Problem Statement

In the past decade, biomarkers have gained significant traction in the diagnostic field due to their remarkable capabilities. These biomarkers, which are measurable indicators present in blood, body fluids, organs, and tissues, have become invaluable tools in disease detection and evaluation.[1] They are utilized as diagnostic aids, playing an essential role in assessing disease risk and monitoring biological processes and pharmacological reactions. Currently, there are 3100 different biomarkers being employed to test for a wide array of 2600 diseases.[2] The term "biomarker" (derived from "biological marker") has been defined by the Food and Drug Administration. According to this definition, biomarkers serve multiple purposes, including aiding in research and development of therapies, diagnosing complications, providing prognoses, monitoring disease progression, and evaluating the response of treatment.[3] The detection of diseases using biomarkers is a process that unfolds over an extended period. These biomarkers act as a preliminary diagnostic aid, emitting warning signs that can be analyzed. Concentrations of biomarkers are assessed within 5-7 days for liquid samples and 2-4 days for tissue biopsies.[4] The timing of these assessments depends on the distribution of samples to the appropriate laboratory centers. Biomarkers have emerged as innovative tools in the medical field, enabling clinicians and researchers to gain crucial insights into diseases, their progression, and responses to treatments.[5] Their applications highlight their significance in advancing healthcare and shaping the future of diagnostic and therapeutic approaches. The Penn State iGEM Team has utilized the power of biomarkers to significantly reduce the waiting time for individuals dependent on their test results. Leveraging biomarkers found in biological samples, such as blood or tissue, the team has streamlined the diagnostic process. Waiting for test results can be an anxious and lengthy process, often taking several days or even weeks; however, by utilizing biomarkers, the Penn State team has implemented a more efficient and rapid method of analysis. Instead of relying on conventional testing procedures that might take days to process, biomarkers offer a quicker route to diagnosis. These biomarkers act as specific indicators, providing valuable information about the presence or progression of a disease with a single on-the-spot blood test.

Riboswitches

A Riboswitch is a special sequence within mRNA comprised of two essential segments: the aptamer region and the expression region. In the aptamer region, specific small molecules or proteins of interest bind with high affinity[6]. This means the aptamers are highly selective, ensuring they exclusively bind to the desired molecules. When this binding occurs, the expression region undergoes a conformational change. This change can either unveil or conceal the ribosome binding site (RBS), consequently permitting or obstructing the translation of nucleotides downstream. In our experimentation, we have targeted the permitting of transcription/translation. Riboswitches are invaluable tools, often harnessed as detection methods. The utilization of riboswitches lies in the ability to alter the sequence surrounding the RBS. This customization allows for the creation of a measurable reporter.

Figure 1: [LEFT] Riboswitch sequence depicted before binding to protein of
interest and [RIGHT] riboswitch sequence shown bound to biomarker
of interest withe exposed RBS and active translation.


In our project, we've engineered specific riboswitches designed to respond to target biomarkers. These riboswitches were specifically designed so that when exposed to the intended biomarkers, they undergo a conformational change. The resulting change transcribes an enzyme used in our detection process.

The Riboswitch Calculator

We used the Salis Lab’s Riboswitch Calculator to design our riboswitch sequences. The Riboswitch Calculator is a physics-based model that uses thermodynamics to alter the pre- and post-aptamer sequences that optimize activation ratio, essentially changing certain nucleotides to provide detectable ON and OFF states for regulating translation. Researchers have successfully created cell-free genetically encoded biosensors capable of detecting small molecules and nucleic acids. An automated platform was designed to transform protein-binding RNA aptamers into riboswitch sensors. These sensors can function effectively in cell-free assays, the ideology the Penn State team utilized. The Salis team engineered 35 riboswitches capable of sensing proteins, including human monomeric C-reactive protein, human interleukin-32γ, and phage MS2 coat protein. These riboswitch sensors adjusted output expression levels by up to 16-fold in response to protein concentrations found in human serum. Through computational analysis, the researchers identified two distinct mechanisms governing riboswitch-mediated regulation of translation rates. By refining the protein-binding aptamer regions, they improved the design accuracy of the sensors. This advancement broadens the toolkit for cell-free sensors and demonstrates the application of computational design in creating protein-sensing riboswitches, holding potential for future use in affordable medical diagnostics[7]. The second paper introduced initially to the team by Dr. Howard Salis used riboswitches to regulate gene expression. Riboswitches are specialized RNA molecules that change shape in response to chemicals, thereby regulating gene expression. This mechanism links detection to cellular response directly. However, understanding how their genetic sequence influences riboswitch switching and activation, especially when altering the ligand-binding aptamer region, has remained unclear. The Salis Lab has developed a statistical thermodynamic model that predicts the relationship between sequence, structure, and function for riboswitches that control gene expression. This model was validated both inside cells and in cell-free transcription-translation assays. Using this model, they performed automated computational design to create 62 synthetic riboswitches. These riboswitches utilized six different RNA aptamers to detect various chemicals (theophylline, tetramethylrosamine, fluoride, dopamine, thyroxine, 2,4-dinitrotoluene) and triggered gene expression up to 383-fold. The model explains how the aptamer's structure, affinity to the chemical, energy required for switching, and cellular crowding work together to control riboswitch activation. The model-based approach not only sheds light on the physical mechanisms underlying ligand-induced RNA shape changes but also enables the creation of cell-free and bacterial sensors for a wide array of applications[8]. De Novo DNA, a Salis Lab spin-off, holds the Riboswitch Calculator. This model implements the expertise above allowing for researchers to design specific riboswitches.

SensoREX: Riboswitch-Enabled eXpression

As a means to reduce diagnostic timing the team introduces SensoREX, an innovative in vitro biomarker measurement tool. SensoREX leverages Riboswitch-Enabled eXpression (REX) technology to provide precise and reliable biomarker detection. Comprising a plasmid encoding the riboswitch, a cell-free system, and engineered trehalose, SensoREX integrates these with a standard glucometer. The operational procedure is simple: a blood sample from a finger prick is added to SensoREX. The user initiates the process by obtaining an initial glucose reading, followed by a specified incubation period. After this interval, a final glucose reading is taken. These readings are then input into the Biomarker Calculator, which translates the data into the corresponding biomarker concentration. The concentration variations relate to the stage of the disease and/or treatment progress. SensoREX stands out due to its swiftness, affordability, and user-friendly nature, making biomarker measurement widely accessible. The inherent high affinities and specificities of riboswitches render SensoREX well-suited for diagnostic applications and continuous disease monitoring. The standardized system allows for future biomarker testing with indicators other than the ones selected by the team.

Our Biomarkers

As we began our project with minimal riboswitch expertise, our team was guided by Dr. Salis to select potential aptamers consisting of an average of seventy base pairs. The larger the aptamer size, the more complicated the riboswitch and conformational changes would become. The team combed through hundreds of potential options to identify six aptamers with human implications. The six selected were Monomeric C-Reactive Protein (mCRP), Interleukin-32γ, Thyroxine, Basic Fibroblast Growth Factor (bFGF), Vascular Endothelial Growth factor (VEGF), and Bovine Thrombin.


Monomeric C-Reactive Protein

C-reactive protein (CRP) is a protein that significantly rises during infections or inflammation. It is produced in the form of native CRP (nCRP) which can break down into monomeric CRP (mCRP) at sites of inflammation[9]. Initially used as an infection and cardiovascular marker, recent studies show CRP's role in inflammation, complement pathway, apoptosis, phagocytosis, and other biological processes. Differentiating between CRP isoforms (nCRP and mCRP) is crucial, but commercial antibodies for mCRP are scarce, limiting research. NCRP exhibits anti-inflammatory activities, activating complement pathways and promoting apoptosis. MCRP, in contrast, attracts immune cells to inflammation sites and delays cell death. The mCRP isoform in local inflammation and infection sites was the primary focus of the two.

Figure 2: RNA aptamer sequence and secondary structure for C-reactive protein (CRP)[17].


Bovine Thrombin

Initially, the team chose bovine thrombin due to its short sequence of less than 70 base pairs. However, upon deeper investigation into biomarker concentrations and diseases, we found that bovine thrombin is not suitable for our project. It proves ineffective for human biomarker development and lacks accuracy in quantifying biomarker concentrations. Since thrombin is a clotting factor, its concentration is consistently high and varies based on wounds.

Figure 3: RNA aptamer sequence and secondary structure for bovine thrombin[18].


Interleukin-32

Interleukin-32 (IL-32) is a proinflammatory cytokine present in natural killer cells, T-cells, and monocytes[10]. Among its nine splice variants on human chromosome 16 p13.3, IL-32γ is the primary focus due to its relevance in melanoma immunity. Elevated levels of IL-32γ enhance melanoma tumor immunity, making it a crucial factor. Studies show that IL-32γ, with its larger size, exhibits significant bioactivity. Murine experiments have demonstrated that increased IL-32γ expression hampers tumor growth by triggering apoptosis[11].
Research revealed a positive correlation between IL-32 expression and myeloid markers, underscoring the importance of heightened melanoma patient survival with elevated IL-32 levels. Apart from melanoma, elevated IL-32 is implicated in various inflammatory autoimmune diseases, wound healing, and other potential illnesses under active investigation. The IL-32 biomarker concentration can be monitored prior and during after cancer incidence as a warning method/treatment progression.

Figure 4: RNA aptamer sequence and secondary structure for interleukin-32γ (IL-32γ)[19].


Thyroxine

Thyroxine (T4) is a vital hormone produced by the thyroid gland, regulating growth, metabolism, and various bodily functions[12]. When released into the bloodstream, T4 undergoes deiodination, transforming into triiodothyronine (T3), a key player in the metabolic process. This process affects digestion, heart rate, brain development, fertility, as well as skin and bone maintenance. Maintaining appropriate T4 levels is crucial for bodily homeostasis[13].
Insufficient T4 levels can disrupt homeostasis, leading to conditions like hypothyroidism, characterized by symptoms such as cold intolerance, fatigue, weight gain, constipation, and bradycardia due to an underactive thyroid gland. Conversely, an overactive thyroid gland results in hyperthyroidism, causing symptoms like heat intolerance, fine tremors, weight loss, and muscle weakness. Hypothyroidism affects approximately 5% of the global population, equivalent to about 394 million people worldwide[14]. Hyperthyroidism prevalence varies based on iodine deficiency in different geographical regions[15]. In the United States, around 1.2% of the population, or 3.9 million people, are impacted by hyperthyroidism. Monitoring of T4 concentrations allows for preliminary indicators of hypothyroidism or hyperthyroidism.

Figure 5: RNA aptamer sequence and secondary structure for thyroxine[20].


Basic Fibroblast Growth Factor

Research has highlighted the role of basic fibroblast growth factor (bFGF) in tumor development, progression, and prognosis. The bFGF expression levels in female patients with non-small cell lung cancer (NSCLC), colon cancer, breast cancer, and melanoma were studied to evaluate the biomarker as functional. The analysis aimed to explore the connection between bFGF expression and characteristics of these malignant tumors[16].
In NSCLC patients, bFGF protein expression significantly increased in cases with poor differentiation and lymph node metastasis compared to moderately/well-differentiated NSCLC without lymph node involvement. Patients with colon cancer and lymph node metastasis exhibited higher bFGF protein levels than those without lymph node involvement. Similarly, breast cancer patients in tumor metastasis stage III–IV and with lymph node metastasis showed elevated bFGF expression compared to those in stage I–II without lymph node metastasis. In melanoma patients, positive bFGF staining was notably higher in cases with lymph node metastasis compared to those without[16].
This suggests a potential association between bFGF and malignant tumor development and growth. Additionally, bFGF protein expression could serve as a promising biomarker for diagnosing malignant tumor metastasis in females.

Figure 6: RNA aptamer sequence and secondary structure for basic fibroblast growth factor (bFGF or FGF2)[21].


Vascular Endothelial Growth Factor

During the initial stages of the project research, the team identified biomarkers relevant to cancer research and treatment. VEGF was initially considered a broad cancer biomarker and fell within the 70 base pair limit. However, after consulting with Hershey Medical and several oncologists, we realized that VEGF concentration alone was insufficient for determining cancer incidence. We continued to alter the riboswitch accordingly, switching the promoter from J23100 to T7. This riboswitch was used as a testing method to ensure the correct digestion protocol was designed for the riboswitches mentioned above.
Figure 7: RNA aptamer sequence and secondary structure for vascular endothelial growth
factor (VEGF)-165. This aptamer is known as Macugen, which has therapeutic
uses for treating neovascular age-related macular degeneration (AMD)[22].

Challenges

In our development of SensoREX we discovered limitations and challenges to using biomarkers in disease applications[1].

Developing biomarkers presents several challenges:

1. Scientific Basis and Validation: The scientific validity of certain biomarkers can be difficult, making qualification and validation challenging. Ensuring accurate interpretation and avoiding irrelevant connections between biomarkers and diseases is crucial.
2. Increased Development Costs: Longer clinical trials and extensive testing requirements can escalate the costs associated with biomarker development, impacting feasibility.
3. Time and Resource Intensive: Biomarker development demands significant time and resources. To qualify, compelling evidence supporting a favorable benefit-risk analysis is essential, often requiring extensive efforts.


It is also important that a biomarker possesses the following characteristics in order to be ideal:

1. Clinical Relevance: The biomarker should offer rational grounds for its use, demonstrating measurable changes in pathological processes within a relatively short time frame.
2. High Sensitivity and Specificity: It should exhibit precise sensitivity and specificity in evaluating treatment effects, ensuring accurate measurement (affinity).
3. Reliability: The biomarker must be analytically measurable, capable of detecting changes with acceptable accuracy, precision, and reproducibility.

References

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[2] Piñero, J., Rodriguez Fraga, P. S., Valls-Margarit, J., Ronzano, F., Accuosto, P., Lambea Jane, R., Sanz, F., & Furlong, L. I. (2023). Genomic and proteomic biomarker landscape in clinical trials. Computational and structural biotechnology journal, 21, 2110–2118. https://doi.org/10.1016/j.csbj.2023.03.014


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