Open Access

Circulating cervical cancer biomarkers potentially useful in medical attention (Review)

  • Authors:
    • Ruth Ruiz Esparza Garrido
    • Mercedes Gutiérrez
    • Miguel Ángel Velázquez Flores
  • View Affiliations

  • Published online on: January 18, 2023     https://doi.org/10.3892/mco.2023.2609
  • Article Number: 13
  • Copyright: © Ruiz Esparza Garrido et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

Cervical cancer (CC) is a public health problem worldwide, including Mexico. This type of cancer is the fourth most frequent in women worldwide; in Mexico it is the second most common type in women after breast cancer. The diagnosis of CC is based mainly on Pap smears and colposcopy and the identification of molecular tools that serve as a support for these methods is urgent. Regarding this, differential expressions of specific circulating biomolecules has been detected and, based on this, they have been postulated as potential biomarkers for CC diagnosis, prognosis, and/or to identify the response to treatments. Importantly, the combined analysis of these molecules considerably improves their efficacy as biomarkers and their potential use in the medical attention is promising.

1. Introduction

Cervical cancer (CC) is the four most common cancer in women with an estimate of 604,000 new cases and 342,000 deaths per year worldwide (1). Most of the new cases (85%) and deaths (90%) occur in low- and middle-income countries, where CC is the third most common cancer among women. According to GLOBOCAN 2020, CC is the second most common cancer in Mexico with 9,439 new cases and 4,335 deaths per year. The Federation of Gynecology and Obstetrics (FIGO) staging system classifies CC in four stages, I-IV, which in turn are subdivided in various subtypes; this classification is mainly based on surgery, pathologic analysis and imaging (2).

The expression of certain circulating biomolecules is modified when a disease is established, having a great potential to detect and predict the disease as well as to identify the response to different treatments (3-5). For CC, there are several studies showing biomolecules, proteins, non-coding RNAs (ncRNAs), and circulating DNA (cDNA) with a great potential to be useful biomarkers for diagnosis, prognosis, and to determine the response to treatments currently used in medical attention for CC. Although certain of these protein biomarkers may also function as biomarkers for other HPV-related cancers, previous studies showed that the combined use of these molecules increases their potential as biomarkers for this disease (6-8). Although these biomarkers have a sensitivity very similar to that of colposcopy and p16 (Table I) (9-29), a significant advantage is that it is a minimally invasive methodology, having a very important impact on the number of women who would be screened with this test. The aim of the present study was to review the literature related to these potential biomarkers, emphasizing improved results as biomarkers when these molecules have been analyzed in combination.

Table I

Comparison of sensitivity and specificity among biomarkers and other CC detection methods.

Table I

Comparison of sensitivity and specificity among biomarkers and other CC detection methods.

MethodSensitivitySpecificityTechnique strengthsLimitations(Refs.)
Papanicolau51% (37-84%)98% (86-100%)-Success in developed countries.-Unsuccessful test in developing countries.(9-13,17)
 17%83%-Relative high specificity.-Relative low sensitivity. 
 13% -Well-characterized screening method.-A high rate of false negatives. 
 61%  -The effectiveness depends on the technician performing it. 
 72%  -A high rate of false negatives (56%) 
    -A high rate of false negatives (72%) 
    -False negatives: 25% 
    -Expensive for Health systems. 
    -High invasive methodology. 
Colposcopy87%48-66%-Relative high sensitivity.-Relative low specificity, having relatively high false positives.(10,15-17)
 83-98% -It allows to observe the presence of a suspicious area of injury, as well as to limit its extension and its severity to take the biopsy.-Colposcopist experience is need. 
   -Few false negatives-Expensive for Health systems. 
    -High insasive methodology. 
Liquid cervical cytology75%86%In the United Kingdom the NHS cervical screening program has been estimated to prevent ~80% of deaths from cervical cancerAlthough, liquid based systems are routinely used in many countries, the cost of the technique limits its utility in developing countries(20)
P16 detection88% Improves HPV DNA testing and cervical cytology diagnosis.-A biopsy is needed.(19)
    -High invasive methodology. 
PCR45% -PCR allows to detect the virus type and the hybrid capture test generically detects high and low risk types. Relative high sensitivity.-The PCR test does not provide information regarding the type of lesion and has higher cost than conventional colposcopy.(11,14,18)
 60-80%  -A biopsy is needed. 
Protein biomarkers• YLK-40: 78%40%-The combined expression of these potential biomarkers results in a relatively high sensitivity and specificity.-The sensitivity and specificity of these biomarkers may change between ethnicities.(21-24)
 • CTHRC1 and SCC-Ag: 87%84%   
  92%   
microRNAs (combined)•PIGF and Flt-1: 70%76%-Early LGCL and HGCL, and CC detection. (25,26)
 •VEGF: 87%70 and 95%-Prognosis determination.  
LncRNAs (combined)73 and 96% -Prediction of response to treatments. (27,28)
E7 HPV16/18AUC=88%88%-Minimally invasive methodology. (29)
cfDNAAUC=94%    
 100%    

The information was searched in Pubmed and in academic Google. The criteria followed to search the literature were the following: Circulating biomarkers, CC, ncRNAs and cDNA. In addition, biomarkers for HPV-associated cancers and public spending in Mexico for the treatment of CC were searched. The inclusion criterion was full access to the reviewed articles. Those articles that could not be accessed were excluded from the review.

2. Proteins

The search of circulating proteins as potential biomarkers in pathologies such as cancer has been addressed for several decades. The objective is clear, to diagnose and monitor the diverse types of cancer in a minimally invasive way; however, this search has not been easy and even when there are proteins currently used in the medical attention, their sensitivity (the ability to detect a disease in patients in whom the disease is actually present) and specificity (the ability to rule out the disease in patients in whom the disease is actually absent) is relatively low (9). To date, the most common circulating cancer marker proteins used in medical attention for distinct types of cancer are: i) The squamous cell carcinoma antigen (SCC-A), ii) The carcinoembryonic antigen (CEA), iii) The α-fetoprotein, iv) The β-subunit of human chorionic gonadotropin, v) Lactate dehydrogenase and vi) The cancer antigen 125(10). Regarding CC, massive analyses have revealed groups of circulating proteins differentially expressed in this disease with a great potential to be used as biomarkers. Notably, the use of two or more of these proteins has been revealed to considerably increase their sensitivity and specificity (Table II) (30,31).

Table II

Circulating proteins as potential biomarkers for cervical cancer.

Table II

Circulating proteins as potential biomarkers for cervical cancer.

Protein biomarkerDiagnostic biomarkerPrognostic biomarkerType of cervical cancer(Refs.)
SCC-AX SCC(30-32)
CEAX SCC and adenocarcinoma(30,31)
CA-125X Adenocarcinoma(30,31)
YKL-40X SCC and adenocarcinoma(21)
HMGB1 XSCC(33)
TKTX SCC(34)
FGAX   
APOA1X   
CTHRC1X SCC(22)
M-CSFXSCC and adenocarcinoma (35)
VEGFX   
ACTN4 XSCC(36)
PIGFX SCC(23)
VEGFR1X   

[i] X: The corresponding biomarker is useful for the stated purpose. SCC, squamous cell carcinoma; CEA, carcinoembryogenic antigen; CA-125; HMGB1, high mobility group box chromosomal protein 1; CTHRC1, collagen triple helix repeat containing 1; M-CSF, macrophage-colony stimulating factor; VEGF, vascular endothelial growth factor; PIGF, placental growth factor.

In the 1970s, the SCC-A was identified by using the hybridoma technique in SCC of human uterine cervix (11). SCC-A is a serpin that comprises two nearly identical proteins (45 kDa), SCC-1 and SCC-2, which possess unique proteinase inhibitory properties (10,11). SCC-1 exerts an anti-apoptotic action through the inhibition of chymotrypsin and cathepsin L. The mechanism of protection of tumor cells from apoptosis involves the inhibition of the caspase-3 activity and/or upstream proteases. SCC-2 inhibits cathepsin G and mast cell chymase, thus protecting epithelial cells from these proteases-induced inflammation (32).

Increased serum SCC-A levels were observed in more advanced SCC stages (in 28-88% of the patients) allowing the use of SCC-A as diagnostic and prognostic biomarker for this cancer subtype (30-32). Differences in the percentage of SCC-A detection were attributed to various factors, such as the histological grade and the cutoff in the SCC-A serum concentration. Although numerous years have passed since its discovery, the clinical use of SCC-A remains under debate, for the increase on its expression has been reported in patients with SCC of the esophagus, lung, head, neck, and in anal canal and uterine cervix, as well as in patients with several non-malignant skin lesions, such as pemphigus and renal failure. Regarding this, the exposure to TNF-α significantly increased the production of SCC-A in normal human epidermal keratinocytes (33).

In addition to SCC-A, other potential circulating biomarkers have been identified. Mitsuhashi et al (21) described that the serum YKL-40 level was elevated in both SCC and adenocarcinoma. YLK-40 is a glycoprotein member of the glycosyl hydrolase 18 family; it is secreted by active macrophages, chondrocytes, neutrophils and synovial cells. Recent studies suggested that YLK-40 plays a role in the inflammation process and tissue remodeling (34-36). This molecule appears to be a favorable CC biomarker in both SSC and adenocarcinoma subtypes, and it appears to be more specific than SCC-A and CA125. Previous findings demonstrated that serum YKL-40 level is increased in several solid tumors with a variety of histological types (37,38). This protein is a biomarker associated with inflammation and, despite this, it could be a correlation between the C-reactive protein (CRP) and YKL-40(39). YKL-40 serum appears to be more a non-specific biomarker of inflammation, since its expression was higher than that of CRP, allowing to discriminate patients with CC from tumor-free individuals. In addition, YKL-40 appears to be an improved serum biomarker for adenocarcinomas detection than CA-125 exhibiting 78 and 68% sensitivity for all grades and for stage I tumors, respectively (21). Although it does not appear to be an ideal biomarker due to its relative low sensitivity to detect CC, the receiver operating characteristic (ROC) and area under a ROC curve (AUC) analysis revealed that YKL-40 discriminates healthy individuals from patients with CC. Similarly, the YKL-40 levels were identified to be a poor prognostic variable for relapse of the disease (40).

Sheng et al (41) examined the clinical value of serum high mobility group box chromosomal protein 1 (HMGB1) levels in the early diagnosis of recurrent cervical SCC and compared them with the values obtained for SCC-A, cytokeratin fragment 21-1 (CYFRA) and CEA. HMGSB1 is a nuclear DNA-binding protein able to regulate transcription and is involved in organization of DNA, playing a role in several cellular processes including inflammation, cell differentiation and tumor cell migration. In the present study, serum HMGB1 levels-in patients with recurrent CSCC-were significantly higher than in patients with non-recurrent disease and healthy controls. The combination of the HMGB1 expression with other biomarkers such as SCCA, CYFRA21-1 and CEA increased the sensitivity of HMGB1 to detect CC and serial combinations of these markers also increased the specificity. Relatively high serum expression levels of HMGB1 were inversely correlated with disease-free survival and overall survival.

A proteomic screening carried out by Chen et al (42) in 10 healthy control women and 39 patients with CC, before and after surgery, identified three peptide biomarkers, distinguishing patients with CC from individuals without cancer as well as preoperative patients with CC from those who had already been subjected to surgery. TKT and FGA peptides were upregulated in CC and preoperative patients, whereas the APOA1 peptide region was downregulated. Meanwhile, collagen triple helix repeat containing 1 (CTHRC1), a protein that may play a role in the cellular response to arterial injury through the involvement in vascular remodeling, was evaluated as another potential serum marker for CC detection, particularly for SCC. Xu et al (22) studied the CTHRC1 expression in three different groups [individuals without cancer, SCC, and cervical intraepithelial lesions (CIN)], demonstrating its overexpression in SCC relative to CIN and individuals without cancer. The ROC curve showed an AUC value for CTHRC1 and SCC-Ag of 0.665±0.034, and 0.878±0.027 respectively; the sensitivity and specificity for these biomarkers were 57 and 85% (CTHRC1), and 78 and 86% (SCC-Ag), respectively. Importantly, the combined analysis of CTHRC1 and SCC-Ag considerably increased the AUC value (0.879±0.027) and the sensitivity (87%) and specificity (84%). The aforementioned study strongly suggested the potential use of CTHRC1 as a novel prognostic and metastatic biomarker for SCC, whose potential as a biomarker increased considerably when combined with SCC.

It is well documented that activation of Macrophage-Colony Stimulating Factor (M-CSF) and vascular endothelial growth factor (VEGF) is involved in the pathogenesis and spread of distinct types of cancer, including CC. Regarding this, Sidorkiewicz et al (24) examined the M-CSF and VEGF plasma levels and compared them with those of CA-125 and SCC-A in three groups of patients: i) The CC group (patients with either SCC or adenocarcinoma), ii) The cervical dysplasia group and iii) The control group. The median levels of M-CSF and VEGF as well as those of CA-125 and SCC-A were significantly different in the three groups relative to the control group. The sensitivity and specificity for VEGF and SCC-Ag were of 82 and 76%, and 81 and 74%, respectively. In the adenocarcinoma group, the VEGF sensitivity and specificity were respectively of 87 and 76% (24). The results indicated a possible clinical applicability for these proteins and a relatively high diagnostic power for the M-CSF, VEGF, CA-125 and SCC-Ag combination. Similarly, the combined analysis of α-Actinin 4 (ACTN4) and SSC-A is a promising serological examination for CC detection. ACTN4 plays an essential role in regulating cellular signaling pathways correlated with various types of cancer progression and poor patient prognosis, involved in the invasion and metastasis of colorectal, pancreatic and ovarian cancer. Its principal function is by regulating cell invasion due to its participation in the epithelial-to-mesenchymal transition; however, it is also involved in controlling the cancer stem cell properties and chemoresistance in CC. Zhu et al (43) demonstrated the circulating and tumor ACTN4 overexpression in patients with CIN3 or more advanced stages. In addition, the ACTN4 mRNA was also overexpressed in CC tissues and in tissues with advanced FIGO stages, larger tumor sizes, and positive lymph node metastasis. In conclusion, ACTN4, in combination with SCC-Ag, is a potential biomarker for the diagnosis and prognosis of patients with CIN3 or more advanced stages.

Yang et al (23) proposed that circulating placental growth factor (PIGF) and its receptor VEGFR-1 (Flt-1) can serve as possible valuable diagnostic biomarkers for CC, and their combined use increased the potential to diagnose patients with early CC. A total of 44 preoperative patients with CC, 18 cases with CIN, and 20 controls were studied and both PlGF and Flt-1 were significantly increased in the CC group when compared with that with CIN or without cancer. PlGF presented a relatively high power to detect CC with a 61% sensitivity and an 89% specificity; meanwhile, Flt-1 showed a 50% sensitivity and a 92.11% specificity. Remarkably, the combined use of PlGF and Flt-1 increased the CC diagnosis (sensitivity of 70% and specificity of 92%) (23).

Summarizing, different circulating proteins are differentially expressed in patients with CC relative to individuals without cancer, having a great potential to be used in clinical diagnosis and even more when two or more proteins are analyzed in a combined manner. Importantly, not only circulating proteins have been identified as biomarkers for CC but also microRNAs (miRNAs) and long non-coding RNAs (lncRNAs), as well as cDNA.

3. ncRNAs

ncRNAs are RNA molecules, which are not translated into a protein, including transfer RNAs, ribosomal RNAs, small non-coding RNAs (snRNAs) and lncRNAs (44). snRNAs and lncRNAs regulate numerous biological functions and their expression is finely regulated at different stages of development of organisms to fulfill very particular functions (45,46). Numerous lines of evidence indicate their involvement in cancer, specifically in CC, and their differential expression, mainly in blood, has been related to diagnosis, prognosis, and treatment response of patients with CC, as described below.

MiRNAs

MiRNAs are snRNAs of 18-34 and 80-100 nucleotides (nt) (47-49) in size, which control gene expression by inhibiting protein translation, by regulating gene transcription and the expression and/or the function of lncRNAs (50-52). Notably, circulating miRNAs act as Toll-receptors ligands to activate intracellular signaling pathways resulting in the control of cellular response in other organs and tissues (53).

To date, numerous circulating miRNAs have been identified as possible biomarkers for low-grade squamous intraepithelial lesions (LSIL), CIN and CC and most of them demonstrate higher AUC values and a higher sensitivity and specificity than proteins. Notably, both sensitivity and specificity to detect CC by miRNAs is relatively high and they were considerably increased when analyzed in combination (6-8,54-72) (Fig. 1, Fig. 2 and Fig. 3). The majority of miRNAs have the potential to be biomarkers for CIN and CC diagnosis and only certain for prognosis (Fig. 3). MiRs 34a and 218 are particularly important, since they allow to distinguish LSIL and CC HPV16+ from healthy women (60) (Fig. 1). Their clinical use in LSIL detection-in a minimally invasive form-would have a huge impact on public health in countries where CC remains a public health problem, such as Mexico.

A very interesting study showed the miR-221-3p enrichment in exosomes, which were secreted by CSCC and captured by human lymphatic endothelial cells (HLECs), resulted in their migration promotion, tube formation, lymphanogenesis induction and LN metastasis in CSCC patients. These processes appear to be regulated, at least partly, by targeting vasohibin-1, leading to the ERK/AKT pathway activation in HLECs (65).

To date, there are several circulating miRNAs that can be used for the LSIL, CIN and CC diagnosis and certain of them are specific to differentiate HPV+ CC from the negative one. Importantly, certain miRNAs render it possible to identify CC metastasis to the lymph nodes.

LncRNAs

LncRNAs are ≥200 nt RNAs with very complex secondary structures and a myriad of cellular functions: i) Maintaining the chromatin structure and regulating gene transcription (73), ii) They are molecular scaffolds for several factors involved in transcription control (74) and iii) They are miRNAs sponges (75). These type of RNAs have been detected in body fluids and have been associated with cancer, including CC; however, the information regarding circulating lncRNAs participating in CC is very scarce. Sun et al (27) found that lncRNAs HOTAIR, PVT1, XLOC_000303 and AL592284 are overexpressed in the blood serum of patients with CC when compared with the controls. The analysis of these four lncRNAs together improved the AUC value: 0.875. In a similar way, the analysis of the overexpressed lncRNAs CCAT2, LINC01133 and LINC00511 by including the SCC-A, increased the AUC value to 0.94(28). Meanwhile, the expression of HOTAIR was increased in patients with CC relative to the controls and this correlated with numerous clinical aspects as well as with tumor recurrence and short overall survival (76). The identification of more circulating lncRNAs as potential CC biomarkers will definitely have a noticeable impact on the diagnosis, prognosis and response to treatments of this type of cancer. In addition, the discovery of the functions performed by these RNAs in time shall allow the identification of therapeutic targets in the future.

4. The estrogen effect on the expression of biomarkers

There is a close relationship between gynecological cancers and alterations in hormone-mediated regulatory pathways, modifying gene expression. Most information is related to protein biomarkers and some of them were regulated by estrogens in tissues: SCC-Ag, C-125, VEGFA and ACTN4, and only circulating HMGB1 and YKL-40 were regulated by estrogens (77-81). Notably, the circulating miR-21 expression was downregulated by estrogens (82).

To the best of our knowledge, for the remaining biomarkers there is no evidence indicating changes on their circulating expression in response to estrogens; however, this does not mean that their expression cannot be regulated by this hormone, since most of them show a close relationship with the expression of estrogen receptors.

5. cDNA

cDNA was discovered several years ago (82) and its relationship with cancer was later identified (83). The total cDNA concentration is considerably lower in healthy individuals than in patients with cancer (84) and it varies depending on the cancer type (85). Notably, diverse subtypes of cfDNA can be found in circulation, such as mitochondrial DNA and extrachromosomal and single-stranded DNA, viral, bacterial, and food-derived (86). The majority of free cDNA is originated from the nucleus and it is packaged in mono- or oligonucleosomes, but most free cDNA is associated with exosomes. Free cDNA release does not correlate with the necrosis and apoptosis levels, but it does correlate with the percentage of cells in G1 phase (87). Perhaps most importantly, cDNA appears to have various cancer-related functions (88-90).

Previous studies showed that HPV-cDNA detection positively correlates with low-grade cervical lesions (LGCL) and high-grade cervical lesions (HGCL), CIN and CC, tumor grade, and with the genomic HPV insertion, which is associated with a poor patient's prognosis (91-98) (Table III). Importantly, Rungkamoltip et al (29) showed a 100% sensitivity and 88% specificity to detect E7 HPV16/18 cfDNA by using the amplification-by recombinase polymerase-in combination with lateral Flow strip. In addition to cDNA, the presence of specific cDNA mutations allows to detect CC from healthy individuals and positively correlates with disease progression and with a shorter progression-free survival, as well as with the overall survival of patients with metastatic relapse CC compared with the controls (patients without any detectable of these mutations) (99).

Table III

cDNA expression levels.

Table III

cDNA expression levels.

HPV-cDNA Detection (%)Overexpression in CC patients vs. the controls or early stages of the diseaseRelated to tumoral grade and/or progressionAssociated with treatment responseAssociated with poor prognosis(Refs.)
12% of the HPV-positive patients with CC • CC patients without detectable cDNA did not progress • 50% of the patients were in stage IIB or in recurrent metastasis(77)
Undetected in the controls or HPV-negative patients  • Three-fold higher expression in patients with metastases 
    • Detection of cDNA predisposed to develop metastases 
Undetermined • Decreased of the cDNA expression levels; 83% of patients responded to treatment (27)
Undetermined• cDNA expression higher in stage II-III patients than in stage I or CIN patients or controls  (78)
HPV 16: 50% of the CC patients HPV 18: 6% of the CC patients and 1% of the controls • Decreased of the cDNA expression levels; 76% of patients responded to treatment (79)
51% of patients with squamous intraepithelial lesions.   (80)
More than half of these patients were positive for at least one high-risk HPV     
85% of patients with CC• The cDNA expression levels increased according to the degree of malignancy  (81)
UndeterminedUndetermined • After the treatment, the cDNA levels were undetectable in 68% of patients• After treatment, relative high cDNA expression levels were associated with metastases development (in 50% of the patients)(82)
   • Only one patient showed recurrence.  
   • 46% of the patients showed no residual disease (at three months follow-up)  
UndeterminedUndetermined  • The HPV-ctDNA detection correlated with a lower disease free survival and overall survival(82)
E7 HPV16/18 cell free DNA highly specific to detect CC (100% sensitivity and 88% specificity)   (83)

[i] CC, cervical cancer; SCC, squamous cell carcinoma; cDNA, circulating DNA.

Very importantly, cDNA detection allows to differentiate among LGCL and HGCL, and CC from patients with non-HPV dependent CC as well as from individuals without CC. LGCL detection by means of cDNA is very promising since the early detection of this type of lesions can significantly prevent their progression to cancer. In addition, cDNA concentration appears to be useful for monitoring treatment response and patient's prognosis.

6. Putative molecular mechanisms altered by the CC biomarkers

Making a prediction of which mechanisms will be regulated by specific circulating molecules-only based on their canonical functions-is a high-risk task. This is because the few studies that have focused on studying the action of circulating molecules have elucidated mechanisms of action somewhat unexpected and that have nothing to do with the previously reported effects.

In general, it is known that exogenous miRNAs regulate gene expression through the canonical pathway, involving the binding to their target mRNA; however, Fabbri et al (100) revealed that miRs-21 and -29a function by a different mechanism. The aforementioned study demonstrated the interaction of these miRNAs with Toll-like receptor (TLR) 7 and TRL8 in cells from the immune system. Notably, the binding of miRs-21 and -29a to these receptors triggered a prometastatic inflammatory response, resulting in the tumor growth induction and metastasis. Thus, this is the first indication that miRNAs function as paracrine agonists of TLRs to regulate tumor environment.

Kyoto encyclopedia of genes and genomes (KEGG) analysis

Based on canonical functions reported for the proteins proposed as biomarkers for CC, KEGG analysis showed their involvement mainly in the control of signaling pathways, such as PI3K-Akt, HIF-1, and Rap1, among others (Table IV). The cellular processes that may be modified by changes in these signaling pathways were cell proliferation, adhesion, migration, cytoskeleton remodeling and gene expression regulation (Table IV).

Table IV

Kyoto Encyclopedia of Genes and Genomes analysis.

Table IV

Kyoto Encyclopedia of Genes and Genomes analysis.

IdentifierSignaling pathwayNumber of genes involvedCellular processes potentially altered
Ko04151PI3K-Akt signaling pathway3 (FLT1; VEGFA; CSF1)Cell proliferation. Angiogenesis. DNA repair.
Ko04066HIF-1 signaling pathway3 (LDH; FLT1; VEGFA)Angiogenesis. Pyruvate to Lactate.
Ko04015Rap1 signaling pathway3 (FLT1; VEGFA; CSF1)Defective angiogenesis. Smg cross-talk. Cell adhesion, migration, polarity. Proliferation and survival. Gene activation.
Ko04010MAPK signaling pathway3 (FLT1; VEGFA; CSF1)Proliferation. Differentiation.
Ko04014Ras signaling pathway3 (FLT1; VEGFA; CSF1)Apoptosis. Cell-cycle arrest. Cytoskeleton organization. Cell motility. Cell survival, growth, migration. Cell cycle progression. Transcription. Endocytosis. Gene expression. Cell-cell junctions. Cytoskeletal remodeling. Cell spreading and migration.
Ko04510Focal adhesion3 (FLT1; VEGFA; ACTN1)Actin polymerization. Cell survival.
Ko05323Rheumatoid arthritis3 (FLT1; VEGFA; CSF1)Angiogenesis.

[i] VEGF, vascular endothelial growth factor; ACTN4, Actinin 4; CSF, colony stimulating factor.

DIANA miRPath analysis (Tarbase)

Changes on expression of miRNAs and/or on their function could alter numerous signaling pathways and cellular processes, which is related to their ability to regulate several mRNAs in the same cell. Secretion of miRNAs to blood serum and target organ recognition could mainly alter proteoglycans in cancer, pathways in cancer, renal cell carcinoma, viral carcinogenesis, among others; these signaling pathways control cellular processes related with hallmarks of cancer (Table V).

Table V

DIANA miRPath v.3.

Table V

DIANA miRPath v.3.

Kyoto Encyclopedia of Genes and Genomes pathwayP-valueGenesMicroRNAsCellular processes potentially altered
Proteoglycans in cancer 1.06x10-2416526Angiogenesis. Proliferation and survival. Tumor cell migration and invasion.
Pathways in cancer 7.31x10-1529928Carcinogenesis. Genomic damage. Resistance to chemotherapy. Insensitive to anti-growth signals. Failed repair of genes. Sustained angiogenesis. Evading apoptosis. Proliferation. Block of differentiation. Tissue and metastasis.
Renal cell carcinoma 8.81x10-136125Increased nutrients and oxygen. Glucose transport. Angiogenesis. Autocrine growth stimulation. Cell proliferation, migration, invasion. Genetic alterations. Ubiquitin mediated pathway.
Prostate cancer 3.00x10-118127Anti-apoptotic genes. Proliferative genes. G1/S progression. Cytoskeleton remodeling. Inhibition of apoptosis. Loss of growth inhibitory effects of TGFβ. Failed repair of genes.
Colorectal cancer 3.43x10-115826Genetic alterations. DNA repair genes. Anti-apoptosis. Proliferation. Loss of growth inhibitory effects of TGFβ. Karyotypic instability. Impaired G1 cycle arrest. Reduced apoptosis.
Viral carcinogenesis 3.02x10-1215626Proliferation. Viral infectivity and replication. Proliferation. Inhibition of apoptosis. Survival. Inhibition of p53-mediated apoptosis. Inhibition of nucleotide excision repair. Induction of FasL. Mitochondrial dysfunction. Alteration of host cellular gene expression. Stimulation/inhibition of cell proliferation. Inhibition of mitogenic signaling. Growth retardation. Inhibition of transcriptional activation by p53. Basal transcription factors. Transformation. Suppression of immunoresponse. Decreasing differentiation.
Fatty acid metabolism 2.12x10-93733Citrate cycle.
Transcriptional misregulation in cancer (hsa05202) 5.14x10-914745Differentiation resistance. Self-renewal of T cells. Proliferation, cell survival. Myeloma adhesion to bone marrow stroma. Cell cycle progression. Inhibition of apoptosis. Repression of tumor suppressors. Escape from growth inhibition, senescence, apoptosis. Low radiosensitivity of tumor cells. Interactions with ECM, migration, invasion. Karyotypic instability, impaired G1 cycle arrest, reduced apoptosis.
Endocytosis 6.80x10-917243Lysosome. TGF-beta signaling pathway. Phosphatidylinositol signaling System.
Hippo signaling pathway 6.80x10-912545Pro-apoptotic genes. Anti-apoptotic genes. Pro-proliferation genes. Cell contact inhibition Organ. size control. Adherens junction. Tight junction.
Non-small cell lung cancer 8.62x10-95339Tumour progression. Impaired G1and G2 arrest. Reduced apoptosis. Genomic instability. Metastatic squamous cell carcinoma. Metastatic adenocarcinoma.
Prostate cancer 8.62x10-98245Cell cycle. Apoptosis inhibition. Tumor growth. Androgen and estrogen metabolism.
Acute myeloid leukemia 1.05x10-85539Anti-apoptotic genes. Proliferative genes. AML1 target genes. Block of differentiation.
Cell cycle 2.15x10-810544Ubiquitin-mediated proteolysis. Apoptosis. DNA damage checkpoint. DNA biosynthesis.

Numerous functional studies are necessary to know the mechanism(s) of action of each of these molecules separately and/or together, and what ‘benefit’ the tumor obtains by releasing these molecules.

7. Expression of circulating biomarkers in other HPV-related cancers

The aforementioned biomarkers are postulated as a favorable tool for both the detection of cervical lesions and cancer; however, various studies have shown the expression of some of these biomarkers in other types of HPV-related cancers. Their expression has been detected mainly at the tumor level and to a markedly lesser extent as circulating molecules. SCC-A is the most studied biomarker and is overexpressed in distinct squamous cell cancers, including the following: Esophagus, lung, head, neck, and in anal canal, and uterine cervix, as well as in vulvar and penile carcinoma (101-105). Meanwhile, YKL-40 has demonstrated high tissue levels in anal carcinoma and it has been detected in the plasma of patients with esophageal cancer (106) and CA-125 showed relatively high circulating levels in vulvar carcinoma (107). In addition, CA-125 had an increased expression in oropharyngeal cancer (108) and relatively high VEGFA expression levels were detected in vulvar carcinoma (109) and oropharyngeal cancer (110). Although PIGF was detected in oropharyngeal cancer, its expression was not related with the malignancy of this cancer type (111).

In the case of ncRNAs, to the best of our knowledge only miR-205 and HOTAIR have been related with head and neck (112), and oropharyngeal cancers (113), as well as with cervicovaginal lavage specimens, respectively (114).

8. How feasible is it to use a test of this type in the heath sector of undeveloped countries?

Even though the Mexican Institute of Social Security has a substantial cost for the detection, follow-up and treatment of CC, this cancer type remains the second most common in Mexican women after breast cancer. A previous study carried out by Granados-García et al (17) revealed the high cost of evaluating a patient's condition regarding CC by cytology, colposcopy, biopsies, and pathology, as well as by diagnostic tests and treatments for cervical intraepithelial neoplasia grade II and III (CIN 2/3) and CC. The aforementioned study identified that the cost to perform 2.7 million cytology tests was nearly 38 million dollars, representing 26.1% of the total program cost (145.4 million). False negatives account for nearly 43% of the program costs. According to the aforementioned results, it was concluded that the low sensitivity of the cytology test generates high rates of false negatives, resulting in high institutional costs from the treatment of undetected CC cases.

In accordance with the aforementioned studies, the establishment of a panel of biomarkers with high sensitivity and specificity would be a great molecular tool to improve the diagnosis and treatment of women with LGCLs, HGCLs and CC. An increase in the detection of women with LGCLs and HGCLs-by this panel-may decrease the number of women progressing towards CC.

9. The best biomarkers panel, according to the authors' point of view

From the authors' point of view, the biomarkers that would have a greater impact on women and health sector are those detecting both LGCLs and HGCLs. Early detection of these type of lesions would allow early treatment of women and this would considerably decrease the progression towards cancer. At this point it is important to mention that the use of this biomarker panel will increase the power of detection, prognosis and response to treatments (Table VI).

Table VI

Panel of biomarkers.

Table VI

Panel of biomarkers.

Low-grade squamous intraepithelial lesionsmiR-34a, miR-15b, miR-18 and circulating DNA
Early CC stages from the controlsmiR-21, miR-125b and miR370
CC detectionProteins: Collagen Triple Helix Repeat containing 1 and squamous cell carcinoma antigen
 Long non-coding RNAs: CCAT2, LINC01133 and LINC00511
Cisplatin resistancemiR-651

[i] miR, microRNA; CC, cervical cancer.

10. Conclusions and future directions

As observed, early CC detection is a crucial factor to effectively treat low-grade CC lesions and thus avoid the transition to cancer; therefore, the establishment of molecular tools that allow performing this task is imperative. Currently, there are diverse biomolecules-particularly ncRNAs-which have a high sensitivity and specificity to detect LGCLs as well as CC, thus the establishment of these biomarkers for their use in the clinical studies to detect LGCLs and CC is crucial. In addition, the biomolecules that enable us to know the response to treatments is also very important and, in the same way, it should be part of the molecular tools used in the medical attention.

Collectively, the biomarkers found to date have great potential to be used as clinically useful biomarkers for detection and response to treatments. Further studies are needed to establish which are the ones that will best support the medical attention.

Acknowledgements

Not applicable.

Funding

Funding: The present study was supported by Proyectos-ATSO.

Availability of data and materials

Not applicable.

Authors' contributions

RREG searched and organized the information and wrote the manuscript. MGS reviewed the last version of the manuscript. MAVF reviewed and corrected the information of the last version of the manuscript. All authors read and approved the final version of the manuscript.

Ethics approval and consent to participate

Not applicable.

Patient consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

References

1 

Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A and Bray F: Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 71:209–249. 2021.PubMed/NCBI View Article : Google Scholar

2 

Lee SI and Atri M: 2018 FIGO staging system for uterine cervical cancer: Enter cross-sectional imaging. Radiology. 292:15–24. 2019.PubMed/NCBI View Article : Google Scholar

3 

Cho H, Oh CK, Cha J, Chung JI, Byun SS, Hong SK, Chung JS and Han KH: Association of serum prostate-specific antigen (PSA) level and circulating tumor cell-based PSA mRNA in prostate cancer. Prostate Int. 10:14–20. 2022.PubMed/NCBI View Article : Google Scholar

4 

Nieder C, Dalhaug A and Mannsåker B: Established serum biomarkers are prognostic factors in patients with oligometastatic cancer and brain involvement. In Vivo. 36:801–805. 2022.PubMed/NCBI View Article : Google Scholar

5 

López-Aguilar JE, Velázquez-Flores MA, Simón-Martínez LA, Ávila-Miranda R, Rodríguez-Florido MA and Ruiz-Esparza Garrido R: Circulating microRNAs as biomarkers for pediatric astrocytomas. Arch Med Res. 48:323–332. 2017.PubMed/NCBI View Article : Google Scholar

6 

Zheng S, Li R, Liang J, Wen Z, Huang X, Du X, Dong S, Zhu K, Chen X, Liu D, et al: Serum miR-638 combined with squamous cell carcinoma-related antigen as potential screening biomarkers for cervical squamous cell carcinoma. Genet Test Mol Biomarkers. 24:188–194. 2020.PubMed/NCBI View Article : Google Scholar

7 

Jia W, Wu Y, Zhang Q, Gao GE, Zhang C and Xiang Y: Expression profile of circulating microRNAs as a promising fingerprint for cervical cancer diagnosis and monitoring. Mol Clin Oncol. 3:851–858. 2015.PubMed/NCBI View Article : Google Scholar

8 

Qiu H, Liang D, Liu L, Xiang Q, Yi Z and Ji Y: A novel circulating MiRNA-based signature for the diagnosis and prognosis prediction of early-stage cervical cancer. Technol Cancer Res Treat. 19(1533033820970667)2020.PubMed/NCBI View Article : Google Scholar

9 

ACCP. Pap smears: An important but imperfect method. Cervical Cancer Prevention Fact Sheet, 2002.

10 

Milla Villeda RH, Alvarado Zaldívar G, Sánchez Anguiano LF, Barrera Tovar M and Vázquez Arreola I: Colposcopy and cervical biopsy in patients with routine Papanicolaou smear. Ginecol Obstet Mex. 65:235–238. 1997.PubMed/NCBI

11 

Chu E, Bratwaite O, Gonzalez I, Campo Z and De León RG: Diagnosis of human papillomavirus by Papanicolau and PCR in a group of adolescents and young women. Instituto conmemorativo gorgas de estudios de la salud, centro de investigación en reproducción humana. URL: Microsoft Word-2087_2002_doc(gorgas.gob.pa).

12 

Flores-Juárez DJ and García-González GA: Usefulness of Papanicolau for cervical dysplasia in patients HPV positive with CD4 <200 cell/mm3. Escuela de Estudios de Postgrado de la Facultad de Ciencias Médicas Maestría en Ginecología y Obstetricia Tesis para obtener el grado de Maestras en Ciencias en Ginecología y Obstetricia, pp1-45, 2014. URL: https://biblioteca.medicina.usac.edu.gt/tesis/post/2014/071.pdf.

13 

Terrádez Raro JJ, Coloma Colomer F, Navarro Conde P and Gasull Ibáñez J: Cervical cancer screening in public health system in Valencia community and Pap test limit. Rev ESP Patol. 38:3–7. 2005.

14 

Dzul-Rosado KR, Puerto-Solís M and González Losa MR: Cáncer cervicouterino: Métodos actuales para su detección. Rev Biomed. 15:233–241. 2004.

15 

Vlastos AT, Richards-Kortum R, Zuluaga A and Follen M: New approaches to cervical cancer screening. Contemporary Ob/Gyn. 47:87–107. 2002.

16 

Andrade AZ, Zaragoza JZ, Blanco BR and Marañón RT: Evaluación del papanicolaou y la colposcopia en el diagnóstico de la infección por el virus del papiloma humano. Rev Fac Med UNAM. 44:5–7. 2001.

17 

Granados-García V, Flores YN, Pérez R, Rudolph SE, Lazcano-Ponce E and Salmerón J: Cost of the cervical cancer screening program at the mexican social security institute. Salud Publica Mex. 56:502–510. 2014.PubMed/NCBI View Article : Google Scholar

18 

Solares LF, Álvarez AM, García-Echeverría AM and Velasco MJ: Diagnóstico citológico de ASCUS. Identificación del riesgo para displasia cervical mediante test del virus del papiloma humano. Clin Invest Ginecol Obstet. 32:50–53. 2005.

19 

Zhang Q, Kuhn L, Denny LA, De Souza M, Taylor S and Wright TC Jr: Impact of utilizing p16INK4A immunohistochemistry on estimated performance of three cervical cancer screening tests. Int J Cancer. 120:351–356. 2007.PubMed/NCBI View Article : Google Scholar

20 

Mattosinho de Castro Ferraz Mda G, Nicolau SM, Stávale JN, Focchi J, Castelo A, Dôres GB, Mielzynska-Lohnas I, Lorincz A and Rodrigues de Lima G: Cervical biopsy-based comparison of a new liquid-based thin-layer preparation with conventional Pap smears. Diagn Cytopathol. 30:220–226. 2004.PubMed/NCBI View Article : Google Scholar

21 

Mitsuhashi A, Matsui H, Usui H, Nagai Y, Tate S, Unno Y, Hirashiki K, Seki K and Shozu M: Serum YKL-40 as a marker for cervical adenocarcinoma. Ann Oncol. 20:71–77. 2009.PubMed/NCBI View Article : Google Scholar

22 

Xu G, Fan W, Wang F, Lu H, Xing X, Zhang R and Jiang P: CTHRC1 as a novel biomarker in the diagnosis of cervical squamous cell carcinoma. Int J Clin Exp Pathol. 11:847–854. 2018.PubMed/NCBI

23 

Yang SH, Wang XL, Cai J and Wang SH: Diagnostic value of circulating PIGF in combination with Flt-1 in early cervical cancer. Curr Med Sci. 40:973–978. 2020.PubMed/NCBI View Article : Google Scholar

24 

Sidorkiewicz I, Zbucka-Krętowska M, Zaręba K, Lubowicka E, Zajkowska M, Szmitkowski M, Gacuta E and Ławicki S: Plasma levels of M-CSF and VEGF in laboratory diagnostics and differentiation of selected histological types of cervical cancers. BMC Cancer. 19(398)2019.PubMed/NCBI View Article : Google Scholar

25 

Ning R, Meng S, Wang L, Jia Y, Tang F, Sun H, Zhang Z, Zhang C, Fan X, Xiao B, et al: 6 Circulating miRNAs can be used as non-invasive biomarkers for the detection of cervical lesions. J Cancer. 12:5106–5113. 2021.PubMed/NCBI View Article : Google Scholar

26 

Chen J, Yao D, Li Y, Chen H, He C, Ding N, Lu Y, Ou T, Zhao S, Li L and Long F: Serum microRNA expression levels can predict lymph node metastasis in patients with early-stage cervical squamous cell carcinoma. Int J Mol Med. 32:557–567. 2013.PubMed/NCBI View Article : Google Scholar

27 

Sun W, Wang L, Zhao D, Wang P, Li Y and Wang S: Four circulating long non-coding RNAs Act as biomarkers for predicting cervical cancer. Gynecol Obstet Invest. 83:533–539. 2018.PubMed/NCBI View Article : Google Scholar

28 

Wang WJ, Wang D, Zhao M, Sun XJ, Li Y, Lin H, Che YQ and Huang CZ: Serum lncRNAs (CCAT2, LINC01133, LINC00511) with squamous cell carcinoma antigen panel as novel non-invasive biomarkers for detection of cervical squamous carcinoma. Cancer Manag Res. 12:9495–9502. 2020.PubMed/NCBI View Article : Google Scholar

29 

Rungkamoltip P, Temisak S, Piboonprai K, Japrung D, Thangsunan P, Chanpanitkitchot S, Chaowawanit W, Chandeying N, Tangjitgamol S and lempridee T: Rapid and ultrasensitive detection of circulating human papillomavirus E7 cell-free DNA as a cervical cancer biomarker. Exp Biol Med (Maywood). 246:654–666. 2021.PubMed/NCBI View Article : Google Scholar

30 

Gadducci A, Tana R, Cosio S and Genazzani AR: The serum assay of tumour markers in the prognostic evaluation, treatment monitoring and follow-up of patients with cervical cancer: A review of the literature. Crit Rev Oncol Hematol. 66:10–20. 2008.PubMed/NCBI View Article : Google Scholar

31 

Duffy MJ: Evidence for the clinical use of tumor markers. Ann Clin Biochem. 41:370–377. 2004.PubMed/NCBI View Article : Google Scholar

32 

Uemera Y, Pak SC, Luke C, Cataltepec S, Tsu C, Schick C, Kamachi Y, Pomeroy SL, Perlmutter DH and Silverman GA: Circulating serpin tumor markers SCCA1 and SCCA2 are not actively secreted but reside in the cytosol of squamous carcinoma cells. Int J Cancer. 89:368–377. 2000.PubMed/NCBI View Article : Google Scholar

33 

Numa F, Takeda O, Nakata M, Nawata S, Tsunaga N, Hirabayashi K, Suminami Y, Kato H and Hamanaka S: Tumor necrosis factor-alpha stimulates the production of squamous cell carcinoma antigen in normal squamous cells. Tumour Biol. 17:97–101. 1996.PubMed/NCBI View Article : Google Scholar

34 

Liposits G, Skuladottir H, Ryg J, Winther SB, Möller S, Hofsli E, Shah CH, Poulsen LØ, Berglund Å, Qvortrup C, et al: The prognostic value of pre-treatment circulating biomarkers of systemic inflammation (CRP, dNLR, YKL-40, and IL-6) in vulnerable older patients with metastatic colorectal cancer receiving palliative chemotherapy-the randomized NORDIC9-study. J Clin Med. 11(5603)2022.PubMed/NCBI View Article : Google Scholar

35 

Dolin TG, Christensen IJ, Lund CM, Bojesen SE, Lykke J, Nielsen DL, Larsen JS and Johansen JS: Preoperative plasma vitamin D in patients with localized colorectal cancer: Age-dependent association with inflammation, postoperative complications, and survival. Eur J Surg Oncol. (S0748-7983(22)00651-5)2022.PubMed/NCBI View Article : Google Scholar : (Epub ahead of print).

36 

Rathcke CN and Vestergaard H: YKL-40, a new inflammatory marker with relation to insulin resistance and with a role in endothelial dysfunction and atherosclerosis. Inflamm Res. 55:221–227. 2006.PubMed/NCBI View Article : Google Scholar

37 

Bao J, Ouyang Y, Qiao L, He J, Liu F, Wang Y, Miao L, Fu A, Lou Z, Zang Q, et al: Serum CHI3L1 as a biomarker for non-invasive diagnosis of liver fibrosis. Discov Med. 33:41–49. 2022.PubMed/NCBI

38 

Shi M, Ge Q, Wang X, Diao W, Yang B, Sun S, Wang G, Liu T, Chan AML, Gao Z, et al: Functional analysis of the short splicing variant encoded by CHI3L1/YKL-40 in glioblastoma. Front Oncol. 12(910728)2022.PubMed/NCBI View Article : Google Scholar

39 

Videmark AN, Christensen IJ, Feltoft CL, Villadsen M, Borg FH, Jørgensen BM, Bojesen SE, Kistorp C, Ugleholdt R and Johansen JS: Combined plasma C-reactive protein, interleukin 6 and YKL-40 for detection of cancer and prognosis in patients with serious nonspecific symptoms and signs of cancer. Cancer Med: Nov 28, 2022 (Epub ahead of print).

40 

Hermunen K, Soveri LM, Boisen MK, Mustonen HK, Dehlendorff C, Haglund CH, Johansen JS and Osterlund P: Postoperative serum CA19-9, YKL-40, CRP and IL-6 in combination with CEA as prognostic markers for recurrence and survival in colorectal cancer. Acta Oncol. 59:1416–1423. 2020.PubMed/NCBI View Article : Google Scholar

41 

Sheng X, Du X, Zhang X, Li D, Lu C, Li Q, Ma Z, Song Q and Wang C: Clinical value of serum HMGB1 levels in early detection of recurrent squamous cell carcinoma of uterine cervix: Comparison with serum SCCA, CYFRA21-1, and CEA levels. Croat Med J. 50:455–464. 2009.PubMed/NCBI View Article : Google Scholar

42 

Chen Y, Xiong X, Wang Y, Zhao J, Shi H, Zhang H, Wang Y, Wei Y, Xue W and Zhang J: Proteomic screening for serum biomarkers for cervical cancer and their clinical significance. Med Sci Monit. 25:288–297. 2019.PubMed/NCBI View Article : Google Scholar

43 

Zhu B, Dong B, Hong S, Wang M, Dai W, Zheng Q, Wu D and Cao Y: Combined detection of ACTN4 and SCC-Ag is a promising serological biomarker for cervical intraepithelial neoplasia 3 or worse: A case-control study. Risk Manag Health Policy. 13:2677–2687. 2020.PubMed/NCBI View Article : Google Scholar

44 

Lander ES, Linton LM, Birren B, Nusbaum C, Zody MC, Baldwin J, Devon K, Dewar K, Doyle M, FitzHugh W, et al: Initial sequencing and analysis of the human genome. Nature. 409:860–921. 2001.PubMed/NCBI View Article : Google Scholar

45 

Wang F, Sun H, Li K, Yang K, Xiang Y and Tian X: CircRASSF2 promotes IGF1R and osteosarcoma metastasis via sponging miR-6838-5p. Ann Transl Med. 10(11)2022.PubMed/NCBI View Article : Google Scholar

46 

Gupta A, Vats A, Ghosal A, Mandal K, Sarkar R, Bhattacharya I, Das S, Pal R and Majumdar SS: Follicle-stimulating hormone-mediated decline in miR-92a-3p expression in pubertal mice Sertoli cells is crucial for germ cell differentiation and fertility. Cell Mol Life Sci. 79(136)2022.PubMed/NCBI View Article : Google Scholar

47 

Bartel DP: Metazoan MicroRNAs. Cell. 173:20–51. 2018.PubMed/NCBI View Article : Google Scholar

48 

Hansen TB, Venø MT, Jensen TI, Schaefer A, Damgaard CK and Kjems J: Argonaute-associated short introns are a novel class of gene regulators. Nat Commun. 7(11538)2016.PubMed/NCBI View Article : Google Scholar

49 

Vincent K, Pichler M, Lee GW and Ling H: MicroRNAs, genomic instability and cancer. Int J Mol Sci. 15:14475–14491. 2014.PubMed/NCBI View Article : Google Scholar

50 

Fabian MR, Sonenberg N and Filipowicz W: Regulation of mRNA translation and stability by microRNAs. Annu Rev Biochem. 79:351–379. 2010.PubMed/NCBI View Article : Google Scholar

51 

Liu H, Lei C, He Q, Pan Z, Xiao D and Tao Y: Nuclear functions of mammalian MicroRNAs in gene regulation, immunity and cancer. Mol Cancer. 17(64)2018.PubMed/NCBI View Article : Google Scholar

52 

Leucci E, Patella F, Waage J, Holmstrøm K, Lindow M, Porse B, Kauppinen S and Lund AH: microRNA-9 targets the long non-coding RNA MALAT1 for degradation in the nucleus. Sci Rep. 3(2535)2013.PubMed/NCBI View Article : Google Scholar

53 

Zitzer NC, Garzon R and Ranganathan P: Toll-like receptor stimulation by MicroRNAs in acute graft-vs-host disease. Front Immunol. 9(2561)2018.PubMed/NCBI View Article : Google Scholar

54 

Zhao S, Yao D, Chen J and Ding N: Circulating miRNA-20a and miRNA-203 for screening lymph node metastasis in early stage cervical cancer. Genet Test Mol Biomarkers. 17:631–636. 2013.PubMed/NCBI View Article : Google Scholar

55 

Ma Q, Wan G, Wang S, Yang W, Zhang J and Yao X: Serum microRNA-205 as a novel biomarker for cervical cancer patients. Cancer Cell Int. 14(81)2014.PubMed/NCBI View Article : Google Scholar

56 

Kong Q, Tang Z, Xiang F, Jiang J, Yue H, Wu R and Kang X: Diagnostic value of serum hsa-mir-92a in patients with cervical cancer. Clin Lab. 63:335–340. 2017.PubMed/NCBI View Article : Google Scholar

57 

Hoelzle CR, Arnoult S, Borém CRM, Ottone M, de Magalhaes KCSF, da Silva IL and Simoes RT: MicroRNA levels in cervical cancer samples and relationship with lesion grade and HPV infection. Microrna. 10:139–145. 2021.PubMed/NCBI View Article : Google Scholar

58 

Zhang Y, Qiu S, Guo Y, Zhang J, Wu X and Hong G: Diagnostic value of vaginal microecology, serum miR-18a, and PD-L1 for identifying HPV-positive cervical cancer. Technol Cancer Res Treat. 20(1533033821995281)2021.PubMed/NCBI View Article : Google Scholar

59 

Cai Y, Zhang K, Cao L, Sun H and Wang H: Inhibition of microrna-766-5p attenuates the development of cervical cancer through regulating SCAI. Technol Cancer Res Treat. 19(1533033820980081)2020.PubMed/NCBI View Article : Google Scholar

60 

Ocadiz-Delgado R, Lizcano-Meneses S, Trejo-Vazquez JA, Conde-Perezprina JC, Garrido-Palmas F, Alvarez-Rios E, García-Villa E, Ruiz G, Illades-Aguiar B, Leyva-Vázquez MA, et al: Circulating miR-15b, miR-34a and miR-218 as promising novel early low-invasive biomarkers of cervical carcinogenesis. APMIS. 129:70–79. 2021.PubMed/NCBI View Article : Google Scholar

61 

Yang D and Zhang Q: miR-152 may function as an early diagnostic and prognostic biomarker in patients with cervical intraepithelial neoplasia and patients with cervical cancer. Oncol Lett. 17:5693–5698. 2019.PubMed/NCBI View Article : Google Scholar

62 

Ding N, Lu Y, Zhu SL, Zhao S, Chen JY, He CJ, Ren F and Yao DS: MiR-17 promotes cervical squamous cell tumorigenesis and metastasis by targeting E2F1. Int J Clin Exp Pathol. 9:10224–10232. 2016.

63 

Shukla V, Varghese VK, Kabekkodu SP, Mallya S, Chakrabarty S, Jayaram P, Pandey D, Banerjee S, Sharan K and Satyamoorthy K: Enumeration of deregulated miRNAs in liquid and tissue biopsies of cervical cancer. Gynecol Oncol. 155:135–143. 2019.PubMed/NCBI View Article : Google Scholar

64 

Pulati N, Zhang Z, Gulimilamu A, Qi X and Yang J: HPV16+ -miRNAs in cervical cancer and the anti-tumor role played by miR-5701. J Gene Med. 21(e3126)2019.PubMed/NCBI View Article : Google Scholar

65 

Zhou CF, Ma J, Huang L, Yi HY, Zhang YM, Wu XG, Yan RM, Liang L, Zhong M, Yu YH, et al: Cervical squamous cell carcinoma-secreted exosomal miR-221-3p promotes lymphangiogenesis and lymphatic metastasis by targeting VASH1. Oncogene. 38:1256–1268. 2019.PubMed/NCBI View Article : Google Scholar

66 

Zhu X, Long L, Xiao H and He X: Cancer-derived exosomal miR-651 as a diagnostic marker restrains cisplatin resistance and directly targets ATG3 for cervical cancer. Dis Markers. 2021(1544784)2021.PubMed/NCBI View Article : Google Scholar

67 

Yamanaka Z, Sasaki T, Yamanaka A, Kato K and Nishi H: Circulating and tissue miR-100 acts as a potential diagnostic biomarker for cervical cancer. Cancer Biomark. 32:551–558. 2021.PubMed/NCBI View Article : Google Scholar

68 

Lv A, Tu Z, Huang Y, Lu W and Xie B: Circulating exosomal miR-125a-5p as a novel biomarker for cervical cancer. Oncol Lett. 21(54)2021.PubMed/NCBI View Article : Google Scholar

69 

Zheng M, Hou L, Ma Y, Zhou L, Wang F, Cheng B, Wang W, Lu B, Liu P, Lu W and Lu Y: Exosomal let-7d-3p and miR-30d-5p as diagnostic biomarkers for non-invasive screening of cervical cancer and its precursors. Mol Cancer. 18(76)2019.PubMed/NCBI View Article : Google Scholar

70 

Zhang Y, Zhang D, Wang F, Xu D, Guo Y and Cui W: Serum miRNAs panel (miR-16-2*, miR-195, miR-2861, miR-497) as novel non-invasive biomarkers for detection of cervical cancer. Sci Rep. 5(17942)2015.PubMed/NCBI View Article : Google Scholar

71 

Xin F, Liu P and Ma CF: A circulating serum miRNA panel as early detection biomarkers of cervical intraepithelial neoplasia. Eur Rev Med Pharmacol Sci. 20:4846–4851. 2016.PubMed/NCBI

72 

Wang WT, Zhao YN, Yan JX, Weng MY, Wang Y, Chen YQ and Hong SJ: Differentially expressed microRNAs in the serum of cervical squamous cell carcinoma patients before and after surgery. J Hematol Oncol. 7(6)2014.PubMed/NCBI View Article : Google Scholar

73 

Subhash S, Mishra K, Akhade VS, Kanduri M, Mondal T and Kanduri C: H3K4me2 and WDR5 enriched chromatin interacting long non-coding RNAs maintain transcriptionally competent chromatin at divergent transcriptional units. Nucleic Acids Res. 46:9384–9400. 2018.PubMed/NCBI View Article : Google Scholar

74 

Montero JJ, López-Silanes I, Megías D, F Fraga M, Castells-García Á and Blasco MA: TERRA recruitment of polycomb to telomeres is essential for histone trymethylation marks at telomeric heterochromatin. Nat Commun. 9(1548)2018.PubMed/NCBI View Article : Google Scholar

75 

Kallen AN, Zhou XB, Xu J, Qiao C, Ma J, Yan L, Lu L, Liu C, Yi JS, Zhang H, et al: The imprinted H19 lncRNA antagonizes let-7 microRNAs. Mol Cell. 52:101–112. 2013.PubMed/NCBI View Article : Google Scholar

76 

Li J, Wang Y, Yu J, Dong R and Qiu H: A high level of circulating HOTAIR is associated with progression and poor prognosis of cervical cancer. Tumour Biol. 36:1661–1665. 2015.PubMed/NCBI View Article : Google Scholar

77 

Catanzaro JM, Guerriero JL, Liu J, Ullman E, Sheshadri N, Chen JJ and Zong WX: Elevated expression of squamous cell carcinoma antigen (SCCA) is associated with human breast carcinoma. PLoS One. 6(e19096)2011.PubMed/NCBI View Article : Google Scholar

78 

Qiao D, Qin X, Yang H, Liu X, Liu L, Liu S and Jia Z: Estradiol mediates the interaction of LINC01541 and miR-429 to promote angiogenesis of G1/G2 endometrioid adenocarcinoma in-vitro: A pilot study. Front Oncol. 12(951573)2022.PubMed/NCBI View Article : Google Scholar

79 

Lu Z, Zhang Y, Yan X, Chen Y, Tao X, Wang J, Jia N, Lyu T, Wang J, Ding J, et al: Estrogen stimulates the invasion of ovarian cancer cells via activation of the PI3K/AKT pathway and regulation of its downstream targets E-cadherin and α-actinin-4. Mol Med Rep. 10:2433–2440. 2014.PubMed/NCBI View Article : Google Scholar

80 

Liu L, Liu S, Luo H, Chen C, Zhang X, He L and Tu G: GPR30-mediated HMGB1 upregulation in CAFs induces autophagy and tamoxifen resistance in ERα-positive breast cancer cells. Aging (Albany NY). 13:16178–16197. 2021.PubMed/NCBI View Article : Google Scholar

81 

Johansen JS, Brasso K, Iversen P, Teisner B, Garnero P, Price PA and Christensen IJ: Changes of biochemical markers of bone turnover and YKL-40 following hormonal treatment for metastatic prostate cancer are related to survival. Clin Cancer Res. 13:3244–3249. 2007.PubMed/NCBI View Article : Google Scholar

82 

Hu X, Wang Q, Zhao H, Wu W, Zhao Q, Jiang R, Liu J, Wang L and Yuan P: Role of miR-21-5p/FilGAP axis in estradiol alleviating the progression of monocrotaline-induced pulmonary hypertension. Animal Model Exp Med. 5:217–226. 2022.PubMed/NCBI View Article : Google Scholar

83 

Mandel P and Métais P: Les acides nucléiques du plasma sanguin chez l'homme. C R Seances Soc Biol Ses Fil. 142:241–243. 1948.PubMed/NCBI

84 

Leon SA, Shapiro B, Sklaroff DM and Yaros MJ: Free DNA in the serum of cancer patients and the effect of therapy. Cancer Res. 37:646–650. 1977.PubMed/NCBI

85 

Schwarzenbach H, Hoon DSB and Pantel K: Cell-free nucleic acids as biomarkers in cancer patients. Nat Rev Cancer. 11:426–437. 2011.PubMed/NCBI View Article : Google Scholar

86 

Bettegowda C, Sausen M, Leary RJ, Kinde I, Wang Y, Agrawal N, Bartlett BR, Wang H, Luber B, Alani RM, et al: Detection of circulating tumor DNA in early- and late-stage human malignancies. Sci Transl Med. 6(224ra24)2014.PubMed/NCBI View Article : Google Scholar

87 

Kustanovich A, Schwartz R, Peretz T and Grinshpun A: Life and death of circulating cell-free DNA. Cancer Biol Ther. 20:1057–1067. 2019.PubMed/NCBI View Article : Google Scholar

88 

Wang W, Kong P, Ma G, Li L, Zhu J, Xia T, Xie H, Zhou W and Wang S: Characterization of the release and biological significance of cell-free DNA from breast cancer cell lines. Oncotarget. 8:43180–43191. 2017.PubMed/NCBI View Article : Google Scholar

89 

Trejo-Becerril C, Pérez-Cárdenas E, Taja-Chayeb L, Anker P, Herrera-Goepfert R, Medina-Velázquez LA, Hidalgo-Miranda A, Pérez-Montiel D, Chávez-Blanco A, Cruz-Velázquez J, et al: Cancer progression mediated by horizontal gene transfer in an in vivo model. PLoS One. 7(e52754)2012.PubMed/NCBI View Article : Google Scholar

90 

Marsman G, Zeerleder S and Luken BM: Extracellular histones, cell-free DNA, or nucleosomes: Differences in immunostimulation. Cell Death Dis. 7(e2518)2016.PubMed/NCBI View Article : Google Scholar

91 

Takahashi A, Okada R, Nagao K, Kawamata Y, Hanyu A, Yoshimoto S, Takasugi M, Watanabe S, Kanemaki MT, Obuse C and Hara E: Exosomes maintain cellular homeostasis by excreting harmful DNA from cells. Nat Commun. 8(15287)2017.PubMed/NCBI View Article : Google Scholar

92 

Pornthanakasem W, Shotelersuk K, Termrungruanglert W, Voravud N, Niruthisard S and Mutirangura A: Human papillomavirus DNA in plasma of patients with cervical cancer. BMC Cancer. 1(2)2001.PubMed/NCBI View Article : Google Scholar

93 

Guan T, Guo XY, Ye CL and Jiang YH: Analysis of circulating DNA level in the plasma of cervical cancer patients. Nan Fang Yi Ke Da Xue Xue Bao. 28:1663–1664, 1667. 2008.PubMed/NCBI(In Chinese).

94 

Yang HJ, Liu VWS, Tsang PCK, Yip AMW, Tam KF, Wong LC, Ng TY and Ngan HYS: Quantification of human papillomavirus DNA in the plasma of patients with cervical cancer. Int J Gynecol Cancer. 14:903–910. 2004.PubMed/NCBI View Article : Google Scholar

95 

Venezuela RF, Kiguen AX, Frutos MC and Cuffini CG: Circulation of human papillomavirus (HPV) genotypes in women from Córdoba, Argentina, with squamous intraepithelial lesions. Rev Inst Med Trop Sao Paulo. 54:11–16. 2012.PubMed/NCBI View Article : Google Scholar

96 

Campitelli M, Jeannot E, Peter M, Lappartient E, Saada S, de la Rochefordière A, Fourchotte V, Alran S, Petrow P, Cottu P, et al: Human papillomavirus mutational insertion: Specific marker of circulating tumor DNA in cervical cancer patients. PLoS One. 78(e43393)2012.PubMed/NCBI View Article : Google Scholar

97 

Han K, Leung E, Barbera L, Barnes E, Croke J, Di Grappa MA, Fyles A, Metser U, Milosevic M, Pintilie M, et al: Circulating human papillomavirus DNA as a biomarker of response in patients with locally advanced cervical cancer treated with definitive chemoradiation. JCO Precis Oncol. 2:1–8. 2018.PubMed/NCBI View Article : Google Scholar

98 

Cabel L, C Bonneau C, Bernard-Tessier A, Héquet D, Tran-Perennial C, Bataillon G, Rouzier R, Féron JG, Fourchotte V, Le Brun JF, et al: HPV ctDNA detection of high-risk HPV types during chemoradiotherapy for locally advanced cervical cancer. ESMO Open. 6(100154)2021.PubMed/NCBI View Article : Google Scholar

99 

Tian X, Ge D, Zhang F, Zhang B, Bai W, Xu X, Li Z, Cao Y, Li P, Zou K and Zou L: Dynamic analysis of circulating tumor DNA to predict prognosis and monitor therapeutic response in metastatic relapsed cervical cancer. Int J Cancer. 148:921–931. 2021.PubMed/NCBI View Article : Google Scholar

100 

Fabbri M, Paone A, Calore F, Galli R, Gaudio E, Santhanam R, Lovat F, Fadda P, Mao C, Nuovo GJ, et al: MicroRNAs bind to Toll-like receptors to induce prometastatic inflammatory response. Proc Natl Acad Sci USA. 109:E2110–E2116. 2012.PubMed/NCBI View Article : Google Scholar

101 

Quillien V, Raoul JL, Laurent JF, Meunier B and Le Prise E: Comparison of Cyfra 21-1, TPA and SCC tumor markers in esophageal squamous cell carcinoma. Oncol Rep. 5:1561–1565. 1998.PubMed/NCBI View Article : Google Scholar

102 

Bi H, Yin L, Fang W, Song S, Wu S and Shen J: Association of CEA, NSE, CYFRA 21-1, SCC-Ag, and ProGRP with clinicopathological characteristics and chemotherapeutic outcomes of lung cancer. Lab Med: lmac122, 2022 (Epub ahead of print).

103 

Fatica EM, Larson BJ, Algeciras-Schimnich A and Bornhorst JA: Performance characteristics of the BRAHMS KRYPTOR automated squamous cell carcinoma antigen assay. J Immunol Methods. 504(113257)2022.PubMed/NCBI View Article : Google Scholar

104 

Petrelli NJ, Shaw N, Bhargava A, Daufeldt J, Herrera L, Stulc JP, Sischy B and Mittelman A: Squamous cell carcinoma antigen as a marker for squamous cell carcinoma of the anal canal. J Clin Oncol. 6:782–785. 1988.PubMed/NCBI View Article : Google Scholar

105 

Kommu S, Hadway P and Watkin N: Squamous cell carcinoma antigen as a biomarker for penile cancer. BJU Int. 95:478–479. 2005.PubMed/NCBI View Article : Google Scholar

106 

Huang R, Yao J, Ding X, Liu J, Fan C, Duan H and Ye H: Plasma YKL-40: A potential biomarker for tumor invasion in esophageal cancer. Clin Lab. 66:2020.PubMed/NCBI View Article : Google Scholar

107 

Tomas C, Risteli J, Risteli L, Stenback F and Kauppila A: Measurement of epithelial and stromal changes in vulvar carcinoma-a clinical, biochemical and immunohistochemical study. Int J Oncol. 7:101–105. 1995.PubMed/NCBI

108 

Kannan A, Hertweck KL, Philley JV, Wells RB and Dasgupta S: Genetic mutation and exosome signature of human papilloma virus associated oropharyngeal cancer. Sci Rep. 7(46102)2017.PubMed/NCBI View Article : Google Scholar

109 

Zhang T, Liu Q, Yu M, Lan Y and Zhou J: Expression profiles reveal involvement of VEGF, IGF1, BIRC5, and MMP1 in vulvar carcinogenesis. Technol Cancer Res Treat. 20(15330338211004922)2021.PubMed/NCBI View Article : Google Scholar

110 

Ramqvist T, Näsman A, Franzén B, Bersani C, Alexeyenko A, Becker S, Haeggblom L, Kolev A, Dalianis T and Munck-Wikland E: Protein expression in tonsillar and base of tongue cancer and in relation to human papillomavirus (HPV) and clinical outcome. Int J Mol Sci. 19(978)2018.PubMed/NCBI View Article : Google Scholar

111 

Lassig AAD, Joseph AM, Lindgren BR and Yueh B: Association of oral cavity and oropharyngeal cancer biomarkers in surgical drain fluid with patient outcomes. JAMA Otolaryngol Head Neck Surg. 143:670–678. 2017.PubMed/NCBI View Article : Google Scholar

112 

Emmett SE, Stark MS, Pandeya N, Panizza B, Whiteman DC and Antonsson A: MicroRNA expression is associated with human papillomavirus status and prognosis in mucosal head and neck squamous cell carcinomas. Oral Oncol. 113(105136)2021.PubMed/NCBI View Article : Google Scholar

113 

Weiss BG, Anczykowski MZ, Ihler F, Bertlich M, Spiegel JL, Haubner F, Canis M, Küffer S, Hess J, Unger K, et al: MicroRNA-182-5p and microRNA-205-5p as potential biomarkers for prognostic stratification of p16-positive oropharyngeal squamous cell carcinoma. Cancer Biomark. 33:331–347. 2022.PubMed/NCBI View Article : Google Scholar

114 

Zhang J, Liu SC, Luo XH, Tao GX, Guan M, Yuan H and Hu DK: Exosomal long noncoding RNAs are differentially expressed in the cervicovaginal lavage samples of cervical cancer patients. J Clin Lab Anal. 30:1116–1121. 2016.PubMed/NCBI View Article : Google Scholar

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Volume 18 Issue 2

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Spandidos Publications style
Ruiz Esparza Garrido R, Gutiérrez M and Velázquez Flores MÁ: Circulating cervical cancer biomarkers potentially useful in medical attention (Review). Mol Clin Oncol 18: 13, 2023
APA
Ruiz Esparza Garrido, R., Gutiérrez, M., & Velázquez Flores, M.Á. (2023). Circulating cervical cancer biomarkers potentially useful in medical attention (Review). Molecular and Clinical Oncology, 18, 13. https://doi.org/10.3892/mco.2023.2609
MLA
Ruiz Esparza Garrido, R., Gutiérrez, M., Velázquez Flores, M. Á."Circulating cervical cancer biomarkers potentially useful in medical attention (Review)". Molecular and Clinical Oncology 18.2 (2023): 13.
Chicago
Ruiz Esparza Garrido, R., Gutiérrez, M., Velázquez Flores, M. Á."Circulating cervical cancer biomarkers potentially useful in medical attention (Review)". Molecular and Clinical Oncology 18, no. 2 (2023): 13. https://doi.org/10.3892/mco.2023.2609