High-Yield Methylation Markers for Stool-Based Detection of Colorectal Cancer

Background Many methylation markers associated with colorectal cancer have been reported, but few of them are actually used in clinical practice. Aims This study was designed to identify promising methylation markers for stool-based detection of colorectal cancer. Methods We first tested 324 reported methylated genes in colorectal cancer cell lines. A total of 111 heavily methylated genes were selected for further evaluation with a pilot set of colorectal cancer and adjacent normal tissues. Ten high-yield methylated markers were further studied in 319 tissue samples. Eventually, the four best markers, namely methylated COL4A1 , COL4A2 , TLX2 , and ITGA4 , were validated in 240 stool samples. Methylation-specific PCR (MSP) and real-time MSP (qMSP) were employed for methylation detection. Results After hierarchical selection, ten differentially methylated genes demonstrated high sensitivity and specificity for the detection of colorectal cancer in tissue. When validated in stool samples, the four with the best performance— COL4A1 , COL4A2 , TLX2 , and ITGA4 —were able to detect 82.5–92.5% of colorectal cancers and 41.6–58.4% of adenomas (≥ 1 cm) with specificity of 88.0–96.4%. The best combination, COL4A2 and TLX2 , detected 91.3% of CRCs and 51.9% of advanced adenomas in stool with 97.6% specificity. Conclusions Methylated COL4A1 , COL4A2 , TLX2 , and ITGA4 demonstrated high accuracy for the detection of colorectal neoplasms in stool. They are potentially valuable markers for the detection of colorectal cancer.