Clinical evaluation of potential usefulness of CEA, CA 15-3, and MCA in follow-up of breast cancer patients

Magnetic microspheres enhanced peanut structure cascaded lasso shaped fiber laser biosensor for cancer marker-CEACAM5 detection in serum

The detection of trace cancer markers in body fluids such as blood/serum is crucial for cancer diseases screening and treatment, which requires high sensitivity and specificity of biosensors. In this study, a peanut structure cascaded lasso (PSCL) shaped fiber sensing probe based on fiber laser demodulation method was proposed to specifically detect the carcinoembryonic antigen related cell adhesion molecules 5 (CEACAM5) protein in serum. Thanks for the narrow linewidth and high signal-to-noise ratio (SNR) of the laser spectrum, it is easier to distinguish small spectral changes than interference spectrum. Adding the antibody modified magnetic microspheres (MMS) to form the sandwich structure of "antibody-antigen-antibody-MMS", and amplified the response caused by biomolecular binding. The limit of detection (LOD) for CEACAM5 in buffer could reach 0.11 ng/mL. Considering the common threshold of 5 ng/mL for CEA during medical screening and the cut off limit of 2.5 ng/mL for some kits, the LOD of proposed biosensor meets the actual needs. Human serum samples from a hospital were used to validate the real sensing capability of proposed biosensor. The deviation between the measured value in various serum samples and the clinical value ranged from 1.9 to 9.8 %. This sensing scheme holds great potential to serve as a point of care testing (POCT) device and extend to more biosensing applications.

Diagnostic impact of CEA and CA 15-3 on monitoring chemotherapy of breast cancer patients

Objective: Serum tumor markers has been evolved as an effective tool to determine prognosis and treatment efficiency in different types of cancer. The aim of this study was to explore the chemotherapy monitoring efficiency and prognostic sensitivity of tumor associated cancer antigen 15-3 (CA 15-3) and carcinoembryonic antigen (CEA) markers in early (II) and late (IV) clinical stages of breast cancer patients.   Methods: CA 15-3 and CEA serum levels were assessed in 56 breast cancer patients at early II (n = 26) and late IV (n = 30) clinical stages with primary inclusion criteria: who received adjuvant chemotherapy AC (Adriamycin & Cyclophosphamide) or AC-T (Adriamycin & Cyclophosphamide followed by Taxane) regimes and human epidermal growth factor receptor 2 (HER2) negative by using particle enhanced turbid metric assay.   Results: Higher elevation of CA 15-3 as compared to CEA in pre-treatment group of breast cancer patients as compared to healthy control was observed. Late-stage patients showed higher positive serum levels as compared to early-stage one for both markers with preference of CA 15-3 over CEA. AC-T chemotherapy regime treatment in both clinical stages revealed significantly higher level of both markers as compared to AC regime with preference of CA 15-3 over CEA at late stage. Both markers levels were significantly higher in late-stage group as compared with early-stage ones for both chemotherapy regimens.   Conclusion: CA 15-3 is more efficient as prognostic monitoring marker in comparison with CEA and revels a positive connection between chemotherapy regime system and staging, more observed in late-stage.  

Technological advances in electrochemical biosensors for the detection of disease biomarkers

With an increasing focus on health in contemporary society, interest in the diagnosis, treatment, and prevention of diseases has grown rapidly. Accordingly, the demand for biosensors for the early diagnosis of disease is increasing. However, the measurement range of existing electrochemical sensors is relatively high, which is not suitable for early disease diagnosis, requiring the detection of small amounts of biocomponents. Various attempts have been made to overcome this and amplify the signal, including binding with various labeling molecules, such as DNA, enzymes, nanoparticles, and carbon materials. Efforts are also being made to increase the sensitivity of electrochemical sensors, and the combination of nanomaterials, materials, and biotechnology offers the potential to increase sensitivity in a variety of ways. Recent studies suggest that electrochemical sensors can be a powerful tool in providing comprehensive insights into the targeting and detection of disease-associated biomarkers. Significant advances in nanomaterial and biomolecule approaches for improved sensitivity have resulted in the development of electrochemical biosensors capable of detecting multiple biomarkers in real time in clinically relevant samples. In this review, we have discussed the recent studies on electrochemical sensors for detection of diseases such as diabetes, degenerative diseases, and cancer. Further, we have highlighted new technologies to improve sensitivity using various materials, including DNA, enzymes, nanoparticles, and carbon materials.

Molecular beacon-based quantitiation of epithelial tumor marker mucin 1

Mucin 1 (Muc1) is a glycoprotein expressed on most epithelial cell surfaces, which has been confirmed as a useful biomarker for the diagnosis of early cancers. In this study, we demonstrate that a quantum dot (QD)-aptamer beacon acts by folding-induced dissociation of a DNA intercalating dye, BOBO-3, in the presence of the target molecules, Muc1. Release of intercalated BOBO-3s from the QD-conjugated aptamers results in a decrease in QD fluorescence resonance energy transfer (FRET)-mediated BOBO-3 emission, allowing for label-free Muc1 detection and quantitation. We attain highly specific and wide-range detection (from 50nM to 20μM) of Muc1, suggesting that our QD-aptamer beacon can be a potential alternative to immuno-based assays for Muc1 detection. The detection methodology is expected to be improved for the early diagnosis of different types of epithelial cancers of large populations.

Aptamer-based detection of epithelial tumor marker mucin 1 with quantum dot-based fluorescence readout

Mucin 1 (MUC1) is a glycoprotein expressed on most epithelial cell surfaces, which has been confirmed as a useful biomarker for the diagnosis of early cancers. In this paper, we report an aptamer-based, quantitative detection protocol for MUC1 using a 3-component DNA hybridization system with quantum dot (QD)-labeling: in the absence of MUC1 peptides, strong fluorescence is observed upon mixing the three specially designed DNA strands (quencher, QD-labeled reporter, and the MUC1 aptamer stem); in the presence of MUC1 peptides, a successive decrease in fluorescence intensity is detected since the MUC1 peptide binds to the aptamer strand in such a way to allow the quencher and fluorescence reporter to be brought into close proximity (which leads to the occurrence of fluorescence resonance energy transfer, FRET, between the quencher and QD). The detection limit for MUC1 with this novel approach is in the nanomolar (nM) level, and a linear response can be established for the approximate range found in blood serum. This study also provided further insight into the aptamer/analyte binding site/mode for MUC1, which augments the possibility of improving this detection methodology for the early diagnosis of different types of epithelial cancers of large populations.

Electrochemical immunoassay of carcinoembryonic antigen based on a lead sulfide nanoparticle label

We describe a lead sulfide nanoparticle (PbS NP)-based electrochemical immunoassay to detect a tumor biomarker, carcinoembryonic antigen (CEA). Cubic PbS NPs were prepared and functionalized with thioglycolic acid (TGA), which stabilized the formed NPs and offered carboxyl groups to conjugate with CEA antibodies. PbS NP conjugated with monoclonal CEA antibody was used as a label in an immunorecognition event. After a complete sandwich immunoreaction among the primary CEA antibody (immobilized on the carboxyl-modified magnetic beads), CEA and the PbS-labeled secondary antibody (PbS-anti-CEA), PbS labels were captured to the magnetic-bead (MB) surface through the antibody-antigen immunocomplex. Electrochemical stripping analysis of the captured PbS was used to quantify the concentration of CEA after an acid-dissolution step. The MBs and the magnetic separation platform were used to integrate a facile antibody immobilization with immunoreactions and the isolation of immunocomplexes from reaction solutions in the immunoassay. The voltammetric response is highly linear over the range of 1-50 ng ml(-1) CEA, and the limit of detection is estimated to be 0.5 ng ml(-1). The performance of this nanoparticle-based electrochemical immunoassay was successfully evaluated with human serum spiked with CEA, indicating that this convenient and sensitive technique offers great promise for rapid, simple and cost-effective analysis of tumor biomarkers in biological fluids.

Preoperative CA 15-3 and CEA serum levels as predictor for breast cancer outcomes

BACKGROUND

To investigate the association between tumor markers [cancer antigen 15-3 (CA 15-3) and carcinoembryonic antigen (CEA)] and clinicopathological parameters and patient outcomes in breast cancer.

MATERIALS AND METHODS

A total of 740 patients with stages I-III breast cancer had preoperative CA 15-3 and CEA concentrations measured. Univariate and multivariate analyses were used to investigate associations between marker concentration and clinicopathological parameters and patient outcomes.

RESULTS

Among 740 patients, elevated preoperative levels of CA 15-3 and CEA were identified in 92 (12.4%) and 79 (10.7%) patients, respectively. Tumor size (>5 cm), node metastases (> or =4), and advanced stage (> or =III) were associated with higher preoperative levels. Elevated CA 15-3 and CEA levels were associated with poor disease-free survival (DFS, P = 0.0014, P = 0.0001, respectively) and overall survival (OS, P = 0.018, P = 0.015) even in stage-matched analysis. Patients with normal levels of both CA 15-3 and CEA showed better DFS and OS than those with elevated group. In multivariate analysis, age (<35 years), tumor size (>2 cm), node metastases, estrogen receptor expression, and elevated CA 15-3 and CEA preoperative values were independent prognostic factors for DFS.

CONCLUSION

High preoperative CA 15-3 and CEA levels may reflect tumor burden and are associated with advanced disease and poor outcome. Measuring preoperative levels of CA 15-3 and CEA can be helpful for predicting outcomes.

Electrochemical Immunosensor for Carcinoembryonic Antigen Based on Antigen Immobilization in Gold Nanoparticles Modified Chitosan Membrane

A disposable electrochemical immunosensor for carcinoembryonic antigen (CEA) was proposed based on the antigen immobilized in a colloidal gold nanoparticles modified chitosan membrane on the surface of an indium-tin oxide (ITO) electrode. The different membranes were characterized by scanning electron microscope and electrochemical methods. Based on a competitive immunoassay format, the immobilized antigen of the immunosensor was incubated with a horseradish peroxidase (HRP) labeled antibody and sample CEA antigen, and the formed immunoconjugate in the immunosensor was detected by an o-phenylenediamine-H(2)O(2)-HRP electrochemical system. Under the optimal experimental conditions, the electrocatalytic current decreased linearly with the competitive mechanism. CEA could be determined in the linear range from 2.0 to 20 ng/ml with a detection limit of 1.0 ng/ml. The prepared CEA immunosensor is not only economic due to the low-cost ITO electrode obtained from industrial mass production, but is also capable with good stability and reproducibility for batch fabrication.

Intensive post-operative follow-up of breast cancer patients with tumour markers: CEA, TPA or CA15.3 vs MCA and MCA-CA15.3 vs CEA-TPA-CA15.3 panel in the early detection of distant metastases

Background

In breast cancer current guidelines do not recommend the routine use of serum tumour markers. Differently, we observed that CEA-TPA-CA15.3 (carcinoembryonic (CEA) tissue polypeptide (TPA) and cancer associated 115D8/DF3 (CA15.3) antigens) panel permits early detection and treatment for most relapsing patients. As high sensitivity and specificity and different cut-off values have been reported for mucin-like carcinoma associated antigen (MCA), we compared MCA with the above mentioned tumour markers and MCA-CA15.3 with the CEA-TPA-CA15.3 panel.

Methods

In 289 breast cancer patients submitted to an intensive post-operative follow-up with tumour markers, we compared MCA (cut-off values, ≥ 11 and ≥ 15 U/mL) with CEA or CA15.3 or TPA for detection of relapse. In addition, we compared the MCA-CA15.3 and CEA-TPA-CA15.3 tumour marker panels.

Results

Distant metastases occurred 19 times in 18 (6.7%) of the 268 patients who were disease-free at the beginning of the study. MCA sensitivity with both cut-off values was higher than that of CEA or TPA or CA15.3 (68% vs 10%, 26%, 32% and 53% vs 16%, 42%, 32% respectively). With cut-off ≥ 11 U/mL, MCA showed the lowest specificity (42%); with cut-off ≥ 15 U/mL, MCA specificity was similar to TPA (73% vs 72%) and lower than that of CEA and CA15.3 (96% and 97% respectively). With ≥ 15 U/mL MCA cut-off, MCA sensitivity increased from 53% to 58% after its association with CA15.3. Sensitivity of CEA-TPA-CA15.3 panel was 74% (14 of 19 recurrences). Eight of the 14 recurrences early detected with CEA-TPA-CA15.3 presented as a single lesion (oligometastatic disease) (5) or were confined to bony skeleton (3) (26% and 16% respectively of the 19 relapses). With ≥ 11 U/mL MCA cut-off, MCA-CA15.3 association showed higher sensitivity but lower specificity, accuracy and positive predictive value than the CEA-TPA-CA15.3 panel.

Conclusion

At both the evaluated cut-off values serum MCA sensitivity is higher than that of CEA, TPA or CA15.3 but its specificity is similar to or lower than that of TPA. Overall, CEA-TPA-CA15.3 panel is more accurate than MCA-CA15.3 association and can "early" detect a few relapsed patients with limited metastatic disease and more favourable prognosis. These findings further support the need for prospective randomised clinical trial to assess whether an intensive post-operative follow-up with an appropriate use of serum tumour markers can significantly improve clinical outcome of early detected relapsing patients.

A disposable electrochemical immunosensor for flow injection immunoassay of carcinoembryonic antigen

A new simple immunoassay method for carcinoembryonic antigen (CEA) detection using a disposable immunosensor coupled with a flow injection system was developed. The immunosensor was prepared by coating CEA/colloid Au/chitosan membrane at a screen-printed carbon electrode (SPCE). Using a competitive immunoassay format, the immunosensor inserted in the flow system with an injection of sample and horseradish peroxidase (HRP)-labeled CEA antibody was used to trap the labeled antibody at room temperature for 35 min. The current response obtained from the labeled HRP to thionine-H(2)O(2) system decreased proportionally to the CEA concentration in the range of 0.50-25 ng/ml with a correlation coefficient of 0.9981 and a detection limit of 0.22 ng/ml (S/N=3). The immunoassay system could automatically control the incubation, washing and current measurement steps with good stability and acceptable accuracy. Thus, the proposed method proved its potential use in clinical immunoassay of CEA.

Flow injection immunoassay for carcinoembryonic antigen combined with time-resolved fluorometric detection

Time-resolved fluorescence has been developed for immunoassay to obtain higher sensitivity than usual immunoassays. In this paper, a simple, sensitive and specific method was developed for immunoassay of serum carcinoembryonic antigen (CEA) by combining time-resolved fluoroimmunoassay (TRFIA) and flow injection analysis. Based on a sandwich immunoassay format, a monoclonal antibody immobilized immunoaffinity column inserted in a flow system was used for immunoreactions. The cleaved solution was collected after the reaction between the immunocomplex in the immunoaffinity column and the enhancement solution that was used to cleave the Eu-labels from the immunocomplex, and then detected by time-resolved fluorescence. Serum CEA could be detected in the linear range from 2.5 to 100 ng/ml with a correlation coefficient of 0.997 and the detection limit of 1.0 ng/ml. Twenty human serum samples detected by this method were in good agreement with the results obtained by the electrochemiluminescence immunoassay. This method could be further developed for fast practical clinical detection of serum CEA levels.

MUC1 gene-derived glycoprotein assays for monitoring breast cancer (CA 15-3, CA 27.29, BR): are they measuring the same antigen?

CONTEXT

There are 2 general types of assays measuring MUC1 gene-derived glycoprotein: assays for cancer antigen (CA) 15-3, which are sandwich assays, and assays for CA 27.29, which are competitive assays. These 2 types of assays measure slightly different parts of this tandem-repeat molecule. Across-method assay differences hinder the exchange of patient test values among integrated health care networks and among countries.

OBJECTIVE

This report evaluates the method differences among these assays to determine if the differences between these assays are mainly related to variations in calibration or differences in analyte specificity.

DESIGN

Data from 22 College of American Pathologists survey challenges were analyzed to compare 10 commercial assay methods for these 2 related analytes. In addition, data from 58 patient samples were analyzed to compare 3 of these assays.

RESULTS

The linear correlation coefficients comparing the within-method medians of these proficiency test distributions were very high (>0.99) for all of the methods; however, the regression slopes varied from 0.836 to 1.095. The regression slopes for the patient specimens varied similarly, but the correlation coefficients were lower.

CONCLUSIONS

This study indicates that many of the test value differences for these measurements are due to differences in assay calibration rather than differences in the specificity of the assay measurement systems. Survey test data potentially could be used to help harmonize these assay differences.

Noncompetitive enzyme immunoassay for carcinoembryonic antigen by flow injection chemiluminescence

BACKGROUND

Recently, many automated immunoassay analyzers have been developed for carcinoembryonic antigen (CEA) to overcome the shortcomings in traditional immunoassay methods that are time-consuming and labor-intensive. Flow injection immunoassay (FIIA) has been increasingly applied to laboratory medicine due to its ease in automation, rapid speed and reproducible results. It is important to develop a FIIA method for CEA determination.

METHODS

Based on a noncompetitive immunoassay format, a CEA-immobilized immunoaffinity column inserted in the flow system was used to trap the unbound horseradish peroxidase (HRP)-labeled antibody after an off-line incubation of CEA and HRP-labeled anti-CEA. The trapped enzyme conjugate was detected by injecting substrates to produce an enhanced chemiluminescence (CL).

RESULTS

The linear range for CEA was 1.0-25 ng/ml with a correlation coefficient of 0.997 and a detection limit of 0.5 ng/ml. The sampling and chemiluminescence detection time for one sample was 5 min after a preincubation procedure of 25 min. Twenty five human serum samples detected by this method were in good agreement with the results obtained by immunoradiometric assay (IRMA).

CONCLUSIONS

This method could be used for rapid analysis of CEA and potentially other antigens.

Serum tissue polypeptide specific antigen (TPS): a complementary tumor marker to CA 15-3 in the management of breast cancer

The efficacy of CEA and CA15-3 tumor markers in monitoring breast cancer was evaluated in 1365 patients with either benign (n = 534) or malignant (n = 831) breast diseases. Thirty-nine breast cancer patients were monitored before and after neoadjuvant chemotherapy. Three hundred forty-nine patients were monitored during post-surgical follow-up for either a minimum of 5 years or until time of recurrence. Twenty-one patients with metastases were also monitored during chemotherapy. Elevated CA 15-3 and TPS levels were found in 28.6% and 30.0% of patients. CA 15-3 and TPS sensitivities rose to 71.9% and 66.3% in metastatic patients, respectively. The addition of TPS to CA 15-3 increased the sensitivity up to 44.4% in the overall population, and to 87.6% in patients with metastases. During post-surgical follow-up CA 15-3 was elevated in 65.7% and TPS in 61.3% of patients with recurrence. The combination of TPS and CA 15-3 increased the overall sensitivity by 12.7%. Longitudinal monitoring of metastatic patients undergoing chemotherapy demonstrated that, when positive, both CA 15-3 and TPS paralleled response to treatment. TPS monitoring may provide additional value when used in combination with CA15-3 during post-surgical follow-up of breast cancer patients.