FRR) and total proteins (TP) in healthy individuals and in patients with oral potentially malignant disorders (OPMD), assessing the potential role of saliva as a diagnostic tool. METHODS A total of 91 subjects participated in the study, divided into two groups-59 patients with OPMD (oral leukoplakia or oral lichen planus) and 32 healthy controls-with measurements being made of salivary ADA, ferritin (FRR) and total proteins (TP). RESULTS There were no significant differences in salivary mean ADA between the OPMD group 0.85 ± 2.18 UI/I and the controls 0.71 ± 1.72 UI/I (p = 0.934), though the levels of both FRR mean OPMD, 12.66 ± 10.50 (µg/L), versus control, 7.19 ± 4.44 (p = 0.001), and TP, 23.41 ± 17, versus control, 14.15 ± 15.19, were significantly higher in the OPMD group (p = 0.001). Patients with oral lichen planus showed significant differences in terms of FRR (p = 0.009) and TP (p = 0.003). The ferritin in LPO with a cut-off point of 8.5C showed a sensitivity and specificity of 54.3% and 82.3, respectively. The area under the curve (AUC) was 0.69 (95% confidence interval (95% CI): 0.58-0.82; p = 0.003). CONCLUSIONS Ferritin and total proteins may constitute potential salivary biomarkers for oral lichen planus, though further studies are still needed in this field. In addition, saliva testing is a reliable and noninvasive diagnostic tool and appears to be a reliable strategy offering an interesting alternative for the screening of large populations.
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Affiliation(s)
- Pia López-Jornet
- Faculty of Medicine and Odontology, Hospital Morales Meseguer, Clínica Odontológica, Marqués del Los Vélez s/n, 30008 Murcia, Spain;
| | - Aitana Olmo-Monedero
- Faculty of Medicine and Odontology, Hospital Morales Meseguer, Clínica Odontológica, Marqués del Los Vélez s/n, 30008 Murcia, Spain;
| | - Camila Peres-Rubio
- Interdisciplinary Laboratory of Clinical Analysis (Interlab-UMU), Veterinary School, Regional Campus of International Excellence Mare Nostrum, University of Murcia, Campus de Espinardo s/n, Espinardo, 30100 Murcia, Spain; (C.P.-R.); (A.T.)
| | - Eduardo Pons-Fuster
- Departamento de Anatomía Humana y Psicobiología, Faculty of Medicine and Odontology, Biomedical Research Institute (IMIB-Arrixaca), University of Murcia Spain, 30100 Murcia, Spain;
| | - Asta Tvarijonaviciute
- Interdisciplinary Laboratory of Clinical Analysis (Interlab-UMU), Veterinary School, Regional Campus of International Excellence Mare Nostrum, University of Murcia, Campus de Espinardo s/n, Espinardo, 30100 Murcia, Spain; (C.P.-R.); (A.T.)
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5
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Adeoye J, Zheng LW, Thomson P, Choi SW, Su YX. Explainable ensemble learning model improves identification of candidates for oral cancer screening. Oral Oncol 2023; 136:106278. [PMID: 36525782 DOI: 10.1016/j.oraloncology.2022.106278] [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: 11/04/2022] [Revised: 11/26/2022] [Accepted: 12/06/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Artificial intelligence could enhance the use of disparate risk factors (crude method) for better stratification of patients to be screened for oral cancer. This study aims to construct a meta-classifier that considers diverse risk factors to identify patients at risk of oral cancer and other suspicious oral diseases for targeted screening. MATERIALS AND METHODS A retrospective dataset from a community oral cancer screening program was used to construct and train the novel voting meta-classifier. Comprehensive risk factor information from this dataset was used as input features for eleven supervised learning algorithms which served as base learners and provided predicted probabilities that are weighted and aggregated by the meta-classifier. Training dataset was augmented using SMOTE-ENN. Additionally, Shapley additive explanations (SHAP) values were generated to implement the explainability of the model and display the important risk factors. RESULTS Our meta-classifier had an internal validation recall, specificity, and AUROC of 0.83, 0.86, and 0.85 for identifying the risk of oral cancer and 0.92, 0.60, and 0.76 for identifying suspicious oral mucosal disease respectively. Upon external validation, the meta-classifier had a significantly higher AUROC than the crude/current method used for identifying the risk of oral cancer (0.78 vs 0.46; p = 0.001) Also, the meta-classifier had better recall than the crude method for predicting the risk of suspicious oral mucosal diseases (0.78 vs 0.47). CONCLUSION Overall, these findings showcase that our approach optimizes the use of risk factors in identifying patients for oral screening which suggests potential clinical application.
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Affiliation(s)
- John Adeoye
- Division of Oral and Maxillofacial Surgery, Faculty of Dentistry, University of Hong Kong, Hong Kong, China
| | - Li-Wu Zheng
- Division of Oral and Maxillofacial Surgery, Faculty of Dentistry, University of Hong Kong, Hong Kong, China
| | - Peter Thomson
- College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
| | - Siu-Wai Choi
- Division of Oral and Maxillofacial Surgery, Faculty of Dentistry, University of Hong Kong, Hong Kong, China
| | - Yu-Xiong Su
- Division of Oral and Maxillofacial Surgery, Faculty of Dentistry, University of Hong Kong, Hong Kong, China.
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Maciejczyk M, Nesterowicz M, Szulimowska J, Zalewska A. Oxidation, Glycation, and Carbamylation of Salivary Biomolecules in Healthy Children, Adults, and the Elderly: Can Saliva Be Used in the Assessment of Aging? J Inflamm Res 2022; 15:2051-2073. [PMID: 35378954 PMCID: PMC8976116 DOI: 10.2147/jir.s356029] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 03/11/2022] [Indexed: 12/12/2022] Open
Abstract
Background Aging is inextricably linked to oxidative stress, inflammation, and posttranslational protein modifications. However, no studies evaluate oxidation, glycation, and carbamylation of salivary biomolecules as biomarkers of aging. Saliva collection is non-invasive, painless, and inexpensive, which are advantages over other biofluids. Methods The study enrolled 180 healthy subjects divided into six groups according to age: 6–13, 14–19, 20–39, 40–59, 60–79, and 80–100 years. The number of individuals was determined a priori based on our previous experiment (power of the test = 0.8; α = 0.05). Non-stimulated saliva and plasma were collected from participants, in which biomarkers of aging were determined by colorimetric, fluorometric, and ELISA methods. Results The study have demonstrated that modifications of salivary proteins increase with age, as manifested by decreased total thiol levels and increased carbonyl groups, glycation (Nε-(carboxymethyl) lysine, advanced glycation end products (AGE)) and carbamylation (carbamyl-lysine) protein products in the saliva of old individuals. Oxidative modifications of lipids (4-hydroxynonenal) and nucleic acids (8-hydroxy-2’-deoxyguanosine (8-OHdG)) also increase with age. Salivary redox biomarkers correlate poorly with their plasma levels; however, salivary AGE and 8-OHdG generally reflect their blood concentrations. In the multivariate regression model, they are a predictor of aging and, in the receiver operating characteristic (ROC) analysis, significantly differentiate children and adolescents (under 15 years old) from the working-age population (15–64 years) and the older people (65 years and older). Conclusion Salivary AGE and 8-OHdG have the most excellent diagnostic utility in assessing the aging process. Saliva can be used to evaluate the aging of the body.
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Affiliation(s)
- Mateusz Maciejczyk
- Department of Hygiene, Epidemiology and Ergonomics, Medical University of Bialystok, Bialystok, Poland
- Correspondence: Mateusz Maciejczyk, Department of Hygiene, Epidemiology and Ergonomics, Medical University of Bialystok, 2c Mickiewicza Street, Bialystok, 15-233, Poland, Email
| | - Miłosz Nesterowicz
- Students Scientific Club “Biochemistry of Civilization Diseases” at the Department of Hygiene, Epidemiology, and Ergonomics, Medical University of Bialystok, Bialystok, Poland
| | - Julita Szulimowska
- Department of Conservative Dentistry, Medical University of Bialystok, Bialystok, Poland
| | - Anna Zalewska
- Department of Conservative Dentistry, Medical University of Bialystok, Bialystok, Poland
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Abstract
The use of saliva as a diagnostic biofluid has been increasing in recent years, thanks to the identification and validation of new biomarkers and improvements in test accuracy, sensitivity, and precision that enable the development of new noninvasive and cost-effective devices. However, the lack of standardized methods for sample collection, treatment, and storage contribute to the overall variability and lack of reproducibility across analytical evaluations. Furthermore, the instability of salivary biomarkers after sample collection hinders their translation into commercially available technologies for noninvasive monitoring of saliva in home settings. The present review aims to highlight the status of research on the challenges of collecting and using diagnostic salivary samples, emphasizing the methodologies used to preserve relevant proteins, hormones, genomic, and transcriptomic biomarkers during sample handling and analysis.
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Affiliation(s)
- Luciana d'Amone
- Silklab, Department of Biomedical Engineering, Tufts University, Medford, Massachusetts 02155, United States
| | - Giusy Matzeu
- Silklab, Department of Biomedical Engineering, Tufts University, Medford, Massachusetts 02155, United States
| | - Fiorenzo G Omenetto
- Silklab, Department of Biomedical Engineering, Tufts University, Medford, Massachusetts 02155, United States.,Department of Electrical and Computer Engineering, Tufts University, Medford, Massachusetts 02155, United States.,Department of Physics, Tufts University, Medford, Massachusetts 02155, United States.,Laboratory for Living Devices, Tufts University, Medford, Massachusetts 02155, United States
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Piyarathne NS, Rasnayake RMSGK, Angammana R, Chandrasekera P, Ramachandra S, Weerasekera M, Yasawardene S, Abu-Eid R, Jayasinghe JAP, Gupta E. Diagnostic salivary biomarkers in oral cancer and oral potentially malignant disorders and their relationships to risk factors - A systematic review. Expert Rev Mol Diagn 2021; 21:789-807. [PMID: 34148471 DOI: 10.1080/14737159.2021.1944106] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Oral squamous cell carcinoma (OSCC) and oral potentially malignant disorders (OPMD) are a significant health burden globally. Smoking, alcohol, and betel quid are the main risk factors. Lack of screening methods has been highlighted as a significant challenge in management. Salivary biomarkers are proposed as noninvasive diagnostic tools. The aim of this systematic review was to study salivary biomarkers reported in OSCC and OPMD. Specific objectives were to select a salivary biomarker panel suitable for early detection of OSCC and OPMD and to assess relationships between salivary biomarkers and risk factors. METHODS Electronic literature search was conducted in academic databases (Scopus, Medline, Embase and Web of Science) without any restrictions. Following calibration, two blinded reviewers screened the studies and extracted data. A risk of bias assessment was conducted using Newcastle Ottawa scale. 295 studies were included with descriptive data analysis. EXPERT OPINION A salivary biomarker panel including Interleukin (IL) 1β, IL6, and IL8 was selected for OSCC and OPMD. Reported relationships between salivary biomarkers and risk factors are discussed and research gaps are highlighted. Future research should be directed to assess potential salivary biomarkers and their relationships to risk factors in order to understand the biomarker's role in disease initiation.
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Affiliation(s)
- Nadisha S Piyarathne
- Institute of Dentistry, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK.,Faculty of Dental Sciences, University of Peradeniya, Peradeniya, Sri Lanka
| | | | | | | | | | - Manjula Weerasekera
- Faculty of Medical Sciences, University of Sri Jayewardenepura, Gangodawila, Nugegoda, Sri Lanka
| | - Surangi Yasawardene
- Faculty of Medical Sciences, University of Sri Jayewardenepura, Gangodawila, Nugegoda, Sri Lanka
| | - Rasha Abu-Eid
- Institute of Dentistry, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - J A P Jayasinghe
- Institute of Dentistry, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Ekta Gupta
- Institute of Dentistry, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
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9
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Cohen ER, Raslan S, Smith DH, Franzmann EJ. Update on CD44 biomarker in oral rinses and tissues in oral and oropharyngeal cancer patients. J Oral Pathol Med 2021; 50:841-842. [PMID: 34164853 DOI: 10.1111/jop.13222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 06/15/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Erin R Cohen
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Shahm Raslan
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Drew H Smith
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Elizabeth J Franzmann
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL, USA.,Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
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10
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Adeoye J, Alade AA, Zhu WY, Wang W, Choi SW, Thomson P. Efficacy of hypermethylated DNA biomarkers in saliva and oral swabs for oral cancer diagnosis: Systematic review and meta-analysis. Oral Dis 2021; 28:541-558. [PMID: 33423350 DOI: 10.1111/odi.13773] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 12/18/2020] [Accepted: 01/05/2021] [Indexed: 01/21/2023]
Abstract
OBJECTIVES This study aims to determine the diagnostic test accuracy (DTA) of hypermethylated DNA biomarkers in saliva and oral swabs for oral squamous cell carcinoma (OSCC) detection from the prevalidation studies available. MATERIALS AND METHODS Electronic database searching of PubMed, EMBASE, Cochrane Library, Scopus, Web of Science, and LILACS was conducted to identify relevant articles that were published between January 1, 2000, and August 1, 2020. RESULTS Meta-analysis was conducted based on 11 of 20 studies selected for review. Included studies had high bias concerns on the QUADAS-2 study assessment tool. We found that salivary and oral swab hypermethylation markers had better specificity than sensitivity for oral cancer detection. Summary sensitivity and specificity (95% CI) of hypermethylation panels were 86.2% (60-96.2) and 90.6% (85.9-93.9) while for individual markers, summary sensitivity and specificity (95% CI) were 70% (56.9-80.5) and 91.9% (80.3-96.9), respectively. Respective positive and negative likelihood ratios for combined markers were 9.2 (5.89-14.36) and 0.15 (0.05-0.5), and 8.61 (3.39-21.87) and 0.33 (0.22-0.49) for single-application biomarkers. CONCLUSION DNA hypermethylation biomarkers especially in combination have acceptable DTA that warrants further optimization with rigorous biomarker evaluation methods for conclusive determination of their efficacy.
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Affiliation(s)
- John Adeoye
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China.,Oral Cancer Research Group, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Azeez Arisekola Alade
- Department of Oral Pathology, Radiology and Medicine, College of Dentistry, University of Iowa, Iowa City, IA, USA.,Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Wang-Yong Zhu
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Weilan Wang
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China.,Oral Cancer Research Group, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Siu-Wai Choi
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China.,Oral Cancer Research Group, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Peter Thomson
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China.,Oral Cancer Research Group, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
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11
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Adeoye J, Wan CCJ, Thomson P. An appraisal of pivotal evaluation designs in validating noninvasive biomarkers for head and neck cancer detection. Acta Oncol 2020; 59:1500-1502. [PMID: 32924723 DOI: 10.1080/0284186x.2020.1820077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- John Adeoye
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
- Oral Cancer Research Group, The University of Hong Kong, Hong Kong SAR, China
| | - Chi Ching Joan Wan
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Peter Thomson
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
- Oral Cancer Research Group, The University of Hong Kong, Hong Kong SAR, China
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12
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Adeoye J, Wan CCJ, Thomson P. Mock clinical testing in the validation of fluid-phase biomarkers for head and neck carcinoma diagnosis: Scoping review. Head Neck 2020; 43:691-704. [PMID: 33151603 DOI: 10.1002/hed.26526] [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: 08/25/2020] [Revised: 10/22/2020] [Accepted: 10/23/2020] [Indexed: 12/24/2022] Open
Abstract
This review sought to determine the range and nature of prospective-sampling and blinding methods for validating nonviral biofluid markers diagnostic of head and neck carcinomas. Electronic database searching was conducted to identify studies published in English from January 1, 2009 to August 1, 2020. Sixteen studies from 17 articles published between 2011 and 2020 were included in this review. We found that about 3 out of 100 studies utilized at least one of the mock testing approaches for biomarker validation. Protein, mRNA, and metabolomic markers also represented the only groups whose validation has been attempted using these methods. Furthermore, studies that utilized both methods were found to have lower bias concerns on the quality assessment of diagnostic accuracy studies (QUADAS-2) tool. Overall, there is a need to include these protocols in research endeavours verifying diagnostic biomarkers for head and neck carcinomas following the preliminary establishment of their classification accuracy.
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Affiliation(s)
- John Adeoye
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China.,Oral Cancer Research Group, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Chi Ching Joan Wan
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Peter Thomson
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China.,Oral Cancer Research Group, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
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13
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Chang YT, Chu LJ, Liu YC, Chen CJ, Wu SF, Chen CH, Chang IYF, Wang JS, Wu TY, Dash S, Chiang WF, Chiu SF, Gou SB, Chien CY, Chang KP, Yu JS. Verification of Saliva Matrix Metalloproteinase-1 as a Strong Diagnostic Marker of Oral Cavity Cancer. Cancers (Basel) 2020; 12:cancers12082273. [PMID: 32823758 PMCID: PMC7463746 DOI: 10.3390/cancers12082273] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 08/05/2020] [Accepted: 08/10/2020] [Indexed: 12/12/2022] Open
Abstract
Oral squamous cell carcinoma (OSCC) accounts for >90% of cases of oral cancer, including cancer at the lip and oral cavity and cancer at the oropharynx. Most OSCCs develop from oral potentially malignant disorders (OPMDs), which consist of heterogeneous lesions with different malignant transformation potentials that make early detection of OSCC a challenge. Using a targeted mass spectrometry-based assay to compare multiple candidate proteins, we previously identified matrix metalloproteinase-1 (MMP-1) as one of the most promising salivary OSCC biomarkers. To explore the clinical utility of MMP-1 in OSCC detection, we developed an in-house, sensitive enzyme-linked immunosorbent assay (ELISA) for measuring MMP-1 content, and tested it on saliva samples from 1160 subjects (313 healthy controls, and 578 OPMD and 269 OSCC patients) collected at two medical centers. Salivary MMP-1 levels measured by our in-house ELISA significantly discriminated OSCC patients from non-cancerous groups. A receiver operating characteristic curve analysis showed that MMP-1 was effective in separating non-cancer groups from patients with OSCCs at the oral cavity. Additionally, salivary MMP-1 levels in oral cavity cancer patients were highly correlated with tumor progression (tumor size, lymph node metastasis, and overall stage). Collectively, our results indicate that salivary MMP-1 is an effective biomarker for OSCC that can be sensitively detected using our newly developed ELISA. The newly developed MMP-1 ELISA may be used as a new adjunctive tool to aid in detecting and monitoring OSCC.
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Affiliation(s)
- Ya-Ting Chang
- Molecular Medicine Research Center, Chang Gung University, Taoyuan 33302, Taiwan; (Y.-T.C.); (L.J.C.); (Y.-C.L.); (C.-J.C.); (S.-F.W.); (C.-H.C.); (I.Y.-F.C.); (K.-P.C.)
| | - Lichieh Julie Chu
- Molecular Medicine Research Center, Chang Gung University, Taoyuan 33302, Taiwan; (Y.-T.C.); (L.J.C.); (Y.-C.L.); (C.-J.C.); (S.-F.W.); (C.-H.C.); (I.Y.-F.C.); (K.-P.C.)
- Liver Research Center, Chang Gung Memorial Hospital, Linkou 33305, Taiwan
| | - Yen-Chun Liu
- Molecular Medicine Research Center, Chang Gung University, Taoyuan 33302, Taiwan; (Y.-T.C.); (L.J.C.); (Y.-C.L.); (C.-J.C.); (S.-F.W.); (C.-H.C.); (I.Y.-F.C.); (K.-P.C.)
| | - Chih-Jou Chen
- Molecular Medicine Research Center, Chang Gung University, Taoyuan 33302, Taiwan; (Y.-T.C.); (L.J.C.); (Y.-C.L.); (C.-J.C.); (S.-F.W.); (C.-H.C.); (I.Y.-F.C.); (K.-P.C.)
| | - Shu-Fang Wu
- Molecular Medicine Research Center, Chang Gung University, Taoyuan 33302, Taiwan; (Y.-T.C.); (L.J.C.); (Y.-C.L.); (C.-J.C.); (S.-F.W.); (C.-H.C.); (I.Y.-F.C.); (K.-P.C.)
| | - Chien-Hua Chen
- Molecular Medicine Research Center, Chang Gung University, Taoyuan 33302, Taiwan; (Y.-T.C.); (L.J.C.); (Y.-C.L.); (C.-J.C.); (S.-F.W.); (C.-H.C.); (I.Y.-F.C.); (K.-P.C.)
| | - Ian Yi-Feng Chang
- Molecular Medicine Research Center, Chang Gung University, Taoyuan 33302, Taiwan; (Y.-T.C.); (L.J.C.); (Y.-C.L.); (C.-J.C.); (S.-F.W.); (C.-H.C.); (I.Y.-F.C.); (K.-P.C.)
| | - Jun-Sheng Wang
- National Applied Research Laboratories, Taiwan Instrument Research Institute, Zhubei City, Hsinchu 30261, Taiwan;
| | - Tzong-Yuan Wu
- Department of Bioscience Technology, Chung Yuan Christian University, Taoyuan 32023, Taiwan;
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung 40402, Taiwan
| | - Srinivas Dash
- Graduate Institute of Biomedical Sciences, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan;
| | - Wei-Fan Chiang
- Department of Oral and Maxillofacial Surgery, Chi-Mei Medical Center, Liouying, Tainan 73657, Taiwan; (W.-F.C.); (S.-F.C.); (S.-B.G.)
- School of Dentistry, National Yang Ming University, Taipei 11221, Taiwan
| | - Sheng-Fu Chiu
- Department of Oral and Maxillofacial Surgery, Chi-Mei Medical Center, Liouying, Tainan 73657, Taiwan; (W.-F.C.); (S.-F.C.); (S.-B.G.)
| | - Shin-Bin Gou
- Department of Oral and Maxillofacial Surgery, Chi-Mei Medical Center, Liouying, Tainan 73657, Taiwan; (W.-F.C.); (S.-F.C.); (S.-B.G.)
| | - Chih-Yen Chien
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan;
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Kai-Ping Chang
- Molecular Medicine Research Center, Chang Gung University, Taoyuan 33302, Taiwan; (Y.-T.C.); (L.J.C.); (Y.-C.L.); (C.-J.C.); (S.-F.W.); (C.-H.C.); (I.Y.-F.C.); (K.-P.C.)
- Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou 33305, Taiwan
| | - Jau-Song Yu
- Molecular Medicine Research Center, Chang Gung University, Taoyuan 33302, Taiwan; (Y.-T.C.); (L.J.C.); (Y.-C.L.); (C.-J.C.); (S.-F.W.); (C.-H.C.); (I.Y.-F.C.); (K.-P.C.)
- Liver Research Center, Chang Gung Memorial Hospital, Linkou 33305, Taiwan
- Department of Cell and Molecular Biology, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
- Research Center for Food and Cosmetic Safety, College of Human Ecology, Chang Gung University of Science and Technology, Taoyuan 33303, Taiwan
- Correspondence: ; Tel.: +886-3-2118800 (ext. 5171); Fax: +886-3-2118891
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14
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Adeoye J, Thomson P. 'The Double-Edged Sword' - An hypothesis for Covid-19-induced salivary biomarkers. Med Hypotheses 2020; 143:110124. [PMID: 32721813 PMCID: PMC7372268 DOI: 10.1016/j.mehy.2020.110124] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 07/17/2020] [Indexed: 12/21/2022]
Abstract
Utilising biomarkers for COVID-19 diagnosis, prediction of treatment response and overall prognostication have been investigated recently. However, these ventures have only considered the use of blood-based molecular markers. Saliva is another biofluid that warrants being applied in similar fashion with major advantages that centres on its non-invasive and repeatable collection as well as cost-efficiency. To this end, this article presents a hypothesis for the sources of biomarkers useful clinically for COVID-19 disease outcome estimation and identify the likely implications of their detection in saliva.
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Affiliation(s)
- John Adeoye
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China.
| | - Peter Thomson
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China.
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15
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Cohen ER, Reis IM, Gomez-Fernandez C, Smith D, Pereira L, Freiser ME, Marotta G, Thomas GR, Sargi ZB, Franzmann EJ. CD44 and associated markers in oral rinses and tissues from oral and oropharyngeal cancer patients. Oral Oncol 2020; 106:104720. [PMID: 32325304 DOI: 10.1016/j.oraloncology.2020.104720] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 04/04/2020] [Accepted: 04/11/2020] [Indexed: 01/04/2023]
Abstract
OBJECTIVES Oral and oropharyngeal squamous cell carcinoma (OOPSCC) is a debilitating disease. Salivary rinses contain soluble tumor markers including CD44 (solCD44) and total protein (TP) that may aid detection and prognosis of these aggressive tumors. Here we aim to examine the relationship between these salivary biomarkers and tissue markers p16 and CD44 and determine whether these markers can predict progression-free survival (PFS) and overall survival (OS). MATERIALS AND METHODS Prospective study to update biomarkers using oral rinses and tissues from OOPSC patients enrolled between 2007 and 2012 at an academic tertiary referral center. 64 cases from a 300-subject case-control study with archived tissue for immunohistochemistry were included. RESULTS 82.8% were male, 84.4% were ever smokers, 70.3% had disease stage T3-T4, and 57.8% presented with nodal disease. Nineteen patients (25%) were p16 positive. The group with strong tissue CD44 expression in membrane and cytoplasm had higher levels of solCD44 (mean 10.73 ng/ml) than other groups (5.47 ng/ml) (p = 0.033). TP levels were significantly reduced in oral rinses from subjects with p16 universal gross tumor tissue staining (mean 0.80 vs. 1.08 mg/ml; p = 0.039). On multivariate analysis, universal CD44 gross tissue staining and TP levels ≥ 1 mg/ml demonstrated poorer PFS, with the latter also affecting OS. Poorer survival was associated with soluble CD44 ≥ 5.33 ng/ml and TP ≥ 1 mg/ml. CONCLUSIONS Direct associations were found between high solCD44 levels and strong membrane and cytoplasmic CD44 expression, and between high TP levels and peripheral/mixed p16 gross staining. Poorer PFS and OS are significantly associated with higher levels of solCD44 and protein in oral rinses.
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Affiliation(s)
- Erin R Cohen
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Isildinha M Reis
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL 33136, USA; Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Carmen Gomez-Fernandez
- Department of Pathology, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Drew Smith
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Lutecia Pereira
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Monika E Freiser
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Gia Marotta
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Giovana R Thomas
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL 33136, USA; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Zoukaa B Sargi
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL 33136, USA; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Elizabeth J Franzmann
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL 33136, USA; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL 33136, USA.
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