Pleural fluid cell-free DNA in parapneumonic pleural effusion

Alarcón, José; Batalha-Caetano, Paula; Macher, Hada C.; Guerrero, Juan M.

doi:10.1016/j.clinbiochem.2015.07.096

Cited by 9 publications

(5 citation statements)

References 9 publications

(7 reference statements)

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“…9 MPEs have a far lower burden of extracellular DNA, reducing the need for DNase. 16 There are several limitations to this study, most notably its retrospective nature and small sample size, in particular for patients treated with repeat procedures. There was no formal protocolized manner in which a particular intervention was selected outside of standard risk-benefit discussion between physicians and patients, which increases the potential for selection bias.…”

Section: Discussionmentioning

confidence: 98%

“…In the MIST2 trial of intrapleural tPA-DNase for the treatment of empyema, authors postulated that DNase was required to cleave free extracellular DNA and other bacterial components, reducing fluid viscosity and thus permitting pleural clearance by fibrinolytic drugs 9 . MPEs have a far lower burden of extracellular DNA, reducing the need for DNase 16 …”

Section: Discussionmentioning

confidence: 99%

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Combination Tissue Plasminogen Activator and DNase for Loculated Malignant Pleural Effusions

Chan

Sekowski

Zheng

et al. 2022

Journal of Bronchology &Amp; Interventional Pulmonology

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Background: Indwelling pleural catheters (IPCs) are frequently used for the management of malignant pleural effusions (MPEs), but drainage can be impaired by pleural loculations. We aimed to evaluate the safety and effectiveness of intrapleural tissue plasminogen activator (tPA) versus combination tPA-deoxyribonuclease (DNase) in the treatment of loculated MPE. Methods: We performed a retrospective review of patients with confirmed or presumed MPEs requiring IPC insertion. We compared the efficacy of intrapleural tPA, tPA-DNase, and procedural intervention on pleural fluid drainage. Secondary endpoints included the need for future pleural procedures (eg, thoracentesis, IPC reinsertion, chest tube insertion, or surgical intervention), IPC removal due to spontaneous pleurodesis, and IPC-related complications. Results: Among 437 patients with MPEs, loculations developed in 81 (19%) patients. Twenty-four (30%) received intrapleural tPA, 46 (57%) received intrapleural tPA-DNase, 4 (5%) underwent a procedural intervention, and 7 (9%) received ongoing medical management. tPA improved pleural drainage in 83% of patients, and tPA-DNase improved pleural drainage in 80% of patients. tPA alone may be associated with increased rates of spontaneous pleurodesis compared with tPA-DNase. There was no difference in complications when comparing tPA, combination tPA-DNase, procedural intervention, and no therapy. Conclusion: Both intrapleural tPA and combination tPA-DNase appear to be safe and effective in improving pleural fluid drainage in selected patients with loculated MPE, although further studies are needed.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Combination Tissue Plasminogen Activator and DNase for Loculated Malignant Pleural Effusions

Chan

Sekowski

Zheng

et al. 2022

Journal of Bronchology &Amp; Interventional Pulmonology

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“…Two studies have evaluated pleural fluid cell-free DNA for diagnosis of PPE [10, 13]. While we used the β-globin gene to represent nuclear DNA and the ND2 gene to represent mitochondria DNA, both previous studies used only the β-globin gene to represent cell-free DNA.…”

Section: Discussionmentioning

confidence: 99%

“…Cell-free DNA can exist in biological fluids other than plasma such as cerebrospinal and pleural fluids. Although pleural fluid cell-free DNA has had a higher area under curve (AUC) (0.904-0.950) for diagnosis of PPE in previous studies, case numbers have been low, and the relationship of pleural fluid cell-free DNA levels with PPE severity has not been adequately addressed [10, 13]. The aim of this study was to evaluate the use of both serum and pleural fluid cell-free DNA levels for diagnosis of PPE and to determine whether these levels correlate with severity of PPE.…”

Section: Introductionmentioning

confidence: 99%

Diagnosis of Parapneumonia Pleural Effusion with Serum and Pleural Fluid Cell-Free DNA

Kung

Hsiao

et al. 2019

BioMed Research International

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Objective. As cell-free DNA levels in the pleural fluid and serum of parapneumonic pleural effusion (PPE) patients have not been thoroughly explored, we evaluated their diagnostic potential. Methods. Twenty-two PPE and 16 non-PPE patients were evaluated. Serum and pleural fluids were collected, and cell-free DNA was quantified. All biomarkers were assessed for correlation with days after admission. Receiver operating characteristic (ROC) curve analysis was used to determine diagnostic accuracy and optimal cut-off point. Results. Nuclear and mitochondrial DNA levels in the pleural fluid and nuclear DNA levels in serum of PPE patients were significantly higher than in those of the non-PPE patients. However, only cell-free DNA levels in pleural fluid correlated with days after admission among PPE patients (r= 0.464, 0.538, respectively). ROC curve analysis showed that nuclear and mitochondrial DNA in pleural fluid had AUCs of 0.945 and 0.889, respectively. With cut-off values of 134.9 and 17.8 ng/ml for nuclear and mitochondrial DNA in pleural fluid, respectively, 96% sensitivity and 81% specificity were observed for PPE diagnosis. Conclusion. Nuclear and mitochondrial DNA in pleural fluid possess PPE diagnostic potential and correlated with disease severity. Serum nuclear DNA could also be used to distinguish freshly admitted PPE patients (Day 1) from non-PPE patients, but with less accuracy.

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“…In contrast, an exudate implies inflammatory and cellular responses into the pleural cavity due to an increased microvessel permeability and/or lymphatic blockage [ 16 ]. The infiltration of leukocytes in infectious PE constitutes a source of cfDNA from dying cells [ 17 ], whereas the presence of a pleural tumor increases ctDNA concentrations. MPEs, which are typically exudative, showed a significant increase in cfDNA compared to transudative PEs.…”

Section: Tumor-derived Products In the Pleural Fluidmentioning

confidence: 99%

Diving into the Pleural Fluid: Liquid Biopsy for Metastatic Malignant Pleural Effusions

Sorolla

Parisi

et al. 2021

Cancers

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Liquid biopsy is emerging as a promising non-invasive diagnostic tool for malignant pleural effusions (MPE) due to the low sensitivity of conventional pleural fluid (PF) cytological examination and the difficulty to obtain tissue biopsies, which are invasive and require procedural skills. Currently, liquid biopsy is increasingly being used for the detection of driver mutations in circulating tumor DNA (ctDNA) from plasma specimens to guide therapeutic interventions. Notably, malignant PF are richer than plasma in tumor-derived products with potential clinical usefulness, such as ctDNA, micro RNAs (miRNAs) and long non-coding RNAs (lncRNAs), and circulating tumor cells (CTC). Tumor-educated cell types, such as platelets and macrophages, have also been added to this diagnostic armamentarium. Herein, we will present an overview of the role of the preceding biomarkers, collectively known as liquid biopsy, in PF samples, as well as the main technical approaches used for their detection and quantitation, including a proper sample processing. Technical limitations of current platforms and future perspectives in the field will also be addressed. Using PF as liquid biopsy shows promise for use in current practice to facilitate the diagnosis and management of metastatic MPE.

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Pleural fluid cell-free DNA in parapneumonic pleural effusion

Cited by 9 publications

References 9 publications

Combination Tissue Plasminogen Activator and DNase for Loculated Malignant Pleural Effusions

Combination Tissue Plasminogen Activator and DNase for Loculated Malignant Pleural Effusions

Diagnosis of Parapneumonia Pleural Effusion with Serum and Pleural Fluid Cell-Free DNA

Diving into the Pleural Fluid: Liquid Biopsy for Metastatic Malignant Pleural Effusions

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