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  • 1
    Online Resource
    Online Resource
    American Society of Clinical Oncology (ASCO) ; 2014
    In:  Journal of Clinical Oncology Vol. 32, No. 15_suppl ( 2014-05-20), p. e22231-e22231
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 32, No. 15_suppl ( 2014-05-20), p. e22231-e22231
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
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    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2014
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  • 2
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 36, No. 4_suppl ( 2018-02-01), p. 698-698
    Abstract: 698 Background: Altered extracellular matrix (ECM) remodeling is an important part of the pathology of gastrointestinal (GI) disorders. In the intestine, type XVI collagen (col-16) plays a role in pathogenesis by affecting ECM architecture and induce cell invasion. Measuring col-16 in serum may therefore have biomarker potential in GI disorders such as colorectal cancer (CRC) and ulcerative colitis (UC). The aim of this study was to determine whether col-16 can serve as a biomarker for altered ECM remodeling in patients with CRC and UC. Methods: A monoclonal antibody was raised against the C-terminal end of col-16 (C16-C) and a competitive enzyme-linked immunosorbent assay (ELISA) was developed and technically validated. Levels of C16-C were measured in serum from patients with CRC (before (n = 50) and three months after (n = 23) tumor resections), UC (n = 39) and healthy controls (n = 50). Results: The C16-C ELISA was specific towards the C-terminal of col-16. C16-C was significantly elevated both in serum from patients with CRC (p = 0.0026) and UC (p 〈 0.0001) compared to controls. No difference was detected in levels of C16-C between patients with CRC at baseline and three months after tumor resections (p 〉 0.999). Levels of C16-C identified patients with a GI disorder with a positive predictive value of 0.9 and an odds ratio of 12 (95%CI = 4.5-29.5, p 〈 0.0001). Conclusions: The newly developed assay detected significantly elevated levels of C16-C in serum from patients with GI disorders compared to controls suggesting its potential as a biomarker in this setting. Future studies are needed to validate these findings.
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
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    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2018
    detail.hit.zdb_id: 2005181-5
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  • 3
    In: International Journal of Health Governance, Emerald, Vol. 26, No. 2 ( 2021-06-04), p. 199-212
    Abstract: As the coronavirus disease 2019 (COVID-19) continues to spread across countries, it is becoming increasingly clear that the presence of pre-existing noncommunicable diseases (NCDs) dramatically increases the risk of aggravation in persons who contract the virus. The neglect in managing NCDs during emergencies may result in fatal consequences for individuals living with comorbidities. This paper aims to highlight the need for a paradigm shift in the governance of public health emergencies to simultaneously address NCD and noncommunicable disease (CD) pandemics while taking into account the needs of high-risk populations, underlying etiological factors, and the social, economic, and environmental determinants that are relevant for both CDs and NCDs. Design/methodology/approach The paper reviews the available global frameworks for pandemic preparedness to highlight the governance challenges of addressing the dual agenda of NCDs and CDs during a public health emergency. It proposes key strategies to strengthen multilevel governance in support of countries to better prepare for public health emergencies through the engagement of a wide range of stakeholders across sectors. Findings Addressing both CD and NCD pandemics during public health emergencies requires (1) a new framework that unites the narratives and overcomes service and system fragmentations; (2) a multisectoral and multistakeholder governance mechanism empowered and resourced to include stakeholders across sectors and (3) a prioritized research agenda to understand the political economy of pandemics, the role played by different political systems and actors and implementation challenges, and to identify combined strategies to address the converging agendas of CDs and NCDs. Research limitations/implications The article is based on the review of available published evidence. Practical implications The uptake of the strategies proposed will better prepare countries to respond to NCD and CD pandemics during public health emergencies. Originality/value The article is the first of its kind addressing the governance challenges of the dual pandemic of NCDs and CDs in emergencies.
    Type of Medium: Online Resource
    ISSN: 2059-4631
    Language: English
    Publisher: Emerald
    Publication Date: 2021
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  • 4
    Online Resource
    Online Resource
    Springer Science and Business Media LLC ; 2019
    In:  Journal of Cancer Research and Clinical Oncology Vol. 145, No. 2 ( 2019-2), p. 383-392
    In: Journal of Cancer Research and Clinical Oncology, Springer Science and Business Media LLC, Vol. 145, No. 2 ( 2019-2), p. 383-392
    Type of Medium: Online Resource
    ISSN: 0171-5216 , 1432-1335
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    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2019
    detail.hit.zdb_id: 1459285-X
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  • 5
    In: Scientific Reports, Springer Science and Business Media LLC, Vol. 9, No. 1 ( 2019-12-24)
    Abstract: Pancreatic ductal adenocarcinoma (PDAC) patients have poor prognosis and poor response to treatment. This is largely due to PDAC being associated with a dense and active stroma and tumor fibrosis (desmoplasia). Desmoplasia is characterized by excessive degradation and formation of the extracellular matrix (ECM) generating collagen fragments that are released into circulation. We evaluated the association of specific collagen fragments measured in pre-treatment serum with outcome in patients with PDAC. Matrix metalloprotease (MMP)-degraded type I collagen (C1M), type III collagen (C3M), type IV collagen (C4M) and a pro-peptide of type III collagen (PRO-C3) were measured by ELISA in pre-treatment serum from a randomized phase 3 clinical trial of patients with stage III/IV PDAC treated with 5-fluorouracil based therapy (n = 176). The collagen fragments were evaluated for their correlation (r, Spearman) with serum CA19-9 and for their association with overall survival (OS) based on Cox-regression analyses. In this phase 3 PDAC trial, pre-treatment serum collagen fragment levels were above the reference range for 67%-98% of patients, with median values in PDAC approximately two-fold higher than reference levels. Collagen fragment levels did not correlate with CA19-9 (r = 0.049–0.141, p  =  ns ). On a continuous basis, higher levels of all collagen fragments were associated with significantly shorter OS. When evaluating degradation (C3M) and formation (PRO-C3) of type III collagen further, higher PRO-C3 was associated with poor OS ( 〉 25 th percentile cut-point, HR = 2.01, 95%CI = 1.33–3.05) and higher C3M/PRO-C3 ratio was associated with improved OS ( 〉 25 th percentile cut-point, HR = 0.53, 95%CI = 0.34–0.80). When adjusting for CA19–9 and clinical covariates, PRO-C3 remained significant (HR = 1.65, 95%CI = 1.09–2.48). In conclusion, collagen remodeling quantified in pre-treatment serum as a surrogate measure of desmoplasia was significantly associated with OS in a phase 3 clinical PDAC trial, supporting the link between desmoplasia, tumorigenesis, and response to treatment. If validated, these biomarkers may have prognostic and/or predictive potential in future PDAC trials.
    Type of Medium: Online Resource
    ISSN: 2045-2322
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2019
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  • 6
    In: Cancer Research, American Association for Cancer Research (AACR), Vol. 79, No. 13_Supplement ( 2019-07-01), p. 1899-1899
    Abstract: Background: Extracellular matrix (ECM) deposition and stiffening have emerged as an important player in cancer progression. ECM deposition is stimulated by transforming growth factor-beta (TGF-β) that is being widely evaluated as a new therapeutic target in cancer. ECM stiffness is characterized by type III collagen deposition and cross-linking in the tumor microenvironment. Cross-linked type III collagen products reflecting ECM stiffness and TGF-β signaling may therefore have biomarker potential in cancer. By developing an assay to quantify cross-linked type III collagen pro-peptides and applying the “Scar-in-a-jar” (SiaJ) model, we evaluated the impact of TGF-β on this novel biomarker and assessed the biomarker potential in colorectal cancer (CRC). Methods: A monoclonal antibody was raised against the N-terminal pro-peptide of type III collagen and a sandwich ELISA was developed and technically validated. The cross-linked type III collagen product levels were assessed in supernatants from the SiaJ culture model in which primary human healthy lung fibroblasts were cultured up to 12 days in the presence of ficoll and 1ng/ml TGF-β, with or without addition of 1µM ALK-5/type I TGF-β receptor kinase inhibitor (iTGF-β). The pathological relevance of cross-linked type III collagen products was assessed in serum from patients with CRC (n=34) and healthy controls (n=39). Levels were compared using unpaired, two-tailed Mann-Whitney test. Results: The newly developed sandwich ELISA was shown to be technically robust and specific towards cross-linked type III collagen pro-peptides. Stimulating lung fibroblasts with TGF-β induced the production of cross-linked type III collagen with levels increasing up to 22-fold compared to without TGF-β (p=0.029), and iTGF-β reduced this induction. Levels of cross-linked type III collagen were significantly elevated in CRC patients compared to healthy controls (7.0 ng/ml vs. 5.6 ng/ml, p=0.0009). Furthermore, the diagnostic accuracy to separate CRC patients from healthy controls was 72% (p=0.0003, AUC: 0.72) with an odds ratio of 8 (95%Cl=2.4-23.2, p=0.0006) for having CRC. Conclusions: Cross-linked pro-peptides of type III collagen can be quantified in serum from CRC patients as a potential surrogate marker of tissue stiffness and stromal reactivity driving tumor progression. In addition, TGF-β induces increased production of cross-linked type III collagen suggesting that this novel biomarker could potentially interrogate the effect of anti-TGF-β therapy. Future studies are needed to investigate the prognostic and predictive potential. Citation Format: Christina Jensen, Sarah Rønnow, Jannie M. Sand, Lars N. Jørgensen, Morten A. Karsdal, Nicholas Willumsen. Non-invasive quantification of cross-linked type III collagen products - A measure of extracellular matrix stiffness related to TGF-β signaling in colorectal cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 1899.
    Type of Medium: Online Resource
    ISSN: 0008-5472 , 1538-7445
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    Language: English
    Publisher: American Association for Cancer Research (AACR)
    Publication Date: 2019
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  • 7
    In: Cancer Research, American Association for Cancer Research (AACR), Vol. 80, No. 16_Supplement ( 2020-08-15), p. 3091-3091
    Abstract: Background: Non-invasive biomarkers for predicting response to immune checkpoint inhibitors (ICI) are urgently needed. Crucial for response to ICI's is a T-cell permissive tumor microenvironment (hot tumor), characterized by presence of activated T-cells and low fibrotic activity. Activated T-cells release the protease granzyme B (GzB), which can cleave type IV collagen during tumor infiltration. We evaluated the potential of measuring GzB generated type IV collagen degradation fragments in a liquid biopsy for identifying metastatic melanoma (MM) patients responding to ipilimumab. Methods: A monoclonal antibody was raised against a GzB generated neo-epitope on type IV collagen (C4G), and used to develop a technically robust competitive electro-chemiluminescence immunoassay (ECLIA). C4G was measured in serum from MM patients (n=54) before initiation of ipilimumab treatment. C4G was combined with the fibrosis biomarker PRO-C3, measuring type III collagen formation. Biomarker levels were associated with objective response rate (ORR) and overall survival (OS) outcomes. Results: The C4G assay was specific for a neo-epitope on type IV collagen degradation fragments generated by GzB. The ORR was 2.6 fold higher (18% vs 7%) in patients with high C4G levels ( & gt;25th percentile) vs low levels (≤25th percentile). Likewise, high C4G levels at baseline were associated with longer OS, with a median OS of 646 days vs 290 days for low C4G levels (HR=0.48, 95%CI: 0.24-0.98, p=0.045). When combining high C4G with low PRO-C3, the HR dropped to 0.30 (95%CI: 0.15-0.60, p=0.0006), and remained significant when adjusted for the covariates age, lactate dehydrogenase levels and prior treatment (HR: 0.35, 95%CI: 0.18-0.72, p=0.004). Conclusions: A liquid biopsy measuring granzyme B degraded type IV collagen (C4G) as a surrogate of active immune infiltration into the tumor microenvironment is associated with response to the ICI therapy ipilimumab. When combining C4G with the fibrosis biomarker PRO-C3, patients with this special phenotype - low fibrosis and high immune infiltration - have an even better chance of responding compared to high C4G levels alone. If validated, this suggests that specific collagen remodeling biomarkers (C4G+PRO-C3) have potential for predicting response to ICI's in clinical cancer trials. Citation Format: Christina Jensen, Dovile Sinkeviciute, Daniel H. Madsen, Patrik Önnerfjord, Morten Hansen, Henrik Schmidt, Inge Marie Svane, Morten A. Karsdal, Nicholas Willumsen. Liquid biopsy reflecting a T-cell permissive tumor microenvironment identifies metastatic melanoma patients responding to immune checkpoint inhibitor therapy [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 3091.
    Type of Medium: Online Resource
    ISSN: 0008-5472 , 1538-7445
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    Language: English
    Publisher: American Association for Cancer Research (AACR)
    Publication Date: 2020
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  • 8
    Online Resource
    Online Resource
    American Association for Cancer Research (AACR) ; 2020
    In:  Cancer Research Vol. 80, No. 16_Supplement ( 2020-08-15), p. 3953-3953
    In: Cancer Research, American Association for Cancer Research (AACR), Vol. 80, No. 16_Supplement ( 2020-08-15), p. 3953-3953
    Abstract: Introduction: Type XIX collagen is a poorly characterized collagen associated with the basement membrane zone along with type XVIII and XV collagen. Type XIX collagen has shown altered regulation during tumor progression of melanoma and breast cancer. In this study, we developed and validated an ELISA targeting the natural C-terminus of type XIX collagen and quantified it in serum of cancer patients, demonstrating the biomarker potential of type XIX collagen. Methods: A monoclonal antibody was raised against the C-terminus of type XIX collagen and utilized in a competitive ELISA named PRO-C19. PRO-C19 was quantified in serum from patients with breast (n=12), colon (n=7), gastric (n=9), melanoma (n=6), non-small cell lung cancer (NSCLC) (n=11), small cell lung cancer (SCLC) (n=7), ovarian (n=8), pancreas (n=2), prostate cancer (n=13) and healthy controls (n=38). PRO-C19 was further assessed in another cohort comprising stage III (n=20) and stage IV (n=20) NSCLC patients and healthy controls (n=24). Lastly, PRO-C19 was assessed in the conditioned media of a cell model mimicking the fibroblast activation found in fibrotic lung diseases using lung fibroblasts stimulated with TGF-β. Results: The PRO-C19 assay was technically robust and specific for the C-terminus of type XIX collagen. PRO-C19 was significantly elevated in serum from breast (p=0.0201), NSCLC (p & lt;0.0001) and ovarian cancer patients (p=0.0108) compared to healthy controls. PRO-C19 was also elevated in colon, pancreatic and SCLC cancers, although this was not statistically significant. The separation between NSCLC and healthy controls was excellent as demonstrated by an AUROC of 0.995 (p & lt;0.0001). Consequently, PRO-C19 was also assessed in a separate cohort of NSCLC patients. Here PRO-C19 was also significantly elevated in NSCLC patients compared to healthy controls (p & lt;0.0001) and the AUROC was 0.980 (p & lt;0.0001). Lastly, because PRO-C19 performed well in lung cancer, we assessed it in a lung fibrosis cell model. PRO-C19 was found in the conditioned media of the lung fibroblasts, but levels were independent of TGF-β stimulation. Conclusion: This study demonstrates that type XIX collagen is elevated in several types of cancer and proved excellent at separating NSCLC and healthy controls. The elevated levels seen in NSCLC patients do not seem to be induced by lung fibrosis. This all provide novel clues to the function of type XIX collagen - an otherwise poorly characterized collagen. Further investigations are ongoing to explore diagnostic or prognostic uses of PRO-C19 and the function of type XIX collagen. Citation Format: Jeppe Thorlacius-Ussing, Samuel Daniels, Morten Karsdal, Nicholas Willumsen. Serum type XIX collagen is significantly elevated in non-small cell lung cancer and is a biomarker with clinical potential [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 3953.
    Type of Medium: Online Resource
    ISSN: 0008-5472 , 1538-7445
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    Language: English
    Publisher: American Association for Cancer Research (AACR)
    Publication Date: 2020
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  • 9
    In: Cancer Research, American Association for Cancer Research (AACR), Vol. 83, No. 7_Supplement ( 2023-04-04), p. 1341-1341
    Abstract: Background Collagen remodeling is an essential part of embryogenesis and defines tissue structure and function in adulthood. The 28 different collagens are all important for maintaining tissue homeostasis and are deregulated in cancer. The abundant, major collagens, such as type I collagen, serve a structural role, whereas the less abundant, minor collagens serve a more regulatory role. Fibroblasts are the primary source of collagens and different cancer-associated fibroblast (CAF) subtypes, such as myCAFs or iCAFs, have been attributed important roles in cancer and are the target of novel therapies. Emerging evidence suggests minor collagens may be aberrantly expressed in cancer and linked to specific fibroblast subtypes, suggesting novel biomarker potential. This study aimed to evaluate the association between different CAF subtypes and collagen expression. Methods We investigated collagen expression in pancreatic cells and CAF subtypes in a publicly available single-cell RNA-Seq dataset (GSA: CRA001160). 24 samples were from patients with pancreatic ductal adenocarcinoma (PDAC) as this is one of the most collagen rich tumor types, and 11 samples were from pancreatic cysts, bile duct- or duodenal-tumors. In addition, we generated a collagen turnover profile using a panel of immunoassays to measure specific collagen fragments in the serum of 220 patients with various solid tumor types and 33 healthy controls. The included immunoassays measured collagen epitopes associated with either formation, degradation, or other modifications of collagens. Results Based on the single-cell RNA-Seq dataset, fibroblasts were the primary source of collagens. Major collagens, including COL1A1, COL3A1, COL4A1, and COL6A1, were highly expressed in both healthy fibroblasts and PDAC CAFs, whereas minor collagens such as COL8A1, COL10A1, COL11A1, and COL12A1 were exclusively expressed in CAFs. When further examining the CAF subtypes, major collagens were expressed in all CAF subtypes, with high expression in myCAFs and iCAFs. In contrast, the minor collagens were exclusively expressed in the myCAFs. When measuring these collagens in serum, the minor collagens were elevated across all cancer types when compared to healthy control serum. Contrastingly, the major collagens were not elevated in any cancers or only elevated in a few cancer types. Conclusions Collagens in general are highly expressed in cancer. However, minor collagens may be more cancer-specific than major collagens. Our findings also suggest that minor collagens may be specific to certain subtypes of CAFs. These collagens can be quantified in blood, making them promising actionable biomarkers that may guide drug development aimed at targeting CAFs. Citation Format: Jeppe Thorlacius-Ussing, Christina Jensen, Emilie Madsen, Morten Karsdal, Nicholas Willumsen. Non-invasive biomarkers quantifying collagens essential for embryogenesis are elevated in the circulation of solid tumor patients and may guide drug development [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 1341.
    Type of Medium: Online Resource
    ISSN: 1538-7445
    Language: English
    Publisher: American Association for Cancer Research (AACR)
    Publication Date: 2023
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    detail.hit.zdb_id: 1432-1
    detail.hit.zdb_id: 410466-3
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  • 10
    In: Cancer Research, American Association for Cancer Research (AACR), Vol. 82, No. 12_Supplement ( 2022-06-15), p. 3840-3840
    Abstract: Background: The major constituents of the tumor microenvironment (TME), are besides the tumor cells themselves, cancer associated fibroblasts (CAFs), stromal cells and the extracellular matrix (ECM). CAFs synthesize excess amounts of collagens leading to a fibrotic TME with poor response to anti-cancer treatment. Traditionally, tumor fibrosis is defined by quantification of fibrillar collagens such as type I collagen (COL1). So-called Fibril-Associated Collagen with Interrupted Triple helices (FACITs) are less studied in this context. Type XXII collagen (COL22) is a minor FACIT located at the basement membrane. COL22 may therefore provide a different value compared to standard COL1 assessment traditionally associated with tumor fibrosis. Methods: Levels of COL1 (PRO-C1) and COL22 (PRO-C22) was measured non-invasively using competitive enzyme-linked immunosorbent assays in serum from patients diagnosed with bladder-, breast-, colorectal-, head and neck-, kidney-, lung-, melanoma-, pancreatic-, prostate-, and stomach cancer (n=220) and compared to healthy controls (n=33) (Cohort 1). Based on results from Cohort 1, PRO-C22 was evaluated in an independent cohort (Cohort 2) comprising patients with pancreatic ductal adenocarcinoma (PDAC) (n=39) and healthy controls (n=20). Receiver operating characteristic (ROC) curve analysis was performed to assess the diagnostic performance of PRO-C22. Kaplan-Meier curves and Cox proportional hazard models were used to assess the association between PRO-C22 and overall survival (OS) after dichotomizing PRO-C22 at the median cutpoint. Results: In Cohort 1, PRO-C22 was significantly higher in patients with all individual cancer types compared to healthy controls (p & lt;0.01 to p & lt;0.0001). In support, the area under the ROC (AUROC) for separation of patients with cancer from healthy controls using PRO-C22 ranged from 0.89 to 0.98 (p & lt;0.0001). As comparison PRO-C1 assesment showed no significant difference. PRO-C22 was also significantly higher in patients with PDAC (Cohort 2) when compared to healthy (p & lt;0.0001) with an AUROC of 0.87 (p & lt;0.0001). Furthermore, high PRO-C22 levels were associated with shorter OS (median OS days 162 and 1363 for ‘high’ and ‘low’ PRO-C22 subgroups, respectively, p=0.0011). Likewise, high PRO-C22 levels at baseline predicted increased risk of mortality (HR=3.53, 95% CI 1.59-7.86, p=0.0020). Conclusion: These proof-of-concept data indicate that PRO-C22 may exhibit potential as a novel diagnostic and prognostic tumor fibrosis biomarker in cancer. PRO-C22 may be superior to type PRO-C1. Larger comprehensive clinical cohorts are needed to fully understand the biology associated with COL22 in cancer as well as the biomarker potential of PRO-C22 in various cancer types. Citation Format: Emilie Albrecht Madsen, Jeppe Thorlacius-Ussing, Christina Jensen, Neel I. Nissen, Astrid Z. Johansen, Inna M. Chen, Julia S. Johansen, Tina Manon-Jensen, Hadi M. Diab, Lars N. Jørgensen, Morten Karsdal, Nicholas Willumsen. Novel aspects of tumor fibrosis: Non-invasively assessed type XXII collagen, and not type I collagen, depicts highy elevated levels in patients with various solid tumor types [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 3840.
    Type of Medium: Online Resource
    ISSN: 1538-7445
    Language: English
    Publisher: American Association for Cancer Research (AACR)
    Publication Date: 2022
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