We read with great interest the article by Flemer et al , which suggests that analysis of the oral microbiota could potentially be used as a screening method for colorectal cancer (CRC) and polyp detection.1  Fusobacterium  ( F .) nucleatum is one of the most densely colonised bacterial species in the oral cavity and is known to be associated with periodontitis.2 Recently, many researchers have demonstrated that F . nucleatum is related to CRC development and pathogenicity.3 4 However, the relationship between F . nucleatum in CRC and the oral cavity is not well understood. For this purpose, we examined whether identical strains of F . nucleatum could be isolated from CRC and saliva specimens obtained from the same patient. The approach used in this study is detailed in figure 1A (see online supplementary information for details). We collected CRC and saliva samples from 14 patients (online supplementary table 1) and isolated bacteria from the specimens on Fusobacterium -selective agar. All colonies (1,351 in total) were analysed by PCR using …

https://gut.bmj.com/content/gutjnl/68/7/1335.full.pdf

Patients with colorectal cancer have identical strains of Fusobacterium nucleatum in their colorectal cancer and oral cavity.

The oral microbiota and its role in carcinogenesis

It is well-known that microbiota dysbiosis is closely associated with numerous diseases in the human body The oral cavity and gut are the two largest microbial habitats, playing a major role in microbiome-associated diseases Even though the oral cavity and gut are continuous regions connected through the gastrointestinal tract, the oral and gut microbiome profiles are well-segregated due to the oral-gut barrier However, the oral microbiota can translocate to the intestinal mucosa in conditions of the oral-gut barrier dysfunction Inversely, the gut-to-oral microbial transmission occurs as well in inter- and intrapersonal manners Recently, it has been reported that oral and gut microbiomes interdependently regulate physiological functions and pathological processes Oral-to-gut and gut-to-oral microbial transmissions can shape and/or reshape the microbial ecosystem in both habitats, eventually modulating pathogenesis of disease However, the oral-gut microbial interaction in pathogenesis has been underappreciated to date Here, we will highlight the oral-gut microbiome crosstalk and its implications in the pathogenesis of the gastrointestinal disease and cancer Better understanding the role of the oral-gut microbiome axis in pathogenesis will be advantageous for precise diagnosis/prognosis and effective treatment

https://ir.ymlib.yonsei.ac.kr/bitstream/22282913/182940/1/T202101615.pdf

Oral–Gut Microbiome Axis in Gastrointestinal Disease and Cancer

Bacteria identified in the oral cavity are highly complicated. They include approximately 1000 species with a diverse variety of commensal microbes that play crucial roles in the health status of individuals. Epidemiological studies related to molecular pathology have revealed that there is a close relationship between oral microbiota and tumor occurrence. Oral microbiota has attracted considerable attention for its role in in-situ or distant tumor progression. Anaerobic oral bacteria with potential pathogenic abilities, especially Fusobacterium nucleatum and Porphyromonas gingivalis, are well studied and have close relationships with various types of carcinomas. Some aerobic bacteria such as Parvimonas are also linked to tumorigenesis. Moreover, human papillomavirus, oral fungi, and parasites are closely associated with oropharyngeal carcinoma. Microbial dysbiosis, colonization, and translocation of oral microbiota are necessary for implementation of carcinogenic functions. Various underlying mechanisms of oral microbiota-induced carcinogenesis have been reported including excessive inflammatory reaction, immunosuppression of host, promotion of malignant transformation, antiapoptotic activity, and secretion of carcinogens. In this review, we have systemically described the impact of oral microbial abnormalities on carcinogenesis and the future directions in this field for bringing in new ideas for effective prevention of tumors.

https://onlinelibrary.wiley.com/doi/pdf/10.1002/cam4.3206

Role of the oral microbiota in cancer evolution and progression.

Background: The microbiota plays a critical role in the process of human carcinogenesis. Pancreatic head carcinoma (PHC)-associated tongue coating microbiome dysbiosis has not yet been clea...

https://www.tandfonline.com/doi/pdf/10.1080/20002297.2018.1563409

Tongue coating microbiome data distinguish patients with pancreatic head cancer from healthy controls

Emerging evidence has shown the potential of oral microbiota as a noninvasive diagnostic tool in gastrointestinal (GI) cancer. PubMed, Web of Science, and Embase were systematically searched for eligible studies published until May 31, 2019. Of the 17 included studies published between 2011 and 2019, five kinds of GI cancer, including colorectal cancer (n=6), pancreatic cancer (n=5), gastric cancer (n=4), esophageal cancer (n=2) and liver cancer (n=1), were reported. Generally, the diagnostic performance of the multi-bacteria model for GI cancer was strong with the best area under the receiver operator characteristic curve (AUC) exceeding 0.90, but only one study had a validation phase. Pathogens involved in periodontal disease, such as Porphyromonas gingivalis and Tannerella forsythia, were linked to various kinds of GI cancer. Besides, more oral bacteria significantly differed between cases with upper digestive cancer and healthy controls when compared to colorectal cancer (the most common form of lower digestive cancer), probably indicating a different mechanism due to anatomical and physiological differences in the digestive tract. Oral microbiota changes were associated with risk of various kinds of GI cancer, which could be considered as a potential tool for early prediction and prevention of GI cancer, but validation based on a large population, reproducible protocols for oral microbiota research and oral-gut microbiota transmission patterns are required to be resolved in further studies.

/pdf/oral-microbiota-as-promising-diagnostic-biomarkers-for-4xtmuhyt52.pdf

Oral Microbiota as Promising Diagnostic Biomarkers for Gastrointestinal Cancer: A Systematic Review.

Previous studies have shown a strong coexistence of colorectal neoplasia (CRN) and cardiovascular diseases (CVD). This study was aimed to summarize the available evidence on association of CVD risk with early CRN detection in asymptomatic populations. PubMed, Web of Science, and Embase were systematically searched for eligible studies published until Dec 20, 2019. Studies exploring the associations of recommended CVD risk assessment methods (e.g., risk scores, carotid artery plaque, and coronary artery calcium score [CACS]) with risk of CRN were included. Meta-analyses were conducted to determine the overall association of CVD risk with the CRN. A total of 12 studies were finally included. The association of carotid artery plaque with the risk of colorectal adenoma (AD) was weakest (pooled odds ratio [OR)] 1.27, 95% confidence interval [CI), 1.12, 1.45]. Participants with CACS>100 had about 2-fold increased risk of AD than those with CACS=0. The pooled ORs were 3.36 (95% CI, 2.15, 5.27) and 2.30 (95% CI, 1.69, 3.13) for the risk of advanced colorectal neoplasia (AN) and AD, respectively, in participants with Framingham risk score (FRS)>20%, when compared to participants at low risk (FRS<10%). FRS might help identify subgroups at increased risk for AN, but further studies are needed.

/pdf/association-of-cardiovascular-risk-assessment-with-early-22newym10p.pdf

Association of Cardiovascular Risk Assessment with Early Colorectal Neoplasia Detection in Asymptomatic Population: A Systematic Review and Meta-Analysis.

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Oral Microbiota as Promising Diagnostic Biomarkers for Gastrointestinal Cancer: A Systematic Review.

Association of Cardiovascular Risk Assessment with Early Colorectal Neoplasia Detection in Asymptomatic Population: A Systematic Review and Meta-Analysis.