Fibrin and fibrinogen degradation products in plasma of patients with colorectal adenocarcinoma

Transcriptomic Meta-Analysis Identifies Upregulated Clotting and Fibrinolysis Pathways in Colorectal Cancer Tumors Containing Hereditary PMS2 Mismatch Repair Deficiency

Lynch Syndrome is characterized by deficient mismatch repair (dMMR) components. We performed a meta-analysis of multiple RNA-sequencing datasets from patients with different dMMR variants (PMS2, MLH1, and MSH2) to better characterize the unique transcriptional profiles. Our results reveal enriched signaling pathways from tumor samples with germline mutations in the PMS2 gene including upregulation in pathways related to intrinsic and extrinsic prothrombin activation, fibrinolysis, and uPA/uPAR-mediated signaling. These pathways have been associated with tumor growth, invasiveness, and metastasis. This work provides support for further exploration into the role of PMS2 in tumor development, and as a potential therapeutic mechanism.

Quantification of Plasma Fibrinogen Degradation Products in Areca Nut Chewers with and without Oral Submucous Fibrosis

INTRODUCTION

Fibrinogen degradation products (FDPs) are the products that are released from fibrin/fibrinogen. Recently, it has been observed that these FDPs have been identified in the plasma of OSMF patients. Areca nut being the major aetiological agent for OSMF may play a role in the increased plasma levels of FDPs in OSMF.

AIM

The aim of this study was to quantify the plasma FDPs levels in the individuals with the habit of areca nut chewing with and without OSMF.

MATERIALS & METHODS

Total of 95 subjects were included,35 subjects with the habit of areca nut chewing with OSMF, 30 with the habit of areca nut chewing without OSMF, 30 without any habit of areca nut chewing without OSMF (control group). Five ml of venous blood was withdrawn from all the subjects and plasma FDP levels were estimated.

RESULTS

Plasma FDPs were detected in all the subjects of OSMF but could not be detected in other two groups. As the clinical grades of OSMF increased, levels of plasma FDPs also increased.

CONCLUSION

When plasma FDP increases, fibrin deposition also increases. This strengthens the finding that these FDPs may be an early indicator of the OSMF.

A systematic review of the pathophysiology of 5-fluorouracil-induced cardiotoxicity

Background

Cardiotoxicity is a serious side effect to treatment with 5-fluorouracil (5-FU), but the underlying mechanisms are not fully understood. The objective of this systematic review was to evaluate the pathophysiology of 5-FU- induced cardiotoxicity.

Methods

We systematically searched PubMed for articles in English using the search terms: 5-FU OR 5-fluorouracil OR capecitabine AND cardiotoxicity. Papers evaluating the pathophysiology of this cardiotoxicity were included.

Results

We identified 27 articles of 26 studies concerning the pathophysiology of 5-FU-induced cardiotoxicity. The studies demonstrated 5-FU-induced: hemorrhagic infarction, interstitial fibrosis and inflammatory reaction in the myocardium; damage of the arterial endothelium followed by platelet aggregation; increased myocardial energy metabolism and depletion of high energy phosphate compounds; increased superoxide anion levels and a reduced antioxidant capacity; vasoconstriction of arteries; changes in red blood cell (RBC) structure, function and metabolism; alterations in plasma levels of substances involved in coagulation and fibrinolysis and increased endothelin-1 levels and N-terminal-pro brain natriuretic peptide levels. Based on these findings the proposed mechanisms are: endothelial injury followed by thrombosis, increased metabolism leading to energy depletion and ischemia, oxidative stress causing cellular damage, coronary artery spasm leading to myocardial ischemia and diminished ability of RBCs to transfer oxygen resulting in myocardial ischemia.

Conclusions

There is no evidence for a single mechanism responsible for 5-FU-induced cardiotoxicity, and the underlying mechanisms might be multifactorial. Further research is needed to elucidate the pathogenesis of this side effect.

Low-mass-ion discriminant equation: a new concept for colorectal cancer screening

Blood metabolites can be detected as low-mass ions (LMIs) by mass spectrometry (MS). These LMIs may reflect the pathological changes in metabolism that occur as part of a disease state, such as cancer. We constructed a LMI discriminant equation (LOME) to investigate whether systematic LMI profiling might be applied to cancer screening. LMI information including m/z and mass peak intensity was obtained by five independent MALDI-MS analyses, using 1,127 sera collected from healthy individuals and cancer patients with colorectal cancer (CRC), breast cancer (BRC), gastric cancer (GC) and other types of cancer. Using a two-stage principal component analysis to determine weighting factors for individual LMIs and a two-stage LMI selection procedure, we selected a total of 104 and 23 major LMIs by the LOME algorithms for separating CRC from control and rest of cancer samples, respectively. CRC LOME demonstrated excellent discriminating power in a validation set (sensitivity/specificity: 93.21%/96.47%). Furthermore, in a fecal occult blood test (FOBT) of available validation samples, the discriminating power of CRC LOME was much stronger (sensitivity/specificity: 94.79%/97.96%) than that of the FOBT (sensitivity/specificity: 50.00%/100.0%), which is the standard CRC screening tool. The robust discriminating power of the LOME scheme was reconfirmed in screens for BRC (sensitivity/specificity: 92.45%/96.57%) and GC (sensitivity/specificity: 93.18%/98.85%). Our study demonstrates that LOMEs might be powerful noninvasive diagnostic tools with high sensitivity/specificity in cancer screening. The use of LOMEs could potentially enable screening for multiple diseases (including different types of cancer) from a single sampling of LMI information.

Serum D-dimer as a prognostic marker in patients undergoing radiofrequency ablation of colorectal liver metastasis

BACKGROUND

Although traditionally used for coagulation disorders, there has been a recent interest in serum D-dimer as a tumor marker. The aim of this prospective study is to determine its value as a tumor marker in patients with colorectal liver metastasis.

PATIENTS AND METHODS

Between January 2000 and October 2007, 242 patients undergoing laparoscopic radiofrequency ablation (RFA) of colorectal liver metastasis were evaluated prospectively. The relationship of D-dimer levels to pre-ablation parameters, recurrence, and survival was prospectively assessed. All data are expressed as mean ± SEM.

RESULTS

Preoperative D-dimer levels correlated with liver tumor volume (p = .04) and CEA (p = .003). D-dimer levels increased by a mean of 11.4 ± 1.5 folds after RFA on POD#7 and returned to preoperative values in three months. The rate of the elevation of D-dimer values after RFA was related to tumor volume ablated. The median overall survival was six months for patients with preoperative D-dimer > 1,000 ng/ml vs. 32 months for patients with D-dimer < 1,000 ng/ml (p = .02). On multivariate analysis preoperative serum D-dimer was an independent predictor of overall survival along with CEA and liver tumor burden.

CONCLUSION

Serum D-dimer levels reflect liver tumor burden and independently predict survival in patients with colorectal liver metastasis undergoing RFA.

Advantages of the AMDL-ELISA DR-70 (FDP) assay over carcinoembryonic antigen (CEA) for monitoring colorectal cancer patients

The DR-70® (FDP) test was the first cancer test cleared by USFDA for monitoring colorectal cancer (CRC) since Carcinoembryonic Antigen (CEA) in 1982. Conservatively, 50% of biopsy-positive CRC patients have negative CEA values. DR-70 and CEA values were compared for 113 CRC monitoring patients. Total concordance rates for DR-70 and CEA were 0.665 and 0.686, respectively. CRC patient pairs were grouped based on their CEA value to deduce DR-70's effectiveness at monitoring patients with low CEA values. DR-70 had 12% to 100% greater positive concordance rates than CEA in this group. DR-70 is a welcome new option for CRC patients.

Preoperative plasma D-dimer is a predictor of postoperative deep venous thrombosis in colorectal cancer patients: a clinical, prospective cohort study with one-year follow-up

PURPOSE

The study examined if preoperative plasma D-dimer level was associated with the postoperative cumulative incidence of deep venous thrombosis in patients with colorectal cancer admitted for intended curative surgery.

METHODS

In 176 consecutive patients with newly-diagnosed colorectal cancer and absence of preoperative deep venous thrombosis, we measured the preoperative plasma D-dimer levels and performed compression ultrasonography for deep venous thrombosis prior to surgery, as well as one week, one month, and one year after surgery.

RESULTS

The cumulative incidence of deep venous thrombosis up to one year after surgery was 20 percent (95 percent confidence interval, 12 to 31 percent) in the positive D-dimer group compared with 5 percent (95 percent confidence interval, 2 to 12 percent) in the negative D-dimer group. The adjusted hazard ratio of deep venous thrombosis in the positive vs. the negative D-dimer group was 6.53 (95 percent confidence interval, 1.58 to 27.0).

CONCLUSIONS

A positive preoperative D-dimer was associated with a higher cumulated incidence of postoperative deep venous thrombosis. D-dimer might be useful in identifying those colorectal cancer patients who fail to respond to standard prophylaxis for deep venous thrombosis.

The new DR-70 immunoassay detects cancer of the gastrointestinal tract: a validation study

BACKGROUND

Malignant cells characteristically possess high levels of plasminogen activator, which induce local fibrinolysis. The DR-70 immunoassay is a newly developed test, which quantifies fibrin degradation products in serum by a proprietary antibody.

AIM

To evaluate the DR-70 immunoassay as a detection assay for the presence of gastrointestinal cancers.

METHODS

We prospectively collected blood sera of 85 patients with histologically proven tumour and 100 healthy blood donors. Ten microlitres of the sera was used for the DR-70 immunoassay. Nineteen patients had a hepatocellular and 10 cholangiocellular carcinoma, 13 cancer of the pancreas, 30 colorectal cancer, 10 stomach cancer and three cancer of the oesophagus.

RESULTS

Receiver-operator curve analysis revealed <0.7 microg/mL as the best cut-off value to distinguish between patients with cancer and healthy controls. Using this cut-off value, the DR-70 immunoassay showed a good clinical performance with a sensitivity of 91% and a specificity of 93%. Patients with advanced tumour spread showed significantly higher DR-70 values than those with early-stage tumours (P < 0.0003).

CONCLUSION

The DR-70 immunoassay reliably differs between cancer patients and healthy controls. Therefore, it promises to become a useful test for the detection of cancer in clinical practice.

Sequential Compression Devices as Prophylaxis for Venous Thromboembolism in High-Risk Colorectal Surgery Patients: Reconsidering American Society of Colorectal Surgeons Parameters

The American Society of Colorectal Surgeons (ASCRS) recently endorsed low-molecular-weight heparin and low-dose heparin as primary prophylaxis for venous thromboembolism (VTE) in highest-risk patients. Our study evaluates the feasibility of sequential compression device (SCD) use for VTE prophylaxis in these patients. Computerized databases of discharge diagnoses from three hospitals were reviewed. All patients with colorectal cancer or inflammatory bowel disease during a 7-year period were identified. Those who underwent major abdominal surgery and received VTE prophylaxis exclusively with SCDs were selected for the study. Patients diagnosed with postoperative VTE were identified through review of the three databases and of patient records for 90 days after surgery. One thousand two hundred eighty-one patients classified as highest-risk under the published ASCRS parameters underwent major abdominal surgery and received SCDs perioperatively. The incidence of clinically detectable postoperative VTE was 0.78 per cent. There were trends toward lower incidence among patients with malignancy (0.53%) compared with inflammatory bowel disease (1.48%, P = 0.09), and those with abdominal compared to pelvic procedures (0.62% vs. 1.04%, P = 0.41). Prophylaxis for perioperative VTE solely with SCD is a viable option for patients classified as highest-risk under ASCRS parameters.