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Petersen MM, Ferm L, Kleif J, Piper TB, Rømer E, Christensen IJ, Nielsen HJ. Triage May Improve Selection to Colonoscopy and Reduce the Number of Unnecessary Colonoscopies. Cancers (Basel) 2020; 12:E2610. [PMID: 32932734 PMCID: PMC7563245 DOI: 10.3390/cancers12092610] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 09/11/2020] [Accepted: 09/11/2020] [Indexed: 12/18/2022] Open
Abstract
Implementation of population screening for colorectal cancer by direct colonoscopy or follow-up colonoscopy after a positive fecal blood test has challenged the overall capacity of bowel examinations. Certain countries are facing serious colonoscopy capacity constraints, which have led to waiting lists and long time latency of follow-up examinations. Various options for improvement are considered, including increased cut-off values of the fecal blood tests. Results from major clinical studies of blood-based, cancer-associated biomarkers have, however, led to focus on a Triage concept for improved selection to colonoscopy. The Triage test may include subject age, concentration of hemoglobin in a feces test and a combination of certain blood-based cancer-associated biomarkers. Recent results have indicated that Triage may reduce the requirements for colonoscopy by around 30%. Such results may be advantageous for the capacity, the healthcare budgets and in particular, the subjects, who do not need an unnecessary, unpleasant and risk-associated bowel examination.
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Affiliation(s)
- Mathias M. Petersen
- Department of Surgical Gastroenterology, Hvidovre Hospital, 2650 Hvidovre, Denmark; (M.M.P.); (L.F.); (J.K.); (T.B.P.); (E.R.); (I.J.C.)
| | - Linnea Ferm
- Department of Surgical Gastroenterology, Hvidovre Hospital, 2650 Hvidovre, Denmark; (M.M.P.); (L.F.); (J.K.); (T.B.P.); (E.R.); (I.J.C.)
| | - Jakob Kleif
- Department of Surgical Gastroenterology, Hvidovre Hospital, 2650 Hvidovre, Denmark; (M.M.P.); (L.F.); (J.K.); (T.B.P.); (E.R.); (I.J.C.)
| | - Thomas B. Piper
- Department of Surgical Gastroenterology, Hvidovre Hospital, 2650 Hvidovre, Denmark; (M.M.P.); (L.F.); (J.K.); (T.B.P.); (E.R.); (I.J.C.)
| | - Eva Rømer
- Department of Surgical Gastroenterology, Hvidovre Hospital, 2650 Hvidovre, Denmark; (M.M.P.); (L.F.); (J.K.); (T.B.P.); (E.R.); (I.J.C.)
| | - Ib J. Christensen
- Department of Surgical Gastroenterology, Hvidovre Hospital, 2650 Hvidovre, Denmark; (M.M.P.); (L.F.); (J.K.); (T.B.P.); (E.R.); (I.J.C.)
| | - Hans J. Nielsen
- Department of Surgical Gastroenterology, Hvidovre Hospital, 2650 Hvidovre, Denmark; (M.M.P.); (L.F.); (J.K.); (T.B.P.); (E.R.); (I.J.C.)
- Institute of Clinical Medicine, University of Copenhagen, 2100 Copenhagen, Denmark
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Lech Pedersen N, Mertz Petersen M, Ladd JJ, Lampe PD, Bresalier RS, Davis GJ, Demuth C, Jensen SØ, Andersen CL, Ferm L, Christensen IJ, Nielsen HJ. Development of blood-based biomarker tests for early detection of colorectal neoplasia: Influence of blood collection timing and handling procedures. Clin Chim Acta 2020; 507:39-53. [PMID: 32272156 DOI: 10.1016/j.cca.2020.03.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 03/24/2020] [Accepted: 03/24/2020] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Blood-based, cancer-associated biomarkers are susceptible to a variety of well-known preanalytical factors. The influence of bowel preparation before a diagnostic colonoscopy on biomarker levels is, however, poorly investigated. The present study assessed the influence of bowel preparation on colorectal cancer-associated biomarkers. In addition, the effect of single versus double centrifugation of plasma biomarkers was assessed. METHODS Blood samples were collected pre- and post-bowel preparation from 125 subjects scheduled for first time diagnostic colonoscopy due to symptoms attributable to CRC. The samples were separated into serum and EDTA plasma, and analyzed by four independent collaborators for: 1) the proteins AFP, CA19-9, CEA, hs-CRP, CyFra21-1, Ferritin, Galectin-3 and TIMP-1, 2) the proteins BAG4, IL6ST, vWF, CD44 and EGFR, 3) the glycoprotein Galectin-3 ligand, and 4) cell-free DNA (cfDNA). Statistical analysis of biomarker data has been performed using mixed modelling, including repeated measures. RESULTS The biomarkers generally showed negligible variation between pre- and post-bowel preparation except for CyFra21-1, Ferritin, BAG4 and cfDNA. CyFra21-1 levels were systematically reduced with 29% (95% CI 21-36%) by bowel preparation (p ≤ 0.0001). Ferritin was not significantly different between pre- and post-bowel preparation (p = 0.07), however the estimated difference (increase) was 18%. BAG4 was systematically reduced by 12% (95% CI 1-22%, p = 0.04), while cfDNA showed a significant increase of 28% (95% CI 17-39%, p < 0.0001). Double centrifugation compared to single centrifugation showed reduced vWF (ratio 0.86, p ≤ 0.0001) and CD44 (ratio 0.85, p = 0.016), but increased IL6ST levels (ratio 1.18, p = 0.014). CONCLUSIONS Results of the present study demonstrated systematic, statistically significant differences between pre-bowel and post-bowel preparation levels for three independent blood-based biomarkers (BAG4, CyFra21-1, cfDNA), illustrating the importance of timing of sample collection for biomarker analyses.
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Affiliation(s)
- Niels Lech Pedersen
- Department of Surgical Gastroenterology, Hvidovre Hospital, Hvidovre, Denmark
| | - Mathias Mertz Petersen
- Department of Surgical Gastroenterology, Hvidovre Hospital, Hvidovre, Denmark. http://www.colorectalcancer.dk
| | - Jon J Ladd
- Translational Research Program, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Paul D Lampe
- Translational Research Program, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Robert S Bresalier
- Department of Gastroenterology, Hepatology & Nutrition, MD Anderson Cancer Center, Houston, TX, USA
| | - Gerard J Davis
- Abbott Laboratories Inc., Cancer Core R&D, Abbott Park, IL, USA
| | - Christina Demuth
- Department of Molecular Medicine, Aarhus University Hospital, Skejby, Denmark
| | - Sarah Ø Jensen
- Department of Molecular Medicine, Aarhus University Hospital, Skejby, Denmark
| | - Claus L Andersen
- Department of Molecular Medicine, Aarhus University Hospital, Skejby, Denmark
| | - Linnea Ferm
- Department of Surgical Gastroenterology, Hvidovre Hospital, Hvidovre, Denmark
| | - Ib J Christensen
- Department of Surgical Gastroenterology, Hvidovre Hospital, Hvidovre, Denmark
| | - Hans J Nielsen
- Department of Surgical Gastroenterology, Hvidovre Hospital, Hvidovre, Denmark; Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Mertz-Petersen M, Piper TB, Kleif J, Ferm L, Christensen IJ, Nielsen HJ. Triage for selection to colonoscopy? Eur J Surg Oncol 2018; 44:1539-1541. [PMID: 30251643 DOI: 10.1016/j.ejso.2018.06.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 06/14/2018] [Indexed: 01/14/2023] Open
Abstract
Implementation of population screening for colorectal cancer by direct colonoscopy or follow-up colonoscopy after a positive fecal blood test has challenged the overall capacity of bowel examinations. Certain countries are facing serious colonoscopy capacity constraints, which have led to waiting lists and long-time latency of follow-up examinations. Various options for improvement are considered, including increased cut-off values of the fecal blood tests. Results from major clinical studies of blood-based, cancer-associated biomarkers have led to focus, however, on a triage concept for improved selection to colonoscopy. The triage test may include subject age, concentration of hemoglobin in a feces test and a combination of certain blood-based cancer associated biomarkers. Recent results have indicated that triage may reduce the requirements for colonoscopy by around 30%. Such results may be advantageous for the capacity, the heath budgets and in particular, the subjects, who do not need an unnecessary, unpleasant and risk-associated bowel examination.
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Affiliation(s)
- Mathias Mertz-Petersen
- Center for Surgical Research, Department of Surgical Gastroenterology, Hvidovre Hospital, Hvidovre, Denmark
| | - Thomas B Piper
- Center for Surgical Research, Department of Surgical Gastroenterology, Hvidovre Hospital, Hvidovre, Denmark
| | - Jakob Kleif
- Center for Surgical Research, Department of Surgical Gastroenterology, Hvidovre Hospital, Hvidovre, Denmark
| | - Linnea Ferm
- Center for Surgical Research, Department of Surgical Gastroenterology, Hvidovre Hospital, Hvidovre, Denmark
| | - Ib Jarle Christensen
- Center for Surgical Research, Department of Surgical Gastroenterology, Hvidovre Hospital, Hvidovre, Denmark
| | - Hans J Nielsen
- Center for Surgical Research, Department of Surgical Gastroenterology, Hvidovre Hospital, Hvidovre, Denmark; Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
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Wilhelmsen M, Christensen IJ, Jørgensen LN, Madsen MR, Vilandt J, Hillig T, Klærke M, Nielsen KT, Laurberg S, Gawel S, Yang X, Davis G, Heijboer AM, Martens F, Nielsen HJ. Clean Colorectum at Diagnostic Colonoscopy: Subsequent Detection of Extracolonic Malignancies by Plasma Protein Biomarkers? BIOMARKERS IN CANCER 2018; 10:1179299X18776974. [PMID: 29872358 PMCID: PMC5977429 DOI: 10.1177/1179299x18776974] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 04/15/2018] [Indexed: 12/20/2022]
Abstract
Introduction Most of the subjects undergoing diagnostic colonoscopy do not have neoplastic bowel lesions. Potentially, some of the symptoms may therefore be caused by extracolonic malignancy, and subjects with persisting symptoms may need subsequent examinations. Blood-based, cancer-associated biomarkers may aid in directing the examinations for other specific malignant diseases. Methods EDTA plasma samples available from a previous prospective study of subjects undergoing diagnostic colonoscopy were used for analysis of 18 protein biomarkers. The study population of 3732 subjects included 400 patients with colorectal cancer (CRC) and 177 patients with extracolonic malignancies. Univariable analysis of the association of specific biomarkers and extracolonic cancers included those with 10 or more cases. Subsequently, reduced models of 4 or 6 biomarkers, respectively, were established by choosing those with the highest likelihood; age and sex were included as well. Results Univariable analyses showed that CyFra21-1 had an area under curve (AUC) of 0.87 for lung cancers (n = 33), CA19-9 had an AUC of 0.85 for pancreatic cancer (n = 22), CA125 had an AUC of 0.95 for ovary cancer (n = 16), B2M had an AUC of 0.81 for non-Hodgkin lymphoma (n = 12), and total prostate-specific antigen had an AUC of 0.99 for prostate cancer (n = 10). The multivariable analysis of 4 or 6 biomarkers plus age and sex as explanatory variables showed AUCs of 0.82 to 0.85 both for extracolonic cancers and CRC. The 4 biomarkers included in the model for detection of extracolonic cancers were CA125, hsCRP, CA19-9, and CyFra21-1; the 2 additional for the 6 biomarkers model were CEA and Galectin-3. Similarly, the 4 biomarkers included in the model for detection of CRC were CEA, CyFra21-1, Ferritin, and HE4; the two additional for the 6 biomarkers model were hsCRP and Pepsinogen 2. Conclusions Results of this study indicate that it may be possible to detect subjects that have an increased risk of extracolonic cancer following a colonoscopy without findings of neoplastic lesions. Combinations of various protein biomarkers may direct subsequent examination after colonoscopy with clean colorectum. The results, although preliminary, may form the basis for additional research directed both for primary examinations of subjects with symptoms of malignancy and subsequent examinations after colonoscopy.
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Affiliation(s)
- Michael Wilhelmsen
- Department of Surgical Gastroenterology, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark
| | - Ib J Christensen
- Department of Surgical Gastroenterology, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark
| | - Lars N Jørgensen
- Department of Surgical Gastroenterology, Bispebjerg Hospital, Copenhagen, Denmark
| | | | - Jesper Vilandt
- Department of Surgery, Hillerød Hospital, Hillerød, Denmark
| | - Thore Hillig
- Department of Clinical Biochemistry, Hillerød Hospital, Hillerød, Denmark
| | - Michael Klærke
- Department of Surgery, Horsens Hospital, Horsens, Denmark
| | - Knud T Nielsen
- Department of Surgery, Randers Hospital, Randers, Denmark
| | - Søren Laurberg
- Department of Surgical Gastroenterology, Aarhus Hospital THG, Aarhus, Denmark
| | - Susan Gawel
- Abbott Cancer Core R&D, Abbott Diagnostics Division, Abbott Park, Chicago, IL, USA
| | - Xiaoping Yang
- Abbott Cancer Core R&D, Abbott Diagnostics Division, Abbott Park, Chicago, IL, USA
| | - Gerard Davis
- Abbott Cancer Core R&D, Abbott Diagnostics Division, Abbott Park, Chicago, IL, USA
| | | | - Frans Martens
- Department of Clinical Chemistry, VUMC, Amsterdam, The Netherlands
| | - Hans J Nielsen
- Department of Surgical Gastroenterology, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark
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Teras LR, Gapstur SM, Maliniak ML, Jacobs EJ, Gansler T, Michel A, Pawlita M, Waterboer T, Campbell PT. Prediagnostic Antibodies to Serum p53 and Subsequent Colorectal Cancer. Cancer Epidemiol Biomarkers Prev 2017; 27:219-223. [PMID: 29254936 DOI: 10.1158/1055-9965.epi-17-0407] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 07/27/2017] [Accepted: 11/22/2017] [Indexed: 11/16/2022] Open
Abstract
Background: The presence of circulating antibodies to the p53 tumor suppressor protein is a potential early detection colorectal cancer biomarker. However, studies of prediagnostic measures of p53 seropositivity in relation to colorectal cancer risk are limited.Methods: We conducted a nested case-control study of serum p53 autoantibodies and risk of colorectal cancer within the Cancer Prevention Study-II Nutrition Cohort. Among cohort participants who were cancer free at the time of blood collection, 392 were subsequently diagnosed with colorectal cancer over 11 years of follow-up. Two controls were matched to each case on birth date, blood draw date, race, and sex. Autoantibodies to p53 were detected in 41 of the 392 cases (10.5%) and 49 of the 774 controls (6.3%).Results: Participants who were seropositive for p53 antibodies before diagnosis were more likely to be subsequently diagnosed with colorectal cancer [RR = 1.77; 95% confidence interval (CI), 1.12-2.78]. This association was strongest within 3 years of diagnosis (RR = 2.26; 95% CI, 1.06-4.83). An association was also suggested when colorectal cancer was diagnosed 4 to <6 years after p53 measurement (RR = 1.84; 95% CI, 0.89-3.79), but not 6 or more years later (RR = 1.15; 95% CI, 0.44-2.99).Conclusions: If these results are confirmed, serum p53 antibodies may be useful on a panel of early detection markers for colorectal cancer.Impact: Individuals who were seropositive for p53 antibodies were twice as likely to develop colorectal cancer within the next 3 years compared with those who were seronegative. This marker is a good candidate for inclusion on an early detection marker panel for colorectal cancer. Cancer Epidemiol Biomarkers Prev; 27(2); 219-23. ©2017 AACR.
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Affiliation(s)
- Lauren R Teras
- Epidemiology Research Program, American Cancer Society, Atlanta, Georgia.
| | - Susan M Gapstur
- Epidemiology Research Program, American Cancer Society, Atlanta, Georgia
| | - Maret L Maliniak
- Epidemiology Research Program, American Cancer Society, Atlanta, Georgia
| | - Eric J Jacobs
- Epidemiology Research Program, American Cancer Society, Atlanta, Georgia
| | - Ted Gansler
- Epidemiology Research Program, American Cancer Society, Atlanta, Georgia
| | - Angelika Michel
- Infection, Inflammation and Cancer Program, German Cancer Research Center (Deutsches Krebsforschungszentrum, DKFZ), Heidelberg, Germany
| | - Michael Pawlita
- Infection, Inflammation and Cancer Program, German Cancer Research Center (Deutsches Krebsforschungszentrum, DKFZ), Heidelberg, Germany
| | - Tim Waterboer
- Infection, Inflammation and Cancer Program, German Cancer Research Center (Deutsches Krebsforschungszentrum, DKFZ), Heidelberg, Germany
| | - Peter T Campbell
- Epidemiology Research Program, American Cancer Society, Atlanta, Georgia
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Soares F, Becker K, Anzanello MJ. A hierarchical classifier based on human blood plasma fluorescence for non-invasive colorectal cancer screening. Artif Intell Med 2017; 82:1-10. [PMID: 28939302 DOI: 10.1016/j.artmed.2017.09.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 08/15/2017] [Accepted: 09/12/2017] [Indexed: 01/06/2023]
Abstract
Colorectal cancer (CRC) a leading cause of death by cancer, and screening programs for its early identification are at the heart of the increasing survival rates. To motivate population participation, non-invasive, accurate, scalable and cost-effective diagnosis methods are required. Blood fluorescence spectroscopy provides rich information that can be used for cancer identification. The main challenges in analyzing blood fluorescence data for CRC classification are related to its high dimensionality and inherent variability, especially when analyzing a small number of samples. In this paper, we present a hierarchical classification method based on plasma fluorescence to identify not only CRC, but also adenomas and other non-malignant colorectal findings that may require further medical investigation. A feature selection algorithm is proposed to deal with the high dimensionality and select discriminant fluorescence wavelengths. These are used to train a binary support vector machine (SVM) in the first level to identify the CRC samples. The remaining samples are then presented to a one-class SVM trained on healthy subjects to detect deviant samples, and thus non-malignant findings. This hierarchical design, together with the one class-SVM, aims to reduce the effects of small samples and high variability. Using a dataset analyzed in previous studies comprised of 12,341 wavelengths, we achieved much superior results. Sensitivity and specificity are 0.87 and 0.95 for CRC detection, and 0.60 and 0.79 for non-malignant findings, respectively. Compared to related work, the proposed method presented a better accuracy, required fewer features, and provides a unified approach that expands CRC detection to non-malignant findings.
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Affiliation(s)
- Felipe Soares
- Institute of Informatics - Universidade Federal do Rio Grande do Sul, Av. Bento Gonçalves, 9500, Porto Alegre, RS, Brazil.
| | - Karin Becker
- Institute of Informatics - Universidade Federal do Rio Grande do Sul, Av. Bento Gonçalves, 9500, Porto Alegre, RS, Brazil.
| | - Michel J Anzanello
- Department of Industrial Engineering - Universidade Federal do Rio Grande do Sul, Av. Osvaldo Aranha, 99-5° andar, Porto Alegre, RS, Brazil.
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Wilhelmsen M, Christensen IJ, Rasmussen L, Jørgensen LN, Madsen MR, Vilandt J, Hillig T, Klaerke M, Nielsen KT, Laurberg S, Brünner N, Gawel S, Yang X, Davis G, Heijboer A, Martens F, Nielsen HJ. Detection of colorectal neoplasia: Combination of eight blood-based, cancer-associated protein biomarkers. Int J Cancer 2017; 140:1436-1446. [PMID: 27935033 DOI: 10.1002/ijc.30558] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 11/08/2016] [Indexed: 12/11/2022]
Abstract
Serological biomarkers may be an option for early detection of colorectal cancer (CRC). The present study assessed eight cancer-associated protein biomarkers in plasma from subjects undergoing first time ever colonoscopy due to symptoms attributable to colorectal neoplasia. Plasma AFP, CA19-9, CEA, hs-CRP, CyFra21-1, Ferritin, Galectin-3 and TIMP-1 were determined in EDTA-plasma using the Abbott ARCHITECT® automated immunoassay platform. Primary endpoints were detection of (i) CRC and high-risk adenoma and (ii) CRC. Logistic regression was performed. Final reduced models were constructed selecting the four biomarkers with the highest likelihood scores. Subjects (N = 4,698) were consecutively included during 2010-2012. Colonoscopy detected 512 CRC patients, 319 colonic cancer and 193 rectal cancer. Extra colonic malignancies were detected in 177 patients, 689 had adenomas of which 399 were high-risk, 1,342 had nonneoplastic bowell disease and 1,978 subjects had 'clean' colorectum. Univariable analysis demonstrated that all biomarkers were statistically significant. Multivariate logistic regression demonstrated that the blood-based biomarkers in combination significantly predicted the endpoints. The reduced model resulted in the selection of CEA, hs-CRP, CyFra21-1 and Ferritin for the two endpoints; AUCs were 0.76 and 0.84, respectively. The postive predictive value at 90% sensitivity was 25% for endpoint 1 and the negative predictive value was 93%. For endpoint 2, the postive predictive value was 18% and the negative predictive value was 97%. Combinations of serological protein biomarkers provided a significant identification of subjects with high risk of the presence of colorectal neoplasia. The present set of biomarkers could become important adjunct in early detection of CRC.
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Affiliation(s)
- Michael Wilhelmsen
- Department of Surgical Gastroenterology, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark
| | - Ib J Christensen
- Department of Surgical Gastroenterology, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark
| | - Louise Rasmussen
- Department of Surgical Gastroenterology, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark
| | - Lars N Jørgensen
- Department of Surgical Gastroenterology, Bispebjerg Hospital, University of Copenhagen, København, Denmark
| | - Mogens R Madsen
- Department of Surgical Gastroenterology, Herning Hospital, University of Copenhagen, Herning, Denmark
| | - Jesper Vilandt
- Department of Surgical Gastroenterology, Hillerød Hospital, University of Copenhagen, Hillerød, Denmark
| | - Thore Hillig
- Department of Clinical Biochemistry, Hillerød Hospital, Denmark
| | - Michael Klaerke
- Department of Surgical Gastroenterology, Horsens Hospital, University of Copenhagen, Horsens, Denmark
| | - Knud T Nielsen
- Department of Surgical Gastroenterology, Randers Hospital, University of Copenhagen, Randers, Denmark
| | - Søren Laurberg
- Department of Surgical Gastroenterology, Aarhus Hospital, University of Copenhagen, Aarhus, Denmark
| | - Nils Brünner
- Department of Veterinary Disease Biology, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Susan Gawel
- Cancer Core R&D, Abbott Diagnostics Division, Abbott Park, Chicago, IL, USA
| | - Xiaoqing Yang
- Cancer Core R&D, Abbott Diagnostics Division, Abbott Park, Chicago, IL, USA
| | - Gerard Davis
- Cancer Core R&D, Abbott Diagnostics Division, Abbott Park, Chicago, IL, USA
| | - Annemieke Heijboer
- Department of Clinical Biochemistry, VU medical center, Amsterdam, The Netherlands
| | - Frans Martens
- Department of Clinical Biochemistry, VU medical center, Amsterdam, The Netherlands
| | - Hans J Nielsen
- Department of Surgical Gastroenterology, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark
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Rasmussen L, Wilhelmsen M, Christensen IJ, Andersen J, Jørgensen LN, Rasmussen M, Hendel JW, Madsen MR, Vilandt J, Hillig T, Klærke M, Münster AMB, Andersen LM, Andersen B, Hornung N, Erlandsen EJ, Khalid A, Nielsen HJ. Protocol Outlines for Parts 1 and 2 of the Prospective Endoscopy III Study for the Early Detection of Colorectal Cancer: Validation of a Concept Based on Blood Biomarkers. JMIR Res Protoc 2016; 5:e182. [PMID: 27624815 PMCID: PMC5039335 DOI: 10.2196/resprot.6346] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 08/12/2016] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Programs for population screening of colorectal cancer (CRC) have been implemented in several countries with fecal immunochemical testing (FIT) as the preferred platform. However, the major obstacle for a feces-based testing method is the limited compliance that reduces the clinical sensitivity for detection of participants with non-symptomatic CRC. Therefore, research approaches have been initiated to develop screening concepts based on biomarkers in blood. Preliminary results show that protein, genetic, epigenetic, and metabolomic components may be valuable in blood-based screening concepts, particularly when combinations of the various components appear to lead to significant improvements. OBJECTIVES The protocol described in this paper focuses on the validation of concepts based on biomarkers in blood in a major population screened by FIT. METHODS In Part 1, participants will be identified and included through the Danish CRC Screening Program comprising initial FIT and subsequent colonoscopy to those with a positive result. Blood samples will be collected from 8000 FIT-positive participants, who are offered subsequent colonoscopy. Findings and interventions at colonoscopy together with personal data including co-morbidity will be recorded. Blood samples and data will also be collected from 6000 arbitrarily chosen participants with negative FIT. In Part 2, blood samples and data will be collected from 30,000 FIT-negative participants three times within 4 years. The blood samples will be analyzed using various in-house and commercially available manual and automated analysis platforms. RESULTS We anticipate Part 1 to terminate late August 2016 and Part 2 to terminate late September 2022. The results from Parts 1 and 2 will be presented within 12 to 18 months from termination. CONCLUSIONS The purpose of this study is to improve the efficacy of identifying participants with neoplastic bowel lesions, to identify false negative participants, to identify participants at risk of interval neoplastic lesions, to improve the compliance in screening sessions, and to establish guidelines for out-patient follow-up of at-risk participants based on combinations of blood-based biomarkers.
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Affiliation(s)
- Louise Rasmussen
- Department of Surgical Gastroenterology, Hvidovre Hospital, Hvidovre, Denmark.
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Ostenfeld MS, Jensen SG, Jeppesen DK, Christensen LL, Thorsen SB, Stenvang J, Hvam ML, Thomsen A, Mouritzen P, Rasmussen MH, Nielsen HJ, Ørntoft TF, Andersen CL. miRNA profiling of circulating EpCAM(+) extracellular vesicles: promising biomarkers of colorectal cancer. J Extracell Vesicles 2016; 5:31488. [PMID: 27576678 PMCID: PMC5005366 DOI: 10.3402/jev.v5.31488] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 06/14/2016] [Accepted: 07/14/2016] [Indexed: 01/06/2023] Open
Abstract
Cancer cells secrete small membranous extracellular vesicles (EVs) into their microenvironment and circulation. These contain biomolecules, including proteins and microRNAs (miRNAs). Both circulating EVs and miRNAs have received much attention as biomarker candidates for non-invasive diagnostics. Here we describe a sensitive analytical method for isolation and subsequent miRNA profiling of epithelial-derived EVs from blood samples of patients with colorectal cancer (CRC). The epithelial-derived EVs were isolated by immunoaffinity-capture using the epithelial cell adhesion molecule (EpCAM) as marker. This approach mitigates some of the specificity issues observed in earlier studies of circulating miRNAs, in particular the negative influence of miRNAs released by erythrocytes, platelets and non-epithelial cells. By applying this method to 2 small-scale patient cohorts, we showed that blood plasma isolated from CRC patients prior to surgery contained elevated levels of 13 EpCAM+-EV miRNAs compared with healthy individuals. Upon surgical tumour removal, the plasma levels of 8 of these were reduced (miR-16-5p, miR-23a-3p, miR-23b-3p, miR-27a-3p, miR-27b-3p, miR-30b-5p, miR-30c-5p and miR-222-3p). These findings indicate that the miRNAs are of tumour origin and may have potential as non-invasive biomarkers for detection of CRC. This work describes a non-invasive blood-based method for sensitive detection of cancer with potential for clinical use in relation to diagnosis and screening. We used the method to study CRC; however, it is not restricted to this disease. It may in principle be used to study any cancer that release epithelial-derived EVs into circulation.
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Affiliation(s)
| | - Steffen Grann Jensen
- Department of Molecular Medicine (MOMA), Aarhus University Hospital, Aarhus, Denmark
| | | | | | - Stine Buch Thorsen
- Department of Veterinary Disease Biology, University of Copenhagen, Copenhagen, Denmark
| | - Jan Stenvang
- Department of Veterinary Disease Biology, University of Copenhagen, Copenhagen, Denmark
| | - Michael Lykke Hvam
- Interdisciplinary Nanoscience Center (iNANO), Department of Molecular Biology and Genetics, Aarhus University, Aarhus, Denmark
| | | | | | | | - Hans Jørgen Nielsen
- Department of Surgical Gastroenterology 360, Hvidovre Hospital, Hvidovre, Denmark
| | - Torben Falck Ørntoft
- Department of Molecular Medicine (MOMA), Aarhus University Hospital, Aarhus, Denmark
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Blume JE, Wilhelmsen M, Benz RW, Brünner N, Christensen IJ, Croner LJ, Dillon R, Hillig T, Jones JJ, Jørgensen LN, Kao A, Klaerke M, Laurberg S, Madsen MR, Nielsen KT, Vilandt J, Wilcox BE, You J, Nielsen HJ. Discovery and Validation of Plasma-Protein Biomarker Panels for the Detection of Colorectal Cancer and Advanced Adenoma in a Danish Collection of Samples from Patients Referred for Diagnostic Colonoscopy. ACTA ACUST UNITED AC 2016; 1:181-193. [DOI: 10.1373/jalm.2016.020271] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 06/21/2016] [Indexed: 11/06/2022]
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11
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Teixeira Y, Lima JM, Souza MLAPO, Aguiar P, Silva TD, Forones NM. HUMAN DNA QUANTIFICATION IN THE STOOLS OF PATIENTS WITH COLORECTAL CANCER. ARQUIVOS DE GASTROENTEROLOGIA 2016; 52:293-8. [PMID: 26840470 DOI: 10.1590/s0004-28032015000400008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 08/18/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Colorectal cancer is one of the main cause of cancer in the world. Colonoscopy is the best screen method, however the compliance is less than 50%. Quantification of human DNA (hDNA) in the feces may be a possible screen non-invasive method that is a consequence of the high proliferation and exfoliation of cancer cells. OBJECTIVE To quantify the human DNA in the stools of patients with colorectal cancer or polyps. METHODS Fifty patients with CRC, 26 polyps and 53 with normal colonoscopy were included. Total and human DNA were analyzed from the frozen stools. RESULTS An increased concentration of hDNA in the stools was observed in colorectal cancer patients compared to controls and polyps. Tumors localized in the left side of the colon had higher concentrations of hDNA. There were no difference between polyps and controls. A cut off of 0.87 ng/mL of human DNA was determined for colorectal cancer patients by the ROC curve, with a sensitivity of 66% and a specificity of 86.8%. For polyps the cut off was 0.41, the sensitivity was 41% and the specificity 77.4%. CONCLUSION A higher concentration of hDNA had been found in colorectal cancer patients The quantification of hDNA from the stools can be a trial method for the diagnosis of colorectal cancer.
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Affiliation(s)
| | | | | | - Pedro Aguiar
- Universidade Federal de São Paulo, São Paulo, SP, Brasil
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12
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Rasmussen L, Herzog M, Rømer E, Micallef J, Bulut O, Wilhelmsen M, Christensen IJ, Nielsen HJ. Pre-analytical variables of circulating cell-free nucleosomes containing 5-methylcytosine DNA or histone modification H3K9Me3. Scandinavian Journal of Clinical and Laboratory Investigation 2016; 76:448-53. [PMID: 27291394 DOI: 10.1080/00365513.2016.1190862] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
AIM To evaluate pre-analytical variables of circulating cell-free nucleosomes containing 5-methylcytosine DNA (5mC) or histone modification H3K9Me3 (H3K9Me3). MATERIALS AND METHODS Six studies were designed to assess the possible influence of pre-analytical variables. Study 1: influence of stasis and contamination with white-cells and platelets. Study 2: influence of within-day variations. Study 3: influence of day-to-day variation. Study 4: influence of temperature during handling and storage, and of neoplastic disease. Study 5: influence of colonoscopy. Study 6: influence of the surgical trauma. 5mC and H3K9Me3 measurements were performed using enzyme-linked immunosorbent assays. RESULTS Stasis, white-cell and platelet contamination, within-day variations, varying storage time before centrifugation, colonoscopy, and surgical trauma had no significant influence on levels of 5mC or H3K9Me3. Day-to-day variations of 12.7% and 11.5% (intra-individual) and 98.1% and 60.8% (inter-individual) were shown for 5mC and H3K9Me3, respectively. Levels of 5mC or H3K9Me3 were significantly higher in samples stored at room temperature until centrifugation compared to samples stored on ice. Patients with cancer had significantly lower levels of 5mC or H3K9Me3 compared to levels in healthy individuals. CONCLUSION Levels of 5mC or H3K9Me3 appear stable in most pre-analytical settings if blood samples are stored at room temperature until centrifugation.
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Affiliation(s)
- Louise Rasmussen
- a Department of Surgical Gastroenterology , Hvidovre Hospital, University of Copenhagen , Hvidovre , Denmark
| | - Marielle Herzog
- b Belgian Volition SA, Rue du Séminaire 20A, Centre Technologique , Namur , Belgium
| | - Eva Rømer
- a Department of Surgical Gastroenterology , Hvidovre Hospital, University of Copenhagen , Hvidovre , Denmark
| | - Jake Micallef
- b Belgian Volition SA, Rue du Séminaire 20A, Centre Technologique , Namur , Belgium
| | - Orhan Bulut
- a Department of Surgical Gastroenterology , Hvidovre Hospital, University of Copenhagen , Hvidovre , Denmark ;,c Institute of Clinical Medicine, University of Copenhagen , Copenhagen , Denmark
| | - Michael Wilhelmsen
- a Department of Surgical Gastroenterology , Hvidovre Hospital, University of Copenhagen , Hvidovre , Denmark
| | - Ib Jarle Christensen
- a Department of Surgical Gastroenterology , Hvidovre Hospital, University of Copenhagen , Hvidovre , Denmark
| | - Hans J Nielsen
- a Department of Surgical Gastroenterology , Hvidovre Hospital, University of Copenhagen , Hvidovre , Denmark ;,c Institute of Clinical Medicine, University of Copenhagen , Copenhagen , Denmark
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Ørntoft MBW, Nielsen HJ, Ørntoft TF, Andersen CL. Performance of the colorectal cancer screening marker Sept9 is influenced by age, diabetes and arthritis: a nested case-control study. BMC Cancer 2015; 15:819. [PMID: 26514170 PMCID: PMC4625973 DOI: 10.1186/s12885-015-1832-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 10/16/2015] [Indexed: 02/06/2023] Open
Abstract
Background Annually, colorectal cancer (CRC) is diagnosed in >1.4 million subjects worldwide and incidence is increasing. Much effort has therefore been focused on screening, which has proven to reduce cancer-related mortality. The Sept9 DNA-methylation assay is among the most well studied blood-based screening markers. However, earlier reported performances may be misleading: the Sept9 test was recently examined in two screening based cohorts and yielded performances lower than expected. We hypothesize that comorbidities and/or demographic characteristics affect the results of the Sept9 test. Methods Using a retrospective nested case–control study design, we studied plasma from 150 cancer and 150 controls selected from a well-characterized cohort of 4698 subjects referred for diagnostic colonoscopy due to CRC-related symptoms. The cases and controls were matched on age and gender, and moreover cases were stratified on tumor-site and tumor-stage. The selected cohort included a wide range of comorbidities. Plasma Sept9 levels were assessed using a commercially available PCR based assay (Epi-proColon). Results Clinical sensitivity for CRC stages I-IV was 37 %, 91 %, 77 %, and 89 %, and the overall sensitivity 73 % (95 % CI, 64–80 %) and specificity 82 % (95 % CI, 75–88 %), respectively. Age >65 was associated with both increased false positive and false negative results (p < 0.05). Arthritis was associated with a higher false negative rate (p = 0.005) whereas Arteriosclerosis was associated with a higher false positive rate (p = 0.007). Diabetes was associated with Sept9 positivity with an OR of 5.2 (95 % CI 1.4–19.1). When the performance of Sept9 was adjusted for these parameters in a final multivariate regression model, the OR for a positive Sept9 test to be associated with CRC increased from 8.25 (95 % CI 4.83–14.09) to 29.46 (95 % CI 12.58–69.02). Conclusions The results indicate that the performance of the Sept9 assay is negatively affected by several factors commonly associated with CRC screening populations: early-stage disease, age > 65 years, diabetes, arthritis, and arteriosclerosis. This should be taken into account if the Sept9 assay is used as a single marker for CRC screening, but may also have a wider impact, as it is likely that such factors may affect other blood based DNA markers as well. Electronic supplementary material The online version of this article (doi:10.1186/s12885-015-1832-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mai-Britt W Ørntoft
- Department of Molecular Medicine, MOMA, Aarhus University Hospital, Skejby, DK-8200, Aarhus N, Denmark.
| | - Hans J Nielsen
- Department of Surgical Gastroenterology 360, Hvidovre Hospital, University of Copenhagen, DK-2650, Hvidovre, Denmark.
| | - Torben F Ørntoft
- Department of Molecular Medicine, MOMA, Aarhus University Hospital, Skejby, DK-8200, Aarhus N, Denmark.
| | - Claus L Andersen
- Department of Molecular Medicine, MOMA, Aarhus University Hospital, Skejby, DK-8200, Aarhus N, Denmark.
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14
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Kring TS, Piper TB, Jørgensen LN, Olsen J, Rahr HB, Nielsen KT, Laurberg S, Davis G, Dowell B, Johansen JS, Christensen IJ, Brünner N, Nielsen HJ. Blood-based Biomarkers at Large Bowel Endoscopy and Prediction of Future Malignancies. BIOMARKERS IN CANCER 2015; 7:57-61. [PMID: 26526637 PMCID: PMC4620935 DOI: 10.4137/bic.s31330] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 09/03/2015] [Accepted: 09/09/2015] [Indexed: 12/11/2022]
Abstract
Soluble cancer-related protein biomarker levels may be increased in subjects without findings at large bowel endoscopy performed due to symptoms associated with colorectal cancer. The present study focused on a possible association between increased biomarker levels in such subjects and subsequent development of malignant diseases. In a major study of 4,990 subjects undergoing large bowel endoscopy, 691 were without pathology and comorbidity. Plasma levels of TIMP-1, CEA, CA19-9, and YKL-40 were determined in samples collected just before endoscopy and compared with subsequent development of a malignant disease within a period of 7-8 years. The upper 90% limits of the reference levels of every single protein were used to differentiate between normal and increased levels. The levels were separated into three groups: 0, none of the biomarkers increased; 1, one biomarker increased; 2, two or more biomarkers increased. A total of 43 subjects developed a primary malignant disease in the observation period. Univariatly, increase of all four biomarkers was significantly associated with subsequent development of a malignant disease. A multivariate analysis showed that increased biomarker levels were associated with subsequent development of a malignant disease (P = 0.002). The cumulative risk of developing malignant disease within the first 5 years after endoscopy was group 0, 3.3%; group 1, 5.8%; group 2, 7.8%. It is concluded that increased levels of plasma TIMP-1, CEA, CA19-9, and serum YKL-40 at large bowel endoscopy without findings may be associated with an increased risk of developing a subsequent malignant disease.
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Affiliation(s)
- Thomas S Kring
- Department of Surgical Gastroenterology, Hvidovre Hospital, Hvidovre, Denmark
| | - Thomas B Piper
- Department of Surgical Gastroenterology, Hvidovre Hospital, Hvidovre, Denmark
| | - Lars N Jørgensen
- Digestive Disease Center, Bispebjerg Hospital, Copenhagen, Denmark. ; Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jesper Olsen
- Department of Surgical Gastroenterology, Glostrup Hospital, Glostrup, Denmark
| | - Hans B Rahr
- Department of Surgical Gastroenterology, Odense University Hospital, Odense, Denmark
| | - Knud T Nielsen
- Department of Surgery, Randers Hospital, Randers, Denmark
| | - Søren Laurberg
- Department of Surgical Gastroenterology, Aarhus Hospital THG, Aarhus, Denmark
| | | | | | | | - Ib J Christensen
- Department of Surgical Gastroenterology, Hvidovre Hospital, Hvidovre, Denmark
| | - Nils Brünner
- Institute of Veterinary Disease Biology, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg, Denmark
| | - Hans J Nielsen
- Department of Surgical Gastroenterology, Hvidovre Hospital, Hvidovre, Denmark. ; Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Bresalier RS, Kopetz S, Brenner DE. Blood-based tests for colorectal cancer screening: do they threaten the survival of the FIT test? Dig Dis Sci 2015; 60:664-71. [PMID: 25680874 DOI: 10.1007/s10620-015-3575-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 01/31/2015] [Indexed: 02/06/2023]
Abstract
Colorectal cancer is the second leading cause of cancer death in industrialized nations, accounting for 10% of the total cancer burden with an individual lifetime risk of ~6% in the USA (Siegel et al. in CA Cancer J Clin 62:9-29, 2014, American Cancer Society in Colorectal cancer facts and figures 2011-2013. American Cancer Society, Atlanta, 2011, Siegel et al. in CA Cancer J Clin 61:212-236, 2011). Although numerous screening methods have been incorporated into guidelines for colorectal cancer screening, no guideline includes a noninvasive blood-based test as a recommended option.
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Affiliation(s)
- Robert S Bresalier
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1466, Houston, TX, 77030, USA,
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Storm L, Christensen IJ, Jensenius JC, Nielsen HJ, Thiel S. Evaluation of complement proteins as screening markers for colorectal cancer. Cancer Immunol Immunother 2015; 64:41-50. [PMID: 25261356 PMCID: PMC11028411 DOI: 10.1007/s00262-014-1615-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 09/17/2014] [Indexed: 01/28/2023]
Abstract
BACKGROUND Colorectal cancer (CRC) is a leading cause of cancer death worldwide. Lack of symptoms results in late detection and increased mortality. Inflammation, including complement activation, plays an important role in tumorigenesis. EXPERIMENTAL DESIGN The concentrations of nine proteins of the lectin pathway of the complement system were determined using time-resolved immunofluorometric assays. The first cohort investigated comprised a matched case-control study of 95 patients with CRC, 48 patients with adenomas and 48 individuals without neoplastic findings. Based on the results, Collectin-liver 1 (CL-L1), M-ficolin and MAp44 were determined as the most promising biomarkers and were subsequently evaluated in a case-control study of 99 CRC patients, 196 patients with adenomas and 696 individuals without neoplastic bowel lesions. RESULTS Using logistic regression, we found that CL-L1, M-ficolin and MAp44 levels could significantly distinguish between patients with CRC, patients with adenomas and individuals without neoplastic bowel lesions. Higher levels of CL-L1 or MAp44 were associated with lower odds of CRC (OR 0.42 (0.25-0.70) p = 0.0003 and OR 0.39 (0.23-0.65) p = 0.0003, respectively), whereas higher levels of M-ficolin were associated with higher odds of CRC compared to individuals without CRC (OR 1.94 (1.46-2.59) p < 0.0001). The combination of CL-L1, M-ficolin and MAp44 in a test of CRC versus individuals without CRC resulted in 36 % sensitivity at 83 % specificity. CONCLUSION CL-L1, M-ficolin and MAp44 in combination discriminate between CRC and patients without cancer. The markers did not have sufficient discriminatory value for CRC detection, but may prove useful for screening when combined with other markers.
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Affiliation(s)
- Line Storm
- Department of Biomedicine, Faculty of Health Sciences, Aarhus University, Wilhelm Meyers Allé 4, Aarhus C, Denmark
| | - Ib J. Christensen
- Finsen Laboratory, Rigshospitalet and Biotech Research and Innovation Center (BRIC), University of Copenhagen, Copenhagen, Denmark
| | - Jens C. Jensenius
- Department of Biomedicine, Faculty of Health Sciences, Aarhus University, Wilhelm Meyers Allé 4, Aarhus C, Denmark
| | - Hans J. Nielsen
- Department of Surgical Gastroenterology, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark
| | - Steffen Thiel
- Department of Biomedicine, Faculty of Health Sciences, Aarhus University, Wilhelm Meyers Allé 4, Aarhus C, Denmark
| | - the Danish Study Group on Early Detection of Colorectal Cancer
- Department of Biomedicine, Faculty of Health Sciences, Aarhus University, Wilhelm Meyers Allé 4, Aarhus C, Denmark
- Finsen Laboratory, Rigshospitalet and Biotech Research and Innovation Center (BRIC), University of Copenhagen, Copenhagen, Denmark
- Department of Surgical Gastroenterology, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark
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17
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Kurlapska A, Serrano-Fernández P, Baszuk P, Gupta S, Starzyńska T, Małecka-Panas E, Dabrowski A, Dębniak T, Kurzawski G, Suchy J, Rogoza-Mateja W, Scott RJ, Lubiński J. Cumulative effects of genetic markers and the detection of advanced colorectal neoplasias by population screening. Clin Genet 2014; 88:234-40. [PMID: 25117299 DOI: 10.1111/cge.12481] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 07/25/2014] [Accepted: 08/05/2014] [Indexed: 01/12/2023]
Abstract
Genetic markers associated with colorectal cancer may be used in population screening for the early identification of patients at elevated risk of disease. We genotyped 3059 individuals with no cancer family history for eight markers previously associated with colorectal cancer. After colonoscopy, the genetic profile of cases with advanced colorectal neoplasia (213) was compared with the rest (2846). rs2066847 and rs6983267 were significantly associated with the risk of advanced colorectal neoplasia but with limited effect on their own [odds ratio (OR) 1.59; 95% confidence interval (CI) 1.02-2.41; p = 0.033 and OR 1.45; 95% CI 1.02-2.12; p = 0.044, respectively]. Cumulative effects, in contrast, were associated with high risk: the combination of rs2066847, rs6983267, rs4779584, rs3802842 and rs4939827 minimized the number of markers considered, while maximizing the relative size of the carrier group and the risk associated to it, for example, for at least two cumulated risk markers, OR is 2.57 (95% CI 1.50-4.71; corrected p-value 0.0079) and for three or more, OR is 3.57 (95% CI 1.91-6.96; corrected p-value 0.00074). The identification of cumulative models of - otherwise - low-risk markers could be valuable in defining risk groups, within an otherwise low-risk population (no cancer family history).
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Affiliation(s)
- A Kurlapska
- Department of Genetics, Pomeranian Medical University, Szczecin, Poland
| | | | - P Baszuk
- Department of Genetics, Pomeranian Medical University, Szczecin, Poland
| | - S Gupta
- Department of Genetics, Pomeranian Medical University, Szczecin, Poland
| | - T Starzyńska
- Department of Gastroenterology, Pomeranian Medical University, Szczecin, Poland
| | - E Małecka-Panas
- Department of Digestive Tract Diseases, Faculty of Medicine, Medical University of Łódź, Łódź, Poland
| | - A Dabrowski
- Department of Gastroenterology and Internal Medicine, Medical University of Białystok, Białystok, Poland
| | - T Dębniak
- Department of Genetics, Pomeranian Medical University, Szczecin, Poland
| | - G Kurzawski
- Department of Genetics, Pomeranian Medical University, Szczecin, Poland
| | - J Suchy
- Department of Genetics, Pomeranian Medical University, Szczecin, Poland
| | - W Rogoza-Mateja
- Department of Gastroenterology, Pomeranian Medical University, Szczecin, Poland
| | - R J Scott
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, Australia
| | - J Lubiński
- Department of Genetics, Pomeranian Medical University, Szczecin, Poland
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Abstract
Colorectal cancer is associated with diabetes mellitus and both of these common conditions are often managed together by a surgeon. The surgical focus is usually upon cancer treatment rather than diabetes management. The relationship between colorectal cancer and diabetes is a complex one and can raise problems in both diagnosis and the management of patients with both conditions. This literature review explores the relationship between diabetes, diabetic treatment and colorectal cancer and addresses the issues that arise in diagnosing and treating this patient group. By highlighting these difficulties, this review aims to improve understanding and to provide clearer insight into both surgical and non-surgical management.
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Thorsen SB, Lundberg M, Villablanca A, Christensen SLT, Belling KC, Nielsen BS, Knowles M, Gee N, Nielsen HJ, Brünner N, Christensen IJ, Fredriksson S, Stenvang J, Assarsson E. Detection of serological biomarkers by proximity extension assay for detection of colorectal neoplasias in symptomatic individuals. J Transl Med 2013; 11:253. [PMID: 24107468 PMCID: PMC3827929 DOI: 10.1186/1479-5876-11-253] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Accepted: 09/28/2013] [Indexed: 12/13/2022] Open
Abstract
Background Although the potential of biomarkers to aid in early detection of colorectal cancer (CRC) is recognized and numerous biomarker candidates have been reported in the literature, to date only few molecular markers have been approved for daily clinical use. Methods In order to improve the translation of biomarkers from the bench to clinical practice we initiated a biomarker study focusing on a novel technique, the proximity extension assay, with multiplexing capability and the possible additive effect obtained from biomarker panels. We performed a screening of 74 different biomarkers in plasma derived from a case–control sample set consisting of symptomatic individuals representing CRC patients, patients with adenoma, patients with non-neoplastic large bowel diseases and healthy individuals. Results After statistical evaluation we found 12 significant indicators of CRC and the receiver operating characteristic (ROC) curve of Carcinoembryonic antigen (CEA), Transferrin Receptor-1 (TFRC), Macrophage migration inhibitory factor (MIF), Osteopontin (OPN/SPP1) and cancer antigen 242 (CA242) showed additive effect. This biomarker panel identified CRC patients with a sensitivity of 56% at 90% specificity and thus the performance is sufficiently high to further investigate this combination of five proteins as serological biomarkers for detection of CRC. Furthermore, when applying the indicators to identify early-stage CRC a combination of CEA, TFRC and CA242 resulted in a ROC curve with an area under the curve of 0.861. Conclusions Five plasma protein biomarkers were found to be potential CRC discriminators and three of these were additionally found to be discriminators of early-stage CRC. These explorative data in symptomatic individuals demonstrates the feasibility of the multiplex proximity extension assay for screening of potential serological protein biomarkers and warrants independent analyses in a larger sample cohort, including asymptomatic individuals, to further validate the performances of our CRC biomarker panel.
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Affiliation(s)
- Stine Buch Thorsen
- Department of Veterinary Disease Biology, Faculty of Health and Medical Sciences, University of Copenhagen, Strandboulevarden 49, DK-2100, Copenhagen, Denmark.
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20
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Jenab-Wolcott J, Giantonio B. The Continuum of Care in Chemotherapy Approach to Metastatic Colorectal Cancer. CURRENT COLORECTAL CANCER REPORTS 2013. [DOI: 10.1007/s11888-013-0178-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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21
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Bro R, Nielsen HJ, Savorani F, Kjeldahl K, Christensen IJ, Brünner N, Lawaetz AJ. Data fusion in metabolomic cancer diagnostics. Metabolomics 2013; 9:3-8. [PMID: 23335866 PMCID: PMC3548087 DOI: 10.1007/s11306-012-0446-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Accepted: 07/03/2012] [Indexed: 11/16/2022]
Abstract
We have recently shown that fluorescence spectroscopy of plasma samples has promising abilities regarding early detection of colorectal cancer. In the present paper, these results were further developed by combining fluorescence with the biomarkers, CEA and TIMP-1 and traditional metabolomic measurements in the form of (1)H NMR spectroscopy. The results indicate that using an extensive profile established by combining such measurements together with the biomarkers is better than using single markers.
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Affiliation(s)
- Rasmus Bro
- Department of Food Science, University of Copenhagen, Rolighedsvej 30, Frederiksberg, 1958 Copenhagen, Denmark
| | - Hans Jørgen Nielsen
- Department of Surgical Gastroenterology, Copenhagen University Hospital, Hvidovre, Denmark
| | - Francesco Savorani
- Department of Food Science, University of Copenhagen, Rolighedsvej 30, Frederiksberg, 1958 Copenhagen, Denmark
| | - Karin Kjeldahl
- Department of Food Science, University of Copenhagen, Rolighedsvej 30, Frederiksberg, 1958 Copenhagen, Denmark
| | - Ib Jarle Christensen
- The Finsen Laboratory, Rigshospitalet, Copenhagen Biocenter, Copenhagen, Denmark and Biotech Research and Innovation Centre (BRIC), University of Copenhagen, Copenhagen, Denmark
| | - Nils Brünner
- Department of Veterinary Disease Biology, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg, 1870 Copenhagen, Denmark
| | - Anders Juul Lawaetz
- Department of Food Science, University of Copenhagen, Rolighedsvej 30, Frederiksberg, 1958 Copenhagen, Denmark
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22
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Pedersen JW, Gentry-Maharaj A, Fourkala EO, Dawnay A, Burnell M, Zaikin A, Pedersen AE, Jacobs I, Menon U, Wandall HH. Early detection of cancer in the general population: a blinded case-control study of p53 autoantibodies in colorectal cancer. Br J Cancer 2012; 108:107-14. [PMID: 23169294 PMCID: PMC3553520 DOI: 10.1038/bjc.2012.517] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background: Recent reports from cancer screening trials in high-risk populations suggest that autoantibodies can be detected before clinical diagnosis. However, there is minimal data on the role of autoantibody signatures in cancer screening in the general population. Methods: Informative p53 peptides were identified in sera from patients with colorectal cancer using an autoantibody microarray with 15-mer overlapping peptides covering the complete p53 sequence. The selected peptides were evaluated in a blinded case–control study using stored serum from the multimodal arm of the United Kingdom Collaborative Trial of Ovarian Cancer Screening where women gave annual blood samples. Cases were postmenopausal women who developed colorectal cancer following recruitment, with 2 or more serum samples preceding diagnosis. Controls were age-matched women with no history of cancer. Results: The 50 640 women randomised to the multimodal group were followed up for a median of 6.8 (inter-quartile range 5.9–8.4) years. Colorectal cancer notification was received in 101 women with serial samples of whom 97 (297 samples) had given consent for secondary studies. They were matched 1 : 1 with 97 controls (296 serial samples). The four most informative peptides identified 25.8% of colorectal cancer patients with a specificity of 95%. The median lead time was 1.4 (range 0.12–3.8) years before clinical diagnosis. Conclusion: Our findings suggest that in the general population, autoantibody signatures are detectable during preclinical disease and may be of value in cancer screening. In colorectal cancer screening in particular, where the current need is to improve compliance, it suggests that p53 autoantibodies may contribute towards risk stratification.
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Affiliation(s)
- J W Pedersen
- Copenhagen Center for Glycomics, Department of Cellular and Molecular Medicine, University of Copenhagen, Copenhagen N, DK-2200, Denmark
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