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Erickson JA, Chiang FI, Walker CM, Genzen JR, Doyle K. Comparison of two chromogranin A assays and investigation of nonlinear specimens. Pract Lab Med 2022; 32:e00299. [PMID: 36035319 PMCID: PMC9400116 DOI: 10.1016/j.plabm.2022.e00299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 07/09/2022] [Accepted: 08/05/2022] [Indexed: 11/04/2022] Open
Abstract
Background As a marker for functional and non-functional neuroendocrine tumors, serum chromogranin A (CgA) concentrations have shown value for detecting and monitoring disease. Here we describe a comparison between an established micro-titer plate assay (Cisbio CgA ELISA) and an analyzer-based assay (B·R·A·H·M·S CgA II KRYPTOR). Reference limits were established along with a performance evaluation of the KRYPTOR assay. Nonlinearity observed in approximately 0.03% of patients was also investigated. Methods Samples were tested according to kit manufacturer's protocols. Reference limits were established for both assays testing the same cohort of healthy volunteers. Potential causes of nonlinearity investigated were HAMA, macromolecule effects and elevated serum creatinine. Results KRYPTOR vs. Cisbio: slope=0.692, y-intercept=−40.0 (r2=0.967, n=186). Upper reference limits were 160 and 103 ng/mL for the Cisbio and KRYPTOR assays, respectively. Linearity: slope=1.012 (r2=0.998) with 95.0–105.5% recoveries. Precision: repeatability ≤2.4%, within-laboratory ≤3.1% (79 and 738 ng/mL). Limit of detection: 8 ng/mL. Strong nonlinear specimens (n=6) retested for HAMA interference generated differences (block-no block) ranging −3.2–4.2%. Polyethylene glycol precipitation recoveries ranged from 157 to >5714% for affected specimens versus 71–79% for normal specimens. Eight of 14 nonlinear specimens (57%) had elevated serum creatinine results (>1.20 mg/dL). Conclusions The CgA II KRYPTOR assay performs acceptably for quantifying CgA in human serum. While adequate correlation is observed against the Cisbio ELISA, there is significant disagreement overall. Efforts to identify a cause of the nonlinearity observed in a small percentage of patients were inconclusive, but neither HAMA interference, macromolecule effects nor renal failure appear as major factors. The Cisbio Chromoa® ELISA is a well-established assay for measuring chromogranin A. The CgA II KRYPTOR® performs acceptably for quantifying chromogranin A in serum. Studies of the CgA II KRYPTOR vs. the established Cisbio Chomoa ELISA are lacking. Agreement between the Cisbio Chromoa CgA ELISA and the CgA II KRYPTOR is suboptimal. Causes for the nonlinearity in approximately 0.02–0.03% of specimens remain unclear.
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Affiliation(s)
- J Alan Erickson
- ARUP Institute for Clinical and Experimental Pathology, ARUP Laboratories, Salt Lake City, UT, USA
| | | | | | - Jonathan R Genzen
- ARUP Institute for Clinical and Experimental Pathology, ARUP Laboratories, Salt Lake City, UT, USA.,University of Utah School of Medicine, Department of Pathology, Salt Lake City, UT, USA
| | - Kelly Doyle
- ARUP Institute for Clinical and Experimental Pathology, ARUP Laboratories, Salt Lake City, UT, USA.,University of Utah School of Medicine, Department of Pathology, Salt Lake City, UT, USA
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Gurung B, Hua X, Runske M, Bennett B, LiVolsi V, Roses R, Fraker DA, Metz DC. PTCH 1 staining of pancreatic neuroendocrine tumor (PNET) samples from patients with and without multiple endocrine neoplasia (MEN-1) syndrome reveals a potential therapeutic target. Cancer Biol Ther 2015; 16:219-24. [PMID: 25482929 DOI: 10.4161/15384047.2014.987574] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Pancreatic neuroendocrine tumors (PNETs) are rare, indolent tumors that may occur sporadically or develop in association with well-recognized hereditary syndromes, particularly multiple endocrine neoplasia type 1 (MEN-1). We previously demonstrated that the hedgehog (HH) signaling pathway was aberrantly up-regulated in a mouse model that phenocopies the human MEN-1 syndrome, Men1l/l;RipCre, and that inhibition of this pathway suppresses MEN-1 tumor cell proliferation. We hypothesized that the HH signaling pathway is similarly upregulated in human PNETs. We performed immunohistochemical (IHC) staining for PTCH1 in human fresh and archival PNET specimens to examine whether human sporadic and MEN-1-associated PNETs revealed similar abnormalities as in our mouse model and correlated the results with clinical and demographic factors of the study cohort. PTCH1 staining was positive in 12 of 22 PNET patients (55%). Four of 5 MEN-1 patients stained for PTCH1 (p = 0.32 as compared with sporadic disease patients). Nine of 16 patients with metastatic disease stained for PTCH1 as compared with zero of 3 with localized disease only (p = 0.21). No demographic or clinical features appeared to be predictive of PTCH 1 positivity and PTCH 1 positivity per se was not predictive of clinical outcome. PTCH1, a marker of HH pathway up regulation, is detectable in both primary and metastatic tumors in more than 50% of PNET patients. Although no clinical or demographic factors predict PTCH1 positivity and PTCH1 positivity does not predict clinical outcome, the frequency of expression alone indicates that perturbation of this pathway with agents such as Vismodegib, an inhibitor of Smoothened (SMO), should be examined in future clinical trials.
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Key Words
- ACTH, Adrenocorticotrophic hormone
- BCNS, basal cell nevus syndrome
- CgA, chromogranin A
- HH, hedgehog
- IHC, immunohistochemical
- MEN-1
- MEN-1, multiple neuroendocrine tumor syndrome type 1
- NF-1, neurofibromatosis type 1
- PNET, pancreatic neuroendocrine tumor
- PRRT, peptide radioreceptor therapy
- PTCH 1, protein patched homolog 1
- SMO, smoothened
- VHL, von Hippel Lan- dau
- WHO, World Health Organization
- hedgehog
- neuroendocrine
- pancreas
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Affiliation(s)
- Buddha Gurung
- a Abramson Family Cancer Research Center; Department of Cancer Biology ; University of Pennsylvania School of Medicine ; Philadelphia , PA USA
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van der Knaap RHP, Kwekkeboom DJ, Ramakers CRB, de Rijke YB. Evaluation of a new immunoassay for chromogranin A measurement on the Kryptor system. Pract Lab Med 2015; 1:5-11. [PMID: 28932793 PMCID: PMC5597707 DOI: 10.1016/j.plabm.2015.03.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Revised: 02/23/2015] [Accepted: 03/03/2015] [Indexed: 12/04/2022] Open
Abstract
Background Chromogranin A (CgA) is a biomarker for neuroendocrine tumors (NETs). The aims of this study were to evaluate differences in measurement between the ThermoFisher Brahms CgA Kryptor assay and the CisBio assay and to investigate the influence of patient covariates. Temperature stability of CgA using both assays was determined. Design and Methods 406 patients were analyzed for serum CgA using both assays. We performed a comparison study to determine whether several patient covariates (gender, use of protein pump inhibitors, impaired kidney function, referral department and tumor location) influenced the results. For the stability study, pooled serum samples were aliquoted and stored at different storage temperatures (room temperature, 4 °C and −20 °C) until assayed. In addition, 15 individual samples were evaluated after storage at 4 °C using the Kryptor assay. Results Differences in measured concentrations between the assays were statistically significant. Passing & Bablok fit showed ln Y(Kryptor)=1.05 ln X(CisBio) – 0.20 with a bias of 1.0% after logarithmic transformation. Patient covariates were not associated. Patients׳ sera showed variable stability for CgA in the Kryptor assay at room temperature and 4 °C, whereas the recovery in the CisBio assay was stable at both temperatures. Conclusion Differences in measured CgA concentration between the assays could not be explained by the investigated patient covariates. Serum should be stored at –20 °C prior to determination using the Kryptor assay. A Kryptor assay measured significant higher levels of CgA compared with CisBio. Difference between Kryptor and CisBio not explained by patient covariates in this study. Storage at room temperature and 4 °C should be avoided when using the Kryptor assay.
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Key Words
- CgA, chromogranin A
- Chromogranin A methods
- ELISA, enzyme-linked immuno sorbent assay
- ENETS, European Neuroendocrine Tumor Society
- GEP-NET, gastroentropancreatic NET
- H2RA, H2-receptor antagonist
- LD, lactate dehydrogenase
- MDRD, modification of diet in renal diseases
- NET, neuroendocrine tumor
- Neuroendocrine tumors
- PPI, proton pump inhibitor
- TRACE, time-resolved amplified cryptate emission
- Temperature stability
- Tumor markers
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Affiliation(s)
- R H P van der Knaap
- Department of Clinical Chemistry, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - D J Kwekkeboom
- Department of Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - C R B Ramakers
- Department of Clinical Chemistry, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Y B de Rijke
- Department of Clinical Chemistry, Erasmus University Medical Center, Rotterdam, The Netherlands
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Kidd M, Modlin IM, Bodei L, Drozdov I. Decoding the Molecular and Mutational Ambiguities of Gastroenteropancreatic Neuroendocrine Neoplasm Pathobiology. Cell Mol Gastroenterol Hepatol 2015; 1:131-153. [PMID: 28210673 PMCID: PMC5301133 DOI: 10.1016/j.jcmgh.2014.12.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 12/19/2014] [Indexed: 02/08/2023]
Abstract
Gastroenteropancreatic neuroendocrine neoplasms (GEP-NEN), considered a heterogeneous neoplasia, exhibit ill-defined pathobiology and protean symptomatology and are ubiquitous in location. They are difficult to diagnose, challenging to manage, and outcome depends on cell type, secretory product, histopathologic grading, and organ of origin. A morphologic and molecular genomic review of these lesions highlights tumor characteristics that can be used clinically, such as somatostatin-receptor expression, and confirms features that set them outside the standard neoplasia paradigm. Their unique pathobiology is useful for developing diagnostics using somatostatin-receptor targeted imaging or uptake of radiolabeled amino acids specific to secretory products or metabolism. Therapy has evolved via targeting of protein kinase B signaling or somatostatin receptors with drugs or isotopes (peptide-receptor radiotherapy). With DNA sequencing, rarely identified activating mutations confirm that tumor suppressor genes are relevant. Genomic approaches focusing on cancer-associated genes and signaling pathways likely will remain uninformative. Their uniquely dissimilar molecular profiles mean individual tumors are unlikely to be easily or uniformly targeted by therapeutics currently linked to standard cancer genetic paradigms. The prevalence of menin mutations in pancreatic NEN and P27KIP1 mutations in small intestinal NEN represents initial steps to identifying a regulatory commonality in GEP-NEN. Transcriptional profiling and network-based analyses may define the cellular toolkit. Multianalyte diagnostic tools facilitate more accurate molecular pathologic delineations of NEN for assessing prognosis and identifying strategies for individualized patient treatment. GEP-NEN remain unique, poorly understood entities, and insight into their pathobiology and molecular mechanisms of growth and metastasis will help identify the diagnostic and therapeutic weaknesses of this neoplasia.
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Key Words
- 5-HT, serotonin, 5-hydroxytryptamine
- Akt, protein kinase B
- BRAF, gene encoding serine/threonine-protein kinase B-Raf
- Blood
- CGH, comparative genomic hybridization
- CREB, cAMP response element-binding protein
- Carcinoid
- CgA, chromogranin A
- D cell, somatostatin
- DAG, diacylglycerol
- EC, enterochromaffin
- ECL, enterochromaffin-like
- EGFR, epidermal growth factor receptor
- ERK, extracellular-signal-regulated kinase
- G cell, gastrin
- GABA, γ-aminobutyric acid
- GEP-NEN, gastroenteropancreatic neuroendocrine neoplasms
- GPCR, G-protein coupled receptor
- Gastroenteropancreatic Neuroendocrine Neoplasms
- IGF-I, insulin-like growth factor-I
- ISG, immature secretory vesicles
- Ki-67
- LOH, loss of heterozygosity
- MAPK, mitogen-activated protein kinase
- MEN-1/MEN1, multiple endocrine neoplasia type 1
- MSI, microsatellite instability
- MTA, metastasis associated-1
- NEN, neuroendocrine neoplasms
- NFκB, nuclear factor κB
- PET, positron emission tomography
- PI3, phosphoinositide-3
- PI3K, phosphoinositide-3 kinase
- PKA, protein kinase A
- PKC, protein kinase C
- PTEN, phosphatase and tensin homolog deleted on chromosome 10
- Proliferation
- SD-208, 2-(5-chloro-2-fluorophenyl)-4-[(4-pyridyl)amino]p-teridine
- SNV, single-nucleotide variant
- SSA, somatostatin analog
- SST, somatostatin
- Somatostatin
- TGF, transforming growth factor
- TGN, trans-Golgi network
- TSC2, tuberous sclerosis complex 2 (tuberin)
- Transcriptome
- VMAT, vesicular monoamine transporters
- X/A-like cells, ghrelin
- cAMP, adenosine 3′,5′-cyclic monophosphate
- mTOR, mammalian target of rapamycin
- miR/miRNA, micro-RNA
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Affiliation(s)
| | - Irvin M. Modlin
- Correspondence Address correspondence to: Irvin M. Modlin, MD, PhD, The Gnostic Consortium, Wren Laboratories, 35 NE Industrial Road, Branford, Connecticut, 06405.
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Abstract
Given our recent finding that the lymph node (LN) can serve as an in vivo factory to generate complex structures like liver, pancreas, and thymus, we investigated whether LN could also support early development and maturation from several mid-embryonic (E14.5/15.5) mouse tissues including brain, thymus, lung, stomach, and intestine. Here we observed brain maturation in LN by showing the emergence of astrocytes with well-developed branching processes. Thymus maturation in LN was monitored by changes in host immune cells. Finally, newly terminally differentiated mucus-producing cells were identified in ectopic tissues generated by transplantation of lung, stomach and intestine in LN. Thus, we speculate the LN offers a unique approach to study the intrinsic and extrinsic differentiation potential of cells and tissues during early development, and provides a new site for bioengineering complex body parts.
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Key Words
- 21wEcT, 21-week ectopic thymus
- 2D, 2-dimensional
- 3D, 3-dimensional
- 3wEcI, 3-week ectopic intestine
- 3wEcL, 3-week ectopic lung
- 3wEcS, 3-week ectopic stomach
- 6wEcT, 6-week ectopic thymus
- AdT, adult thymus
- Aire, autoimmune regulator
- CgA, chromogranin A
- E14.5/15.5, embryonic day 14.5 to 15.5
- ECM, extracellular matrix
- ER-TR7, reticular fibroblasts and reticular fibers
- EmI, embryonic intestine
- EmL, embryonic lung
- EmS, embryonic stomach
- EmT, embryonic thymus
- EpCAM1, epithelial cell adhesion molecule 1
- FACS, fluorescence-activated cell sorting
- FAH, fumarylacetoacetate hydrolase
- GFAPδ, glial fibrillary acid protein delta
- GM-CSF, granulocyte-macrophage colony-stimulating factor
- K5, keratin 5
- K8, keratin 8
- LN, lymph node
- MAP-2, Microtubule-associated protein 2
- bioreactor
- cTEC, cortical thymic epithelial cell
- chimerism
- development
- lymph node
- mTEC, medullary thymic epithelial cell
- mTOR, mammalian target of rapamycin
- terminal differentiation
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Affiliation(s)
- Maria Giovanna Francipane
- a McGowan Institute for Regenerative Medicine; Department of Pathology ; University of Pittsburgh School of Medicine ; Pittsburgh , PA USA
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Parmiani G, Pilla L, Corti A, Doglioni C, Cimminiello C, Bellone M, Parolini D, Russo V, Capocefalo F, Maccalli C. A pilot Phase I study combining peptide-based vaccination and NGR-hTNF vessel targeting therapy in metastatic melanoma. Oncoimmunology 2014; 3:e963406. [PMID: 25941591 DOI: 10.4161/21624011.2014.963406] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 09/04/2014] [Indexed: 11/19/2022] Open
Abstract
Administration of NGR-TNF, a tumor vessel-targeting and tumor necrosis factor α TNFα) peptide conjugate, with immunotherapy has been shown to inhibit tumor growth in mice. Thus, we planned a Phase I pilot clinical trial to assess safety, immune and clinical response of this combination treatment for advanced melanoma. NA17.A2 and MAGE-3.A1 peptides were used as vaccine. HLA-A*0201 or HLA-A*01 metastatic melanoma patients received human NGR-hTNF i.v. alternating with s.c. weekly injections of either of the peptides emulsified in Montanide. The T-cell response was assessed ex-vivo using peripheral blood mononuclear cells (PBMCs) before, during and after therapy. The serum level of chromogranin A (CgA), soluble TNF receptors (sTNFR1/2), vascular endothelial growth factor (VEGF), and MIP-1β and MCP-1 chemokines, was determined. In 3 subjects, pre- and post-treatment tumor lesions were examined by immunohistochemistry. Clinically, chills were observed in 4 patients during NGR-hTNF infusion and erythema at vaccination site was seen in 7 patients. T-cell response against the vaccine or against other melanoma-associated antigens was detectable after treatment in 6 out of 7 tested patients. Low level or reduction of CgA and sTNFR and increase of MIP-1β and MCP-1 were found in patients sera. In the lesions examined the immune infiltrate was scanty but macrophage number increased in post-therapy lesions. From a clinical standpoint, a long term survival (>4 months) was found in 6 out of 8 evaluable patients (4, 4, 7, 11, 23+, 25+, 25+, 29+ months). The combination of NGR-hTNF and vaccine in metastatic melanoma patients was well tolerated, often associated with an ex-vivo T cell response and long-term overall survival. These findings warrant confirmation in a larger group of patients.
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Key Words
- APC, antigen presenting cell
- CT, cancer/testis
- CgA, chromogranin A
- DFS, disease-free survival
- MAA, melanoma-associated antigens
- MCP-1, macrophage chemoattractant protein 1
- MIP-1β, macrophage inflammatory protein 1β; OS, overall survival
- PBMC, peripheral blood mononuclear cell
- PD, progression of disease
- PFS, progression-free survival
- RR, response rate
- T cells
- TNFα, tumor necrosis factor α
- anti-vascular target therapy
- combination therapy
- inflammatory cytokines
- melanoma
- peptide-based vaccines
- sTNFR, soluble tumor necrosis factor receptor
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Affiliation(s)
- Giorgio Parmiani
- Unit of Immuno-biotherapy of Melanoma and Solid Tumors; San Raffaele Foundation Research Institute ; Via Olgettina , Milan
| | - Lorenzo Pilla
- Unit of Immuno-biotherapy of Melanoma and Solid Tumors; San Raffaele Foundation Research Institute ; Via Olgettina , Milan
| | - Angelo Corti
- Unit of Tumor Biology and Vascular Targeting; San Raffaele Foundation Research Institute ; Via Olgettina , Milan
| | - Claudio Doglioni
- Unit of Pathology; San Raffaele Foundation Research Institute ; Via Olgettina , Milan
| | - Carolina Cimminiello
- Unit of Immuno-biotherapy of Melanoma and Solid Tumors; San Raffaele Foundation Research Institute ; Via Olgettina , Milan
| | - Matteo Bellone
- Unit of Cellular Immunology; San Raffaele Foundation Research Institute ; Via Olgettina , Milan
| | - Danilo Parolini
- Unit of Gastrointestinal Surgery; San Raffaele Foundation Research Institute ; Via Olgettina , Milan
| | - Vincenzo Russo
- Unit of Cancer Gene Therapy; San Raffaele Foundation Research Institute ; Via Olgettina , Milan
| | - Filippo Capocefalo
- Unit of Immuno-biotherapy of Melanoma and Solid Tumors; San Raffaele Foundation Research Institute ; Via Olgettina , Milan
| | - Cristina Maccalli
- Unit of Immuno-biotherapy of Melanoma and Solid Tumors; San Raffaele Foundation Research Institute ; Via Olgettina , Milan
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