Plasma prostasin: a novel risk marker for incidence of diabetes and cancer mortality

Bridging diabetes and cancer: harnessing biomarkers as dual sentinels for diagnosis, prognosis, and therapeutic advancements

The complex two-way relationship between diabetes mellitus (DM) and cancer poses a significant global health challenge. Shared mechanisms such as hyperinsulinemia, chronic inflammation, and oxidative stress create an environment that fosters cancer development, increasing the risk for certain cancers in individuals with diabetes, including pancreatic, colorectal, breast, liver, and endometrial malignancies. In this context, biomarkers emerge as essential tools, offering a means to untangle the connections between these two conditions by providing insights into early detection, diagnosis, prognosis, and treatment monitoring. For diabetic patients, biomarkers are particularly valuable as they help differentiate between changes caused by cancer and those driven by metabolic imbalances, illuminating disease evolution. This review examines the unique challenges encountered by diabetic patients with cancer, emphasizing the contributions of targeted biomarkers in identifying cancer subtypes, predicting outcomes, and guiding treatment decisions. We explore organ-specific biomarker profiles across various cancers, including pancreatic, colorectal, breast, liver, and lung, highlighting their potential to enhance diagnostic precision and enable personalized treatment strategies. Ultimately, we aim to illustrate how a deeper understanding of biomarker signatures can inform innovative clinical approaches and improve care for patients facing the dual burden of diabetes and cancer.

GPI-anchored serine proteases: essential roles in development, homeostasis, and disease

The glycosylphosphatidylinositol (GPI)-anchored serine proteases, prostasin and testisin, have essential roles in diverse physiological functions including development, reproduction, homeostasis and barrier function of epithelia, angiogenesis, coagulation, and fibrinolysis. Important functions in pathological conditions such as cancer, kidney disease and cardiovascular disease have also been reported. In this review, we summarize current knowledge of the cellular and in vivo roles of prostasin and testisin in physiology and pathophysiology and explore the underlying molecular mechanisms. We discuss how new insights of their role in cancer and cardiovascular disease may facilitate translation into clinical settings in the future.

Urinary Proteomics and Outcomes in Heart Failure With Preserved Ejection Fraction

BACKGROUND

Although several studies have addressed plasma proteomics in heart failure with preserved ejection fraction, limited data are available on the prognostic value of urinary proteomics. The objective of our study was to identify urinary proteins/peptides associated with death and heart failure admission in patients with heart failure with preserved ejection fraction.

METHODS AND RESULTS

The study population included participants enrolled in TOPCAT (Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist Trial). The relationship between urine protein levels and the risk of death or heart failure admission was assessed using Cox regression, in both nonadjusted analyses and adjusting for urine creatinine levels, and the MAGGIC (Meta-Analysis Global Group in Chronic Heart Failure) score. A total of 426 (12.4%) TOPCAT participants had urinary protein data and were included. There were 40 urinary proteins/peptides significantly associated with death or heart failure admission in nonadjusted analyses, 21 of which were also significant adjusted analyses. Top proteins in the adjusted analysis included ANGPTL2 (angiopoietin-like protein 2) (hazard ratio [HR], 0.5731 [95% CI, 0.47-0.7]; P=3.13E-05), AMY2A (α amylase 2A) (HR, 0.5496 [95% CI, 0.44-0.69]; P=0.0001), and DNASE1 (deoxyribonuclease-1) (HR, 0.5704 [95% CI, 0.46-0.71]; P=0.0002). Higher urinary levels of proteins involved in fibrosis (collagen VI α-1, collagen XV α-1), metabolism (pancreatic α-amylase 2A/B, mannosidase α class 1A member 1), and inflammation (heat shock protein family D member 1, inducible T cell costimulatory ligand) were associated with a lower risk of death or heart failure admission.

CONCLUSIONS

Our study identifies several novel associations between urinary proteins/peptides and outcomes in heart failure with preserved ejection fraction. Many of these associations are independent of clinical risk scores and may aid in risk stratification in this patient population.