Abstract
Early diagnosis of malignant pleural mesothelioma (MPM) is a challenge for clinicians. The disease is usually detected in an advanced stage which precludes curative treatment. We assume that only new and non-invasive biomarkers allowing earlier detection will result in better patient management and outcome. Many efforts have already been made to find suitable biomarkers in blood and pleural effusions, but have not yet resulted in a valid and reproducible diagnostic one. In this review, we will highlight the strengths and shortcomings of blood and fluid based biomarkers and highlight the potential of breath analysis as a non-invasive screening tool for MPM. This method seems very promising in the early detection of diverse malignancies, because exhaled breath contains valuable information on cell and tissue metabolism. Research that focuses on breath biomarkers in MPM is in its early days, but the few studies that have been performed show promising results. We believe a breathomics-based biomarker approach should be further explored to improve the follow-up and management of asbestos exposed individuals.
Highlights
Malignant pleural mesothelioma (MPM) is a rare and aggressive cancer originating from the mesothelial cells of the pleura
We searched for relevant studies concerning biomarkers in mesothelioma through MEDLINE (PubMed Database) and Web of Science using the following keywords and their combinations: “mesothelioma”, “biomarker”, “diagnosis”, “tumor marker”, “mesothelin”, “fibulin-3”, “osteopontin”, “megakaryocyte potentiating factor”, “galectin-3”, “thioredoxin” and “HMGB-1”, “RNA”, “lung cancer”, “volatile organic compounds”, “electronic nose”, “ion mobility spectrometry”, “gas chromatography-mass spectrometry (GC-MS)”, “headspace”, “cell line”, “asbestos”, “exhaled breath”, “breath analysis” and “metabolomics”
This study showed that soluble mesothelin-related peptide (SMRP) and TRX-1 are the most valuable serum biomarkers for early detection of malignant pleural mesothelioma (MPM)
Summary
Malignant pleural mesothelioma (MPM) is a rare and aggressive cancer originating from the mesothelial cells of the pleura. When asbestos fibers are inhaled in the lungs, they cause oxidative stress and chronic inflammation. Because of the high iron content of these fibers, Fenton-like reactions take place, resulting in the constant generation of reactive oxygen species (ROS). Chronic inflammation is due to the prolonged phagocytic activity of macrophages engulfing the inhaled asbestos fibers [5]. This process generates both ROS and reactive nitrogen species (RNS), which both cause DNA damage, resulting in large-scale alterations in chromosomal loci harboring tumor-suppressor genes such as NF2 and BAP1 [6]. Mesothelioma is the prototypical illustration of the genotoxic effects of protracted tissue inflammation, culminating in carcinogenesis with a long latency period after initial asbestos exposure
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