Carnitine Palmitoyl Transferase 1A Is a Novel Serum Biomarker for the Diagnosis of Breast Cancer

Background: Carnitine palmitoyl transferase 1A (CPT1A) is the rate-limiting enzyme of fatty acid oxidation. It is overexpressed in advanced breast cancer and leads to poor survival. Here we aimed to examine the serum levels of CPT1A in a large-scale study and develop CPT1A as a biomarker for the early diagnosis of breast cancer. Methods: An ELISA was conducted to detect serum CPT1A levels in 432 breast cancer patients, 200 patients with benign breast disease, and 400 healthy controls in a training set and a test set. Receiver operating characteristic curves were generated, and binary logistic regression analyses were performed to evaluate the effectiveness of CPT1A, CA15-3, CEA, and CA125 as biomarkers in breast cancer diagnosis and to develop novel diagnostic panels. Findings: Serum CPT1A levels were significantly higher in breast cancer patients than in patients with benign breast disease or in healthy controls. CPT1A levels were even more significantly elevated in serum from advanced or triple-negative breast cancer cases and were decreased in paired post-operative samples compared with pre-operative samples. CPT1A exhibited a higher efficacy in differentiating breast cancer patients from healthy controls (area under the curve, AUC: training set, 0.870; test set, 0.901) than did CA15-3, CEA, or CA125. The panel combining CPT1A with CA15-3, CEA, and CA125 was more effective in breast cancer diagnosis (AUC: training set, 0.908; test set, 0.909) than CPT1A alone. Interpretation: CPT1A can be a novel serum biomarker for the diagnosis and disease monitoring of breast cancer. Funding Statement: The work was supported by National Science Foundation of China (81802653), Research Fund of Hubei Province Public Health Bureau (WJ2015MB144) and Research Fund of Wuhan Public Health Bureau (WX15A12 and WX18Y11). Declaration of Interests: No potential conflicts of interest were disclosed. Ethics Approval Statement: The study was approved by the ethics committee of the two hospitals. Written informed consent was obtained from every participant for the use of blood samples and medical records for research purposes.