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Liquid biopsy reveals collateral tissue damage in cancer
Asael Lubotzky, Hai Zemmour, Daniel Neiman, Marc Gotkine, Netanel Loyfer, Sheina Piyanzin, Bracha-Lea Ochana, Roni Lehmann-Werman, Daniel Cohen, Joshua Moss, Judith Magenheim, Maureen F. Loftus, Lauren Brais, Kimmie Ng, Raul Mostoslavsky, Brian M. Wolpin, Aviad Zick, Myriam Maoz, Albert Grinshpun, Anatoli Kustanovich, Chen Makranz, Jonathan E. Cohen, Tamar Peretz, Ayala Hubert, Mark Temper, Azzam Salah, Shani Avniel-Polak, Simona Grozinsky-Glasberg, Kirsty L. Spalding, Ariel Rokach, Tommy Kaplan, Benjamin Glaser, Ruth Shemer, Yuval Dor
Asael Lubotzky, Hai Zemmour, Daniel Neiman, Marc Gotkine, Netanel Loyfer, Sheina Piyanzin, Bracha-Lea Ochana, Roni Lehmann-Werman, Daniel Cohen, Joshua Moss, Judith Magenheim, Maureen F. Loftus, Lauren Brais, Kimmie Ng, Raul Mostoslavsky, Brian M. Wolpin, Aviad Zick, Myriam Maoz, Albert Grinshpun, Anatoli Kustanovich, Chen Makranz, Jonathan E. Cohen, Tamar Peretz, Ayala Hubert, Mark Temper, Azzam Salah, Shani Avniel-Polak, Simona Grozinsky-Glasberg, Kirsty L. Spalding, Ariel Rokach, Tommy Kaplan, Benjamin Glaser, Ruth Shemer, Yuval Dor
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Research Article Cell biology Oncology

Liquid biopsy reveals collateral tissue damage in cancer

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Abstract

Cancer inflicts damage to surrounding normal tissues, which can culminate in fatal organ failure. Here, we demonstrate that cell death in organs affected by cancer can be detected by tissue-specific methylation patterns of circulating cell-free DNA (cfDNA). We detected elevated levels of hepatocyte-derived cfDNA in the plasma of patients with liver metastases originating from different primary tumors, compared with cancer patients without liver metastases. In addition, patients with localized pancreatic or colon cancer showed elevated hepatocyte cfDNA, suggesting liver damage inflicted by micrometastatic disease, by primary pancreatic tumor pressing the bile duct, or by a systemic response to the primary tumor. We also identified elevated neuron-, oligodendrocyte-, and astrocyte-derived cfDNA in a subpopulation of patients with brain metastases compared with cancer patients without brain metastasis. Cell type–specific cfDNA methylation markers enable the identification of collateral tissue damage in cancer, revealing the presence of metastases in specific locations and potentially assisting in early cancer detection.

Authors

Asael Lubotzky, Hai Zemmour, Daniel Neiman, Marc Gotkine, Netanel Loyfer, Sheina Piyanzin, Bracha-Lea Ochana, Roni Lehmann-Werman, Daniel Cohen, Joshua Moss, Judith Magenheim, Maureen F. Loftus, Lauren Brais, Kimmie Ng, Raul Mostoslavsky, Brian M. Wolpin, Aviad Zick, Myriam Maoz, Albert Grinshpun, Anatoli Kustanovich, Chen Makranz, Jonathan E. Cohen, Tamar Peretz, Ayala Hubert, Mark Temper, Azzam Salah, Shani Avniel-Polak, Simona Grozinsky-Glasberg, Kirsty L. Spalding, Ariel Rokach, Tommy Kaplan, Benjamin Glaser, Ruth Shemer, Yuval Dor

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Figure 1

Hepatocyte cfDNA in patients with liver metastasis.

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Hepatocyte cfDNA in patients with liver metastasis.
(A) Hepatocyte cfDNA...
(A) Hepatocyte cfDNA (average signal of 3 hepatocyte markers) in healthy controls (n = 65), localized cancer patients (n = 85), metastatic cancer patients with no liver metastasis (n = 55), and cancer patients with liver metastasis (n = 63). Each dot represents 1 plasma sample processed to extract cfDNA, treated with bisulfite, and PCR amplified and sequenced. The fraction of hepatocyte-derived cfDNA was multiplied by the total concentration of cfDNA per sample. Kruskal-Wallis test with Dunn’s post hoc correction for multiple comparisons. (B) Percentage of hepatocyte-derived cfDNA in the same plasma samples as in A. Kruskal-Wallis test with Dunn’s post hoc correction for multiple comparisons. (C) Total cfDNA levels in the same patients as in A. Kruskal-Wallis test with Dunn’s post hoc correction for multiple comparisons. (D) ROC curve for distinguishing cancer patients with liver metastases from other cancer patients (having localized or metastatic disease without liver involvement), based on the 3 hepatocyte cfDNA markers. AUC 0.81 (95% CI = 0.74 to 0.87), P < 0.0001. (E) ROC curve for distinguishing stage 4 cancer patients with or without liver metastases, using hepatocyte markers. AUC 0.81 (95% CI = 0.73 to 0.89), P < 0.0001. (F) Correlation between hepatocyte cfDNA levels and alanine transaminase (ALT, blue) or aspartate transaminase (AST, red) in cancer patients with liver metastases. Spearman’s correlation, ALT r = 0.6, P < 0.0001; AST r = 0.68, P < 0.0001. (G) Assessment of hepatocyte-derived cfDNA using data from Illumina 450K arrays, on an independent group (n = 12 healthy controls, 7 patients with metastatic cancer not involving the liver, and 6 patients with liver metastasis). Plasma samples were subjected to whole-methylome analysis using 450K arrays, and analyzed using an atlas of cell type–specific methylomes (13) (Methods). Hepatocyte cfDNA levels in cancer patients with liver metastasis compared with metastatic cancer patients with no liver metastasis; Wilcoxon’s P < 0.014.

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