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Clinical evaluation of nuclear matrix protein 22 (NMP22) in urine as a novel marker for urothelial cancer.

OBJECTIVES: This study was undertaken to determine the clinical usefulness of nuclear matrix protein 22 (NMP22) as a novel urine marker for urothelial cancer, particularly, to substitute for voided-urine cytology. METHODS: NMP22 values were determined for 280 patients and 20 healthy volunteers by NMP22 Test Kit based on an enzyme-linked immunosorbent assay. RESULTS: When the cut-off value was set at 10 U/ml, the positive rate of urinary NMP22 for urothelial cancer was 80.9% (38/47), whereas that for posttreatment cases and benign diseases was 35.7% (74/207). When urinary NMP22 and voided-urine cytology were compared, the test for urinary NMP22 showed higher sensitivity than cytology in patients with urothelial cancer. When urinary NMP22 values were determined pre- and postoperatively in patients with urothelial cancer, the postoperative value decreased in all patients, and were below the cut-off value in all except one patient. CONCLUSIONS: Urinary NMP22 is a useful diagnostic marker as a substitute for voided-urine cytology for the surveillance of urothelial cancer.

Adenocarcinoma↗

Urinary level of nuclear matrix protein 22 in the diagnosis of bladder cancer: experience with 130 patients with biopsy confirmed tumor.

PURPOSE: We prospectively evaluated the value of nuclear matrix protein 22 (NMP22dagger) and cytology in the diagnosis of bladder cancer. MATERIALS AND METHODS: We analyzed NMP22 in voided urine from 235 patients before cystoscopy. Of the patients 130 had transitional cell carcinoma of the bladder and subsequently underwent surgery. In a subset of 200 patients bladder washout samples for cytology were collected during cystoscopy. The cutoff for NMP22 was 10.0 units per ml. For cytology only high grade atypia was considered positive. RESULTS: Histology showed 77 superficial (pTa, pTis) and 53 invasive (pT1 or greater) tumors. Sensitivity of NMP22 was 51% and specificity was 83%. NMP22 sensitivity was 36% for superficial tumors and 73% for invasive transitional cell carcinoma. Overall sensitivity of cytology was 52% and specificity was 89%. Cytology sensitivity was 38% for superficial tumors and 83% for invasive transitional cell carcinoma. NMP22 sensitivity for grades 1, 2 and 3 tumors was 30%, 56% and 68%, respectively. Cytology sensitivity for grades 1, 2 and 3 tumors was 30%, 50% and 91%, respectively. Combined NMP22 and cytology had a sensitivity of 70%. CONCLUSIONS: NMP22 has sensitivity and specificity similar to those of cytology from bladder washout samples. Particularly in low stage and low grade tumors both tests show the same disappointing sensitivity. Because of a false-negative rate of 49%, NMP22 cannot replace cystoscopy in clinical practice, as the danger of missing NMP22 negative tumors is too high to rely on its results in an individual patient.

Biomarkers, Tumor↗

Comparative evaluation of the nuclear matrix protein, fibronectin, urinary bladder cancer antigen and voided urine cytology in the detection of bladder tumors.

PURPOSE: We evaluate the diagnostic efficacy of nuclear matrix protein-22 (NMP22, Matritech, Newton, Massachusetts), fibronectin and urinary bladder cancer antigen (UBC, IDL Biotech, Borlange, Sweden) compared with voided urine cytology in the detection of bladder cancer. MATERIALS AND METHODS: A total of 168 patients provided a single voided urine sample for NMP22, fibronectin an ideal monoclonal for urinary bladder cancer and cytology before cystoscopy. Cystoscopy was done for all patients as the reference standard for identification of bladder cancer. Biopsy of any suspicious lesion was performed for histopathological examination. Of the 168 cases 100 were histologically diagnosed as bladder cancer, whereas the remaining 68 had benign urological disorders. A group of 47 healthy volunteers were also enrolled in this study. Voided urine was evaluated by NMP22, fibronectin and UBC, and their values were expressed relative to mg. creatinine. RESULTS: The optimal threshold values for NMP22, fibronectin and UBC were calculated by receiver operator characteristics curves as 27 units per mg. creatinine, 198 mg./mg. creatinine and 13 ng./mg. creatinine, respectively. The levels and positive rates of the 3 parameters were significantly higher in the malignant group compared to either the benign group or normal controls. Of the entire group NMP22, fibronectin and UBC were positive in 93.2%, 91% and 68.2%, respectively in bladder cancer cases with positive cytology. Moreover, these positive rates were significantly higher in bilharzial bladder cancer cases (58.8%, 67.5%, 58.8%, respectively) compared to nonbilharzial cases (35.6%, 36.3%, 31.1%). Overall sensitivity and specificity were 85% and 91.3% for NMP22, 83% and 82.6% for fibronectin, 67% and 80.8% for UBC and 44% and 100% for voided urine cytology. Combined sensitivity of voided urine cytology with the 3 biomarkers together was higher than either combined sensitivity of voided urine cytology with 1 of the biomarkers or than that of the biomarker alone. CONCLUSIONS: Our data indicate that NMP22 and fibronectin had superior sensitivities compared to UBC and voided urine cytology, while NMP22 and voided urine cytology had the highest specificities. The combined use of markers increased the sensitivity of cytology from 44% to 95.3%. The higher sensitivities of markers in bilharzial than nonbilharzial bladder cancer highlight their clinical use in screening patients with urinary bilharziasis.

Adult↗

Comparison of cytology and nuclear matrix protein 22 for the detection and follow-up of bladder cancer.

OBJECTIVES: This study was designed to determine the clinical usefulness of the nuclear matrix METHODS: 84 patients suffering from bladder cancer or suspected bladder cancer, 25 patients with benign urological lesions and 60 healthy controls participated in a prospective study. Freshly voided spot urine samples were taken for cytological examination and determination of NMP 22 levels by enzyme-linked immunoassay. RESULTS: The sensitivity of the NMP 22 test according to the tumor grading was (results of cytology in brackets): G1 25.0% (20.0%); G2 68.2% (59.1%), and G3 100.0% (66.7); overall sensitivity was 62.5% (45.0%). The sensitivity for superficial bladder cancer was 46.7% (36.7%) and for invasive bladder cancer 90.0% (70.0%). The specificity was 65.9% (88.9%). CONCLUSIONS: NMP 22 is a reliable tool for detecting invasive bladder cancer. Results for the frequently occurring low grade superficial bladder cancer are as poor as those obtained with cytology. In addition benign lesions such as urolithiasis or urinary tract infection lead to false-positive results. Therefore cystoscopy has to be performed when trying to detect and follow-up bladder cancer.

Biomarkers, Tumor↗

The association of transcribed genes with the nuclear matrix of Drosophila cells during heat shock.

Using the transcriptional modulation afforded by heat shock, we found that the association of active genes with the nuclear matrix was not dependent on their level of transcription. Heat shock genes were matrix associated both before heat shock (when transcription was relatively low), and during heat shock (when transcription was greatly increased). Conversely, the cytoplasmic actin gene was matrix associated during normal growth conditions (when transcription was high) and during heat shock (when transcription was greatly decreased). Removal of greater than 99.7% of nascent RNA during preparation of the matrices did not affect these findings. Detailed examination of the cytoplasmic actin gene revealed that its matrix association was apparently mediated by multiple interactions near the 5' end of the gene.

Actins↗

Evaluation of nuclear matrix protein 22 as a tumour marker in the detection of transitional cell carcinoma of the bladder.

OBJECTIVES: To evaluate the sensitivity and specificity of urinary nuclear matrix protein-22 (NMP22) in detecting bladder cancer, to compare the diagnostic performance of NMP22 alone and when corrected by urinary creatinine level, and to correlate NMP22 level with the histological and clinical characteristics of bladder cancer. PATIENTS, SUBJECTS AND METHODS: The study included 267 patients classified into five groups: group 1 comprised 111 patients with active transitional cell carcinoma (TCC) of the bladder; group 2 included 76 patients who had had bladder TCC but were being followed and were free of disease, as confirmed by cystoscopy; group 3 comprised 25 patients with benign urological diseases; group 4 included 25 patients with other malignant pathological conditions; group 5 constituted a control group of 30 healthy subjects free of urological diseases. Urinary NMP22 was measured using an enzyme-linked immunosorbent assay. Receiver operating characteristic (ROC) curves were constructed to obtain the thresholds which gave optimal sensitivity and specificity for combinations of NMP22 alone and when corrected by urinary creatinine level. Stage, grade, tumour size, pattern of growth, focality and the presence of recurrence were recorded and their associations with NMP22 evaluated. RESULTS: The mean levels of NMP22 were 122.8, 5.1, 3.7, 2.3 and 0.3 U/mL for groups 1-5, respectively; overall, these values were significantly different (P<0.001). The mean (95% CI) optimal combination of 78.2% (69.3-85.5) sensitivity and 95.5% (87.3-99.0) specificity was obtained from the ROC analysis with a threshold value of 13.7 U/mL NMP22. When values were corrected by urinary creatinine levels, the threshold given by the best combination of sensitivity and specificity, at 73.2% (63.2-81.7) and 97.0% (89.6-99.5), respectively, was 3.0 U/mg creatinine. NMP22 level was statistically associated with stage, grade, tumour size and focality. CONCLUSIONS: Urinary NMP22 appeared to be a potential tumour marker for detecting TCC of the bladder; when corrected by urinary creatinine level, it might provide a better interpretation than when used alone. NMP22 correlated with the most relevant variables in bladder cancer. As a noninvasive adjunct, NMP22 might have a role in guiding urologists about the need for cystoscopy in such patients.

Biomarkers, Tumor↗

The nuclear matrix continues DNA synthesis at in vivo replicational forks.

Alkaline cesium chloride gradient analysis of in vivo [3H]bromodeoxyuridine-labeled and in vitro [alpha-32P]dCTP-labeled DNA was used to determine whether in vitro DNA synthesis in regenerating rat liver nuclei and nuclear matrices continued from sites of replication initiated in vivo. At least 70 and 50% of the products of total nuclear and matrix-bound in vitro DNA synthesis, respectively, were continuations of in vivo initiated replicational forks. The relationship of the in vitro DNA synthetic sites in total nuclei versus the nuclear matrix was examined by using [3H]bromodeoxyuridine triphosphate to density label in vitro synthesized DNA in isolated nuclei and [alpha-32P]dCTP to label DNA synthesized in isolated nuclear matrix. A minimum of about 40% of matrix-bound DNA synthesis continued from sites being used in vitro by isolated nuclei. Furthermore, nuclear matrices prepared from in vitro labeled nuclei were 5-fold enriched in DNA synthesized by the nuclei and were several-fold enriched, compared to total nuclear DNA, in a particularly high density labeled population of DNA molecules.

Animals↗

Urinary nuclear matrix protein 22 (NMP22): a diagnostic adjunct to urine cytologic examination for the detection of recurrent transitional-cell carcinoma of the bladder.

This study compares urine nuclear matrix protein 22 (NMP22) immunoassay and conventional urine cytologic examination for detecting recurrent transitional-cell carcinoma (TCC) of the urinary bladder. One hundred twenty-eight urine specimens from 107 patients with a history of TCC of the urinary bladder were studied. NMP22 immunoassay and conventional cytologic examination were performed on each specimen. The NMP22 and cytology results were then compared with the results of subsequent cystoscopies/surgical biopsies performed over a 6-mo follow-up period. The sensitivity of urine cytologic study for predicting recurrent TCC was 60%, while the sensitivity of NMP22 assay was 47%. When both NMP22 assay results and the cytologic interpretation were positive for TCC, the positive predictive value of the combined tests was 74%. When both tests showed negative results, the negative predictive power was 81%. Our findings suggest that urine NMP22 assay may represent a useful diagnostic adjunct to conventional urine cytologic examination for the detection of recurrent TCC of the urinary bladder.

Adult↗

Usefulness of urinary nuclear matrix protein 22 (NMP22) as a marker for transitional cell carcinoma of the bladder.

OBJECTIVES: The purpose of this study was to evaluate an immunoassay for urinary nuclear matrix protein, NMP22, as a novel marker for urothelial cancer. PATIENTS AND METHODS: NMP22 values were determined for 71 patients and 21 healthy volunteers. Each subject provided a single (3 voids) urine sample for analysis at the time of entry into the study. Each sample was assayed for levels of NMP22. RESULTS: When the cut-off value was set at 10 U/ml, the positive rate for urinary NMP22 in bladder cancer was 37.8% (17 out of 45), whereas that in post-treatment cases and benign diseases was 30.8% (8 out of 26) compared to 14.3% (3 out of 21) for healthy volunteers. This cut-off value provided a sensitivity of 37.8% and a specificity of 80.9%. In the bladder cancer group, NMP22 levels were related to tumor size, shape, grade and stage. CONCLUSIONS: Despite the many reports that suggest NMP22 as a promising urinary marker for monitoring transitional cell carcinoma, this study does not support its usefulness as a substitute tool for urinary cytology in the control of bladder tumors.

Adult↗

Nuclear matrix protein alterations associated with colon cancer metastasis to the liver.

PURPOSE: The development of colon cancer markers that can detect liver metastases early and predict which patients are at risk to develop liver metastases would have a major impact on this disease. We have previously identified G. Brunagel, et al., Cancer Research, 62:2437-2442, 2002, nuclear matrix proteins (NMPs), which are associated with colon cancer. The objective of this study is to identify the existence of a specific NMP "fingerprint" for human liver metastasis from colon cancer. EXPERIMENTAL DESIGN: Using high-resolution two-dimensional gel electrophoresis, we analyzed the NMP expression of 12 matched liver metastases and adjacent normal samples and three normal donor liver samples. These were compared with colon cancer NMP patterns, along with several primary cell systems and lines. RESULTS: Analysis of multiple gels for each sample revealed three proteins present in all liver metastases, which are not present in normal liver tissue and normal hepatocytes. These three proteins were also present in colon cancer samples. CONCLUSION: Data provided here demonstrate that the NMP composition is able to differentiate liver metastases from normal liver tissue and normal hepatocytes and that these proteins are also expressed in colon cancer. These results further show that the adjacent normal liver tissue changes its NMP pattern of expression. Development of an assay to detect these specific NMPs in tissue and/or serum specimens is a promising modality for early detection of liver metastases from colon cancer or potentially as a prognostic tool. In addition the functional characterization of these proteins will significantly enhance our understanding of the development of liver metastases of this disease.

Adenocarcinoma↗

Fibronectin observed in the nuclear matrix of HeLa tumour cells.

We have investigated the intracellular distribution of insoluble fibronectin in HeLa tumour cells. By indirect immunofluorescence microscopy fibronectin was detected in the nuclear region, but not in the region of the cell surface. Isolated nuclei and isolated nuclear matrices also stained for fibronectin. By quantitative enzyme-linked immunosorbent assay (ELISA), fibronectin was found almost exclusively in the subcellular fraction of isolated nuclear matrices. Using immunoblotting techniques fibronectin was detected in nuclear matrices isolated from cells grown in standard and in fibronectin-depleted medium. The data demonstrate that fibronectin in HeLa tumour cells is preferentially associated with the nuclear matrix.

Cell Nucleus↗

Comparison of cytology and nuclear matrix protein 22 (NMP 22) for the detection and follow-up of bladder-cancer.

OBJECTIVES: This study was designed to determine the clinical usefulness of the Nuclear Matrix Protein 22 (NMP 22) Test for the detection of bladder cancer in comparison to urine cytology. METHODS: One hundred sixty-four patients suffering from or being suspicious for bladder cancer and 64 healthy controls participated in a prospective study. Freshly voided spot urine samples were taken for cytological examination and determination of NMP 22-levels by enzyme-linked immunoassay. RESULTS: Sensitivity to the NMP 22 Test according to the tumor grading was (results of cytology in parentheses): GI 25.0% (20.0%), G2 68.2% (59.1%), and G3 100.0% (66.7%); overall sensitivity was 62.5% (45.0%). Sensitivity according to superficial bladder cancer was 46.7% (36.7%), and to invasive bladder cancer 90.0% (70.0%). Specificity was 65.9% (88.9%). CONCLUSIONS: NMP 22 is a reliable tool for detecting invasive bladder cancer. Results for the well-differentiated superficial bladder cancer occurring frequently are as poor as those obtained with cytology. In addition, benign lesions such as urolithiasis or urinary tract infection lead to false positive results. Therefore, cystoscopy has to be performed when trying to detect and follow-up bladder cancer.

Biomarkers, Tumor↗

Nuclear matrix proteins as biomarkers for breast cancer.

Breast cancer remains a leading cause of cancer death in women despite widespread screening, in part because screening mammography has high rates of false-negative results and because many women decline to have routine mammograms. The development of sensitive and specific assays for breast tumor markers would improve detection and facilitate screening, diagnosis, therapeutic monitoring and surveillance for recurrence. Nuclear matrix proteins (NMPs) are promising candidates for tumor markers because they are involved in malignant transformation. Therefore, they may be useful for screening and early diagnosis of small tumors. Proteomic analysis was used to demonstrate that a 28.3 kD serum protein, designated NMP66, can distinguish malignant disease from benign conditions and normal controls. NMP66 is now being evaluated as a potential biomarker for early breast cancer detection in large-scale clinical trials.

Adult↗

In vitro DNA replication in association with the nuclear matrix of permeable mammalian cells.

DNA replication has been studied in in vitro cultured bovine liver cells permeabilized in 0.02% Triton X-100. The Km for TTP was 20 microM. The initial incorporation rate at 10 microM TTP concentration was about 12% of the in vivo synthesis and declined very strongly within 1 h. A similar decline of the incorporation rate was found at 0.12 microM TTP concentration. DNAase I digestion of DNA-matrix complexes obtained from isolated nuclei in 2 M NaCl revealed that newly replicated DNA was preferentially bound to the nuclear matrix. A similar digestion with S1 nuclease caused a selective release of short duplexes of Okazaki fragments with the complementary parental strand. The results show that in vivo replication continues in permeabilized cells in an almost unchanged way, except for a gradual decline of its rate which is mainly due to inactivation of one or more essential components.

Animals↗

Urinary dosage of nuclear matrix protein 22 (NMP22) like biologic marker of transitional cell carcinoma (TCC): a study on patients with hematuria.

UNLABELLED: This study was performed to evaluate the clinical usefulness of nuclear matrix protein 22 (NMP22) as urinary marker for bladder cancer and to define its role in comparison with urinary cytology in diagnostic management of patients with hematuria. MATERIALS AND METHODS: NMP22 values in voided urines were determined on 90 patients (81 males, 14 females) with macro or microscopical hematuria, using the NMP22 test-kit (Matritech) based on an enzyme-linked immuno-sorbant assay. The cut-off value for positive samples was 10U/ml. In all cases urinary cytology was performed on the same sample. Patients suspected for the presence of a transitional cell carcinoma (TCC) underwent cytoscopic control. Statistical signification of the medians difference was analyzed using both medians variance analysis and Student's test. The increasing in diagnostic predictivity was analyzed elaborating contingency tables and performing consequently chi 2 test. RESULTS: 32 cases of TCC were endoscopically detected: sensitivity of cytopathology was 75.8%, specificity was 62.5%. The positive predictive value of the cytology was 22% and negative predictive value was 49%. The results concerning NMP22 dosage are: sensitivity 84%, specificity 62%. Positive predictive value of NMP22 test was 30% and predictive negative value was 40%. No significant differences between cytopathology and NMP22 dosage were founded (p > 0.995). Considering both cytopathology and NMP22 dosage, sensitivity was 82.7% and specificity raises up to 90.6% with statistical signification (P < 0.001). The median NMP22 value in patients affected by TCC endoscopically confirmed (group A) was 55.2 U/ml, in subjects with no evidence of malignancy (group B) it was 19.1 U/ml. The difference shows statistical signification (p < 0.001). In 20 cases with TCC, hystological grading were available and were investigated in relationship with NMP22 title in U/ml, median NMP22 value for each grade was: CIS = 102 U/ml, G0 = 35 U/ml, G1 = 30 U/ml, G2 = 66 U/ml, G3 = 54 U/ml. It can be assessed that NMP22 test is useful in differentiating subjects affected by TCC from subjects with no evidence of malignancy and may help in early diagnosis of TCC and in predicting recurrent even if low grade tumors especially if used in association with cytology and endoscopy.

Biomarkers, Tumor↗

Changes in a nuclear matrix antigen during the cell cycle: interphase and mitotic cells.

We studied the behaviour in interphase and mitotic human cells of a 125 kDa (pI 6.5) antigen, associated with the nuclear matrix and detected in proliferating cells. Indirect immunofluorescence with a specific monoclonal antibody reveals that during interphase in WISH and Namalwa cells, as well as phytohaemagglutinin-stimulated lymphocytes, the antigen displays a speckled distribution in the nucleoplasm of all cells. At early prophase the fluorescence intensity of the coalesced speckles increases markedly. During metaphase and anaphase the antigen gives maximal fluorescence distributed diffusely in the nucleoplasm, while chromosomes remain negative. At anaphase and cytokinesis the antigen is still cytoplasmic, but fluorescence intensity decreases. Two-dimensional gel electrophoresis and immunoblotting reveal that the p125/6.5 antigen displays a net increase in isolated mitotic cells as compared to interphase cells. These results suggest that the p125/6.5 protein participates in late G2 phase and G2/M transition events preparing the cell for mitosis.

Antibodies, Monoclonal↗

[Stimulation with triiodothyronine of the synthesis of DNA, total proteins, nuclear proteins and nuclear matrix proteins in cultured cells of hepatoma Morris 7777].

Intensity of DNA and protein biosynthesis was decreased in Morris hepatoma 7777 cultivated cells in absence of thyroid hormones. Physiological concentrations of triiodothyronine increased synthesis of DNA and total proteins after lag phase within 12-48 hrs, while synthesis of nuclear and nuclear matrix proteins was stimulated already within 2 hrs. This suggests that stimulation of nuclear proteins biosynthesis occurred prior to the hormone effect on proliferation and cell metabolism. Alterations in sensitivity of chromatin to DNAase I were not observed. Response of the Morris hepatoma cells to thyroid hormones may be used in studies of molecular mechanisms of thyroid hormones action.

Amino Acids↗