Urinary cancer refers to the presence of cancerous cells in the urinary system, which includes the kidneys, bladder, ureters (the tubes that connect the kidneys to the bladder), and urethra (the tube that carries urine from the bladder out of the body). The most common types of urinary cancer are kidney cancer and bladder cancer, although cancer can also develop in other parts of the urinary system.

Also Read: Types of Bladder Cancer

Overview

Investigating effective biomarkers for malignancies is now a hot topic of study in clinical and medical research since it can lead to pre-cancer screening or pre-cancer diagnosis. It can provide crucial information on urinary cancer's kind and its progression.

At the stage at which the disease progresses, more biochemical or chemical fluid components of the human body, such as urine, blood, and cerebrospinal fluid, are being studied. These biomarkers are valuable in cancer research, pre-cancer diagnosis, and cancer follow-ups or after cancer therapy. Several current Gas Chromatography (GC), High-Performance Liquid Chromatography (HPLC), Capillary Electrophoresis (CE), and other separation techniques, as well as hyphenated techniques, have been widely used in analysis. CE is a very efficient and practical analytical technique due to its modest sample volume requirement and great separation adaptability, ranging from small inorganic compounds to significant biomolecules. Routine urinalysis is commonly used in the modern clinical laboratory to monitor a patient's kidney function, bacterial infection, glucose levels, and other diagnostic reasons. Although it is debatable whether urine, blood, cerebrospinal fluid or another body fluid is more useful in diagnosis, There is no doubt that urine plays a vital role in treating diseases. It helps in determining the Biological matrix for determining a patient's physical condition.

Urinary cancer is currently one of our most serious public health issues. With the advancement of biochemistry and analytical technology, pre-cancer diagnosis has become a hot topic in clinical and preclinical research. As pre-cancer research advances, cancer biomarkers become more visible in providing vital information. It is feasible to determine the kind of cancer and the location of progression of a patient at a very early stage.

The characteristics of an ideal biomarker are as follows:

(i)specific for the malignant process

(ii) tumor type-specific

(iii) easily detectable in body fluids and tissue extracts

(iv) detectable early in the course of disease before the disease is clinically apparent

(v) indicative of the overall tumour cell burden

(vi) indicative of the presence of micrometastases and

(vii) predictive of relapse

Capillary electrophoresis

CE is a very efficient analytical technique that has had a significant impact on biomedical research and clinical and forensic practices during the last decade. CE has been linked to several detection systems based on the type of analytes, including UV-visible analytes.

Absorption, conductimetry, MS, patch-clamp, electrochemical (EC) detection and laser-induced fluorescence are some techniques used. CE has been exceptionally competent in studying a wide range of analytes from tiny molecules using these diverse detection methods (inorganic ions and organic molecules) in comparison to more significant biomolecules (DNA and proteins). Capillary electrophoresis holds several distinct advantages. More and more studies have been recently reported in the area of determination and screening of cancer biomarkers by CE, including nucleosides, ribonucleic acid (RNA), hydroxydeoxyguanosine, DNA mutation, DNA-adduct, glycans, proteins, glycoproteins, and small biomolecules.

1.Modified nucleosides

One type of chemical seen in human urine is nucleic acid breakdown products. RNA, particularly transfer-RNA (tRNA), is a significant source of the modified nucleosides seen in the urine. There are more than 93 changed nucleosides identified in the urine for all RNA forms. Because of these observations, changed nucleosides are currently thought to be a general tumour marker for various cancer types. It includes leukaemias and lymphomas, thyroid cancer, head and neck cancer, breast cancer, ovarian cancer, prostate cancer, lung cancer, and so on. CE was first used to separate and determine nucleosides in 1987 for both ribonucleosides and deoxyribonucleosides. Because nucleosides are uncharged molecules under experimental conditions, micellar electrokinetic capillary chromatography (MEKC) is the primary mode employed in nucleoside separations. According to studies, some nucleoside levels in cancer patients' urine samples are always more significant than those in healthy people. Therefore a pattern recognition method might be utilized to give more information on the disparities between the two groups.

2. DNA adducts, damaged DNA, and 8-hydroxydeoxyguanosine

Many exogenous and endogenous chemicals have been shown to cause DNA mutations via the initial covalent binding of electrophilic or radical intermediates to DNA. This DNA adduction can then result in the structural alteration of a nucleic acid component. If such damages are not healed, irreversible mutations will emerge, triggering degenerative diseases such as cancer. Direct examination of carcinogenic DNA adducts is highly effective.

In determining carcinogenicity, the method must be precise and dependable of xenobiotic chemicals and the study of endogenous carcinogens. According to clinical research, the quantities and identities of DNA adducts can be utilized to assess cancer risk. The investigation of DNA adducts necessitates the identification of approximately one adduct in every 106108 unaltered nucleobases among people who have not been exposed to anything odd. Damaged DNAs, particularly 8-hydroxydeoxyguanosine, are another sort of essential DNA biomarker for cancer (8-OhdG). Among the several types of DNA damage, oxidative damage caused by active oxygen species like two and H2O2 is regarded as one of the most significant factors in degenerative disorders such as cancer, ageing, heart disease, and other diseases associated with old age. DNA analysis is critical for disease diagnosis and the advancement of the genome project.

Aside from speed and automation, CE has various advantages over classical gel electrophoresis (GE).DNA analysis is crucial for illness diagnosis and genome project advancement.

Apart from speed and automation, CE has several advantages over traditional gel electrophoresis (GE). CE can also be used as a highly efficient analytical tool for analyzing specific urine DNA components that serve the same function as other DNA component biomarkers for cancer. 8-OhdG is thought to have the most potential as a cancer-causing DNA mutation. Many studies have shown that urine 8-OHdG concentrations in smokers are 50% greater than in nonsmokers over 24 hours. 8-OhdG has been found as a biomarker for a few forms of cancer including breast cancer, lung cancer, and liver cancer. Because 8-OhdG is eliminated in urine without additional metabolism, urinary 8-OhdG determination has been deemed a noninvasive approach. For the detection of cancer. Nonetheless, the concentration of8-OhdG levels in urine are typically as low as 110 nM.

Preclinical evidence

In a clinical analysis of nine urine samples of healthy persons and ten urine samples of ten cancer patients, it was found that the concentrations of urinary 8-OhdG varied from 6.34 to 21.33 nM in healthy individuals, while it varied from 13.83 to130.12 nM in cancer patients. The excretion level of 8-OhdG in cancer patients was much higher than in healthy people, demonstrating that the approach was practical. It could be used to routinely determine urine 8-OhdG as a cancer biomarker. CE has been used to separate DNA fragments from urine samples in addition to deciding mutations. Acrylamide gel-CE, for example, has been used to isolate sample DNA, amplify a target DNA sequence, and analyze data. Distinguish between mutant and wild-type DNA sequences Kras sequences that can be used to detect mutations p53 gene, as well as colorectal, bladder, bronchus, and pancreas cancer discovery.

3. Proteins, glycans, and glycoproteins

CE is the most promising analytical approach for protein studies due to its distinct benefits over traditional protein separation techniques such as GE and HPLC [28, 103111].CE has been used to diagnose illnesses such as adenylosuccinase deficiency, 5-oxoprolinuria, Bence-Jones proteinuria, and nephrotic syndrome, and it is becoming more popular for use in regular clinical analysis [14-17]

Based on the following research findings, CE offers a high potential for use in a clinical laboratory for screening these compounds and providing diagnostic information.

3.1Paraproteins

Monoclonal components (the immunoglobulin product of a clone of plasma cells) in serum and urine are critical markers for leukaemia and urologic malignancies. CE can screen monoclonal immunoglobulin molecules (paraproteins) because these proteins are small. Researchers have tried to apply this technique to urine samples. However, difficulties have been encountered as a result. The main reason was that the urine samples contained low concentrations of monoclonal components. Even though many laboratories used ultrafiltration concentrators to provide a concentration factor of 10100-fold, it was still not sensitive enough to detect monoclonal IgA with CE and IS-CE. However, the authors believe that the technique will be successfully developed for urine sample analysis shortly.

3.2 Sialic acid and acid glycoprotein

Cancer cells have more heavily sialylated glycans on their surface, and reports have shown significantly elevated sialic acid concentrations in brain tumours, leukaemia, melanomas, malignant pleural effusions, hypopharyngeal and laryngeal carcinomas, cholangiocarcinoma, and urinary cancers of the lung, ovary, endometrium, cervix, prostate, mouth, stomach, breast, and colon.

Clinical evidence

Numerous studies have found a significant association between sialic levels in tumours, which can be employed as prognostic and diagnostic indicators for cancer[19]. However, further clinical research found that the clinical value of sialic acid determination for urinary cancer screening patients was restricted due to its apparent nonspecificity for a particular disease, as well as other nonpathological factors. Age, pregnancy, and contraception use are examples of risk factors. Changes in sialic acid levels may be caused by drugs or smoking.

3.3 Cancer cachexia factor

Cachexia, defined as starvation and the wasting away of body tissues such as cardiac, respiratory, and skeletal muscle tissues, reduces cancer patients' chances of survival. According to a recent investigation, this enhanced muscle proteolysis, usually linked with proteolysis-inducing factor (PIF), has been identified as a sulfated glycoprotein. This glycoprotein could cause muscle protein degradation in isolated gastrocnemius muscle preparations and could influence weight gain loss in vivo. As a result, it was thought to be a sign of cancer cachexia. The same components have been identified in the urine of pancreatic cancer patients, who were trying to lose weight; the Cachexia factor was effectively discovered in the urine of all patients, including one in the early stages of the disease. Precisely the same, the following techniques were used to produce the results multidimensional CE, MLC, and CEC integrated instruments.

4. Some other small biomolecules cancer markers

Aside from the cancer biomarkers mentioned above, a few other small molecules can be used as cancer indicators. Pteridines are a class of biomarkers that could be useful. Pteridine levels are crucial in clinical diagnosis because they are essential cofactors in the process of cell metabolism. Humans eliminate them in urine when the cellular system is increased by certain diseases.

Further research revealed that pteridine concentrations varied according to tumour type and stage of development. Every kind of change in pteridine shows a distinct pattern in tumour concentrations because different pteridine compounds may play numerous roles in many tumour-related disorders.

Further trends

Shortly, significant developments in this area will focus on speeding up, improving sensitivity, and the resolution power of CE analysis due to the complexity of urine samples and low analyte concentrations. CE is a promising technology for separating and analyzing several cancer biomarkers that have recently been discovered, even though its applications are still significantly less than traditional methods HPLC and GE. There will be an increase in the number of applications.

Also Read: Diet and Bladder Cancer

Using urine biomarkers for cancer screening

Because of its noninvasive sampling nature, it will be used in the future. Another conceivable development is the merging of multi biomarkers. The advancement of genomic and proteomic investigations has resulted in many biomarker possibilities for early cancer detection. This will allow us to create "fingerprint" patterns that will be valuable in considering the complex milieu of malignancies and so provide a more precise diagnosis through simultaneous multi-biomarker determination.

Conclusion

Specific biomarkers serve different tasks in biological systems, yet they all have unique properties. Monitoring biomarker concentrations in urine is the most convenient technique for assessing the clinical importance of a cancer patient's state at regular intervals while still predicting tumour formation and relapse. To determine different biomarkers, CE will be a highly efficient analytical technique with great potential in biomarker research due to its advantages of requiring small sample volumes, having high sensitivity and excellent resolution, creating little waste and pollution to the environment, and providing rapid analysis with low cost. Because this approach's history is very brief compared to that of many other analytical techniques, more work remains to be done before CE is extensively employed in routine tests in various clinic laboratories. Simultaneously, other alternative instrumental procedures, such as GC, HPLC, and LC-MS, with diverse detection systems, are used.UV, EC, MS, and LIF will continue to be the primary work. Horses used in biomarker analysis in clinical trial laboratories.

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Reference:

1. Metts MC, Metts JC, Milito SJ, Thomas CR Jr. Bladder cancer: a review of diagnosis and management. J Natl Med Assoc. 2000 Jun;92(6):285-94. PMID: 10918764; PMCID: PMC2640522.