Biomarkers are the key to prevention and early detection of disease …
… of this I am convinced. And I am firmly convinced that laboratory diagnostics and the use of biomarkers will have a critical effect on the medicine of tomorrow.
Why am I so sure of this? It has already been demonstrated that biomarkers can be used to optimize treatment for individual patients with diabetes. In the future, individualized medicine (also sometimes called “personalized medicine”) will not only significantly increase the efficiency of treatment; it will also greatly improve prevention and early detection. Today it is already possible to carry out a diagnosis in the symptom-free phase of a disease by using biomarkers. This is of great benefit to the patients who receive early and targeted treatment.
DGKL Annual Scientific Conference 2010: Biomarkers and early detection of disease
This (and much more!) is the topic of the 7th Annual Conference of the German Society for Clinical Chemistry and Laboratory Medicine (DGKL, Deutsche Vereinte Gesellschaft für Klinische Chemie und Laboratoriumsmedizin e.V.) in Mannheim. The theme is precisely this: “Biomarker – Schlüssel zur Prävention und Früherkennung / Biomarkers – the Key to the Prevention and Early Detection of Disease”. The title of this year’s DGKL conference and the fact that our colleagues will be making a presentation in Mannheim (will take place on Thursday, September 30, 2010, 3:30 p.m. in the Stamitz room: “Biomarker als Basis der personalisierten Medizin / Biomarkers as the Basis for Personalized Medicine” – see the DGKL Congress’ program) are what inspired me to write this blog post. Our co-workers will also be on the trade show in a booth (booth number 61) at the DGKL Scientific Conference (the conference will take place from 29/09 to 02/10/2010). – You also will find more information about personalized medicine and about biomarkers in my background article on the rheumachec website: What Biomarkers Tell Us – Early Detection and Personalised Medicine.
Diagnostic Markers for Rheumatoid Arthritis
A good example from my daily work here at ORGENTEC Diagnostika of the effectiveness of modern biomarkers is ACPAs (anti-citrullinated protein antibodies). These are autoantibodies that are used as specific biomarkers for the diagnosis of suspected rheumatoid arthritis and for monitoring the progression of RA in patients.
In fact, ACPAs have been known for a number of years; the first citrullinated autoantigens were identified as early as the mid seventies (see references below). However, it has taken a long time for them to be accepted as a diagnostic criterion. Instead, for decades the detection of rheumatoid factors in patient serum was the only autoantibody test (yes, rheumatic factors, or: RF, are also autoantibodies!) approved for the diagnosis of RA. This despite the fact that it was always known that rheumatoid factors have only slight diagnostic specificity for RA.
And today? In the last several weeks, ACPA detection has become an important EULAR and ACR classification criterion for rheumatoid arthritis. Two large professional associations, the US-based American College of Rheumatology (ACR) and the European League Against Rheumatology (EULAR), have teamed up to develop these criteria together – which is a big step forward in itself. In a “gigantic transatlantic project”, the leading minds working in rheumatology have evaluated the latest insights and analyzed numerous studies. With The 2010 ACR-EULAR Rheumatoid Arthritis Classification Criteria they have very officially and on paper recognized the paradigm shift that has occurred in RA diagnosis and treatment over the last few years. I am certain that the rheumatologic societies of individual nations and regions will also respond by updating their recommendations for RA diagnosis and treatment.
Biomarkers for the more targeted treatment
Another important aspect of biomarkers in general is the ability they provide for the use of a more targeted approach with drugs in treatment. I assume this will also be true of the ACPA. In one way or another ACPA will be helpful in making treatment gentler and more effective for patients. The (possibly) higher costs for the use of biomarkers can be justified in that their higher efficiency should reduce expenditures in other areas.
The use of biomarkers in general and ACPA, anti-citrullinated protein antibodies, in specific will thus not only mean safer and better treatment with fewer side effects for patients, but also the efficient use of drugs – and thus savings for health insurers and for all insurance consumers. This would achieve the “patient-oriented treatment” being demanded on all sides. And this isn’t just a dream, but is partly reality today.
Author of this article: Tobias Stolzenberg.
Recommended Reading:
- More information about personalized medicine and about biomarkers in the background article on the rheumachec website: What Biomarkers Tell Us: Early Detection and Personalised Medicine.
- New Classification Criteria for Rheumatoid Arthritis (RA). Posted on 24/08/2010 on The ORGENTEC Autoimmunity Blog
- The 2010 ACR – EULAR Rheumatoid Arthritis Classification Criteria in brief. Posted on The ORGENTEC Autoimmunity Blog on 06/09/2010.
Web links:
- DGKL, Deutsche Vereinte Gesellschaft für Klinische Chemie und Laboratoriumsmedizin e.V.
- The biomarkers Consortium, A Foundation for the National Institutes of Health.
Literature (accessed 28/09/2010):
- Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, Bingham CO 3rd, Birnbaum NS, Burmester GR, Bykerk VP, Cohen MD, Combe B, Costenbader KH, Dougados M, Emery P, Ferraccioli G, Hazes JM, Hobbs K, Huizinga TW, Kavanaugh A, Kay J, Kvien TK, Laing T, Mease P, Ménard HA, Moreland LW, Naden RL, Pincus T, Smolen JS, Stanislawska-Biernat E, Symmons D, Tak PP, Upchurch KS, Vencovsky J, Wolfe F, Hawker G. The 2010 ACR-EULAR classification criteria for rheumatoid arthritis. Ann Rheum Dis. 2010 Sep;69(9):1580-8 – Free full text article!
- Egerer K, Feist E, Burmester G. Serologische Diagnostik der rheumatoiden Arthritis: Antikörper gegen citrullinierte Antigene / The Serological Diagnosis of Rheumatoid Arthritis – Antibodies to citrullinated Antigens. Dtsch Arztebl Int 2009; 106(10): 159-63 – Free full text article, ENGLISH and GERMAN!
- Mathsson L, Mullazehi M, Wick MC, Sjöberg O, van Vollenhoven R, Klareskog L, Rönnelid J. Antibodies against citrullinated vimentin in rheumatoid arthritis: higher sensitivity and extended prognostic value concerning future radiographic progression as compared with antibodies against cyclic citrullinated peptides. Arthritis Rheum. 2008 Jan;58(1):36-45. – Free full text article!
- Nicaise Roland P, Grootenboer Mignot S, Bruns A, Hurtado M, Palazzo E, Hayem G, Dieudé P, Meyer O, Chollet Martin S. Antibodies to mutated citrullinated vimentin for diagnosing rheumatoid arthritis in anti-CCP-negative patients and for monitoring infliximab therapy. Arthritis Res Ther. 2008;10(6):R142. – Free full text article!
- Schellekens GA, de Jong BA, van den Hoogen FH, van de Putte LB, van Venrooij WJ. Citrulline is an essential constituent of antigenic determinants recognized by rheumatoid arthritis-specific autoantibodies. J Clin Invest. 1998 January 1; 101(1): 273–281. – Free full text article!
- Szodoray P, Szabó Z, Kapitány A, Gyetvai A, Lakos G, Szántó S, Szücs G, Szekanecz Z. Anticitrullinated protein/peptide autoantibodies in association with genetic and environmental factors as indicators of disease outcome in rheumatoid arthritis. Autoimmun Rev. 2009 May 6. – To the abstract!
- van Venrooij WJ, Pruijn GJ. Citrullination: a small change for a protein with great consequences for rheumatoid arthritis. Arthritis Res. 2000;2(4):249-51. – Free full text article!
