Evaluation of serum midkine as a biomarker in differentiated thyroid cancer

The role of preoperative serum thyroglobulin in the diagnosis and treatment of differentiated thyroid cancer: a systematic review and meta-analysis

BACKGROUND

Serum thyroglobulin (Tg) is a critical marker for monitoring tumor recurrence and metastasis in patients who have undergone total thyroidectomy for differentiated thyroid cancer (DTC). While the definitive role of preoperative serum Tg in DTC is not yet established, studies suggest its importance in differentiating between benign and malignant thyroid nodules with indeterminate cytology, as well as in predicting distant metastasis (DM) in patients with DTC.

METHODS

A thorough literature review was conducted on the use of preoperative serum Tg in differentiating between benign and malignant thyroid nodules, and in evaluating the extent of DTC lesions. Relevant studies were systematically searched in PubMed, Embase, Cochrane, Scopus, and ClinicalTrials databases. A meta-analysis was performed on studies where the ratios between serum Tg diagnostic thresholds and the upper limit of the reference range were similar.

RESULTS

Recent studies showed significantly elevated preoperative serum Tg levels in patients with DTC compared with normal individuals. However, there are inconsistencies in the serum Tg levels between patients with preoperative DTC and benign thyroid nodules across different studies. In patients with thyroid nodules who had indeterminate cytology (negative Tg antibody), the preoperative serum Tg levels were significantly higher in malignant nodules than in benign ones (meta-analysis: odds ratio: 2.59, 95% confidence intervals: 1.59-4.21, P = 0.0001). Although the meta-analysis indicated that high preoperative serum Tg is a risk factor for central lymph node metastasis in patients with DTC (meta-analysis: odds ratio: 1.68, 95% confidence interval: 1.32-2.14, P < 0.0001), some studies suggest that high preoperative serum Tg in patients with DTC does not necessarily lead to central lymph node metastasis. Furthermore, preoperative serum Tg might possess a suggestive value regarding the likelihood of DTC patients developing DM.

CONCLUSION

Preoperative serum Tg shows promise in differentiating between benign and malignant nodules in thyroid nodule patients with indeterminate cytology. However, further research is necessary to determine its predictive significance for lymph node metastasis and DM in patients with DTC.

SYSTEMATIC REVIEW REGISTRATION

https://www.crd.york.ac.uk/PROSPERO/#searchadvanced, identifier CRD42024472074.

Midkine promotes thyroid cancer cell migration and invasion by activating the phosphatidylinositol 3 kinase/protein kinase B/mammalian target of rapamycin pathway

Objective

Thyroid cancer (TC) therapy, which is routinely used at present, can improve patients' survival rates. However, lymph node metastasis results in a higher degree of TC malignancy in patients who experience recurrence and/or death. The elucidation of new mechanisms of TC metastasis can help identify new therapeutic targets. Midkine (MDK) is expressed aberrantly in various cancers. However, the regulatory mechanisms of MDK in TC remain largely unknown. Hence, this study mainly explores the effect and molecular function of MDK in TC.

Material and Methods

MDK gene expression and protein levels were analyzed using the Gene Expression Profiling Interactive Analysis and the Human Protein Atlas online databases. MDK messenger RNA (mRNA) in TC was analyzed by quantitative real-time polymerase chain reaction. MDK, phosphatidylinositol 3 kinase (PI3K), phosphorylated AKT (p-AKT), and phosphorylated mammalian target of rapamycin (p-mTOR) protein in TC were analyzed by Western blotting. Transwell and wound healing assays were performed to evaluate TC cell metastasis.

Results

MDK mRNA was significantly highly expressed in most patients with TC (P < 0.05). Moreover, MDK gene expression levels correlated with different TC stages. MDK protein was negative in normal tissues and positive in TC tissues. MDK mRNA and protein were significantly highly expressed in TC cells (P < 0.01). Compared with metastasis in the control group, that in the MDK group is significantly suppressed by MDK knockdown (P < 0.001). MDK knockdown also significantly inhibited PI3K, p-AKT, and p-mTOR protein expression in TPC-1 and K1 cells (P < 0.001). The activation of PAmT-P significantly enhanced the PI3K, p-AKT, and p-mTOR protein expression in TPC-1 and K1 cells (P < 0.001) and promoted metastasis (P < 0.001), thereby disrupting the inhibitory effect of the MDK knockdown.

Conclusion

Our findings confirmed that MDK promotes TC migration and invasion by activating PAmT-P. MDK is a novel molecular target for the treatment of patients with metastatic TC.

Midkine noncanonically suppresses AMPK activation through disrupting the LKB1-STRAD-Mo25 complex

Midkine (MDK), a secreted growth factor, regulates signal transduction and cancer progression by interacting with receptors, and it can be internalized into the cytoplasm by endocytosis. However, its intracellular function and signaling regulation remain unclear. Here, we show that intracellular MDK interacts with LKB1 and STRAD to disrupt the LKB1-STRAD-Mo25 complex. Consequently, MDK decreases the activity of LKB1 to dampen both the basal and stress-induced activation of AMPK by glucose starvation or treatment of 2-DG. We also found that MDK accelerates cancer cell proliferation by inhibiting the activation of the LKB1-AMPK axis. In human cancers, compared to other well-known growth factors, MDK expression is most significantly upregulated in cancers, especially in liver, kidney and breast cancers, correlating with clinical outcomes and inversely correlating with phosphorylated AMPK levels. Our study elucidates an inhibitory mechanism for AMPK activation, which is mediated by the intracellular MDK through disrupting the LKB1-STRAD-Mo25 complex.

Urinary iodine concentration and radioactive iodine therapeutic response in patients with differentiated thyroid cancer

Aim: Urinary iodine concentration (UIC) may assess radioactive iodine ablation. Materials & methods: According the 2015 American Thyroid Association guidelines, patients were categorized into low- to intermediate-risk or high-risk groups. The iodine concentration in the morning urine specimens was measured by the ceric ion-arsenious acid method. Results: In the low- to intermediate-risk group (113 cases), nonexcellent response (non-ER) was associated with higher UIC, higher UIC subgroups (p < 0.05), higher pre-ablative stimulated thyroglobulin levels (p < 0.01). In the high-risk group (68 cases), the non-ER rate was higher in the higher pre-ablative stimulated thyroglobulin group (p < 0.01), but not significantly different between the UIC and UIC subgroups (p > 0.05). Conclusion: The non-ER rate was related to UIC in the low- to intermediate-risk group; however, UIC did not affect the non-ER rate in the high-risk group.

Serum midkine as non-invasive biomarker for detection and prognosis of non-small cell lung cancer

Lung cancer continues to be the leading cause for cancer-related deaths in men and women worldwide. Sufficient screening tools enabling early diagnosis are essential to improve patient outcomes. The aim of this study was to evaluate serum midkine (S-MK) both as a diagnostic and prognostic biomarker in non-small cell lung cancer (NSCLC). This single-center analysis included 59 NSCLC patients counting 30 squamous cell cancers and 29 adenocarcinomas. Preoperative S-MK concentration was determined using ELISA. Patients were followed up to five years. S-MK was found to be significantly overexpressed in patients with NSCLC compared to healthy controls (p < 0.001). The discriminative power of S-MK to differentiate NSCLC subjects from controls was fairly high with an area under the receiver operating characteristic curve of 0.83 (p < 0.001). Optimal sensitivity of 92% and reasonable specificity of 68% was reached at a threshold of 416 pg/ml S-MK. Patients with high S-MK concentration showed a significantly shorter overall survival compared to patients with low S-MK expression (p < 0.05). In conclusion, S-MK is overexpressed in patients with NSCLC and serves as an independent prognostic factor for overall survival. S-MK may thus be considered as an additional non-invasive biomarker not only for NSCLC screening but also for outcome prediction.

Prognostic value and dynamics of antithyroglobulin antibodies for differentiated thyroid carcinoma

Background: The clinical value of antithyroglobulin antibodies (TgAb) as a tumor marker for differentiated thyroid cancer (DTC) is still controversial. Materials & methods: We studied 110 TgAb positive DTC patients who underwent total thyroidectomy and 131I therapies. Multivariate logistic regression was conducted to analyze the association between prognostic factors and disease outcomes. Results & conclusion: Pre-ablation TgAb levels and the changes of TgAb in 6-12 months after the first 131I therapy were risk factors for disease outcome in patients younger than 55, while extrathyroid extension was a risk factor in patients older than 55. The median TgAb half-life was 7.7 months and the median time for TgAb positivity to become negative was 15.8 months. The dynamics of TgAb within the first year after remnant ablation could predict disease outcome for DTC patients.

Blood prognostic predictors of treatment response for patients with papillary thyroid cancer

BACKGROUND

Papillary thyroid cancer (PTC) is a very common malignant disease with high morbidity. We needed some pretreatment indicators to help us predict prognosis and guide treatment. We conducted a study about some pretreatment prognostic indicators.

METHODS

This clinical study recruited 705 postoperative PTC patients (211 males, 494 females). Clinical data before radioactive iodine (RAI) treatment were collected. Patients' response to therapy were classified into two categories: 'Good Prognosis Group' (GPG) and 'Poor Prognosis Group' (PPG), according to '2015 American Thyroid Association Guidelines'. Differences of indicators between different prognosis groups were compared. Odds ratios (ORs) were calculated by univariate/multiple binary logistic regression models. Difference of body mass index (BMI) changes before and after RAI treatment between different prognosis groups was also compared.

RESULTS

A total of 546 (77.45%) belonged to GPG, and 159 (22.55%) belonged to PPG. Platelet (PLT), neutrophil (NEUT), PLT subgroups, and combination of red blood cell distribution width (RDW) and BMI (COR-BMI) were different between two prognosis groups. The significance of the difference between the two groups of BMI disappeared after the Bonferroni correction. PLT and PLT subgroups had detrimental effects on the risk of PPG; T stage had a positive effect on the risk of PPG. PLT subgroup showed a detrimental effect on the risk of PPG when we included additional covariates.

CONCLUSIONS

We found that lower pretreatment PLT levels may indicate a poor prognosis for PTC. The relationship between platelet-derived growth factor (PDGF) and radiation sensitivity may be the key to this association.

The Blood Biomarkers of Thyroid Cancer

Introduction

With the gradual increase in the incidence of thyroid cancer, people’s attention to thyroid cancer has also gradually increased. Although the prognosis of thyroid cancer is rather mild compared to other cancers, it will still bring a heavy psychological burden on people who have been diagnosed. At present, the diagnosis of thyroid cancer mainly depends on ultrasound and percutaneous fine needle aspiration (pFNA). Due to the unsatisfactory accuracy of the diagnosis methods we use now, there are still some thyroid nodules that cannot be clearly diagnosed before surgery.

Methods

In this article, we have searched for relevant research on blood markers of thyroid cancer in the past five years and categoried them into four groups.

Discussion

Though we have not found a biomarker which can diagnose thyroid cancer both sensitively and specifically, we do found many substances that are related to it, and have the potential to recognize it and help the diagnosis. And perhaps combined models can do it better.

Serum biomarkers for thyroid cancer

The high prevalence of thyroid cancer requires a reliable serum biomarker for diagnosis and prognostic monitoring. Serum thyroglobulin has been established as the primary postoperative and postablative monitoring biomarker for this malignancy. However, the presence of thyroglobulin antibody imposes a significant interference on its overall management, which cannot be diminished by currently available assays. Trends on the level of the thyroglobulin antibody during follow-up is considered as a surrogate biomarker, but controversy exists. A variety of alternative biomarkers are being proposed and investigated, nevertheless, clinical trials and prospective validations are needed before they can be regarded as clinically viable serum parameters for thyroid cancer.

Association of Midkine and Pleiotrophin Gene Polymorphisms With Systemic Lupus Erythematosus Susceptibility in Chinese Han Population

In a previous study, we have reported an increased plasma midkine (MK) and pleiotrophin (PTN) concentrations in patients with systemic lupus erythematosus (SLE) and the increase in MK and PTN associated with inflammatory cytokines interleukin (IL)-17 level and some clinical manifestations, suggesting the underlying association of MK and PTN with SLE. This study was conducted to investigate the association between common single-nucleotide polymorphisms (SNPs) in the MK and PTN gene and SLE susceptibility. A total of 989 subjects (496 SLE patients and 493 healthy controls) were included and genotyped for three MK SNPs and seven PTN SNPs in using improved multiple ligase detection reaction (iMLDR). Results have demonstrated no significant differences for genotype and allele frequencies in all 10 SNPs between SLE patients and healthy controls. Case-only analysis in SLE revealed that, in MK gene, the genotype frequency of AA/AG (rs35324223) was significantly lower in patients with photosensitivity than those without; the allele frequency of A/G (rs20542) was significantly higher in patients without serositis. In PTN gene, the A/G allele frequency (rs322236), C/T allele frequency, and TT/CT genotype frequency (rs6970141) showed significantly increased results in patients with immunological disorder compared to those without. Furthermore, no significant differences in plasma MK and PTN concentrations with its SNPs genotypes were found. MK and PTN SNPs showed no associations with SLE genetic susceptibility, but it may be associated with the course of this disease; further studies are needed to focus on the mechanism of MK and PTN genes in the pathogenesis of SLE.

Changes of serum midkine as a dynamic prognostic factor to monitor disease status in papillary thyroid cancer

This study aimed to investigate the value of dynamic changes of midkine (MK) to monitor post-surgical patients with papillary thyroid cancer (PTC) who were managed with I therapies.MK concentration at initial I ablation therapy (MK1) as well as 10 to 12 months thereafter (MK2) was evaluated. And the dynamic changes of thyroglobulin (Tg) were compared (Tg1 and Tg2). Patients with MK influencing co-morbidities and with positive thyroglobulin antibodies were excluded. Concentrations of MK were measured by enzyme-linked immunosorbent assay.There were 241 PTC patients (36 males, 205 females) enrolled, 55 cases had metastases (8 males, 47 females) during their follow-up. Cox regression showed if Tg2 decreased (compared with Tg1), but not to less than 1.0ng/mL under TSH stimulation, the risk of metastases was 12.554 times more than if it could decrease to the optimal level. If Tg2 increased, the risk is 19.461 times higher. As for MK, if MK2 level decreased (compared with MK1), but not to a normal level, the risk of metastases is 3.006. If MK2 level increased, it would be 5.030 likely to had metastases.Our results indicated that MK could potentially be used as a disease monitoring biomarker for PTC, although inferior to Tg.

Midkine is a serum and urinary biomarker for the detection and prognosis of non-small cell lung cancer

Midkine, a heparin-binding growth factor, has been identified as a promising cancer biomarker. In non-small cell lung cancer (NSCLC), the serum and urine midkine levels have not been intensively investigated. The aim of the present study was to investigate the diagnostic and prognostic potential of serum and urine midkine levels in patients with NSCLC. The serum midkine levels were measured in 153 patients with NSCLC, 23 patients with benign pulmonary disease and 95 healthy controls using ELISA. Urine midkine levels were examined in 20 controls and 45 patients with NSCLC. Midkine expression in tumor tissues from 72 patients with NSCLC who underwent definitive surgical resection without any pre-operative treatments was examined by immunohistochemistry. Serum levels were significantly higher in patients with NSCLC than in healthy controls (657.36±496.58 pg/ml vs. 194.49±122.57 pg/ml, P<0.001). As shown in the ROC curve analysis, the sensitivity and specificity of the cut-off serum midkine concentration of 400 pg/ml for predicting the presence of NSCLC were 71.2% and 88.1%, respectively. Positive correlations between the serum midkine levels and immunohistochemistry staining scores (r=0.315, P=0.007) and between the serum midkine levels and urine midkine levels (r=0.636, P<0.001) were observed using Spearman's bivariate correlations. The serum midkine concentration was identified as an independent prognostic factor by multivariate analysis, and its overexpression yielded a relative risk of death of 2.072 (0.01<P<0.05, 95%CI: 1.104-3.890). Thus, the serum and urine midkine levels may be useful, minimally invasive biomarkers for detecting and predicting the prognosis of NSCLC.

Diagnostic accuracy of ELISA for detecting serum Midkine in cancer patients

Midkine (MK) has been reported as the potential novel diagnostic biomarker for cancer in several studies, but their results were controversial. Therefore, we performed a diagnostic meta-analysis to assess the diagnostic value of serum MK in cancer patients. A systematic electronic and manual search was performed for relevant literatures through several databases up to June 1, 2017. The quality of the studies included in the meta-analysis was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. All analyses were conducted using stata12.0 software. Ten studies collectively included 1119 cancer patients and 1441 controls met the eligible criteria. The summary estimates were: sensitivity 0.78 (95% CI = 0.68-0.85), specificity 0.83 (95% CI = 0.72-0.90), positive likelihood ratio 4,54 (95% CI = 2.64-7.80), negative likelihood 0.27 (95% CI = 0.18-0.40), diagnostic odds ratio 16.79 (95% CI = 7.17-39.33), and area under the curve 0.87 (95% CI = 0.84-0.89). Publication bias was suggested by Deeks' funnel plot asymmetry test (P = 0.92). According to our results, serum MK has greater diagnostic value in diagnosing cancer, however, more reliable studies in larger cohort should be conducted to evaluate the diagnostic accuracy of serum MK.

Effects of first radioiodine ablation on functions of salivary glands in patients with differentiated thyroid cancer

The aim of this study was to evaluate the effects of the first radioactive iodine (I) therapy on functions of salivary glands in patients with differentiated thyroid carcinoma (DTC).There were 36 consented patients with DTC enrolled in this study, who received 3.7 GBq (100mCi) I for ablation after total thyroidectomy. Salivary gland function was assessed using salivary gland scintigraphy in two phases, one 4 hours before and the other 6 months after I therapy (both under thyrotropin stimulation condition). Quantitative parameters including uptake fraction (UF), uptake index (UI), excretion fraction (EF), and excretion ratio (ER) were measured and compared. Blood parameters were also compared. Associations between sex and outcome of the first I therapy as well as individual salivary gland function were measured. Wilcoxon Signed Rank Sum test and χ test were used for statistical analysis.When compared between pre-ablation and post-ablation, UF of bilateral parotid and submandibular glands were significantly increased (all P < .01). UI of both submandibular glands were significantly increased (P < .05). This seemingly increased uptake function after the first I therapy was actually compensatory mechanism of salivary gland, which indicated a possible intermediate state after radiation. But salivary glands' secretory function had not changed significantly except for left submandibular gland; we demonstrated that only left submandibular gland showed significantly decreased ER (P < .05). Thyroglobulin and thyroglobulin antibody significantly decreased after I therapy (P < .05). There were no sex differences on therapeutic outcome and salivary gland dysfunctions after the first I therapy. Salivary gland of both males and females could be affected by I therapy.The first I ablative therapy may impair the salivary uptake and secretory function of patients with DTC. There was no association between sex and salivary gland dysfunction.

Serum midkine as a surrogate biomarker for metastatic prediction in differentiated thyroid cancer patients with positive thyroglobulin antibody

Serum thyroglobulin (Tg) is the main post-operative tumor biomarker for patients with differentiated thyroid cancer (DTC). However, the presence of thyroglobulin antibodies (TgAb) can interfere with Tg level and invalidate the test. In this study, we aimed to investigate the predicative value of midkine (MK) as a cancer biomarker for DTC patients with positive TgAb before the first 131I therapy. MK levels were measured by enzyme-linked immunosorbent assay in 151 recruited DTC patients after exercising strict inclusion and exclusion criteria. There were 28 TgAb positive DTC patients with metastases and 123 DTC patients without metastases. The value of pre-131I-ablative MK to predict metastasis was assessed by receiver operating characteristic (ROC) curves in these two groups of patients. MK levels in the TgAb positive DTC patients were significantly higher than the DTC patients without metastases. ROC showed good predictability of MK, with an area under the curve of 0.856 (P < 0.001), and a diagnostic accuracy of 83% at the optimal cut-off value of 550 pg/ml. In conclusion, we show that MK can potentially be used as a surrogate biomarker for predicting DTC metastases when Tg is not suitable due to TgAb positivity.

Midkine: A Novel Biomarker to Predict Malignancy in Patients with Nodular Thyroid Disease

Background. Midkine (MK), a new heparin-binding growth factor, plays important roles in a variety of biological phenomena such as carcinogenesis, inflammation, and angiogenesis. In this study, we aimed to evaluate serum midkine (SMK) and nodular midkine (NMK) levels in patients with thyroid nodules to predict malignancy and whether there was any association between. Methods. A total of 105 patients (74 women, 31 men) with thyroid nodules were enrolled. The levels of SMK and NMK were measured. Any possible correlation between SMK, NMK, and biochemical, cytopathological, or radiological variables was investigated. Results. Both SMK and NMK were found to be higher in hypoechoic nodules with an irregular border and without a halo (p < 0.05). Serum MK levels were significantly higher in nodules with microcalcifications than nodules with macrocalcification or without calcification (p = 0.001). SMK levels were found to be correlated with NMK levels (SMK 0.63 ng/ml versus 1.04 ng/mL and NMK 0.55 ng/mL versus 0.55 ng/mL, r (2) = 0.54, p < 0.001). Conclusion. Both SMK and NMK can predict tumorigenesis of highly malignant/suspicious thyroid cytopathology and also well correlated with sonographic features of thyroid nodules. We suggest that MK levels may serve as an alternative biomarker, in conjunction with the cytopathological results in preoperative assessment of thyroid nodules.