Palanca-Ballester Cora, Rodriguez-Casanova Aitor, Torres Susana, Calabuig-Fariñas Silvia, Exposito Francisco, Serrano Diego, Redin Esther, Valencia Karmele, Jantus-Lewintre Eloisa, Diaz-Lagares Angel, Montuenga Luis, Sandoval Juan, Calvo Alfonso
Biomarkers and Precision Medicine (UBMP) and Epigenomics Unit, IIS, La Fe, 46026 Valencia, Spain.
Cancer Epigenomics, Translational Medical Oncology (Oncomet), Health Research Institute of Santiago (IDIS), University Clinical Hospital of Santiago (CHUS/SERGAS), 15706 Santiago de Compostela, Spain.
Cancers (Basel). 2021 Jun 16;13(12):3016. doi: 10.3390/cancers13123016.
Early alterations in cancer include the deregulation of epigenetic events such as changes in DNA methylation and abnormal levels of non-coding (nc)RNAs. Although these changes can be identified in tumors, alternative sources of samples may offer advantages over tissue biopsies. Because tumors shed DNA, RNA, and proteins, biological fluids containing these molecules can accurately reflect alterations found in cancer cells, not only coming from the primary tumor, but also from metastasis and from the tumor microenvironment (TME). Depending on the type of cancer, biological fluids encompass blood, urine, cerebrospinal fluid, and saliva, among others. Such samples are named with the general term "liquid biopsy" (LB). With the advent of ultrasensitive technologies during the last decade, the identification of actionable genetic alterations (i.e., mutations) in LB is a common practice to decide whether or not targeted therapy should be applied. Likewise, the analysis of global or specific epigenetic alterations may also be important as biomarkers for diagnosis, prognosis, and even for cancer drug response. Several commercial kits that assess the DNA promoter methylation of single genes or gene sets are available, with some of them being tested as biomarkers for diagnosis in clinical trials. From the tumors with highest incidence, we can stress the relevance of DNA methylation changes in the following genes found in LB: (for lung cancer); , , and (for lung, breast, genitourinary and colon cancers); and (for colon cancer). Moreover, multi-cancer high-throughput methylation-based tests are now commercially available. Increased levels of the microRNA miR21 and several miRNA- and long ncRNA-signatures can also be indicative biomarkers in LB. Therefore, epigenetic biomarkers are attractive and may have a clinical value in cancer. Nonetheless, validation, standardization, and demonstration of an added value over the common clinical practice are issues needed to be addressed in the transfer of this knowledge from "bench to bedside".
癌症的早期改变包括表观遗传事件的失调,如DNA甲基化变化和非编码(nc)RNA水平异常。尽管这些变化可在肿瘤中被识别,但替代样本来源可能比组织活检具有优势。由于肿瘤会释放DNA、RNA和蛋白质,含有这些分子的生物体液不仅能准确反映原发肿瘤癌细胞中的改变,还能反映转移灶和肿瘤微环境(TME)中的改变。根据癌症类型的不同,生物体液包括血液、尿液、脑脊液和唾液等。这类样本被统称为“液体活检”(LB)。在过去十年中,随着超灵敏技术的出现,在液体活检中识别可指导治疗的基因改变(即突变)已成为决定是否应用靶向治疗的常规做法。同样,对整体或特定表观遗传改变的分析作为诊断、预后甚至癌症药物反应的生物标志物也可能很重要。有几种评估单个基因或基因集DNA启动子甲基化的商业试剂盒可供使用,其中一些正在临床试验中作为诊断生物标志物进行测试。在发病率最高的肿瘤中,我们可以强调液体活检中以下基因DNA甲基化变化的相关性:(用于肺癌); 、 和 (用于肺癌、乳腺癌、泌尿生殖系统癌和结肠癌);以及 (用于结肠癌)。此外,基于甲基化的多癌高通量检测现在已有商业产品。微小RNA miR21水平升高以及几种微小RNA和长链非编码RNA特征也可作为液体活检中的指示性生物标志物。因此,表观遗传生物标志物很有吸引力,可能在癌症中具有临床价值。尽管如此,在将这些知识从“实验室到临床应用”的转化过程中,仍需解决验证、标准化以及证明其相对于常规临床实践的附加价值等问题。