News
First ever blood tests to diagnose cancer 'could be ready in one year'
Jasmine Zhou and her team at the University of California, Los Angeles have developed a computer program that uses genetic data to detect tumour DNA and specify where in the body it is coming from. The program, called CancerLocator, works by measuring the amount of tumour DNA circulating in the blood and compares it to a database of genetic information from hundreds of people to identify where the tumour is located. Published in the journal Genome Biology, the study focused on three cancer types (breast, liver and lung) and was able to detect early stage cancers in 80% of cases. Zhou said the next step was to collect solid tissue samples to improve the accuracy of the blood tests, which could then be trialled in a clinical setting.
Lara Bennett of Worldwide Cancer Research, said while blood testing methods were still being researched, she believed they "will have an important part in the future of diagnosing cancer". "The fact it's non-invasive is a huge thing," adding that it could save lives if it succeeds in spotting cancers early. "We are very excited by it, but it's not ready to go, due to limited blood samples, and they've only done it in three cancer types."
Surprising new role for lungs—making blood
Using video microscopy in the living mouse lung, University of California San Francisco scientists have revealed that lungs play a previously unrecognized role in blood production. Published in Nature, the researchers found that the lungs produced more than half of the platelets—blood components required for the clotting that stanches bleeding—in the mouse circulation. In another surprise finding, the scientists also identified a previously unknown pool of blood stem cells capable of restoring blood production when the stem cells of the bone marrow, previously thought to be the principal site of blood production, are depleted.
The findings were made possible by a recent refinement of a technique known as two-photon intravital. This imaging approach allowed the researchers to visualize an engineered strain of platelets that emitted bright green fluorescence. The team observed the surprisingly large population of platelet-producing cells called megakaryocytes (MK) in the lung vasculature
Video: A dynamic release of platelets in the lung vasculature
Video: MKs with intact nuclei circulating in the lung vasculature
Smartphone device sizes up sperm health
Although male infertility is as common as female infertility, it often goes undiagnosed because of socioeconomic factors such as stigma, high cost of testing, and availability of laboratory facilities. A new smartphone device has shown early promise as a convenient way for men to check the health of their sperm in the privacy of their home. The infertility test analyzes semen using a disposable rubberized microchip that's designed to enclose and handle samples. The microchip is slid into an attachment that can be plugged into a smartphone. The semen sample is kept within the microchip, with the smartphone app able to scan and video the sample for analysis. Approximately five seconds later test results are produced, indicating whether or not the sample meets World Health Organization standards in terms of healthy sperm concentrations and sperm motility.
Results published in Science Translational Medicine indicate the test has a 98% accuracy rate. The work suggests that the integration of microfluidics, optical sensing accessories, and advances in consumer electronics, particularly smartphone capabilities, can make remote semen quality testing accessible to people in both developed and developing countries who have access to smartphones.
Quality
Coming face-to-face with unneeded tests
When Yale’s Department of Emergency Medicine embarked on a test overuse reduction program, it employed academic detailing, in which clinicians engage in face-to-face education with their peers about the value of particular tests and treatments. The efforts were made to reduce the number of unnecessary blood coagulation studies performed at three emergency departments. Their resulting strategy included both face-to-face meetings with emergency physicians and a "leave behind" of cafeteria vouchers, and educational materials (e.g., screen savers and postings on message boards) in nursing break rooms. After one month of the intervention, unnecessary studies ordered for patients with chest pain declined from 55% to 30%, and orders for patients as a whole declined from 12% to 8%.
This intervention followed earlier efforts to reduce point-of-care blood testing and orders for urine cultures (duplicate orders declined from 230 to about 100 per week). A second effort addressed a similar problem. The project led to an annualized reduction of approximately 10,000 urine cultures. Read the complete article to find out the details.
Clinical Chemistry
Scientists discover urinary biomarker that may help track ALS
A study in Neurology suggests that analyzing levels of the protein p75ECD in urine samples from people with amyotrophic lateral sclerosis (ALS) may help monitor disease progression as well as determine the effectiveness of therapies. Further analysis of the samples from 54 patients revealed that those who began the study with lower levels of urinary p75ECD survived longer than did patients who had higher levels of the protein initially, suggesting that it could be a prognostic marker of the disease and may inform patients about their illness.
"It was encouraging to see changes in p75ECD over the course of the study, because it suggests an objective new method for tracking the progression of this aggressive disease," said Dr. Amelie Gubitz, program director at National Institute of Neurological Disorders and Stroke. "In addition, it indicates the possibility of assessing whether levels of that protein decrease while patients try future treatments, to tell us whether the therapies are having any beneficial effects." The research team noted that this may be useful in selecting participants for clinical trials and in improving study design.
A second hCG blood test that can be performed at the point-of-care
Recently, a team of scientists published their evaluation of the NOWDiagnostics ADEXUSDx™hCG test, a qualitative immunoassay device for the detection of hCG in anticoagulant-free whole blood, heparinized whole blood, or heparinized plasma. Overall, the device performed very well but has several limitations according to the article:
- The ADEXUSDx product is a qualitative, not quantitative device. This is different than the Abbott iSTAT device as the iSTAT is quantitative with a range of 5-2000 IU/L. However, since hCG concentrations in women rise so rapidly in early pregnancy, and with such a narrow dynamic range some would argue that the iSTAT device is almost a qualitative device.
- The authors reported that the device recognized 100% of samples at a concentration of 27 IU/L and approximately 50% of samples at a concentration around 10 IU/L. This analytical sensitivity is similar to the POCT serum devices currently used in hospitals.
- Finally, the ADEXUSDx device showed susceptibility to the high-dose hook effect, as decreasing test line intensity was observed at concentrations ≥600,000 IU/L, but all devices were interpreted as positive. This limitation is similar to that seen with the iSTAT device.
Hematology
First patient cured of rare blood disorder
Using a technique that avoids the use of high-dose chemotherapy and radiation in preparation for a stem cell transplant, physicians at the University of Illinois Hospital & Health Sciences System have documented the first cure of an adult patient with congenital dyserythropoietic anemia (CDA; lack of red blood cells production, causing early death). The transplant technique used is unique - it allows a donor's cells to gradually take over a patient's bone marrow without using toxic agents to eliminate a patient's cells prior to the transplant.
For more than 30 years, David Levy's only course of treatment for CDA was regular blood transfusions to ensure his organs and tissues received enough oxygen. Levy was 24 when the pain became so severe he had to withdraw from graduate school. By age 32, Levy required transfusions every two to three weeks; had lost his spleen; had an enlarged liver; and was suffering severely from fatigue, heart palpitations and iron poisoning, a side effect of regular blood transfusions. Now, "I still have some pain and some lingering issues from the years my condition was not properly managed, but I can be independent now. That is the most important thing to me." Levy is finishing his doctorate in psychology and running group therapy sessions at a behavioral health hospital.
Transfusion Medicine
Discovery enables 'mass produced blood'
With increasing worldwide demand for safe blood, there is much interest in generating red blood cells (RBC) in vitro as an alternative clinical product. However, available methods do not yet provide a sustainable supply, and current systems using pluripotent stem cells as progenitors do not generate viable red cells.
Published in Nature Communications, researchers describe the first human immortalized adult erythroid line (Bristol Erythroid Line Adult; BEL-A), which provides a sustainable supply of erythroid cells. It is able to fully recapitulate normal erythropoiesis, enucleating to generate mature reticulocytes, characterization of which revealed no differences functionally or at the molecular level to in vitro-cultured adult reticulocytes.
A preliminary test demonstrates similar survival rates to adult donor RBCs in vivo. The technique is robust and reproducible according to the authors, with multiple additional lines successfully generated. In addition to facilitating the development of novel therapeutic products, BEL-A is easily transduced and a superior research tool for the study of erythropoiesis and RBC disease.
Molecular Genetics
Each child with cancer will have tumor DNA sequenced to find treatment
Every individual child in the UK with cancer will get their tumours’ DNA sequenced in order to find the best treatment and drugs available. The charity organization Children with Cancer UK announced today that £1.5 million funds will go to youngsters’ screening and treatment that will be more effective as well as less toxic.
Louis Chesler, a professor at the Institute of Cancer Research, who also leads this initiative stated: "Integration of modern technologies to cancer treatment is very important because it maximises the chance of developing a new generation of 'targeted' cancer drugs. It is incredibly exciting and their application to children’s cancers could be ground-breaking, but only if the drugs are properly applied to patients with very precise knowledge about the unique changes in genes, proteins and cancer cells that occur in each child’s tumour. This funding will help us move towards a more comprehensive and structured approach to genetic testing to match children with cancer to specific targeted treatments, which could be an incredibly important step towards increasing survival and reducing the side-effects of treatment.
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