A study of circulating anti-CD25 antibodies in non-small cell lung cancer

Prediction model for the early recurrence of stage IA-IIA non-small cell lung cancer based on hematological indexes and imaging features

BACKGROUND

Some patients with non-small cell lung cancer (NSCLC) experience early relapse within 2 years post-surgery. Screening patients who are prone to recurrence is crucial. This study aimed to determine factors influencing early recurrence within 2 years of surgery for stage IA-IIA NSCLC and to establish a prediction model.

METHODS

We retrospectively analyzed the hematological indices and imaging indicators of patients with stage IA-IIA NSCLC who underwent surgery at our hospital, and relevant clinical data were obtained through long-term follow-up from September 2019 to September 2020. Least absolute shrinkage and selection operator (LASSO) regression and univariate and multivariate Cox regression analyses were used to identify high-risk factors influencing postoperative recurrence, establish a predictive model, and construct a nomogram associated with recurrence-free survival.

RESULTS

Among 186 patients (90 male and 96 female), 29 (15.6%) experienced recurrence or metastasis during the follow-up period. Univariate analysis identified several significant factors, including tumor size, direct bilirubin, indirect bilirubin, albumin, globulin, serum creatinine, platelet-lymphocyte ratio, lymphocyte-monocyte ratio, prognostic nutrition index, albumin-alkaline phosphatase ratio, marginal lobulation, air bronchogram sign, pathological type of squamous cell carcinoma, tumor stage IB, and solid nodules. LASSO regression was used to further select variables and construct a multivariate Cox model showing globulin levels, air bronchogram signs, and solid nodules as independent prognostic factors for early recurrence within 2 years in patients with stage IA-IIA NSCLC. The Cox model stratified patients into high- and low-risk groups and was validated by Kaplan-Meier survival analysis, which demonstrated that high-risk patients had a significantly lower survival rate than low-risk patients, demonstrating the robust discriminative power of the predictive model.

CONCLUSION

Globulin content, air bronchogram signs, and solid nodules were independent prognostic factors for early recurrence within 2 years in patients with stage IA-IIA NSCLC. The proposed model, developed based on the above factors and the albumin-alkaline phosphatase ratio, can effectively predict recurrence risk, potentially aiding clinicians in quantifying prognostic risk, making personalized survival assessments, and devising the most effective treatment plans.

A Novel IgG-IgM Autoantibody Panel Enhances Detection of Early-stage Lung Adenocarcinoma from Benign Nodules

Autoantibodies hold promise for diagnosing lung cancer. However, their effectiveness in early-stage detection needs improvement. In this study, we investigated novel IgG and IgM autoantibodies for detecting early-stage lung adenocarcinoma (Early-LUAD) by employing a multi-step approach, including Human Proteome Microarray (HuProtTM) discovery, focused microarray verification, and ELISA validation, on 1246 individuals consisting of 634 patients with Early-LUAD (stage 0-I), 280 patients with benign lung disease (BLD), and 332 normal healthy controls (NHCs). HuProtTM selected 417 IgG/IgM candidates, and focused microarray further verified 55 significantly elevated IgG/IgM autoantibodies targeting 32 tumor-associated antigens in Early-LUAD compared to BLD/NHC/BLD+NHC. A novel panel of 10 autoantibodies (ELAVL4-IgM, GDA-IgM, GIMAP4-IgM, GIMAP4-IgG, MGMT-IgM, UCHL1-IgM, DCTPP1-IgM, KCMF1-IgM, UCHL1-IgG, and WWP2-IgM) demonstrated a sensitivity of 70.5% and a specificity of 77.0% or 80.0% for distinguishing Early-LUAD from BLD or NHC in ELISA validation. Positive predictive values for distinguishing Early-LUAD from BLD with nodules ≤ 8 mm, 9-20 mm, and > 20 mm significantly increased from 47.27%, 52.00%, and 62.90% [low-dose computed tomography (LDCT) alone] to 79.17%, 71.13%, and 87.88% (10-autoantibody panel combined with LDCT), respectively. The combined risk score (CRS), based on the 10-autoantibody panel, sex, and imaging maximum diameter, effectively stratified the risk for Early-LUAD. Individuals with 10 ≤ CRS ≤ 25 and CRS > 25 indicated a higher risk of Early-LUAD compared to the reference (CRS < 10), with adjusted odds ratios of 5.28 [95% confidence interval (CI): 3.18-8.76] and 9.05 (95% CI: 5.40-15.15), respectively. This novel panel of IgG and IgM autoantibodies offers a complementary approach to LDCT in distinguishing Early-LUAD from benign nodules.

Blood protein biomarkers in lung cancer

Lung cancer has consistently ranked first as the cause of cancer-associated mortality. The 5-year survival rate has risen slowly, and the main obstacle to improving the prognosis of patients has been that lung cancer is usually diagnosed at an advanced or incurable stage. Thus, early detection and timely intervention are the most effective ways to reduce lung cancer mortality. Tumor-specific molecules and cellular elements are abundant in circulation, providing real-time information in a noninvasive and cost-effective manner during lung cancer development. These circulating biomarkers are emerging as promising tools for early detection of lung cancer and can be used to supplement computed tomography screening, as well as for prognosis prediction and treatment response monitoring. Serum and plasma are the main sources of circulating biomarkers, and protein biomarkers have been most extensively studied. In this review, we summarize the research progress on three most common types of blood protein biomarkers (tumor-associated antigens, autoantibodies, and exosomal proteins) in lung cancer. This review will potentially guide researchers toward a more comprehensive understanding of candidate lung cancer protein biomarkers in the blood to facilitate their translation to the clinic.

Further Study of Circulating Antibodies to P16, CD25 and FOXP3 in Hepatocellular Carcinoma

Purpose

It has been reported that circulating levels of IgG antibodies against p16, CD25 and FOXP3 proteins were significantly changed in patients with lung cancer, breast cancer and esophageal cancer. However, different peptide fragments appear to trigger different immune responses. This work aimed to analyze the alteration of plasma IgG for p16-derived peptide antigen called p16a, CD25-derived peptide antigen called CD25a and a FOXP3-derived antigen in hepatocellular carcinoma (HCC).

Patients and methods

An enzyme-linked immunosorbent assay (ELISA) was developed in-house to detect plasma IgG to p16a, CD25a and FOXP3 in 119 patients with HCC and 132 control subjects.

Results

Circulating levels of IgG antibodies for all three peptide antigens were significantly higher in HCC patients than control subjects (P<0.001 for all 3 assays); male patients mainly contributed to increase (P<0.01 for all 3 assays). Further analysis showed that plasma anti-p16a, anti-CD25a and anti-FOXP3 IgG levels were increased mainly in patients with intermediate and late-stage HCC (P<0.01 for both assays). Receiver operating characteristic (ROC) curve analysis showed that with a specificity of >95%, the area under the ROC curve (AUC) was 0.62 with 11.4% sensitivity for anti-p16a assay, 0.68 with 14.3% sensitivity for anti-CD25a IgG assay and 0.64 with 10.1% sensitivity for anti-FOXP3 assay. Of the three groups of HCC patients, group 3 (BCLC stage C+D) showed the best sensitivity for the detection of plasma anti-p16a and anti-FOXP3 IgG levels with an AUC of 0.66 and 0.65.

Conclusion

Circulating IgG antibody to p16a, CD25a and FOXP3 proteins may be a useful biomarker for assessment of HCC prognosis of this malignancy, especially in male patients with HCC.

Autoantibodies as diagnostic biomarkers for lung cancer: A systematic review

Lung cancer (LC) accounts for the largest number of tumor-related deaths worldwide. As the overall 5-year survival rate of LC is associated with its stages at detection, development of a cost-effective and noninvasive cancer screening method is necessary. We conducted a systematic review to evaluate the diagnostic values of single and panel tumor-associated autoantibodies (TAAbs) in patients with LC. This review included 52 articles with 64 single TAAbs and 19 with 20 panels of TAAbs. Enzyme-linked immunosorbent assays (ELISA) were the most common detection method. The sensitivities of single TAAbs for all stages of LC ranged from 3.1% to 92.9% (mean: 45.2%, median: 37.1%), specificities from 60.6% to 100% (mean: 88.1%, median: 94.9%), and AUCs from 0.416 to 0.990 (mean: 0.764, median: 0.785). The single TAAb with the most significant diagnostic value was the autoantibody against human epididymis secretory protein (HE4) with the maximum sensitivity 91% for NSCLC. The sensitivities of the panel of TAAbs ranged from 30% to 94.8% (mean: 76.7%, median: 82%), specificities from 73% to 100% (mean: 86.8%, median: 89.0%), and AUCs from 0.630 to 0.982 (mean: 0.821, median: 0.820), and the most significant AUC value in a panel (M13 Phage 908, 3148, 1011, 3052, 1000) was 0.982. The single TAAb with the most significant diagnostic calue for early stage LC, was the autoantibody against Wilms tumor protein 1 (WT1) with the maximum sensitivity of 90.3% for NSCLC and its sensitivity and specificity in a panel (T7 Phage 72, 91, 96, 252, 286, 290) were both above 90.0%. Single or TAAbs panels may be useful biomarkers for detecting LC patients at all stages or an early-stage in high-risk populations or health people, but the TAAbs panels showed higher detection performance than single TAAbs. The diagnostic value of the panel of six TAAbs, which is higher than the panel of seven TAAbs, may be used as potential biomarkers for the early detection of LC and can probably be used in combination with low-dose CT in the clinic.

Alteration of circulating natural autoantibodies to CD25-derived peptide antigens and FOXP3 in non-small cell lung cancer

Natural autoantibody is a key component for immune surveillance function. Regulatory T (Treg) cells play indispensable roles in promoting tumorigenesis via immune escape mechanisms. Both CD25 and FOXP3 are specific markers for Treg cells and their natural autoantibodies may be involved in anticancer activities. This work was designed to develop an in-house enzyme-linked immunosorbent assay (ELISA) to examine plasma natural IgG against CD25 and FOXP3 in non-small cell lung cancer (NSCLC). Compared with control subjects, NSCLC patients had significantly higher levels of plasma IgG for CD25a (Z = -8.05, P < 0.001) and FOXP3 (Z = -4.17, P < 0.001), lower levels for CD25b (Z = -3.58, P < 0.001), and a trend toward lower levels for CD25c (Z = -1.70, P = 0.09). Interestingly, the anti-CD25b IgG assay had a sensitivity of 25.0% against a specificity of 95.0% in an early stage patients (T1N0M0) who showed the lowest anti-CD25b IgG levels among 4 subgroups classified based on staging information. Kaplan-Meier survival analysis showed that patients with high anti-FOXP3 IgG levels had shorter survival than those with low anti-FOXP3 IgG levels (χ2 = 3.75, P = 0.05). In conclusion, anti-CD25b IgG may be a promising biomarker in terms of screening individuals at high risk of lung cancer.

Potential Contributions of Antioxidants to Cancer Therapy: Immunomodulation and Radiosensitization

Antioxidants play important roles in the maintenance of cellular integrity and thus are critical in maintaining the homeostasis of the host immune system. A balance between the levels of pro-oxidants and antioxidants defines the cellular fate of genomic integrity via maintaining the redox status of the cells. An aberration in this balance modulates host immunity that affects normal cellular signaling pathways resulting in uncontrolled proliferation of cells leading to neocarcinogenesis. For decades, there have been scientific debates on the use of antioxidants for the treatment of human cancers. This review is focused on current updates on the implications of antioxidant use as adjuncts in cancer therapy with an emphasis on immunomodulation and radiosensitization.

Serum tumor-associated autoantibodies as diagnostic biomarkers for lung cancer: A systematic review and meta-analysis

OBJECTIVE

We performed a comprehensive review and meta-analysis to evaluate the diagnostic values of serum single and multiplex tumor-associated autoantibodies (TAAbs) in patients with lung cancer (LC).

METHODS

We searched the MEDLINE and EMBASE databases for relevant studies investigating serum TAAbs for the diagnosis of LC. The primary outcomes included sensitivity, specificity and accuracy of the test.

RESULTS

The systematic review and meta-analysis included 31 articles with single autoantibody and 39 with multiplex autoantibodies. Enzyme-linked immunosorbent assay (ELISA) was the most common detection method. For the diagnosis of patients with all stages and early-stage LC, different single or combinations of TAAbs demonstrated different diagnostic values. Although individual TAAbs showed low diagnostic sensitivity, the combination of multiplex autoantibodies offered relatively high sensitivity. For the meta-analysis of a same panel of autoantibodies in patients at all stages of LC, the pooled results of the panel of 6 TAAbs (p53, NY-ESO-1, CAGE, GBU4-5, Annexin 1 and SOX2) were: sensitivity 38% (95% CI 0.35-0.40), specificity 89% (95% CI 0.86-0.91), diagnostic accuracy 65.9% (range 62.5-81.8%), AUC 0.52 (0.48-0.57), while the summary estimates of 7 TAAbs (p53, CAGE, NY-ESO-1, GBU4-5, SOX2, MAGE A4 and Hu-D) were: sensitivity 47% (95% CI 0.34-0.60), specificity 90% (95% CI 0.89-0.92), diagnostic accuracy 78.4% (range 67.5-88.8%), AUC 0.90 (0.87-0.93). For the meta-analysis of the same panel of autoantibodies in patients at early-stage of LC, the sensitivities of both panels of 7 TAAbs and 6 TAAbs were 40% and 29.7%, while their specificities were 91% and 87%, respectively.

CONCLUSIONS

Serum single or combinations of multiplex autoantibodies can be used as a tool for the diagnosis of LC patients at all stages or early-stage, but the combination of multiplex autoantibodies shows a higher detection capacity; the diagnostic value of the panel of 7 TAAbs is higher than the panel of 6 TAAbs, which may be used as potential biomarkers for the early detection of LC.

Further study of circulating IgG antibodies to CD25-derived peptide antigens in nonsmall cell lung cancer

A recent study reported that circulating antibodies to CD25-derived peptide antigens were significantly higher in patients with nonsmall cell lung cancer (NSCLC) than control subjects. The present study was, thus, undertaken to replicate the initial finding with different sample sets. An in-house ELISA was applied to determine circulating IgG antibodies to linear peptide antigens derived from CD25. A total of 111 patients with NSCLC and 216 control subjects were recruited and divided into the discovery sample (51 vs 108) and the validation sample (60 vs 108) based on the time of sampling. Student's t test showed that circulating anti-CD25 IgG levels were significantly higher in the patient group than the control group (t = 2.23, P = 0.027) and the validation sample replicated this finding (t = 3.31, P = 0.0012), generating a combined P value of 0.0004 (χ(2) = 20.8, df = 4). Fisher's combining probability revealed that patients with stage IV NSCLC had a significant increase in anti-CD25 IgG levels compared with control subjects (χ(2) = 22.1, df = 4, P = 0.0002) but those with the other three stages did not. This study suggests that circulating anti-CD25 IgG antibodies may have prognostic rather than early diagnostic values for lung cancer.

Use of autoantibodies to detect the onset of breast cancer

The widespread use of screening mammography has resulted in increased detection of early-stage breast disease, particularly for in situ carcinoma and early-stage breast cancer. However, the majority of women with abnormalities noted on screening mammograms are not diagnosed with cancer because of several factors, including radiologist assessment, patient age, breast density, malpractice concerns, and quality control procedures. Although magnetic resonance imaging is a highly sensitive detection tool that has become standard for women at very high risk of developing breast cancer, it lacks sufficient specificity and costeffectiveness for use as a general screening tool. Therefore, there is an important need to improve screening and diagnosis of early-invasive and noninvasive tumors, that is, in situ carcinoma. The great potential for molecular tools to improve breast cancer outcomes based on early diagnosis has driven the search for diagnostic biomarkers. Identification of tumor-specific markers capable of eliciting an immune response in the early stages of tumor development seems to provide an effective approach for early diagnosis. The aim of this review is to describe several autoantibodies identified during breast cancer diagnosis. We will focus on these molecules highlighted in the past two years and discuss the potential future use of autoantibodies as biomarkers of early-stage breast cancer.

Detection of circulating antibodies to linear peptide antigens derived from ANXA1 and DDX53 in lung cancer

The EarlyCDT®-Lung test was the first autoantibody-based diagnostic tool for lung cancer, which was developed with a panel of recombinant protein antigens. To confirm whether the antibody test developed with linear peptide antigens has a similar power to that developed with the whole protein molecules, the present work was then undertaken to develop an in-house enzyme-linked immunosorbent assay with linear peptide antigens derived from annexin A1 (ANXA1) and DEAD box protein 53 (DDX53), which have been used to develop the EarlyCDT®-Lung test. A total of 272 patients with non-small cell lung cancer (NSCLC) and 227 control subjects matched in age and smoking history were recruited. Student's t test showed that the levels of circulating IgG to ANXA1-derived peptide antigens were significantly higher in patients with NSCLC than control subjects (t = 5.66, P < 0.0001), in which the increased anti-ANXA1 IgG levels were observed only in patients at stages I, II, or III, but not in those at stage IV. However, the levels of circulating IgG to DDX53-derived peptide antigens were not significantly altered in NSCLC (t = 1.78, P = 0.076). Receiver operating characteristic analysis showed that the sensitivity against specificity of >90% was 23.7% for ANXA1 IgG assay and 13.8% for DDX53 IgG assay. This work suggests that the linear peptide antigen derived from ANXA1 may be suitable for the development of diagnostic tool for lung cancer although further screening is needed to identify more such peptide antigens derived from tumor-associated antigens.

Study of circulating antibodies against CD25 and FOXP3 in breast cancer

Our recent work suggests that circulating levels of anti-CD25 and anti-FOXP3 antibodies were significantly increased in patients with either lung cancer or esophageal cancer. To confirm if these two autoantibodies are specific for certain types of malignant tumors, the present work was thus undertaken to examine an alteration of anti-CD25 and anti-FOXP3 IgG levels in breast cancer. A total of 152 patients with breast cancer and 112 control subjects were recruited in this study. The levels of circulating anti-CD25 and anti-FOXP3 IgG antibodies were tested using an in-house enzyme-linked immunosorbent assay (ELISA). Student's t test showed no significant differences in the levels of either anti-CD25 IgG or anti-FOXP3 IgG between patients with breast cancer and control subjects, although patients at stage I had increased levels of anti-CD25 IgG compared with control subjects (t = 2.11, P = 0.037); there was no significant association of the anti-FOXP3 IgG levels with stages of breast cancer. In conclusion, circulating IgG autoantibody to CD25 instead of FOXP3 may be a potential biomarker for early diagnosis of breast cancer but further investigation remains needed to replicate this initial finding.

Circulating autoantibody to CD25 may be a potential biomarker for early diagnosis of esophageal squamous cell carcinoma

BACKGROUND

The present study was undertaken to develop an in-house enzyme-linked immunosorbent assay (ELISA) using human leukocyte antigen class II restricted epitopes to test circulating autoantibodies to CD25 as a biomarker for esophageal cancer.

METHODS

A total of 97 patients with esophageal squamous cell carcinoma (ESCC) and 226 healthy subjects were recruited for this study and their plasma samples were collected for antibody analysis with the ELISA approach.

RESULTS

Mann-Whitney U test showed that the IgG anti-CD25 antibody level was significantly higher in the patient group than the control group (P < 0.001) while the IgA antibody level was not significantly different between these two groups (P = 0.361). Spearman correlation analysis failed to reveal a significant correlation between the levels of anti-CD25 IgG and IgA antibodies in either the patient group (r = -0.027, P = 0.797, n = 94) or the control group (r = 0.055, P = 0.429, n = 209). The sensitivity against >90 % specificity was 37.2 % for the IgG assay with an inter-assay deviation of 9.4 %, and 8.2 % for the IgA assay with an inter-assay deviation of 13.0 %. Based on a cut-off value determined by the 99th percentile of control IgG levels, the positive rate was 7.4 % in patients with ESCC, in which patients at stage I had the highest positivity (11.5 %) (χ (2) = 11.10, P = 0.001, OR = 12.12, 95 % CI 1.93-75.94).

CONCLUSIONS

This work suggests that circulating IgG autoantibody to CD25 may be a potential biomarker for early diagnosis of esophageal cancer.