Abstract 2027: Anal cancer among African Americans associate with HPV16 lineage B and HIV

Background: Human papillomavirus type 16 (HPV16) is one of the most common and carcinogenic HPV types associated with high risk of anal, vagina, vulva, penis and cervical neoplastic transformations. However, many genetic variants exist within this virus and not all seem to have the same carcinogenic potential.

Aim: To determine HPV16 lineages and their association with risk of high-grade anal lesions in African Americans in an inner-city hospital.

Methods: We reviewed medical records of 370 African Americans with anal lesions from Jan. 2007 to Dec. 2015. This study was approved by Howard University Institutional Review Board. Demographic, clinical and pathological data including HPV, HIV, HCV (hepatitis C virus), diabetes mellitus, hypertension and body mass index (BMI) were collected. DNA was extracted from a subset of HPV16-positive patients with FFPE tissue samples (72 patients, 111 samples) and used for HPV16 whole-genome sequencing. We assessed HPV16 variant lineages and associations with disease stage. Statistical analyses were performed using Chi-square tests, Student's t-tests, and logistic regression. Odds ratios (OR) and p-values were calculated for comparisons of normal/condyloma/high-grade dysplasia (HGD) vs. squamous cell carcinoma (SCC) and for normal/condyloma vs. HGD. The most common HPV16 A1 sublineage was used as a reference in these comparisons.

Results: Males represented 75% of the patients (n=276), with a median age of 44 years and BMI of 25.8 kg/m2. The frequency of condyloma, high-grade dysplasia, SCC and adenocarcinoma was 191 (52%), 26 (7%), 31 (8%) and 8 (2%), respectively. The frequency of HPV, HIV, and HCV was 231 (68%), 147 (43%) and 42 (12%), respectively. HPV and HIV were risk factors for condyloma and dysplasia (P<0.05). All four main lineages of HPV16 (A,B,C,D) were detected in our specimens, with sublineage A1 most common. Lineage B, also named the African-1 HPV16 lineage because it is most common in Africa, had the strongest association with SCC (OR=10.5) whether alone or in combination with lineages A4 and D (OR=10.5), although with a lower statistical significance (0.054 vs. 0.009). As for HGD, lineage B along with A4, C and D only gave an OR of 1.4.

Conclusion: We show that the majority of patients with anal lesions are young males with HPV and HIV co-infections. HPV16 lineage B was associated with a high risk of SCC development.

Citation Format: Hassan Brim, Lisa Mirabello, Ali Afsari, Muneer Abbas, Meredith Yeager, Joseph Boland, Sara Bass, Mia Steinberg, Michael Cullen, Adeyinka Laiyemo, Tammy Naab, Babak Shokrani, Edward Lee, Mehdi Nouraie, Hassan Ashktorab. Anal cancer among African Americans associate with HPV16 lineage B and HIV [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 2027.

Saffron Crudes and Compounds Restrict MACC1-Dependent Cell Proliferation and Migration of Colorectal Cancer Cells

The high mortality rate of colorectal cancer (CRC) patients is directly associated with metastatic dissemination. However, therapeutic options specifically for metastasis are still limited. We previously identified Metastasis-Associated in Colon Cancer 1 (MACC1) as a major causal metastasis-inducing gene. Numerous studies confirmed its value as a biomarker for metastasis risk. We investigated the inhibitory impact of saffron on MACC1-induced cancer cell growth and motility. Saffron crudes restricted the proliferation and migration of MACC1-expressing CRC cells in a concentration- and MACC1-dependent manner. Saffron delays cell cycle progression at G2/M-phase and does not induce apoptosis. Rescue experiments showed that these effects are reversible. Analysis of active saffron compounds elucidated that crocin was the main compound that reproduced total saffron crudes effects. We showed the interaction of MACC1 with the cancer stem cell (CSC) marker DCLK1, which contributes to metastasis formation in different tumor entities. Saffron extracts reduced DCLK1 with crocin being responsible for this reduction. Saffron's anti-proliferative and anti-migratory effects in MACC1-expressing cells are mediated by crocin through DCLK1 down-regulation. This research is the first identification of saffron-based compounds restricting cancer cell proliferation and motility progression via the novel target MACC1.

Inflammatory polyps occur more frequently in inflammatory bowel disease than other colitis patients

BACKGROUND

Colitis is generally considered a risk factor for colon neoplasia. However, not all types of colitis seem to have equal neoplastic transformation potential.

AIM

To determine the prevalence of colorectal polyps in a predominantly African American population with inflammatory bowel disease (IBD) and Non-IBD/Non-Infectious Colitis (NIC).

METHODS

We retrospectively evaluated medical records of 1060 patients previously identified with colitis at Howard University Hospital, based on ICD-10 code. Among these, 485 patients were included in the study: 70 IBD and 415 NIC based on a thorough review of colonoscopy, pathology and clinical reports. Logistic regression analysis was applied to estimate the risk of polyps in patients with IBD compared to those with NIC after adjusting for age and sex. A subgroup analysis within the IBD group was performed.

RESULTS

Of the 485 patients, 415 were NIC and 70 were IBD. Seventy-three percent of the NIC patients and 81% of the IBD patients were African Americans. Forty six percent of IBD and 41% of NIC cases were male. IBD patients were younger than NIC patients (median age of 38 years vs. 50, P < 0.001). The prevalence of all types of polyps was 15.7 and 8.2% in the IBD and NIC groups, respectively (P = 0.045). Among patients with polyps, the prevalence of inflammatory polyps was higher in the IBD group (55%) compared to the NIC group (12%). After adjusting for age, sex and race, odds ratio of inflammatory polyps in IBD patients was 6.0 (P = 0.016). Adenoma prevalence was 4.3% (3/70) in IBD patients and 3.9% (16/415) in the NIC patients (p = 0.75). The anatomic distribution of lesions and colitis shows that polyps occur predominantly in the colitis field regardless of colitis type. More polyps were present in the ulcerative colitis patients when compared to Crohn's disease patients (27% vs. 5%, P < 0.001) within the IBD group.

CONCLUSION

Our study shows that inflammatory polyps are more common in IBD patients when compared to NIC patients. Most polyps were in the same location as the colitis.

Abstract IA25: The role of genetics and microbiomics in colorectal cancer among African American patients

Colorectal cancer (CRC) is the third cause of death in the USA and genomic and microbiomic alterations play an important role in its development. Much of the underlying genomic “cancer driver” mutations and microbiomic actors in sporadic CRC are still under investigation. Here, we report the identification of distinct novel variants from CRC patients in mismatch repair (MMR) genes (MSH2, MHS3, and MSH6), and APC. We used targeted sequencing in 138 colon tissues to examine 98.8% of the targeted exons and splice junctions at a depth of sequencing that allowed for high confidence variant calling. After alignment and variant calling, we annotated the variants with information from the 1000 Genomes Project, COSMIC, Polyphen2, and PFAM domain and transcription factor motifs. Excluding synonymous SNVs, 212 deleterious variants in adenoma, 760 in advanced adenoma, and 2624 variants in tumors were detected. Novel variants (1591 and 1363) were found in MMR genes (MSH6 and MSH3) and APC gene, respectively. We also evaluated the utility of fecal bacterial marker candidates identified by our metagenomic analysis for CRC diagnosis. We identified Fusobacterium nucleatum as a major marker when comparing cancer vs. matched normal tissue and adenoma patients' stools vs. healthy subjects' stools. We also identified a novel bacterium Streptococcus sp. VT_162 with high diagnostic value in stool samples of preneoplastic patients. In vitro experiments showed that this bacterium promotes several carcinogenic pathways and downregulates apoptotic functions. This bacterium's diagnostic value was validated in an independent CRC cohort. Together our findings highlight the relevance of APC gene in CRC onset but also the potential underestimation of the MSI-H phenotype, especially the one associating with MSH3 alterations that correlate with poor prognosis. Many of the so-called “uncertain significance” novel mutations in MMR genes detected here were of a deleterious nature with potential therapeutic impact. Functional analysis of the novel gene targets is needed to confirm their roles in associated carcinogenic pathways. The role of immune markers is an important player in MMR defective tumors (MSI) as a result of neoantigen formation and in response to microbiomic alterations. These findings might facilitate noninvasive screening for CRC.

Citation Format: Hassan Ashktorab, Hassan Brim. The role of genetics and microbiomics in colorectal cancer among African American patients [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr IA25.

Abstract IA35: Molecular characterization of sessile serrated adenoma/polyps: A risk factor for higher colorectal cancer that further associates with endometrial polyps in female African Americans

Colorectal cancer is the third leading cause of cancer-related deaths in the United States, and rates are highest among African Americans (AAs). Sessile serrated adenoma/polyps (SSA/Ps) may be precursors to up to 30% of all colorectal cancers. Flat and mucinous features make SSA/Ps difficult to detect and diagnose. As such, there is a need for specific sensitive molecular biomarkers for an accurate and reliable diagnosis. Our aim was to assess the diagnostic value of molecular biomarkers that may distinguish SSA/Ps from benign hyperplastic polyps (HPs) among AA SSA/P patients. We conducted a retrospective study of all colonoscopies (n=12,085) performed at Howard University Hospital (2010-2015), which confirmed 4,070 AA patients with polyps, including 252 with SSA/Ps. Gene expression and mutation frequency profiles were analyzed in a total of 47 patients (62 specimens: 29 SSA/Ps, 26 HPs, 3 tubular adenomas, and 4 normal tissues). We tested 4 transcripts (MUC6, FSCN1, SEMG1, and TRNP1) using qRT-PCR. MSI and BRAF mutations were analyzed. CIMP analysis was performed using CACNA1G, IGF2, NEUROG1, RUNX, SOCS, and MLH1. In a parallel study, we assessed the association between endometrial polyp occurrence in patients with different types of colorectal lesions. MUC6, SEMG1, TRNP1, and FSCN1 were significantly more expressed in SSA/Ps vs. HPs (P&lt;0.05; fold differences of 37.2, 10.7, 5.8 and 2.5, respectively). BRAF mutation was found in 55.6% of SSA/Ps vs. 12.0% in HPs (P = 0.001). The frequency of CIMP was higher in SSA/Ps but not statistically significant, while MSI was more prevalent in HPs (P &gt; 0.05). There was a higher loss of MLH1 expression in HPs than SSA/Ps (42.9% showing expression vs 70.3% IHC staining &gt;=2 in HPs and SSA/Ps). The SSA/Ps in our AA study were primarily distal (67%). In female patients, SSA/Ps associated with the higher frequency of endometrial polyps (8% vs. 2% in controls, p=0.003). Our results show that MUC6-SEMG1-TRNP1 expression and BRAF mutation have the strongest correlation with SSA/Ps. The distal location might help explain why MSI and CIMP may not be optimal molecular biomarkers in African American patients with SSA/Ps. These markers may be of high relevance for the diagnosis of ambiguous lesions and will benefit patients’ management for scheduling follow-ups based on the nature of index lesions. Females with colon lesions of the SSA/Ps type might benefit from a screening for an endometrial polyp in an age-independent manner.

Citation Format: Hassan Ashktorab, Saman Azam, Babak Shokrani, Edward Lee, Taraneh Arjomand, Priyanka Kanth, Don Delker, Adeyinka Laiyemo, John Caretheres, Mehdi Nouraie, Hassan Brim. Molecular characterization of sessile serrated adenoma/polyps: A risk factor for higher colorectal cancer that further associates with endometrial polyps in female African Americans [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr IA35.

Determination of distinctive hypomethylated genes in African American colorectal neoplastic lesions

BACKGROUND

Few studies have analyzed progressive demethylation in the path to cancer. This is of utmost importance, especially in populations such as African Americans, who display aggressive tumors at diagnosis, and for whom markers of early neoplastic transformation are needed. Here, we determined hypomethylated targets in the path to colorectal cancer (CRC) using Reduced Representation Bisulfite Sequencing (RRBS).

METHODS

DNA was extracted from fresh frozen tissues of patients with different colon lesions (normal, tubular adenoma, tubulovillous adenoma, and five cancers). RRBS was performed on these DNA extracts to identify hypomethylated gene targets. Alignment, mapping, and methylation analyses were performed. Pathways affected by the hypomethylated gene targets were determined using Ingenuity Pathway Analysis (IPA).

RESULTS

Pairwise analyses of samples led to the identification of the following novel hypomethylated genes: ELMO3 (Engulfment and cell motility 3), SLC6A2 (Solute carrier family 6 member 2), SYNM (Synemin), and HMX2 (Homeobox 2). The ELMO3 promoter was significantly hypomethylated at five CpG sites, SYNM at two CpG sites, SLC6A2 at one CpG site, and the HMX2 gene at one CpG site. IPA placed these genes within important carcinogenic pathways.

CONCLUSIONS

This work provides insight into the role of hypomethylation in colon carcinogenesis in African Americans. The identified targets affected many important pathways, as demonstrated through IPA. These targets might serve as biomarkers for early diagnosis and potential targets for therapy.

Comparison of patterns of laxative ingestion to improve bowel preparation for colonoscopy: a pilot randomized clinical trial

Background and study aims  Negative experiences with bowel preparation are a barrier to uptake of colonoscopy. The aim of this study was to examine the impact of different flavoring of polyethylene glycol (PEG) laxatives on patient satisfaction with and adequacy of bowel preparation during colonoscopy. Patients and methods  This was a single-blind (endoscopist), parallel design, randomized trial (NCT02062112) during which patients scheduled for colonoscopy were assigned to one of three groups: Group 1 (no laxative flavoring, n = 84); Group 2 (flavored entire laxative, n = 90) and Group 3 (tasted PEG with and without flavoring and decided how they want to drink the rest of the laxatives (choice group), n = 82). Patients rated their bowel preparation experience (satisfaction) and endoscopists accessed adequacy of bowel preparation during colonoscopy. Results  There were no differences in patient ratings across the groups (1, 2 and 3) in taste of the laxatives ( P  = 0.67), ease of drinking ( P  = 0.53), and overall experience of bowel preparation process ( P  = 0.18). However, higher percentage of patients in the choice group would want the same laxative again if they were going to have a repeat colonoscopy in the future (72.5 % vs 81.3 % vs 88.9 %, P  = 0.04). Surprisingly, adequacy of bowel preparation was highest among patients who drank their PEG unflavored (89.3 % vs 80 % vs 75.5 %, P  = 0.07) and the had highest rates of adenoma detection (40.5 % vs 23.3 vs 39.0, P  = 0.03). Conclusions  There were no differences in overall tolerability of bowel preparation by patterns of flavoring of PEG. Those who drank unflavored PEG were less satisfied but had better clinical outcome, suggesting minimum justification effect in bowel preparation process.

Altered ARID1A expression in colorectal cancer

Background

ARID1A has been described as a tumor suppressor gene, participating in chromatin re-modeling, epithelial-mesenchymal-transition and many other cellular and molecular processes. It has been cited as a contribute in tumorigenesis. The role of ARID1A in CRC is not yet defined.

Aim

To investigate the role of ARID1A methylation and CNV in its expression in CRC cell lines and to examine the relationship between ARID1A status with survival and clinicopathologic characteristics in patients with CRC.

Methods

We used RT-PCR to determine both CNV and expression of ARID1A from six CRC cell lines. We used MSP to evaluate methylation of ARID1A. IHC was used to assess ARID1A protein expression. We also evaluated MSI and EMAST status in 18 paired CRC and adjacent normal tissues. 5AzadC was used to assess effect of DNA demethylation on ARID1A expression. Statistical analysis was performed to establish correlations between ARID1A expression and other parameters.

Results

Among the 18 CRC tumors studied, 7 (38.8%) and 5 tumors (27.7%) showed no or low ARID1A expression, respectively. We observed no significant difference in ARID1A expression for overall patient survival, and no difference between clinicopathological parameters including MSI and EMAST. However, lymphatic invasion was more pronounced in the low/no ARID1A expression group when compared to moderate and high expression group (33% VS. 16.6% respectively. ARID1A promoter methylation was observed in 4/6 (66%) cell lines and correlated with ARID1A mRNA expression level ranging from very low in SW48, to more pronounced in HCT116 and HT-29/219. Treatment with the methyltransferase inhibitor 5-Azacytidine (5-aza) resulted in a 25.4-fold and 6.1-fold increase in ARID1A mRNA expression in SW48 and SW742 cells, respectively, while there was no change in SW480 and LS180 cells. No ARID1A CNV was observed in the CRC cell lines.

Conclusion

ARID1A expression is downregulated in CRC tissues which correlates with it being a tumor suppressor protein. This finding confirms ARID1A loss of expression in CRC development. Our in-vitro results suggest high methylation status associates with reduced ARID1A expression and contributes to CRC tumorigenesis. However, there was no significant association between ARID1A loss of expression and clinicopathological characteristics. Future in-vivo analysis is warranted to further establish ARID1A role in colorectal neoplastic transformation.

Factors influencing treatment outcome in hepatitis C virus minority patients at an inner-city hospital: A STROBE-complaint article

Chronic hepatitis C virus (HCV) infection disproportionately affects African-Americans (AAs) and is a major contributor to liver failure and mortality. Genetic factors may not be the only cause in outcome disparity. We retrospectively investigated whether genetic host factors, viral genotypes, and treatment compliance in AA patients impacted the efficacy and the sustained virological response (SVR) rate of the interferon (IFN)-based treatment regimen. The medical chart review included 76 African-American patients (age ranging from 26 to 76) with varying levels of hepatitis condition. Fifty-seven (75%) of them had a clinically verifiable HCV infection and were followed by a hepatologist for 2 years at Howard University Hospital in Washington, DC. Both comprehensive metabolic profile and complete blood count analyses were performed. Among the 57 patients whose viral and IL28B genotypes were determined, sixty-eight percent (68%) were infected with viral genotype 1 and 71% harbored the CT allele of the IL28B gene. Among the 12 patients who completed treatment with IFN-based dual or triple therapy, 58% had achieved SVR 12 weeks following completion of treatment; 33% had a partial response with under 6000 viral count after 16 weeks of treatment; and there was one patient with viral genotype 1a and CT allele who did not respond to the medications. The results of this study prove that the PEG IFN-based regimen was effective in treating HCV-infected AA patients despite the current availability of new direct-acting antivirals. The major obstacles contributing to a low reduction in HCV infection and outcome in the AA community were avoidance or lack of treatment or compliance; contraindications, medication side effects, non-adherence, and payer eligibility restrictions.

Genetic Polymorphisms in IL-10 Promoter Are Associated With Smoking and Prostate Cancer Risk in African Americans

BACKGROUND/AIM

Even though prostate cancer (PCa) has good prognosis, there is a discrepancy in the risk among ethnic groups, with high morbidity in African American men. Single nucleotide polymorphisms (SNPs) in interleukin 10 (IL-10) have been associated with inflammation and cancer risk. We investigated the association of five SNPs in the IL-10 promoter with clinical features such as Gleason score and smoking.

MATERIALS AND METHODS

A total of 413 DNA samples were obtained from a nested case-control study of African American males who were genotyped for 5 SNPs utilizing pyrosequencing. Multiple and binary logistic regression models were applied to analyze the clinical and genotypic data.

RESULTS

rs12122923 and rs1800871 were associated with PCa risk. Smoking was also found to increase the risk of PCa by 1.6-fold. rs1800893 was found to be associated with lower grades for prostate cancer.

CONCLUSION

IL-10 promoter polymorphisms might be a risk factor for PCa development in smoking subjects and PCa progression.

Abstract 1607: Saffron restricts MACC1-dependent cell proliferation and motility of colorectal cancer cells, and alters the microbiome structure

Saffron has proven a beneficial effect as a supplement in the treatment of many conditions through its perceived anti-oxidative and anti-inflammatory properties. We previously identified the gene MACC1 and demonstrated its importance as metastasis inducer, prognostic and predictive biomarker for colorectal cancer (CRC). It is confirmed as decisive driver for tumorigenesis and metastasis for a broad range of solid cancers. Therefore, we explored the inhibitory impact of saffron extracts on MACC1-induced cancer cell growth and motility and its effects on the gut microbiome. First, we assessed cell proliferation of MACC1-high and MACC1-low expressing cells using MTT and the IncuCyte real-time cell imaging system. We employed the endogenously MACC1-low expressing colon cancer cell line SW480 and clones with ectopic MACC1 overexpression. In addition, SW620 cells with endogenous high MACC1 expression and CRISPR-Cas9 mediated MACC1 knock-out were used. Cells were treated with increasing amounts of extracts from 4 different saffron species and concentration-dependent proliferation was analyzed by MTT assay. Changes in cell cycle were assessed by FACS. In vitro migration was measured by Boyden chamber assays. Activation of caspases was analyzed by Western blot. In addition, rats treated with saffron had their gut microbiome analyzed through 16S rDNA sequencing of fecal DNA samples. Upon addition of saffron, cells with high MACC1 expression showed a growth delay compared to cells with reduced MACC1 expression. Further, MACC1-dependent migration was reduced when cells were treated with saffron extracts. We did not find activation of caspases, but we showed a cell cycle arrest of MACC1 positive cells treated with saffron extracts. Using real-time measurement of cell proliferation we identified crocin as most active compound, in our system. Furthermore, rats fed with saffron showed major changes at the phylum level of their gut microbiome. A dramatic reduction/depletion of Cyanobacteria and Proteobacteria and a decrease of Bacteroidetes/Firmicutes ratio was found within the saffron treated rats. These reductions were accompanied by enrichment in Spirochaetes, Tenericutes and Candidatus saccharribacteria phyla in these rats. This is the first identification of saffron-based compounds restricting cancer cells proliferation and motility progression via the novel target MACC1. In addition, change of microbiome composition by saffron favors short chain fatty acid synthesis. The use of saffron or some of its extracts might be of therapeutic value to CRC patients.

Citation Format: Nazli Güllü, Hassan Brim, Marjorie Gondre-Lewis, Silvia Bisti, Hamid Shoraka, Dennis Kobelt, Akbar Soleimani, Lena Timm, Janice Smith, Hassan Ashktorab, Ulrike Stein. Saffron restricts MACC1-dependent cell proliferation and motility of colorectal cancer cells, and alters the microbiome structure [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 1607.

Abstract 2578: Serum analysis of obese and diabetic African American colon adenoma patients reveals novel potential miRNA markers of carcinogenesis

We have previously demonstrated that Adiponectin, leptin, TNF-alpha, and IGF-1 were highly prevalent in patients with colon adenomas when compared to healthy individuals. In the present study, we aimed to establish specific miRNA signatures in obese and diabetic African American patients developing colorectal adenomas.

Patients & Methods: Serum samples from 72 individuals (18 normal, 18 adenoma-obese, 18 adenoma-diabetic, and 18 adenoma-obese-diabetic) seen at Howard University Hospital were collected. All selected patients were age and gender-matched across the 4 groups. Serum RNA extracts were used for library preparation and sequencing on an Illumina NextSeq 500 using SR75 High Output kit. Sequencing data were processed through the miasma-Seq pipeline. CutAdapt was used to trim Illumina adapters and remove reads that were less than 15 bp long. Reads were aligned to the UCSC hg38 human genome reference sequence using Bowtie2. Annotation data in the form of a GFF file from mirBase was used to count the number of reads falling in each hairpin locus. To estimate differential expression between different groups of samples, the count data were used in the DESeq2 R package and the 4 patient groups comparisons were performed. MiRNAs with statistically significant (p &lt; 0.05) expression difference from normal and log 2 FC &gt; 2 and/or &lt; -2 were selected for functional analysis using Ingenuity Pathway Analysis (IPA).

Results: Comparisons to normals revealed that 11 miRNAs [hsa-mir-34a, hsa-mir-133a-1, hsa-mir-127, hsa-mir-99b, hsa-mir-485, hsa-mir-378d-2, hsa-mir-3168, hsa-mir-3679, hsa-mir-378e, hsa-mir-4635, hsa-mir-6509] were down-regulated in Adenoma-Obese; 3 miRNAs were down-regulated [hsa-mir-1228, hsa-mir-3912, hsa-mir-4665] and 3 up-regulated [hsa-mir-455, hsa-mir-219b, hsa-mir-8072 ] in Adenoma-Diabetic patients; and 2 down-regulated [hsa-mir-487b, hsa-mir-6777] and 1 up-regulated miRNA [hsa-mir-4525] in Adenoma-Obese-Diabetic patients. The IPA analysis revealed that many of the altered miRNA have known roles in carcinogenic and metabolic syndrome pathways.

Conclusion: From the pairwise comparison, diabetes seems to be associated with more alterations of the miRNA profile in the analyzed samples when compared to patients developing colon adenomas on an obesity background. MiRNA-4525 can be used as a potential serum marker in obese patients while miRNA-455, miRNA-219b, and miRNA-8072 can serve as such in diabetic patients. Except for miRNA-455 that was previously described as a promotor of migration and invasion in breast cancer, the other mi-RNAs are novel and their mechanisms of action need further study.

Citation Format: Hassan Brim, Mohammad Daremipouran, Gail Nunlee-Bland, Adeyinka Laiyemo, Hassan Ashktorab. Serum analysis of obese and diabetic African American colon adenoma patients reveals novel potential miRNA markers of carcinogenesis [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 2578.

Abstract 3159: Do molecular markers differentiate between sessile serrated adenoma/polyps and hyperplastic polyps

Background: A significant proportion of colorectal cancers, as much as up to 30%, develop through the alternate serrated pathway. The precursor lesions in this pathway comprise of sessile serrated adenomas or polyps (SSA/SSPs) and hyperplastic polyps (HPs), both with a varying risk-profile associated with them for progression into colorectal cancer. Although both types of polyps can be identified histologically, the clinical challenge for gastroenterologists and pathologists remain for risk-prediction as to which of these polyps have a higher likelihood for subsequent development and progression into colorectal cancer. These data highlight the imperative need for the development of more specific and objective markers that can adequately differentiate between the two types of colonic polyps.

Aim: The aim of our study was to determine a variety of molecular biomarkers that may distinguish SSA/Ps and HPs, and to establish biomarker profiles that associate with low vs. high-risk SSA/Ps.

Methods: We conducted a retrospective study of all colonoscopies (n=12,085) performed at the Howard University Hospital between January 2010 to December 2015; of which 83% were conducted in patients of African American (AA) descent (n=10,027). Among AAs, pathology reports confirmed 4,070 patients with polyps, including 252 with SSA/Ps. Gene expression and mutation frequency profiles were analyzed in a total of 47 patients which included 62 specimens (29 SSPs, 26 HP, 3 tubular adenomas (TA) and 4 normal colonic tissues). From a panel of 51 candidate transcripts, we validated 4 RNA markers (MUC6, FSCN1, SEMG1, and TRNP1) using qRT-PCR. MSI and BRAF mutations were also analyzed. CIMP analysis was performed for the aberrant methylation of CACNA1G, IGF2, NEUROG1, RUNX, SOCS and MLH1. The frequency of gender, age groups, anatomic location, clinical/pathological symptoms and reason for colonoscopy in SSA/P patients was analyzed. The median age range for SSA/P diagnosis was between 50 to 64 years.

Results: MUC6, SEMG1, TRNP1, and FSCN1 expression was significantly higher in SSA/Ps vs. HPs (P &lt; 0.05); with corresponding fold differences of 37.2 10.7, 5.8 and 2.5, respectively. BRAF mutations were found in 55.6% of SSA/Ps as opposed to 12.0% of HPs (P &lt; 0.05). The frequency of CIMP was higher in SSA/Ps and correlated with BRAF mutation, while the degree of MSI was more prevalent in HP (P &gt; 0.05). SSA/P lesions were distal (67%).

Conclusion: Our results show that MUC6 and SEMG1 expression and BRAF mutation have the strongest correlation with SSA/Ps in comparison to HPs. In addition, SSA/Ps were predominantly distal in location. These are novel and distinguishing features compared to the published literature in non-AA populations and may help explain why MSI and CIMP, usually linked to proximal lesions, are not optimal molecular biomarkers in AA patients with such serrated lesions.

Note: This abstract was not presented at the meeting.

Citation Format: Hassan Ashktorab, Saman Azam, Taraneh Tarjoman, Priyanka Kanth, Edward Lee, Mehdi Nouraie, Nazli Atefi, Babak Shokrani, Adeyinka Laiyemo, Ajay Goel, Mark W. Hazel, Ruoxin Yao, Angela Snow, Deborah Neklason, Don Delker, Hassan Brim. Do molecular markers differentiate between sessile serrated adenoma/polyps and hyperplastic polyps [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 3159.

Abstract 4003: Colon sessile serrated polyps associate with endometrial polyps

Background: Colon and endometrial polyps are current health issues and their incidences are on the rise. Due to conflicting reports of higher colon polyps in patients with endometrial polyps, we aimed to evaluate if there is such an association in African Americans, a population at high risk for colorectal cancer.

Method: We retrospectively reviewed all female patients who had endometrial (EN) presentations (n=3,600) and colonoscopy (n=14,888) at Howard University Hospital from January 2004 to December 2015. We selected cases with endometrial poly and control without this diagnosis who underwent colonoscopy. Clinical [Body Mass Index (BMI), diabetes (DM), hypertension (HTN), Tamoxifen intake, age] and pathological (histology, location, type of lesions) features of Cases and Controls were collected. Association between EN and colon polyp was tested using multivariable logistic regression analysis. We excluded the patients with endometrial cancer.

Results: We recruited 664 cases and 118 controls. Cases were statistically significant older (median age of 60 vs. 57 in controls) and had higher rates of smoking and DM than controls. However, the overall colon polyp prevalence in the two groups was not statistically different (54% vs 52% in controls and cases, respectively). In subgroups of subject with colon polyp, sigmoid and rectal polyps were more prevalent in controls than cases. Sessile serrated polyps/adenomas (SSPs) were more frequent in cases (8% vs. 2%, p=0.03) while benign mucosa was more so in controls. Whether considering the overall study population or just those with colon polyps, SSPs lesions associated with an Odds Ratio of 4.6 (p=0.02) for EN polyp occurrence, after adjusting for confounder.

Conclusion: Our study shows that the overall colon polyp’s prevalence was similar in endometrial polyp patients compared to endometrial-polyp free controls. However, a significant association between SSP with endometrial polyps was noted. Females with colon lesions of the SSP type might benefit from a screening for endometrial polyp in an age-independent manner.

Note: This abstract was not presented at the meeting.

Citation Format: Hassan Brim, Taraneh Tarjoman, Shirin Ganjali, Saman Azam, Negin Farsi, Edward Lee, Babak Shokrani, Farshad Aduli, Carla Williams, Adeyinka Laiyemo, Akbar Soleimani, Zaki Sherif, Mehdi syed Nouraie, Hassan Ashktorab. Colon sessile serrated polyps associate with endometrial polyps [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 4003.

Abstract 1858: Saffron restricts MACC1-dependent cell proliferation and motility of colorectal cancer cells, and alters the microbiome structure

Saffron has proven a beneficial effect as a supplement in the treatment of many conditions through its perceived anti-oxidative and anti-inflammatory properties. We previously identified the gene MACC1 and demonstrated its importance as metastasis inducer, prognostic and predictive biomarker for colorectal cancer (CRC). It is confirmed as decisive driver for tumorigenesis and metastasis for a broad range of solid cancers. Therefore, we explored the inhibitory impact of saffron extracts on MACC1-induced cancer cell growth and motility and its effects on the gut microbiome. First, we assessed cell proliferation of MACC1-high and MACC1-low expressing cells using MTT and the IncuCyte real-time cell imaging system. We employed the endogenously MACC1-low expressing colon cancer cell line SW480 and clones with ectopic MACC1 overexpression. In addition, SW620 cells with endogenous high MACC1 expression and CRISPR-Cas9 mediated MACC1 knock-out were used. Cells were treated with increasing amounts of extracts from 4 different saffron species and concentration-dependent proliferation was analyzed by MTT assay. Changes in cell cycle were assessed by FACS. In vitro migration was measured by Boyden chamber assays. Activation of caspases was analyzed by Western blot. In addition, rats treated with saffron had their gut microbiome analyzed through 16S rDNA sequencing of fecal DNA samples. Upon addition of saffron, cells with high MACC1 expression showed a growth delay compared to cells with reduced MACC1 expression. Further, MACC1-dependent migration was reduced when cells were treated with saffron extracts. We did not find activation of caspases, but we showed a cell cycle arrest of MACC1 positive cells treated with saffron extracts. Using real-time measurement of cell proliferation we identified crocin as most active compound, in our system. Furthermore, rats fed with saffron showed major changes at the phylum level of their gut microbiome. A dramatic reduction/depletion of Cyanobacteria and Proteobacteria and a decrease of Bacteroidetes/Firmicutes ratio was found within the saffron treated rats. These reductions were accompanied by enrichment in Spirochaetes, Tenericutes and Candidatus saccharribacteria phyla in these rats. This is the first identification of saffron-based compounds restricting cancer cells proliferation and motility progression via the novel target MACC1. In addition, change of microbiome composition by saffron favors short chain fatty acid synthesis. The use of saffron or some of its extracts might be of therapeutic value to CRC patients.

Citation Format: Nazli Güllü, Dennis Kobelt, Hassan Brim, Lena Timm, Janice Smith, Hamid Shoraka, Akbar Soleimani, Silvia Bisti, Marjorie Gondre-Lewis, Hassan Ashktorab, Ulrike S. Stein. Saffron restricts MACC1-dependent cell proliferation and motility of colorectal cancer cells, and alters the microbiome structure [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 1858.

Can the rate and location of sessile serrated polyps be part of colorectal Cancer disparity in African Americans?

BACKGROUND

Up to 30% of colorectal cancers develop through the serrated pathway. African Americans (AAs) suffer a disproportionate burden of colorectal cancer. The aim of this study was to evaluate clinicopathological features of AA patients diagnosed with sessile serrated polyps (SSPs).

METHODS

We conducted a retrospective study of all colonoscopies (n = 12,085) performed at Howard University Hospital, from January 1st, 2010 to December 31st, 2015, of which 83% were in AA patients, (n = 10,027). Among AAs, pathology reports confirmed 4070 patients with polyps including 252 with SSPs. Demographic and clinical variables (i.e. sex, age, BMI, anatomic location, clinical symptoms, polyp size, and clinical indications were collected at colonoscopy.

RESULTS

In the AA population, the median age was 56 with interquartile range (IQR) of 51 to 62 years, 54% were female, and 48% had a BMI > 30. The most common reason for colonoscopy was screening (53%), whereas the prevalent reasons for diagnostic colonoscopies were changes in bowel habits (18%) and gastrointestinal bleeding (17%). The total number of SSPs among the 252 AA (diagnosed with SSPs) was 338. Of these, 9% (n = 29/338) had some degree of cytological dysplasia, primarily in the ascending colon (n = 6/42, 14%), Transverse colon (n = 2/16, 13%) and rectosigmoid (n = 19/233, 8%). About 24% of patients had more than 2 polyps. Most patients (76%) had distal SSPs (rectal and rectosigmoid), in comparison to 14% of proximal polyps and 10% of bilateral locations. Median SSA/P size for all locations was 0.6 cm.

CONCLUSION

The prevalence of SSPs accounts for 6% of all polyps in AA patients and was diagnosed in 2.5% of all colonoscopies (n = 252/10,027), which is higher than Caucasians in the US. SSPs were predominantly located in the left side, as compared to published literature showing the predominance in the right side of the colon. Screening of CRC will have the chance to detect high risk SSA/P in this population.

Saffron: The Golden Spice with Therapeutic Properties on Digestive Diseases

Saffron is a natural compound that has been used for centuries in many parts of the world as a food colorant and additive. It was shown to have the ability to mitigate various disorders through its known anti-inflammatory and anti-oxidant properties. Several studies have shown the effectiveness of saffron in the treatment of various chronic diseases like inflammatory bowel diseases, Alzheimer's, rheumatoid arthritis as well as common malignancies of the colon, stomach, lung, breast, and skin. Modern day drugs generally have unwanted side effects, which led to the current trend to use naturally occurring products with therapeutic properties. In the present review, the objective is to systematically analyze the wealth of information regarding the potential mechanisms of action and the medical use of saffron, the "golden spice", especially in digestive diseases. We summarized saffron influence on microbiome, molecular pathways, and inflammation in gastric, colon, liver cancers, and associated inflammations.

Driver genes exome sequencing reveals distinct variants in African Americans with colorectal neoplasia

BACKGROUND

Colorectal cancer (CRC) is the third leading cause of cancer-related deaths in the United States. African Americans are disproportionately affected by CRC. Our hypothesis is that driver genes with known and novel mutations have an impact on CRC outcome in this population. Therefore, we investigated the variants' profiles in a panel of 15 CRC genes.

PATIENTS & METHODS

Colorectal specimens (n=140) were analyzed by targeted exome sequencing using an Ion Torrent platform. Detected variants were validated in 36 samples by Illumina sequencing. The novel status of the validated variants was determined by comparison to publicly available databases. Annotated using ANNOVAR and in-silico functional analysis of these variants were performed to determine likely pathogenic variants.

RESULTS

Overall, 121 known and novel variants were validated: APC (27%), AMER1 (3%), ARID1 (7%), MSH3 (12%), MSH6 (10%), BRAF (4%), KRAS (6%), FBXW7 (4%), PIK3CA (6%), SMAD4 (5%), SOX9 (2%), TCF7L2 (2%), TGFBR2 (5%), TP53 (7%). From these validated variants, 12% were novel in 8 genes (AMER1, APC, ARID1A, BRAF, MSH6, PIK3CA, SMAD4, and TCF7L2). Of the validated variants, 23% were non-synonymous, 14% were stopgains, 24% were synonymous and 39% were intronic variants.

CONCLUSION

We here report the specifics of variants' profiles of African Americans with colorectal lesions. Validated variants showed that Tumor Suppressor Genes (TSGs) APC and ARID1 and DNA Mismatch repair (MMR) genes MSH3 and MSH6 are the genes with the highest numbers of validated variants. Oncogenes KRAS and PIK3CA are also altered and likely participate in the increased proliferative potential of the mutated colonic epithelial cells in this population.

GPNMB methylation: a new marker of potentially carcinogenic colon lesions

Background

Epigenetic plays an important role in colorectal neoplasia process. There is a need to determine sound biomarkers of colorectal cancer (CRC) progression with clinical and therapeutic implications. Therefore, we aimed to examine the role and methylation status of Glyco Protein Non-Metastatic GPNM B (GPNMB) gene in normal, adenoma and CRC in African American (AA) patients.

Methods

The methylation status of 13 CpG sites (chr7: 23287345–23,287,426) in GPNMB gene’s promoter, was analyzed by pyrosequencing in human CRC cell lines (HCT116, SW480, and HT29) and microdissected African American paraffin embedded samples (20 normal, 21 non-advanced adenoma (NA), 48 advanced adenoma (AD), and 20 cancer tissues. GPNMB expression was analyzed by immunohistochemistry (IHC) on tissue microarrays (TMA). Correlations between GPNMB methylation and expression with clinicopathological features were analyzed. GPNMB functional analysis was performed in triplicates using cell proliferation, migration and invasion assays in HCT116 colon cell line after stable transfection with a GPNMB-cDNA expression vector.

Results

GPNMB methylation was lower in normal mucosa compared to CRC samples (1/20 [5%] vs. 18/20 [90%]; P < 0.001). AD also had a significantly higher GPNMB methylation frequency than normal colon samples (42/48 [88%] vs 1/20 [5%]; P < 0.001). GPNMB was more frequently methylated in AD than in matched normal mucosa from three patients (3/3 [100%] vs 1/3 [33.3%]; P < 0.001). The frequency of GPNMB methylation in NA differed significantly from that in the normal mucosa (16/21 [76%] vs 1/20 [5%]; P = 0.008). There was statistically significant correlation of higher methylation at advanced stages and lower methylation at stage 1 CRCs (P < 0.05). In agreement with these findings, GPNMB protein expression decreased in CRC tissues compared with AD and NA colon mucosa (p < 0.05). GPNMB overexpression in HCT116 colon cancer cell line decreased cell proliferation [(24 h, P = 0.02), (48 h, P < 0.001, 72 h, P = 0.007)], invasion (p < 0.05) and migration (p > 0.05) compared to the mock-transfected cells.

Conclusion

Our data indicate a high methylation profile leading to a lower GPNMB expression in adenoma and CRC samples. The functional analysis established GPNMB as a potential tumor suppressor gene. As such, GPNMB might be useful as a biomarker of adenomas with high carcinogenic potential.

Obesity and Pancreatic Cysts in African American Patients

Objective

Obesity is one of the risk factors for pancreatic cancer and a prognostic factor for acute-chronic pancreatitis.

Aim

To explore the relationship and association between obesity and pancreatic cysts over a 25-year period in African American patients.

Methods

We reviewed the medical records of 207 patients diagnosed with pancreatic cysts via radiology and pathology data from January 1988 to December 2012. A control group was selected from a separate group of healthy patients without a history of pancreatic disease. The patients were evaluated in five groups according to the last 20 years of diagnosis in five-year intervals.

Results

Most patients with pancreatic cyst (73%) were overweight (defined as a body mass index (BMI) ≥ 25), and 53% had a history of chronic pancreatitis compared to patients in the control group. There was a significant difference between the two groups; 79% of patients group were overweight (BMI ≥ 25) vs. 66% in control group (p = 0.02). The incidence of obese and overweight patients was significant (85%) during the 2008 to 2012 interval for the test group (p = 0.009).

Conclusion

Given the increasing proportion of obese pancreatic cyst patients in recent decades compared to the proportion noted in the 1990s, obesity plays a large role in the formation of pancreatic cysts.

Abstract 647: Identification of novel and known hotspot variants in African Americans with colorectal cancer

Background: The recent introduction of the cancer hotspot panel can help enhance targeted cancer therapy, but requires further refinement to identify which genes have significant clinical value for the population of interest. We aim to determine such genes by identifying somatic alterations in the 48 cancer gene panel in African Americans.

Methods: Tumor matched normal tissues (n=16) from African American colorectal cancer patients were analyzed using a 48 hotspot cancer panel by Ion Torrent sequencing. Variants of the genes found in TruSeq Amplicon - Cancer Panel (TSACP) were identified and validated. The type of variant was determined using bioinformatic pipelines including Ensembl's Variant Effect Predictor. The genes with relevant clinical value were determined based on frequency of somatic variants and results from previous studies.

Results: Somatic variants were detected in 39/48 (82%) genes. Of the 39 genes, the 7 with the most clinical value were selected for further analysis. Overall, 46 novel and known hotspot somatic variants were determined in the following 7 genes: KRAS (7/46 [15%]), NRAS (2/46 [4%]), MLH1 (1/46 [2%]), PIK3CA (8/46 [18%]), SMAD4 (6/46 [13%]), RET (9/46 [20%]), and TP53 (13/46 [28%]). Of the KRAS variants, 57% (4/7) were found in codons 12 and 13 while the other 43% (3/7) were found in codons 117 and 146. Out of the 46 somatic variants, 30% (14/46) were in hotspot regions. Of the KRAS hotspot variants, 100% (4/4) were in codons 12 and 13. The 2 NRAS variants were in codons 59 and 61. Lastly, the 9 genes without variants in our population are CDKN2A, SMARCB1, AKT1, ALK, FGFR2, IDH2, CSF1R, HNF1A and MPL.

Conclusion: We have identified novel and known hotspot somatic variants in African Americans with colorectal lesions. Patients with significant hotspot variants, primarily missense alterations, had a worse prognosis. As a result, cancer gene panel hotspot profile should be taken into consideration when treating African American CRC patients.

Citation Format: Hassan Brim, Payaam Tavakoli, Mohammad Reza Daremipouran, Babak Shokrani, Edward Lee, Mehdi Nouraie, Adeinko O. Laiyemo, Hassan Ashktorab. Identification of novel and known hotspot variants in African Americans with colorectal cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 647.

Abstract 1638: Is short interval colonoscopy at the discretion of the gastroenterologist

BACKGROUND: Gastroenterologists do not always follow guidelines for performing colonoscopies. Short interval colonoscopies are recommended at the discretion of gastroenterologists depending on various factors. We here evaluated such factors in an African American patient population.

AIM: To assess factors contributing to short interval (within 3 months) colonoscopies.

METHODS: Data was retrieved retrospectively from Howard University Hospital database (Jan. 2010 to Dec. 2016). African American patients who had repeated colonoscopies within a period of 3 months were selected for this study. We analyzed patients' demographics, family history, polyp characteristics, and reasons for repeat colonoscopy along with latest follow-up findings.

RESULTS: There were 36 patients who underwent two colonoscopies within 3 months, 13 females and 23 males with mean age of 61 years. Out of these, 7 patients (19.4%) had poor bowel preparation. For the remaining 29 patients, the reason for second colonoscopy were partial removal and suspicion of partial removal (61.1%), difficult access (16.7%), and follow-up for Crohn's disease (2.8%). Follow-up of these 36 patients after their last colonoscopy revealed that 8 patients (22.2%) had colon cancer/resection, 4 other patients (11.1%) had cancer of other organs. Of the remaining, 6 (16.6%) had future colon polyp resection, 3 (8.3%) had normal screening colonoscopy and 4 (11.1%) visited the hospital for reasons unrelated to gastroenterology while 11 patients (30.6%) had no follow up.

CONCLUSION: Even though there are no recommendations to repeat colonoscopy within 3 months, endoscopists perform such colonoscopies at their own discretion based on factors like high risk individuals, poor bowel preparation, multiple lesions, type of lesions and resection clearance. Of interest, a significant number of patients in our study had colon cancer/resection on eventual follow-ups.

Citation Format: Hassan Brim, Abhimanyu Tushir, Shashidhar Manchegowda, Negin Farsi, Edward L. Lee, Laiyemo O. Adeyinka, Seyed M. Nouraie, Hassan Ashktorab. Is short interval colonoscopy at the discretion of the gastroenterologist [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 1638.

Abstract 5056: HPV, HIV and male gender as major risk factors for anal neoplastic transformation in African Americans

Background: Human Papilloma Virus (HPV) is the most common sexually transmitted infectious agent. The incidence HPV-related anal cancers increased among HIV infected people. Aim: To assess risk factors of anal lesions among African Americans in an inner city hospital. Methods: We reviewed medical records of 370 African-Americans with anal lesions at Howard University Hospital from Jan. 2007 to Dec. 2015. Demographic, clinical and pathological data including; HPV, HIV, HCV (hepatitis C virus), diabetes mellitus (DM), hypertension (HTN) and body mass index (BMI) were collected. Statistical analysis was performed using Chi-square and Student's t-test. Results: 276 (75%) patients were male, with median age of 44 years and BMI of 25.8 kg/m2. The frequency of condyloma, high grade dysplasia, squamous cell carcinoma (SCC) and adenocarcinoma was 191 (52%), 26 (7%), 31 (8%) and 8 (2%), respectively. The frequency of HPV, HIV, and HCV was 231 (68%), 147 (43%) and 42 (12%), respectively. HPV and HIV were risk factors for condyloma and dysplasia (P&lt;0.05). Forty two percent of patients had diabetes (DM) and hypertension (HTN). Conclusion: Our results shows that majority of patients with condyloma are male and young with HPV and HIV infection. A clinical utility of HPV as risk factor may be use for prediction of anal lesions.

Citation Format: Hassan Brim, Ali Afsari, Nazli Atefi, Nicole Retland, Muneer Abbas, Tammey Naab, Babak Shokrani, Adeyinka O. Laiyemo, Edward L. Lee, Seyed M. Nouraie, Hassan Ashktorab. HPV, HIV and male gender as major risk factors for anal neoplastic transformation in African Americans [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 5056.