Levels of tissue inhibitor of metalloproteinases 1 in plasma and urine from patients with bladder cancer.

AIM: To assess the potential use of plasma and urine levels of tissue inhibitor of metalloproteinases 1 (TIMP-1) in urothelial cancer. METHODS: TIMP-1 levels were determined in urine and plasma from healthy donors (n=26), patients with bacterial bladder infection (n=24), urothelial bladder adenoma (n=3) or adenocarcinoma (n=7). RESULTS: Free and total TIMP-1 in plasma were weakly but significantly correlated with age; urinary TIMP-1 was not. A strong correlation between free and total TIMP-1 in plasma was observed, with an average ratio of 0.85. No correlation between total TIMP-1 in urine and plasma was found (p=0.55). No significant differences in free or total TIMP-1 in plasma were found between healthy individuals, patients with cystitis or bladder cancer (p=0.4). Urinary TIMP-1 levels were significantly increased in patients with cystitis (p=0.001). No apparent differences in TIMP-1 levels were found in patients with bladder cancer at different stages. CONCLUSION: Our previous observation of a weak but significant correlation between plasma TIMP-1 and age was confirmed. Likewise, an association between free and total TIMP-1 in plasma with a ratio of 0.85 was established. No correlation between plasma and urine TIMP-1 was found. Measurement of TIMP-1 in plasma and/or urine is apparently not useful for the identification of bladder cancer.

Evaluation of sample handling in relation to levels of tissue inhibitor of metalloproteinases-1 measured in blood by immunoassay.

BACKGROUND: The possible effect of preanalytical conditions such as blood sample preparation and handling on TIMP-1 levels in blood needs thorough investigation. MATERIALS AND METHODS: Blood was collected in dry tubes and tubes containing EDTA and kept at 4 degrees C or 20 degrees C for 1, 3, 8, 24 or 72 hours before processing into serum or EDTA plasma. In addition, serum and EDTA plasma samples were frozen and thawed 1-8 times. TIMP-1 was measured by ELISA. RESULTS: Time to processing for up to 72 hours did not significantly affect TIMP-1 levels in serum. In EDTA plasma, TIMP-1 levels were stable for up to eight hours; however, if samples were kept for 24 hours or longer the TIMP-1 levels increased (p < 0.0001). Repeated freezing and thawing had a significant effect on TIMP-1 levels in serum (p = 0.04). In plasma, repeated freezing and thawing for up to six times did not influence TIMP-1. However, in plasma samples exposed to seven or eight freeze/thaw cycles TIMP-1 levels decreased, although not significantly (p = 0.23). CONCLUSIONS: Handling and processing of blood samples is crucial for TIMP-1 measurement by immunoassay. In serum, TIMP-1 levels are unaffected by time to processing. Plasma samples should be processed within eight hours to avoid a TIMP-1 increase. For the measurement of TIMP-1 in archival material, serum should not be used because TIMP-1 levels are significantly affected by repeated freezing and thawing; archival plasma can readily be used provided that samples have not been frozen and thawed more than six times.

Levels of tissue inhibitor of metalloproteinases-1 in blood transfusion components.

Blood transfusion during surgery for solid tumors may reduce patient survival because of various bioactive substances present in blood preparations. The anti-proteolytic protein tissue inhibitor of metalloproteinases-1 (TIMP-1) present in large quantities in platelets has been shown to stimulate cell growth and to inhibit apoptosis and may therefore be considered to influence tumor progression. We measured TIMP-1 levels in blood transfusion preparations. especially in platelet-containing preparations, before and after leucofiltration and at different time-points during storage. The mean TIMP-1 levels in whole blood (WB) and platelet-rich plasma (PRP) were slightly reduced by leucofiltration; WB: 41.6 microg/L versus 34.9 microg/L. PRP: 139.8 microg/L versus 127.2 microg/L. However, with prestorage leucofiltration. TIMP-1 levels in buffy-coat-derived platelet (BCP) pools were significantly reduced from 134.2 microg/L to 102.2 microg/L (p=0.0013). In saline-adenine-glucose-mannitol (SAG-M) blood preparations in which the platelet content is reduced by more than 99%,. TIMP-1 could not be detected. Extracellular TIMP-1 accumulated significantly in non-filtered WB and in aferesis platelet concentrates (APC), but TIMP-1 was at no time detectable in SAG-M blood during storage. In conclusion. TIMP-1 is present in various platelet-containing blood preparations, but not in platelet-free preparations such as SAG-M, indicating that most of the TIMP-1 measured in blood preparations originates from platelets. Furthermore, TIMP-1 levels increased during storage in preparations containing platelets. which suggests a continuous disintegration of platelets. These data imply that information on preoperative blood transfusions should be taken into account when evaluating plasma TIMP-1 levels in patients.

High preoperative plasma tissue inhibitor of metalloproteinase-1 levels are associated with short survival of patients with colorectal cancer.

The objective of the present study was to measure preoperative plasma tissue inhibitor of metalloproteinase (TIMP)-1 levels in colorectal cancer patients and relate these values to clinical and biochemical patient characteristics. TIMP-1 levels were determined by ELISA in EDTA plasma samples collected preoperatively from 588 colorectal cancer patients. Plasma TIMP-1 levels were distributed with a median value of 141.1 microg/liter (range, 53.7-788.7 microg/liter). Whereas no significant differences were found in the median plasma TIMP-1 levels among patients with Dukes' stage A, B, and C disease, patients with Dukes' stage D disease had significantly higher plasma TIMP-1 levels (P < 0.0001); however, high plasma TIMP-1 levels were not restricted to advanced disease. A relatively weak correlation between plasma TIMP-1 level and age was found (r = 0.35; P < 0.0001). There was no significant difference in TIMP-1 levels between males and females (P = 0.97). Univariate analysis demonstrated an increasing risk of mortality with increasing TIMP-1 levels [scored as the log(e)(TIMP-1); hazard ratio = 3.3; 95% confidence interval, 2.6-4.2; P < 0.0001]. Including covariates (Dukes' stage, primary tumor location, gender, age, plasminogen activator inhibitor type 1, and soluble urokinase plasminogen activator receptor) in a multivariate analysis, TIMP-1 was retained in the final model (hazard ratio = 2.5; 95% confidence interval, 1.7-3.7; P < 0.0001). This study showed a highly significant association between preoperative plasma TIMP-1 levels and survival in colorectal cancer patients, with higher plasma TIMP-1 levels being associated with poor outcome. Independent of clinical parameters including Dukes' stage, plasma TIMP-1 levels were found to strongly predict prognosis of colorectal cancer patients. Additional studies are needed to validate the clinical usefulness of plasma TIMP-1 measurements.

Quantitation of TIMP-1 in plasma of healthy blood donors and patients with advanced cancer.

A kinetic enzyme-linked immunosorbent assay (ELISA) for plasma tissue inhibitor of metalloproteinase (TIMP)-1 was developed in order to examine the potential diagnostic and prognostic value of TIMP-1 measurements in cancer patients. The ELISA enabled specific detection of total TIMP-1 in EDTA, citrate and heparin plasma. The assay was rigorously tested and requirements of sensitivity, specificity, stability and good recovery were fulfilled. TIMP-1 levels measured in citrate plasma (mean 69.2+/-13.1 microg I(-1)) correlated with TIMP-1 measured in EDTA plasma (mean 73.5+/-14.2 microg I(-1)) from the same individuals in a set of 100 healthy blood donors (Spearman's rho = 0.62, P< 0.0001). The mean level of TIMP-1 in EDTA plasma from 143 patients with Dukes' stage D colorectal cancer was 240+/-145 microg I(-1) and a Mann-Whitney test demonstrated a highly significant difference between TIMP-1 levels in healthy blood donors and colorectal cancer patients (P < 0.0001). Similar findings were obtained for 19 patients with advanced breast cancer (mean 292+/-331 microg I(-1)). The results show that TIMP-1 is readily measured in plasma samples by ELISA and that increased levels of TIMP-1 are found in patients with advanced cancer. It is proposed that plasma measurements of TIMP-1 may have value in the management of cancer patients.