Evaluation of Blood Soluble CD26 as a Complementary Biomarker for Colorectal Cancer Screening Programs

SIMPLE SUMMARY: Many countries have implemented, or are implementing, general age-based screening programs to reduce mortality due to colorectal cancer. Fecal hemoglobin immunodetection (FIT) in combination with endoscopy has already been relatively successful in achieving this goal. However, there are issues that can be improved in relation to participation rates and reduction in false positives. We studied whether the blood biomarker soluble-CD26 (sCD26), a glycoprotein with dipeptidyl peptidase enzyme activity (DPP4), could help in the early diagnosis of colorectal cancer and advanced adenomas in combination with FIT, also reducing false positives. We propose a sequential testing strategy for FIT positive individuals, offering an alternative blood test with our biomarker for a confirmation prior to colonoscopy in the short term. ABSTRACT: Fecal hemoglobin immunodetection (FIT) in combination with endoscopy has been implemented to reduce mortality from colorectal cancer (CRC), although there are issues that can be improved in relation to participation rates. We studied whether the blood biomarker soluble-CD26 (sCD26), related at least in part to the immune system and inflammation, and/or its dipeptidyl peptidase enzyme activity (DPP4), could help reduce false positives. In a cohort of 1703 individuals who underwent colonoscopy and had a serum sample, sCD26 and DPP4 activity showed statistically significant differences regarding sex and age. According to the colonoscopy findings, sCD26 and DPP4 activity progressively decreased in advanced adenomas and CRC, with statistically significant differences, even between both groups; 918 of them had a FIT result (n = 596 positive cases) with approximately 70% of these (n = 412) false positives. With cut-offs of 440 ng/mL for sCD26, 42 mU/mL for DPP4, and 11 ng/mU for their ratio, the combined information of the three biomarkers (at least positive for one biomarker) identified almost all advanced adenomas and CRC cases in the FIT cohort with approximately half of the false positives compared to FIT. A sequential testing strategy with FIT and our blood biomarker test is proposed.