Significance of Telomerase Activity, C-erbB2, Malondialdhyde and NO as Biological Markers in Urine of Bladder Cancer Patients

At the National Cancer Institute (NCI), Cairo, Egypt, bladder neoplasm constitutes 30% of all cancers. Evaluation of urinary markers may hold a promising method for detection of bladder neoplasms with higher sensitivity and specificity, for follow-up in order to regulate the interval of cystoscopic examination, reduce the burden and discomfort of patients and enhance the opportunities to excise the tumor preceding muscular invasion. The present study aims to evaluate the possible diagnostic role of telomerase activity, C-erbB2, malondialdehyde and NO in the urine of bladder cancer patients. Eighty urine samples were taken from 3 groups of individuals; 1) Ten healthy age matched control subjects, 2) Twenty schistsoma haematobium infested patients and 3) Fifty pre-operative bladder cancer patients. Urine samples (50mL) were collected and subjected to the assay of telomerase activity in urine (TAU), it was measured by PCR-ELISA technique using the telomerase repeat amplification protocol (TRAP), malondialdehyde and nitric oxide were determined spectrophotometrically and c-erbB2 was measured by ELISA technique TAU was increased in 72% of bladder cancer cases, it was normal in bilhazial non malignant group compared to controls. Its increase in bladder cancer patients with bilharzial infection was statistically insignificant compared to non bilharzial cancer group. TAU of bladder cancer patients were increased in ascending manner with grades of the tumor (GI = 62.5±16.7, G II = 66.64±9.37 and GIII = 163±51). Malondialdehyde level was increased in bladder cancer patients with bilharzial infestation than those without bilharziasis, but the difference was statistically insignificant. C-erbB2 expression was increased in 27% of bladder cancer patients; while no single case of the bilharzial group showed positive c-erbB2 expression. As regard the stage of tumor NO level in bladder cancer patients showed statistical significant difference between stage I, II and stage III (p = 0.04). There was only a statistically significant positive correlation between telomerase and CerbB2 in bladder cancer patients (r = 0.456 p = 0.005). In conclusion: The study of telomerase activity in the urine of bladder cancer cases may be used as an indicator for early detection of this disease. Further studies should be done to evaluate the possibility of using telomerase as one of the most important tumor markers.