These differential expressions were then correlated with gene expression profiles of similar tissues, which revealed that proteins related to cell junctions and the extracellular matrix, become altered during chemotherapy [82]. Another study used paired primary and recurrent post-chemotherapy samples from high-grade serous OvCa patients to identify numerous proteins elevated in recurrent tissues, which were also confirmed by gene expression analysis [83]. Subsequent knockdown of these proteins in carboplatin-resistant see more cell lines using short hairpin RNA, identified RELA, the p65 subunit of NF-kB, and STAT5, as modulators

of drug resistance [83]. As a result, inhibition of both proteins reduced the chemoresistance potential of cancer cell lines, and therefore, may represent a novel treatment for recurrent OvCa platinum-resistant patients [83]. Interestingly, both studies used an integrated approach to find chemoresistant makers, as they employed gene expression profiling to validate their proteomic discovery data. Perhaps, future efforts may benefit from integrating data obtained from genomic, this website transcriptomic, and proteomic

approaches as means to understanding the molecular basis of chemoresistance. Moreover, Kim et al. used the differential protein expression profiles of chemosensitive and chemoresistant tissues obtained from 2-DE to construct a two marker panel, SGEF and keratin 1, to serve as predictive markers for chemoresistant disease with a sensitivity and specificity of 80% and 92% respectively [84];

however, although promising, these markers require further validation in larger sample cohorts. Methane monooxygenase Lastly, rather than focusing on individual proteins, biological signalling pathways could also be used as targets for overcoming chemoresistance. A recent study investigated the expression of proteins from molecular pathways associated with OvCa progression [85]. Using reverse phase protein arrays and normalized CA125 values, numerous proteins from the TGF-β pathway were implicated in playing a role in chemoresistance in high-grade serous OvCa [85]. Overall, the importance of using biological tissues for discovery is evident through the various studies that implicate different biological pathways in drug resistance. Given that none or very few protein expression changes are common between the different studies, we have to question whether tissue proteomics is a viable route for investigating chemoresistance. Alternatively, the lack of consistent results may be due to the heterogeneity of the disease as well as patient-to-patient variability. In addition, biases from the methodologies used, including pre-analytical and post-analytical variables, may also have an effect on the variability and reproducibility between studies.