Key Terms: Biomarker, Biopsy, Laser capture microdissection microscope, Mass spectroscopy, Mass-to-charge ratio, Phosphorylation, Prostate specific antigen, Protein array.
Definition
Proteomics is the systematic study of all of the proteins in a cell, tissue, or organism.
Description
The term proteome was coined in 1994 to describe all of the proteins in a given cell, tissue, or organism. Proteomes are extremely complex and differ among individuals, cell types, and within the same cell depending on cell activity, stimuli, and disease. There are estimated to be between one and ten million different proteins in the human body. Relatively few of these proteins have been identified.
Proteomics is being developed for use in cancer diagnosis and treatment. A protein pattern or array from blood or a cancer cell eventually may be the primary means of diagnosing cancer. Although significant advances have been made in clinical studies, as of 2005, proteomics was not yet available in clinical settings.
Proteomics technology for cancer diagnosis and treatment identifies biomarkers—proteins and protein patterns in blood, urine, and tissue that can be used to detect:
It is expected that proteomics will be used to:
- develop better cancer treatments
- predict the effects of various treatments
- develop individualized therapies for each patient
Proteomics has led to the identification of many biomarker proteins and the discovery of many new proteins in the blood. As of 2005, proteomics has been used to identify hundreds of proteins in the ovary, prostate, breast, and esophagus that increase or decrease as cells begin to grow abnormally.
Procedures
Progress in proteomics has been made possible by the development of new technologies including:
- high-resolution mass spectrometry (MS) that can sort out thousands of proteins and protein fragments on the basis of their molecular weight and electrical charge
- sophisticated artificial intelligence computer programs that can learn to identify the specific patterns of a few proteins present in a huge protein array
- laser capture microdissection microscopes that use low-energy laser beams and special transfer film to lift single cells from a tissue, to collect and analyze all of the proteins in the cell by (MS) and computer technology
A mass spectrometer consists of:
- an ionization source that removes electrons from (ionizes) the proteins and protein fragments in a sample so that they all have a positive charge
- a mass analyzer that measures the mass-to-charge ratio (m/z) of the ionized (charged) proteins and fragments, as gases under a vacuum
- a detector that determines the number of ions present at each m/z value
The result is a mass spectrum or chart with a series of spikes or peaks, each representing a charged protein fragment from the sample. The height of each peak represents the amount of that particular protein or fragment that is present in the sample. The size of the peaks and the distance between them is the protein pattern or array of the entire sample. Each spectrum may have more than 15,000 data points—one for every protein and protein fragment—with their molecular weight and intensity values reflecting their relative abundance in the sample.
Computers rapidly analyze the MS data searching for subtle differences among multiple protein patterns and for proteins that might serve as biomarkers. Once potential biomarkers are identified, the computer is trained to sort through the patterns of thousands of proteins for the few small protein biomarkers that can distinguish between cancer and control samples or between cancer protein patterns before and after treatment.
MS-based proteomic analysis is very fast. The entire process—from collecting a few drops of blood to the spectral analysis—can occur in less than one minute. Extremely small amounts of protein can be detected and hundreds of samples can be analyzed sequentially.
Laser capture microdissection microscopes enable scientists to use tissue removed from a patient by a biopsy to isolate pure samples of normal cells, precancerous cells, and tumor cells from a single tissue of a single patient. Analysis of the protein patterns from these cells enable researchers to study:
- patterns that may predict early-stage cancer
- how a particular treatment affects the network of proteins in a cell
- early signs of cancer drug toxicity
- mechanisms of drug resistance
- means for reducing side effects of treatment
- changes in protein patterns during tumor recurrenceIt may be possible to predict from the protein patterns which patients are likely to have an early toxic response to a treatment, so that doses can be lowered or a different treatment can be chosen.
Initially, researchers are concentrating on ovarian and prostate cancers, which usually are not detected in early stages when the cancer is progressing without symptoms. By using proteomics for early detection, tumors may be treated before they spread (metastasize) to other parts of the body. Scientists also are studying the most common, solid human tumors including breast, colon, lung, and pancreatic cancers.
Cancers
Ovarian Cancer
More than 80% of ovarian cancers are not diagnosed until they have reached an advanced stage when the five-year-survival rate is 20% or less. However in the 20% of women whose ovarian cancer is diagnosed at an early stage, the prognosis is excellent, with a five-year-survival rate of over 95%.
In 2002 researchers used MS-based proteomics to examine the protein patterns in blood serum, obtained with a finger prick, from 50 patients with stage-I ovarian cancer and 66 controls who were either healthy or had a benign (non-cancerous) condition such as ovarian cysts, fibroids, endometriosis, or general inflammatory disease. Such conditions are much more common than ovarian cancer but may have symptoms that suggest the possibility of cancer. Out of the complex patterns of tens of thousands of serum proteins, the computer identified a specific combination of five proteins that could distinguish between the cancer patients and the controls. Using this identified sub-pattern, all of the cancer patients tested positive—a 100% sensitivity. Among the controls, 5% were false positives demonstrating a specificity of 95%.
In 2004, using higher-resolution MS, a different protein pattern, and a larger group of patients and controls, researchers were able to achieve 100% sensitivity and specificity for diagnosing ovarian cancer. However validation of the procedure on a large clinical sample is needed before a commercial test becomes available. These clinical studies are being carried out in high-risk clinics, in which many women are considering prophylactic oophorectomies—removal of the ovaries—to prevent ovarian cancer, because they have a family history of the disease or carry mutations in the BRCA genes that greatly increase their risk for breast and ovarian cancers.
As of 2005, a clinical trial also was underway comparing proteomics with standard CA-125 blood tests that use a single protein as a biomarker for ovarian cancer. The blood protein CA-125 may be elevated in women with benign conditions as well as ovarian cancer. Another ongoing clinical trial is attempting to use proteomics to predict the early recurrence of ovarian cancer.
The small low-level proteins that have proven useful for the proteomics of ovarian cancer have been found to accumulate on large carrier blood proteins such as albumin. Scientists have found that by extracting the carrier-protein fraction of the blood they can obtain much higher quantities of these biomarkers.
Prostate Cancer
Prostate specific antigen (PSA) levels are used as a preliminary screen for prostate cancer. However 70–75% of men who undergo biopsies because of abnormal PSA levels do not have cancer. It has been difficult to rule-out cancer without a biopsy in patients with slightly elevated PSA levels (4–10 nanograms per ml). MS-based proteomics of the blood proteins in 167 patients with prostate cancer, 77 patients with benign prostate hyperplasia, and 82 healthy males correctly classified 96% of the samples as either prostate cancer or non-cancer including benign prostate hyperplasia. Most of the cancers were correctly identified and the specificity was 71%, meaning that were a number of false positives. The test was effective in men with normal, slightly elevated, and high PSA levels. Thus proteomics may prove useful for choosing whether to perform a biopsy and may reduce the incidence of unnecessary biopsies.
Molecules called phosphates commonly are added to or removed from proteins to change their activity or function. Specific changes in phosphorylated proteins—those with attached phosphates—are believed to be important for prostate cancer progression. Researchers are studying whether changes in phosphorylation, as detected by MS-based proteomics, can be used as biomarkers for diagnosing the progression of prostate and other cancers.
Breast Cancer
Proteomic studies on breast cancer have found a combination of three blood proteins that may be useful for discriminating between women with breast cancer, women with benign breast disease, and healthy women. About 70–80% of breast cancers originate in the mammary ducts—the thin tubes that lead to the nipples. Nipple aspirate fluid from these ducts has a higher concentration of breast-specific proteins than blood. Possible tumor-marker proteins from this fluid are being studied by proteomics.
A 2003 proteomics study successfully identified fluctuating levels of specific active proteins inside breast and ovarian tumor cells. This may help determine early in treatment whether a particular drug is effective in a given patient.
About 25–30% of women with breast cancer have high levels of the protein Her-2/neu on the surfaces of their cancer cells. The cancer drug Herceptin is an anti-body that attaches to Her-2/neu and prevents the protein from promoting cancer cell growth. Ongoing proteomics studies are monitoring key signaling systems in cells that may be influenced by Herceptin and other cancer drugs that target specific molecules. Proteomics has been used to measure the levels of active and inactive signaling proteins in isolated cancer cells obtained from tumor biopsies before and at various times after drug treatment. It has been found that breast cancer patients with a poor prognosis have more of the active form of the protein AKT that promotes cell survival. Herceptin lowers this AKT levels, promoting tumor cell death.
Other Cancers
A 2004 proteomics study found a protein pattern that may predict which people with familial adenomatous polyposis (FAP)—an inherited condition that often leads to colon cancer—will respond to the preventive drug celecoxib. Protein patterns from patients before and after drug treatment distinguished between those in which celecoxib decreased the number of colon polyps that are characteristic of FAB and those who did not respond to the drug. One particular protein peak appeared only in patterns from non-responsive patients. A few protein peaks changed significantly in all patients following treatment with celecoxib.
Scientists are searching for blood protein patterns that may predict a person's risk for prostate cancer, pancreatic cancer, and melanoma. Protein patterns have been found in tumor tissue from lung and bladder cancers that may be able to discriminate between cancerous and healthy tissues.
As of 2005 proteomics clinical trials were testing blood protein patterns to:
- determine the response to radiation therapy in patients with localized prostate cancer and identify patients who might benefit from aggressive treatment
- predict the development of non-small cell lung cancer in patients with suspicious lung abnormalities
- determine whether a patient has a type of lymphoma known as mycosis fungoides/cutaneous T-cell lymphoma
- predict whether patients with psoriasis or cutaneous T-cell lymphoma will remain in remission.
Resources
Books
Baxevanis, Andreas D., and B. F. Francis Ouellette, editors. Bioinformatics: A Practical Guide to the Analysis of Genes and Proteins. 3rd ed. Hoboken, NJ: John Wiley, 2005.
Clark, David P. Molecular Biology. Boston: Elsevier Academic Press, 2005.
Fuchs, Jurgen, and Maurizio Podda, editors. Encyclopedia of Medical Genomics and Proteomics. New York: Dekker, 2005.
Periodicals
Aebersold, R., and M. Mann. 'Mass Spectrometry-Based Proteomics.' Nature 422 (2003): 198–207.
Petricoin, E. F., et al. 'Use of Proteomic Patterns in Serum to Identify Ovarian Cancer.' Lancet 369 (2002): 772–7.
Rosenblatt, Kevin P., et al. 'Serum Proteomics in Cancer Diagnosis and Management.' Annual Review of Medicine 55 (2004): 97.
Zhu, W., et al. 'Detection of Cancer-Specific Markers Amid Massive Mass Spectral Data.' Proceedings of the National Academy of Sciences 100 (2003): 14666–71.
Organizations
American Cancer Society. PO Box 102454, Atlanta, GA 30368-2454. 800-ACS-2345. . Information, research, and patient support.
Proteomics Program, Center for Cancer Research, National Cancer Institute. Public Inquiries Office, Suite 30361, 6116 Executive Blvd., MSC-8322, Bethesda, MD 20892-8322. 301-451-4347. . Research and clinical trials on proteomics.
Other
NCI-CCR Initiatives: Proteomics. Center for Cancer Research, National Cancer Institute. [cited March 30, 2005]. .
NCI Press Office Staff. 'Proteomics: Research for the 21st Century.' BenchMarks 2, no. 2. February 7, 2002. National Cancer Institute. [cited March 30, 2005]. .
'Protein Patterns in Blood May Predict Prostate Cancer Diagnosis.' News. October 15, 2002. National Cancer Institute. [cited March 30, 2005]. .
'Protein Patterns May Identify Ovarian Cancer.' News. February 7, 2002. National Cancer Institute. [cited March 30, 2005]. .
'Proteomics Shows Promise in Colon Cancer Chemoprevention Study.' News. April 15, 2004. National Cancer Institute. [cited March 30, 2005]. .
'Proteomics Research Aids Cancer Diagnosis and Treatment.' News. April 9, 2003. National Cancer Institute. [cited March 30, 2005]. .
'Questions and Answers: Proteomics and Cancer.' News. April 30, 2004. National Cancer Institute. [cited March 30, 2005]. .
Understanding Cancer Series: Molecular Diagnostics. January 28, 2005. National Cancer Institute. [cited March 30, 2005]. .
—Margaret Alic, Ph.D.