NTX Magazine Volume 3 - Page 40

Industry spotlight health care Finding cancer A blood test developed at Baylor Research Institute can identify cancer-related components before tumors start to grow. Dr. Ajay Goel, director of Epigenetics and Cancer Prevention, helped develop the test. 38 Ajay Goel, Ph.D., director of Epigenetics and Cancer Prevention at Baylor Research Institute, is not – as he says – your typical scientist. “Most Ph.D. scientists are expected to do very basic research. However, I have been very fortunate to work with some of the very best physicians, and we develop these things together. Over the years, I have become a translational scientist, using my work to change clinical science. This is exciting for a basic scientist like me.” The test that has put Goel on the map – and North Texas front and center in the world of cancer research – is a new blood test developed in the Gastrointestinal Cancer Research Lab at Baylor Research Institute that shows very promising results for finding cancer-related components in the blood before a tumor develops in the colon. This small, simple blood-based test examines the levels of a single microRNA (MiRNA) – a small RNA molecule that can be readily identified in a wide variety of bodily fluids, including blood – and determines a patient’s risks for developing polyps that may lead to colon cancer. Goel credits Dr. C. Richard Boland, an investigator with Baylor Research Institute and chief of gastroenterology at Baylor University Medical Center, for helping to develop the test. “I was fortunate enough to work with Dr. Boland. We developed this together.” “We have been working for several years on the epigenetics of colorectal cancer, which is the study of changes in gene expression not caused by a change in the DNA sequence. Dr. Goel has been at the forefront of work on microRNAs,” Boland explained. “A test like this could make it clear how important it would be to go ahead with the colonoscopic exam, or may permit the person to wait another year.” The current screening method, a colonoscopy, is currently the best standard for early detection of colon cancer. However, low compliance and people’s anatomy often make it hard for even the best physicians to catch all polyps in a person’s colon. Using colonoscopy alone as a screening tool is risky, Goel notes. “It is invasive, and therefore, it has poor compliance, even in the U.S. The cost is high, and it involves human bias. With a blood test, there is no bias.” By contrast, the test Goel is developing is highly accurate and very sensitive. In this seminal study, the investigators studied several hundred patients with colorectal polyps and cancers and reported that measuring levels of miR-21 in the blood can accurately identify up to 92 percent of patients with colorectal cancer. Even more importantly, the test can accurately identify up to 82 percent of patients with advanced colonic polyps, which present the highest risk for developing into colorectal cancers several years later in life. A little bit like predicting the future, isn’t it? While Goel shrugs off any crystal ball references, he does point out that the test not only has accuracy, it’s also inexpensive and easy for others to replicate. Previous tests developed by others were gene- or DNA-based tests, which include long sequences and large samples to review. Although some of these tests came close, Goel says they were ultimately not the answer. “You cannot collect that kind of sample, because the signatures are not very stable,” Goel said. “You cannot effectively use DNA or RNA. MiRNA, on the other hand, is very small, which makes it very stable. You can draw blood and analyze it years later – in fresh tissue or in archival tissues. It can be stable on trips across the oceans. From a biomarker or practical standpoint, that is always a huge concern.” Goel’s test is the first early diagnostic test to focus on miRNA in the blood, which is extolled for its virtues including its non-invasiveness, low cost and ability for many people to replicate even without expensive equipment. “You don’t have to open up anyone, you don’t have to do surgery. And, if you can find them at the polyp stage, you can remove polyps,” he explains. Goel also stresses that this test does not replace a colonoscopy for those with potential for colon cancer – it’s meant as a screening tool to keep those who do not have polyps from needing the test as a routine screen. Goel’s test is one of more than 800 active research protocols being conducted today at the Baylor Research Institute, the research component of the Baylor Health Care System, which works to bring innovative treatments from the laboratory workbench to the patient’s bedside, making a real difference for patients in North Texas and around the world. The institute’s 250 research investigators are doing important work in areas ranging from human immunology and orphan metabolic diseases to diabetes, cardio-vascular disease and many other unmet medical needs. “No two cancers are alike,” he noted. “Even with people with the same disease – no two cancers are similar. Heterogeneity is why you need more than one marker.”