Circulating miRNAs in blood and urine as diagnostic and prognostic biomarkers for bladder cancer: an update in 2017

A Path of Novelty from Nanoparticles to Nanobots: Theragnostic Approach for Targeting Cancer Therapy

Pharmaceutical development of cancer therapeutics is a dynamic area of research. Even after decades of intensive work, cancer continues to be a dreadful disease with an ever-increasing global incidence. The progress of nanotechnology in cancer research has overcome inherent limitations in conventional cancer chemotherapy and fulfilled the need for target-specific drug carriers. Nanotechnology uses the altered patho-physiological microenvironment of malignant cells and offers various advantages like improved solubility, reduced toxicity, prolonged drug circulation with controlled release, circumventing multidrug resistance, and enhanced biodistribution. Early cancer detection has a crucial role in selecting the best drug regime, thus, diagnosis and therapeutics go hand in hand. Furthermore, nanobots are an amazing possibility and promising innovation with numerous significant applications, particularly in fighting cancer and cleaning out blood vessels. Nanobots are tiny robots, ranging in size from 1 to 100 nm. Moreover, the nanobots would work similarly to white blood cells, watching the bloodstream and searching for indications of distress. This review articulates the evolution of various organic and inorganic nanoparticles and nanobots used as therapeutics, along with their pros and cons. It also highlights the shift in diagnostics from conventional methods to more advanced techniques. This rapidly growing domain is providing more space for engineering desired nanoparticles that can show miraculous results in therapeutic and diagnostic trials.

MiR-424 Acts as a Novel Biomarker in the Diagnosis of Patients with Hepatocellular Carcinoma

Objective: MicroRNA-424 (MiR-424) is proved to be a tumor suppressor against many malignancies, including hepatocellular carcinoma (HCC). Nevertheless, its role in diagnosing HCC remained poorly understood. The authors' research investigated diagnostic value of serum miR-424 in HCC. Materials and Methods: Relative expression levels of serum miR-424 in HCC patients and healthy individuals were measured via quantitative real-time polymerase chain reaction. χ2 test was applied to analyze the correlation between miR-424 expression and clinical features of HCC cases. Diagnostic value was estimated via plotting a receiver operating characteristic (ROC) curve. Results: Serum miR-424 expression was obviously downregulated in HCC cases in comparison to healthy persons (p < 0.001). miR-424 expression presented strong correlation with tumor node metastasis stage (p = 0.022), Barcelona Clinic Liver Cancer stage (p < 0.001), metastasis (p = 0.037), and vein invasion (p = 0.033). ROC curve analysis manifested an area under the curve of 0.768 with a sensitivity of 75.0% and a specificity of 72.4%, suggesting that serum miR-424 had high diagnostic value in HCC patients. Conclusions: The data suggest that serum miR-424 may represent a biomarker in early detection of HCC.

A serum miRNAs signature for early diagnosis of bladder cancer

BACKGROUND

Bladder cancer accounts for the most common type of urologic malignancy and presents high recurrence rate after surgical resection and adjuvant intravesical therapy. We aim to search for an early diagnostic biomarker in serum for bladder cancer in this study.

METHODS

The expression profiles of miRNAs in serum samples of 112 bladder cancer patients and 112 healthy controls were detected with real-time polymerase chain reaction (RT-qPCR). Receiver operating characteristic (ROC) curve and area under curve (AUC) analysis were performed to assess the diagnostic efficiency of miRNAs. Stepwise logic regression analysis was used to construct a diagnostic signature with highest sensitivity and specificity. Bioinformatics analysis was applied to explore the potential biological functions and mechanisms of candidate miRNAs.

RESULTS

Five miRNAs including miR-451a, miR-381-3p, miR-223-3p, miR-142-5p and miR-27b-3p were found differentially expressed in serum samples of bladder patients and healthy subjects. The diagnostic signature was constructed with miR-27b-3p, miR-381-3p and miR-451a. AUC of the three-miRNA signature was 0.894 (0.837-0.936, p < 0.001). The sensitivity and specificity of this signature were 86.90% and 77.38%, respectively, indicating that this signature has a good ability to diagnose bladder cancer.

CONCLUSION

The three-miRNA signature we constructed has favorable diagnostic capacity and may be a promising non-invasive biomarker in the early diagnosis of bladder cancer.KEY MESSAGESThere is still no clinical utilization of serum miRNAs in the early detection of bladder cancer.We screened and constructed a three-miRNA signature with the sensitivity of 86.90% and specificity of 77.38% which may be a promising non-invasive biomarker in the early diagnosis of bladder cancer.

Urinary MicroRNAs as Biomarkers of Urological Cancers: A Systematic Review

MicroRNAs (miRNAs) are emerging as biomarkers for the detection and prognosis of cancers due to their inherent stability and resilience. To summarize the evidence regarding the role of urinary miRNAs (umiRNAs) in the detection, prognosis, and therapy of genitourinary cancers, we performed a systematic review of the most important scientific databases using the following keywords: (urinary miRNA) AND (prostate cancer); (urinary miRNA) AND (bladder cancer); (urinary miRNA) AND (renal cancer); (urinary miRNA) AND (testicular cancer); (urinary miRNA) AND (urothelial cancer). Of all, 1364 articles were screened. Only original studies in the English language on human specimens were considered for inclusion in our systematic review. Thus, a convenient sample of 60 original articles was identified. UmiRNAs are up- or downregulated in prostate cancer and may serve as potential non-invasive molecular biomarkers. Several umiRNAs have been identified as diagnostic biomarkers of urothelial carcinoma and bladder cancer (BC), allowing us to discriminate malignant from nonmalignant forms of hematuria. UmiRNAs could serve as therapeutic targets or recurrence markers of non-muscle-invasive BC and could predict the aggressivity and prognosis of muscle-invasive BC. In renal cell carcinoma, miRNAs have been identified as predictors of tumor detection, aggressiveness, and progression to metastasis. UmiRNAs could play an important role in the diagnosis, prognosis, and therapy of urological cancers.

Human Milk-Derived Levels of let-7g-5p May Serve as a Diagnostic and Prognostic Marker of Low Milk Supply in Breastfeeding Women

Low milk supply (LMS) is associated with early breastfeeding cessation; however, the biological underpinnings in the mammary gland are not understood. MicroRNAs (miRNAs) are small non-coding RNAs that post-transcriptionally downregulate gene expression, and we hypothesized the profile of miRNAs secreted into milk reflects lactation performance. Longitudinal changes in milk miRNAs were measured using RNAseq in women with LMS (n = 47) and adequate milk supply (AMS; n = 123). Relationships between milk miRNAs, milk supply, breastfeeding outcomes, and infant weight gain were assessed, and interactions between milk miRNAs, maternal diet, smoking status, and BMI were determined. Women with LMS had lower milk volume (p = 0.003), were more likely to have ceased breast feeding by 24 wks (p = 0.0003) and had infants with a lower mean weight-for-length z-score (p = 0.013). Milk production was significantly associated with milk levels of miR-16-5p (R = -0.14, adj p = 0.044), miR-22-3p (R = 0.13, adj p = 0.044), and let-7g-5p (R = 0.12, adj p = 0.046). Early milk levels of let-7g-5p were significantly higher in mothers with LMS (adj p = 0.0025), displayed an interaction between lactation stage and milk supply (p < 0.001), and were negatively related to fruit intake (p = 0.015). Putative targets of let-7g-5p include genes important to hormone signaling, RNA regulation, ion transport, and the extracellular matrix, and down-regulation of two targets (PRLR and IGF2BP1/IMP1) was confirmed in mammary cells overexpressing let-7g-5p in vitro. Our data provide evidence that milk-derived miRNAs reflect lactation performance in women and warrant further investigation to assess their utility for predicting LMS risk and early breastfeeding cessation.

Functional Implications and Clinical Potential of MicroRNAs in Irritable Bowel Syndrome: A Concise Review

MicroRNAs (miRNAs) are tiny (20-24 nucleotides long), non-coding, highly conserved RNA molecules that play a crucial role within the post-transcriptional regulation of gene expression via sequence-specific mechanisms. Since the miRNA transcriptome is involved in multiple molecular processes needed for cellular homeostasis, its altered expression can trigger the development and progression of several human pathologies. In this context, over the last few years, several relevant studies have demonstrated that dysregulated miRNAs affect a wide range of molecular mechanisms associated with irritable bowel syndrome (IBS), a common gastrointestinal disorder. For instance, abnormal miRNA expression in IBS patients is related to the alteration of intestinal permeability, visceral hyperalgesia, inflammatory pathways, and pain sensitivity. Besides, specific miRNAs are differentially expressed in the different subtypes of IBS, and therefore, they might be used as biomarkers for precise diagnosis of these pathological conditions. Accordingly, miRNAs have noteworthy potential as theragnostic targets for IBS. Hence, in this current review, we present an overview of the recent discoveries regarding the clinical relevance of miRNAs in IBS, which might be useful in the future for the development of miRNA-based drugs against this disorder.

Noninvasive Prognosis of Postmyocardial Infarction Using Urinary miRNA Ultratrace Detection Based on Single-Target DNA-Functionalized AuNPs

Urine is the most appropriate body fluid for analysis because it is easily and less-invasively obtained than blood; thus, urinary miRNAs can better represent the local stage of the disease and might grow up to be a new class of noninvasive biomarkers of postmyocardial infarction (MI). Monofunctionalized Au nanoparticles (AuNPs) with only one selective DNA at a specific location are more promising in nanotechnology. This study developed a urinary miRNA ultratrace detection strategy based on single-target DNA-functionalized AuNPs for the noninvasive prognosis of post-MI. The AuNPs were designed with only single-stranded biotinylated DNA complementary to the target miRNA through a ratio-optimized stoichiometric method for the first time. Combined with the duplex specific nuclease-assisted target recycling amplification, the single-target DNA-functionalized AuNPs for the first time were used in inductively coupled plasma-mass spectrometry for the determination of urinary miRNA with high sensitivity. After optimizing the reaction conditions, a linear detection range between 1 fM and 10 pM for miR-155 and a detection limit of 0.47 fM were obtained. Finally, the target miR-155 in urine samples collected from MI rats was quantified and the level of miR-155 in MI groups was 30 times higher than in the control groups. The results suggest that urinary miR-155 could be a novel biomarker for the noninvasive diagnosis of MI.

The miR-200 Family of microRNAs: Fine Tuners of Epithelial-Mesenchymal Transition and Circulating Cancer Biomarkers

The miR-200 family of microRNAs (miRNAs) includes miR-200a, miR-200b, miR-200c, miR-141 and miR-429, five evolutionarily conserved miRNAs that are encoded in two clusters of hairpin precursors located on human chromosome 1 (miR-200b, miR-200a and miR-429) and chromosome 12 (miR-200c and miR-141). The mature -3p products of the precursors are abundantly expressed in epithelial cells, where they contribute to maintaining the epithelial phenotype by repressing expression of factors that favor the process of epithelial-to-mesenchymal transition (EMT), a key hallmark of oncogenic transformation. Extensive studies of the expression and interactions of these miRNAs with cell signaling pathways indicate that they can exert both tumor suppressor- and pro-metastatic functions, and may serve as biomarkers of epithelial cancers. This review provides a summary of the role of miR-200 family members in EMT, factors that regulate their expression, and important targets for miR-200-mediated repression that are involved in EMT. The second part of the review discusses the potential utility of circulating miR-200 family members as diagnostic/prognostic biomarkers for breast, colorectal, lung, ovarian, prostate and bladder cancers.

MiR-10a-5p: A Promising Biomarker for Early Diagnosis and Prognosis Evaluation of Bladder Cancer

Introduction

MiRNAs play a critical role in carcinogenesis, among which miR-10a-5p has been reported in several types of human cancer. Nevertheless, the role of miR-10a-5p remain uncovered in bladder cancer (BCa).

Methods

We recruited 88 BCa patients and 36 healthy controls (HC) to form the training cohort, and other 120 BCa patients to form the validation cohort. The clinical samples were collected for analysis. The expression level of miR-10a-5p was evaluated using RT-qPCR. Receiver operating characteristic (ROC) curves were utilized to calculate diagnostic accuracy. Survival curves were generated to analyze survival outcomes. CCK-8 and transwell assays were conducted to test the cell proliferation, migration, and invasion capacities.

Results

MiR-10a-5p was upregulated in human BCa tissues and closely associated with advanced clinicopathological features, including advanced tumor grade, histological grade, and T stage. High expression of miR-10a-5p was associated with worse survival outcomes in BCa patients. Circulating plasma miR-10a-5p expression had the great performance power to discriminate BCa patients form HC patients before surgery, and to differentiate muscle invasive bladder cancer (MIBC) from non-muscle invasive bladder cancer (NMIBC). In addition, overexpression of miR-10a-5p could promote BCa cell proliferation, migration, and invasion.

Conclusion

This study indicates that miR-10a-5p is a crucial diagnostic and prognostic biomarker for BCa patients, and miR-10a-5p exerted a tumor promoting role during BCa cell progression.

A miRNA signature predicts benefit from addition of hypoxia-modifying therapy to radiation treatment in invasive bladder cancer

BACKGROUND

miRNAs are promising biomarkers in oncology as their small size makes them less susceptible to degradation than mRNA in FFPE tissue. We aimed to derive a hypoxia-associated miRNA signature for bladder cancer.

METHODS

Taqman miRNA array cards identified miRNA seed genes induced under hypoxia in bladder cancer cell lines. A signature was derived using feature selection methods in a TCGA BLCA training data set. miRNA expression data were generated for 190 tumours from the BCON Phase 3 trial and used for independent validation.

RESULTS

A 14-miRNA hypoxia signature was derived, which was prognostic for poorer overall survival in the TCGA BLCA cohort (n = 403, p = 0.001). Univariable analysis showed that the miRNA signature predicted an overall survival benefit from having carbogen-nicotinamide with radiotherapy (HR = 0.30, 95% CI 0.094-0.95, p = 0.030) and performed similarly to a 24-gene mRNA signature (HR = 0.47, 95% CI 0.24-0.92, p = 0.025). Combining the signatures improved performance (HR = 0.26, 95% CI 0.08-0.82, p = 0.014) with borderline significance for an interaction test (p = 0.065). The interaction test was significant for local relapse-free survival LRFS (p = 0.033).

CONCLUSION

A 14-miRNA hypoxia signature can be used with an mRNA hypoxia signature to identify bladder cancer patients benefitting most from having carbogen and nicotinamide with radiotherapy.

Urinary microRNA and mRNA in Tumors

Liquid biopsy is gaining importance in the context of analysis of circulating subcellular components, such as exosomes and nucleic acids, and the investigation of biological fluids is increasing because they express features common to the tissue of origin. Particularly, urine has become one of the most attractive biofluids in clinical practice due to its easy collection approach, its availability of large quantities, and its noninvasiveness. Furthermore, a peculiarity is that, compared to serum or plasma, urine is characterized by a simpler composition that improves isolation and identification of biomarkers. Recent studies have been associated with the investigation of mRNAs and microRNAs as potential noninvasive cancer biomarkers in urine, and to date, several approaches for isolating and measuring urinary nucleic acids have been established, despite still developing. This chapter aims at giving some main published evidences on urinary microRNAs and mRNAs, with the intent to consider their potential translational use in clinical practice.

Evaluation of miR-130 family members as circulating biomarkers for the diagnosis of bladder cancer

OBJECTIVE

Previous research has shown that the miR-130 family is closely related to the occurrence and development of bladder cancer. We hope to use the miR-130 family members as new, non-invasive, and easily detectable biomarkers for bladder cancer.

METHODS

We analyzed 428 cases in The Cancer Genome Atlas-Bladder Urothelial Carcinoma database and verified that the miR-130 family members were significantly overexpressed in bladder cancer. A total of 74 bladder cancer patients and 90 controls were enrolled. The relative expression of the miR-130 family in serum was detected using quantitative reverse transcription-polymerase chain reaction. The diagnostic efficacy of the miR-130 family members was determined using the receiver operating characteristic method (ROC), and a diagnostic panel was built using logistic regression. The results of the study were further confirmed in an external validation set of 492 samples from the Gene Expression Omnibus database.

RESULTS

The expression of the miR-130 family members (except for miR-301b-3p) in the serum of bladder cancer patients was higher than that in the controls. The diagnostic capabilities for bladder cancer were 0.847 (miR-130a-3p), 0.762 (miR-130b-3p), and 0.892 (miR-301a-3p). We established a three-miRNA panel with an area under the ROC curve as high as 0.961, indicating that it is a promising clinical diagnostic biomarker of bladder cancer with high sensitivity and specificity.

CONCLUSION

The expression levels of miR-130 family members in serum can effectively distinguish the bladder cancer patients from healthy controls. This finding will facilitate the clinical diagnosis of bladder cancer.

Prognostic Stratification of Bladder Cancer Patients with a MicroRNA-based Approach

Robust non-invasive tests for prognostic stratification of bladder cancer (BCa) patients are in high demand. Following a comprehensive analysis of studies on BCa, we selected a panel of 29 microRNAs (miRNAs) and analyzed their levels in urine and plasma samples in a prospective cohort of 63 BCa patients (32 at high risk of recurrence and 31 low-risk cases) and 37 healthy controls using RT-qPCR. To design an assay suitable for large-scale testing, we applied a hierarchical pipeline to select the miRNAs that were not affected by confounding factors such as haematuria and urine specific gravity, and exceeded stringent cut-off criteria (fold change >2.5 and p-value < 0.005). Using a two-step decision tree based on the urine levels of miR-34a-5p, miR-200a-3p and miR-193a-5p, normalized against miR-125b-5p, patients could be classified as high- or low-risk with a sensitivity of 0.844, specificity of 0.806 and accuracy of 0.825. Furthermore, univariate Cox proportional hazards regression analyses indicated that increased urine levels of miR-29a-3p, miR-34a-5p, miR-193a-5p, miR-200c-3p, miR-205-5p and miR-532-5p were associated with a shorter event-free survival (hazard ratios > 3.1, p-value < 0.05). Taken together, our findings suggest that measuring the urine levels of these miRNAs could provide a novel cost-effective, noninvasive test for risk assessment of BCa patients.

Small Non-Coding RNA Profiling in Plasma Extracellular Vesicles of Bladder Cancer Patients by Next-Generation Sequencing: Expression Levels of miR-126-3p and piR-5936 Increase with Higher Histologic Grades

Bladder cancer (BC) is the tenth most frequent cancer worldwide. Due to the need for recurrent cystoscopies and the lack of non-invasive biomarkers, BC is associated with a high management burden. In this respect, small non-coding RNAs (sncRNAs) have been investigated in urine as possible biomarkers for BC, but in plasma their potential has not yet been defined. The expression levels of sncRNAs contained in plasma extracellular vesicles (EVs) from 47 men with BC and 46 healthy controls were assessed by next-generation sequencing. The sncRNA profiles were compared with urinary profiles from the same subjects. miR-4508 resulted downregulated in plasma EVs of muscle-invasive BC patients, compared to controls (adj-p = 0.04). In World Health Organization (WHO) grade 3 (G3) BC, miR-126-3p was upregulated both in plasma EVs and urine, when compared to controls (for both, adj-p < 0.05). Interestingly, two sncRNAs were associated with the risk class: miR-4508 with a downward trend going from controls to high risk BC, and piR-hsa-5936 with an upward trend (adj-p = 0.04 and adj-p = 0.05, respectively). Additionally, BC cases with low expression of miR-185-5p and miR-106a-5p or high expression of miR-10b-5p showed shorter survival (adj-p = 0.0013, adj-p = 0.039 and adj-p = 0.047, respectively). SncRNAs from plasma EVs could be diagnostic biomarkers for BC, especially in advanced grade.

Update on urine as a biomarker in cancer: a necessary review of an old story

Introduction: Cancer causes thousands of deaths worldwide each year. Therefore, monitoring of health status and the early diagnosis of cancer using noninvasive assays, such as the analysis of molecular biomarkers in urine, is essential. However, effective biomarkers for early diagnosis of cancer have not been established in many types of cancer.Areas covered: In this review, we discuss recent findings with regard to the use of urine composition as a biomarker in eleven types of cancer. We also highlight the use of urine biomarkers for improving early diagnosis.Expert opinion: Urinary biomarkers have been applied for clinical application of early diagnosis. The main limitation is a lack of integrated approaches for identification of new biomarkers in most cancer. The utilization of urinary biomarker detection will be promoted by improved detection methods and new data from different types of cancers. With the development of precision medicine, urinary biomarkers will play an increasingly important clinical role. Future early diagnosis would benefit from changes in the utilization of urinary biomarkers.

Expression levels of miR-21, miR-146b and miR-326 as potential biomarkers in Behcet's disease

Aim: Behcet's disease (BD) is a vasculitis. Lines of evidence suggest miRNAs as diagnostic and prognostic markers in autoimmune diseases. This study was designed to investigate the potential role of miR-21, miR-146b and miR-326 as biomarkers for diagnosis, predicting organs involvement and measuring BD activity. Patients & methods: In this cross-sectional study, the study groups consisted of 46 BD patients and 70 age- and sex-matched healthy volunteers. The expression rates of three miRNAs were determined by quantitative real-time PCR. Results: Our results demonstrated significantly lower expression of miR-21 and miR-146b and higher expression of miR-326 in BD patients. MiR-21 expression rate in patients with severe eye involvement and miR-326 expression rate in patients with uveitis and severe eye involvement were increased. Conclusion: MiR-326 expression rate can be used as a biomarker for prediction of uveitis and severe eye involvement in patients with BD.

Isolation and Detection Technologies of Extracellular Vesicles and Application on Cancer Diagnostic

The vast majority of cancers are treatable when diagnosed early. However, due to the elusive trace and the limitation of traditional biopsies, most cancers have already spread widely and are at advanced stages when they are first diagnosed, causing ever-increasing mortality in the past decades. Hence, developing reliable methods for early detection and diagnosis of cancer is indispensable. Recently, extracellular vesicles (EVs), as circulating phospholipid vesicles secreted by cells, are found to play significant roles in the intercellular communication as well as the setup of tumor microenvironments and have been identified as one of the key factors in the next-generation technique for cancer diagnosis. However, EVs present in complex biofluids that contain various contaminations such as nonvesicle proteins and nonspecific EVs, resulting in the interference of screening for desired biomarkers. Therefore, applicable isolation and enrichment methods that guarantee scale-up of sample volume, purity, speed, yield, and tumor specificity are necessary. In this review, we introduce current technologies for EV separation and summarize biomarkers toward EV-based cancer liquid biopsy. In conclusion, a novel systematic isolation method that guarantees high purity, recovery rate, and tumor specificity is still missing. Besides that, a dual-model EV-based clinical trial system includes isolation and detection is a hot trend in the future due to efficient point-of-care needs. In addition, cancer-related biomarkers discovery and biomarker database establishment are essential objectives in the research field for diagnostic settings.