Blood Test Might Predict Knee Osteoarthritis Years Early

Lori Saxena wrote . . . . . . . . .

A blood test could help doctors spot the signs of knee osteoarthritis at least eight years before it shows up on X-rays, a new study claims.

After analyzing the blood of 200 white British women, half diagnosed with knee osteoarthritis and half without, researchers discovered a small number of biomarkers distinguished the women with osteoarthritis from those without it.

“We found we were able to identify people who are at risk for knee osteoarthritis, but what was exciting was that we were able to identify it eight years before they had any X-ray changes,” said senior study author Dr. Virginia Byers Kraus, a professor in the departments of Medicine, Pathology and Orthopedic Surgery at Duke University School of Medicine, in Durham, N.C.

The study, published in the journal Science Advances, builds on previous research where the blood test demonstrated 74% accuracy in predicting knee arthritis progression and 85% accuracy in diagnosing knee arthritis.

Knee arthritis strikes approximately 35 million adults in the United States. While there are no cures, the success of new therapies could hinge on identifying the disease early and slowing its progression.

The researchers emphasized that just like heart disease, osteoporosis or Alzheimer’s disease, knee osteoarthritis is a chronic disorder that is typically diagnosed late in the game. By identifying it earlier, doctors could potentially stop the disease before it becomes debilitating, the researchers said.

“The reason that this is really important is that until now, we have been thinking about osteoarthritis as a disease with X-ray changes. But it turns out that, in fact, there are a lot of things going on prior to that and by actually identifying it much earlier, we can prevent disability, pain and the deterioration of quality of life that people who develop the X-ray changes usually get,” Kraus said.

According to Kraus, if patients discover through a blood test that they are at a high risk for knee osteoarthritis, they could make lifestyle changes that include weight loss, exercise, eating healthy or even getting steroid injections.

Researchers also emphasized that knee osteoarthritis is more than just painful for patients: It also leads to the majority of all joint replacements, creating a massive economic burden.

These concerns were echoed by Stephen Messier, a professor of health and exercise science at Wake Forest University and an Arthritis Foundation-funded investigator.

“The burden of osteoarthritis [OA] continues to rise, driving higher healthcare costs and poorer patient outcomes,” Messier said. “Early detection of knee OA could help clinicians intervene sooner and reduce the pain and loss of function of patients before joint replacement surgery is necessitated.”

However, more research is needed to validate the test before it can be deployed in the general population. This test was also performed only in white women, and future studies should broaden the patient population.

According to Kraus, there are also about 100 different types of arthritis including OA, rheumatoid arthritis and gout, and they can affect multiple joints besides the knee.

Future studies will include examining the hips, hands and spine of patients, to see whether they are similarly affected.

Overall, the researchers noted that adoption of a blood test could aid in the development of early and targeted intervention for patients who previously would not be identified as having knee osteoarthritis.

“I think that one of the take-home messages is that osteoarthritis is not just the disease of older people, it’s the disease of younger people as well, especially if they’ve had a major joint injury,” Kraus said. “The second message would be that it truly is very, very important, whether you have chronic disease risk or not, to try to do the important lifestyle management.”

Source: HealthDay

 

 

 

 

Blood Test Spots Early Pancreatic Cancers With 97% Accuracy

Dennis Thompson wrote . . . . . . . . .

A blood test appears capable of detecting early-stage pancreatic cancers with up to 97% accuracy, a new study reports.

The test looks for eight small RNA particles and eight larger DNA markers shed by pancreatic cancers, which together create a genetic “signature” for the disease, researchers said.

Currently, it’s tough to catch pancreatic cancer before it has reached an advanced stage. The organ is located deep in the abdomen, and the cancer has symptoms that can be mistakenly attributed to other diseases.

“Pancreatic cancer is one of the most fatal malignancies, in large part because the majority of patients are diagnosed only after the cancer has already metastasized,” senior researcher Ajay Goel, chair of molecular diagnostics and experimental therapeutics at City of Hope Cancer Center said in a news release.

The five-year survival rate for patients diagnosed with early-stage pancreatic cancer is 44%, but that drops to 3% if the cancer is caught after it has spread elsewhere in the body, researchers noted.

An earlier trial of this blood test in 95 patients from the U.S. and Japan found a detection rate of 98%.

This latest trial involved 523 people with pancreatic cancer and 461 healthy people from Japan, the U.S., South Korea and China.

The blood test detected:

• 93% of pancreatic cancers among the U.S. participants.
• 91% of pancreatic cancers among the South Koreans.
• 88% of pancreatic cancers in the Chinese group.

When researchers combined the blood test with a test for an already-established pancreatic cancer marker called CA 19-9, the accuracy increased to 97% of stage 1 and 2 cancers among the U.S. participants.

Stage 1 pancreatic cancers are confined to the organ, while stage 2 have spread to nearby lymph nodes but not elsewhere.

“Our approach offers a liquid biopsy test superior to CA19-9 measurement alone for early-stage disease,” Goel said.

However, researchers said more research is needed to validate the test before it can be deployed to the general population.

Researchers were scheduled to present the trial results Monday at a meeting of the American Association for Cancer Research in San Diego. Findings presented at medical meetings should be considered preliminary until published in a peer-reviewed journal.

Source: HealthDay

 

 

 

 

Blood Test Could Determine Diabetes Risks

A blood test could potentially be used to assess a patient’s risk of type 2 diabetes, a new study from Edith Cowan University (ECU) has found.

The most commonly used inflammatory biomarker currently used to predict the risk of type 2 diabetes is high-sensitivity C-reactive protein (CRP). However, emerging research has suggested that the joint assessment of biomarkers, rather than assessing each individually, would improve the chances of predicting diabetes risk and diabetic complications.

A study by ECU researcher Dan Wu investigated the connection between systematic inflammation, assessed by joint cumulative high-sensitivity CRP and another biomarker called monocyte to high-density lipoprotein ratio (MHR), and incident type 2 diabetes.

The study followed more than 40,800 non-diabetic participants over a near ten-year period, with more than 4,800 of the participants developing diabetes over this period. Wu said that of those patients presenting with type 2 diabetes, significant interaction between MHR and CRP was observed.

“Specifically, increases in the MHR in each CRP stratum increased the risk of type 2 diabetes; concomitant increases in MHR and CRP presented significantly higher incidence rates and risks of diabetes.

“Furthermore, the association between chronic inflammation (reflected by the joint cumulative MHR and CRP exposure) and incident diabetes was highly age- and sex-specific and influenced by hypertension, high cholesterol, or prediabetes. The addition of the MHR and CRP to the clinical risk model significantly improved the prediction of incident diabetes,” said Wu.

Females most at risk

The study found that females had a greater risk of type 2 diabetes conferred by joint increases in CRP and MHR, with Wu stating that sex hormones could account for these differences.

Wu said that the research findings corroborated the involvement of chronic inflammation in causing early-onset diabetes and merited specific attention.

“Epidemiological evidence indicates a consistent increase in early-onset diabetes, especially in developing countries. Leveraging this age-specific association between chronic inflammation and type 2 diabetes may be a promising method for achieving early identification of at-risk young adults and developing personalised interventions,” she added.

Wu noted that the chronic progressive nature of diabetes and the enormous burden of subsequent comorbidities further highlighted the urgent need to address this critical health issue.

Although aging and genetics are non-modifiable risk factors, other risk factors could be modified through lifestyle changes. Inflammation is strongly influenced by life activities and metabolic conditions such as diet, sleep disruptions, chronic stress, and glucose and cholesterol dysregulation, thereby indicating the potential benefits of monitoring risk-related metabolic conditions.

Wu said that the dual advantages of cost effectiveness and the wide availability of cumulative MHR and CRP in current clinical settings, potentiated the widespread use of these measures as a convenient tool for predicting the risk of diabetes.

The research was published in BMC’s Journal of Translational Medicine.

Source: Edith Cowan University

 

 

 

 

Monitoring Lesser-known Numbers in a Blood Screening Can Help Heart Health

Michael Precker wrote . . . . . . . . .

When you get the results from a routine blood screening, some familiar terms and numbers may jump out: cholesterol levels that point to a risk for heart disease, for example, and A1C, a blood sugar measurement used to diagnose diabetes.

But are there other numbers that merit a closer look?

“There are lesser-known numbers to look at regarding heart-related risk,” said Dr. Elliot Davidson, medical director of the Center for Family Medicine at Cleveland Clinic Akron General in Ohio. “They can be helpful for anybody on the fence about taking medication.”

Standard bloodwork typically includes tests for liver and kidney function “that are important considerations for the heart,” said Dr. Parag Joshi, a preventive cardiologist and an associate professor at UT Southwestern Medical Center in Dallas. “That kind of stuff is important to know.”

First, the basics: Health care professionals encourage people to monitor five numbers to track their heart health. They are blood pressure; blood sugar, or glucose; cholesterol; body mass index or waist measurement; and sleep duration.

Davidson and Joshi said there are more results on your blood test to consider as well.

Non-HDL cholesterol

The total cholesterol number is calculated by adding HDL (“good” cholesterol), LDL (“bad” cholesterol) and 20% of the triglyceride number. Triglycerides are the most common type of fat in the body. They store excess energy from your diet. High LDL cholesterol and triglyceride levels, along with low HDL, contribute to fatty buildup in arteries.

If you take the total cholesterol number and subtract the HDL, you get the non-HDL cholesterol. “Sometimes that picks up some risk that the LDL or the triglycerides and the total (numbers) don’t totally capture, and that we might be missing if we just focus on the usual results,” Joshi said.

Non-HDL cholesterol is measured in deciliters of blood. An optimal range for non-HDL in adults would be less than 130 mg/dL, according to the National Institutes of Health.

Davidson said doctors can use cholesterol and blood pressure results, as well as other health factors, to calculate the risk for having a heart attack, stroke or other disease caused by the buildup of plaque in arteries.

People can work with health care professionals to calculate their risk. Tools are available from the American College of Cardiology and the American Heart Association, which recently released a new risk calculator that incorporates kidney function and other newly added factors. The AHA tool can predict risk for heart attack, stroke and heart failure over the next 10 years and 30 years in people ages 30 to 79.

“Even if you have a low 10-year risk, you might have a pretty significant lifetime risk,” Davidson said.

Lipoprotein(a)

Another measurement to know is lipoprotein(a), a larger type of “bad” cholesterol that can build up in arteries and increase the risk of a heart attack or stroke. It’s mostly genetic, Joshi said, rather than caused by lifestyle factors, and no treatments have yet been proven to lower lipoprotein(a) levels.

About 1 in 5 people worldwide has high lipoprotein(a) levels, according to the American Heart Association.

“For people with a strong family history of heart disease or early strokes or early blockages, it sometimes shows up as the only risk factor we can identify,” Joshi said. “It is something I often check in preventive cardiology, and people are becoming more aware of it.”

There is no consensus on risk thresholds for lipoprotein(a) levels, but AHA and ACC guidelines consider a high measurement to be 50 mg/dL or higher.

Hemoglobin

When patients report they are fatigued, that’s a reason to focus on their hemoglobin, or red blood cell count, Davidson said.

“If it’s lower than it should be, you have to look for a reason,” he said. “A common cause would be gastrointestinal blood loss. You’ve got to make sure you’re not losing blood somewhere.”

A low count, a condition called anemia, also may be caused by iron and vitamin deficiencies.

Normal ranges for hemoglobin can vary slightly, but in general they are 13.5 g/dL to 18 g/dL for men, 12 g/dL to 15 g/dL for women, and 11 g/dL to 16 g/dL for children.

Creatinine

Blood tests for kidney and liver function also can indicate cardiovascular risk, Joshi said.

The level of creatinine, a waste product formed by digestion of protein, is a marker of kidney function. “It’s supposed to be cleared out in the blood by the kidneys,” Joshi said. “If the creatinine in the blood goes up, the kidneys aren’t doing a good job.”

Protein in urine is another risk indicator, he said, “because the kidneys are supposed to retain all your proteins. So, if you’re losing protein through your urine, there’s something wrong with the kidney. We’re learning a lot about how kidney problems increase the risk of heart problems, and vice versa.”

Davidson noted that high creatinine levels are “not only an independent marker for heart disease, but you have to be very careful about certain medications like ibuprofen and other things that would aggravate your kidney function.”

Creatinine levels above 1.2 for women and 1.4 for men may be cause for concern, according to the Centers for Disease Control and Prevention.

Liver enzymes

Tests for liver enzymes known as ALT and AST can indicate impaired liver function or unhealthy fat deposits in the liver, Joshi said. There are several reasons for elevated ALT or AST, he said. “But one of those reasons is this deposition of fat in the liver, and that is a marker of increased risk of heart disease in the future.”

The enzymes are measured in units per liter. For ALT, a standard range is 29-33 for men and 19-25 for women. AST levels should be less than 35.

The bottom line, according to Davidson: “Have a primary care doctor that you trust, keep in close contact, and discuss your bloodwork.”

Source: American Heart Association

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New Blood Test Gives Very High Accuracy to Screen for Alzheimer’s Disease

A new blood test called p-tau217 shows promise as an Alzheimer’s disease biomarker, and when used in a two-step workflow very high accuracy to either identify or exclude brain amyloidosis, the most important and earliest pathology. That is an innovation now presented by researchers at the University of Gothenburg, together with colleagues at University of Lund and in Montreal, Canada.

In recent years, a lot of effort has been put on developing biomarkers in blood that could potentially help to identify Alzheimer’s disease (AD). Tau protein, in particular its phosphorylated variant (p-tau) – and one of the main proteins involved in AD pathology – has been the focus of extensive research and developments the last years.

The new blood-based p-tau biomarkers, especially a variant called p-tau217, have shown great promise as clinically useful tools to screen patients with memory problems or other early cognitive symptoms suggestive of early Alzheimer’s disease.

However, even if promising, a concern has been that classifying early patients into either having “AD or not AD” will still result in a rather high percentage of false positives (individuals with a positive test result who do not have AD) and false negatives (individuals with a negative test result who prove to have AD based on other examinations such as amyloid PET scans).

Considering not only ethical and psychological concerns induced by possible misdiagnosis, but also high costs and potential medical risks of initiating treatments on people not having the target disease), the scientists at the University of Gothenburg and their colleagues developed a novel strategy for the clinical implementation of blood biomarkers.

Two-step workflow

The two-step model is built on a first step with a diagnostic model (based on plasma p-tau217 together with age and APOE e4) to stratify patients with mild cognitive impairment (MCI) for risk of amyloid PET positivity. Step 2 is based on confirmatory testing with CSF Ab42/40 ratio (or amyloid EPT) only in those with uncertain outcomes in step 1.

The workflow was evaluated in 348 MCI participants from the Swedish BioFINDER studies (Lund University) and validated in the independent TRIAD cohort (McGill University, Montreal, Canada) also using an independent method for analysis of plasma p-tau217.

Very high accuracy

The model was evaluated at three different thresholding strategies were explored to classify participants into groups with low, intermediate and high risk for being “Aβ positive” (having AD-type pathology). At the stringent lower probability thresholds with 97.5% sensitivity (to avoid missing detection of patients who are Aβ positive), as little as 6.6% false negatives was found, while the stringent 97.5% specificity (to avoid classifying patients who are Aβ negative as ‘high risk’) gave only 2.3% false positives.

At the stringent sensitivity/specificity thresholds, 41% of patients fell into the intermediate risk group (compared to 29% of patients for the 95% thresholds). Further evaluations of this group with CSF Aβ42/40 showed very good agreement (86%) with amyloid PET results. Results were verified in the independent McGill cohort of patients.

Clinically useful strategy

The study presents a blood plasma p-tau217-based two-step model for risk stratification of patients with MCI into high, low- and intermediate-risk of having brain amyloidosis and early AD pathology. The blood test applied in step 1 shows very high accuracy to identify high-risk patients, who depending on the clinical situation can either be given a diagnosis and be initiated on symptomatic treatments, or in the future be referred to the specialist clinic for possible initiation disease-modifying treatment.

In the low-risk group, AD can be excluded with high degree of certainty. The intermediate risk group will only encompass around one third of patients, which substantially will reduce the need for confirmatory CSF or PET testing at the specialist clinic, and thus cost savings for the society.

According to the researchers the two-step model is a clinically useful strategy for p-tau217 blood test for AD screening. The study is published in the journal Nature Aging.

Source: University of Gothenburg