Kartal, Ece, Schmidt, Thomas S B, Wirbel, Jakob, Maistrenko, Oleksandr M, Akanni, Wasiu A, Alashkar Alhamwe, Bilal, Alves, Renato J, Carrato, Alfredo, Erasmus, Hans-Peter, Estudillo, Lidia, Finkelmeier, Fabian, Fullam, Anthony, Glazek, Anna M, Gómez-Rubio, Paulina, Hercog, Rajna, Jung, Ferris, Kandels, Stefanie, Kersting, Stephan, Langheinrich, Melanie, Márquez, Mirari, Molero, Xavier, Orakov, Askarbek, Van Rossum, Thea, Torres-Ruiz, Raul, Telzerow, Anja, Zych, Konrad, Benes, Vladimir, Zeller, Georg, Trebicka, Jonel, Bork, Peer, Malats, Nuria, Molina-Montes, Esther, Rodriguez Perales, Sandra, Real Arribas, Francisco, World Cancer Research Fund International, European Research Council, Unión Europea. Comisión Europea, Federal Ministry of Education & Research (Alemania), Unión Europea. Fondo Europeo de Desarrollo Regional (FEDER/ERDF), Instituto de Salud Carlos III, Red Temática de Investigación Cooperativa en Cáncer (España), Institut Català de la Salut, [Kartal E, Wirbel J] Structural and Computational Biology Unit, European Molecular Biology Laboratory, Heidelberg, Germany. Collaboration for joint PhD degree, European Molecular Biology Laboratory and Heidelberg University, Heidelberg, Germany. [Schmidt TSB, Maistrenko OM] Structural and Computational Biology Unit, European Molecular Biology Laboratory, Heidelberg, Germany. [Molina-Montes E] Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Centre (CNIO), Madrid, Spain. Centro de Investigación Biomédica en Red de Oncología (CIBERONC), Madrid, Spain. [Rodríguez-Perales S] Centro de Investigación Biomédica en Red de Oncología (CIBERONC), Madrid, Spain. Molecular Cytogenetics Unit, Spanish National Cancer Research Centre (CNIO), Madrid, Spain. [Molero X] Vall d’Hebron Hospital Universitari, Barcelona, Spain. Vall d’Hebron Institut de Recerca (VHIR), Barcelona, Spain. Universitat Autònoma de Barcelona, Bellaterra, Spain. Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain, and Vall d'Hebron Barcelona Hospital Campus
Cancer prevention; Intestinal microbiology; Pancreatic tumours Prevenció del càncer; Microbiologia intestinal; Tumors pancreàtics Prevención de cáncer; Microbiología intestinal; Tumores pancreáticos Background Recent evidence suggests a role for the microbiome in pancreatic ductal adenocarcinoma (PDAC) aetiology and progression. Objective To explore the faecal and salivary microbiota as potential diagnostic biomarkers. Methods We applied shotgun metagenomic and 16S rRNA amplicon sequencing to samples from a Spanish case–control study (n=136), including 57 cases, 50 controls, and 29 patients with chronic pancreatitis in the discovery phase, and from a German case–control study (n=76), in the validation phase. Results Faecal metagenomic classifiers performed much better than saliva-based classifiers and identified patients with PDAC with an accuracy of up to 0.84 area under the receiver operating characteristic curve (AUROC) based on a set of 27 microbial species, with consistent accuracy across early and late disease stages. Performance further improved to up to 0.94 AUROC when we combined our microbiome-based predictions with serum levels of carbohydrate antigen (CA) 19–9, the only current non-invasive, Food and Drug Administration approved, low specificity PDAC diagnostic biomarker. Furthermore, a microbiota-based classification model confined to PDAC-enriched species was highly disease-specific when validated against 25 publicly available metagenomic study populations for various health conditions (n=5792). Both microbiome-based models had a high prediction accuracy on a German validation population (n=76). Several faecal PDAC marker species were detectable in pancreatic tumour and non-tumour tissue using 16S rRNA sequencing and fluorescence in situ hybridisation. Conclusion Taken together, our results indicate that non-invasive, robust and specific faecal microbiota-based screening for the early detection of PDAC is feasible. We acknowledge funding from EMBL, CNIO, World Cancer Research (#15–0391), the European Research Council (ERC-AdG-669830 MicrobioS), the BMBF-funded Heidelberg CenterCentre for Human Bioinformatics (HD-HuB) within the German Network for Bioinformatics Infrastructure (de.NBI #031A537B), Fondo de Investigaciones Sanitarias (FIS), Instituto de Salud Carlos III-FEDER, Spain (grant numbers PI15/01573, PI18/01347, FIS PI17/02303); Red Temática de Investigación Cooperativa en Cáncer, Spain (grant numbers RD12/0036/0034, RD12/0036/0050, RD12/0036/0073); III beca Carmen Delgado/Miguel Pérez-Mateo de AESPANC-ACANPAN; EU-6FP Integrated Project (#018771-MOLDIAG-PACA); EU-FP7-HEALTH (#259737-CANCERALIA). Funders had no involvement in the study design, patient enrolment, analysis, manuscript writing or reviewing.