Abstract

Colorectal cancer (CRC) remains the third most common cancer worldwide, with a growing incidence among young adults. Multiple studies have presented associations between the gut microbiome and CRC, suggesting a link with cancer risk. Although CRC microbiome studies continue to profile larger patient cohorts with increasingly economical and rapid DNA sequencing platforms, few common associations with CRC have been identified, in part due to limitations in taxonomic resolution and differences in analysis methodologies. Complementing these taxonomic studies is the newly recognized phenomenon that bacterial organization into biofilm structures in the mucus layer of the gut is a consistent feature of right-sided (proximal), but not left-sided (distal) colorectal cancer. In the present study, we performed 16S rRNA gene amplicon sequencing and biofilm quantification in a new cohort of patients from Malaysia, followed by a meta-analysis of eleven additional publicly available data sets on stool and tissue-based CRC microbiota using Resphera Insight, a high-resolution analytical tool for species-level characterization. Results from the Malaysian cohort and the expanded meta-analysis confirm that CRC tissues are enriched for invasive biofilms (particularly on right-sided tumors), a symbiont with capacity for tumorigenesis (Bacteroides fragilis), and oral pathogens including Fusobacterium nucleatum, Parvimonas micra, and Peptostreptococcus stomatis. Considered in aggregate, species from the Human Oral Microbiome Database are highly enriched in CRC. Although no detected microbial feature was universally present, their substantial overlap and combined prevalence supports a role for the gut microbiota in a significant percentage (>80%) of CRC cases.

Highlights

  • While numerous environmental risk factors for colorectal cancer (CRC) were established decades ago,[1] only in recent years have we begun to appreciate the role of the gut microbiome in CRC

  • Four species known to be oral pathogens were significantly enriched in CRC tissue: Fusobacterium nucleatum, Parvimonas micra, Peptostreptococcus stomatis, and Gemella morbillorum. Given this strong association between oral pathogens and CRC, we subsequently looked for enrichment of total oral bacteria from the Human Oral Microbiome Database (HOMD), a curated list of bacteria derived from 16S rRNA gene sequencing of healthy and diseased oral samples from patients.[27]

  • Our meta-analysis demonstrates that the vast majority (>80%) of CRC cases contain aberrant microbial signatures indicative of dysbiosis

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Summary

Introduction

While numerous environmental risk factors for colorectal cancer (CRC) were established decades ago,[1] only in recent years have we begun to appreciate the role of the gut microbiome in CRC. Over a dozen studies have established that CRC is associated with some form of microbial dysbiosis in terms of taxonomic composition and/or mucosal structural organization (e.g., biofilms), as detected either via stool or tumor tissue.[2,3,4,5,6,7,8,9,10,11,12,13,14,15,16] these CRC microbiome profiling studies have yielded inconsistent findings, likely due to differences in study design and analysis methodologies.

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