The institute launched a tumor tissue donation program Tuesday with the goal of developing a ready supply of fresh tissue for use in its gene expression profiling research that enables scientists to pinpoint genes that play a role in the disease and determine targeted treatment options for patients with various forms of cancer.
George Vande Woude, director of the VARI, said the institute had been seeking tissue donations informally and had been trying to get a donation program up and running for some time.
The VARI’s partners in the donation drive are Spectrum Health, Hackley Hospital in Muskegon, Holland Hospital, Pennock Health Services of Hastings and Hastings Surgeons PC, and Bronson Hospital and Borgess Hospital in Kalamazoo. All are collaborating in the collection and analysis of tissue, Vande Woude said. Several other hospitals are still expected to join.
The group is asking cancer patients to donate tissue samples left over after scheduled tumor surgeries or biopsies — extra tissue that is normally discarded after those procedures are completed.
Donors are guaranteed complete anonymity, there is no cost to either patients or their health care providers, and no additional tests or surgeries are required of donors. Tissue samples, however, can only be obtained with a patient’s written permission, and that’s why the VARI is pushing to get the word out, Vande Woude said.
“We felt that this was something that would be useful to go to the public about so that they’re aware of what we’re trying to do and can actually help participate in the research.”
From the looks of the program, cancer patients have nothing to lose by participating, but the world has everything to gain.
Vande Woude said public calls for tissue donations are standard among research institutes and academic university hospitals. What’s different about the VARI program is that it’s taking place in a community hospital setting, he pointed out.
“We view this as a contribution to the people of western Michigan. By us getting people familiar with it and the hospitals familiar with what’s going on, I think it will be a service to the community.”
VARI is putting the finishing touches on a program brochure it plans to distribute to patients through physicians in hospitals. Vande Woude said he hopes for a positive response, but anticipates people will initially have some questions.
Not all the tissue collected will be analyzed immediately; some will be stored in the VARI’s tissue bank for later use. The institute will collect and build various tissue banks that will allow studies to be performed over time, Vande Woude said.
“When you’re looking at any kind of marker for a disease, you have to have enough samples from different individuals to see if it’s statistically significant.”
Does the probability of a discovery rise when researchers have a greater number of tissue samples to work with?
“Up to a certain number, yes,” he said. “If you’ve done 100, maybe that’s enough. What we and others that are doing this are discovering is that when you look at what has classically been called one type of cancer, there are many different subtypes based upon the molecular profile. And that’s going to be very important for correlating with responses to drugs and treatments, etc., and disease prognosis.”
The new technology of gene expression profiling is “revolutionizing” cancer diagnosis, Vande Woude said. It’s coming on fast and furious and is going to have significant impact in the area of diagnostics in the next few years.
VARI researchers have been using the technology since the institute opened in May 2000. The technology is a fingerprint of all the genes in the human genome on a chip that allows scientists to compare cancerous tumor tissue to uninvolved, adjacent normal cells to determine whether the expression of the gene is the same in both tissues, or is higher in one or the other. Some 20,000 genes can be studied in just one analysis, Vande Woude said.
What defines the seriousness of cancer is its malignancy — its capacity to invade surrounding normal tissues and metastasize through the blood and lymphatic systems to distant organs. That’s when the disease becomes difficult to manage, he said. Metastasis is responsible for more than 90 percent of all cancer deaths.
The VARI has made significant strides in the study of metastasis.
Using gene expression profiling on tumor tissue collected from about 20 colon cancer patients, Dr. Craig Webb, principal investigator in the VARI Laboratory of Tumor Metastasis and Angiogenesis, recently identified about 30 genes that may predict recurrence of colon cancer and the patient’s risk of developing metastases.
“Of all the things that have been done to date in my lab, it’s probably the most significant,” Webb said. He’s now working toward publishing the study in a major scientific journal.
VARI initiated the colon cancer project in early 2002. In the two years prior, Webb had had worked with local surgeons and physicians on collecting samples of both primary tumors and metastic tumors. Dr. Lonson Barr, a general surgeon at both Spectrum Health and Metropolitan Hospital, was particularly instrumental in that effort, Webb noted.
All told, they had access to about 200 tissue samples and of those selected 40 representative samples for the study.
They examined and compared gene expression and metastastic lesions with primary tumors, looking for genes that are in common among different patients.
“Certain patients respond very differently to different treatments and there are variables within that response,” he said. For that reason researchers try to match samples as accurately as possible by age, sex, stage of the disease and location where it originated. The number of fresh frozen tissue samples he’s working with is currently up to about 240.
“From those we can pretty much answer a whole bunch of questions at a genetic level and molecular level related to all these various clinical variations.
“As we move into now we’re trying to look for markers of treatment outcome so we can predict whether or not to give a patient one treatment or another up front,” he said.
Webb said the tumor tissue sample donation program just launched by the institute will be “huge” in terms of furthering his research. Where will he take it from here?
“One of the things I’m trying to work with local clinicians on is how this will benefit the patient at some level. That’s what we’re really trying to push this toward. For example, if we get these primary tumors from 10 years ago and I was able to predict that patient would develop metastasis five years later, now as we get these fresh samples coming in we’re going to be able to make these predictions that in five years’ time these patients are going to have to be watched very carefully.”
At the very least, that should start influencing follow-ups and treatment, he added.
VARI scientists have regular meetings with hospital physicians and surgeons collaborating on the project, so they get regular feedback they can apply in their own clinical practices.
The public needs to be aware of how important tissue donation from patients is going to be, he said.
“Whether or not we can benefit them right now — it may take a few years actually, but not more than two or three years to actually start benefiting the patients who are donating the tissues,” Webb said. Most of the analysis up to this point has been retrospective, he said.
“We have tissues and we look back at patients and what happened to them after they fought tumors. Anything we find now is too late for those patients. But, obviously, we’re then going to apply the rules to prospective status, which is taking live patients today, analyzing the tumors and coming up with some sort of alternative treatment strategies.”
In addition to colon cancer, VARI scientists are involved in research of pancreatic cancer, melanoma, kidney cancer, testicular cancer and multiple myaloma, or blood cancer.