Ulcerative colitis is a chronic inflammatory disease that mainly affects the colon and rectum. Onset of disease is most common between the ages of 15-35 years. There is an observed increased risk of colorectal cancer associated with the disease. The risk is often described to be 2% after 10 years, 8% after 20 years and 18% after 30 years disease. Since 1977, all known patients with ulcerative colitis in the catchment area of Örnsköldsvik Hospital have been invited to attend a colonoscopic surveillance programme. At endpoint of the studies included in this thesis there were 214 patients that had attended the surveillance programme. The aims of these studies have been to evaluate the efficiency of the surveillance programme, analyse the impact of findings of DNA aneuploidy, and determine the outcome for patients that underwent limited resections instead of complete proctocolectomy. Further, we have studied the long-term outcome for patients who had an early onset of disease and analysed the expression of cytokeratin 7 and 20 in respect to findings of dysplasia, DNA aneuploidy and colorectal cancer. At the end of the studies the prevalence for ulcerative colitis was 261/100 000 and the incidence rate was 7.6/100 000/year. During the period 1977-2005, four patients died of ulcerative colitis. Nine colorectal cancers were diagnosed in eight patients, one of whom died of the cancer. Fifty-two patients had findings of dysplasia and five of these patients developed colorectal cancer. In the subgroup of patients studied (N= 147) for DNA aneuploidy, 20 were found to have specimens with DNA aneuploidy on at least one occasion. The sensitivity of aneuploidy for development of dysplasia (LGD or higher) was found to be 0.50 and the specificity 0.94. The investigation of the outcome for the patients that underwent limited resections of the colon or rectum showed that none of the patients under surveillance died of colorectal cancer or metachronous cancer in their remaining colon or rectum. A separate study concerning early onset of ulcerative colitis revealed no particular increased risk of colorectal cancer in this cohort but a fairly high incidence of primary sclerosing cholangitis was seen. In the analyses of cytokeratins it was found that 7 out of 10 patients with low-grade dysplasia and 3 of 6 with high-grade dysplasia were positive for CK7. Our results indicate a possible relationship between the expression of CK7 and CK20 and neoplastic development of colorectal mucosa in patients with ulcerative colitis. The studies on which this thesis is based, were performed on a relatively small number of patients, however the time of observation was long and, most importantly, the patients were from a well defined catchment area. We conclude that the surveillance programme has been efficient in minimising the risk of lethal colorectal cancer. Analysing DNA ploidy helps to target the patients that need more attention but the method cannot stand alone. Our study on cytokeratins points to a relationship between dysplasia and CK7 but the results are preliminary and further studies needs to be done. We have shown that it is safe to do a limited colorectal resection in respect to lethal colorectal cancer. Early onset of ulcerative colitis as a risk factor for colorectal cancer was not found in the group we have studied, which could be due to effective surveillance and/or medication. A fairly high operation rate in this group may also have contributed. The most important variable in the beneficial outcome regarding lethal colorectal cancer in these studies is, in our opinion, the outstanding compliance of the patients to the colonoscopic surveillance programme.

Made available in DSpace on 2014-06-11T19:32:22Z (GMT). No. of bitstreams: 0 Previous issue date: 2008-03-17Bitstream added on 2014-06-13T19:43:01Z : No. of bitstreams: 1 penteado_fcl_dr_arafcf.pdf: 1008387 bytes, checksum: 40b22d48514b2c755f67d69d9ae8cff6 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Universidade Estadual Paulista (UNESP) / Alguns trabalhos realizados recentemente relatam que as células-tronco mesenquimais (CTM) podem ser induzidas à aquisição de marcadores hepatocíticos pelo transplante em modelos animais de dano hepático, ou pelo cultivo in vitro com fatores de crescimento e citocinas. O presente trabalho teve por objetivo avaliar o comportamento das CTM frente à indução da diferenciação hepatocítica. As CTM foram isoladas da medula óssea de quatro doadores saudáveis, caracterizadas e submetidas ao protocolo de indução à diferenciação hepatocítica in vitro e in vivo. As células induzidas in vitro apresentaram mudanças na sua morfologia, mostrando a morfologia semelhante à do hepatócito, porém, o perfil imunofenotípico não foi modificado. As células induzidas também não apresentaram o aumento dos transcritos de albumina, citoqueratina 18 e citoqueratina 19 quando analisadas por RT-PCR em tempo real, e não alteraram a expressão de albumina, citoqueratina 18 e alfafetoproteína como demonstrado por imunofluorescência. Quando analisadas in vivo, as CTM demonstraram o potencial migratório para o tecido hepático danificado de camundongos imunodeficientes. Em conjunto, os resultados sugerem que as CTM da medula óssea não são capazes de se diferenciar em hepatócitos quando estimuladas in vitro pela metodologia utilizado neste trabalho, mas são capazes de migrar para o tecido hepático danificado in vivo, o que sugere o seu papel no reparo do fígado. A contribuição para o reparo pode estar associada com o efeito parácrino dessas células. / Some recently works have been reported that mesenchymal stem cells (MSC) can be induced to the acquisition of hepatocytic markers for the transplant in animal models of liver damage, or for the in vitro culture with growth factors and cytokines. The present work aim is to evaluate the behavior of the MSC in front of the induction of the hepatocytic differentiation. The MSC was isolated from the bone morrow of 4 normal donators, characterized and submitted to the protocol of in vitro and in vivo induction of hepatocytic differentiation. The in vitro induced cells showed morphology changes acquiring hepatocytes-like morphology. However, the immunophenotypic profile of those cells was not modified. The induced cells did not present increase of the albumin, cytokeratin 18 and cytokeratin 19 transcripts, when analyzed by real time RTPCR. The expression of albumin, cytokeratin 18 and alpha foetoprotein was also not modified as demonstrated by immunofluorescence. In vivo, the MSC have demonstrated the migratory potential for the damaged liver of immunodeficient mice. Together, the results suggest that the bone morrow MSC are not capable of in vitro hepatocytic differentiating according to the approach in this work, but are capable to homming into damaged hepatic tissue in vivo. This migration capacity suggests their role in the repair mechanisms.

Trypanosoma cruzi, agente causador da Doença de Chagas, é um protozoário intracelular obrigatório. Vários estudos foram realizados visando a caracterização de moléculas de 85-90 kDa, presentes na superfície do parasita bem como de seus possíveis receptores nas células do hospedeiro vertebrado. Um membro da superfamília das gp85/trans-sialidases (Tc85-11), expresso somente na superfície das formas intectivas tripomastigotas e que adere em laminina e em células, foi clonado e caracterizado em nosso laboratório. Peptídeo J, fragmento de Tc85-11 não implicado em adesão a laminina, que contém o motivo conservado na superfamília, com seqüência VTVXNVFLYNR, aqui denominado \"domínio FLY\", foi identificado como sendo responsável pela adesão da porção carboxi-terminal da proteína em células epiteliais e, adicionado ao meio de cultura, promoveu aumento do número de células infectadas por T.cruzi. Seu receptor foi descrito como CK18 (Magdesian et al., 2001). Dando continuidade a esse estudo, em nosso laboratório caracterizamos a porção amino-terminal de CK18 como a região da interação com \"domínio FLY\" e identificamos o provável sítio de ligação, localizado entre os 15 aminoácidos iniciais da proteína. Adicionalmente, com o intuito de determinar a função do \"domínio FLY\", caracterizamos o peptídeo J como molécula extremamente adesiva, interagindo com a superfície de células epiteliais, matriz extracelular e promovendo interação entre tripomastigotas e ECM, possivelmente por meio de interações hidrofóbicas não dependentes de sua estrutura tridimensional adotada na proteína nativa. \"Domínio FLY\" foi caracterizado, ainda, como possível modulador da infecção por tripomastigotas já que, da mesma forma que estimula a invasão quando adicionado ao meio de cultura (Magdesian et al., 2001), promove secreção de proteínas imunorelacionadas com CK18 e ligantes de proteína A para o sobrenadante celular. Esse sobrenadante é capaz de in vitro inibir o processo infectivo do parasita em cerca de 40%. / Trypanosoma cruzi the causative agent of Chagas´ disease is an obligatory intracellular parasite in the mammalian host. Altrough the mechanism of trypomastigotes invasion of host cells has been intensively studied, a final and integrate picture of the process remains elusive. Members of the gp85/trans-sialidase superfamily have been implicated in the parasite-host interaction, with Tc85 family (85 kDa glycoproteins) implicated in the adhesion step. Our laboratory showed that Tc85-11, one member of Tc85 family, is a multi-adhesive molecule, with binding sites located at the amino- and carboxi-portions of the protein. The conserved \"FLY domain\" (peptide J) is present in all members of the family, binds to cytokeratin 18 (CK18) and enhances T. cruzi invasion (Magdesian et al., 2001). Herein, we localized the binding site of \"FLY domain\" on the amino-portion of CK18 and demonstrated an increase of trypomastigotes adhesion to extracellular matrix upon FLY treatment. The \"FLY domain\" can modulate T. cruzi infection in vitro and apparently is responsible for inducing the secretion of molecules by the host that inhibit trypomastigote invasion.

A utilização de fatores hepatotróficos (FH) tem trazido importantes avanços no tratamento de algumas doenças hepáticas. A avaliação dos efeitos dessas substâncias pode ser feita com o uso de modelos in vivo, como a regeneração hepática após a hepatectomia parcial ou in vitro, como a cultura de hepatócitos, células estreladas ou outros tipos celulares do fígado. O modelo de cultura demonstra ser útil por possibilitar a análise individualizada de determinadas substâncias ou soluções diretamente nas células-alvo, facilitando o delineamento de seu mecanismo de ação. Dessa forma, o presente trabalho estudou in vitro os efeitos da administração de fatores hepatotróficos (FH) em hepatócitos isolados de fígados de ratos, avaliando seu metabolismo e proliferação celular. Trinta ratos Wistar fêmeas foram utilizados, o fígado retirado e, por digestão enzimática in situ, suas células foram dissociadas e os hepatócitos separados em gradiente de Percoll 45%; cultivados em meio DMEM/F12, tratadas com diferentes concentrações dos FH (1X, 5X e 10X) e analisadas em intervalos de 24, 48 e 72 horas. A viabilidade e a proliferação celular foram avaliadas pelo método colorimétrico MTT, a toxicidade pelo iodeto de propídeo, o potencial elétrico da membrana mitocondrial pela Rodamina 123 e a expressão da citoqueratina 8, 18 e desmina como marcadores do citoesqueleto. O metabolismo hepático foi avaliado pela depuração do verde de indocianina (VIC), pela quantificação de colágeno tipo I e pela formação de radicais lipídicos poliinsaturados peroxidados. A técnica utilizada para a obtenção de hepatócitos mostrou-se eficaz com viabilidade superior a 90%, sem apresentar toxicidade, com manutenção do potencial mitocondrial e com marcação positiva para citoqueratinas 8, 18 e desmina. A adição dos FH aumentou a proliferação dos hepatócitos nos três períodos analisados em relação ao grupo controle. Os FH não demonstraram toxicidade em cultura primária de hepatócitos em nenhuma das concentrações avaliadas ao longo de todos os períodos experimentais. A adição dos FH na concentração de 10X evitou a formação de radicais livres, protegendo os hepatócitos da lipoperoxidação. Por outro lado, a avaliação funcional das culturas primárias pelo teste VIC mostrou-se eficaz na determinação do metabolismo dos hepatócitos, como a manutenção dos níveis das transaminases e amilase. Os hepatócitos mantidos em cultura primária após a adição dos FH em todos os períodos analisados aumentaram a produção de colágeno, e também foram capazes de modificar a distribuição da população de células nas fases quiescentes, aumentando sua capacidade de síntese. A adição dos FH nas concentrações estudadas nas culturas de hepatócitos mostrou-se eficaz na manutenção dessas células, mantendo-se funcionalmente ativos, com a expressão dos marcadores de seu metabolismo e diferenciação. / The use of hepatrotophic hic factors (HF) has provided important advances in the treatment of several hepatic disorders. The evaluation of this treatment may be carried out by in vivo models, as experiments on hepatic regeneration after partial hepatectomy; or in vitro models as culture of hepatocytes, stellate cells or any other hepatic cell. This last model allows an individual analysis of the studied substances on their target cells, providing the possibility of further investigation on the mechanisms involved. Therefore, the present study evaluated the in vitro effects of the hepatotrophic factors administration on the metabolism and proliferation of cultured hepatocytes from normal rat liver. Liver from 30 Wistar rats were used, and after in situ enzimatic dissociation, hepatocytes were collected and separated by 45% Percoll density gradient, cultivated in DMEN/F12 media supplemented with different HF concentrations (1×, 5× and 10×) and finally analyzed at 24, 48 and 72hs intervals. Cell viability and proliferation were assessed by MTT colorimetric assay, cell toxicity by propidium iodide, mitochondrial membrane electrical potential by 123 rodamine test and cytokeratin 8, 18 and desmin as cytoskeleton markers. Hepatic metabolism was evaluated by infusion of indocianine green (ICG), by type I collagen quantification and by peroxided polyunsaturated lipid radicals production. The techniques used in order to collect hepatocytes proved to be efficient, with a viability higher than 90%, no toxicity, and the maintenance of the mitochondrial membrane potential and positive labeling for cytokeratins (CK) 8, 18 and desmin. The HF addition increased the proliferation of hepatocytes in the three periods analyzed, when compared to the control group. The HF did not show any toxicity in primary hepatocytes culture regardless of the concentration evaluated along the experimental periods. The HF addition impaired the production of free radicals, protecting the hepatocytes from the lipid peroxidation. On the other hand, the functional evaluation of primary hepatocytes cultures using the ICG test proved to be efficient in the determination of the hepatocytes metabolism, as the maintenance of the transaminase and amylase levels. The hepatocytes kept in primary culture after HF addition in all the analyzed periods increased the collagen production and were also able to shift the distribution of quiescent cells population of, thus increasing their synthesis capacity. The HF addition in the studied concentrations in hepatocytes cultures proved to be efficient in the maintenance of these cells, that remain functionally active and expressing their metabolism and differentiation characteristic markers.

Background. Immunohistochemistry is a useful method in the differential diagnosis between pleural mesotheliomas and metastatic adenocarcinomas in the pleura. Cytokeratin 20 and 7 have been used successfully as markers in studies determining primary location of adenocarcinomas from metastases. The current study is a complementary research of archived paraffininbedded material of cases with cancer origin. This study contributes a bigger statistical material that may facilitate the search for unknown primary site of adenocarcinoma by identification of metastatic cells in the pleura. Methods. Cells from the pleura taken from fifteen patients with diagnosed cancer of different types and eleven patients with cancer of unknown origin, were stained with antibodies against the tumour markers: Ber EP 4, calretinin, cytokeratin 20 and 7, estrogen receptor α, thyroid transcription factor, prostate-specific antigen and Cdx2.The staining was conducted in an automated immunohistochemical system. The staining of each kind of antibody was confirmed by a control section staining. Results. All control staining ended perfect The whole panel of antibodies used on mammary cancer showed the same pattern for every antibody. Of the patients with cancer of unknown origin there were four that gave the same pattern, two men and two women. The women are deceased. To make a more careful evaluation more information and clinic background is needed. The number of samples is too small to draw any statistical conclusions. Comment. Although the control staining was perfect the negative result of CK20 in the cases of diagnosed colon cancer was unexpected. This staining should be performed again to confirm the result. In some cases the number of cells were to few for a certain evaluation. The slides and the results of this work will be archived for further research.

Radioimmunotherapy (RIT) and radioimmunolocalisation (RIL) are developing and promising technologies to diagnose and treat tumours by use of radiolabelled antibodies targeting tumour specific antigens. The major reason why RIL and RIT not are efficient enough, is the comparatively low accumulation of radiolabelled antibodies in the tumours. Irrespective of the antigen - antibody system used, the maximal tumour uptake in humans is often limited to below 0.1 % of the total injected dose, with significant radionuclide remaining in the blood pool and extravascular fluid. In the present thesis, the following putative improvement techniques for radioimmunotargeting have been evaluated in an experimental model using HeLa cell-xenografted nude mice: 1) Repetitive, simultaneous targeting of different antigens, 2) Removal of non-targeting antibodies using secondary antiidiotypic antibodies, 3) Preinjection of unlabelled antibody to remove shedded antigen and 4) Use of fractionated antibody administration. By use of multiple injections of mixtures of two different 131I-labelled monoclonal antibodies targeting placental alkaline phosphatase (H7) and cytokeratin 8 (TS1), respectively, a significant tumour growth inhibition compared to controls, was obtained. In the treated group, a negligible increase in tumour volume was seen compared to the control group, in which a 20-fold increase was observed. Quantitative determinations of volume densities of viable tumour cells, necrotic cells and connective tissue demonstrated no significant differences in the relative proportions between the groups, indicating that the irradiation caused decelerated growth. Using hybridoma technology, monoclonal antiidiotypic antibodies were generated against both TS1 and H7. The in vitro and in vivo effects of these antibodies, aH7 and aTSl, were investigated. Both these antiidiotypes were found to generate stable complexes with the radiolabelled idiotypic antibody, as revealed by gel-electrophoresis and autoradiography. Using biosensor technology (BIAcore, Pharmacia) the interactions were followed in real time and the association rate-, dissociation rate-, and affinity constants between the reactants were determined. In vivo, the antiidiotypes promoted a rapid dose dependent clearance of the 125I-labelled idiotypes with a decrease in total body radioactivity and concomitant dramatic increase in non-protein bound 125I excreted in the urine. The syngeneic monoclonal antiidiotypic antibody αTSl, was furthermore evaluated as a secondary clearing antibody at radioimmunolocalisation. Injection of αTSl in a molar ratio of 0.5-0.75:1 to TS1, 24 hours after the 125I-labelled TS1 improved the tumour to normal tissue ratio 2-3 fold. This was due to a decreased level of total body radioactivity as well as a slight decrease in tumour-radioactivity. A model describing the kinetics of the involved components, i.e. the antigen, the idiotype and the antiidiotype was presented. It is concluded that high affinity monoclonal antiidiotypes can be used as tools to regulate the levels of idiotypic antibodies in vivo. This strategy, combined with preinjection of non­labelled idiotypic antibodies, caused accumulated doses of 3 Gy to the tumour and 0.9 Gy to non tumour tissues as calculated for 125I-labelled antibodies (80 MBq/mg) by MIRD formalism based on repetitive quantitative radioimmunoscintigraphies. By approaching the maximal tolerated whole body radiation dose for mice (i.e. 6 Gy), it can be estimated that doses up to 20 Gy are possible to obtain following one single injection of labelled antibody. It was furthermore demonstrated that a single bolus injection of antibody is to be preferred, compared to exactly the same dose divided into three or ten fractions. Thus, not only the dose of radioactivity, but also the amount of antibody should be considered for fractionated RIT. In summary, the thesis demonstrates that several techniques can be used to improve radioimmunolocalisation and to approach the proposed 70 Gy required to sterilise tumours at radioimmunotherapy. / digitalisering@umu.se

Orientador: Dimas Tadeu Covas / Banca: José Orlando Bordin / Banca: Carmino Antônio de Souza / Banca: Orlando Castro e Silva Júnior / Banca: Aparecida Maria Fontes / Resumo: Alguns trabalhos realizados recentemente relatam que as células-tronco mesenquimais (CTM) podem ser induzidas à aquisição de marcadores hepatocíticos pelo transplante em modelos animais de dano hepático, ou pelo cultivo in vitro com fatores de crescimento e citocinas. O presente trabalho teve por objetivo avaliar o comportamento das CTM frente à indução da diferenciação hepatocítica. As CTM foram isoladas da medula óssea de quatro doadores saudáveis, caracterizadas e submetidas ao protocolo de indução à diferenciação hepatocítica in vitro e in vivo. As células induzidas in vitro apresentaram mudanças na sua morfologia, mostrando a morfologia semelhante à do hepatócito, porém, o perfil imunofenotípico não foi modificado. As células induzidas também não apresentaram o aumento dos transcritos de albumina, citoqueratina 18 e citoqueratina 19 quando analisadas por RT-PCR em tempo real, e não alteraram a expressão de albumina, citoqueratina 18 e alfafetoproteína como demonstrado por imunofluorescência. Quando analisadas in vivo, as CTM demonstraram o potencial migratório para o tecido hepático danificado de camundongos imunodeficientes. Em conjunto, os resultados sugerem que as CTM da medula óssea não são capazes de se diferenciar em hepatócitos quando estimuladas in vitro pela metodologia utilizado neste trabalho, mas são capazes de migrar para o tecido hepático danificado in vivo, o que sugere o seu papel no reparo do fígado. A contribuição para o reparo pode estar associada com o efeito parácrino dessas células. / Abstract: Some recently works have been reported that mesenchymal stem cells (MSC) can be induced to the acquisition of hepatocytic markers for the transplant in animal models of liver damage, or for the in vitro culture with growth factors and cytokines. The present work aim is to evaluate the behavior of the MSC in front of the induction of the hepatocytic differentiation. The MSC was isolated from the bone morrow of 4 normal donators, characterized and submitted to the protocol of in vitro and in vivo induction of hepatocytic differentiation. The in vitro induced cells showed morphology changes acquiring hepatocytes-like morphology. However, the immunophenotypic profile of those cells was not modified. The induced cells did not present increase of the albumin, cytokeratin 18 and cytokeratin 19 transcripts, when analyzed by real time RTPCR. The expression of albumin, cytokeratin 18 and alpha foetoprotein was also not modified as demonstrated by immunofluorescence. In vivo, the MSC have demonstrated the migratory potential for the damaged liver of immunodeficient mice. Together, the results suggest that the bone morrow MSC are not capable of in vitro hepatocytic differentiating according to the approach in this work, but are capable to homming into damaged hepatic tissue in vivo. This migration capacity suggests their role in the repair mechanisms. / Doutor

Orientador: Rosemeri de Oliveira Vasconcelos / Resumo: A glândula mamária é o segundo sítio mais comum de desenvolvimento tumoral em cadelas. Uma das formas de estadiamento destes tumores é avaliar a presença ou ausência de metástase à distância, inclusive na medula óssea. Este achado, na Medicina, associa-se a baixa sobrevida de mulheres com tumores mamários, porém na Medicina Veterinária esse estadiamento clínico é mais utilizado para pacientes com linfomas e mastocitomas. Estudos que utilizem a biópsia de medula óssea como método de pesquisa de estadiamento em tumores mamários são escassos. Desta forma o presente estudo teve como objetivo avaliar lesões mamárias e a medula óssea de 36 cadelas, buscando-se células tumorais disseminadas ou focos metastáticos. Para isso realizou-se a análise histopatológica dos tumores de mama, linfonodos e medula óssea dessas cadelas, corados com Hematoxilina e Eosina. Na medula óssea também foram utilizadas a coloração com Tricrômio de Masson, para avaliação de fibrose medular, e a imunohistoquímica, para a pesquisa de micrometástase. O carcinoma em tumor misto grau I fora o mais observado (18,08%), não havendo diferença estatística com relação ao tamanho tumoral e a presença de metástase em linfonodos. Na medula óssea de uma cadela com carcinossarcoma (4,35%) houve marcação citoplasmática de uma provável célula tumoral disseminada, de origem epitelial, com o anticorpo citoqueratina-19 pela imunohistoquímica. Nenhuma das cadelas que apresentou diminuição da celularidade ou fibrose medular (Tric... (Resumo completo, clicar acesso eletrônico abaixo) / Mestre

No description available.

A Cytokeratin 8 (K8)/Green Fluorescent Protein (GFP) fusion construct was created to better understand the behavior of K8 within cancer cells. This intermediate filament (IF) protein is a member of the cytoskeletal gene family along with actin and tubulin. IF's are normally expressed in a tissue specific and differentiation dependant manner, in which their role is more supportive than essential to the cell. Such roles include rigidity of cellular shape, protein trafficking, cellular locomotion, and cell signaling platforms. K8 mutation, over expression, and aberrant post translational modifications have been observed in various carcinoma cell lines to be the cause of several phenotypes including apoptosis inhibition, drug resistance, transformation, Mallory-Denk body (MDB) formation, localization at the plasma membrane, and secretion of the protein. In order to study these abnormal phenotypes the K8 gene was generated and inserted into the GFP over expression vector. This allowed for the study of K8 within a well defined cervical cancer cell line named Hela. This study intended to provide answers to K8's localization at the plasma membrane in carcinoma cell models while avoiding criticisms to previous immunohistochemical localization studies. A model which exhibits established phenotypes found in the literature was thus created which has the potential to address several paramount questions related to K8's role in supporting the development and progression of cancer. It could also be utilized as an assay for the discovery of K8 filament formation inhibitors, which may prove useful in combination with current chemotherapeutics. The model could also be used to provide weight to diagnostics, such as the Cancer Recognition test, which utilizes antibodies against K8 as biomarkers for malignancy via an Enzyme-Link ImmunoSorbent Assay (ELISA).