Levels of 5Α-Reductase Gene in Intestinal Lavage Fluid Decrease with Progression of Colorectal Cancer.

Introduction. Colorectal cancer (CRC) is a leading cause of cancer deaths, closely linked to the intestinal microbiota and bile acid metabolism. Secondary bile acids, like deoxycholic and lithocholic acid, are associated with increased CRC risk due to their disruption of vital cellular functions. In contrast, isoallolithocholic acid (isoalloLCA) shows potential health benefits, highlighting the complex role of bile acids in CRC. A specific primer set was previously developed to amplify homologs of the 5 alpha-reductase alpha- reductase gene (5ar), 5ar ), which are involved in the biosynthesis of isoalloLCA, thereby enabling the estimation of abundance of 5ar ( 5ar levels) in the intestine. Hypothesis/Gap Statement. We hypothesized that 5ar levels in the intestine are associated with CRC. Aim. This study aimed to investigate intestinal 5ar levels and compare them across different stages of the adenoma-carcinoma sequence, providing insights into novel strategies for monitoring CRC risk. Methodology. DNA was extracted from intestinal lavage fluids (ILF) collected during 144 colonoscopies. Next- generation sequencing (NGS) was employed to examine the sequence of 5ar homologues, using a specific primer set on DNA from seven selected ILFs - four from carcinoma patients and three from individuals with nonneoplastic mucosa. Additionally, we used quantitative PCR (qPCR) to measure 5ar levels in all 144 DNA samples. R esults. We conducted 144 colonoscopies and categorized patients according to the adenoma-cancer sequence: 52 with nonneoplastic mucosa, 69 with adenomas and 23 with carcinoma. Analysis of 292,042 NGS- derived 5ar sequences revealed the seven most prevalent amplicon sequence variants, each 254 base pairs in length. These closely matched or were identical to 5ar sequences in Bacteroides uniformis, , Phocaeicola vulgatus and Phocaeicola dorei. . Furthermore, qPCR analysis demonstrated significantly lower 5ar levels in the carcinoma group compared to those in the nonneoplastic mucosa group (P P = 0.0004). A similar, though not statistically significant, trend was observed in the adenoma group (P P = 0.0763), suggesting that 5ar levels decrease as CRC progresses. Conclusion. These findings indicate that PCR- based monitoring of 5ar levels in intestinal samples over time could provide a noninvasive, rapid and cost- effective method for assessing an increased risk of CRC.