Microbiota biomarkers might predict risk of HSIL progression: succinyl-CoA and cobalamin

Simon Collins, HIV i-Base

An oral presentation by Sergio Serrano-Villar from Hospital Ramón y Cajal, Madrid looked at whether certain microbiota could predict the risk of progression from HSIL to anal cancer.

The group developed two cohorts of largely MSM in Spain and Italy who were being screened for HSIL with high-resolution anoscopy and anal biopsies to confirm HSIL. One cohort (n=167, with 70 confirmed HSIL) was used to identify potential biomarkers from the bacterial DNA, proteins, and metabolites from anal cytology samples and the second (n=46, with 25 confirmed HSIL) was used to validate any findings.

HSIL was associated with higher levels of Prevotella copri (over-expressing proteins to produce succinyl-CoA and cobalamin) and lower levels of Sneathia sanguinegens.

The combination of succinyl-CoA and cobalamin improved the sensitivity of testing (compared to anal cytology) from 91.2% to 96.6%, and the specificity from 34.1% to 81.8%. This increased the positive predictive value from 48.1% to 77.8%, and negative predictive value from 85.3% to 97.3%.

The combination of both metabolites improved the classification to 87.7% compared to only 59.9% with anal cytology and the study concluded that these two biomarkers could improve the current strategy for anal cancer screening.


These preliminary results are interesting and other research groups are investigating changes in metabolic pathways (metabonomics) in cancer detection and diagnosis, so this might become a useful tool in the future.

However, what works in one specialist centre’s research lab does not often translate to universal applicability. Non-standardised tests need to be validated and will come with additional costs that may outweigh the cost efficiency advantage of improved accuracy of screening.


Serrano-Villar S et al. Microbiota-derived metabolites are powerful biomarkers for anal cancer prevention. CROI 2023. 19 – 22 February 2023. Oral abstract 148.

This report was first posted on 12 May 2023.

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