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Zhou D, Chen Y, Wang Z, Zhu S, Zhang L, Song J, Bai T, Hou X. Integrating clinical and cross-cohort metagenomic features: a stable and non-invasive colorectal cancer and adenoma diagnostic model. Front Mol Biosci 2024; 10:1298679. [PMID: 38455360 PMCID: PMC10919151 DOI: 10.3389/fmolb.2023.1298679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 11/24/2023] [Indexed: 03/09/2024] Open
Abstract
Background: Dysbiosis is associated with colorectal cancer (CRC) and adenomas (CRA). However, the robustness of diagnostic models based on microbial signatures in multiple cohorts remains unsatisfactory. Materials and Methods: In this study, we used machine learning models to screen metagenomic signatures from the respective cross-cohort datasets of CRC and CRA (selected from CuratedMetagenomicData, each disease included 4 datasets). Then select a CRC and CRA data set from the CuratedMetagenomicData database and meet the requirements of having both metagenomic data and clinical data. This data set will be used to verify the inference that integrating clinical features can improve the performance of microbial disease prediction models. Results: After repeated verification, we selected 20 metagenomic features that performed well and were stably expressed within cross-cohorts to represent the diagnostic role of bacterial communities in CRC/CRA. The performance of the selected cross-cohort metagenomic features was stable for multi-regional and multi-ethnic populations (CRC, AUC: 0.817-0.867; CRA, AUC: 0.766-0.833). After clinical feature combination, AUC of our integrated CRC diagnostic model reached 0.939 (95% CI: 0.932-0.947, NRI=30%), and that of the CRA integrated model reached 0.925 (95%CI: 0.917-0.935, NRI=18%). Conclusion: In conclusion, the integrated model performed significantly better than single microbiome or clinical feature models in all cohorts. Integrating cross-cohort common discriminative microbial features with clinical features could help construct stable diagnostic models for early non-invasive screening for CRC and CRA.
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Affiliation(s)
- Dan Zhou
- Division of Gastroenterology, Union Hospital, Tongji Medical College Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Youli Chen
- State Key Laboratory for Oncogenes and Related Genes, NHC Key Laboratory of Digestive Diseases, Division of Gastroenterology and Hepatology, Shanghai Institute of Digestive Disease, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zehao Wang
- School of Management, Huazhong University of Science and Technology, Wuhan, China
| | - Siran Zhu
- Division of Gastroenterology, Union Hospital, Tongji Medical College Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lei Zhang
- Division of Gastroenterology, Union Hospital, Tongji Medical College Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jun Song
- Division of Gastroenterology, Union Hospital, Tongji Medical College Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tao Bai
- Division of Gastroenterology, Union Hospital, Tongji Medical College Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaohua Hou
- Division of Gastroenterology, Union Hospital, Tongji Medical College Medical College, Huazhong University of Science and Technology, Wuhan, China
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Ustjanzew A, Sencio V, Trottein F, Faber J, Sandhoff R, Paret C. Interaction between Bacteria and the Immune System for Cancer Immunotherapy: The α-GalCer Alliance. Int J Mol Sci 2022; 23:ijms23115896. [PMID: 35682578 PMCID: PMC9180740 DOI: 10.3390/ijms23115896] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 05/19/2022] [Accepted: 05/22/2022] [Indexed: 11/25/2022] Open
Abstract
Non-conventional T cells, such as γδ T and invariant natural killer T (iNKT) cells, are emerging players in fighting cancer. Alpha-galactosylceramide (α-GalCer) is used as an exogenous ligand to activate iNKT cells. Human cells don’t have a direct pathway producing α-GalCer, which, however, can be produced by bacteria. We searched the literature for bacteria strains that are able to produce α-GalCer and used available sequencing data to analyze their presence in human tumor tissues and their association with survival. The modulatory effect of antibiotics on the concentration of α-GalCer was analyzed in mice. The human gut bacteria Bacteroides fragilis, Bacteroides vulgatus, and Prevotella copri produce α-GalCer structures that are able to activate iNKT cells. In mice, α-GalCer was depleted upon treatment with vancomycin. The three species were detected in colon adenocarcinoma (COAD) and rectum adenocarcinoma tissues, and Prevotella copri was also detected in bone tumors and glioblastoma tissues. Bacteroides vulgatus in COAD tissues correlated with better survival. In conclusion, α-GalCer-producing bacteria are part of the human gut microbiome and can infiltrate tumor tissues. These results suggest a new mechanism of interaction between bacteria and immune cells: α-GalCer produced by bacteria may activate non-conventional T cells in tumor tissues, where they can exert a direct or indirect anti-tumor activity.
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Affiliation(s)
- Arsenij Ustjanzew
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany;
| | - Valentin Sencio
- Centre d’Infection et d’Immunité de Lille, Inserm U1019, CNRS UMR 8204, University of Lille, CHU Lille, Institut Pasteur de Lille, 59000 Lille, France; (V.S.); (F.T.)
| | - François Trottein
- Centre d’Infection et d’Immunité de Lille, Inserm U1019, CNRS UMR 8204, University of Lille, CHU Lille, Institut Pasteur de Lille, 59000 Lille, France; (V.S.); (F.T.)
| | - Jörg Faber
- Department of Pediatric Hematology/Oncology, Center for Pediatric and Adolescent Medicine, University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany;
| | - Roger Sandhoff
- Lipid Pathobiochemistry, German Cancer Research Center, 69120 Heidelberg, Germany;
| | - Claudia Paret
- Department of Pediatric Hematology/Oncology, Center for Pediatric and Adolescent Medicine, University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany;
- Correspondence:
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3
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Villar-Ortega P, Expósito-Ruiz M, Gutiérrez-Soto M, Ruiz-Cabello Jiménez M, Navarro-Marí JM, Gutiérrez-Fernández J. The association between Fusobacterium nucleatum and cancer colorectal: A systematic review and meta-analysis. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2022; 40:224-234. [PMID: 35256335 DOI: 10.1016/j.eimce.2022.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 01/05/2021] [Accepted: 01/06/2021] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The etiological factors of colorectal cancer (CRC) are not precisely known, although genetic and environmental factors have been implicated. A possible association with Fusobacterium nucleatum may provide opportunities for an early diagnosis. OBJECTIVE To review studies that address the association between F. nucleatum and CRC. METHODS The MEDLINE PubMed database was searched using the terms «colorectal cancer» and "Fusobacterium nucleatum", retrieving publications published up to January 1 2020. Stata software was used for a meta-analysis. RESULTS The systematic review included 57 articles. Meta-analysis results indicated a more frequent presence of F. nucleatum in CRC tumour tissue samples in comparison to control samples of healthy tissue, with an odds ratio of 4.558 (95% CI: 3.312-6.272), and in comparison, to control samples of colorectal adenomas, with an odds ratio of 3.244 (95 % CI: 2.359-4.462). CONCLUSION There is a more frequent resence of F. nucleatum in the CRC. However, further studies are needed to verify this relationship.
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Affiliation(s)
- Paola Villar-Ortega
- Departamento de Microbiología, Universidad de Granada-Instituto de Investigación BioSanitaria-ibs-Granada, Granada, Spain
| | - Manuela Expósito-Ruiz
- Departamento de Bioestadística de FIBAO, Hospital Universitario Virgen de las Nieves-Instituto de Investigación BioSanitaria-ibs-Granada, Granada, Spain
| | | | - Miguel Ruiz-Cabello Jiménez
- UGC de Digestivo, Hospital Universitario Virgen de las Nieves-Instituto de Investigación BioSanitaria-ibs-Granada, Granada, Spain
| | - José María Navarro-Marí
- Laboratorio de Microbiología, Hospital Universitario Virgen de las Nieves-Instituto de Investigación BioSanitaria-ibs-Granada, Granada, Spain
| | - José Gutiérrez-Fernández
- Departamento de Microbiología, Universidad de Granada-Instituto de Investigación BioSanitaria-ibs-Granada, Granada, Spain; Laboratorio de Microbiología, Hospital Universitario Virgen de las Nieves-Instituto de Investigación BioSanitaria-ibs-Granada, Granada, Spain.
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4
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Plundrich D, Chikhladze S, Fichtner-Feigl S, Feuerstein R, Briquez PS. Molecular Mechanisms of Tumor Immunomodulation in the Microenvironment of Colorectal Cancer. Int J Mol Sci 2022; 23:2782. [PMID: 35269922 PMCID: PMC8910988 DOI: 10.3390/ijms23052782] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 02/24/2022] [Accepted: 02/25/2022] [Indexed: 12/12/2022] Open
Abstract
Colorectal cancer remains one of the most important health challenges in our society. The development of cancer immunotherapies has fostered the need to better understand the anti-tumor immune mechanisms at play in the tumor microenvironment and the strategies by which the tumor escapes them. In this review, we provide an overview of the molecular interactions that regulate tumor inflammation. We particularly discuss immunomodulatory cell-cell interactions, cell-soluble factor interactions, cell-extracellular matrix interactions and cell-microbiome interactions. While doing so, we highlight relevant examples of tumor immunomodulation in colorectal cancer.
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Affiliation(s)
- Dorothea Plundrich
- Department of General and Visceral Surgery, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Sophia Chikhladze
- Department of General and Visceral Surgery, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
- Department of Biomedical Sciences, Cedars-Sinai Cancer Institute, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 900048, USA
- Department of Medicine, Cedars-Sinai Cancer Institute, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 900048, USA
| | - Stefan Fichtner-Feigl
- Department of General and Visceral Surgery, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Reinhild Feuerstein
- Department of General and Visceral Surgery, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Priscilla S Briquez
- Department of General and Visceral Surgery, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
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5
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Matsuoka T, Shimizu T, Minagawa T, Hiranuma W, Takeda M, Kakuta R, Kawamoto S. First case of an invasive Bacteroides dorei infection detected in a patient with a mycotic aortic aneurysm-raising a rebellion of major indigenous bacteria in humans: a case report and review. BMC Infect Dis 2021; 21:625. [PMID: 34193073 PMCID: PMC8247135 DOI: 10.1186/s12879-021-06345-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 06/21/2021] [Indexed: 02/05/2023] Open
Abstract
Background Bacteroides dorei is an anaerobic gram-negative bacterium first described in 2006. Because of the high similarity in mass spectra between B. dorei and Bacteroides vulgatus, discriminating between these species is arduous in clinical practice. In recent decades, 16S rRNA gene sequencing has been a complementary method for distinguishing taxonomically close bacteria, including B. dorei and B. vulgatus, at the genus and species levels. Consequently, B. dorei has been shown to contribute to some diseases, including type 1 autoimmune diabetes mellitus and atherosclerotic diseases. However, there are no reports on invasive infectious diseases caused by B. dorei. This report describes the first case of direct invasion and colonisation of human tissue by B. dorei, thus providing a warning regarding the previously proposed application of B. dorei as a live biotherapeutic for atherosclerotic diseases. Case presentation A 78-year-old Japanese man complained of intermittent chest/back pain and was diagnosed with a mycotic thoracic aortic aneurysm by enhanced computed tomography on admission. Despite strict blood pressure control and empirical antibiotic therapy, the patient’s condition worsened. To prevent aneurysmal rupture and eliminate infectious foci, the patient underwent surgical treatment. The resected specimen was subjected to tissue culture and 16S rRNA gene sequencing analysis to identify pathogenic bacteria. A few days after the surgery, culture and sequencing results revealed that the pathogen was B. dorei/B. vulgatus and B. dorei, respectively. The patient was successfully treated with appropriate antibacterial therapy and after improvement, was transferred to another hospital for rehabilitation on postoperative day 34. There was no recurrence of infection or aneurysm after the patient transfer. Conclusions This report describes the first case of invasive infectious disease caused by B. dorei, casting a shadow over its utilisation as a probiotic for atherosclerotic diseases. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06345-8.
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Affiliation(s)
- Takayuki Matsuoka
- Department of Cardiovascular Surgery, Tohoku Medical and Pharmaceutical University, 1-12-1 Fukumuro, Miyagino Ward, Sendai, Miyagi, 983-8512, Japan.
| | - Takuya Shimizu
- Department of Cardiovascular Surgery, Tohoku Medical and Pharmaceutical University, 1-12-1 Fukumuro, Miyagino Ward, Sendai, Miyagi, 983-8512, Japan
| | - Tadanori Minagawa
- Department of Cardiovascular Surgery, Tohoku Medical and Pharmaceutical University, 1-12-1 Fukumuro, Miyagino Ward, Sendai, Miyagi, 983-8512, Japan
| | - Wakiko Hiranuma
- Department of Cardiovascular Surgery, Tohoku Medical and Pharmaceutical University, 1-12-1 Fukumuro, Miyagino Ward, Sendai, Miyagi, 983-8512, Japan
| | - Miki Takeda
- Department of Cardiovascular Surgery, Tohoku Medical and Pharmaceutical University, 1-12-1 Fukumuro, Miyagino Ward, Sendai, Miyagi, 983-8512, Japan
| | - Risako Kakuta
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Shunsuke Kawamoto
- Department of Cardiovascular Surgery, Tohoku Medical and Pharmaceutical University, 1-12-1 Fukumuro, Miyagino Ward, Sendai, Miyagi, 983-8512, Japan
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6
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Villar-Ortega P, Expósito-Ruiz M, Gutiérrez-Soto M, Ruiz-Cabello Jiménez M, Navarro-Marí JM, Gutiérrez-Fernández J. The association between Fusobacterium nucleatum and cancer colorectal: a systematic review and meta-analysis. Enferm Infecc Microbiol Clin 2021; 40:S0213-005X(21)00026-4. [PMID: 33632539 DOI: 10.1016/j.eimc.2021.01.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 01/05/2021] [Accepted: 01/06/2021] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The etiological factors of colorectal cancer (CRC) are not precisely known, although genetic and environmental factors have been implicated. A possible association with Fusobacterium nucleatum may provide opportunities for an early diagnosis. OBJECTIVE To review studies that address the association between F. nucleatum and CRC. METHODS The MEDLINE PubMed database was searched using the terms «colorectal cancer» and «Fusobacterium nucleatum», retrieving publications published up to January 1 2020. Stata software was used for a meta-analysis. RESULTS The systematic review included 57 articles. Meta-analysis results indicated a more frequent presence of F. nucleatum in CRC tumor tissue samples in comparison to control samples of healthy tissue, with an odds ratio of 4.558 (95% CI: 3.312-6.272), and in comparison, to control samples of colorectal adenomas, with an odds ratio of 3.244 (95% CI: 2.359-4.462). CONCLUSION There is a more frequent presence of F. nucleatum in the CRC. However, further studies are needed to verify this relationship.
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Affiliation(s)
- Paola Villar-Ortega
- Departamento de Microbiología, Universidad de Granada-Instituto de Investigación BioSanitaria-ibs-Granada, Granada, España
| | - Manuela Expósito-Ruiz
- Departamento de Bioestadística de FIBAO. Hospital Universitario Virgen de las Nieves-Instituto de Investigación BioSanitaria-ibs-Granada, Granada, España
| | | | - Miguel Ruiz-Cabello Jiménez
- UGC de Digestivo, Hospital Universitario Virgen de las Nieves-Instituto de Investigación BioSanitaria-ibs-Granada, Granada, España
| | - José María Navarro-Marí
- Laboratorio de Microbiología, Hospital Universitario Virgen de las Nieves-Instituto de Investigación BioSanitaria-ibs-Granada, Granada, España
| | - José Gutiérrez-Fernández
- Departamento de Microbiología, Universidad de Granada-Instituto de Investigación BioSanitaria-ibs-Granada, Granada, España; Laboratorio de Microbiología, Hospital Universitario Virgen de las Nieves-Instituto de Investigación BioSanitaria-ibs-Granada, Granada, España.
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7
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Luo J, Liu P, Wang L, Huang Y, Wang Y, Geng W, Chen D, Bai Y, Yang Z. Establishment of an immune-related gene pair model to predict colon adenocarcinoma prognosis. BMC Cancer 2020; 20:1071. [PMID: 33167940 PMCID: PMC7654612 DOI: 10.1186/s12885-020-07532-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 10/15/2020] [Indexed: 02/07/2023] Open
Abstract
Background Colon cancer is the most common type of gastrointestinal cancer and has high morbidity and mortality. Colon adenocarcinoma (COAD) is the main pathological type of colon cancer, and much evidence has supported the correlation between the prognosis of COAD and the immune system. The current study aimed to develop a robust prognostic immune-related gene pair (IRGP) model to estimate the overall survival of patients with COAD. Methods The gene expression profiles and clinical information of patients with colon adenocarcinoma were obtained from the TCGA and GEO databases and were divided into training and validation cohorts. Immune genes were selected that showed a significant association with prognosis. Results Among 1647 immune genes, a model with 17 IRGPs was built that was significantly associated with OS in the training cohort. In the training and validation datasets, the IRGP model divided patients into the high-risk group and low-risk group, and the prognosis of the high-risk group was significantly worse (P<0.001). Univariate and multivariate Cox proportional hazard analyses confirmed the feasibility of this model. Functional analysis confirmed that multiple tumor progression and stem cell growth-related pathways were upregulated in the high-risk groups. Regulatory T cells and macrophages M0 were significantly highly expressed in the high-risk group. Conclusion We successfully constructed an IRGP model that can predict the prognosis of COAD, providing new insights into the treatment strategy of COAD. Supplementary information Supplementary information accompanies this paper at 10.1186/s12885-020-07532-7.
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Affiliation(s)
- Jihang Luo
- Cancer Hospital, Second Affiliated Hospital of Zunyi Medical University, Zunyi City, 563000, Guizhou Province, China
| | - Puyu Liu
- Department of Pathology, Second Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou Province, China
| | - Leibo Wang
- Department of Urology, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou Province, China
| | - Yi Huang
- Cancer Hospital, Second Affiliated Hospital of Zunyi Medical University, Zunyi City, 563000, Guizhou Province, China
| | - Yuanyan Wang
- Cancer Hospital, Second Affiliated Hospital of Zunyi Medical University, Zunyi City, 563000, Guizhou Province, China
| | - Wenjing Geng
- Cancer Hospital, Second Affiliated Hospital of Zunyi Medical University, Zunyi City, 563000, Guizhou Province, China
| | - Duo Chen
- Cancer Hospital, Second Affiliated Hospital of Zunyi Medical University, Zunyi City, 563000, Guizhou Province, China
| | - Yuju Bai
- Cancer Hospital, Second Affiliated Hospital of Zunyi Medical University, Zunyi City, 563000, Guizhou Province, China.
| | - Ze Yang
- Cancer Hospital, Second Affiliated Hospital of Zunyi Medical University, Zunyi City, 563000, Guizhou Province, China.
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8
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Magat EM, Balanag GA, CariÑo AM, Fellizar A, Ortin TS, Guevarra L, Albano PM. Clostridioides difficile antibody response of colorectal cancer patients versus clinically healthy individuals. BIOSCIENCE OF MICROBIOTA FOOD AND HEALTH 2020; 39:123-127. [PMID: 32775130 PMCID: PMC7392905 DOI: 10.12938/bmfh.2020-010] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 02/04/2020] [Indexed: 01/04/2023]
Abstract
Dysbiosis, defined as an imbalance in the gut microbiota caused by too few beneficial bacteria and an overgrowth of bad bacteria, yeast, and/or parasites, is now being associated
with several diseases, including the development of colorectal carcinoma (CRC). In this study, the potential association of Clostridioides difficile (formerly
Clostridium difficile) with CRC was investigated. Plasma samples obtained from preoperative histologically confirmed CRC patients (n=39) and
their age- and sex-matched clinically healthy controls (n=39) were analyzed for antibodies to toxin B of C. difficile (anti-tcdB) by enzyme-linked
immunosorbent assay (ELISA). A significantly greater number (p=0.012) of CRC cases (n=26/39, 66.7%) had anti-tcdB IgG levels above the cutoff value compared with
controls (n=12/39, 30.8%). Eight cases (8/39, 20.5%) and none of the controls registered anti-tcdB IgA levels above the cutoff value (p=0.0039). Anti-tcdB IgG and
IgA levels were not shown to be significantly associated with tumor grade or tumor stage. Anti-tcdB IgG showed 66.7% sensitivity and 69.2% specificity. For anti-tcdB IgA,
sensitivity and specificity were 20.5% and 100%, respectively. The positive predictive values for anti-tcdB IgA and IgG were 100% and 68.4%, respectively. The anti-tcdB IgA and IgG
negative predictive values were 55.7% and 67.5%, respectively. The results suggest the potential association of C. difficile with CRC and anti-tcdB levels,
particularly the IgA level. Hence, anti-tcdB antibodies can be candidate serologic markers for CRC.
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Affiliation(s)
- Edrienne Myenna Magat
- The Graduate School, University of Santo Tomas, España Blvd., Manila, Philippines.,Research Center for the Natural and Applied Sciences, University of Santo Tomas, España Blvd., Manila, Philippines
| | - Gregg Austine Balanag
- The Graduate School, University of Santo Tomas, España Blvd., Manila, Philippines.,Research Center for the Natural and Applied Sciences, University of Santo Tomas, España Blvd., Manila, Philippines
| | - Ana Maria CariÑo
- The Graduate School, University of Santo Tomas, España Blvd., Manila, Philippines.,Research Center for the Natural and Applied Sciences, University of Santo Tomas, España Blvd., Manila, Philippines.,Quirino State University, Quirino, Philippines
| | - Allan Fellizar
- The Graduate School, University of Santo Tomas, España Blvd., Manila, Philippines.,Research Center for the Natural and Applied Sciences, University of Santo Tomas, España Blvd., Manila, Philippines.,Mariano Marcos Memorial Hospital and Medical Center, Ilocos Norte, Philippines
| | - Teresa Sy Ortin
- The Graduate School, University of Santo Tomas, España Blvd., Manila, Philippines.,Benavides Cancer Institute, University of Santo Tomas Hospital, España Blvd., Manila, Philippines
| | - Leonardo Guevarra
- Research Center for the Natural and Applied Sciences, University of Santo Tomas, España Blvd., Manila, Philippines.,Department of Biochemistry, University of Santo Tomas, España Blvd., Manila, Philippines
| | - Pia Marie Albano
- The Graduate School, University of Santo Tomas, España Blvd., Manila, Philippines.,Research Center for the Natural and Applied Sciences, University of Santo Tomas, España Blvd., Manila, Philippines.,Department of Biological Sciences, University of Santo Tomas, España Blvd., Manila, Philippines
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