The one thing almost everyone knows about cancers is that early detection is the best start to dealing with them. I make no apologies for repeatedly stressing this both in Betrayed by Nature and in these articles, most recently in Seeing the Invisible: A Cancer Early Warning System. Putting my cards on the table, if I had a bank balance resembling that of Mr. Bill Gates and wanted to go down in history as the guy who did most to reduce the major cancers to manageable conditions, I’d open a research centre dedicated to identifying biomarkers – i.e. molecules in circulating blood – that appear as the earliest sign of something abnormal.
Crikey, you might think. If he does financial fantasy on that scale maybe he just makes up the science too! Undeterred, and seeing as I’ve started, I’ll reveal that the first thing I’d do to staff my own institute would be to get on the phone to a fellow by the name of Johannes Kettunen in Helsinki. Reason: he’s one of the lead authors of a quite astonishing paper that came out last week.
Thinking outside the box
Those of us who live in more gentle climates occasionally wonder what the Finns and their fellow far north dwellers get up to in the long winter nights (ah! those Scandinavian fantasies!). Well, this paper told us nothing remotely titillating (how did it get by the reviewers?!) but instead revealed that, presumably cloistered in their sauna having exhausted all the interesting possibilities, Kettunen & Co came up with a cracker. “I know” someone said “let’s screen a huge number of blood samples for biomarkers that predict the risk of death amongst the general population.” Wow! Gasps all round. “Why didn’t I think of that – far more fun than all this naked cavorting and birching.”
A bit of discussion showed that all they needed was a nuclear magnetic resonance (NMR) machine (to measure the amount of each biomarker molecule) and a vast number of blood samples from a random group of people. They had both to hand: NMR machine? No prob courtesy of the University of Helsinki and by collaborating with friends just across the Baltic they could combine the extensive store of blood samples and health records that Finland has built up over many years with a corresponding Estonian collection.
So that was the gig: they picked 106 candidate biomarkers, quantitated each in blood samples from 17,345 people and looked to see if any correlated with what happened to the donors in the following five years – i.e. whether they died. Almost incredibly, the levels of four biomarkers appeared to predict with great accuracy the risk of death within this short period. Perhaps equally surprising, the marker molecules weren’t remotely exotic. There were a couple of proteins (albumin – the most abundant protein in blood sometimes called a molecular ‘taxi’ as it carries all sorts of things around the circulation) and alpha-1-acid glycoprotein (which also operates a blood taxi service), a cluster of proteins (very-low-density lipoprotein (VLDL) that carries fats and cholesterol around the bloodstream – the size of the particle being the ‘marker’) and citrate (a metabolite involved in turning food into chemical energy in the form of ATP).
So there you have it: the levels of four very drab molecules floating around in us can indicate whether otherwise healthy people are at short-term risk of dying. They cover all the major causes of death – heart disease, cancer and other illnesses – and what’s more, this biological tarot mularkey seems to work just as well in men as in women and at any age.
As one of Kettunen’s pals put it:“It was a pretty amazing result. First of all we didn’t really believe it. It was astonishing that these biomarkers appeared to actually predict mortality independent of disease. These were all apparently healthy people but to our surprise it appears these biomarkers show an undetected frailty which people did not know they had.”
So where does that leave us?
Well, first with all the usual reservations them scientists tend to attach to their utterances. Need to study a larger group, maybe these markers only apply to Finns and Estonians – no offence northern relatives but there can be differences between ethnic groups, need to screen more markers as there may be even better ones lurking in our system – and the markers themselves tell us nothing about underlying causes. And then, of course, would you take a death test when, however accurate the results, we can’t do anything about it?
But it certainly makes you think a bit doesn’t it – and whatever your thoughts, the finding that the same four biomarkers are associated with a short-term risk of death from a variety of diseases is quite mind-boggling and, who knows, maybe these very ordinary molecules will eventually lead us to causes that can be stopped or slowed.
So, next time you’ve worked your way through the Kama Sutra trying to fill in the winter nights, think laterally, try and come up with something utterly tedious that takes enormous effort and is almost certain to come up with nothing interesting or useful. Then be prepared to be amazed!
Fischer K, Kettunen J, Würtz P, Haller T, Havulinna AS, et al. (2014) Biomarker Profiling by Nuclear Magnetic Resonance Spectroscopy for the Prediction of All-Cause Mortality: An Observational Study of 17,345 Persons. PLoS Med 11(2): e1001606. doi:10.1371/journal.pmed.1001606.