MGMT Promoter Methylation Is a Strong Prognostic Biomarker for Benefit from Dose-Intensified Temozolomide Rechallenge in Progressive Glioblastoma: The DIRECTOR Trial.

PURPOSE: Rechallenge with temozolomide (TMZ) at first progression of glioblastoma after temozolomide chemoradiotherapy (TMZ/RT→TMZ) has been studied in retrospective and single-arm prospective studies, applying temozolomide continuously or using 7/14 or 21/28 days schedules. The DIRECTOR trial sought to show superiority of the 7/14 regimen. EXPERIMENTAL DESIGN: Patients with glioblastoma at first progression after TMZ/RT→TMZ and at least two maintenance temozolomide cycles were randomized to Arm A [one week on (120 mg/m(2) per day)/one week off] or Arm B [3 weeks on (80 mg/m(2) per day)/one week off]. The primary endpoint was median time-to-treatment failure (TTF) defined as progression, premature temozolomide discontinuation for toxicity, or death from any cause. O(6)-methylguanine DNA methyltransferase (MGMT) promoter methylation was prospectively assessed by methylation-specific PCR. RESULTS: Because of withdrawal of support, the trial was prematurely closed to accrual after 105 patients. There was a similar outcome in both arms for median TTF [A: 1.8 months; 95% confidence intervals (CI), 1.8-3.2 vs. B: 2.0 months; 95% CI, 1.8-3.5] and overall survival [A: 9.8 months (95% CI, 6.7-13.0) vs. B: 10.6 months (95% CI, 8.1-11.6)]. Median TTF in patients with MGMT-methylated tumors was 3.2 months (95% CI, 1.8-7.4) versus 1.8 months (95% CI, 1.8-2) in MGMT-unmethylated glioblastoma. Progression-free survival rates at 6 months (PFS-6) were 39.7% with versus 6.9% without MGMT promoter methylation. CONCLUSIONS: Temozolomide rechallenge is a treatment option for MGMT promoter-methylated recurrent glioblastoma. Alternative strategies need to be considered for patients with progressive glioblastoma without MGMT promoter methylation.

Circulating FABP4 Is a prognostic biomarker in patients with acute coronary syndrome but not in asymptomatic individuals.

OBJECTIVE: Blood-borne biomarkers reflecting atherosclerotic plaque burden have great potential to improve clinical management of atherosclerotic coronary artery disease and acute coronary syndrome (ACS). APPROACH AND RESULTS: Using data integration from gene expression profiling of coronary thrombi versus peripheral blood mononuclear cells and proteomic analysis of atherosclerotic plaque-derived secretomes versus healthy tissue secretomes, we identified fatty acid-binding protein 4 (FABP4) as a biomarker candidate for coronary artery disease. Its diagnostic and prognostic performance was validated in 3 different clinical settings: (1) in a cross-sectional cohort of patients with stable coronary artery disease, ACS, and healthy individuals (n=820), (2) in a nested case-control cohort of patients with ACS with 30-day follow-up (n=200), and (3) in a population-based nested case-control cohort of asymptomatic individuals with 5-year follow-up (n=414). Circulating FABP4 was marginally higher in patients with ST-segment-elevation myocardial infarction (24.9 ng/mL) compared with controls (23.4 ng/mL; P=0.01). However, elevated FABP4 was associated with adverse secondary cerebrovascular or cardiovascular events during 30-day follow-up after index ACS, independent of age, sex, renal function, and body mass index (odds ratio, 1.7; 95% confidence interval, 1.1-2.5; P=0.02). Circulating FABP4 predicted adverse events with similar prognostic performance as the GRACE in-hospital risk score or N-terminal pro-brain natriuretic peptide. Finally, no significant difference between baseline FABP4 was found in asymptomatic individuals with or without coronary events during 5-year follow-up. CONCLUSIONS: Circulating FABP4 may prove useful as a prognostic biomarker in risk stratification of patients with ACS.

Urine Fetuin-A is a biomarker of autosomal dominant polycystic kidney disease progression.

BACKGROUND: Autosomal dominant polycystic kidney disease (ADPKD) is a genetic disorder characterized by numerous fluid-filled cysts that frequently result in end-stage renal disease. While promising treatment options are in advanced clinical development, early diagnosis and follow-up remain a major challenge. We therefore evaluated the diagnostic value of Fetuin-A as a new biomarker of ADPKD in human urine. RESULTS: We found that renal Fetuin-A levels are upregulated in both Pkd1 and Bicc1 mouse models of ADPKD. Measurement by ELISA revealed that urinary Fetuin-A levels were significantly higher in 66 ADPKD patients (17.5 ± 12.5 μg/mmol creatinine) compared to 17 healthy volunteers (8.5 ± 3.8 μg/mmol creatinine) or 50 control patients with renal diseases of other causes (6.2 ± 2.9 μg/mmol creatinine). Receiver operating characteristics (ROC) analysis of urinary Fetuin-A levels for ADPKD rendered an optimum cut-off value of 12.2 μg/mmol creatinine, corresponding to 94% of sensitivity and 60% of specificity (area under the curve 0.74 ; p = 0.0019). Furthermore, urinary Fetuin-A levels in ADPKD patients correlated with the degree of renal insufficiency and showed a significant increase in patients with preserved renal function followed for two years. CONCLUSIONS: Our findings establish urinary Fetuin-A as a sensitive biomarker of the progression of ADPKD. Further studies are required to examine the pathogenic mechanisms of elevated renal and urinary Fetuin-A in ADPKD.

Diffusion-weighted magnetic resonance imaging: biomarker for treatment response in oncology

The authors report a case where a quantitative assessment of the apparent diffusion coefficient (ADC) of liver metastasis in a patient undergoing chemotherapy has shown to be an effective early marker for predicting therapeutic response, anticipating changes in tumor size. A lesion with lower initial ADC value and early increase in such value in the course of the treatment tends to present a better therapeutic response.

Hepcidin as a new biomarker for detecting autologous blood transfusion.

Autologous blood transfusion (ABT) is an efficient way to increase sport performance. It is also the most challenging doping method to detect. At present, individual follow-up of haematological variables via the athlete biological passport (ABP) is used to detect it. Quantification of a novel hepatic peptide called hepcidin may be a new alternative to detect ABT. In this prospective clinical trial, healthy subjects received a saline injection for the control phase, after which they donated blood that was stored and then transfused 36 days later. The impact of ABT on hepcidin as well as haematological parameters, iron metabolism, and inflammation markers was investigated. Blood transfusion had a particularly marked effect on hepcidin concentrations compared to the other biomarkers, which included haematological variables. Hepcidin concentrations increased significantly: 12 hr and 1 day after blood reinfusion, these concentrations rose by seven- and fourfold, respectively. No significant change was observed in the control phase. Hepcidin quantification is a cost-effective strategy that could be used in an "ironomics" strategy to improve the detection of ABT. Am. J. Hematol. 91:467-472, 2016. © 2016 Wiley Periodicals, Inc.

Brain-Derived Neurotrophic Factor as a potential biomarker of cognitive recovery in schizophrenia

Brain-derived neurotrophic factor (BDNF) has been proposed as a biomarker of schizophrenia and, more specifically, as a biomarker of cognitive recovery. Evidence collected in this review indicates that BDNF is relevant in the pathophysiology of schizophrenia and could play a role as a marker of clinical response. BDNF has been shown to play a positive role as a marker in antipsychotic treatment, and it has been demonstrated that typical antipsychotics decrease BDNF levels while atypical antipsychotics maintain or increase serum BDNF levels. Furthermore, BDNF levels have been associated with severe cognitive impairments in patients with schizophrenia. Consequently, BDNF has been proposed as a candidate target of strategies to aid the cognitive recovery process. There is some evidence suggesting that BDNF could be mediating neurobiological processes underlying cognitive recovery. Thus, serum BDNF levels seem to be involved in some synaptic plasticity and neurotransmission processes. Additionally, serum BDNF levels significantly increased in schizophrenia subjects after neuroplasticity-based cognitive training. If positive replications of those findings are published in the future then serum BDNF levels could be definitely postulated as a peripheral biomarker for the effects of intensive cognitive training or any sort of cognitive recovery in schizophrenia. All in all, the current consideration of BDNF as a biomarker of cognitive recovery in schizophrenia is promising but still premature.

Potential Urinary Protein Biomarker Candidates for the Accurate Detection of Prostate Cancer among Benign Prostatic Hyperplasia Patients

Globally, Prostate cancer (PCa) is the most frequently occurring non-cutaneous cancer, and is the second highest cause of cancer mortality in men. Serum prostate specific antigen (PSA) has been the standard in PCa screening since its approval by the American Food & Drug Administration (FDA) in 1994. Currently, PSA is used as an indicator for PCa - patients with a serum PSA level above 4ng/mL will often undergo prostate biopsy to confirm cancer. Unfortunately fewer than similar to 30% of these men will biopsy positive for cancer, meaning that the majority of men undergo invasive biopsy with little benefit. Despite PSA's notoriously poor specificity (33%), there is still a significant lack of credible alternatives. Therefore an ideal biomarker that can specifically detect PCa at an early stage is urgently required. The aim of this study was to investigate the potential of using deregulation of urinary proteins in order to detect Prostate Cancer (PCa) among Benign Prostatic Hyperplasia (BPH). To identify the protein signatures specific for PCa, protein expression profiling of 8 PCa patients, 12 BPH patients and 10 healthy males was carried out using LC-MS/MS. This was followed by validating relative expression levels of proteins present in urine among all the patients using quantitative real time-PCR. This was followed by validating relative expression levels of proteins present in urine among all the patients using quantitative real time-PCR. This approach revealed that significant the down-regulation of Fibronectin and TP53INP2 was a characteristic event among PCa patients. Fibronectin mRNA down-regulation, was identified as offering improved specificity (50%) over PSA, albeit with a slightly lower although still acceptable sensitivity (75%) for detecting PCa. As for TP53INP2 on the other hand, its down-regulation was moderately sensitive (75%), identifying many patients with PCa, but was entirely non-specific (7%), designating many of the benign samples as malignant and being unable to accurately identify more than one negative.

Potential Urinary miRNA Biomarker Candidates for the Accurate Detection of Prostate Cancer among Benign Prostatic Hyperplasia Patients

MicroRNAs (miRNAs) are a class of short (similar to 22nt), single stranded RNA molecules that function as post-transcriptional regulators of gene expression. MiRNAs can regulate a variety of important biological pathways, including: cellular proliferation, differentiation and apoptosis. Profiling of miRNA expression patterns was shown to be more useful than the equivalent mRNA profiles for characterizing poorly differentiated tumours. As such, miRNA expression "signatures" are expected to offer serious potential for diagnosing and prognosing cancers of any provenance. The aim of this study was to investigate the potential of using deregulation of urinary miRNAs in order to detect Prostate Cancer (PCa) among Benign Prostatic Hyperplasia (BPH). To identify the miRNA signatures specific for PCa, miRNA expression profiling of 8 PCa patients, 12 BPH patients and 10 healthy males was carried out using whole genome expression profiling. Differential expression of two individual miRNAs between healthy males and BPH patients was detected and found to possibly target genes related to PCa development and progression. The sensitivity and specificity of miR-1825 for detecting PCa among BPH individuals was found to be 60% and 69%, respectively. Whereas, the sensitivity and specificity of miR-484 were 80% and 19%, respectively. Additionally, the sensitivity and specificity for miR-1825/484 in tandem were 45% and 75%, respectively. The proposed PCa miRNA signatures may therefore be of great value for the accurate diagnosis of PCa and BPH. This exploratory study has identified several possible targets that merit further investigation towards the development and validation of diagnostically useful, non-invasive, urine-based tests that might not only help diagnose PCa but also possibly help differentiate it from BPH.

Phytoplankton Pigment Signatures as a Biomarker in a Tropical Estuary

We are in the cutting edge of a new era of development without leaving any promises to next generation. But the scale and size of the problem are only partially blamed. The juggernaut of Globalisation has trampled upon whatever little hope we might have had making a quick transition to a less energy – intensive world. “Environment friendliness begins at home”. Our quest for productivity and profitability should progress simultaneous with our cooperative responsibility of leaving behind a clean and green earth for the generation to come. Climate change is the most pressing global environmental challenge being faced by humanity, with the quest for better productivity for our fragile ecosystem. It is too late to rely solely on reduction in Green house gas emissions to mitigate climate change although this is undoubtedly crucial. Coastal belts are more prone to these devastating impacts and its protection is an intensive filed of research. The present study describes how the colourful Carotenoids and Chlorophylls can be used in rapid hand on tool in conjunction with molecular biology to open sources and it also explores the fate of organic matter in the aquatic system and underlying sediments.

Source Characterization of Sedimentary Organic Matter in a Tropical Estuary, Southwest Coast of India: A Biomarker Approach

The source, fate and diagentic pathway of sedimentary organic matter in estuaries are difficult to delineate due to the complexity of organic matter sources, intensive physical mixing and biological processes. A combination of bulk organic matter techniques and molecular biomarkers are found to be successful in explaining organic matter dynamics in estuaries. The basic requirement for these multi-proxy approaches are (i) sources have significantly differing characteristics, (ii) there are a sufficient number of tracers to delineate all sources and (iii) organic matter degradation and processing have little, similar or predictable effects on end member characteristics. Although there have been abundant researches that have attempted to tackle difficulties related to the source and fate of organic matter in estuarine systems, our understanding remains limited or rather inconsistent regarding the Indian estuaries. Cochin estuary is the largest among many extensive estuarine systems along the southwest coast of India. It supports as much biological productivity and diversity as tropical rain forests. In this study, we have used a combination of bulk geochemical parameters and different group of molecular biomarkers to define organic matter sources and thereby identifying various biogeochemical processes acting along the salinity gradient of the Cochin estuary

Biomarker pigment signatures in Cochin back water system e A tropical estuary south west coast of India

Sedimentary biomarker pigments around Cochin estuary situated in the southwest coast of India were determined by HPLC. Fucoxanthin, an indicator of diatom was observed to be the most abundant carotenoid pigment in the estuary. Dinoflagellate derived carotenoid pigment peridinin was confined in the southern part of estuary and zeaxanthin pigment indicative of cyanobacteria were more found in sites influenced by anthropogenic activities. One compound having close similarity to fucoxanthin was also detected. Alloxanthin (cryptophyceae), chl b (green algae), canthaxanthin, neoxanthin, lutein and peridinin isomer were also detected by spectra and corresponding algal class were identified. The highest concentration of chl a (11.01 mg g 1) found near to the anthropogenic affected area while the lowest chl a (0.65 mg g 1) was recorded in industrial area. Degradation products of chl a, such as pheophorbide and pheophytin were observed and principal mode of mechanism of degradation were derived. Higher pheopigments content than chl a, reflects a density trapping of dead cells and early degradation of phytopigments from grazing activities

Protein-Expressions-Analysen zur Etablierung prädiktiver Biomarker bei der Behandlung fortgeschrittener Tumoren der Mamma und der Prostata

Aktuelle Entwicklungen auf dem Gebiet der zielgerichteten Therapie zur Behandlung maligner Erkrankungen erfordern neuartige Verfahren zur Diagnostik und Selektion geeigneter Patienten. So ist das Ziel der vorliegenden Arbeit die Identifizierung neuer Zielmoleküle, die die Vorhersage eines Therapieerfolges mit targeted drugs ermöglichen. Besondere Aufmerksamkeit gilt dem humanisierten monoklonalen Antikörper Trastuzumab (Herceptin), der zur Therapie Her-2 überexprimierender, metastasierter Mammakarzinome eingesetzt wird. Jüngste Erkenntnisse lassen eine Anwendung dieses Medikamentes in der Behandlung des Hormon-unabhängigen Prostatakarzinoms möglich erscheinen. Therapie-beeinflussende Faktoren werden in der dem Rezeptor nachgeschalteten Signaltransduktion oder Veränderungen des Rezeptors selbst vermutet. Mittels Immunhistochemie wurden die Expressions- und Aktivierungsniveaus verschiedener Proteine der Her-2-assoziierten Signaltransduktion ermittelt; insgesamt wurden 37 molekulare Marker untersucht. In Formalin fixierte und in Paraffin eingebettete korrespondierende Normal- und Tumorgewebe von 118 Mammakarzinom-Patientinnen sowie 78 Patienten mit Prostatakarzinom wurden in TMAs zusammengefasst. Die in Zusammenarbeit mit erfahrenen Pathologen ermittelten Ergebnisse dienten u.a. als Grundlage für zweidimensionales, unsupervised hierarchisches clustering. Ergebnis dieser Analysen war für beide untersuchten Tumorentitäten die Möglichkeit einer Subklassifizierung der untersuchten Populationen nach molekularen Eigenschaften. Hierbei zeigten sich jeweils neue Möglichkeiten zur Anwendung zielgerichteter Therapien, deren Effektivität Inhalt weiterführender Studien sein könnte. Zusätzlich wurden an insgesamt 43 Frischgeweben die möglichen Folgen des sog. shedding untersucht. Western Blot-basierte Untersuchungen zeigten hierbei die Möglichkeit der Selektion von Patienten aufgrund falsch-positiver Befunde in der derzeit als Standard geltenden Diagnostik. Zusätzlich konnte durch Vergleich mit einer Herceptin-sensitiven Zelllinie ein möglicher Zusammenhang eines Therapieerfolges mit dem Phosphorylierungs-/ Aktivierungszustand des Rezeptors ermittelt werden. Fehlende klinische Daten zum Verlauf der Erkrankung und Therapie der untersuchten Patienten lassen keine Aussagen über die tatsächliche Relevanz der ermittelten Befunde zu. Dennoch verdeutlichen die erhaltenen Resultate eindrucksvoll die Komplexität der molekularen Vorgänge, die zu einem Krebsgeschehen führen und damit Auswirkungen auf die Wirksamkeit von targeted drugs haben können. Entwicklungen auf dem Gebiet der zielgerichteten Therapie erfordern Verbesserungen auf dem Gebiet der Diagnostik, die die sichere Selektion geeigneter Patienten erlauben. Die Zukunft der personalisierten, zielgerichteten Behandlung von Tumorerkrankungen wird verstärkt von molekularen Markerprofilen hnlich den hier vorgestellten Daten beeinflusst werden.