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Glaab E, Rauschenberger A, Banzi R, Gerardi C, Garcia P, Demotes J. Biomarker discovery studies for patient stratification using machine learning analysis of omics data: a scoping review. BMJ Open 2021; 11:e053674. [PMID: 34873011 PMCID: PMC8650485 DOI: 10.1136/bmjopen-2021-053674] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 11/09/2021] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To review biomarker discovery studies using omics data for patient stratification which led to clinically validated FDA-cleared tests or laboratory developed tests, in order to identify common characteristics and derive recommendations for future biomarker projects. DESIGN Scoping review. METHODS We searched PubMed, EMBASE and Web of Science to obtain a comprehensive list of articles from the biomedical literature published between January 2000 and July 2021, describing clinically validated biomarker signatures for patient stratification, derived using statistical learning approaches. All documents were screened to retain only peer-reviewed research articles, review articles or opinion articles, covering supervised and unsupervised machine learning applications for omics-based patient stratification. Two reviewers independently confirmed the eligibility. Disagreements were solved by consensus. We focused the final analysis on omics-based biomarkers which achieved the highest level of validation, that is, clinical approval of the developed molecular signature as a laboratory developed test or FDA approved tests. RESULTS Overall, 352 articles fulfilled the eligibility criteria. The analysis of validated biomarker signatures identified multiple common methodological and practical features that may explain the successful test development and guide future biomarker projects. These include study design choices to ensure sufficient statistical power for model building and external testing, suitable combinations of non-targeted and targeted measurement technologies, the integration of prior biological knowledge, strict filtering and inclusion/exclusion criteria, and the adequacy of statistical and machine learning methods for discovery and validation. CONCLUSIONS While most clinically validated biomarker models derived from omics data have been developed for personalised oncology, first applications for non-cancer diseases show the potential of multivariate omics biomarker design for other complex disorders. Distinctive characteristics of prior success stories, such as early filtering and robust discovery approaches, continuous improvements in assay design and experimental measurement technology, and rigorous multicohort validation approaches, enable the derivation of specific recommendations for future studies.
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Affiliation(s)
- Enrico Glaab
- Luxembourg Centre for Systems Biomedicine, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Armin Rauschenberger
- Luxembourg Centre for Systems Biomedicine, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Rita Banzi
- Center for Health Regulatory Policies, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Chiara Gerardi
- Center for Health Regulatory Policies, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Paula Garcia
- European Clinical Research Infrastructure Network, ECRIN, Paris, France
| | - Jacques Demotes
- European Clinical Research Infrastructure Network, ECRIN, Paris, France
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Wen G, Zhou T, Gu W. The potential of using blood circular RNA as liquid biopsy biomarker for human diseases. Protein Cell 2021; 12:911-946. [PMID: 33131025 PMCID: PMC8674396 DOI: 10.1007/s13238-020-00799-3] [Citation(s) in RCA: 88] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 10/09/2020] [Indexed: 12/14/2022] Open
Abstract
Circular RNA (circRNA) is a novel class of single-stranded RNAs with a closed loop structure. The majority of circRNAs are formed by a back-splicing process in pre-mRNA splicing. Their expression is dynamically regulated and shows spatiotemporal patterns among cell types, tissues and developmental stages. CircRNAs have important biological functions in many physiological processes, and their aberrant expression is implicated in many human diseases. Due to their high stability, circRNAs are becoming promising biomarkers in many human diseases, such as cardiovascular diseases, autoimmune diseases and human cancers. In this review, we focus on the translational potential of using human blood circRNAs as liquid biopsy biomarkers for human diseases. We highlight their abundant expression, essential biological functions and significant correlations to human diseases in various components of peripheral blood, including whole blood, blood cells and extracellular vesicles. In addition, we summarize the current knowledge of blood circRNA biomarkers for disease diagnosis or prognosis.
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Affiliation(s)
- Guoxia Wen
- State Key Laboratory of Bioelectronics, School of Biological Sciences and Medical Engineering, Southeast University, Nanjing, 210096, China
| | - Tong Zhou
- Department of Physiology and Cell Biology, Reno School of Medicine, University of Nevada, Reno, NV, 89557, USA.
| | - Wanjun Gu
- State Key Laboratory of Bioelectronics, School of Biological Sciences and Medical Engineering, Southeast University, Nanjing, 210096, China.
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3
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New Microbiological Techniques for the Diagnosis of Bacterial Infections and Sepsis in ICU Including Point of Care. Curr Infect Dis Rep 2021; 23:12. [PMID: 34149321 PMCID: PMC8207499 DOI: 10.1007/s11908-021-00755-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2021] [Indexed: 12/22/2022]
Abstract
Purpose of Review The aim of this article is to review current and emerging microbiological techniques that support the rapid diagnosis of bacterial infections in critically ill patients, including their performance, strengths and pitfalls, as well as available data evaluating their clinical impact. Recent Findings Bacterial infections and sepsis are responsible for significant morbidity and mortality in patients admitted to the intensive care unit and their management is further complicated by the increase in the global burden of antimicrobial resistance. In this setting, new diagnostic methods able to overcome the limits of traditional microbiology in terms of turn-around time and accuracy are highly warranted. We discuss the following broad themes: optimisation of existing culture-based methodologies, rapid antigen detection, nucleic acid detection (including multiplex PCR assays and microarrays), sepsis biomarkers, novel methods of pathogen detection (e.g. T2 magnetic resonance) and susceptibility testing (e.g. morphokinetic cellular analysis) and the application of direct metagenomics on clinical samples. The assessment of the host response through new “omics” technologies might also aid in early diagnosis of infections, as well as define non-infectious inflammatory states. Summary Despite being a promising field, there is still scarce evidence about the real-life impact of these assays on patient management. A common finding of available studies is that the performance of rapid diagnostic strategies highly depends on whether they are integrated within active antimicrobial stewardship programs. Assessing the impact of these emerging diagnostic methods through patient-centred clinical outcomes is a complex challenge for which large and well-designed studies are awaited.
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Pinilla L, Benitez ID, González J, Torres G, Barbé F, de Gonzalo-Calvo D. Peripheral blood microRNAs and the COVID-19 patient: methodological considerations, technical challenges and practice points. RNA Biol 2021; 18:688-695. [PMID: 33530819 PMCID: PMC8078525 DOI: 10.1080/15476286.2021.1885188] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 01/30/2021] [Indexed: 02/06/2023] Open
Abstract
The COVID-19 emergency pandemic resulting from infection with SARS-CoV-2 represents a major threat to public health worldwide. There is an urgent clinical demand for easily accessible tools to address weaknesses and gaps in the management of COVID-19 patients. In this context, transcriptomic profiling of liquid biopsies, especially microRNAs (miRNAs), has recently emerged as a robust source of potential clinical indicators for medical decision-making. Nevertheless, the analysis of the circulating miRNA signature and its translation to clinical practice requires strict control of a wide array of methodological details. In this review, we indicate the main methodological aspects that should be addressed when evaluating the circulating miRNA profiles in COVID-19 patients, from preanalytical and analytical variables to the experimental design, impact of confounding, analysis of the data and interpretation of the findings, among others. Additionally, we provide practice points to ensure the rigour and reproducibility of miRNA-based biomarker investigations of this condition.Abbreviations: ACE: angiotensin-converting enzyme; ARDS: acute respiratory distress syndrome; COVID-19: coronavirus disease 2019; ERDN: early Detection Research Network; LMWH: low molecular weight heparin; miRNA: microRNA; ncRNA: noncoding RNA; SARS-CoV-2: severe acute respiratory syndrome coronavirus-2; SOP: standard operating procedure.
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Affiliation(s)
- Lucía Pinilla
- Translational Research in Respiratory Medicine, University Hospital Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Ivan D. Benitez
- Translational Research in Respiratory Medicine, University Hospital Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Jessica González
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
- Respiratory Department, University Hospital Arnau de Vilanova-Santa María, Translational Research in Respiratory Medicine, IRBLleida, University of Lleida, Lleida, Spain
| | - Gerard Torres
- Translational Research in Respiratory Medicine, University Hospital Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain
- Respiratory Department, University Hospital Arnau de Vilanova-Santa María, Translational Research in Respiratory Medicine, IRBLleida, University of Lleida, Lleida, Spain
| | - Ferran Barbé
- Translational Research in Respiratory Medicine, University Hospital Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
- Respiratory Department, University Hospital Arnau de Vilanova-Santa María, Translational Research in Respiratory Medicine, IRBLleida, University of Lleida, Lleida, Spain
| | - David de Gonzalo-Calvo
- Translational Research in Respiratory Medicine, University Hospital Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
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5
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Lin M, Zhang Y, Niu Z, Chi Y, Huang Q. Transcriptomic responses of peripheral blood cells to coronary artery disease. Biosci Trends 2018; 12:354-359. [PMID: 30146615 DOI: 10.5582/bst.2018.01078] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Transcriptomic response of peripheral blood cells to coronary artery diseases (CAD) is a long recognized phenomenon. Currently, accumulating evidence indicates that such response having significant clinical utility in CAD-associated events determination. In this review, we summarized the existing data of transcriptomic biomarkers at mRNA, microRNA, long non-coding RNA, and circular RNA for the diagnosis, progression and outcome prediction and treatment response of CAD. Furthermore, we also discussed the functional significance on the gene expression patterns caused by CAD, and emphasized the importance of inflammatory pathways in CAD tissues-blood cells interaction. Based on the current knowledge, we proposed a perspective on the future strategies to further improve the robustness and reproducibility of transcriptomic biomarkers in the personalized medicine of CAD patients.
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Affiliation(s)
- Mingshan Lin
- Department of Cardiovascular Surgery, Qingdao Municipal Hospital
| | - Yuan Zhang
- Department of Cardiovascular Surgery, Qingdao Municipal Hospital
| | - Zhaozhuo Niu
- Department of Cardiovascular Surgery, Qingdao Municipal Hospital
| | - Yifan Chi
- Department of Cardiovascular Surgery, Qingdao Municipal Hospital
| | - Qiang Huang
- Department of Cardiovascular Surgery, Qingdao Municipal Hospital
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6
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Lydon EC, Ko ER, Tsalik EL. The host response as a tool for infectious disease diagnosis and management. Expert Rev Mol Diagn 2018; 18:723-738. [PMID: 29939801 DOI: 10.1080/14737159.2018.1493378] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION A century of advances in infectious disease diagnosis and treatment changed the face of medicine. However, challenges continue to develop including multi-drug resistance, globalization that increases pandemic risks, and high mortality from severe infections. These challenges can be mitigated through improved diagnostics, and over the past decade, there has been a particular focus on the host response. Since this article was originally published in 2015, there have been significant developments in the field of host response diagnostics, warranting this updated review. Areas Covered: This review begins by discussing developments in single biomarkers and pauci-analyte biomarker panels. It then delves into 'omics, an area where there has been truly exciting progress. Specifically, progress has been made in sepsis diagnosis and prognosis; differentiating viral, bacterial, and fungal pathogen classes; pre-symptomatic diagnosis; and understanding disease-specific diagnostic challenges in tuberculosis, Lyme disease, and Ebola. Expert Commentary: As 'omics have become faster, more precise, and less expensive, the door has been opened for academic, industry, and government efforts to develop host-based infectious disease classifiers. While there are still obstacles to overcome, the chasm separating these scientific advances from the patient's bedside is shrinking.
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Affiliation(s)
- Emily C Lydon
- a Duke University School of Medicine , Duke University , Durham , NC , USA
| | - Emily R Ko
- b Duke Center for Applied Genomics & Precision Medicine, Department of Medicine , Duke University , Durham , NC , USA.,c Duke Regional Hospital, Department of Medicine , Duke University , Durham , NC , USA
| | - Ephraim L Tsalik
- b Duke Center for Applied Genomics & Precision Medicine, Department of Medicine , Duke University , Durham , NC , USA.,d Division of Infectious Diseases & International Health, Department of Medicine , Duke University , Durham , NC , USA.,e Emergency Medicine Service , Durham Veterans Affairs Health Care System , Durham , NC , USA
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7
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Nagalla S, Bray PF. Personalized medicine in thrombosis: back to the future. Blood 2016; 127:2665-71. [PMID: 26847245 PMCID: PMC4891951 DOI: 10.1182/blood-2015-11-634832] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Accepted: 01/31/2016] [Indexed: 01/26/2023] Open
Abstract
Most physicians believe they practiced personalized medicine prior to the genomics era that followed the sequencing of the human genome. The focus of personalized medicine has been primarily genomic medicine, wherein it is hoped that the nucleotide dissimilarities among different individuals would provide clinicians with more precise understanding of physiology, more refined diagnoses, better disease risk assessment, earlier detection and monitoring, and tailored treatments to the individual patient. However, to date, the "genomic bench" has not worked itself to the clinical thrombosis bedside. In fact, traditional plasma-based hemostasis-thrombosis laboratory testing, by assessing functional pathways of coagulation, may better help manage venous thrombotic disease than a single DNA variant with a small effect size. There are some new and exciting discoveries in the genetics of platelet reactivity pertaining to atherothrombotic disease. Despite a plethora of genetic/genomic data on platelet reactivity, there are relatively little actionable pharmacogenetic data with antiplatelet agents. Nevertheless, it is crucial for genome-wide DNA/RNA sequencing to continue in research settings for causal gene discovery, pharmacogenetic purposes, and gene-gene and gene-environment interactions. The potential of genomics to advance medicine will require integration of personal data that are obtained in the patient history: environmental exposures, diet, social data, etc. Furthermore, without the ritual of obtaining this information, we will have depersonalized medicine, which lacks the precision needed for the research required to eventually incorporate genomics into routine, optimal, and value-added clinical care.
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Affiliation(s)
- Srikanth Nagalla
- The Cardeza Foundation for Hematologic Research and the Department of Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Paul F Bray
- The Cardeza Foundation for Hematologic Research and the Department of Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
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8
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Talhouk A, Kommoss S, Mackenzie R, Cheung M, Leung S, Chiu DS, Kalloger SE, Huntsman DG, Chen S, Intermaggio M, Gronwald J, Chan FC, Ramus SJ, Steidl C, Scott DW, Anglesio MS. Single-Patient Molecular Testing with NanoString nCounter Data Using a Reference-Based Strategy for Batch Effect Correction. PLoS One 2016; 11:e0153844. [PMID: 27096160 PMCID: PMC4838303 DOI: 10.1371/journal.pone.0153844] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 04/05/2016] [Indexed: 12/20/2022] Open
Abstract
A major weakness in many high-throughput genomic studies is the lack of consideration of a clinical environment where one patient at a time must be evaluated. We examined generalizable and platform-specific sources of variation from NanoString gene expression data on both ovarian cancer and Hodgkin lymphoma patients. A reference-based strategy, applicable to single-patient molecular testing is proposed for batch effect correction. The proposed protocol improved performance in an established Hodgkin lymphoma classifier, reducing batch-to-batch misclassification while retaining accuracy and precision. We suggest this strategy may facilitate development of NanoString and similar molecular assays by accelerating prospective validation and clinical uptake of relevant diagnostics.
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Affiliation(s)
- Aline Talhouk
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
| | - Stefan Kommoss
- Department of Women’s Health, University Hospital Tuebingen, Tuebingen, Germany
| | - Robertson Mackenzie
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
| | - Martin Cheung
- British Columbia Centre for Disease Control, Vancouver, Canada
| | - Samuel Leung
- Genetic Pathology Evaluation Centre (GPEC), Vancouver General Hospital and The University of British Columbia, Vancouver, Canada
| | - Derek S. Chiu
- Department of Statistics, University of British Columbia, Vancouver, Canada
| | - Steve E. Kalloger
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
- Pancreas Centre BC, Vancouver, Canada
| | - David G. Huntsman
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
- Genetic Pathology Evaluation Centre (GPEC), Vancouver General Hospital and The University of British Columbia, Vancouver, Canada
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada
| | - Stephanie Chen
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, United States of America
| | - Maria Intermaggio
- School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia
| | - Jacek Gronwald
- Department of Genetics and Pathology, International Hereditary Cancer Center, Pomeranian Medical University, Szczecin, Poland
| | - Fong C. Chan
- Centre for Lymphoid Cancer, British Columbia Cancer Agency Cancer Research Centre, Vancouver, Canada
| | - Susan J. Ramus
- School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia
- The Kinghorn Cancer Centre, Garvan Institute of Medical Research, Darlinghurst, NSW, Australia
| | - Christian Steidl
- Centre for Lymphoid Cancer, British Columbia Cancer Agency Cancer Research Centre, Vancouver, Canada
| | - David W. Scott
- Centre for Lymphoid Cancer, British Columbia Cancer Agency Cancer Research Centre, Vancouver, Canada
| | - Michael S. Anglesio
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada
- * E-mail:
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9
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Kraus WE, Granger CB, Sketch MH, Donahue MP, Ginsburg GS, Hauser ER, Haynes C, Newby LK, Hurdle M, Dowdy ZE, Shah SH. A Guide for a Cardiovascular Genomics Biorepository: the CATHGEN Experience. J Cardiovasc Transl Res 2015; 8:449-57. [PMID: 26271459 DOI: 10.1007/s12265-015-9648-y] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Accepted: 08/03/2015] [Indexed: 02/06/2023]
Abstract
The CATHeterization GENetics (CATHGEN) biorepository was assembled in four phases. First, project start-up began in 2000. Second, between 2001 and 2010, we collected clinical data and biological samples from 9334 individuals undergoing cardiac catheterization. Samples were matched at the individual level to clinical data collected at the time of catheterization and stored in the Duke Databank for Cardiovascular Diseases (DDCD). Clinical data included the following: subject demographics (birth date, race, gender, etc.); cardiometabolic history including symptoms; coronary anatomy and cardiac function at catheterization; and fasting chemistry data. Third, as part of the DDCD regular follow-up protocol, yearly evaluations included interim information: vital status (verified via National Death Index search and supplemented by Social Security Death Index search), myocardial infarction (MI), stroke, rehospitalization, coronary revascularization procedures, medication use, and lifestyle habits including smoking. Fourth, samples were used to generate molecular data. CATHGEN offers the opportunity to discover biomarkers and explore mechanisms of cardiovascular disease.
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Affiliation(s)
- William E Kraus
- Division of Cardiology, Department of Medicine, School of Medicine, Duke University, Durham, NC, 27710, USA. .,Duke Molecular Physiology Institute, School of Medicine, Duke University, 300 N. Duke Street, Durham, NC, 27710, USA.
| | - Christopher B Granger
- Division of Cardiology, Department of Medicine, School of Medicine, Duke University, Durham, NC, 27710, USA.,Duke Clinical Research Institute, School of Medicine, Duke University, Durham, NC, 27710, USA
| | - Michael H Sketch
- Division of Cardiology, Department of Medicine, School of Medicine, Duke University, Durham, NC, 27710, USA
| | - Mark P Donahue
- Division of Cardiology, Department of Medicine, School of Medicine, Duke University, Durham, NC, 27710, USA
| | - Geoffrey S Ginsburg
- Duke Center for Applied Genomics and Precision Medicine, Duke University, Durham, NC, 27710, USA
| | - Elizabeth R Hauser
- Division of Cardiology, Department of Medicine, School of Medicine, Duke University, Durham, NC, 27710, USA.,Duke Molecular Physiology Institute, School of Medicine, Duke University, 300 N. Duke Street, Durham, NC, 27710, USA
| | - Carol Haynes
- Duke Molecular Physiology Institute, School of Medicine, Duke University, 300 N. Duke Street, Durham, NC, 27710, USA
| | - L Kristin Newby
- Division of Cardiology, Department of Medicine, School of Medicine, Duke University, Durham, NC, 27710, USA.,Duke Clinical Research Institute, School of Medicine, Duke University, Durham, NC, 27710, USA
| | - Melissa Hurdle
- Duke Molecular Physiology Institute, School of Medicine, Duke University, 300 N. Duke Street, Durham, NC, 27710, USA
| | - Z Elaine Dowdy
- Duke Molecular Physiology Institute, School of Medicine, Duke University, 300 N. Duke Street, Durham, NC, 27710, USA
| | - Svati H Shah
- Division of Cardiology, Department of Medicine, School of Medicine, Duke University, Durham, NC, 27710, USA.,Duke Molecular Physiology Institute, School of Medicine, Duke University, 300 N. Duke Street, Durham, NC, 27710, USA
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10
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Clarke JL, Ladapo JL, Monane M, Lansky A, Skoufalos A, Nash DB. The diagnosis of CAD in women: addressing the unmet need - a report from the national expert roundtable meeting. Popul Health Manag 2015; 18:86-92. [PMID: 25714757 DOI: 10.1089/pop.2015.0006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
A multistakeholder panel comprising experts in the fields of clinical cardiology, medical technology innovation, women's health research and policy analysis, personalized medicine, payers (including self-insured employers), patient advocacy, and health economics was convened at the Heart House in Washington, DC. The following points emerged as key concepts: (1) Diagnostic challenges in the evaluation of women with symptoms suggestive of obstructive coronary artery disease (CAD) result from: (a) presentation with atypical symptoms and lower pretest probability of disease compared to men, (b) fatty tissue and breast tissue attenuation on cardiac imaging leading to false positive findings, and (c) the presence of microvascular CAD. (2) Diagnostic challenges lead to both over-testing of low-risk women and under-testing of high-risk women. (3) Efforts should be directed toward increasing clinician, clinical professional society, and consumer awareness and understanding of sex-specific differences between men and women in the pathophysiology of CAD. (4) Multiple health care stakeholders should be made aware of new advances in genomic approaches to address the challenges of diagnosing obstructive CAD; specifically, the Corus CAD gene expression test, which was shown to have high sensitivity and negative predictive value in a recent clinical trial. As such, it has promise as a tool to help clinicians to rule out obstructive CAD as a cause of a patient's symptoms. (Population Health Management 2015;18:86-92).
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Affiliation(s)
- Janice L Clarke
- 1 Jefferson School of Population Health , Philadelphia, Pennsylvania
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11
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Biological and analytical stability of a peripheral blood gene expression score for obstructive coronary artery disease in the PREDICT and COMPASS studies. J Cardiovasc Transl Res 2014; 7:615-22. [PMID: 25119856 PMCID: PMC4185104 DOI: 10.1007/s12265-014-9583-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 07/28/2014] [Indexed: 11/23/2022]
Abstract
A gene expression score (GES) for obstructive coronary artery disease (CAD) has been validated in two multicenter studies. Receiver-operating characteristics (ROC) analysis of the GES on an expanded Personalized Risk Evaluation and Diagnosis in the Coronary Tree (PREDICT) cohort (NCT no. 00500617) with CAD defined by quantitative coronary angiography (QCA) or clinical reads yielded similar performance (area under the curve (AUC) = 0.70, N = 1,502) to the original validation cohort (AUC = 0.70, N = 526). Analysis of 138 non-Caucasian and 1,364 Caucasian patients showed very similar performance (AUCs = 0.72 vs. 0.70). To assess analytic stability, stored samples of the original validation cohort (N = 526) was re-tested after 5 years, and the mean score changed from 20.3 to 19.8 after 5 years (N = 501, 95 %). To assess patient scores over time, GES was determined on samples from 173 Coronary Obstruction Detection by Molecular Personalized Gene Expression (COMPASS) study (NCT no. 01117506) patients at approximately 1 year post-enrollment. Mean scores increased slightly from 15.9 to 17.3, corresponding to a 2.5 % increase in obstructive CAD likelihood. Changes in cardiovascular medications did not show a significant change in GES.
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