Plain English Summary
Background and study aims
Colorectal cancer (CRC), also known as bowel cancer, is the third most common cancer. It is a global healthcare problem, causing almost 700,000 deaths worldwide every year. This disease usually affects people over the age of 50 and does not produce symptoms at its early stages. Very often CRC is detected too late to be successfully treated. Early detection of this cancer, especially through population screening, saves lives, but the existing tests used for this purpose are not sensitive enough or too expensive. DiagNodus Ltd has recently developed a new technique for collecting samples of colorectal mucus which can be used to measure the levels of chemicals called biomarkers and detect inflammatory bowel disease (IBD). As it is well known that CRC also produces dramatic changes in colorectal mucus, it is highly likely that CRC biomarkers can be found in this material as well. The aim of this study is to examine if the new approach devised by DiagNodus Ltd is suitable for detecting CRC.
Who can participate?
Patients aged over 45 with confirmed colorectal cancer, and tumour-free patients for comparison
What does the study involve?
Participants have their diagnoses confirmed by colonoscopy, a test where the doctor looks at the inner lining of the colon using a thin, flexible tube. Participants are then provided with a kit for sample collection and are instructed to collect two samples of colorectal mucus 3-5 days after colonoscopy (CRC patients usually have surgery at least two weeks after colonoscopy). Sample collection is performed by the participants at home. Once samples are collected, they are sent to the laboratory of DiagNodus Ltd, where all planned laboratory tests are carried out. The results of the tests are matched to diagnostic information (colonoscopy) at the end of the study.
What are the possible benefits and risks of participating?
Although patients are unlikely to benefit from participating, the results of the study are likely to provide significant benefits for patients and medical professionals in terms of developing a new approach to CRC early detection and screening. The eventual goal is to provide a simple, highly sensitive and affordable test for CRC screening. Providing samples does not interfere with routine treatment. Sample collection is safe and very well accepted by patients. For these reasons no potential risks of participating in the study can be identified.
Where is the study run from?
1. DiagNodus Ltd (UK)
2. St George's Hospital (UK)
When is the study starting and how long is it expected to run for?
January 2017 to December 2019
Who is funding the study?
DiagNodus Ltd (UK)
Who is the main contact?
Dr Alexandre Loktionov
Dr Alexandre Loktionov
Babraham Research Campus
Colorectal cancer detection by quantifying biomarkers in non-invasively collected colorectal mucus: an observational case-control study
The main hypothesis is that colorectal mucus excreted during bowel opening constitutes a highly informative material that can be successfully analysed for non-invasively detecting biomarkers of colorectal cancer presence. Performance of a range of candidate biomarkers is going to be tested in order to select the best diagnostic marker(s).
London – South East Research Ethics Committee, 30/12/2016, REC ref: 16/LO/2273
Observational case-control study
Primary study design
Secondary study design
Patient information sheet
No participant information sheet available
At the initial (pilot) stage of this observational case-control study it is planned to recruit at least 50 patients with colorectal cancer (between diagnostic colonoscopy and surgery) and 50 neoplasia-free (endoscopically confirmed) patients. All recruited patients are asked to collect samples of colorectal mucus. The collected samples are used for quantitative biomarker determination (ELISA for protein biomarkers; possibly PCR-based techniques for DNA and RNA) and cytological examination. All analytical procedures are blinded with regard to patient identity and diagnosis. At the end of the study the results of sample analysis are compared with the corresponding diagnostic information (reference standard: colonoscopy) (unblinding). Conclusions on individual biomarker performance are made, and larger scale further study is planned if the pilot phase is successful. The pilot phase is planned to be completed by 31/12/2017, and the decision to extend the study beyond this date depends on its outcome.
Primary outcome measures
All results will be obtained at a single time point.
1. Calprotectin measured using ELISA
2. EDN measured using ELISA
3. MUC2 measured using ELISA
4. MMP9 measured using ELISA
5. VEGF measured using ELISA
6. Soluble Cytokeratin 18 measured using ELISA
7. M2-PK measured using ELISA
8. Haemoglobin measured using ELISA
9. Measurement of additional protein biomarkers may be introduced at later stages of the project
Nucleic acid markers:
1. Total DNA measured by spectrophotometry
2. Total DNA measured by real time PCR (beta-globin gene fragment amplification)
3. Measurement of additional DNA & RNA markers may be introduced at later stages of the project
Cytology and immunocytochemistry:
1. Qualitative cytological examination of collected samples using microscopy
2. Immunocytochemical visualisation of protein biomarkers and qualitative assessment of their distribution using microscopy
Secondary outcome measures
Performance of each of the biomarkers/assays listed above as a diagnostic test comparing CRC presence versus CRC absence, measured by ROC (receiver operating characteristic) curve analysis (area under the curve, sensitivity, specificity) and calculation of test negative and positive predictive values as well as positive and negative likelihood ratios
Overall trial start date
Overall trial end date
Participant inclusion criteria
1. Colorectal cancer (case) group: the presence of endoscopically confirmed colorectal cancer
2. Control group: absence of neoplasia confirmed by endoscopy
3. Aged over 45
Target number of participants
100-150 (pilot phase)
Participant exclusion criteria
1. Age below 45
2. The presence of active gastrointestinal diseases or major gastrointestinal surgery in the past
3. Ongoing treatment with hormonal, immunosuppresive or cytostatic drugs
Recruitment start date
Recruitment end date
Countries of recruitment
Trial participating centre
Bldg 280 Babraham Research Campus
Trial participating centre
St George's Hospital
Funding Body Type
Funding Body Subtype
Results and Publications
Publication and dissemination plan
It is planned to publish the future results of this study in peer-reviewed biomedical journals. Study outcome will also be presented at international scientific conferences.
IPD sharing plan
The datasets generated and/or analysed during the current study are available from Dr Andrew Poullis (firstname.lastname@example.org; Andrew.Poullis@stgeorges.nhs.uk) on reasonable request.
Intention to publish date
Participant level data
Available on request
Results - basic reporting