p53 and p63 Proteoforms Derived from Alternative Splicing Possess Differential Seroreactivity in Colorectal Cancer with Distinct Diagnostic Ability from the Canonical Proteins

Simple Summary: The humoral immune response in cancer has been demonstrated to be useful for distinguishing patients from healthy individuals using serum or plasma. Our study aimed to assess whether p53 and p63 proteoforms derived from alternative splicing could have a differential seroreactivity and higher diagnostic value than canonical proteins in colorectal cancer. Using luminescence assays and biosensing approaches with the proteoforms expressed in vitro fused to HaloTag, we demonstrate the appearance of a differential seroreactivity among the proteoforms in colorectal cancer patients. Our findings reveal increased complexity of the humoral immune response in cancer against specific autoantigens, since specific seroreactivity and different diagnostic values were observed among the p53 and p63 proteoforms and the canonical proteins. Colorectal cancer (CRC) is the third most common cancer and the second most frequent cause of cancer-related death worldwide. The detection in plasma samples of autoantibodies against specific tumor-associated antigens has been demonstrated to be useful for the early diagnosis of CRC by liquid biopsy. However, new studies related to the humoral immune response in cancer are needed to enable blood-based diagnosis of the disease. Here, our aim was to characterize the humoral immune response associated with the different p53 and p63 proteoforms derived from alternative splicing and previously described as aberrantly expressed in CRC. Thus, here we investigated the diagnostic ability of the twelve p53 proteoforms and the eight p63 proteoforms described to date, and their specific N-terminal and C-terminal end peptides, by means of luminescence HaloTag beads immunoassays. Full-length proteoforms or specific peptides were cloned as HaloTag fusion proteins and their seroreactivity analyzed using plasma from CRC patients at stages I-IV (n = 31), individuals with premalignant lesions (n = 31), and healthy individuals (n = 48). p53 gamma, Delta 40p53 beta, Delta 40p53 gamma, Delta 133p53 gamma, Delta 160p53 gamma, TAp63 alpha, TAp63 delta, Delta Np63 alpha, and Delta Np63 delta, together with the specific C-terminal end alpha and delta p63 peptides, were found to be more seroreactive against plasma from CRC patients and/or individuals with premalignant lesions than from healthy individuals. In addition, ROC (receiver operating characteristic) curves revealed a high diagnostic ability of those p53 and p63 proteoforms to detect CRC and premalignant individuals (AUC higher than 85%). Finally, electrochemical biosensing platforms were employed in POC-like devices to investigate their usefulness for CRC detection using selected p53 and p63 proteoforms. Our results demonstrate not only the potential of these biosensors for the simultaneous analysis of proteoforms' seroreactivity, but also their convenience and versatility for the clinical detection of CRC by liquid biopsy. In conclusion, we here show that p53 and p63 proteoforms possess differential seroreactivity in CRC patients in comparison to controls, distinctive from canonical proteins, which should improve the diagnostic panels for obtaining a blood-based biomarker signature for CRC detection.