Towards biomarkers for outcomes after pancreatic ductal adenocarcinoma and ischemic stroke, with focus on (co-)morbidity and aging / cellular senescence (SASKit): protocol for a prospective cohort study

Aging-related processes such as cellular senescence are believed to underlie the accumulation of diseases in time, causing (co-)morbidity, including cancer, thromboembolism and stroke. Intervening into these processes may delay, stop or reverse morbidity. To study the link between (co-)morbidity and aging, by exploring biomarkers and molecular mechanisms of disease-triggered deterioration, we will recruit 50 patients with pancreatic ductal adenocarcinoma, 50 patients with (thromboembolic) ischemic stroke and 50 controls, at Rostock University Medical Center. We will gather routine blood data, clinical performance measurements and patient-reported outcomes at up to 9 points in time, and in-depth transcriptomics & proteomics at two early time points. Aiming for clinically relevant biomarkers, the primary outcome is a composite of probable sarcopenia, clinical performance (described by ECOG Performance Status for patients with pancreatic ductal adenocarcinoma and the Modified Rankin Scale for patients with stroke) and quality of life. Further outcomes cover other aspects of morbidity such as cognitive decline, and of comorbidity such as vascular or cancerous events. The data analysis is comprehensive in that it includes biostatistics & machine learning, both following standard role models & additional explorative approaches. Predictive biomarkers for interventions addressing senescence may become available if the biomarkers that we find are predominantly related to aging / cellular senescence. Similarly, diagnostic biomarkers will be explored for their relationship to aging / cellular senescence. Our findings will require validation in independent studies, and our dataset shall be useful to validate the findings of other studies. In some of the explorative analyses, we shall include insights from systems biology modeling as well as insights from preclinical animal models. We humbly suggest that our detailed study protocol and data analysis plan may also guide other biomarker exploration trials. In Brief The SASKit (“Senescence-Associated Systems diagnostics Kit for cancer and stroke”) study primarily aims to discover novel biomarkers for deterioration of health and (co-)morbidities triggered by pancreatic ductal adenocarcinoma or ischemic stroke.