In their study, MSH2 and MLH1 levels were normalized relative to beta-tubulin levels and the level of MMR proteins in the heterozygous immortalized lymphocyte extracts was reported as percentage of the mean value of three controls. Their quantification of MMR protein levels was not determined as a ratio between MSH2 and MLH1 as we did in our study. While they claim that MLH1 protein levels were not decreased in MLH1+/- cells, their reported data for MLH1 levels show a wide range of variation. Their calculated mean MLH1 protein level for the 12
MLH1+/- lymphocyte find more cell lines was 86.8% of controls, but the range was 44% to 117% of controls with the standard deviation (SDE) being ± 19.1. Given that there was such a wide range, it seems as though MLH1 levels are actually reduced in several of their immortalized lymphocyte lines that are heterozygous for MLH1 mutations. Although our immunoassay is based Apoptosis inhibitor on protein expression, it should have several advantages over assays based on genetic tests. Genetic tests such as DNA sequencing and microsatellite analysis are accurate, but are more expensive, take longer to do, and are mainly available at commercial
laboratories. Also, DNA sequencing and microsatellite analysis is often done on patients who already have cancer and have a positive history of cancer. For these reasons, using genetic tests is not a practical way to screen large populations. In contrast, an immunoassay such as ours could be advanced to an automated diagnostic platform that is inexpensive, rapid and widely available. Moreover, since an immunoassay does not detect a genetic alteration, testing should not require a signed informed consent,
which would be required for patients undergoing genetic testing. Indeed, in testing tumor tissues from patients who have already developed colon cancer for LS, an immunoassay (i.e., immunohistochemistry) is often used as a pre-screen Carnitine dehydrogenase before gene sequencing. In this case, Navitoclax chemical structure immunohistochemistry is considered to be more feasible than the more complex strategy of genotyping for MSI . Moreover, immunohistochemistry on tumor tissue is widely available, cost effective, and widely done without informed consent. This illustrates that clinicians are quite familiar with the use of immunoassays to diagnose human diseases. Also, we are currently in the process of advancing our immunoassay to a sandwich ELISA format, which should have enhanced sensitivity, and would be a step closer to a commercially available clinical assay. Finally, this study bears repeating as a prospective study in which genotyping is done, which was beyond the scope of our current pilot study. Acknowledgements This study was supported by grants from NIH (R44 CA 090122) and The Delaware Economic Development Office. Samar Hassen is grateful to the Graduate Institute of Technology, University of Arkansas at Little Rock for a research assistantship. References 1. Jemal A, Siegel R, Xu J, Ward E: Cancer Statistics.