This Week in Modern Pathology

In Modern Pathology, researchers led by Memorial Sloan-Kettering Cancer Center's Douglas Levine examine whether there are morphological characteristics common to ovarian cancers in cases with BRCA1 and BRCA2 mutations. They found that BRCA1- and BRCA2-associated cancers had more solid, pseudo-endometrioid, and transitional cell carcinoma-like morphology, and that BRCA1-associated cancers also had higher mitotic indices, a greater number of tumor-infiltrating lymphocytes, and geographic or comedo necrosis. "We have demonstrated very strong correlations between genotype and high-grade serous carcinoma phenotype," Levine and his colleagues write. The researchers also developed two algorithms to distinguish BRCA1-associated cancers from non-associated cancers based on morphological features. "The data suggest that the algorithms significantly enrich the pool of patients to be tested by increasing the positive predictive value from that expected by chance (16 [to] 17 percent) to as high as 60 percent, although it is acknowledged that the test set overrepresents the prevalence of BRCA1 germline mutations," the researchers add.

Researchers in Spain examined the sensitivity and specificity of CD2 and CD25 expression for diagnosing systemic mastocytosis. The researchers note that the World Health Organization's diagnostic criterion for the condition includes "aberrant expression of CD2 and/or CD25 by bone marrow, peripheral blood, or other extracutaneous tissue mast cells." From their sample, the researchers found that the WHO criterion had 100 percent sensitivity and 99 percent specificity, while CD25 expression alone yielded 100 percent sensitivity and 99.2 percent specificity — inclusion of CD2 actually decreased the test's specificity. "Our results suggest that expression of CD2 does not add to that of CD25 in the diagnosis of systemic mastocytosis, and that this should be considered in future revisions of the current World Health Organization phenotypic criterion for systemic mastocytosis," the researchers add.

This Week in the American Journal of Translational Research

Researchers led by Brigitte Gomperts at the University of California, Los Angeles, show that interleukin-13 induces epigenetic changes in allergic airway inflammation. Using transgenic mice, the researchers overexpressed IL13, finding that it led to DNA methylation changes in 177 genes. "We have found that IL13 expression in the airways is associated with coordinate changes in the methylation status of promoters of a large number of gene components of the IL13 transcriptome, consistent with an epigenetic regulatory function of gene methylation in allergic airway inflammation," the researchers write, adding that "interventions that manipulate the epigenome of the asthmatic lung may provide highly effective therapies in the future."

Also in the American Journal of Translational Research, Lei Nie from the University of Texas MD Anderson Cancer Center and his colleagues review the roles of long, non-coding RNAs, particularly during cancer development. LncRNAs can mediate epigenetic modifications and directly regulate target gene transcription. In cancer, there is increasing evidence that "lncRNAs are crucial players in a variety of tissue carcinogenesis, invasion, and metastasis," and can be categorized as either onocgenic or tumor-suppressors, Nie et al. write. "Characterization of oncogenic and tumor suppressor lncRNAs is an attractive field, which will lead to new markers of cancer diagnosis and identification of novel therapeutic targets," the authors add.

A Revenue Rise for LabCorp

Laboratory Corporation of America reported an increase in revenue of 4 percent, to $1.42 billion, for the first quarter of 2012, reports Dow Jones Newswires. LabCorp's testing volume increased by 2.8 percent in the first quarter. "Our core business continues to perform well, and we remain extremely pleased with the performance of the Genzyme Genetics and Orchid Cellmark acquisitions," says CEO David King in a statement. Dow Jones notes that LabCorp completed its $84 million acquisition of Orchid Cellmark in December, and that deal is "expected to strengthen LabCorp's domestic presence and provide a foothold in Britain." LabCorp acquired Genzyme in late 2010 for $925 million, our sister publication GenomeWeb Daily News adds.

This Week in the Journal of Molecular Diagnostics

Albrecht Stenzinger from the University Hospital Heidelberg in Germany and his colleagues discuss their assessment of HER2 status diagnostic guidelines in the Journal of Molecular Diagnostics. Using a statistical simulation approach, the researchers looked into how the diagnosed HER2/chromosome 17 ratios are affected by sample size, signal distribution, and method used to calculate the ratio. "The analysis we present shows the limitations of the current recommendations for an imprecision not inflicted by the laboratory method but the data analysis and therefore underlines the importance of rigorous data analysis standards," Stenzinger et al. write.

Quest Diagnostics Reports Growth

Quest Diagnostics reported a profit for the first quarter of 2012, according to Dow Jones Newswires. The company reported a profit of $159.1 million, compared to a loss in 2011 of $53.9 million, Dow Jones says. Clinical testing revenue increased by 6.4 percent, with volume up 3.4 percent, Quest adds. "We saw strong growth in esoteric and advanced gene-based testing as a result of our focus on cancer, cardiovascular disease, infectious disease, and neurological disorders. In addition, we saw improved growth in routine testing," says CEO Surya Mohapatra in a statement. Stephen Rusckowski, CEO of Philips Healthcare, will be taking over Mohapatra's post in May.

Our sister publication GenomeWeb Daily News has more here.

This Week in Experimental and Molecular Pathology

Mutations in the mitochondrial gene ATPase6 occur frequently in Chinese patients with osteosarcoma, report researchers led by Qiao-Nan Guo from the Third Military Medical University in Chongqing, China, in an early online Experimental and Molecular Pathology article. Guo and colleagues sequenced the ATPase6 genes from 39 osteosarcoma samples, finding mutations in 24 of them that occurred at 27 different sites. Of the mutations seen, 19 were novel, though they occurred at low levels. In addition, the researchers noted that there was no association between the mutations and histopathological subtype. "MtDNA ATPase6 mutations may play a role in the tumorigenesis and development of osteosarcoma," the researchers write. "Further studies of the biochemical consequences of mtDNA ATPase6 mutations in osteosarcoma will provide insight into the roles of mitochondria in osteosarcoma tumorigenesis."

N-acetylglucosaminyltransferases V, or GnT-V, may be a marker for hepatocellular carcinoma as well as a possible treatment target for the disease, say Ting Wei from Southern Medical University in Guangzhou, China, and colleagues. To study the role of GnT-V in hepatocellular carcinoma, the researchers developed short hairpin RNAs targeting the GnT-V gene and transfected them into a HepG2 cell line. The researchers also examined clinical samples. From this, Wei et al. report that when GnT-V is down-regulated, the "proliferation, migration, invasion, and metastasisof HepG2 cells" is inhibited, and that GnT-V expression is more frequently seen in hepatocellular carcinoma than in liver cirrhosis or normal liver tissue. In addition, GnT-V expression increases as the cancer progresses. "These data from HepG2 cell line and clinical tissue all implied that GnT-V expression was positively related with malignancy in HCC," Wei et al. say. "Down-regulation of GnT-V may suppress the malignancy of HCC, so GnT-V may be both a differentiation marker and a potential target for the treatment of HCC."

Clostridium Difficile Test Cleared

The US Food and Drug Administration has given 510(k) clearance to Quest Diagnostics' Clostridium difficile test. The Simplexa C. difficile Universal Direct Test runs on the 3M Integrated Cycler, using real-time PCR to detect the C. difficile toxin B gene from stool samples. It uses a chemistry that eliminates the need for nucleic acid extraction, and Quest says the testing process takes about an hour. The test is from Quest's wholly owned business Focus Diagnostics. "Fast, reliable PCR tests that are highly specific and sensitive in the detection of the tcdB gene, a toxin-B producing gene of C. difficile, are essential for identifying and treating this infection as well as containing its spread," says Jay Lieberman, the medical director of infectious disease for Quest Diagnostics and Focus Diagnostics, in a statement.

This Week in the Journal of Clinical Pathology

In the Journal of Clinical Pathology, Antonino Carbone and Paolo De Paoli from Italy's National Cancer Institute review the role that viruses may play in carcinogenesis, and describe pathological and diagnostics techniques. Epstein-Barr virus, Kaposi's sarcoma-associated herpes virus, and human papillomavirus are all associated with carcinogenesis, and there are more sensitive ways to detect such infections including PCR analysis, gene chips, and other assays. "The future scenario we may have to face ahead of us in case the development of vaccines were feasible, and vaccination campaigns were effective, may consist of a 15 to 20 percent reduction of human malignant tumours worldwide," Carbone and De Paoli write.

Priority Testing

The World Health Organization recommends that people with HIV begin antiretroviral therapy when their CD4 count falls below 350 cells per microliter. This requires patients to have their CD4 counts tested, though developing countries may have limited numbers of labs and personnel to do the testing, says a new article in PLoS Medicine. Researchers led by the Wistar Institute's Luis Montaner tested a prediction-based classification method to determine when patients' CD4 levels fall. The model incorporates baseline CD4 levels, white blood cell count, and lymphocyte percent measurements. "Our results support the use of PBC modeling as a triage point at the laboratory, lessening the need for laboratory-based CD4+ T cell count testing; implementation of this tool could help optimize the use of laboratory resources, directing CD4 testing towards higher-risk patients," the researchers report.

This Week in Modern Pathology

Researchers led by Boston University School of Medicine's Meera Mahalingam report in Modern Pathology on their genetic and immunohistochemical assessment of desmoplastic melanoma subtypes. The researchers sequenced the RET, BRAF, and KIT genes of 43 samples desmoplastic melanoma — 24 of which were the pure subtype and 19 of which were mixed — and examined a number of immunohistochemical markers, including nestin, clusterin, SOX10, and CD117. "In this study, although we noted many similarities between these two subtypes on genetic analysis and immunohistochemistry, we also noted a distinct difference in CD117 expression, which has not been previously recognized," Mahalingam and her team write. "This observation requires further study and validation, but may, in part, begin to explain the significant phenotypic differences between these two groups."

Also in Modern Pathology, Luís Muñoz-Bellvis from Hospital Universitario de Salamanca and his colleagues say that primary colorectal cancer and its liver metastases have different genetic profiles. Using high-density SNP arrays, the researchers examined genetic changes present in primary colorectal cancer tumors and liver metastases. While primary and metastatic tumors from the same patient showed similar genetic changes, metastatic tumors had more chromosomal abnormalities. "We show the existence of relevant genetic differences between paired primary and metastatic colorectal tumors, which mainly consist of an increased frequency of genetic lesions of chromosomes that have been associated with metastatic colorectal cancer ... and, more interestingly, acquisition of new chromosomal abnormalities," Muñoz-Bellvis et al. say.

Lung Signature

Genome British Columbia is funding a PROOF Centre of Excellence to develop a test for chronic obstructive pulmonary disease flare-ups, the agency announced. The hope is that this investment will lead to a blood test that could be conducted at any clinical lab. Currently, diagnosing such attacks can only be done by a small number of personnel in certain centers within the province, Genome BC says.

"Our recently discovered genes or protein marker sets that could have the ability to predict lung attacks now must be validated. We will be able to validate the power of the bio-signatures to identify patients at risk for lung attacks within the next two years," says Bruce McManus, director of the PROOF Centre, in a statement.

This Week in Clinical Chemistry

Chris Pemberton from the University of Otago in New Zealand and his colleagues report in Clinical Chemistry that the prepro-A-type natriuretic peptide signal peptide could be a biomarker of cardiovascular disease. Pemberton and his colleagues developed an immunoassay for the preproANP signal peptide and used it to determine the concentrations of the peptide in healthy heart tissue, circulating in healthy volunteers, in heart attack patients, and in patients undergoing catheterization. In addition, they analyzed the circulating ANPsp by tandem mass spec. In the heart attack patients, the researchers found that "plasma concentrations of ANPsp rose to peak values at 5 h after symptom onset, significantly earlier than myoglobin, creatine kinase-MB, and troponin."

University of Washington researchers led by Tomas Vaisar write in Clinical Chemistry that "LC-MRM/MS could be used to replace immunoassays in a variety of settings." They used a shotgun proteomic approach, LC-MRM/MS, and commercially available immunoassays to analyze apoliporoteins A-I, C-II, C-III, E, B, and J. While the shotgun approach did not correlate well with the immunoassay findings, the LC-MRM/MS approach did, the researchers found.

Better Consumers

Patients, said Quest Diagnostics chief medical officer Jon Cohen, are not good healthcare consumers, reports the Wall Street Journal's Health Blog. Speaking at the TedMed conference, held in Washington, DC, Cohen said people consider price, quality, and desire when making a purchase, but those characteristics don't always translate into good healthcare, nor are they simple to evaluate in a medical context. To be better consumers, Cohen said, people need to want better quality care. "Intense desire trumps all barriers," he added.