Basic Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 14, 2021; 27(38): 6430-6441
Published online Oct 14, 2021. doi: 10.3748/wjg.v27.i38.6430
Fecal metabolomic profiles: A comparative study of patients with colorectal cancer vs adenomatous polyps
Giulia Nannini, Gaia Meoni, Leonardo Tenori, Maria Novella Ringressi, Antonio Taddei, Elena Niccolai, Simone Baldi, Edda Russo, Claudio Luchinat, Amedeo Amedei
Giulia Nannini, Maria Novella Ringressi, Antonio Taddei, Elena Niccolai, Simone Baldi, Edda Russo, Amedeo Amedei, Department of Clinical and Experimental Medicine, University of Florence, Florence 50134, Italy
Gaia Meoni, Leonardo Tenori, Department of Chemistry “Ugo Schiff”, University of Florence, Florence 50134, Italy
Claudio Luchinat, Department of Chemistry & Magnetic Resonance Center (CERM), University of Florence, Florence 50134, Italy
Author contributions: Nannini G and Meoni G equally contributed to drafting the manuscript; Nannini G, Meoni G, Tenori L, Luchinat C, and Amedei A designed and coordinated the study; Nannini G and Meoni G performed the research; Niccolai E, Ringressi MN, and Taddei A contributed to providing patients’ clinical information; Niccolai E, Baldi S, and Russo E collected the biological samples; Meoni G and Tenori L analyzed the data; Luchinat C and Amedei A coordinated the research; Nannini G and Meoni G drafted the manuscript; Tenori L, Luchinat C, and Amedei A revised the manuscript.
Institutional review board statement: The study was reviewed and approved by the Comitato Etico Regionale per la Sperimentazione Clinica della Regione Toscana, Sezione AREA VASTA CENTRO Institutional Review Board (CE: 11166_spe and 13080_oss).
Conflict-of-interest statement: All other authors have nothing to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Amedeo Amedei, BSc, Reader (Associate Professor), Department of Clinical and Experimental Medicine, University of Florence, Largo Brambilla 3, Florence 50134, Italy. aamedei@unifi.it
Received: March 9, 2021
Peer-review started: March 9, 2021
First decision: May 1, 2021
Revised: May 17, 2021
Accepted: August 25, 2021
Article in press: August 25, 2021
Published online: October 14, 2021
Processing time: 216 Days and 14.4 Hours
Abstract
BACKGROUND

Colorectal cancer (CRC), the third most common cause of death in both males and females worldwide, shows a positive response to therapy and usually a better prognosis when detected at an early stage. However, the survival rate declines when the diagnosis is late and the tumor spreads to other organs. Currently, the measures widely used in the clinic are fecal occult blood test and evaluation of serum tumor markers, but the lack of sensitivity and specificity of these markers restricts their use for CRC diagnosis. Due to its high sensitivity and precision, colonoscopy is currently the gold-standard screening technique for CRC, but it is a costly and invasive procedure. Therefore, the implementation of custom-made methodologies including those with minimal invasiveness, protection, and reproducibility is highly desirable. With regard to other screening methods, the screening of fecal samples has several benefits, and metabolomics is a successful method to classify the metabolite shift in living systems as a reaction to pathophysiological influences, genetic modifications, and environmental factors.

AIM

To characterize the variation groups and potentially recognize some diagnostic markers, we compared with healthy controls (HCs) the fecal nuclear magnetic resonance (NMR) metabolomic profiles of patients with CRC or adenomatous polyposis (AP).

METHODS

Proton nuclear magnetic resonance spectroscopy was used in combination with multivariate and univariate statistical approaches, to define the fecal metabolic profiles of 32 CRC patients, 16 AP patients, and 38 HCs well matched in age, sex, and body mass index.

RESULTS

NMR metabolomic analyses revealed that fecal sample profiles differed among CRC patients, AP patients, and HCs, and some discriminatory metabolites including acetate, butyrate, propionate, 3-hydroxyphenylacetic acid, valine, tyrosine and leucine were identified.

CONCLUSION

In conclusion, we are confident that our data can be a forerunner for future studies on CRC management, especially the diagnosis and evaluation of the effectiveness of treatments.

Keywords: Colorectal cancer; Adenomatous polyps; Nuclear magnetic resonance metabolomics; Fecal samples; Fecal metabolomics

Core Tip: Colorectal cancer (CRC) is the third leading cause of cancer-related death worldwide. Fecal occult blood and serum tumor markers are indicators currently used in the clinic, but their lack of sensitivity and precision limit their use for CRC diagnosis. Colonoscopy is the gold-standard screening technique for CRC, but it is costly and invasive. Using readily accessible biological samples such as stool specimens, in conjunction with high-throughput molecular profiling techniques, could significantly contribute to diagnosing and understanding the patient’s relationship with CRC. We compared with healthy subjects the fecal nuclear magnetic resonance metabolomic profiles of patients with CRC or adenomatous polyposis.