ABSTRACT
Purpose@#Diagnostic biomarkers of pancreatic ductal adenocarcinoma (PDAC) have been used for early detection to reduce its dismal survival rate. However, clinically feasible biomarkers are still rare. Therefore, in this study, we developed an automated multi-marker enzyme-linked immunosorbent assay (ELISA) kit using 3 biomarkers (leucine-rich alpha-2-glycoprotein [LRG1], transthyretin [TTR], and CA 19-9) that were previously discovered and proposed a diagnostic model for PDAC based on this kit for clinical usage. @*Methods@#Individual LRG1, TTR, and CA 19-9 panels were combined into a single automated ELISA panel and tested on 728 plasma samples, including PDAC (n = 381) and normal samples (n = 347). The consistency between individual panels of 3 biomarkers and the automated multi-panel ELISA kit were accessed by correlation. The diagnostic model was developed using logistic regression according to the automated ELISA kit to predict the risk of pancreatic cancer (high-, intermediate-, and low-risk groups). @*Results@#The Pearson correlation coefficient of predicted values between the triple-marker automated ELISA panel and the former individual ELISA was 0.865. The proposed model provided reliable prediction results with a positive predictive value of 92.05%, negative predictive value of 90.69%, specificity of 90.69%, and sensitivity of 92.05%, which all simultaneously exceed 90% cutoff value. @*Conclusion@#This diagnostic model based on the triple ELISA kit showed better diagnostic performance than previous markers for PDAC. In the future, it needs external validation to be used in the clinic.
ABSTRACT
Genome-wise association studies (GWASs) have become popular approaches to identify genetic variants associated with human biological traits. In this study, we applied Structural Equation Models (SEMs) in order to model complex relationships between genetic networks and traits as risk factors. SEMs allow us to achieve a better understanding of biological mechanisms through identifying greater numbers of genes and pathways that are associated with a set of traits and the relationship among them. For efficient SEM analysis for GWASs, we developed a procedure, comprised of four stages. In the first stage, we conducted single-SNP analysis using regression models, where age, sex, and recruited area were included as adjusting covariates. In the second stage, Fisher's combination test was conducted for each gene to detect significant genes using p-values obtained from the single-SNP analysis. In the third stage, Fisher's exact test was adopted to determine which biological pathways were enriched with significant SNPs. Finally, based on a pathway that was associated with the four traits in common, a SEM was fit to model a causal relationship among the genetic factors and traits. We applied our SEM model to GWAS data with four central obesity related traits: suprailiac and subscapular measures for upper body fat, BMI, and hypertension. Study subjects were collected from two Korean cohort regions. After quality control, 327,872 SNPs for 8842 individuals were included in the analysis. After comparing two SEMs, we concluded that suprailiac and subscapular measures may indirectly affect hypertension susceptibility by influencing BMI. In conclusion, our analysis demonstrates that SEMs provide a better understanding of biological mechanisms by identifying greater numbers of genes and pathways.