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Un espray fluorescente para detectar el cáncer de esófago
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Un espray fluorescente para detectar el cáncer de esófago

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Un espray fluorescente para detectar el cáncer de esófago

Las personas con esófago de Barrett (un reflujo severo) tienen mayor riesgo de cáncer que la población general, por lo que son sometidas a revisiones periódicas para detectar a tiempo la aparición de cualquier cambio maligno en el esófago. Sin embargo, los controles actuales no son suficientes y algunos tumores se "escapan" a esta vigilancia. Un espray fluorescente en experimentación podría ayudar en el futuro.

El uso de proteínas fluorescentes para "teñir" tejidos y observar mejor algunos procesos en el organismo es ampliamente utilizado en laboratorios de todo el mundo; sin embargo, su uso en la práctica clínica no está aún consolidado.


Un estudio que publica la revista Science Traslational Medicine ( doi: 10.1126/scitranslmed.3004733.) demuestra en humanos la utilidad de estos tintes celulares para detectar precozmente tumores malignos en pacientes con esófago de Barrett; un sistema que ya se había probado con éxito en animales con otros tipos de cáncer.

A diferencia de lo que ocurre con otros tumores, algunas de las lesiones malignas que pueden aparecer en el esófago no crecen de manera abultada, sino que son lesiones planas, que se camuflan con el resto de tejido sano y dificultan su detección precoz. Por eso, el espray que acaban de desarrollar en los laboratorios de las universidades de Michigan (EEUU) y Jiaotong (China) podría ser un buen aliado de los oncólogos en el futuro.

"Esta técnica, que ya se utiliza de manera experimental en otros tumores, como el de colon, puede ser muy útil para guiar dónde es necesario biopsiar a los pacientes con esófago de Barrett", explica el doctor Javier Molina-Infante, responsable de estas patologías en la Asociación Española de Gastroenterología.

Como explica por su parte Atanasio Pandiella, subdirector del Centro de Investigación del Cáncer de Salamanca (CIC), el problema es que en estos pacientes es difícil distinguir el tejido que simplemente está alterado por el efecto continuo de los ácidos del estómago, del epitelio pretumoral propiamente dicho. "Por eso, a menudo, se toman dos o tres muestras en zonas diferentes para biopsiar, pero sin mucha certeza porque la inspección visual falla".

Para ayudar a guiar esas biopsias, los investigadores seleccionaron un péptido (una pequeña secuencia de aminoácidos) entre una biblioteca de más de 1000 millones de sustancias. "Primero vieron en una serie de pruebas de laboratorio que ese péptido se unía muy bien a las células tumorales y no a las sanas", aclara Pandiella.

Sólo después probaron el espray en 25 individuos con cáncer de esófago, cuyas lesiones malignas y premalignas se "iluminaron" con éxito al contacto con esta sustancia. "En aquellas zonas con displasia (alteración del tejido), el péptido fluorescente se unió a las células tal y como se pudo observar mediante un microscopio especial", prosigue Pandiella; "eso permitió guiar las biopsias, para obtener el diagnóstico final".

A pesar de sus ventajas y los buenos resultados, el doctor Molina-Infante recuerda que se trata de una técnica todavía cara, que requiere mucho tiempo y obliga a tener un endoscopio especial para visualizar la fluorescencia.

En todo el mundo se diagnostican al año unos 480 000 casos de cáncer de esófago al año, cuya incidencia ha crecido un 460% en varones mayores de 65 años en los últimos años. El retraso en el diagnóstico se traduce en una tasa de supervivencia de apenas el 15% a los cinco años del diagnóstico. Y aunque sólo el 1%-3% de los pacientes con esófago de Barrett desarrolla un tumor maligno, esta acidez severa multiplica por 30 las posibilidades de sufrir este tipo de cáncer.

La utilización de endoscopias (un tubo flexible con una cámara en su extremo) cada dos o tres años para observar el esófago en esta población de riesgo permite cierto grado de detección precoz, pero los oncólogos coinciden en que cualquier mejora en las técnicas de detección precoz sería bienvenida a la clínica. Sin embargo, como reconocen en su artículo Matthew Sturm y su equipo, hasta ahora los métodos para mejorar esta visualización (cromoendoscopia, autofluoresencia...) no han tenido el éxito deseado. Sólo el tiempo -y estudios más amplios- dirán si este espray "fosforito" (seguro y bien tolerado por los pacientes) puede hacerse un hueco en los servicios de Gastroenterología y Oncología.

mayo 13/2013 (Diario Salud)

Sturm MB, Joshi BP, Lu S, Piraka C, Khondee S, Elmunzer BJ.Targeted Imaging of Esophageal Neoplasia with a Fluorescently Labeled Peptide: First-in-Human Results.Sci Transl Med. 2013 May 8;5(184):184ra61.

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