Serum macrophage inhibitory cytokine 1 as a marker of pancreatic and other periampullary cancers.

PURPOSE: Patients with pancreatic ductal adenocarcinoma usually present with advanced-stage disease and a dismal prognosis. One effective strategy likely to improve the morbidity and mortality from pancreatic cancer would be the identification of accurate, noninvasive diagnostic markers that would enable earlier diagnosis of symptomatic patients and earlier detection of cancer in asymptomatic individuals at high risk for developing pancreatic cancer. In this study, we evaluated serum macrophage inhibitory cytokine-1 (MIC-1) as a marker of pancreatic cancer. EXPERIMENTAL DESIGN: MIC-1 expression in primary pancreatic cancers, intraductal papillary mucinous neoplasms, and pancreatic cancer cell lines was determined using the National Center for Biotechnology Information serial analysis of gene expression database, oligonucleotide microarrays analysis, in situ hybridization, and immunohistochemistry. Serum MIC-1 levels were determined by ELISA in 80 patients with pancreatic adenocarcinomas, in 30 patients with ampullary and cholangiocellular carcinomas, in 42 patients with benign pancreatic tumors, in 76 patients with chronic pancreatitis, and in 97 healthy control subjects. The diagnostic performance of serum MIC-1 as a marker of pancreatic cancer was compared with that of serum CA19-9. RESULTS: Oligonucleotide microarray and serial analysis of gene expression data demonstrated that MIC-1 RNA levels were higher in primary pancreatic cancers, intraductal papillary mucinous neoplasms, and pancreatic cancer cell lines than in nonneoplastic pancreatic ductal epithelium. MIC-1 expression was localized to the malignant epithelium in pancreatic adenocarcinomas by in situ hybridization. MIC-1 protein was expressed in 14 of 16 primary pancreatic adenocarcinomas (88%) by immunohistochemistry and was also expressed in some pancreata affected by pancreatitis but not in normal pancreas. Serum MIC-1 levels were significantly higher in patients with pancreatic ductal adenocarcinoma (mean +/- SD, 2428 +/- 2324 pg/ml) and in patients with ampullary and cholangiocellular carcinomas (2123 +/- 2387 pg/ml) than in those with benign pancreatic neoplasms (940 +/- 469 pg/ml), chronic pancreatitis (1364 +/- 1236 pg/ml), or in healthy controls (546 +/- 262 pg/ml). An elevated serum MIC-1 (defined as 2 SD above the mean for healthy controls) performed as well as CA19-9 (area under the receiver operating characteristic curve, 0.81 and 0.77, respectively), and the combination of MIC-1 and CA19-9 significantly improved diagnostic accuracy (P < 0.05; area under the receiver operating characteristic curve, 0.87; sensitivity, 70%; specificity, 85%). CONCLUSION: Serum MIC-1 measurement can aid in the diagnosis of pancreatic adenocarcinoma.     

Serum markers in patients with resectable pancreatic adenocarcinoma: macrophage inhibitory cytokine 1 versus CA19-9.

PURPOSE: More accurate serum markers of pancreatic cancer could improve the early detection and prognosis of this deadly disease. We compared the diagnostic utility of a panel of candidate serum markers of pancreatic cancer. EXPERIMENTAL DESIGN: We collected preoperative serum from 50 patients with resectable pancreatic adenocarcinoma, as well as sera from 50 patients with chronic pancreatitis and 50 age/sex-matched healthy controls from our institution. Sera were analyzed for the following candidate markers of pancreatic cancer: CA19-9, macrophage inhibitory cytokine 1 (MIC-1), osteopontin, tissue inhibitor of metalloproteinase 1, and hepatocarcinoma-intestine-pancreas protein levels. RESULTS: By logistic regression analysis, MIC-1 and CA19-9 were significant independent predictors of diagnosis. Receiver operating characteristic curve analysis showed that MIC-1 was significantly better than CA19-9 in differentiating patients with pancreatic cancer from healthy controls (area under the curve is 0.99 and 0.78, respectively; P = 0.003), but not in distinguishing pancreatic cancer from chronic pancreatitis (area under the curve of 0.81 and 0.74, respectively; P = 0.63). Hepatocarcinoma-intestine-pancreas/pancreatitis-associated protein, osteopontin, and tissue inhibitor of metalloproteinase 1 serum levels did not provide additional diagnostic power. CONCLUSION: In the differentiation of patients with resectable pancreatic cancer from controls, serum MIC-1 outperforms other markers including CA19-9.     

A two-site enzyme-linked immunosorbent assay for cytokeratin 8.

A monoclonal enzyme-linked immunosorbent assay (ELISA) was developed for the determination in biological fluids of cytokeratin 8, a potential marker for malignant diseases. Two monoclonal antibodies (MAbs), TS 3 and TS 4, with different epitope specificity, were selected from 4 cytokeratin-8 reactive antibodies. TS 3 was used for coating and TS 4 as HRP-conjugate, respectively. Antibodies were selected with the aim of optimizing the discriminatory capacity between cytokeratin 8 levels in sera from healthy persons and from patients with malignant diseases. In sera from healthy individuals the mean value was determined to be 3.1 +/- 2.3 ng/ml with an upper cut-off level of 7.8 ng/ml (+ 2 SD) using purified cytokeratin 8 as standard. Sera from patients with colon cancer and pancreatic cancer were found to have significantly elevated levels, showing a 4- to more than 10-fold increase compared with the normal level. In patients with ovarian cancer no significant elevation was seen. Cytokeratin 8 monitoring may be of value for patients with colon and pancreatic cancer.     

Serum diagnosis of pancreatic adenocarcinoma using surface-enhanced laser desorption and ionization mass spectrometry.

PURPOSE: Each year in the United States, approximately 30,000 people die from pancreatic cancer. Fewer than 5% of patients survive >5 years after diagnosis, because most patients present with advanced disease. Early diagnosis may improve the prognosis of patients with pancreatic cancer. EXPERIMENTAL DESIGN: In an attempt to improve on current approaches to the serological diagnosis of pancreatic cancer, we analyzed serum samples from patients with and without pancreatic cancer using surface-enhanced laser desorption and ionization (SELDI) protein chip mass spectrometry. Using a case-control study design, serum samples from 60 patients with resectable pancreatic adenocarcinoma were compared with samples from 60 age- and sex-matched patients with nonmalignant pancreatic diseases, as well as 60 age- and sex-matched healthy controls. To increase the number of proteins potentially identifiable, serum was fractionated using anion exchange and profiled on two ProteinChip surfaces (metal affinity capture and weak cation exchange). RESULTS: We determined a minimum set of protein peaks able to discriminate between patient groups and used the unified maximum separability algorithm to compare the performance of the individual marker panels alone or in conjunction with CA19-9. Among the peaks identified by SELDI profiling that had the ability to distinguish between patient groups, the 2 most discriminating protein peaks could differentiate patients with pancreatic cancer from healthy controls with a sensitivity of 78% and specificity of 97%. These 2 markers performed significantly better than the current standard serum marker, CA19-9 (P < 0.05). The diagnostic accuracy of the 2 markers was improved by using them in combination with CA 19-9. Similarly, a combination of 3 SELDI markers and CA19-9 was superior to CA19-9 alone in distinguishing individuals with pancreatic cancer from the combined pancreatic disease controls and healthy subject groups (P = 0.078). SELDI markers were also better than CA19-9 in distinguishing patients with pancreatic cancer from those with pancreatitis. CONCLUSION: SELDI profiling of serum can be used to accurately differentiate patients with pancreatic cancer from those with other pancreatic diseases and from healthy controls.     

Early diagnosis of pancreatic cancer: neutrophil gelatinase-associated lipocalin as a marker of pancreatic intraepithelial neoplasia

Pancreatic cancer is a highly lethal malignancy with a dismal 5-year survival of less than 5%. The scarcity of early biomarkers has considerably hindered our ability to launch preventive measures for this malignancy in a timely manner. Neutrophil gelatinase-associated lipocalin (NGAL), a 24-kDa glycoprotein, was reported to be upregulated nearly 27-fold in pancreatic cancer cells compared to normal ductal cells in a microarray analysis. Given the need for biomarkers in the early diagnosis of pancreatic cancer, we investigated the expression of NGAL in tissues with the objective of examining if NGAL immunostaining could be used to identify foci of pancreatic intraepithelial neoplasia, premalignant lesions preceding invasive cancer. To examine a possible correlation between NGAL expression and the degree of differentiation, we also analysed NGAL levels in pancreatic cancer cell lines with varying grades of differentiation. Although NGAL expression was strongly upregulated in pancreatic cancer, and moderately in pancreatitis, only a weak expression could be detected in the healthy pancreas. The average composite score for adenocarcinoma (4.26+/-2.44) was significantly higher than that for the normal pancreas (1.0) or pancreatitis (1.0) (P<0.0001). Further, although both well- and moderately differentiated pancreatic cancer were positive for NGAL, poorly differentiated adenocarcinoma was uniformly negative. Importantly, NGAL expression was detected as early as the PanIN-1 stage, suggesting that it could be a marker of the earliest premalignant changes in the pancreas. Further, we examined NGAL levels in serum samples. Serum NGAL levels were above the cutoff for healthy individuals in 94% of pancreatic cancer and 62.5% each of acute and chronic pancreatitis samples. However, the difference between NGAL levels in pancreatitis and pancreatic cancer was not significant. A ROC curve analysis revealed that ELISA for NGAL is fairly accurate in distinguishing pancreatic cancer from non-cancer cases (area under curve=0.75). In conclusion, NGAL is highly expressed in early dysplastic lesions in the pancreas, suggesting a possible role as an early diagnostic marker for pancreatic cancer. Further, serum NGAL measurement could be investigated as a possible biomarker in pancreatitis and pancreatic adenocarcinoma.     

Osteopontin influences the invasiveness of pancreatic cancer cells and is increased in neoplastic and inflammatory conditions

Pancreatic ductal adenocarcinoma (PDAC) is one of the most aggressive malignancies, with an overall 5-year survival rate of less than 5%. Invasive tumor growth and early metastasis are two important reasons for this dismal prognosis. Osteopontin (OPN) is a secretory protein with a variety of functions, for example in cell adhesion and migration, inflammatory reaction and apoptosis. In this study the functional role of OPN in human pancreatic cancer and its potential use as a disease marker were analyzed. By real time quantitative PCR, there was a 2.2-fold and 1.6-fold increase of OPN mRNA in pancreatic cancers (n = 23) and chronic pancreatitis samples (n = 22), respectively, compared to normal pancreatic tissues (n = 20). Immunohistochemical analysis demonstrated OPN staining in 60% of the primary pancreatic tumors and in 72% of the lymph node and liver metastases. ELISA analysis of serum samples obtained from pancreatic cancer patients (n = 70), chronic pancreatitis patients (n = 12), and healthy donors (n = 20) showed a 1.6-fold increase in OPN serum levels in patients with tumors and a 1.9-fold increase in patients with chronic pancreatitis. Recombinant human OPN significantly increased the invasiveness of pancreatic cancer cells, without having any impact on cell proliferation. In addition, down regulation of OPN by specific siRNA molecules decreased pancreatic cancer cell invasion. In conclusion, OPN serum levels in pancreatic cancer and chronic pancreatitis patients are not significantly different, thereby restricting its role as a prognostic or follow-up marker. Our results do suggest, however, that blockade of OPN might be useful as a therapeutic approach to inhibit invasion and metastasis of pancreatic cancer cells.     

Tumor markers in pancreatic cancer: a European Group on Tumor Markers (EGTM) status report

Pancreatic ductal adenocarcinoma is one of the most difficult malignancies to diagnose and treat. The aim of this article is to review how tumor markers can aid the diagnosis and management of patients with this malignancy. The most widely used and best validated marker for pancreatic cancer is CA 19-9. Inadequate sensitivity and specificity limit the use of CA 19-9 in the early diagnosis of pancreatic cancer. In non-jaundiced patients, however, CA 19-9 may complement other diagnostic procedures. In patients with resectable pancreatic cancer, presurgical and postresection CA 19-9 levels correlate with overall survival. In advanced disease, elevated pretreatment levels of CA 19-9 are associated with adverse patient outcome and thus may be combined with other factors for risk stratification. Most, but not all, reports indicate that serial levels of CA 19-9 correlate with response to systemic therapy. Use of CA 19-9 kinetics in conjunction with imaging is therefore recommended in monitoring therapy. Although several potential serum and tissue markers for pancreatic cancer are currently undergoing evaluation, none are sufficiently validated for routine clinical use. CA 19-9 thus remains the serum pancreatic cancer marker against which new markers for this malignancy should be judged.     

Measurement of a pancreatic cancer-associated antigen (DU-PAN-2) detected by a monoclonal antibody in sera of patients with digestive cancers

DU-PAN-2 is a high-molecular-weight glycoprotein defined by a murine monoclonal antibody (MAb) against a pancreatic ductal adenocarcinoma cell line. In order to evaluate the usefulness of this antigen as a tumor marker, we determined the serum level of the antigen by competitive inhibition radioimmunoassay in sera from 139 patients with various malignant tumors, chiefly digestive cancers, 98 patients with different benign diseases and 11 healthy subjects. Values in the healthy subjects were less than 100 U/ml. Levels above 100 U/ml were frequently observed in sera from benign diseases, but levels above 400 U/ml were found in only 6 of the patients with benign diseases. In contrast, levels exceeding 400 U/ml were detected in 72% of patients with pancreatic cancer, 44% of patients with hepatocellular cancer and 40% of patients with biliary tract cancer. The positivity was low in other cancers such as gastric cancer (19%) and colorectal cancer (7%). Serum levels of CEA and CA 19-9 were also determined in cancer patients. Among the pancreatic cancer patients studied, values above 400 U/ml were found in 5 of the 8 CEA-negative patients (less than 5 ng/ml) and 2 of the 3 CA 19-9 negative patients (less than 37 U/ml). These results indicate that determination of the serum DU-PAN-2 can aid in serological diagnosis of cancer of the digestive tract, more particularly of the pancreas.     

CA 15-3 is present as a novel tumor marker in the sera of patients with breast cancer and other malignancies

As a novel tumor marker, we employed a quantitative sandwich RIA system utilizing two monoclonal antibodies (115D8, DF3) which react with a circulating antigen expressed by human breast cancer cells. The optimum condition for this assay was found be a 60 minute incubation at 37 degrees C for the first reaction and a 60 minute one at 25 degrees C for the second reaction. Under these optimum conditions, intra-assay variation of control sera was CV 3.6% and inter-assay variation was CV 6.6%. The observed range of CA 15-3 concentration in 75 healthy persons was 7.5 +/- 3.4 units/ml (mean +/- SD) and mean +2 SD was 14.2 U/ml. Less than 15 U/ml was decided as the cut off level. The positive rate in 113 patients with benign diseases was 18%, the serum levels being less than 25 U/ml. Increased CA 15-3 levels in sera of 178 patients were found respectively, in 0%, 41%, 45%, 50% and 75% of stage I, II, III, IV in primary breast cancer and advanced breast cancer. The sera of 10 patients with advanced breast cancer were collected regularly during a 2 to 4 month period. All patients with PD showed increased CA 15-3 levels and four patients in PR showed a clear decrease of serum levels. In 167 other malignancies, increased levels were found in 76%, 63%, 58%, 33%, 32% and 22% of the sera from uterine, pancreatic, ovarian, prostatic, lung and gastric carcinomas. The data revealed that serum CA 15-3 was clinically useful as a tumor marker especially a monitoring marker of advanced breast cancer, but presently the assay is not suitable for the early detection of breast tumors. Also its measurement seemed to be useful in ovarian cancer, uterine cancer, pancreatic cancer and adenocarcinoma of the lung.     

Comparison of CA-50, a new tumour marker, with carcinoembryonic antigen (CEA) and alpha-fetoprotein (AFP) in patients with gastrointestinal diseases

Serum levels were determined in 434 patients with benign and malignant gastrointestinal diseases and compared with the serum concentrations of carcinoembryonic antigen (CEA) and alpha-fetoprotein (AFP). The highest proportion of elevated CA-50 levels (greater than 17 U ml-1) was found in patients with pancreatic cancer (73%). High levels were mainly associated with advanced cancer, but also half of the patients with a resectable pancreatic tumour had an increased CA-50 concentration. The CA-50 level was elevated in 37-58% of patients with colorectal, gastric, hepatocellular and biliary tract cancers. In all gastrointestinal cancers, CA-50 gave additional information compared with CEA and AFP, except in hepatocellular carcinoma where AFP was the best marker.     

Fibrinogen gamma overexpression in pancreatic cancer identified by large-scale proteomic analysis of serum samples

Detection of serum markers for pancreatic cancer has been elusive. Although CA 19-9 is most commonly used, its sensitivity and specificity are modest. We used large-scale proteomics to identify potential serum markers for pancreatic cancer. Samples were analyzed using high-resolution two-dimensional gel electrophoresis to identify differentially expressed proteins in 32 normal and 30 pancreatic cancer patients. Up to 1,744 protein spots were resolved for each serum sample. Candidate proteins were identified using mass spectrometry. ANOVA was used to identify proteins that could discriminate cancer from normal sera. Serum fibrinogen level was also measured using enzymatic assay. Immunohistochemistry was used to detect fibrinogen in resected pancreatic cancers. One hundred fifty-four proteins were commonly overexpressed in all pancreatic cancers. Nine protein spots (four with identifications by mass spectrometry) could effectively separate cancer from normal controls using cross-validation. These proteins successfully discriminated all pancreatic cancer samples (30 of 30) and 94% of normal (30 of 32) samples. Prominent among these candidates was fibrinogen gamma, which was subsequently confirmed to be overexpressed in pancreatic cancer sera by enzymatic analysis (54.1 +/- 64.1 versus 0.0 +/- 0.0 mg/dL, P < 0.05) and tissue by immunohistochemistry (67% versus 29%, P < 0.05) relative to normal pancreas. Proteomic analysis combining two-dimensional gel electrophoresis and mass spectrometry successfully identified 154 potential serum markers for pancreatic cancer. Of these, fibrinogen gamma, a protein associated with the hypercoagulable state of pancreatic cancer, discriminated cancer from normal sera. Fibrinogen is a potential tumor marker in pancreatic cancer.     

Serum concentrations of soluble interleukin-2 receptor in patients with malignant brain tumors

BACKGROUND AND OBJECTIVES: Interleukin-2 receptor alpha (IL-2Ralpha) can combine with IL-2 firmly, and soluble IL-2Ralpha (sIL-2Ralpha) is elevated in sera from patients with various types of cancers. To investigate the role of this receptor, we studied the changes of serum sIL-2Ralpha in patients with malignant brain tumors. METHODS: SIL-2Ralpha was measured in 100 patients with malignant brain tumors (63 cancer metastasis, 16 malignant gliomas, 21 malignant lymphomas), and 51 patients with cancer who had no distant metastasis such as brain metastasis. RESULTS: In patients with 35 metastatic brain tumors from lung cancer, the levels of sIL-2Ralpha were not significantly different from levels in normal volunteers (311 +/- 62.4 U/ml). In patients with 25 metastatic brain tumors from lung adenocarcinoma, the mean level of serum sIL-2Ralpha was 352 +/- 94.0 U/ml. These same patients showed high levels of serum sIL-2Ralpha (492 +/- 101 U/ml) with regional lymph nodes metastasis. Serum sIL-2Ralpha concentration in 16 patients with malignant glioma varied greatly with the mean concentration of 328 +/- 192 U/ml. In 5 of 16 patients with malignant glioma, we could detect the significant increase of serum sIL-2Ralpha concentration from early stage of recurrence. CONCLUSIONS: Serum levels of sIL-2Ralpha could be a useful immunological marker in patients with malignant brain tumors.     

Clinical evaluation of circulating serum sialyl Tn antigen levels in patients with epithelial ovarian cancer.

Sialyl Tn antigen (NeuAc alpha 2----6GalNac alpha 1----0-Ser/Thr [STN]) with antigenic specificity in the core structure of mucin-type carbohydrate chains has been determined. In the present study, we evaluated the clinical significance of this new carbohydrate antigen, STN, in patients with epithelial ovarian cancer. With the use of a radioimmunoassay developed to detect STN antigen in serum, elevated (greater than or equal to 32.6 U/mL) antigen levels were observed in 50.0% of patients with ovarian cancer. In contrast, 3.8% of healthy individuals had STN antigen levels greater than or equal to 32.6 U/mL. In 9.6% of patients with benign gynecologic diseases and 0% of pregnant women, there were elevated levels of STN antigen. There was a significant difference (P less than .001) in STN antigen levels between patients with ovarian cancer and patients with benign gynecologic diseases, pregnant women, or the controls. The mean +/- SD for all evaluated samples of ovarian cancer was 109.2 +/- 146.8 U/mL. Both the mean values and the positive rate increased as the stage advanced. Classified according to the histologic type, the highest positive rate (61.0%) was observed in mucinous adenocarcinoma. The usefulness of STN antigen as a circulating tumor marker in ovarian cancer was estimated as follows: sensitivity 50.0%, specificity 93.5%, positive predictive value 72.2%, negative predictive value 84.7%, and diagnostic value 46.8%. Serum STN antigen levels were elevated in 12 of 33 patients with ovarian cancer who had serum CA 125 antigen levels less than 35 U/mL. While CA 125 antigen levels were elevated in 74.6% and STN antigen levels were elevated in 50.0% of the same population, the use of both assays indicated the sensitivity of detection of 83.8% in the population studied.     

大肠癌患者外周血骨桥蛋白检测意义

[目的]探讨外周血骨桥蛋白（OPN）作为大肠癌肿瘤标志物检测的临床意义。[方法]应用酶联免疫吸附试验（ELISA）和放射免疫分析技术（RIA）检测40例健康正常志愿者和52例大肠癌患者手术前后外周血OPN和CEA的浓度。[结果]大肠癌患者外周血OPN和CEA检测的敏感性为73．08％和55．77％，特异性为92．50％和87．50％．联合检测的敏感性为76．92％。治疗后两种标志物的浓度均显著性低于治疗前的浓度（P〈0．01）。OPN和CEA水平与大肠癌的临床分期、淋巴结转移和远处转移有关，与组织学分型无关。OPN与肿瘤大小有相关性。[结论]OPN是大肠癌的一种较为理想的肿瘤标志物，与CEA联合检测能提高大肠癌诊断的敏感性。     

Occurrence of carcinoma-associated antigen 494 in colorectal cancer tissue and in Patients' sera during metastatic disease.

CA 494 is a new carbohydrate epitope on a high-molecular-weight mucin-type glycoprotein which has been intensively investigated in pancreatic cancer. In this study, the occurrence of CA 494 was characterized in colorectal cancer tissue and in patients' sera during metastatic disease. CA 494 was detected in cancer tissue from 82% of the 49 patients studied. Serum levels of CA 494 were elevated (>40 U/ml) in 66% of the same patients during metastatic disease (n = 41). The well-established tumor markers carcinoembryonic antigen (CEA) and CA 19-9 were increased (CEA >5 ng/ml; CA 19-9 >37 U/ml) in about 79% of these patients. The correlation of CA 494 with CA 19-9 levels was lower (r = 0.532) than previously reported in pancreatic cancer.     

Elevated serum CA72-4 levels predict poor prognosis in pancreatic adenocarcinoma after intensity-modulated radiation therapy

Carbohydrate antigen 72-4 (CA72-4) is a human tumor-associated glycoprotein, commonly used as a tumor marker for diagnosing and predicting outcome in gastric and ovarian cancers. However, the relationship between serum CA72-4 levels and prognosis of pancreatic adenocarcinoma has not been fully elucidated. A total of 113 consecutive locally advanced pancreatic adenocarcinoma patients who underwent intensity-modulated radiation therapy (IMRT) with or without chemotherapy were enrolled in this study. Serum CA72-4 levels were analyzed using immunoenzymometric assays. The association between serum CA72-4 levels and prognosis was evaluated. Serum CA72-4 levels was related with lymph node metastasis (P<0.001). The median overall survival time was 14.0 months for patients with serum CA72-4 normal levels and 10.0 months for the elevated levels (P<0.001). Multivariate analysis identified that Serum CA72-4 concentration was a significant prognostic factor (P<0.001). The hazard ratio (HR) of elevated serum CA72-4 levels compared with normal serum CA72-4 levels was 2.34 (95% confidence interval [CI]: 1.46-3.73), after adjusted for gender and age. Based on this finding, Serum CA72-4 is a potential marker to predict lymph node metastasis and prognosis in pancreatic adenocarcinoma.     

Reg IV is a serum biomarker for gastric cancer patients and predicts response to 5-fluorouracil-based chemotherapy

Regenerating gene family, member 4 (Reg IV), a secreted protein, is overexpressed in several cancers, including gastric cancer (GC). In the present study, we measured Reg IV levels in sera from patients with GC by enzyme-linked immunosorbent assay. We also examined the effect of forced Reg IV expression on the apoptotic susceptibility to 5-fluorouracil (5-FU). Forced expression of Reg IV inhibited 5-FU-induced apoptosis. Induction of Bcl-2 and dihydropyrimidine dehydrogenase was involved in inhibition of apoptosis. Among 36 GC patients treated with a combination chemotherapy of low-dose 5-FU and cisplatin, all 14 Reg IV-positive patients showed no change or disease progression. The serum Reg IV concentration was similar between healthy individuals (mean+/-s.e., 0.52+/-0.05 ng/ml) and patients with chronic-active gastritis (0.36+/-0.09 ng/ml). However, the serum Reg IV concentration in presurgical GC patients was significantly elevated (1.96+/-0.17 ng/ml), even at stage I. The diagnostic sensitivity of serum Reg IV (36.1%) was superior to that of serum carcinoembryonic antigen (11.5%) or carbohydrate antigen 19-9 (13.1%). These results indicate that expression of Reg IV is a marker for prediction of resistance to 5-FU-based chemotherapy in patients with GC. Serum Reg IV represents a novel biomarker for GC.     

Immune responses to DNA mismatch repair enzymes hMSH2 and hPMS1 in patients with pancreatic cancer, dermatomyositis and polymyositis

To identify tumor antigens useful for diagnosis and immunotherapy of patients with pancreatic ductal adenocarcinoma, we applied a SEREX approach with a cDNA library made from 5 pancreatic cancer cell lines and sera obtained from 8 patients with pancreatic cancer, and isolated total 32 genes, including 14 previously characterized genes and 18 genes with unknown functions. Among these isolated antigens, serum IgG antibodies for 2 isolated DNA mismatch repair enzymes, Homo sapiens mutS homolog 2 (hMSH2) and Homo sapiens postmeiotic segregation increased 1 (hPMS1), were detected in patients with pancreatic ductal adenocarcinoma and dermatomyositis (DM), and polymyositis (PM), but not in sera from healthy individuals. Immunohistochemical study demonstrated that hMSH2 and hPMS1 were over-expressed in pancreatic ductal adenocarcinoma compared to normal pancreatic ducts. These results suggested that hMSH2 and hPMS1 may be useful as CD4+ helper T cell antigens for immunotherapy of pancreatic cancer patients and that serum IgG antibodies may be useful for diagnosis of patients with pancreatic ductal adenocarcinoma and DM/PM.     

Monoclonal antibody immunoradiometric assay for an antigenic determinant (CA 72) on a novel pancarcinoma antigen (TAG-72)

CA 72 is a monoclonal antibody (MAb) -defined antigenic determinant expressed on a pancarcinoma antigen (TAG-72) found in more than 85% of human colorectal carcinomas. An immunoradiometric assay has been developed using the murine MAb B72.3 to quantitate CA 72 in human serum. In a simultaneous immunoradiometric assay, the mean CA 72 concentration in 1,099 serum samples from healthy blood donors was 1.83 +/- 2.03 (SD) units/ml. If the upper limit of normal was set at 10 mu/mol of serum, a value including 99% of healthy blood donors, only 4 of 101 serum samples (4%) from patients with benign disease were elevated, whereas 15 of 26 (58%) and 14 of 25 (56%) of rectal and colon carcinoma patient sera, respectively, were positive. Serum samples from 84 benign colorectal disease cases were examined; of these, 0 of 28 (0%) colorectal adenoma, 1 of 39 (3%) ulcerative proctocolitis, 0 of 15 (0%) diverticulosis, and 0 of 2 (0%) irritable bowel disease sera contained more than 10 mu/ml CA 72. At a reference value of 20 mu/ml, 0 of 101 (0%) benign disease and 2 of 1,060 (0.2%) blood donor sera had elevated values, whereas 10 of 26 (38%) and 9 of 25 (36%) rectal and colon patient sera, respectively, remained positive. The majority of patients with pancreatic and ovarian cancer, and a significant fraction of stomach cancer patient sera, also contained elevated levels of CA 72. The ability of this assay to discriminate between malignant and benign diseases suggests its further evaluation for monitoring and diagnosis in groups at risk for development of cancer.