Assessment of Glutathione Peroxidase-1 (GPX1) Gene Expression as a Specific Diagnostic and Prognostic Biomarker in Malignant Pleural Mesothelioma

Our plain-English summary of Assessment of Glutathione Peroxidase-1 (GPX1) Gene Expression as a Specific Diagnostic and Prognostic Biomarker in Malignant Pleural Mesothelioma, by A.F. Gharib, M. Alaa Eldeen, A.S. Khalifa, et al (Diagnostics, 2021).

The study

• Authors: A.F. Gharib, M. Alaa Eldeen, A.S. Khalifa, W.H. Elsawy, E.M. Eed, A.E. Askary, R.A. Eid, M.A. Soltan, N. Raafat
• Journal: Diagnostics
• Published: 2021;11(12)
• Cited by: 11 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant pleural mesothelioma (MPM) is a malignant tumor of the mesothelial lining of the thorax. It has been related to frequent exposure to asbestos. Diagnosis of malignant pleural mesothelioma is considered a criticizing problem for clinicians. Early diagnosis and sufficient surgical excision of MPM are considered the cornerstone success factors for the management of early MPM. Glutathione peroxidase-1 (GPX1) is an intracellular protein found to be extensively distributed in all cells, and it belongs to the GPX group. In the current study, we included ninety-eight patients with MPM that underwent surgery at the Zagazig University Hospital in Egypt. We assessed GPX1 gene expression level as it was thought to be related to pathogenicity of cancer in a variety of malignant tumors. We observed a significant elevation in GPX1-mRNA levels in MPM relative to the nearby normal pleural tissues. It was found to be of important diagnostic specificity in the differentiation of MPM from normal tissues. Moreover, we studied the survival of patients in correlation to the GPX1 expression levels and we reported that median overall survival was about 16 months in patients with high GPX1 expression levels, while it was found to be about 40 months in low GPX1 levels.

In plain English

This study, from Zagazig University Hospital in Egypt, asked whether expression of a gene called GPX1 could help diagnose malignant pleural mesothelioma and predict survival. It included 98 patients with the disease who had surgery between March 2014 and December 2020. The authors measured GPX1 messenger RNA in tumor tissue and in nearby normal pleural tissue removed during the same operations. The article did not report the patients' asbestos exposure. GPX1 levels in tumor tissue ranged from 1.2 to 9.09 (mean 7.001), compared with 0.005 to 0.92 (mean 0.31) in normal tissue, a statistically significant difference. Higher levels were associated with features including age over 55, female sex, non-epithelioid tumors and higher tumor grade. Median survival was 40 months for patients with low GPX1 and 16 months for those with high GPX1. The article does not say how high and low were defined, and some printed figures appear to be errors, including a diagnostic area-under-the-curve value printed as 1.95%. The authors concluded that GPX1 could be a possible biomarker for diagnosis and prognosis in malignant pleural mesothelioma.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Single-hospital laboratory biomarker study comparing gene expression in surgically removed tumor tissue with adjacent normal pleural tissue, with survival analysis (Kaplan–Meier). The article does not state whether it was retrospective or prospective.
• Who was studied: 98 patients with locally or early advanced malignant pleural mesothelioma who had surgery without prior neoadjuvant therapy at Zagazig University Hospital, Egypt, March 2014 to December 2020 (44 males, 54 females; 66 epithelioid, 32 non-epithelioid).
• Exposure: Asbestos exposure was not studied or reported for these patients. The factor measured was GPX1 gene expression (mRNA, by RT-qPCR, normalized to beta-actin) in tumor and adjacent normal pleural tissue.
• Main results:
  • GPX1 mRNA was higher in mesothelioma tissue (range 1.2 to 9.09, mean 7.001) than in adjacent normal pleural tissue (range 0.005 to 0.92, mean 0.31); t = 31.87, p less than 0.0001.
  • In ROC analysis, the authors reported that GPX1 mRNA distinguished mesothelioma from normal pleural tissue, with an AUC printed as 1.95% (CI 1.000 to 1.000, p less than 0.0001).
  • Among the 98 patients, higher GPX1 levels were associated with age over 55, female sex, non-epithelioid type, high grade, large tumors, lymph node involvement, anemia, raised platelets, white cells and LDH, poor performance status and unresectable tumors (each p less than 0.0001).
  • Median survival was 40 months for patients with low GPX1 mRNA and 16 months for patients with high levels (log-rank 17.59, p less than 0.0001).
• The authors' conclusion: The authors concluded that high GPX1 mRNA expression was found in malignant pleural mesothelioma, was linked to adverse prognosis and poor survival, and can be used as a possible biomarker for diagnosis and prognosis.

Topics

Medical terms in this study, explained in our Lexicon: Glutathione (GSH), Biomarker, Pleural Mesothelioma, Thorax, Median Overall Survival.

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