More Involved

The US Affordable Care Act includes a provision for accountable care organizations in its Shared Savings Program, which could affect clinical laboratorians, writes Bill Malone at Clinical Laboratory News. ARUP Laboratories' Joe Miles tells Malone that laboratorians will have to become involved in care path development initiatives. "Unfortunately, our industry has allowed the whole idea that laboratory services are a commodity to exist," Miles later adds. "The problem now is that in today's world under accountable care, the commodity — which is a lab test result — encompasses far more than a simple test result."

This Week in Experimental and Molecular Pathology

Researchers led by Qiagen's Daniel Groelz write in Experimental and Molecular Pathology that the PAXgene Tissue System does not chemically alter RNA upon fixation and stabilization. They compared the RINs of FFPE, PAXgene-fixed, and fresh-frozen tissue samples and found that, in their model, "processing, which included embedding in low melting point paraffin, had only a minor effect on RNA integrity in PAXgene fixed/stabilized tissue but a moderate effect on RNA integrity in formalin-fixed tissue." Further, they report that RNA from FFPE samples was more likely to have chemical modifications than RNA from the PAXgene samples. "While RNA with acceptable RIN scores could be isolated from both FFPE and PFPE tissue, only RNA from PFPE tissue was comparable to RNA from fresh frozen tissue in real time RT PCR assays and for all amplifications of transcript sequences from 109 to 610 nt," the researchers write. PAXgene was developed by PreAnalytiX, which is a BD-Qiagen joint venture.

Also in Experimental and Molecular Pathology, Josef Wanninger from Regensburg University Hospital in Germany and his colleagues report on their lipidomic study of adiponectin deficient mice. As "adiponectin-deficient mice may compensate for adiponectin deficiency to a certain degree," they examined "the expression of lipogenic genes and lipid composition" in adiponectin-deficient mice. Adiponectin deficiency, Wanniger et al. write, is associated with different lipid classes in the liver and "lower levels of cholesteryl ester, stearate and eventually glucosylceramide may protect the liver from metabolic injury and may partly compensate for adiponectin deficiency."

LabCorp Unaware of Leveraged Buyout Plans

Laboratory Corporation of America says that it has no knowledge of reported plans by private equity firms to effect a leveraged buyout of the firm. Mergermarket, a mergers and acquisitions information provider, reported yesterday that a consortium of private equity firms was looking to acquire LabCorp and take it private. Mergermarket listed TPG Capital and Bain Capital as having the resources to do such a deal.

LabCorp has a market capitalization of around $8.5 billion.

"The report does not surprise us considering we have long thought that LabCorp might be a target because of its strong free cash flow generation and relatively stable business," Wells Fargo Securities analyst Gary Lieberman tells Reuters.

"The company has no knowledge of any such plans and is not in current discussions with any firms to effect such a transaction," LabCorp says in a statement.

A couple of weeks ago, LabCorp reported second-quarter revenue growth of just 1 percent to 1.42 billion. It missed Wall Street's consensus estimate on the top line. Since then, its shares have fallen around 5 percent. In late morning trade Wednesday on the New York Stock Exchange shares of LabCorp were up around 3 percent at $87.02.

This Week in the Journal of Pathology

Researchers in Vancouver report that their nine-gene panel could determine subtypes of endometrial carcinoma in the Journal of Pathology this week. The researchers sequenced the exons of ARID1A, PPP2R1A, PTEN, PIK3CA, KRAS, CTNNB1, TP53, BRAF, and PPP2R5C in 393 endometrial carcinomas from two large cohorts, and found that each subtype of the cancer had a different mutational profile: high-grade endometrioid cancers have different frequencies of PTEN and TP53 mutations than low-grade ones and serous carcinomas and high-grade endometrioid cancers have different mutational frequencies in PTEN, ARID1A, PPP2R1A, TP53, and CTNNB1. "Although endometrial carcinoma subtype diagnoses and grade are currently used in guiding patient management, mutational analysis is emerging as a realistic option in clinical practice," the researchers write. "In the future, we predict that the mutational classification of endometrial carcinomas will become an important tool in diagnosis, guiding mutation-based targeted treatment decisions."

Also in the Journal of Pathology researchers led by Portugal's Carla Oliveira show that deletions in miR-101 lead to its downregulation, overexpression of EZH2, and dysregulation of E-cadherin dysfunction in gastric cancer. "Our data reinforce the critical role of E-cadherin in GC and pinpoint EZH2 over-expression, as a consequence of miR-101 loci deletion and mature miR-101 down-regulation, as one of the missing mechanisms for E-cadherin inactivation in advanced intestinal GC," Oliveria and her colleagues write. "This strong association suggests that therapeutic intervention based on restoration of miR-101 or pharmacological inhibition of EZH2 may have clinical benefit in patients with intestinal-type GC."

Check it Off

The College of American Pathologists has announced its updated molecular pathology checklist. This new version, released yesterday, includes a section dealing with next-generation sequencing. The section lists requirements spanning the length of the sequencing workflow, from library preparation to variant calling and annotation. The organization adds that its lists are used in the Centers for Medicare and Medicaid Services accreditation process. "The workgroup was judicious in developing the requirements by creating the necessary framework for clinical testing using next generation sequencing and yet not being overly prescriptive to accommodate the differences in the technology platforms and the growth of the rapidly evolving technology," says Nazneen Aziz, head of molecular medicine at CAP, in a statement.

23andMe Submits FDA Paperwork

Consumer genomics company 23andMe has submitted its first 510(k) application to the US Food and Drug Administration as part of a plan to seek clearance for its Personal Genome Service. The service provides health and ancestry information to users. In a post to the Spittoon blog, the company says "we believe personal genetic data will power a revolution in healthcare. But we also recognize that appropriate oversight of this industry can be a stepping stone on the path to realizing that revolution."

The Sample's sister publication Pharmacogenomics Reporter adds that although 23andMe is seeking FDA clearance, it still plans to offer its services directly to consumers. "23andMe has publicly expressed its willingness to meet FDA regulations, but has also insisted that the agency's oversight shouldn't necessarily preclude consumer access to genetic testing," Turna Ray reports, adding that "the FDA of course could still delineate certain portions of its service as prescription only."

This Week in Modern Pathology

Researchers in Spain report in Modern Pathology on their study of 47 patients with age-related EBV-positive diffuse large B-cell lymphoma. They found that "EBV-positive diffuse large B-cell lymphoma of the elderly is an aggressive, clonal B-cell neoplasm with prominent nuclear factor-kB pathway activation in the neoplastic cells," and add that "these tumors behave aggressively and have poor [overall survival and [progression-free survival] with conventional treatments." The researchers thus recommend that alternate therapies should be tested to treat patients with age-related EBV-positive diffuse large B-cell lymphoma.

Also in Modern Pathology, Mayo Clinic researchers discuss the range of mucosal CD30-positive T-cell lymphoproliferation disorders. Drawing on data from 15 patients with the disorders who visited their clinic, the researchers say that "mucosal CD30-positive T-cell lymphoproliferations share features with cutaneous CD30-positive T-cell lymphoproliferative disorders, and require clinical staging for stratification into primary and secondary types" and that "primary cases have clinicopathologic features closer to primary cutaneous disease than to systemic anaplastic large cell lymphoma, including indolent clinical behavior." The researchers add that better understanding of the disorders will prevent misdiagnosis and overtreatment.

New Normal References

Clinicians and government officials are working to set normal ranges for clinical tests performed on Chinese patients, reports Shanghai Daily. The paper adds the currently used ranges were developed for Westerners, and may differ for Chinese. "Each testing result means a life. So we must be accurate," says Pan Baishen, director of Shanghai's Zhongshan Hospital's Department of Clinical Laboratory.

This Week in Clinical Chemistry

In a review in Clinical Chemistry, Kristian Linnet from the University of Copenhagen and his colleagues discuss how to evaluate the accuracy of diagnostic tests. They write that prospective cohort studies are generally the best way to determine how well a test will perform in the clinic for the population for which it is intended, but they are not always practical or even possible. In that event, case-control studies could be designed to evaluate such tests. The authors also note that "the accuracy of a diagnostic index test is not constant but varies across different clinical contexts, disease spectrums, and even patient subgroups." Further, they add that "a diagnostic test should always be placed into a specific clinical context and its results judged on the basis of the diagnostic pathway in which it is to be used."

Jill Powlick, a patent attorney at Idaho Technology, discusses the Prometheus and Myriad patents in an opinion piece in Clinical Chemistry. "The question in both the Prometheus and Myriad cases is whether the claimed subject matter does substantially more than describe these laws of nature," she writes. The Supreme Court found that the Prometheus patents covered subject matter that was not patentable — "that the laws of nature are combined only with conventional activities that existed before the invention," she says. The ongoing Myriad case involving patents on the breast cancer genes BRCA1 and BRCA2 involves slightly different claims, and Powlick says "anything can still happen."

Infection Finder

A real-time PCR approach could help diagnose Helicobacter pylori infection in some patients with upper gastrointestinal bleeding, researchers led by Gloria Royo from the Hospital General Universitario de Elche in Spain report in the Journal of Clinical Microbiology. Drawing on samples from 158 patients, the researchers evaluated real-time PCR and conventional tests — such as the rapid urease test, culture studies, histological study, stool antigen test, or breath test — in diagnosing H. pylori infections in patients with bleeding peptic ulcers. "Our results suggest that our method has a good diagnostic capacity as compared with the classical gold standard in bleeding patients, and is slightly greater in antrum than in corpus," the researchers write. However, they note that the clinical significance of a small amount of microorganisms, which often gives a negative result in classical tests, must be examined as that could reflect a transient colonization.

This Week in the Journal of Molecular Diagnostics

Christian Viertler from the Medical University of Graz in Austria and his colleagues present in the Journal of Molecular Diagnostics their development of a new method to stabilize tissues for analysis. They compared their new approach, called the PAXgene Tissue system, to other stabilization methods like FFPE, PFPE, and snap-frozen on the quantity and quality of their preservation of nucleic acids and other biomolecules. "Importantly, PAXgene-fixed, paraffin-embedded tissues provided RNA quantity and quality not only significantly better than that obtained with neutral buffered formalin, but also similar to that from snap-frozen tissue, which currently represents the gold standard for molecular analyses," Viertler et al. report. Some of the researchers involved in this work are employed by Qiagen or PreAnalytiX, which jointly created the PAXgene Tissue System.

Moving Further into Diagnostics, Life Tech Acquires Pinpoint Genomics

Life Technologies has acquired Pinpoint Genomics and its test for early-stage non-small-cell lung cancer, Life Tech announced yesterday, continuing the company's push into the diagnostic arena. Pinpoint's qPCR-based assay can help clinicians determine which patients with early-stage disease are at high risk for progression to late-stage disease. "We see an opportunity in lung cancer to change the treatment paradigm with more effective diagnostics," says Greg Lucier, chairman and CEO of Life Technologies, in a statement. "As Life Technologies moves further into the diagnostics space, we will focus on tests that have strong clinical utility where there is a large unmet need."

Separately, as The Sample's sister publication GenomeWeb Daily News reports, Life Tech has entered into a partnership with diagnostics firm Quidel to develop and commercialize real-time PCR assays for an as-yet-unlaunched molecular instrument system.

Life Tech also recently acquired genetic testing firm Navigenics as part of its strategy to build its molecular diagnostics business.

This Week in Experimental and Molecular Pathology

Alejandro Curina from the Institute of Biochemical Research in Bahía Blanca, Argentina, report in Experimental and Molecular Pathology that heme oxygenase-1, or HO-1, is upregulated in head and neck squamous cell carcinoma and that its localization to the nucleus is associated with malignancy. In their study, the researchers found that HO-1 mRNA and protein expression levels are higher in HNSCC tumors as compared to adjacent non-malignant tissue and normal tissue controls. In HNSCC tumors and cell lines, they also found that atypical nuclear localization of HO-1 increases with tumor progression.

Also in Experimental and Molecular Pathology, Fudan University's Decheng Wang and colleagues discuss the role of the macrophage migration inhibitory factor in granuloma formation in tuberculosis. They examined MIF expression in mouse and zebrafish models of disease as well as in human tissue, and they found that MIF expression increases in tissues that have been infected with Myycobacterium tuberculosis. "Our results revealed that MIF is necessary in granuloma formation of mouse and zebrafish as well as tuberculosis patient tissues," Wang et al. write.