American Journal of Pathology, Vol. 156, No. 4, April 2000
Copyright © American Society for Investigative Pathology
Special Article
Molecular Profiling of Clinical Tissue Specimens
Feasibility and Applications
Michael R. Emmert-Buck,*† Robert L. Strausberg,†
David B. Krizman,†‡ M. Fatima Bonaldo,§
Robert F. Bonner,¶ David G. Bostwick,i
Monica R. Brown,†‡ Kenneth H. Buetow,**
Rodrigo F. Chuaqui,* Kristina A. Cole,* Paul H. Duray,‡
Chad R. Englert,* John W. Gillespie,†
Susan Greenhut,† Lynette Grouse,†
LaDeana W. Hillier,†† Kenneth S. Katz,†
Richard D. Klausner,‡‡ Vladimir Kuznetzov,¶
Alex E. Lash,§§ Greg Lennon,¶¶ W. Marston Linehan,ii
Lance A. Liotta,‡ Marco A. Marra,***
Peter J. Munson,††† David K. Ornstein,*ii
Vinay V. Prabhu,††† Christa Prange,¶¶
Gregory D. Schuler,§§ Marcelo Bento Soares,§
Carolyn M. Tolstoshev,§§ Cathy D. Vocke,ii and
Robert H. Waterston††
the function of a relatively small percentage of genes.
However, biomedical research is in the midst of an informational and technological revolution with the potential to
increase dramatically our understanding of how expression modulates cellular phenotype and response to the
environment. The entire sequence of the human genome
will be known by the year 2003 or earlier.1,2 In concert,
the pace of efforts to complete identification and fulllength cDNA sequencing of all genes has accelerated,
and these goals will be attained within the next few
years.3–7 Accompanying the expanding base of genetic
information are several new technologies capable of global
gene expression measurements.8 –16 Taken together, the
expanding genetic database and developing expression
technologies are leading to an exciting new paradigm in
biomedical research known as molecular profiling.
From the Pathogenetics Unit,* Laboratory of Pathology, National
Cancer Institute, Bethesda, Maryland; the Cancer Genome Anatomy
Project,† Office of the Director, National Cancer Institute, Bethesda,
Maryland; the Laboratory of Pathology,‡ National Cancer Institute,
Bethesda, Maryland; the Departments of Pediatrics and Physiology and
Biophysics,§ University of Iowa, Iowa City, Iowa; the Laboratory of
Integrative and Medical Biophysics,¶ National Institute of Child Health
and Disease, Bethesda, Maryland; Bostwick Laboratories,i Richmond,
Virginia; the Laboratory of Population Genetics,** National Cancer
Institute, Bethesda, Maryland; the Genome Sequencing Center,††
Washington University, St. Louis, Missouri; the Office of the Director,‡‡
National Cancer Institute, Bethesda, Maryland; the National Center for
Biotechnology Information,§§ National Library of Medicine, Bethesda,
Maryland; the Integrated Molecular Analysis of Genomes and their
Expression Consortium,¶¶ Biology and Biotechnology Research
Program, Lawrence Livermore National Laboratory, Livermore,
California; the Urologic Oncology Branch,ii National Cancer Institute,
Bethesda, Maryland; the Genome Sequence Centre,*** British Columbia
Cancer Research Centre, Vancouver, British Columbia, Canada; and
the Mathematical and Statistical Computing Laboratory,††† Center for
Information Technology, National Institutes of Health,
Bethesda, Maryland
Molecular Profiling
Molecular profiling uses measurement of global expression patterns toward identification of the individual genes
and collections of genes that mediate particular aspects
of cellular physiology. The method is primarily hypothesis-generating, emphasizing new discoveries and creation of novel postulates based on analysis of expression
data sets.17–21 Much like an astronomer with a new telescope, investigators use molecular profiling to explore
and observe, with the goal of producing insights that
would not readily be predicted based on the currently
available body of knowledge. In humans, molecular profiling efforts hold great promise to advance our understanding and treatment of diseases. Measurement of expression patterns of normal and affected cell populations
likely will identify specific sets of genes that are disregulated. Moreover, the availability of full-length mRNA codThe work of C. P. was supported by the U.S. Department of Energy under
contract W-7405-Eng-43.
Primary contributors to this article were M. E.-B., R. S., and D. K.
Accepted for publication February 18, 2000.
The relationship between gene expression profiles and
cellular behavior in humans is largely unknown. Expression patterns of individual cell types have yet to be precisely measured, and, at present, we know or can predict
Address reprint requests to Dr. Michael R. Emmert-Buck, National
Cancer Institute Laboratory of Pathology, National Institutes of Health,
Building 10, Room 2A33, 9000 Rockville Pike, Bethesda, MD 20892.
E-mail:
[email protected].
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AJP April 2000, Vol. 156, No. 4
ing sequences will allow prediction of function based on
computer modeling algorithms, promoting a more fundamental understanding of the disease process as well
as new diagnostic and therapeutic targets for clinical
intervention.
There are several experimental systems available for
molecular profiling, including human cells in vitro and
animal models that mimic human pathologies. Each of
these approaches has proven to be valuable in past
studies and hold excellent potential to produce important
discoveries in expression profiling studies. However, in
parallel, it is critical that patients be studied directly.
Molecular profiles of human cells in vivo, as they exist in
patients, may lead to unique insights that are not readily
evident in laboratory-based investigations, and are the
gold standard against which model systems should be
compared.22 Certainly, the ability to peer directly into the
molecular anatomy of normal and diseased human cells
in their complex tissue milieu is a particularly exciting
application of molecular profiling.
However, there are significant technical challenges
associated with expression profiling of clinical samples
and substantive obstacles that must be addressed. For
example, investigators are confronted with the difficulty of
procuring specific microscopic cell foci from heterogeneous tissues. Moreover, high-throughput expression
studies require recovery of a diverse and complex transcriptome, not a trivial task when using small numbers of
cells as template. Although it is exciting in concept, to
date there are few experimental data available that support the possibility of this approach. Therefore, a study
was designed to answer two key questions. Is molecular
profiling of histopathologically defined cell populations
from clinical tissue specimens feasible using available
technologies and methodologies? If so, what are nearterm and long-term applications of global gene expression data sets from patient samples?
Feasibility: Prostate Cancer Study
Molecular profiling studies generate large data sets for
analysis, representing a significant challenge for investigators. Moreover, clinical studies ideally include multiple
samples, such that molecular findings can be assessed
for their frequency among patients and/or correlated with
particular features of a disease. Thus, integration of clinical information, histopathology, developing technologies
and laboratory methods, and bioinformatics algorithms is
essential for profiling efforts. The present study was performed as part of the Cancer Genome Anatomy Project
(CGAP) of the National Cancer Institute (NCI).23–25 CGAP
is an interdisciplinary program that aims to establish the
information and technological tools needed to decipher
the molecular anatomy of cancer cells. All data from the
project are immediately made available to the public and
can be used without restriction.
The feasibility of molecular profiling of microdissected
cell populations was assessed using cDNA library sequencing as an initial gene expression platform and prostate cancer progression as a disease for study. Sample
collection, microdissection, and library production were
performed at the NCI (for additional information on the
technical features of the study, see “Molecular Profiling of
Prostate Cancer” below). The libraries were subsequently
arrayed at Lawrence Livermore National Laboratories,
and selected clones were sent to the Genome Sequencing Center at Washington University. The sequence data
were returned to the National Center for Biotechnology
Information where they were filtered and entered into the
database of expressed sequence tags (dbEST). The flow
of reagents and information essentially followed that initially designed by the Integrated Molecular Analysis of
Genomes and their Expression consortium.5
Twelve microdissection-based libraries were produced from epithelial components of radical prostatectomy or biopsy specimens, including normal epithelium,
premalignant foci, locally invasive cancer, and metastatic
cancer (see Table 1). A total of 29,183 successful sequences was performed. Analysis of the number and
frequency of genes expressed showed that all of the
libraries exhibited a high level of complexity. The majority
of genes were observed only once or twice in each
library, and the overall gene diversity (number of genes
identified/number of sequences analyzed) averaged
39.1%, which compares favorably with standard libraries
derived from whole tissue specimens or cultured cells.
Moreover, a wide range of expression was seen, from
genes observed at high levels (prostate-specific antigen,
b-microseminoprotein) that are known to be abundant in
prostate epithelium, to a large number of low-abundance
genes that were observed infrequently. Thus, the data
clearly demonstrate the feasibility of recovering complex
transcriptomes from microdissected cell populations, encouraging news for investigators interested in molecular
profiling studies of clinical samples.
Applications of Molecular Profiling Data Sets
The first goal of the data analysis was to determine a
prostate epithelial unigene set, ie, a catalogue of genes
expressed in normal and malignant prostate epithelium.
Clustering analysis of sequences derived from the libraries revealed expression of more than 6000 different epithelial genes, representing 35 to 50% of the estimated
total, presumably including all of the genes that are expressed at high levels. The epithelial unigene set serves
as a foundation for multiple analyses of gene expression.
Five separate examples are briefly described below.
Prostate-Unique Gene Expression
Comparison of the expression patterns in the prostate
libraries with all of the library sequence information in
dbEST permits identification of genes that are unique to
prostate epithelium as well as those that are expressed at
significantly higher levels in prostate than in other cell
types. These genes are of biological interest, due to their
presumed specialized function in the gland, as well as
potentially useful as diagnostic or therapeutic targets. For
example, prostate-specific proteins localized to the cell
Molecular Profiling of Clinical Specimens
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Table 1.
Summary of Microdissection-Based Libraries
Library
no.
Library Name
Patient
Sample type
Sequences
No. of new genes
discovered
% Diversity
281
515
526
529
282
511
538
544
283
513
527
523
NCI_CGAP_Pr1
NCI_CGAP_Pr5
NCI_CGAP_Pr9
NCI_CGAP_Pr11
NCI_CGAP_Pr2
NCI_CGAP_Pr6
NCI_CGAP_Pr7
NCI_CGAP_Pr4/4.1
NCI_CGAP_Pr3
NCI_CGAP_Pr8
NCI_CGAP_Pr10
NCI_CGAP_Pr12
1
2
3
4
1
2
2
1
1
2
3
5
Normal epithelium
Normal epithelium
Normal epithelium
Normal epithelium
Premalignant lesion
Premalignant lesion
Premalignant lesion
Premalignant lesion
Adenocarcinoma
Adenocarcinoma
Adenocarcinoma
Metastatic adenocarcinoma
5689
805
1104
1376
5688
1462
468
1928
5209
1100
1139
3215
29,183
152
8
10
15
119
24
5
24
135
14
15
38
559
35.2
40
46.1
45.2
34.9
42.6
39.1
37.8
29.6
42.4
42.6
33.6
39.1
surface may serve as targets for antibody-mediated delivery of therapeutic compounds.26 Alternatively, knowledge of the promoter regions of prostate-unique genes
could have value for virally mediated gene therapy by
restricting transcription to prostate epithelial cells. For
new serum protein markers of cancer, transcripts that are
both highly expressed in tumors and unique to prostate
epithelium have the most potential, because their gene
products will be the easiest to detect and monitor based
on levels of abundance. As an example, prostate-specific
antigen is the current standard as a serum marker for
prostate cancer, and its transcript was consistently observed at high levels in the libraries.
Integration: Genome, Expression, and Disease
Expression profiles of the prostate epithelial libraries can
be integrated with GeneMap’99 to examine specific areas of the genome implicated in cancer. For example,
chromosomal arms 1q, 8q, 8p, 13q, 16q, and Xq have
been identified as important in prostate tumorigenesis
based on linkage studies or chromosomal abnormalities
observed in tumors.27–33 The responsible gene at each of
these regions has yet to be identified. The standard approach to finding such genes involves narrowing the
physical size of the candidate interval using techniques
such as meiotic recombination or marker disequilibrium
in affected families, or tumor deletion/amplification in
sporadic cases.34 –36 An adjunct approach is to use expression patterns to narrow the region, ie, to prioritize the
subset of genes for analysis that map to the minimal
search interval and are expressed in the involved tissue.
The MEN1 and PTEN genes are examples of recently
identified tumor suppressor genes that are found in appropriate libraries (MEN1, NCI CGAP Lu5; PTEN, NCI
CGAP Pr3/Pr22).37–39 Integration of cell type-specific
gene expression and transcript map location is likely to
become an increasingly valuable approach for disease
gene hunting as molecular profiling databases grow and
sequencing and mapping of all human genes are completed.
cDNA Microarray-Based Profiling
Investigators using expression arrays to study prostate
tumorigenesis can prioritize the prostate epithelial unigene set for study. This has both short-term and longterm advantages. In the near term, a practical strategy is
to use the prostate unigene set on an expression array
and focus on measuring the genes of moderate or high
abundance whose expression levels change substantially during tumorigenesis. To facilitate these efforts the
prostate expression data were used to create a commercially available prostate cDNA expression microarray,
which includes a majority of the epithelial unigenes, including those uniquely expressed in prostate.40 The major long-term challenge of array-based studies will be
quantitative measurement of small expression changes,
particularly for those genes present at low levels. Refinement of experimental strategies will likely be required,
such as gene-specific primers to prepare cDNA for analysis and careful selection of sequences used on the array
to avoid cross-hybridization. Efforts to design such custom arrays will be facilitated by a successive reduction in
the number of genes required for analysis, beginning with
prioritization of the relevant unigene set and eventually
reducing to the specific set of genes that mediate the
pathways and processes under study.
Single Nucleotide Polymorphisms (SNPs)
The genetic variation in genes that are found to be important in prostate cancer can be determined through the
Genetic Annotation Initiative (GAI) section of the CGAP
website. The GAI focuses on identifying SNPs in genes
expressed in cancers.25,41 Analysis of the frequency and
transmission of SNPs can be used for many genetic
studies, including traditional linkage mapping and dissection of complex pathways. Gene-specific SNPs are
also valuable polymorphic markers for finely mapping
regions of allelic loss in tumor loss of heterozygosity
studies. The GAI identifies candidate SNPs through an
analytical software package called SNPpipeline and then
verifies the variation by sequencing DNA from several
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individuals. To date, more than 10,000 candidate SNPs
have been identified. To make the information easy to
access, all SNP data are placed on an integrated genetic/physical SNP map available through the GAI website.
Differential Gene Expression
An important use of molecular profiling data sets is to
compare and contrast the expression profiles that occur
during evolution of a disease process. Thus, we analyzed
the sequence data from the normal epithelial, premalignant, and invasive tumor libraries using a variety of
statistical methods and identified the genes that were
differentially expressed during tumor progression. The
transcripts that showed the largest change between normal and tumor cells were a subset of mRNAs that encode
for ribosomal proteins. This finding is expected in cancer
cells due to their requirement for increased protein synthesis for cell division.12 Interestingly, though, these ribosomal protein mRNAs were not increased in libraries from
premalignant cells that showed expression levels similar
to normal epithelium. This finding is at odds with most
current thinking, which presumes that premalignant foci
develop due to a marked increase in growth rate, with
subsequent transition to cancer primarily involving acquisition of an invasive phenotype. Based on the present
gene expression data set, one can propose two alternative hypotheses for testing. First, premalignant cells do
not proliferate at a rate near that of invasive tumor cells,
and fundamental alterations in oncogene and/or tumor
suppressor gene pathways that substantially increase
the rate of cell division are still required for their progression to cancer. Second, a decreased rate of apoptosis is
an important early event in prostate tumor progression;
ie, it is a decreased rate of cell death, as opposed to an
increase in cell division, that mediates the development
of premalignant foci.
In addition to expected findings such as increased
ribosomal protein transcripts in cancer, several unanticipated discoveries were made, including both quantitative and qualitative alterations in gene expression. For
example, the transcript for T cell receptor g was found in
normal and cancerous prostate epithelium, and observed
at statistically elevated levels in cancer libraries. The
presence of T cell receptor g mRNA in prostate epithelium and the high level of expression in tumor cells is both
surprising and puzzling. A second example was detection of a novel splice variant of PB39 transcript in a library
derived from premalignant cells. PB39 mRNA was previously reported to be overexpressed in prostate cancer,
but was not known to exist in an alternative splice form.42
Interestingly, based on a search of all cDNA libraries and
sequences in dbEST the novel splice variant is primarily
expressed in fetal tissues and tumors and thus may be
associated with the loss of cellular differentiation that
occurs during prostate tumor progression.43 Additionally,
PHDhtm and SignalP computer-based analysis of the
predicted amino acid sequence of PB39 indicates the
N-terminus contains a secretory signal peptide sequence
for a secreted protein. Thus, the protein product of the
alternative splice form could potentially serve as a serum
marker of early prostate cancer development.
Certainly, the significance of ribosomal protein mRNAs,
T cell receptor g mRNA, and PB39 splice variant mRNA in
prostate tumors and premalignant lesions remains to be
determined in follow-up studies. However, the larger implication of these findings is immediately clear. There is
much yet to be learned with respect to gene expression
profiles in complex human tissues. Thus, exploratory
studies using developing expression technologies and
the information provided by the Human Genome Project
are likely to have a unique and important role in the study
of normal cell physiology and the development of diseases.17 In this regard, the present study is encouraging and
indicates molecular profiling of clinical tissue specimens
is a feasible and promising experimental approach.
Molecular Profiling of Prostate Cancer
Case Selection
Samples from five different patients were included in the
study to determine whether molecular profiling could be
routinely performed on clinical specimens. The five cases
were randomly selected from the NCI frozen tissue bank,
and 12 libraries were produced. Each specimen was
snap-frozen within 15 minutes of surgical resection, but
no other special procedures were used for handling the
tissues.
Tissue Acquisition
The goal of molecular profiling of human tissue specimens is to measure global gene expression levels as they
exist in cells in patients. In the present study the libraries
were created from tissues that had been surgically removed; thus, it is possible that alterations in gene expression profiles occurred during or after the resection, eg,
transcription of new genes due to environmental stress or
loss of transcripts during tissue handling. This is an important issue that needs to be addressed experimentally
in the future by comparing molecular profiles of needle
biopsy samples (immediate removal and freezing) with
surgically resected samples of the same tissue type. If
molecular alterations are shown to occur in surgical
specimens, then two potential scenarios arise that will
affect how samples should be acquired for future molecular profiling studies. In the first scenario, the induced
changes are minimal and occur reproducibly, and thus
can be predicted and factored into subsequent data
analyses. In this case surgically resected samples will be
useful templates for study as long as they are appropriately acquired and processed. In the second, the induced changes are substantial and cannot reliably be
predicted. In this case, future molecular profiling efforts
will need to use biopsy or cytology samples as templates,
and/or will need to be performed like intraoperative diagnostic frozen section analysis; ie, at the outset of the
operation the surgeon will need to procure and immedi-
Molecular Profiling of Clinical Specimens
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ately freeze several small tissue samples for molecular
profiling studies.
ally, the expression frequency of all individual genes
observed was calculated to determine relative levels of
abundance.
Microdissection
Cells were procured by either manual microdissection or
the initial prototype laser capture microdissection instrument.44,45 Based on careful histopathological review of
the tissue sections, it is estimated each sample contained
.90% of desired cells. Newer laser-based dissection
systems and associated methodologies currently allow
for dissections approaching 100% purity.46 – 48 Following
are some technical observations made during the course
of the study. Rapid dehydration of cryostat sections is
important to inactivate endogenous RNases. Staining
with hematoxylin and eosin allows microscopic visualization during microdissection and does not significantly
diminish mRNA recovery. Approximately 5000 microdissected cells are required to produce a library with acceptable numbers of recombinants (.100,000) and gene
diversity (.20%).
Library Preparation and Characteristics
Detailed protocols for all of the 156 CGAP libraries are
indicated on the web page. Each of the 12 prostate
libraries in the present study was made using microdissection library protocol no. 1.49,50 Evaluation of the library
sequence data showed two important characteristics that
impact on the overall utility of a microdissection-based
approach. First, the clone insert size averaged only 500
to 600 bp in length due to the fragmented mRNA recovered from tissue samples. Technical attempts to increase
the insert size were not considered a high priority, because the libraries were intended solely for gene profiling
and not as templates for full-length gene cloning. Second, the number of recombinants ranged from approximately 100,000 to 200,000 per library, substantially less
than in traditional libraries. Additional PCR cycles of
cDNA could increase the number of recombinants significantly; however, because the libraries were prepared for
expressed sequence tag (EST) analysis as opposed to
traditional screening, the number of PCR cycles was
limited to 10 to minimize amplification bias.
Assessment of Library Quality
Measurement of one or a few genes from small numbers
of cells using RT-PCR is relatively straightforward to perform. However, global expression profiling studies are
significantly more challenging, because the recovered
mRNA and subsequent cDNA must contain a complex
set of genes reflective of the native abundance of the
transcript population. Gene diversity (number of genes
observed/number of sequences) was used as the measure of cDNA library quality and was determined by
sequencing a minimum of 500 randomly selected clones
per library. This was sufficient to provide a statistically
reliable indicator of complexity and was a useful tool that
provided a rigorous measure of library diversity. Addition-
Informatics Analysis
Several analysis tools and all of the present prostate data
are provided on the CGAP website (www.ncbi.nlm.nih.gov/
ncicgap/) to allow statistical comparison of gene expression
profiles in the libraries. For additional information, relevant
website links include:
NCBI, www.ncbi.nlm.nih.gov/
Unigene, www.ncbi.nlm.nih.gov/UniGene/index.html
LibraryBrowser,www.ncbi.nlm.nih.gov/UniGene/lbrowse.
cgi?ORG5Hs
GeneMap’99, www.ncbi.nlm.nih.gov/genemap/
CGAP GAI www.lpg.nci.nih.gov/GAI/
dbEST, www.ncbi.nlm.nih.gov/dbEST/index.html
Genes and Diseases, www.ncbi.nlm.nih.gov/disease/
CGAP Update, www.nih.gov/news/pr/aug99/nci-10a.htm
The dbEST and Unigene sites are continually updated.
Investigators should query the data sets using the latest
Unigene build for the most up-to-date information. As with
all projects using EST data, one must use caution in
interpreting results, and candidate genes of interest
should be subjected to rigorous follow-up analysis.
Prostate-Unique and Prostate-Specific Genes
CGAP website tools were created to be capable of generating two different classifications. Prostate-unique genes
are those that have been observed only in libraries derived from prostate and are precalculated on the website
(query “prostate” under the “Summary Tables of Libraries, Genes and Sequences” section). Prostate-specific
genes include those expressed at statistically elevated
levels in prostate epithelial libraries compared to libraries
from other cell and tissue types. These can be determined using the Digital Differential Display tool.
(Prostate-unique genes are included in this category
based solely on detection in cDNA libraries used as part
of EST projects. A subset of these genes may have been
observed in non-prostate tissue in other studies. It is
anticipated that with additional EST sequencing some of
these genes will shift to the “prostate-specific” category
or will drop out of both classifications.)
cDNA Microarray-Based Studies
We have observed two noteworthy features of expression
array studies. First, intense artifactual hybridization signals can be problematic for 39 cDNA clone-based arrays
due to hybridization to polyA sequences and repetitive
DNA elements, ie, samples can appear to hybridize successfully to a large number of genes on an array when in
fact the majority of signal is artifactual. Thus, one must be
careful in evaluating the apparent success of methods to
prepare array samples from small numbers of microdissected cells, and must also be cautious in using array
results to construct a unigene set of expressed genes
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from a given cell type. Secondly, individual transcripts
often hybridize strongly to at least a few additional DNAs
on arrays besides the intended DNA and hybridize less
strongly to many DNAs. This cross-hybridization reduces the overall sensitivity of arrays to detect expression
changes, and importantly, must be carefully considered
when using gene cluster algorithms to analyze array results.
Differential Gene Expression
This effort was considered a lesser priority goal of the
project, since it was thought that relatively few statistically
valid differences in gene expression could be determined based on the amount of sequencing planned for
the study. In fact, analysis of the library data proved this
to be the case. Even with completion of nearly 30,000
total sequences, the majority of epithelial genes were not
expressed at sufficient levels or in enough libraries to
permit a reliable statistical assessment of differential expression. However, the gene distribution profile in the
libraries indicates that comparison of expression levels of
a significant fraction of the prostate epithelial unigene set
could be achieved by using substantially greater sequencing depth.
Initially, it was presumed that contamination of lymphocytes during the dissection step was responsible for the
presence of T cell receptor g transcript in the prostate
libraries.51 However, epithelial localization was confirmed
by in situ hybridization studies of tissue sections and
appears selective for the g chain, as other components of
the T cell receptor were not observed in the prostate
libraries.52
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