title: Serpin peptidase inhibitor clade A member 1 as a potential marker for malignancy in insulinomas.
abstract: OBJECTIVE
  The biological behavior of insulinomas cannot be predicted based on histopathologic criteria in which the diagnosis of malignancy is confirmed by the presence of metastases. In this study, microarray and quantitative real-time reverse transcription-PCR were applied to identify differentially expressed genes between malignant and nonmalignant insulinomas to search for useful biomarkers to recognize the metastatic potential of insulinomas.
  
  
  METHODS
  Code Link human bioarrays were used to analyze differences in approximately 20,000 genes between six well-differentiated endocrine tumors of benign behavior compared with one well-differentiated endocrine carcinoma (WDEC) and three metastases of endocrine carcinomas (MEC). Quantitative real-time reverse transcription-PCR was used to validate differential expressions of five genes in a series of 35 sporadic insulinomas. Serpin peptidase inhibitor clade A member 1 (SERPINA1; alpha-1-antitrypsin) expression, identified as up-regulated in malignant insulinomas, was also evaluated by immunohistochemistry.
  
  
  RESULTS
  Analysis of microarray data resulted in 230 differentially expressed genes. Gene Ontology analysis identified serine-type endopeptidase activity and serine-type endopeptidase inhibitor activity as pathways presenting significant differential expression. Protease serine 2 and complement factor B (from serine-type endopeptidase activity pathway) were respectively confirmed as up-regulated in well-differentiated endocrine tumors of benign behavior (WDET) and in WDEC/MEC. Angiotensinogen and SERPINA1 (from serine-type endopeptidase inhibitor activity pathway) were confirmed as up-regulated in WDEC/MEC. SERPINA1 was shown to be expressed in 85.7% of malignant versus 14.3% of nonmalignant insulinomas by immunohistochemistry.
  
  
  CONCLUSIONS
  Our data are consistent to the possibility that SERPINA1 is a marker of malignancy in insulinomas. Given the widespread availability of antibody anti-alpha-1-antitrypsin in pathology services, SERPINA1 expression evaluation might be of clinical utility in recognizing patients more likely to develop an aggressive presentation.
authors.affiliation: Laboratory for Cellular and Molecular Endocrinology LIM-25, University of Sao Paulo Medical School, Sao Paulo, Brazil.
authors.forename: Sandra Valéria
authors.initials: SV
authors.lastname: de Sá
authors.forename: Maria Lúcia
authors.initials: ML
authors.lastname: Corrêa-Giannella
authors.forename: Márcio Carlos
authors.initials: MC
authors.lastname: Machado
authors.forename: Karin
authors.initials: K
authors.lastname: Krogh
authors.forename: Madson Queiroz
authors.initials: MQ
authors.lastname: de Almeida
authors.forename: Maria Adelaide
authors.initials: MA
authors.lastname: Albergaria Pereira
authors.forename: Sheila Aparecida
authors.initials: SA
authors.lastname: Coelho Siqueira
authors.forename: Rosely Antunes
authors.initials: RA
authors.lastname: Patzina
authors.forename: Felícia Satie
authors.initials: FS
authors.lastname: Ibuki
authors.forename: Mari Cleide
authors.initials: MC
authors.lastname: Sogayar
authors.forename: Marcel Cerqueira César
authors.initials: MC
authors.lastname: Machado
authors.forename: Daniel
authors.initials: D
authors.lastname: Giannella-Neto
mesh_terms: D014408:Biomarkers, Tumor / Q000032:analysis / Q000235:genetics* / Q000378:metabolism; D018450:Disease Progression; D020869:Gene Expression Profiling; D006801:Humans; D007150:Immunohistochemistry; D007340:Insulinoma / Q000175:diagnosis / Q000473:pathology*; D020411:Oligonucleotide Array Sequence Analysis; D017395:Plasminogen Activator Inhibitor 1 / Q000032:analysis / Q000235:genetics* / Q000378:metabolism; D011379:Prognosis; D012333:RNA, Messenger / Q000032:analysis*
chemical_list: D014408:Biomarkers, Tumor; D017395:Plasminogen Activator Inhibitor 1; D012333:RNA, Messenger; C051321:SERPINE1 protein, human