Multi-omics early stage CRC biomarker discovery

Extracellular vesicles (EVs), including exosomes, are emerging as promising carriers of disease-specific biomarkers due to their molecular cargo reflective of cellular origin. While cell-free DNA (cfDNA) methylation assays have recently been developed for colorectal cancer (CRC) screening and perform well for cancer detection, they show limited sensitivity for advanced adenomas (AA), a key precursor in the CRC pathway. To address this gap, we sought to determine whether other blood-based analytes, specifically EV-derived long and small RNA transcriptomes and EV proteomes, could improve detection of AA and early-stage CRC. In a prospective cohort, we performed a head-to-head comparison of EV transcriptomics, EV proteomics, and their combinations against cfDNA methylation, all measured from the same patient cohort, enabling a direct performance benchmark and identification of the most promising modality for larger-scale CRC screening studies.