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Suggested Citation:"Glossary." Institute of Medicine. 2011. Perspectives on Biomarker and Surrogate Endpoint Evaluation: Discussion Forum Summary. Washington, DC: The National Academies Press. doi: 10.17226/13038.
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Glossary

Accelerated approval—regulatory mechanism by which new drugs meant to treat serious, life-threatening diseases or diseases for which there are no alternative treatments can be approved for marketing by the Food and Drug Administration (FDA) using earlier clinical trial results than would be required for regular approvals; postmarket surveillance and studies generally required

Analytical validation—“assessing [an] assay and its measurement performance characteristics, determining the range of conditions under which the assay will give reproducible and accurate data” (Wagner, 2002)

Angiotensin-converting enzyme (ACE) inhibitor—drug used to treat high blood pressure; prevents formation of a protein that causes constriction of blood vessels, thus lowering blood pressure

Apolipoprotein—a protein component of lipoprotein complexes

Assay—a biochemical or other measurement developed to quantitate a biomarker

Authorized health claim—voluntary statement that characterizes the relationship between a substance and its ability to reduce the risk of disease or a health-related condition (Schneeman, 2007) that meets the significant scientific agreement (SSA) standard

Beta-carotene ( β-carotene)pigment-producing molecule in the skin of several fruits and vegetables; after ingestion, some β-carotene in blood-stream converts to two molecules of retinol (preformed vitamin A)

Suggested Citation:"Glossary." Institute of Medicine. 2011. Perspectives on Biomarker and Surrogate Endpoint Evaluation: Discussion Forum Summary. Washington, DC: The National Academies Press. doi: 10.17226/13038.
×

Biological plausibility—data elucidating how the biological pathways leading from exposure to effect are useful

Biological products (biologics)—a category of products regulated by the FDA, including vaccines, blood and blood components, allergenic compounds, somatic cells, gene therapy, tissues, and recombinant therapeutic proteins

Biomarker—“a characteristic that is objectively measured and evaluated as an indicator of normal biological processes, pathogenic processes, or pharmacologic responses to a[n] … intervention” (Biomarkers Definitions Working Group, 2001). Example: cholesterol level. The committee defines “objectively” to mean “reliably and accurately”

Calcium channel blocker—drug used to treat heart failure caused by high blood pressure; effects the movement of calcium in the cells of the heart and blood vessels to relax blood vessels and increase the supply of blood and oxygen to the heart

Cardiovascular disease—a term encompassing diseases that affect the heart and blood vessels

CD4 cell (CD4+ T-cells)—specialized cells that play a role in measuring immune response in individuals with HIV

Cholesterol—abundant steroid metabolite produced by animals and found in cell membranes and circulating in blood; excess cholesterol can lead to fatty deposits in blood vessels, a risk factor for cardiovascular disease

Chronic disease—a culmination of a series of pathogenic processes in response to internal or external stimuli over time that results in a clinical diagnosis/ailment and health outcomes

Clinical endpoint—a characteristic or variable that reflects how a patient [or consumer] feels, functions, or survives (Biomarkers Definitions Working Group, 2001)

Clinical trial—a formal study carried out according to a prospectively defined protocol that is intended to discover or verify the safety and effectiveness of procedures or interventions in humans (IOM, 2007)

Computed tomography (CT)—a special radiographic technique that uses a computer to assimilate multiple X-ray images into a two-dimensional, cross-sectional image, which also can be reconstructed into a three-dimensional image; can reveal many soft-tissue structures not shown by conventional radiography (IOM, 2007)

Coronary heart disease (CHD)—refers to damage to the heart caused by atherosclerotic constriction of arteries supplying the heart; also known as coronary artery disease

Correlation—a statistical association between two variables that does not imply a cause-and-effect relationship

C-reactive protein (CRP)—an acute-phase, nonspecific, systemic biomarker of inflammation; in normal individuals, CRP is a trace plasma

Suggested Citation:"Glossary." Institute of Medicine. 2011. Perspectives on Biomarker and Surrogate Endpoint Evaluation: Discussion Forum Summary. Washington, DC: The National Academies Press. doi: 10.17226/13038.
×

protein, but the serum concentration of CRP can increase upward of 1,000-fold upon exposure to a strong acute stimulus, such as sepsis or acute myocardial infarction

Diagnosis—a conclusion as to the presence of a disease

Diagnostic test—the investigative tools and techniques used in biological studies to identify or determine the presence of a disease or other condition. Any laboratory-based test that can be used in drug discovery and development as well as in patient care and clinical decision making (IOM, 2007)

Dietary guidance statement—a statement describing general dietary patterns, practices, and recommendations that promote health; these make reference to categories of foods and not specific substances, and they do not describe relationships between a substance (specific food or food component) and a disease or health-related condition; these can be made without FDA review or authorization before use

Drug—materials intended for use in the diagnosis, cure, mitigation, treatment, or prevention of disease; materials (other than food) intended to affect the structure or any function of the body of humans or other animals

Efficacy—ability to produce a desired effect

Epidemiologic studies—studies of the health of various human populations

Food—articles used for food or drink for humans or other animals, chewing gum, and articles used for components of any such article; inclusive of foods consumed as part of meals and snacks, dietary supplements, and components contained in them (nutrients, other bioactive substances)

Health claim—a claim that describes the relationship between a substance (food or food component) and a disease or health-related condition; limited to claims about disease risk reduction and cannot be claims about the cure, mitigation, treatment, or prevention of disease

High-density lipoprotein cholesterol (HDL-C)—a lipoprotein of blood plasma that is composed of a high proportion of protein with little triglyceride and cholesterol and that is associated with decreased probability of developing atherosclerosis

Hypertension—abnormally high arterial blood pressure that is usually indicated by an adult systolic blood pressure of 140 mm Hg or greater or a diastolic blood pressure of 90 mm Hg or greater; can result in thickening and inelasticity of arterial walls and damage to the heart; a risk factor for various pathological conditions or events (e.g., heart attack, heart failure, stroke, end-stage renal disease, or retinal hemorrhage)

In vitro diagnostic—a test that can detect disease, infection, or other health conditions

Suggested Citation:"Glossary." Institute of Medicine. 2011. Perspectives on Biomarker and Surrogate Endpoint Evaluation: Discussion Forum Summary. Washington, DC: The National Academies Press. doi: 10.17226/13038.
×

In vivo—in the living body of a plant or animal

Intervention—any drug, device, biologic, behavioral modification, nutritional modification, lifestyle modification, or other treatment intended to improve health

Low-density lipoprotein cholesterol (LDL-C)—a lipoprotein of blood plasma that is composed of a moderate proportion of protein with little triglyceride and a high proportion of cholesterol and that is associated with increased probability of developing atherosclerosis

Magnetic resonance imaging (MRI)—method by which images are created by recording signals generated from the excitation (the gain and loss of energy) of such elements as the hydrogen of water in tissue when placed in a powerful magnetic field and pulsed with radiofrequencies (IOM, 2007)

Medical device—any instrument, apparatus, appliance, material, or other article intended to be used to affect the structure or any function of a human or animal body

Myocardial infarction—an acute episode of heart disease marked by the death or damage of heart muscle due to insufficient blood supply to the heart muscle, usually as a result of a coronary thrombosis or a coronary occlusion and that is characterized especially by chest pain

Nutrient content claim—statements about the level of a nutrient or dietary substance in the product, using terms such as free, high, and low, or they compare the level of a nutrient in a food to that of another food, using terms such as more, reduced, and lite

Pathophysiology—processes leading to the incidence or progression of disease or other health-related condition; alteration in function as distinguished from structural defects

Phase I trial—clinical trial in a small number of patients in which the toxicity and dosing of an intervention are assessed (IOM, 2007)

Phase II trial—clinical trial in which the safety and preliminary efficacy of an intervention are assessed in patients (IOM, 2007)

Phase III trial—large-scale clinical trial in which the safety and efficacy of an intervention are assessed in a large number of patients; FDA generally requires new drugs to be tested in phase III trials before they can be put on the market (IOM, 2007)

Positron emission tomography (PET)—a highly sensitive technique that uses radioactive probes to image in vivo tumors, receptors, enzymes, DNA replication, gene expression, antibodies, hormones, drugs, and other compounds and processes (IOM, 2007)

Postmarket studies—may be mandated by the FDA for already approved drugs or devices to review potential risks

Prentice criteria—stringent requirements to be met before a biomarker can definitively substitute for a clinical endpoint for a given use; briefly,

Suggested Citation:"Glossary." Institute of Medicine. 2011. Perspectives on Biomarker and Surrogate Endpoint Evaluation: Discussion Forum Summary. Washington, DC: The National Academies Press. doi: 10.17226/13038.
×

the criteria state that a biomarker must perfectly correlate with the clinical outcome it is meant to replace and capture the entire effect of the intervention used to bring about the effect on the clinical outcome

Qualification—evidentiary process of linking a biomarker with biological processes and clinical endpoints

Qualified health claim—voluntary statement that characterizes the relationship between a substance and its ability to reduce the risk of disease or a health-related condition (Schneeman, 2007) that does not meet the significant scientific agreement (SSA) standard

Risk–benefit analysis—the comparison of the risk of a situation to its benefit

Risk biomarker—a biomarker that indicates a risk factor for a disease

Risk factors—variables that predict outcomes and are composed of biomarkers and social and environmental factors

Significant scientific agreement (SSA)—judgment that qualified experts would likely agree that the scientific evidence supports the substance–disease relationship that is the subject of a proposed health claim

Structure–function claim—statements describing the role of a nutrient or dietary ingredient intended to affect normal structure or function in humans; may characterize the means by which a nutrient or dietary ingredient acts to maintain such structure or function; may describe general well-being from consumption of a nutrient or dietary ingredient; manufacturer is responsible for ensuring the accuracy and truthfulness of the statement; FDA does not review these claims prior to manufacturer use

Supplement—a product taken by mouth that contains a dietary ingredient intended to supplement the diet; dietary ingredients may include: vitamins, minerals, herbs or other botanicals, amino acids, and substances such as enzymes, organ tissues, glandulars, and metabolites; may be found in forms such as tablets, capsules, softgels, gelcaps, liquids, or powders

Surrogate endpoint—a biomarker that is intended to substitute for a clinical endpoint; a surrogate endpoint is expected to predict clinical benefit (or harm or lack of benefit or harm) based on epidemiologic, therapeutic, pathophysiologic, or other scientific evidence (Biomarkers Definitions Working Group, 2001)

Surveillance—population-level monitoring for early detection and treatment of advancing disease or complications

Troponin—protein of muscle that together with tropomyosin forms a regulatory protein complex controlling the interaction of actin and myosin and that when combined with calcium ions permits muscular contraction (e.g., of the heart)

Suggested Citation:"Glossary." Institute of Medicine. 2011. Perspectives on Biomarker and Surrogate Endpoint Evaluation: Discussion Forum Summary. Washington, DC: The National Academies Press. doi: 10.17226/13038.
×

Tumor size—inconsistently defined biomarker often used for determining efficacy of cancer therapeutics

Type 2 diabetes—diabetes mellitus of a common form that develops especially in adults and most often in obese individuals and that is characterized by hyperglycemia resulting from impaired insulin utilization coupled with the body’s inability to compensate with increased insulin production

Utilization—contextual analysis based on the specific use proposed and the applicability of available evidence to this use. This includes a determination of whether the validation and qualification conducted provide sufficient support for the use proposed

Suggested Citation:"Glossary." Institute of Medicine. 2011. Perspectives on Biomarker and Surrogate Endpoint Evaluation: Discussion Forum Summary. Washington, DC: The National Academies Press. doi: 10.17226/13038.
×
Page 107
Suggested Citation:"Glossary." Institute of Medicine. 2011. Perspectives on Biomarker and Surrogate Endpoint Evaluation: Discussion Forum Summary. Washington, DC: The National Academies Press. doi: 10.17226/13038.
×
Page 108
Suggested Citation:"Glossary." Institute of Medicine. 2011. Perspectives on Biomarker and Surrogate Endpoint Evaluation: Discussion Forum Summary. Washington, DC: The National Academies Press. doi: 10.17226/13038.
×
Page 109
Suggested Citation:"Glossary." Institute of Medicine. 2011. Perspectives on Biomarker and Surrogate Endpoint Evaluation: Discussion Forum Summary. Washington, DC: The National Academies Press. doi: 10.17226/13038.
×
Page 110
Suggested Citation:"Glossary." Institute of Medicine. 2011. Perspectives on Biomarker and Surrogate Endpoint Evaluation: Discussion Forum Summary. Washington, DC: The National Academies Press. doi: 10.17226/13038.
×
Page 111
Suggested Citation:"Glossary." Institute of Medicine. 2011. Perspectives on Biomarker and Surrogate Endpoint Evaluation: Discussion Forum Summary. Washington, DC: The National Academies Press. doi: 10.17226/13038.
×
Page 112
Next: Appendix A: Discussion Forum Agenda »
Perspectives on Biomarker and Surrogate Endpoint Evaluation: Discussion Forum Summary Get This Book
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In 2010 the Institute of Medicine (IOM) recommended a framework for the evaluation of biomarkers in the chronic disease setting. Published in the book Evaluation of Biomarkers and Surrogate Endpoints in Chronic Disease, the framework is intended to bring consistency and transparency to the previously disparate process of biomarker evaluation.

Following the book's release, the IOM convened a 2-day discussion forum in Washington, DC, in order to provide an opportunity for stakeholders to learn about, react to, and discuss the book. Presentations reviewed the authoring committee's work process, recommendations, and provided perspectives on the book from the point of view of participants. Thomas Fleming, professor of biostatistics and statistics at the University of Washington, gave a keynote presentation on the critical issues in the validation of surrogate endpoints, a specific use of a biomarker.

The present volume recounts the discussion forum proceedings, focusing in turn on each represented sector. A summary of Dr. Fleming's presentation then sets the committee's recommendations within the context of biomarker utilization. Lastly, this summary examines the main themes raised by stakeholders, and the challenges and opportunities presented to stakeholders by the book's recommendations.

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