Acetaldehyde as a common denominator and cumulative carcinogen in digestive tract cancers

Reducing carcinogenic acetaldehyde exposure in the achlorhydric stomach with cysteine

BACKGROUND

Acetaldehyde, associated with alcohol consumption, has recently been classified as a group 1 carcinogen in humans. Achlorhydric atrophic gastritis is a well-known risk factor for gastric cancer. Achlorhydria leads to microbial colonization of the stomach. Several of these microbes are able to produce significant amounts of acetaldehyde by oxidation from alcohol. Acetaldehyde can be eliminated from saliva after alcohol intake and during smoking with a semi-essential amino acid, L-cysteine. The aim of this study was to determine whether cysteine can be used to bind acetaldehyde in the achlorhydric stomach after ethanol ingestion.

METHODS

Seven volunteers with achlorhydric atrophic gastritis were given either slow-release L-cysteine or placebo capsules in a double-blinded randomized trial. Volunteers served as their own controls. A naso-gastric tube was inserted to each volunteer. The volunteers ingested placebo or 200 mg of L-cysteine capsules, and ethanol 0.3 g/kg body weight (15 vol%) was infused intragastrically through a naso-gastric tube. Five-milliliter samples of gastric contents were aspirated at 5-minute intervals.

RESULTS

During the follow-up period, the mean acetaldehyde level of gastric juice was 2.6 times higher with placebo than with L-cysteine (13 vs. 4.7 μM, p < 0.05, n = 7).

CONCLUSIONS

L-cysteine can be used to decrease acetaldehyde concentration in the achlorhydric stomach during alcohol exposure. Intervention studies with L-cysteine are needed on reducing acetaldehyde exposure in this important risk group for gastric cancer.

Deficient aldehyde dehydrogenase 2 is associated with increased risk for esophageal squamous cell carcinoma in the presence of gastric hypochlorhydria

OBJECTIVE

In Orientals, deficient aldehyde dehydrogenase 2 (ALDH2) is associated with an increased risk for esophageal squamous cell carcinoma (ESCC). The local metabolism of carcinogenic acetaldehyde in the upper gastrointestinal tract could be involved in the association, but the underlying mechanism has not been fully elucidated. Since an anacidic stomach can promote bacteria-catalyzed local acetaldehyde production, the gastric acid level could also affect acetaldehyde metabolism. This study investigated whether ALDH2-related susceptibility to ESCC differs depending on the gastric secretion level.

MATERIAL AND METHODS

Sixty-two patients with ESCC and sex- and age-matched normal controls were enrolled in this study. ALDH2 polymorphism was analyzed by polymerase chain-restriction fragment length polymorphism, and those with an inactive allele (ALDH2-1/2-2 or ALDH2-2/2-2) were defined as ALDH2 deficient. Gastrin-stimulated acid output was assessed by endoscopic gastrin test and hypochlorhydria was defined as 0.6 mEq/10 min or lower. Multiple logistic regression analyses were used to adjust for other potential confounders.

RESULTS

ALDH2 deficiency or hypochlorhydria was more prevalent in ESCC compared with controls and both showed increased independent associations with ESCC in multivariate analysis. Stratified analysis by the gastric acid secretion level revealed that the associations between the ALDH2 genotype and ESCC differed according to the individual gastric acid secretion levels and that ALDH2 deficiency was a significant risk factor for ESCC exclusively in individuals with hypochlorhydria with an odds ratio (95% confidence interval): 5.0 (1.2-21.2).

CONCLUSION

Microbial production of carcinogen acetaldehyde in the presence of gastric hypochlorhydria is most probably involved in the mechanism of ALDH2-related susceptibility to ESCC.

Alcohol and gastrointestinal oncology

Results from several large epidemiological studies have firmly established that alcohol is associated with elevated cancer incidence and mortality. Recently the International Agency for Cancer Research stated that acetaldehyde associated with alcoholic beverages is carcinogenic to humans and confirmed the Group 1 classification of alcohol consumption and of ethanol in alcoholic beverages. Alcohol consumption causes cancers of the oral cavity, pharynx, larynx, oesophagus, colorectum, liver, pancreas and female breast. The frequency of most alcohol-induced diseases increases in a linear fashion as intake increases: oral, oesophagus and colon cancer fall into this pattern. Very little is known about safe margins of alcohol consumption. US Department of Health and Human Services suggest a maximum of 28 g of alcohol a day in man and half of this in women.

Artisanal alcohol production in Mayan Guatemala: chemical safety evaluation with special regard to acetaldehyde contamination

There is a lack of knowledge regarding the composition, production, distribution, and consumption of artisanal alcohol, particularly in the developing world. In Nahualá, an indigenous Mayan municipality located in highland Guatemala, heavy alcohol consumption appears to have had a significant negative impact on health, a major role in cases of violence and domestic abuse, and a link to street habitation. Cuxa, an artisanally, as well as commercially produced sugarcane alcohol, is widely consumed by heavy drinkers in this community. Cuxa samples from all distribution points in the community were obtained and chemically analyzed for health-relevant constituents and contaminants including methanol, acetaldehyde, higher alcohols, and metals. From those, only acetaldehyde was confirmed to be present in unusually high levels (up to 126 g/hl of pure alcohol), particularly in samples that were produced clandestinely. Acetaldehyde has been evaluated as "possibly carcinogenic" and has also been identified as having significant human exposure in a recent risk assessment. This study explores the reasons for the elevated levels of acetaldehyde, through both sampling and analyses of raw and intermediary products of cuxa production, as well as interviews from producers of the clandestine alcohol. For further insight, we experimentally produced this alcohol in our laboratory, based on the directions provided by the producers, as well as materials from the town itself. Based on these data, the origin of the acetaldehyde contamination appears to be due to chemical changes induced during processing, with the major causative factors consisting of poor hygiene, aerobic working conditions, and inadequate yeast strains, compounded by flawed distillation methodology that neglects separation of the first fractions of the distillate. These results indicate a preventable public health concern for consumers, which can be overcome through education about good manufacturing practices, as well as financial incentives to separate the acetaldehyde-rich fractions during distillation.

Acetaldehyde production from ethanol and glucose by non-Candida albicans yeasts in vitro

BACKGROUND

Major environmental risk factors for upper digestive tract cancers are tobacco smoking, alcohol intake and poor oral hygiene. They all result in increased acetaldehyde (ACH) levels in saliva which has been shown to be carcinogenic. During alcohol challenge the oral microbiota is the main determinant of the local ACH concentration. Many bacteria and Candida albicans have been shown to be capable of ACH production. Moreover, chronic candidal mucositis can be carcinogenic. The ability of non-C. albicans Candida to produce ACH has not been studied.

AIM

The aim of this study was to explore the ability of non-C. albicans Candida species to produce ACH in vitro during ethanol and glucose incubation.

METHODS

A total of 30 non-C. albicans Candida isolates and one C. albicans reference strain were used. The cells were exposed to 11 mM of ethanol and to 100mM glucose in vitro. ACH was measured by gas chromatography.

RESULTS

All Candida isolates produced significant amounts of ACH in ethanol incubation. C. tropicalis isolates were the highest (252.3 microM) and C. krusei isolates were the lowest (54.6 microM) producers of ACH from ethanol. Only C.glabrata produced significant amounts of ACH by fermentation from glucose.

CONCLUSION

Colonization of oral mucosa with a non-C.albicans species such as C. glabrata, capable of producing carcinogenic amounts of ACH from both ethanol and glucose, may contribute to the development of oral cancer.