1.A study of tissue biomarkers in gastric cancer and its precursors
Nyam-Erdene N ; Tsogzolmaa Sh ; Batchimeg B ; Nomin-Erdene D ; Tuul B ; Оyunbileg N ; Zorigoo Sh ; Ganchimeg D ; Munkhbayar S ; Baasanjav N ; Tulgaa L
Mongolian Medical Sciences 2024;209(3):21-28
Background:
Specifically, stomach cancer ranks as the fifth leading cause of cancer morbidity
and mortality worldwide. Early-stage detection significantly improves survival rates,
with over 90% of patients diagnosed at stages I and II living beyond five years. To
improve the early detection of gastric cancer, it is necessary to complement the
conventional method of endoscopic examination with biomarker analysis. We aimed
to compare biomarkers such as pepsinogen C (PGC), matrix metalloproteinase 2
(MMP2), matrix metalloproteinase 9 (MMP9), and the cell proliferation marker Ki-67
with immunohistochemical analysis.
Purpose:
A comparative study and evaluation of biomarkers for the early detection of gastric
cancer.
Materials and Methods:
The study was conducted using a retrospective cohort design. Research ethics
issues were discussed at the meeting of the Medical Ethics Control Committee of
the Ministry of Health on October 13, 2023, and permission to start the research
was obtained (Resolution No. 23/051). The information was gathered based on the
criteria for K29.3, K29.4, K31, and C1 diagnoses according to the international ICD
10 classification, and participants were selected accordingly. Proteins such as PGC,
MMP2, MMP9, and Ki-67 were examined using a tissue microarray kit and evaluated
through immunohistochemical analysis.
Results:
Negative gastric tumor markers PGC, Ki-67, MMP2 and MMP9 were evaluated
by immunohistochemical analysis. The mean PGC protein staining values were
6.20±2.61 for chronic superficial gastritis, 5.45±2.47 for atrophic gastritis, 3.61±2.0 for
metaplasia, and 3.31±1.75 for gastric cancer, with statistically significant differences
between the groups (P<0.001). The mean Ki-67 protein staining values were 0.1 ±
0.4 for chronic superficial gastritis, 0.33 ± 0.55 for atrophic gastritis, 0.09 ± 0.39 for
metaplasia, and 2.62 ± 0.78 for gastric cancer, also showing statistically significant
differences (P<0.001). The mean MMP2 and MMP9 protein staining values were
0.2±0.76 and 1.2±2.04, respectively, for chronic superficial gastritis; 0.28±0.52
and 3.28±2.82 for atrophic gastritis; 0.35±1.04 and 1.12±1.45 for metaplasia; and
1.38±2.11 and 5.29±2.51 for gastric cancer, with all differences being statistically
significant (P<0.001).
Conclusion
PGC protein, a negative tumor marker, decreases during the transition
from a gastric cancer precursor to cancer. MMP2 protein, a marker of cell migration
and metastasis, has little diagnostic value, while the expression of MMP9 and the Ki
67 are highly effective in gastric cancer. Immunohistochemical analysis of endoscopic
biopsy tissue to detect the negative tumor marker PGC, the positive marker Ki-67,
and MMP9 can be used for early detection of gastric cancer.
2.Spinal muscular atrophy: recent achievements in epidemiology, testing and gene therapy
Sarantsetseg T ; Erdenetuya D ; Yesukhei B ; Khandsuren B ; Oyungerel B ; Bolormaa D ; Mandakhnar M ; Tuul O ; Yundendash D ; Nyam-Erdene N ; Batchimeg B ; Munkhbayar S ; Chimedlkham B ; ;
Mongolian Medical Sciences 2023;205(4):75-83
Background:
Spinal Muscular Atrophy (SMA), an autosomal recessive disorder characterized by lower motor neuron
loss, leads to progressive muscle weakness and atrophy. With a neonatal incidence ranging from
1:6000 to 1:11000, individuals affected by SMA face challenges in locomotor function. The advent
of newborn screening tests, early diagnostic techniques, and the introduction of gene therapy have,
however, shown promise in enabling the acquisition of these motor skills.
Objective:
This review article seeks to shed a light on current understandings of the epidemiology, clinical
presentations, diagnostic methods, and treatments for spinal muscular atrophy, highlighting cutting
edge approaches within the discipline.
Methods:
A thorough search was conducted on PubMed, Cochrane, National Institutes of Health, and Web
of Science databases for recent research articles concerning SMA’s incidence, prevalence, clinical
manifestations, early detection, genetic testing and contemporary gene therapy.
Results:
The prevalence of SMA stands at 1-2 cases per 100,000 population, with an incidence of approximately
8 cases per 100,000 live births. Pre-1995 studies exhibited varying prevalence rates due to using non
molecular-biological methods, small localized populations, diagnostic errors, and regional characteristics.
Diagnosis involving Multiplex ligation-dependent probe amplification (MLPA), quantitative polymerase
chain reaction (qPCR), or next-generation sequencing (NGS) analysis to confirm SMN1 and SMN2
gene status aids in identifying carriers and SMA subtypes. Countries implementing newborn screening
programs have demonstrated early SMA detection in asymptomatic newborns, contributing to reduced
mortality and disability rates. Currently, several types of gene therapy are being used in the treatment
of SMA.
Conclusion
The epidemiology of SMA varies between countries and regions. It is fully possible to confirm the
disease, identify carriers and subtypes. The inclusion of SMA in newborn early detection programs is
crucial for reducing infant mortality and disability, and several gene therapies have received approval from relevant authorities for SMA treatment. In Mongolia, it is possible to introduce tests to confirm the
disease and determine carriers and subtypes.
3.Chronic kidney disease and serum NT-proBNP level
Sodgerel B ; Anudari I ; Buyandelger J ; Pilmaa Yo ; Gantogtokh D ; Yesukhei E ; Bilguun E ; Nyam-Erdene N ; Yundendash D ; Munkhbayar S ; Bolormaa Do ; Sarangerel Ga ; Munkhzul D ; Batbold B ; Sodnomtsogt L
Mongolian Medical Sciences 2024;210(4):9-17
Background:
Serum natriuretic peptide (NT-proBNP) is a critical biomarker for diagnosing left ventricular
dysfunction. Heart failure is the leading cause of mortality in chronic kidney disease (CKD),
emphasizing the need for its early detection and prognosis.
Objective:
This study aimed to determine the serum NT-proBNP levels in participants with CKD and
establish a cut-off value for predicting heart failure.
Methods:
A descriptive cross-sectional study was conducted from April 1 to July 1,2024. This study
received approval from the Ethics Committee of the Institute of Medical Sciences (Approval
No.24/01). A total of 117 CKD patients hospitalized in the Nephrology and Endocrinology
Department of the third state hospital were enrolled based on predefined inclusion and
exclusion criteria. Data were collected using questionnaires, laboratory and heart ultrasound
test results. Serum NT-proBNP levels were measured using a rapid immunofluorescence
quantitative analyzer. Data were analyzed with SPSS 26.0.
Results:
The mean age of the 117 participants was 57.9 ± 14.7 years, with 51.3% being male. The
mean serum NT-proBNP level was 7686 ± 12149 pg/mL. Statistically significant differences
were observed in serum creatinine, sodium, calcium, CKD stage, and arterial hypertension
between genders (p<0.05). NT-proBNP levels in hemodialysis patients differed significantly
between heart failure and non-heart failure groups (p<0.05). Significant differences were
also found in hemoglobin, serum albumin, NT-proBNP levels, and CKD stages (p<0.05).
NT-proBNP correlated significantly with risk factors such as hemodialysis, diabetes, and decreased systolic blood pressure (p<0.0001). A weak inverse relationship was noted
between systolic blood pressure and NT-proBNP (R² = 0.16). The NT-proBNP cut-off value
for predicting heart failure was 3027 pg/mL, with an AUC of 61.7% (sensitivity: 74.5%,
specificity: 55%).
Conclusion
Serum NT-proBNP levels are elevated in CKD patients regardless of heart
failure. The established cut-off value for NT-proBNP in CKD patients to detect heart failure
was 3027 pg/mL, with moderate diagnostic utility (AUC = 61.7%).
4.A result of the detection of homozygous deletion of SMN1 gene in the spinal muscular atrophy
Esukhei E ; Khandsuren B ; Erdenetuya D ; Bolormaa D ; Mandakhnar M ; Oyungerel B ; Sarantsetseg S ; Yundendash D ; Nyam-Erdene N ; Batchimeg B ; Altansukh Ts ; Munkhbayar S ; Chimeglkham B
Mongolian Medical Sciences 2024;207(1):20-29
Background:
Spinal muscular atrophy (SMA) is a degenerative neuromuscular disease that causes progressive
muscle weakness and atrophy due to the loss of the motor neurons. Approximately 95% of patients
with SMA are homozygous for the deletion of SMN1 exon 7. With an incidence of 1/10.000 and a carrier
frequency of 1/40 to 1/50, SMA is the most common genetic cause of death in infants.
Purpose:
To detect homozygous deletion of SMN1 exon 7 and to analyse the SMN1 copy number by molecular
genetic analysis.
Materials and Methods:
In this study, 3 SMA patients with SMN1 gene homozygous deletion and 17 people of their relatives were
included. Molecular genetic analysis was performed in the Central Scientific Research Laboratory of the
Institute of Medical Sciences. DNA was extracted from peripheral blood, and its purity was assessed by
spectrophotometer. Homozygous deletion of SMN1 gene was analyzed with allele-specific PCR, and
the SMN1 gene copy number was evaluated by real-time PCR.
Results:
Among the five participants diagnosed with SMA by clinical symptom and electromyographic test, three
cases were found to have homozygous deletion of exon 7 of the SMN1 gene, while two cases did not
exhibit such mutation by the allele specific PCR analysis.
The mean age of study participants was 27.76±16.07 (ranging from 8 months to 52 years).
Six of the 7 relatives of the first proband had 1 copy number of SMN1 (0.75±0.29) or were carriers
of SMA, while one had 3 copy numbers (2.99) or no deletion of SMN1 gene. Additionally, 6 of the 7
individuals of the second proband had 1 copy number of the SMN1 gene (0.72±0.14), and 1 person
had 2 copy numbers. All 3 relatives of the third proband had 1 copy number of SMN1 gene (0.96±0.37).
Conclusion
We consider that determination of SMN1 gene homozygous deletion and carrier testing
can be performed by the PCR method locally. Further, it is necessary to implement the molecular
genetic testing method into practice and to study the requirements and needs of early detection of SMA
in the newborn screening program of Mongolia.