title: Intermediate endpoint biomarkers for chemoprevention.
abstract: The understanding of intermediate endpoint biomarker expression in relation to the sequential events in bladder tumorigenesis establishes a useful approach for evaluating chemopreventive agents. Biomarkers may be genotypic or phenotypic and function as biomarkers of susceptibility, exposure, effect, or disease. This paper reviews several years of research on biomarkers and their use in monitoring chemoprevention therapy. In initial animal experiments, mice were dosed with N-butyl-N-(4-hydroxybutyl)nitrosamine (OH-BBN) while co-administering N-(4-hydroxyphenyl)retinamide (4-HPR). 4-HPR did not statistically reduce tumor incidence, but did affect tumor differentiation and, consequently, nuclear size and DNA ploidy. These results suggest that nuclear size and ploidy may function as intermediate endpoint biomarkers of effect for oncogenesis and that epigenetic as well as genetic mechanisms may be primary in the oncogenic process. Early biomarkers of effect which occur prior to genetic effects or chromosome aberration may portend a higher probability of being modulated by differentiating agents such as retinoids. In vitro studies demonstrated that RPMI-7666 cells cultured with a phorbol ester tumor promoter (12-O-tetradecanoyl-phorbol-13-acetate) could be redifferentiated with 13-cis-retinoic acid and dimethyl sulfoxide (DMSO). F-actin, a cytoskeletal biomarker with a presumed function in the epigenetic mechanisms of carcinogenesis, could also be normalized in HL-60 cells treated with 4-HPR or DMSO. A clinical evaluation of F-actin in patients with varying degrees of risk confirmed the value of F-actin as a differentiating biomarker useful for bladder cancer risk assessment. The clarification of when the phenotypic changes of F-actin occur in the oncogenic process was achieved when a variety of biochemical changes were mapped in the patients with bladder cancer. These studies confirmed that G-actin, a reciprocal form of F-actin, is increased relatively early in bladder cancer oncogenesis when multiple biomarkers are quantitated in the field, adjacent area, and the tumor. Comparison of each individual biomarker's expression from field, adjacent to tumor, and tumor, and subsequent cluster analysis of these biomarkers, indicated that the possible sequence of phenotypic expression of biomarkers in bladder cancer oncogenesis is from G-actin, to p300 antigen, to epidermal growth factor receptor (EGFR), to p185 (neu oncogene product), to DNA aneuploidy and, finally, to visual morphology.(ABSTRACT TRUNCATED AT 400 WORDS)
authors.affiliation: Department of Urology, Oklahoma University Health Sciences Center, Oklahoma City 73190.
authors.forename: G P
authors.initials: GP
authors.lastname: Hemstreet
authors.forename: J Y
authors.initials: JY
authors.lastname: Rao
authors.forename: R E
authors.initials: RE
authors.lastname: Hurst
authors.forename: R B
authors.initials: RB
authors.lastname: Bonner
authors.forename: P L
authors.initials: PL
authors.lastname: Jones
authors.forename: A M
authors.initials: AM
authors.lastname: Vaidya
authors.forename: Y
authors.initials: Y
authors.lastname: Fradet
authors.forename: R C
authors.initials: RC
authors.lastname: Moon
authors.forename: G J
authors.initials: GJ
authors.lastname: Kelloff
mesh_terms: D000818:Animals; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D015415:Biomarkers / Q000737:chemistry; D002986:Clinical Trials as Topic; D004273:DNA, Neoplasm / Q000032:analysis; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008856:Microscopy, Fluorescence; D013997:Time Factors; D001749:Urinary Bladder Neoplasms / Q000378:metabolism / Q000517:prevention & control*
chemical_list: D000970:Antineoplastic Agents; D015415:Biomarkers; D004273:DNA, Neoplasm