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The interplay of pineal hormones and socioeconomic status leading to colorectal cancer disparity. Transl Oncol 2022; 16:101330. [PMID: 34990909 PMCID: PMC8741600 DOI: 10.1016/j.tranon.2021.101330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 12/21/2021] [Indexed: 12/12/2022] Open
Abstract
Colorectal cancer (CRC) is the third leading cause of cancer-related deaths in the United States. Despite increased screening options and state-of-art treatments offered in clinics, racial differences remain in CRC. African Americans (AAs) are disproportionately affected by the disease; the incidence and mortality are higher in AAs than Caucasian Americans (CAs). At the time of diagnosis, AAs more often present with advanced stages and aggressive CRCs, primarily accounting for the racial differences in therapeutic outcomes and mortality. The early incidence of CRC in AAs could be attributed to race-specific gene polymorphisms and lifestyle choices associated with socioeconomic status (SES). Altered melatonin-serotonin signaling, besides the established CRC risk factors (age, diet, obesity, alcoholism, and tobacco use), steered by SES, glucocorticoid, and Vitamin D status in AAs could also account for the early incidence in this racial group. This review focuses on how the lifestyle factors, diet, allelic variants, and altered expression of specific genes could lead to atypical serotonin and melatonin signaling by modulating the synthesis, secretion, and signaling of these pineal hormones in AAs and predisposing them to develop more aggressive CRC earlier than CAs. Crosstalk between gut microbiota and pineal hormones and its impact on CRC pathobiology is addressed from a race-specific perspective. Lastly, the status of melatonin-focused CRC treatments, the need to better understand the perturbed melatonin signaling, and the potential of pineal hormone-directed therapeutic interventions to reduce CRC-associated disparity are discussed.
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Barber LE, Bertrand KA, Petrick JL, Gerlovin H, White LF, Adams-Campbell LL, Rosenberg L, Roy HK, Palmer JR. Predicted Vitamin D Status and Colorectal Cancer Incidence in the Black Women's Health Study. Cancer Epidemiol Biomarkers Prev 2021; 30:2334-2341. [PMID: 34620630 PMCID: PMC8643345 DOI: 10.1158/1055-9965.epi-21-0675] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 07/20/2021] [Accepted: 09/30/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Observational studies, mostly among White populations, suggest that low vitamin D levels increase colorectal cancer risk. African Americans, who are disproportionately burdened by colorectal cancer, often have lower vitamin D levels compared with other populations. METHODS We assessed predicted vitamin D score in relation to colorectal cancer among 49,534 participants in the Black Women's Health Study, a cohort of African American women followed from 1995 to 2017 through biennial questionnaires. We derived predicted vitamin D scores at each questionnaire cycle for all participants using a previously validated prediction model based on actual 25-hydroxyvitamin D values from a subset of participants. We calculated cumulative average predicted vitamin D score at every cycle by averaging scores from cycles up to and including that cycle. Using Cox proportional hazards regression, we estimated hazard ratios (HR) and 95% confidence intervals (CI) for colorectal cancer incidence according to predicted score quartiles. RESULTS Over follow-up, 488 incident colorectal cancers occurred. Compared with women in the highest quartile of predicted vitamin D score, those in the lowest had an estimated 41% (HR = 1.41; 95% CI, 1.05-1.90) higher colorectal cancer risk. Comparable HRs were 1.44 (95% CI, 1.02-2.01) for colon and 1.34 (95% CI, 0.70-2.56) for rectal cancer. CONCLUSIONS Low vitamin D status may lead to elevated colorectal cancer risk in African American women. IMPACT Our findings, taken together with established evidence that vitamin D levels are generally lower in African Americans than other U.S. groups, suggest that low vitamin D status may contribute to the disproportionately high colorectal cancer incidence among African Americans.
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Affiliation(s)
- Lauren E Barber
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | | | - Jessica L Petrick
- Slone Epidemiology Center at Boston University, Boston, Massachusetts
| | - Hanna Gerlovin
- U.S. Department of Veterans Affairs, Boston, Massachusetts
| | - Laura F White
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | | | - Lynn Rosenberg
- Slone Epidemiology Center at Boston University, Boston, Massachusetts
| | - Hemant K Roy
- Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Julie R Palmer
- Slone Epidemiology Center at Boston University, Boston, Massachusetts.
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3
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Ames BN, Grant WB, Willett WC. Does the High Prevalence of Vitamin D Deficiency in African Americans Contribute to Health Disparities? Nutrients 2021; 13:499. [PMID: 33546262 PMCID: PMC7913332 DOI: 10.3390/nu13020499] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 01/24/2021] [Accepted: 01/28/2021] [Indexed: 02/06/2023] Open
Abstract
African Americans have higher incidence of, and mortality from, many health-related problems than European Americans. They also have a 15 to 20-fold higher prevalence of severe vitamin D deficiency. Here we summarize evidence that: (i) this health disparity is partly due to insufficient vitamin D production, caused by melanin in the skin blocking the UVB solar radiation necessary for its synthesis; (ii) the vitamin D insufficiency is exacerbated at high latitudes because of the combination of dark skin color with lower UVB radiation levels; and (iii) the health of individuals with dark skin can be markedly improved by correcting deficiency and achieving an optimal vitamin D status, as could be obtained by supplementation and/or fortification. Moderate-to-strong evidence exists that high 25-hydroxyvitamin D levels and/or vitamin D supplementation reduces risk for many adverse health outcomes including all-cause mortality rate, adverse pregnancy and birth outcomes, cancer, diabetes mellitus, Alzheimer's disease and dementia, multiple sclerosis, acute respiratory tract infections, COVID-19, asthma exacerbations, rickets, and osteomalacia. We suggest that people with low vitamin D status, which would include most people with dark skin living at high latitudes, along with their health care provider, consider taking vitamin D3 supplements to raise serum 25-hydroxyvitamin D levels to 30 ng/mL (75 nmol/L) or possibly higher.
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Affiliation(s)
- Bruce N. Ames
- Molecular and Cell Biology, Emeritus, University of California, Berkeley, CA 94720, USA;
| | - William B. Grant
- Sunlight, Nutrition and Health Research Center, San Francisco, CA 94164-1603, USA
| | - Walter C. Willett
- Departments of Nutrition and Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA;
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
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4
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Song M, Lee IM, Manson JE, Buring JE, Dushkes R, Gordon D, Walter J, Wu K, Chan AT, Ogino S, Fuchs CS, Meyerhardt JA, Giovannucci EL. No Association Between Vitamin D Supplementation and Risk of Colorectal Adenomas or Serrated Polyps in a Randomized Trial. Clin Gastroenterol Hepatol 2021; 19:128-135.e6. [PMID: 32062040 PMCID: PMC7423703 DOI: 10.1016/j.cgh.2020.02.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 01/24/2020] [Accepted: 02/03/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS The effects of vitamin D on risk of colorectal cancer precursors are not clear. We examined the influence of vitamin D supplementation on risk of colorectal adenomas and serrated polyps in a prespecified ancillary study of a large-scale prevention trial (the vitamin D and omegA-3 trial, VITAL) of individuals who were free of cancer and cardiovascular disease at enrollment. METHODS In VITAL trial, 25,871 adults with no history of cancer or cardiovascular disease (12,786 men 50 years or older and 13,085 women 55 years or older) were randomly assigned to groups given daily dietary supplements (2000 IU vitamin D3 and 1 g marine n-3 fatty acid) or placebo. Patients were assigned to groups from November 2011 through March 2014 and the study ended on December 31, 2017. We confirmed conventional adenomas and serrated polyps by reviewing histopathology reports from participants who had reported a diagnosis of polyps and were asked by their doctors to return for a repeat colonoscopy or sigmoidoscopy in 5 years or less. We calculated the odds ratios (ORs) and 95% CIs by logistic regression, after adjusting for age, sex, n-3 treatment assignment, and history of endoscopy at time of randomization. RESULTS During a median follow-up of 5.3 years, we documented 308 cases of conventional adenomas in 12,927 participants in the vitamin D group and 287 cases in 12,944 participants in the placebo group (OR for the association of vitamin D supplementation with adenoma, 1.08; 95% CI, 0.92-1.27). There were 172 cases of serrated polyps in the vitamin D group and 169 cases in the placebo group (OR for the association of vitamin D supplementation with serrated polyp, 1.02; 95% CI, 0.82-1.26). Supplementation was not associated with polyp size, location, multiplicity, or histologic features. We found evidence for an interaction between vitamin D supplementation and serum level of 25-hydroxyvitamin D, measured in 15,787 participants at randomization. Among individuals with serum levels of 25-hydroxyvitamin D below 30 ng/mL, the OR associated with supplementation for conventional adenoma was 0.82 (95% CI, 0.60-1.13), whereas among individuals with serum levels of 25-hydroxyvitamin D above 30 ng/mL, the OR for conventional adenoma was 1.20 (95% CI, 0.92-1.55) (P for interaction = .07). There was a significant interaction between vitamin D supplementation and serum level of 25-hydroxyvitamin D in their association with advanced adenoma (P for interaction = .04). CONCLUSIONS Based on an ancillary study of data from the VITAL trial, daily vitamin D supplementation (2000 IU) was not associated with risk of colorectal cancer precursors in average-risk adults not selected for vitamin D insufficiency. A potential benefit for individuals with low baseline level of vitamin D requires further investigation. ClinicalTrials.gov number: NCT01169259.
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Affiliation(s)
- Mingyang Song
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Clinical and Translational Epidemiology Unit, Mongan Institute, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
| | - I-Min Lee
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA,Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, MA
| | - JoAnn E. Manson
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA,Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, MA,Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, and Harvard Medical School, Boston, MA
| | - Julie E. Buring
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA,Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, MA
| | - Rimma Dushkes
- Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, MA
| | - David Gordon
- Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, MA
| | - Joseph Walter
- Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, MA
| | - Kana Wu
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Andrew T. Chan
- Clinical and Translational Epidemiology Unit, Mongan Institute, Massachusetts General Hospital and Harvard Medical School, Boston, MA,Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA,Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, and Harvard Medical School, Boston, MA,Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA,Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA
| | - Shuji Ogino
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA,Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA,Department of Oncologic Pathology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA,Program in MPE Molecular Pathological Epidemiology, Department of Pathology, Brigham and Women’s Hospital, and Harvard Medical School, Boston, MA
| | - Charles S. Fuchs
- Yale Cancer Center, New Haven, CT,Department of Medicine, Yale School of Medicine, New Haven, CT,Smilow Cancer Hospital, New Haven, CT
| | - Jeffrey A. Meyerhardt
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA
| | - Edward L. Giovannucci
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA,Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA,Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, and Harvard Medical School, Boston, MA
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5
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Chen L, Zhu H, Harshfield GA, Huang Y, Dong Y. Association between serum 25-hydroxyvitamin D and the effects of Angiotensin II receptor blocker on renal function among African Americans: A post hoc analysis of a randomized placebo-controlled trial. J Clin Hypertens (Greenwich) 2020; 22:1874-1883. [PMID: 32810358 DOI: 10.1111/jch.13997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 07/17/2020] [Accepted: 07/24/2020] [Indexed: 01/13/2023]
Abstract
We tested the hypothesis that vitamin D status may modify the effect of Angiotensin II receptor blocker (ARB) on renal function among African Americans. Sixty-four participants were included in this ancillary study from a randomized, double-blind, placebo-controlled, crossover trial among normotensive African Americans to test the effect of ARB on stress response of blood pressure and renal sodium handling. The participants were randomly assigned to receive either ARB or placebo for one week, washed out for one week and then cross-overed to receive the other intervention for one week. On the final day of each intervention, the participant underwent a mental stress test. Baseline serum 25-hydroxyvitamin D [25(OH)D] level was measured in this ancillary study. Sixty-four participants were included, aged 26.5 ± 10.2 years and 47% were female. Among the participants with the serum 25(OH)D concentrations in the low tertile, ARB treatment was associated with 2.58 mg/dL higher blood urea nitrogen (BUN) (P < .001) and was not associated with serum creatinine (SCr) or estimated glomerular filtration rate (eGFR) (Ps > .05). Among the participants in the high 25(OH)D tertile, ARB was associated with 1.59 mg/dL lower BUN (P < .001), 0.08 mg/dL lower SCr (P = .001), and 8.59 mL/min/1.73 m2 higher eGFR (P = .001). The interactions between vitamin D and ARB on renal function were more significant during stress and recovery than at rest. The effects of ARB treatment on renal function are modified by the vitamin D status among African Americans. ARB may improve renal function only among the ones with optimal vitamin D status.
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Affiliation(s)
- Li Chen
- Department of Medicine, Georgia Prevention Institute, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Haidong Zhu
- Department of Medicine, Georgia Prevention Institute, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Gregory A Harshfield
- Department of Medicine, Georgia Prevention Institute, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Ying Huang
- Department of Medicine, Georgia Prevention Institute, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Yanbin Dong
- Department of Medicine, Georgia Prevention Institute, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
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Heath AK, Hodge AM, Ebeling PR, Kvaskoff D, Eyles DW, Giles GG, English DR, Williamson EJ. Circulating 25-hydroxyvitamin D concentration and cause-specific mortality in the Melbourne Collaborative Cohort Study. J Steroid Biochem Mol Biol 2020; 198:105612. [PMID: 32007563 DOI: 10.1016/j.jsbmb.2020.105612] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 01/02/2020] [Accepted: 01/29/2020] [Indexed: 12/11/2022]
Abstract
Vitamin D deficiency is associated with higher all-cause mortality, but associations with specific causes of death are unclear. We investigated the association between circulating 25-hydroxyvitamin D (25(OH)D) concentration and cause-specific mortality using a case-cohort study within the Melbourne Collaborative Cohort Study (MCCS). Eligibility for the case-cohort study was restricted to participants with baseline dried blood spot samples and no pre-baseline diagnosis of cancer. These analyses included participants who died (n = 2307) during a mean follow-up of 14 years and a sex-stratified random sample of eligible cohort participants ('subcohort', n = 2923). Concentration of 25(OH)D was measured using liquid chromatography-tandem mass spectrometry. Cox regression, with Barlow weights and robust standard errors to account for the case-cohort design, was used to estimate hazard ratios (HRs) and 95 % confidence intervals (CIs) for cause-specific mortality in relation to 25(OH)D concentration with adjustment for confounders. Circulating 25(OH)D concentration was inversely associated with risk of death due to cancer (HR per 25 nmol/L increment = 0.88, 95 % CI 0.78-0.99), particularly colorectal cancer (HR = 0.75, 95 % CI 0.57-0.99). Higher 25(OH)D concentrations were also associated with a lower risk of death due to diseases of the respiratory system (HR = 0.62, 95 % CI 0.43-0.88), particularly chronic obstructive pulmonary disease (HR = 0.53, 95 % CI 0.30-0.94), and diseases of the digestive system (HR = 0.44, 95 % CI 0.26-0.76). Estimates for diabetes mortality (HR = 0.64, 95 % CI 0.33-1.26) and cardiovascular disease mortality (HR = 0.90, 95 % CI 0.76-1.07) lacked precision. The findings suggest that vitamin D might be important for preventing death due to some cancers, respiratory diseases, and digestive diseases.
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Affiliation(s)
- Alicia K Heath
- School of Public Health, Imperial College London, London, UK; Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia.
| | - Allison M Hodge
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia; Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia.
| | - Peter R Ebeling
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia.
| | - David Kvaskoff
- Queensland Brain Institute, University of Queensland, St Lucia, Queensland, Australia
| | - Darryl W Eyles
- Queensland Brain Institute, University of Queensland, St Lucia, Queensland, Australia; Queensland Centre for Mental Health Research, the Park Centre for Mental Health, Wacol, Queensland, Australia.
| | - Graham G Giles
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia; Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia; Precision Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia.
| | - Dallas R English
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia; Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia.
| | - Elizabeth J Williamson
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia; Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK.
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7
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Lau-Min K, Prakash P, Jo E, Thrift AP, Hilsenbeck S, Musher BL. Outcomes Among Minority Patients With Metastatic Colorectal Cancer in a Safety-net Health Care System. Clin Colorectal Cancer 2020; 19:e49-e57. [PMID: 32165040 DOI: 10.1016/j.clcc.2019.09.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 07/24/2019] [Accepted: 09/17/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Metastatic colorectal cancer (CRC) outcomes continue to improve, but they vary significantly by race and ethnicity. We hypothesize that these disparities arise from unequal access to care. MATERIALS AND METHODS The Harris Health System (HHS) is an integrated health delivery network that provides medical care to the underserved, predominantly minority population of Harris County, Texas. As the largest HHS facility and an affiliate of Baylor College of Medicine's Dan L. Duncan Comprehensive Cancer Center, Ben Taub Hospital (BTH) delivers cancer care through multidisciplinary subspecialty that prioritize access to care, adherence to evidence-based clinical pathways, integration of supportive services, and mitigation of financial toxicity. We performed a retrospective analysis of minority patients diagnosed with and treated for metastatic CRC at BTH between January 2010 and December 2012. Kaplan-Meier survival curves were compared with survival curves from randomized control trials reported during that time period. RESULTS We identified 103 patients; 40% were black, 49% were Hispanic, and 12% were Asian or Middle Eastern. Thirty-five percent reported a language other than English as their preferred language. Seventy-four percent of patients with documented coverage status were uninsured. Eighty-four percent of patients received standard chemotherapy with a clinician-reported response rate of 63%. Overall survival for BTH patients undergoing chemotherapy was superior to that of subjects enrolled in the CRYSTAL (Cetuximab Combined with Irinotecan in First-Line Therapy for Metastatic Colorectal Cancer) trial (median, 24.0 vs. 19.9 months; P = .014). CONCLUSION HHS provides a health delivery infrastructure through which minority patients with socioeconomic challenges experience clinical outcomes comparable with highly selected patients enrolled in randomized control trials. Efforts to resolve CRC disparities should focus on improving access of at-risk populations to high-quality comprehensive cancer care.
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Affiliation(s)
- Kelsey Lau-Min
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Preeti Prakash
- Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Eunji Jo
- Department of Medicine, Baylor College of Medicine, Houston, TX; Department of Medicine, Dan L. Duncan Comprehensive Cancer Center, Houston, TX
| | - Aaron P Thrift
- Department of Medicine, Baylor College of Medicine, Houston, TX; Department of Medicine, Dan L. Duncan Comprehensive Cancer Center, Houston, TX
| | - Susan Hilsenbeck
- Department of Medicine, Baylor College of Medicine, Houston, TX; Department of Medicine, Dan L. Duncan Comprehensive Cancer Center, Houston, TX
| | - Benjamin L Musher
- Department of Medicine, Baylor College of Medicine, Houston, TX; Department of Medicine, Dan L. Duncan Comprehensive Cancer Center, Houston, TX.
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Ng K, Nimeiri HS, McCleary NJ, Abrams TA, Yurgelun MB, Cleary JM, Rubinson DA, Schrag D, Miksad R, Bullock AJ, Allen J, Zuckerman D, Chan E, Chan JA, Wolpin BM, Constantine M, Weckstein DJ, Faggen MA, Thomas CA, Kournioti C, Yuan C, Ganser C, Wilkinson B, Mackintosh C, Zheng H, Hollis BW, Meyerhardt JA, Fuchs CS. Effect of High-Dose vs Standard-Dose Vitamin D3 Supplementation on Progression-Free Survival Among Patients With Advanced or Metastatic Colorectal Cancer: The SUNSHINE Randomized Clinical Trial. JAMA 2019; 321:1370-1379. [PMID: 30964527 PMCID: PMC6459117 DOI: 10.1001/jama.2019.2402] [Citation(s) in RCA: 117] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
IMPORTANCE In observational studies, higher plasma 25-hydroxyvitamin D (25[OH]D) levels have been associated with improved survival in metastatic colorectal cancer (CRC). OBJECTIVE To determine if high-dose vitamin D3 added to standard chemotherapy improves outcomes in patients with metastatic CRC. DESIGN, SETTING, AND PARTICIPANTS Double-blind phase 2 randomized clinical trial of 139 patients with advanced or metastatic CRC conducted at 11 US academic and community cancer centers from March 2012 through November 2016 (database lock: September 2018). INTERVENTIONS mFOLFOX6 plus bevacizumab chemotherapy every 2 weeks and either high-dose vitamin D3 (n = 69) or standard-dose vitamin D3 (n = 70) daily until disease progression, intolerable toxicity, or withdrawal of consent. MAIN OUTCOMES AND MEASURES The primary end point was progression-free survival (PFS) assessed by the log-rank test and a supportive Cox proportional hazards model. Testing was 1-sided. Secondary end points included tumor objective response rate (ORR), overall survival (OS), and change in plasma 25(OH)D level. RESULTS Among 139 patients (mean age, 56 years; 60 [43%] women) who completed or discontinued chemotherapy and vitamin D3 (median follow-up, 22.9 months), the median PFS for high-dose vitamin D3 was 13.0 months (95% CI, 10.1 to 14.7; 49 PFS events) vs 11.0 months (95% CI, 9.5 to 14.0; 62 PFS events) for standard-dose vitamin D3 (log-rank P = .07); multivariable hazard ratio for PFS or death was 0.64 (1-sided 95% CI, 0 to 0.90; P = .02). There were no significant differences between high-dose and standard-dose vitamin D3 for tumor ORR (58% vs 63%, respectively; difference, -5% [95% CI, -20% to 100%], P = .27) or OS (median, 24.3 months vs 24.3 months; log-rank P = .43). The median 25(OH)D level at baseline for high-dose vitamin D3 was 16.1 ng/mL vs 18.7 ng/mL for standard-dose vitamin D3 (difference, -2.6 ng/mL [95% CI, -6.6 to 1.4], P = .30); at first restaging, 32.0 ng/mL vs 18.7 ng/mL (difference, 12.8 ng/mL [95% CI, 9.0 to 16.6], P < .001); at second restaging, 35.2 ng/mL vs 18.5 ng/mL (difference, 16.7 ng/mL [95% CI, 10.9 to 22.5], P < .001); and at treatment discontinuation, 34.8 ng/mL vs 18.7 ng/mL (difference, 16.2 ng/mL [95% CI, 9.9 to 22.4], P < .001). The most common grade 3 and higher adverse events for chemotherapy plus high-dose vs standard-dose vitamin D3 were neutropenia (n = 24 [35%] vs n = 21 [31%], respectively) and hypertension (n = 9 [13%] vs n = 11 [16%]). CONCLUSIONS AND RELEVANCE Among patients with metastatic CRC, addition of high-dose vitamin D3, vs standard-dose vitamin D3, to standard chemotherapy resulted in a difference in median PFS that was not statistically significant, but with a significantly improved supportive hazard ratio. These findings warrant further evaluation in a larger multicenter randomized clinical trial. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01516216.
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Affiliation(s)
- Kimmie Ng
- Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Halla S. Nimeiri
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois
| | | | | | | | | | | | | | - Rebecca Miksad
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | | | - Dan Zuckerman
- St Luke’s Mountain States Tumor Institute, Boise, Idaho
| | - Emily Chan
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | | | | | | | | | | | | | - Chen Yuan
- Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | | | | | - Hui Zheng
- Massachusetts General Hospital, Boston
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Hong J, Hatchell KE, Bradfield JP, Bjonnes A, Chesi A, Lai CQ, Langefeld CD, Lu L, Lu Y, Lutsey PL, Musani SK, Nalls MA, Robinson-Cohen C, Roizen JD, Saxena R, Tucker KL, Ziegler JT, Arking DE, Bis JC, Boerwinkle E, Bottinger EP, Bowden DW, Gilsanz V, Houston DK, Kalkwarf HJ, Kelly A, Lappe JM, Liu Y, Michos ED, Oberfield SE, Palmer ND, Rotter JI, Sapkota B, Shepherd JA, Wilson JG, Basu S, de Boer IH, Divers J, Freedman BI, Grant SFA, Hakanarson H, Harris TB, Kestenbaum BR, Kritchevsky SB, Loos RJF, Norris JM, Norwood AF, Ordovas JM, Pankow JS, Psaty BM, Sanghera DK, Wagenknecht LE, Zemel BS, Meigs J, Dupuis J, Florez JC, Wang T, Liu CT, Engelman CD, Billings LK. Transethnic Evaluation Identifies Low-Frequency Loci Associated With 25-Hydroxyvitamin D Concentrations. J Clin Endocrinol Metab 2018; 103:1380-1392. [PMID: 29325163 PMCID: PMC6276579 DOI: 10.1210/jc.2017-01802] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 01/03/2018] [Indexed: 01/08/2023]
Abstract
Context Vitamin D inadequacy is common in the adult population of the United States. Although the genetic determinants underlying vitamin D inadequacy have been studied in people of European ancestry, less is known about populations with Hispanic or African ancestry. Objective The Trans-Ethnic Evaluation of Vitamin D (TRANSCEN-D) genomewide association study (GWAS) consortium was assembled to replicate genetic associations with 25-hydroxyvitamin D [25(OH)D] concentrations from the Study of Underlying Genetic Determinants of Vitamin D and Highly Related Traits (SUNLIGHT) meta-analyses of European ancestry and to identify genetic variants related to vitamin D concentrations in African and Hispanic ancestries. Design Ancestry-specific (Hispanic and African) and transethnic (Hispanic, African, and European) meta-analyses were performed with Meta-Analysis Helper software (METAL). Patients or Other Participants In total, 8541 African American and 3485 Hispanic American (from North America) participants from 12 cohorts and 16,124 European participants from SUNLIGHT were included in the study. Main Outcome Measures Blood concentrations of 25(OH)D were measured for all participants. Results Ancestry-specific analyses in African and Hispanic Americans replicated single nucleotide polymorphisms (SNPs) in GC (2 and 4 SNPs, respectively). An SNP (rs79666294) near the KIF4B gene was identified in the African American cohort. Transethnic evaluation replicated GC and DHCR7 region SNPs. Additionally, the transethnic analyses revealed SNPs rs719700 and rs1410656 near the ANO6/ARID2 and HTR2A genes, respectively. Conclusions Ancestry-specific and transethnic GWASs of 25(OH)D confirmed findings in GC and DHCR7 for African and Hispanic American samples and revealed findings near KIF4B, ANO6/ARID2, and HTR2A. The biological mechanisms that link these regions with 25(OH)D metabolism warrant further investigation.
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Affiliation(s)
- Jaeyoung Hong
- Department of Biostatistics, Boston University School of Public Health, Boston,
Massachusetts
| | - Kathryn E Hatchell
- Department of Population Health Sciences, University of Wisconsin–Madison
School of Medicine and Public Health, Madison, Wisconsin
| | - Jonathan P Bradfield
- Center for Applied Genomics, Division of Human Genetics, The Children’s
Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Andrew Bjonnes
- Center for Genomic Medicine, Massachusetts General Hospital, Boston,
Massachusetts
| | - Alessandra Chesi
- The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Chao-Qiang Lai
- USDA-ARS Human Nutrition Research Center on Aging at Tufts University, Boston,
Massachusetts
| | | | - Lingyi Lu
- Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Yingchang Lu
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of
Medicine at Mount Sinai, New York, New York
| | - Pamela L Lutsey
- Division of Epidemiology and Community Health, University of Minnesota,
Minneapolis, Minnesota
| | - Solomon K Musani
- Department of Medicine, University of Mississippi Medical Center, Jackson,
Mississippi
| | - Mike A Nalls
- Data Tecnica International, Glen Echo, Maryland
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes
of Health, Bethesda, Maryland
| | - Cassianne Robinson-Cohen
- Kidney Research Institute, Division of Nephrology, Department of Medicine,
University of Washington, Seattle, Washington
| | - Jeffery D Roizen
- Center for Applied Genomics, Division of Human Genetics, The Children’s
Hospital of Philadelphia, Philadelphia, Pennsylvania
- Division of Endocrinology, Children’s Hospital of Philadelphia, Philadelphia,
Pennsylvania
| | - Richa Saxena
- Center for Genomic Medicine, Massachusetts General Hospital, Boston,
Massachusetts
| | - Katherine L Tucker
- Department of Biomedical and Nutritional Sciences, University of Massachusetts
Lowell, Lowell, Massachusetts
| | - Julie T Ziegler
- Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Dan E Arking
- McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University
School of Medicine, Baltimore, Maryland
| | - Joshua C Bis
- Cardiovascular Health Research Unit, Department of Medicine, University of
Washington, Seattle, Washington
| | - Eric Boerwinkle
- University of Texas Health Science Center at Houston, Houston, Texas
| | - Erwin P Bottinger
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of
Medicine at Mount Sinai, New York, New York
| | - Donald W Bowden
- Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Vicente Gilsanz
- Department of Radiology, Children’s Hospital of Los Angeles, Keck School of
Medicine, University of Southern California, Los Angeles, California
| | - Denise K Houston
- Department of Internal Medicine, Section on Gerontology and Geriatric
Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Heidi J Kalkwarf
- Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children’s
Hospital Medical Center, Cincinnati, Ohio
| | - Andrea Kelly
- The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Perelman School of Medicine at University of Pennsylvania, Philadelphia,
Pennsylvania
| | | | - Yongmei Liu
- Department of Epidemiology and Prevention, Division of Public Health Sciences,
Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Erin D Michos
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University
School of Medicine, Baltimore, Maryland
| | - Sharon E Oberfield
- Division of Pediatric Endocrinology, Diabetes and Metabolism, Columbia
University Medical Center, New York, New York
| | | | - Jerome I Rotter
- Institute for Translational Genomics and Population Sciences, Department of
Pediatrics and Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center,
Torrance, California
| | - Bishwa Sapkota
- Department of Pediatrics, College of Medicine, University of Oklahoma Health
Sciences Center, Oklahoma City, Oklahoma
| | - John A Shepherd
- University of California San Francisco School of Medicine, San Francisco,
California
| | - James G Wilson
- Department of Physiology and Biophysics, University of Mississippi Medical
Center, Jackson, Mississippi
| | - Saonli Basu
- Division of Biostatistics, University of Minnesota, Minneapolis,
Minnesota
| | - Ian H de Boer
- Kidney Research Institute, Division of Nephrology, Department of Medicine,
University of Washington, Seattle, Washington
| | - Jasmin Divers
- Wake Forest School of Medicine, Winston-Salem, North Carolina
| | | | - Struan F A Grant
- Center for Applied Genomics, Division of Human Genetics, The Children’s
Hospital of Philadelphia, Philadelphia, Pennsylvania
- Division of Endocrinology, Children’s Hospital of Philadelphia, Philadelphia,
Pennsylvania
- Department of Pediatrics, Perelman School of Medicine, University of
Pennsylvania, Philadelphia, Pennsylvania
| | - Hakon Hakanarson
- Center for Applied Genomics, Division of Human Genetics, The Children’s
Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics, Perelman School of Medicine, University of
Pennsylvania, Philadelphia, Pennsylvania
| | - Tamara B Harris
- Laboratory of Epidemiology and Population Sciences, National Institute on
Aging, Bethesda, Maryland
| | - Bryan R Kestenbaum
- Kidney Research Institute, Division of Nephrology, Department of Medicine,
University of Washington, Seattle, Washington
| | - Stephen B Kritchevsky
- Department of Internal Medicine, Section on Gerontology and Geriatric
Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Ruth J F Loos
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of
Medicine at Mount Sinai, New York, New York
- The Mindich Child Health and Development Institute, Icahn School of Medicine
at Mount Sinai, New York, New York
| | - Jill M Norris
- Department of Epidemiology, Colorado School of Public Health, University of
Colorado Denver, Aurora, Colorado
| | - Arnita F Norwood
- Department of Medicine, University of Mississippi Medical Center, Jackson,
Mississippi
| | - Jose M Ordovas
- Nutrition and Genomics, JM-USDA Human Nutrition Research Center on Aging at
Tufts University, Boston, Massachusetts
| | - James S Pankow
- Division of Epidemiology and Community Health, University of Minnesota,
Minneapolis, Minnesota
| | - Bruce M Psaty
- Cardiovascular Health Research Unit, Department of Medicine, University of
Washington, Seattle, Washington
- University of Washington and Department of Epidemiology and Health Sciences,
University of Washington, Seattle, Washington
- Kaiser Permanente Washington Health Research Institute, Seattle,
Washington
| | - Dharambir K Sanghera
- Department of Pediatrics, College of Medicine, University of Oklahoma Health
Sciences Center, Oklahoma City, Oklahoma
- Department of Pharmaceutical Sciences, College of Pharmacy, University of
Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
- Oklahoma Center for Neuroscience, Oklahoma City, Oklahoma
| | | | - Babette S Zemel
- The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Perelman School of Medicine at University of Pennsylvania, Philadelphia,
Pennsylvania
| | - James Meigs
- Division of General Internal Medicine, Massachusetts General Hospital, Harvard
Medical School, Boston, Massachusetts
| | - Josée Dupuis
- Department of Biostatistics, Boston University School of Public Health, Boston,
Massachusetts
- National Heart, Lung, and Blood Institute’s Framingham Heart Study,
Framingham, Massachusetts
| | - Jose C Florez
- Center for Genomic Medicine, Massachusetts General Hospital, Boston,
Massachusetts
- Diabetes Unit, Massachusetts General Hospital, Boston, Massachusetts
- Programs in Metabolism and Medical & Population Genetics, Broad Institute,
Cambridge, Massachusetts
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | | | - Ching-Ti Liu
- Department of Biostatistics, Boston University School of Public Health, Boston,
Massachusetts
| | - Corinne D Engelman
- Department of Population Health Sciences, University of Wisconsin–Madison
School of Medicine and Public Health, Madison, Wisconsin
| | - Liana K Billings
- NorthShore University HealthSystem, Evanston, Illinois
- University of Chicago Pritzker School of Medicine, Chicago, Illinois
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10
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Mondul AM, Weinstein SJ, Layne TM, Albanes D. Vitamin D and Cancer Risk and Mortality: State of the Science, Gaps, and Challenges. Epidemiol Rev 2018; 39:28-48. [PMID: 28486651 DOI: 10.1093/epirev/mxx005] [Citation(s) in RCA: 131] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 01/19/2017] [Indexed: 12/31/2022] Open
Abstract
There has been substantial enthusiasm recently regarding the potential role of vitamin D in the primary and secondary prevention of cancer. Laboratory studies demonstrate a range of anticarcinogenic effects for vitamin D compounds, but human studies have yielded little consistent evidence supporting a protective association. Higher circulating levels of vitamin D (i.e., 25-hydroxyvitamin D or 25(OH)D) appear to be associated with reduced risk of colorectal and bladder malignancies, but higher risk of prostate and possibly pancreatic cancers, with no clear association for most other organ sites examined. Despite there being no official institutional recommendations regarding the use of vitamin D supplements for cancer prevention, screenings for vitamin D deficiency and vitamin D supplement use have increased substantially over the past decade. These widespread practices demonstrate that population sociobehavioral changes are often adopted before scientifically well-informed policies and recommendations are available. This review critically examines the currently available epidemiologic literature regarding the associations between circulating 25(OH)D, vitamin D supplementation, and vitamin D-related genetic variation and cancer risk and mortality, with a particular emphasis on prospective studies. We identify several important gaps in our scientific knowledge that should be addressed in order to provide sufficient reproducible data to inform evidence-based recommendations related to optimal 25(OH)D concentrations (and any role for vitamin D supplementation) for the primary and secondary prevention of cancer. With few exceptions, such recommendations cannot be made at this time.
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Augustus GJ, Ellis NA. Colorectal Cancer Disparity in African Americans: Risk Factors and Carcinogenic Mechanisms. THE AMERICAN JOURNAL OF PATHOLOGY 2017; 188:291-303. [PMID: 29128568 DOI: 10.1016/j.ajpath.2017.07.023] [Citation(s) in RCA: 102] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 07/01/2017] [Accepted: 07/20/2017] [Indexed: 12/13/2022]
Abstract
African Americans have the highest incidence and mortality rates of colorectal cancer (CRC) of any ethnic group in the United States. Although some of these disparities can be explained by differences in access to care, cancer screening, and other socioeconomic factors, disparities remain after adjustment for these factors. Consequently, an examination of recent advances in the understanding of ethnicity-specific factors, including genetic and environmental factors relating to risk of CRC, the biology of CRC progression, and the changes in screening and mortality, is important for evaluating our progress toward eliminating the disparities. An overarching limitation in this field is the number and sample size of studies performed to characterize the etiological bases of CRC incidence and mortality in African Americans. Despite this limitation, significant differences in etiology are manifest in many studies. These differences need validation, and their impacts on disparities need more detailed investigation. Perhaps most heartening, improvements in CRC screening can be attributed to the smallest difference in CRC incidence between African Americans and whites since the late 1980s. Cancer mortality, however, remains a persistent difference.
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Affiliation(s)
- Gaius J Augustus
- Cancer Biology Graduate Interdisciplinary Program, University of Arizona, Tucson, Arizona.
| | - Nathan A Ellis
- University of Arizona Cancer Center, University of Arizona, Tucson, Arizona; Department of Cellular and Molecular Medicine, University of Arizona, Tucson, Arizona.
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12
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Vitamin D receptor deficit induces activation of renin angiotensin system via SIRT1 modulation in podocytes. Exp Mol Pathol 2017; 102:97-105. [PMID: 28069388 DOI: 10.1016/j.yexmp.2017.01.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 01/01/2017] [Indexed: 11/23/2022]
Abstract
Vitamin D receptor (VDR) deficient status has been shown to be associated with the activation of renin angiotensin system (RAS). We hypothesized that lack of VDR would enhance p53 expression in podocytes through down regulation of SIRT1; the former would enhance the transcription of angiotensinogen (Agt) and angiotensinogen II type 1 receptor (AT1R) leading to the activation of RAS. Renal tissues of VDR mutant (M) mice displayed increased expression of p53, Agt, renin, and AT1R. In vitro studies, VDR knockout podocytes not only displayed up regulation p53 but also displayed enhanced expression of Agt, renin and AT1R. VDR deficient podocytes also displayed an increase in mRNA expression for p53, Agt, renin, and AT1R. Interestingly, renal tissues of VDR-M as well as VDR heterozygous (h) mice displayed attenuated expression of deacetylase SIRT1. Renal tissues of VDR-M mice showed acetylation of p53 at lysine (K) 382 residues inferring that enhanced p53 expression in renal tissues could be the result of ongoing acetylation, a consequence of SIRT1 deficient state. Notably, podocytes lacking SIRT1 not only showed acetylation of p53 at lysine (K) 382 residues but also displayed enhanced p53 expression. Either silencing of SIRT1/VDR or treatment with high glucose enhanced podocyte PPAR-y expression, whereas, immunoprecipitation (IP) of their lysates with anti-retinoid X receptor (RXR) antibody revealed presence of PPAR-y. It appears that either the deficit of SIRT1 has de-repressed expression of PPAR-y or enhanced podocyte expression of PPAR-y (in the absence of VDR) has contributed to the down regulation of SIRT1.
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13
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Cipriano TM, Polite BN. Achieving health equity in colorectal cancer: a call to action. Am Soc Clin Oncol Educ Book 2016:169-73. [PMID: 23714491 DOI: 10.14694/edbook_am.2013.33.169] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Whether defined by race, ethnicity, or socioeconomic status, there are clear health disparities in colon cancer-disparities that exist whether you measure screening, incidence, or mortality. Rather than rehash disparity statistics, the purpose of this educational article is to highlight important resources and how they can be used to help narrow these disparities. Although the logistics can be complex, the general solutions to eliminating colon cancer health disparities are not complex. They are as follows: Asymptomatic persons need to be screened. After being screened, they need to be diagnosed. After being diagnosed, they need to receive appropriate treatment in a timely fashion. After receiving treatment, they have to receive appropriate follow-up and information and advice on lifestyle changes. If we can implement these measures, then cancer-specific mortality disparities will be dramatically reduced, if not eliminated.
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Affiliation(s)
- Toni M Cipriano
- From the Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, IL
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14
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Vashi PG, Edwin P, Popiel B, Gupta D. The relationship between circulating 25-hydroxyvitamin D and survival in newly diagnosed advanced non-small-cell lung cancer. BMC Cancer 2015; 15:1012. [PMID: 26704811 PMCID: PMC4691020 DOI: 10.1186/s12885-015-2043-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 12/21/2015] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Serum 25-hydroxyvitamin D [25(OH)D], the major circulating form of vitamin D used for evaluating the vitamin D status of patients, has been associated with survival in a variety of cancers with conflicting evidence. We aimed to investigate this association in newly diagnosed advanced non-small-cell lung cancer (NSCLC) patients. METHODS This was a consecutive cohort of 359 newly diagnosed stages III-IV NSCLC patients who underwent a baseline serum 25(OH)D evaluation prior to receiving any treatment at our institution between January 2008 and December 2010. We used the vitamin D categories of "deficient (<20 ng/ml)" and "not deficient (> = 20 ng/ml)". Cox regression was used to evaluate the prognostic significance of serum 25(OH)D after adjusting for relevant confounders. RESULTS Mean age at diagnosis was 57.4 years. Of the 359 patients, 151 (42.1 %) were deficient in vitamin D at the time of diagnosis. The median survival in deficient and not deficient cohorts was 11.7 and 12.8 months respectively (p = 0.06). Season of diagnosis, performance status, smoking status and hospital location significantly predicted vitamin D status. On univariate Cox analysis, gender, stage of disease, hospital location, histologic subtype, subjective global assessment (SGA), performance status, smoking status, body mass index and serum albumin were significantly associated with survival (p <0.05 for all). On multivariate Cox analysis, six variables demonstrated statistically significant associations with survival: stage of disease, hospital location, histologic subtype, SGA, smoking status and serum albumin (p <0.05 for all). Serum vitamin D, which was borderline significant in univariate analysis, lost its significance in multivariate analysis. CONCLUSIONS We found season of diagnosis, performance status and smoking history to be predictive of vitamin D status. Consistent with previously published research in advanced NSCLC, we did not find any significant association between pre-treatment serum 25(OH)D and survival in our patients.
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Affiliation(s)
- Pankaj G Vashi
- Cancer Treatment Centers of America® (CTCA) at Midwestern Regional Medical Center, 2520 Elisha Ave, Zion, IL, 60099, USA.
| | - Persis Edwin
- Cancer Treatment Centers of America® (CTCA) at Midwestern Regional Medical Center, 2520 Elisha Ave, Zion, IL, 60099, USA.
| | - Brenten Popiel
- Cancer Treatment Centers of America® (CTCA) at Midwestern Regional Medical Center, 2520 Elisha Ave, Zion, IL, 60099, USA.
| | - Digant Gupta
- Cancer Treatment Centers of America® (CTCA) at Midwestern Regional Medical Center, 2520 Elisha Ave, Zion, IL, 60099, USA.
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15
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Chandler PD, Agboola F, Ng K, Scott JB, Drake BF, Bennett GG, Chan AT, Hollis BW, Emmons KM, Fuchs CS, Giovannucci EL. Reduction of Parathyroid Hormone with Vitamin D Supplementation in Blacks: A Randomized Controlled Trial. BMC Nutr 2015; 1:26. [PMID: 26858840 PMCID: PMC4743037 DOI: 10.1186/s40795-015-0024-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Response of parathyroid hormone (PTH) to vitamin D supplementation is determined by the baseline PTH level and change in vitamin D status. Conflicting reports in Blacks exist on the PTH response to vitamin D to supplementation. METHODS During 3 winters from 2007-2010, 328 healthy Blacks (median age, 51 years) living in Boston, MA were randomized into a 4-arm, double-blind trial for 3 months of placebo, 1000, 2000, or 4000 IU of vitamin D3. PTH was measured in 254 participants at baseline and at the end of vitamin D supplementation period. RESULTS The differences in PTH between baseline and 3 months were 3.93 pg/mL for those receiving placebo, -3.37 pg/mL for those receiving 1000 IU/d, -6.76 pg/mL for those receiving 2000 IU/d, and -8.99 pg/mL for those receiving 4000 IU/d ( -2.98 pg/mL for each additional 1000 IU/d of vitamin D3; p<0.001). CONCLUSION We found a significant decrease in PTH with increasing doses of vitamin D supplementation up to intakes of 4000 IU/d in Blacks. Clinical Trials.gov: NCT00585637.
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Affiliation(s)
- Paulette D. Chandler
- Division of Preventive Medicine, Brigham and Women's Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Foluso Agboola
- Division of Policy Translation and Leadership Development, Harvard School of Public Health, Boston, MA
| | - Kimmie Ng
- Harvard Medical School, Boston, MA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Jamil B. Scott
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, MI
| | - Bettina F. Drake
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, St. Louis, MO
| | - Gary G. Bennett
- Department of Psychology and Neuroscience, Duke University, Durham, NC
| | - Andrew T. Chan
- Harvard Medical School, Boston, MA
- Division of Gastroenterology, Massachusetts General Hospital, Boston, MA
| | - Bruce W. Hollis
- Division of Pediatrics, Medical University of South Carolina, Charleston, SC
| | - Karen M. Emmons
- Harvard Medical School, Boston, MA
- Center for Community-Based Research, Dana-Farber Cancer Institute, Boston, MA
| | - Charles S. Fuchs
- Harvard Medical School, Boston, MA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Edward L. Giovannucci
- Harvard Medical School, Boston, MA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, BostoN
- Departments of Nutrition and Epidemiology, Harvard School of Public Health, Boston, MA
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Tagliabue E, Raimondi S, Gandini S. Vitamin D, Cancer Risk, and Mortality. ADVANCES IN FOOD AND NUTRITION RESEARCH 2015; 75:1-52. [PMID: 26319903 DOI: 10.1016/bs.afnr.2015.06.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Antiproliferative effects of 1,25-dihydroxyvitamin D, the biologically active form of vitamin D, are well established in various cell types by influencing cell differentiation and decreasing cell proliferation, growth, invasion, angiogenesis, and metastasis. Several meta-analyses showed that low serum levels of 25(OH)D was associated with colorectal cancer and overall mortality, while the association with cancer mortality was less consistent. VDR is a crucial mediator for the cellular effects of vitamin D and conflicting data have been reported for most malignancies. Beyond VDR, the biological effects of vitamin D are mediated by the vitamin D-binding protein. The GC (group-specific component) gene, encoding DBP, is highly polymorphic and several polymorphisms were investigated in association with cancer development with controversial results. Vitamin D supplementation was found to be associated with a reduced risk of overall mortality, reviewing all published trials on healthy subjects, whereas the evidence of an effect on cancer risk and mortality is less clear. Furthermore, long-term health effects of high doses of vitamin D, extended duration of supplementation, and the association with different baseline vitamin D levels remain to be investigated. In summary, epidemiological and preclinical studies support the development of vitamin D as preventative and therapeutic anticancer agents, with significant associations especially found for low vitamin D status with overall mortality and cancer outcome, more than cancer incidence. However, a definitive conclusion cannot be drawn and only large randomized clinical trials, both in healthy subjects and in cancer patients, will allow to draw definitive conclusions on the effect of vitamin D supplementation on cancer risk, prognosis, and mortality.
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Affiliation(s)
- Elena Tagliabue
- Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy
| | - Sara Raimondi
- Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy
| | - Sara Gandini
- Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy.
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Gupta D, Trukova K, Popiel B, Lammersfeld C, Vashi PG. The association between pre-treatment serum 25-hydroxyvitamin D and survival in newly diagnosed stage IV prostate cancer. PLoS One 2015; 10:e0119690. [PMID: 25774530 PMCID: PMC4361634 DOI: 10.1371/journal.pone.0119690] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 01/15/2015] [Indexed: 12/31/2022] Open
Abstract
Background/Aims Emerging evidence in the literature suggests a positive association between serum 25-hydroxyvitamin D [25(OH)D], a standard indicator of vitamin D status, and survival in certain types of cancer. We investigated this relationship in newly diagnosed stage IV prostate cancer patients. Methods A consecutive cohort of 125 newly diagnosed stage IV prostate cancer patients underwent a baseline serum 25(OH)D evaluation prior to receiving any treatment at our institution between January 2008 and December 2011. We used the vitamin D categories of “deficient (<20 ng/ml)”, “insufficient (20 to 32 ng/ml)”, and “sufficient (>32 ng/ml)”. Cox regression was used to evaluate the prognostic significance of serum 25(OH)D after adjusting for relevant confounders. Results Mean age at diagnosis was 60 years. Of the 125 patients, 32 (25.6%) were deficient, 49 (39.2%) were insufficient and 44 (35.2%) were sufficient in vitamin D at the time of diagnosis. The median survival in deficient, insufficient and sufficient cohorts was 47.8, 44.0 and 52.6 months respectively (p = 0.60). On univariate analysis, four variables demonstrated a statistically significant association with survival: nutritional status, bone metastasis, corrected serum calcium and serum albumin (p<0.05 for all). On multivariate analysis, five variables demonstrated statistically significant associations with survival: hospital location, age, bone metastasis, serum albumin and corrected serum calcium (p<0.05 for all). Serum vitamin D status was not significant on either univariate or multivariate analysis. Conclusion Contrary to previously published research, we found no significant association between pre-treatment serum 25(OH)D and survival in newly diagnosed stage IV prostate cancer patients. The lack of a significant association between serum vitamin D and survival in our study could perhaps be due to the fact that the disease was far too advanced in our patients for vitamin D levels to have any impact on prognosis.
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Affiliation(s)
- Digant Gupta
- Cancer Treatment Centers of America (CTCA) at Midwestern Regional Medical Center, Zion, Illinois, United States of America
- * E-mail:
| | - Kristen Trukova
- Cancer Treatment Centers of America (CTCA) at Midwestern Regional Medical Center, Zion, Illinois, United States of America
| | - Brenten Popiel
- Cancer Treatment Centers of America (CTCA) at Midwestern Regional Medical Center, Zion, Illinois, United States of America
| | - Carolyn Lammersfeld
- Cancer Treatment Centers of America (CTCA) at Midwestern Regional Medical Center, Zion, Illinois, United States of America
| | - Pankaj G. Vashi
- Cancer Treatment Centers of America (CTCA) at Midwestern Regional Medical Center, Zion, Illinois, United States of America
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18
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Wesa KM, Segal NH, Cronin AM, Sjoberg DD, Jacobs GN, Coleton MI, Fleisher M, Dnistrian AM, Saltz LB, Cassileth BR. Serum 25-hydroxy vitamin D and survival in advanced colorectal cancer: a retrospective analysis. Nutr Cancer 2015; 67:424-30. [PMID: 25646565 DOI: 10.1080/01635581.2015.998838] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Higher serum 25-hydroxy vitamin D [25(OH)D] levels are associated with decreased colorectal cancer (CRC) incidence. In this retrospective study of Stage IV CRC patients, we evaluate whether 25(OH)D levels at diagnosis correlate with survival. Stored sera from carcinoembryonic antigen (CEA) measurements obtained between February 2005 and March 2006 were screened. The first 250 patients with CEA ± 30 days of Stage IV CRC diagnosis were included. Serum 25(OH)D levels were determined and categorized as adequate ≥ 30 ng/mL, or deficient <30 ng/mL. Multivariable Cox regression models controlling for albumin and Eastern Cooperative Oncology Group performance status were used to investigate whether higher 25(OH)D levels were associated with prolonged survival. A total of 207 patients (83%) were vitamin D-deficient (median = 21 ng/mL), with deficiencies significantly more likely among non-Hispanic black patients (P = 0.009). Higher levels were associated with prolonged survival in categorical variable analysis: adequate vs. deficient, hazard ratio = 0.61, 95% confidence interval = 0.38-0.98, P = 0.041. A majority of newly diagnosed Stage IV CRC patients are vitamin D-deficient. Our data suggest that higher 25(OH)D levels are associated with better overall survival. Clinical trials to determine whether aggressive vitamin D repletion would improve outcomes for vitamin D-deficient CRC patients are warranted.
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Affiliation(s)
- Kathleen M Wesa
- a Memorial Sloan Kettering Cancer Center, Integrative Medicine Service , New York , New York , USA
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Polite BN. States as the laboratory for democracy: is anybody paying attention, and does anybody care? J Clin Oncol 2015; 33:815-6. [PMID: 25605832 DOI: 10.1200/jco.2014.59.4135] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Prescreening with FOBT Improves Yield and Is Cost-Effective in Colorectal Screening in the Elderly. ISRN GASTROENTEROLOGY 2014; 2014:179291. [PMID: 25101179 PMCID: PMC4004063 DOI: 10.1155/2014/179291] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Accepted: 03/24/2014] [Indexed: 11/18/2022]
Abstract
Background. Utilization of colonoscopy for routine colorectal cancer (CRC) screening in the elderly (patients over 75) is controversial. This study was designed to evaluate if using fecal occult blood test (FOBT) to select patients for colonoscopy can improve yield and be a cost- effective approach for the elderly. Methods. Records of 10,908 subjects who had colonoscopy during the study period were reviewed. 1496 (13.7%) were ≥75 years. In 118 of these subjects, a colonoscopy was performed to evaluate a positive FOBT. Outcomes were compared between +FOBT group (F-Group) and the asymptomatic screening group (AS-Group). The cost-effectiveness was also calculated using a median estimated standardized worldwide colonoscopy and FOBT cost (rounded to closest whole numbers) of 1000 US $ and 10 US $, respectively. Results. 118/1496 (7.9%) colonoscopies were performed for evaluation of +FOBT. 464/1496 (31%) colonoscopies were performed in AS-Group. In F-Group, high risk adenoma detection rate (HR-ADR) was 15.2%, and 11.9% had 1-2 tubular adenomas. In comparison, the control AS-Group had HR-ADR of 19.2% and 17.7% had 1-2 tubular adenomas. In the FOBT+ group, CRC was detected in 5.1% which was significantly higher than the AS-Group in which CRC was detected in 1.7% (P = 0.03). On cost-effectiveness analysis, cost per CRC detected was significantly lower, that is, 19,666 US $ in F-Group in comparison to AS-Group 58,000 US $ (P < 0.05). There were no significant differences in other parameters among groups. Conclusion. Prescreening with FOBT to select elderly for colonoscopy seems to improve the yield and can be a cost-effective CRC screening approach in this subset. The benefit in the risk benefit analysis of screening the elderly appears improved by prescreening with an inexpensive tool.
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Ng K, Scott JB, Drake BF, Chan AT, Hollis BW, Chandler PD, Bennett GG, Giovannucci EL, Gonzalez-Suarez E, Meyerhardt JA, Emmons KM, Fuchs CS. Dose response to vitamin D supplementation in African Americans: results of a 4-arm, randomized, placebo-controlled trial. Am J Clin Nutr 2014; 99:587-98. [PMID: 24368437 PMCID: PMC3927692 DOI: 10.3945/ajcn.113.067777] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Accepted: 12/10/2013] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Association studies have suggested that lower circulating 25-hydroxyvitamin D [25(OH)D] in African Americans may partially underlie higher rates of cardiovascular disease and cancer in this population. Nonetheless, the relation between vitamin D supplementation and 25(OH)D concentrations in African Americans remains undefined. OBJECTIVE Our primary objective was to determine the dose-response relation between vitamin D and plasma 25(OH)D. DESIGN A total of 328 African Americans in Boston, MA, were enrolled over 3 winters from 2007 to 2010 and randomly assigned to receive a placebo or 1000, 2000, or 4000 IU vitamin D₃/d for 3 mo. Subjects completed sociodemographic and dietary questionnaires, and plasma samples were drawn at baseline and 3 and 6 mo. RESULTS Median plasma 25(OH)D concentrations at baseline were 15.1, 16.2, 13.9, and 15.7 ng/mL for subjects randomly assigned to receive the placebo or 1000, 2000, or 4000 IU/d, respectively (P = 0.63). The median plasma 25(OH)D concentration at 3 mo differed significantly between supplementation arms at 13.7, 29.7, 34.8, and 45.9 ng/mL, respectively (P < 0.001). An estimated 1640 IU vitamin D₃/d was needed to raise the plasma 25(OH)D concentration to ≥ 20 ng/mL in ≥ 97.5% of participants, whereas a dose of 4000 IU/d was needed to achieve concentrations ≥ 33 ng/mL in ≥ 80% of subjects. No significant hypercalcemia was seen in a subset of participants. CONCLUSIONS Within African Americans, an estimated 1640 IU vitamin D₃/d was required to achieve concentrations of plasma 25(OH)D recommended by the Institute of Medicine, whereas 4000 IU/d was needed to reach concentrations predicted to reduce cancer and cardiovascular disease risk in prospective observational studies. These results may be helpful for informing future trials of disease prevention.
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Affiliation(s)
- Kimmie Ng
- Department of Medical Oncology (KN, JAM, and CSF) and Center for Community-Based Research (JBS, EG-S, and KME), Dana-Farber Cancer Institute, Boston, MA; the Division of Public Health Sciences, Washington University School of Medicine, St Louis, MO (BFD); the Division of Gastroenterology, Massachusetts General Hospital, Boston, MA (ATC); the Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (ATC, ELG, and CSF); the Division of Pediatrics, Medical University of South Carolina, Charleston, SC (BWH); the Division of General Medicine, Brigham and Women's Hospital, Boston, MA (PDC); the Department of Psychology and Neuroscience, Duke University, Durham, NC (GGB); and the Departments of Nutrition (JBS and ELG) and Social and Behavioral Sciences (KME), Harvard School of Public Health, Boston, MA
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Sarkissyan M, Wu Y, Chen Z, Mishra DK, Sarkissyan S, Giannikopoulos I, Vadgama JV. Vitamin D receptor FokI gene polymorphisms may be associated with colorectal cancer among African American and Hispanic participants. Cancer 2014; 120:1387-93. [PMID: 24510435 DOI: 10.1002/cncr.28565] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Revised: 12/08/2013] [Accepted: 12/18/2013] [Indexed: 12/14/2022]
Abstract
BACKGROUND Vitamin D plays a role in cancer tumorogenesis and acts through the vitamin D receptor (VDR). Although African Americans have the lowest serum vitamin D levels, supplementation has not yielded a significant improvement in cancer. Gene polymorphisms in VDR may play a role. There is a dearth of information on VDR gene polymorphisms and colorectal cancer (CRC) among under-represented ethnic groups. In this study, the authors examined whether VDR gene single nucleotide polymorphisms (SNPs) were associated with CRC in predominately African American and Hispanic study participants. METHODS Blood samples were collected from 378 participants, including a group of 78 patients with CRC (cases), a group of 230 noncancer participants without polyps (controls without polyps), and a group of 70 noncancer participants with polyps (controls with polyps). The 4 polymorphic SNPs in VDR (FokI, BsmI, TaqI, and ApaI) were assessed using the polymerase chain reaction-restriction fragment length polymorphism method. RESULTS There was a significant association of the VDR-FokI FF genotype with CRC cases (odds ratio, 2.9; P= .036) compared with the controls without polyps. The most common VDR-FokI genotype in the overall study population was the FF genotype (46%). However, upon breakdown by ethnicity, the FF genotype was the most common in African American participants (61%), and the Ff genotype was the most common in Hispanic/Latino participants (49%). When the association was assessed in a multivariate model, there was no significant association with any VDR polymorphism and CRC cases (P> .05). The other 3 polymorphic variants of VDR (BsmI, TaqI, and ApaI) were not associated with CRC. CONCLUSIONS The results from this study suggest that genetic variation of the VDR-FokI SNPs may influence CRC risk, particularly in African American cohorts.
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Affiliation(s)
- Marianna Sarkissyan
- Division of Cancer Research and Training, Center to Eliminate Cancer Health Disparities, Department of Internal Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, California
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de Jager DJ, Vervloet MG, Dekker FW. Noncardiovascular mortality in CKD: an epidemiological perspective. Nat Rev Nephrol 2014; 10:208-14. [DOI: 10.1038/nrneph.2014.8] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Lin JH, Giovannucci E. Environmental Exposure and Tumor Heterogeneity in Colorectal Cancer Risk and Outcomes. CURRENT COLORECTAL CANCER REPORTS 2014. [DOI: 10.1007/s11888-014-0208-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Braoudaki M, Lambrou GI, Vougas K, Karamolegou K, Tsangaris GT, Tzortzatou-Stathopoulou F. Protein biomarkers distinguish between high- and low-risk pediatric acute lymphoblastic leukemia in a tissue specific manner. J Hematol Oncol 2013; 6:52. [PMID: 23849470 PMCID: PMC3717072 DOI: 10.1186/1756-8722-6-52] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Accepted: 07/04/2013] [Indexed: 12/13/2022] Open
Abstract
The current study evaluated the differential expression detected in the proteomic profiles of low risk- and high risk- ALL pediatric patients to characterize candidate biomarkers related to diagnosis, prognosis and patient targeted therapy. Bone marrow and peripheral blood plasma and cell lysates samples were obtained from pediatric patients with low- (LR) and high-risk (HR) ALL at diagnosis. As controls, non-leukemic pediatric patients were studied. Cytogenetic analysis was carried out by G- banding and interphase fluorescent in situ hybridization. Differential proteomic analysis was performed using two-dimensional gel electrophoresis and protein identification by matrix-assisted laser desorption ionization time-of-flight mass spectrometry. The differential expression of certain proteins was confirmed by Western blot analysis. The obtained data revealed that CLUS, CERU, APOE, APOA4, APOA1, GELS, S10A9, AMBP, ACTB, CATA and AFAM proteins play a significant role in leukemia prognosis, potentially serving as distinctive biomarkers for leukemia aggressiveness, or as suppressor proteins in HR-ALL cases. In addition, vitronectin and plasminogen probably contributed to leukemogenesis, whilst bicaudal D-related protein 1 could afford a significant biomarker for pediatric ALL therapeutics.
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Affiliation(s)
- Maria Braoudaki
- First Department of Pediatrics, University of Athens Medical School, Choremeio Research Laboratory, Thivon & Levadias 11527 Goudi-Athens, Greece
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Singhal S, Changela K, Momeni M, Krishnaiah M, Anand S. Outcome and safety of colonoscopy in minorities aged 85 and older. J Am Geriatr Soc 2013; 61:832-4. [PMID: 23672553 DOI: 10.1111/jgs.12227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Yao S, Ambrosone CB. Associations between vitamin D deficiency and risk of aggressive breast cancer in African-American women. J Steroid Biochem Mol Biol 2013; 136:337-41. [PMID: 22995734 DOI: 10.1016/j.jsbmb.2012.09.010] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Revised: 08/30/2012] [Accepted: 09/07/2012] [Indexed: 01/17/2023]
Abstract
Although breast cancer incidence in the US is highest for women of European ancestry (EA), women of African ancestry (AA) have higher incidence of cancer diagnosed before age 40 and tumors with more aggressive features (high grade and negative for estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor (HER2)), which precludes targeted therapies and leads to poorer outcomes. It is unclear what underlies these disparities. It has been hypothesized that dark skin with high melanin content is the ancestral skin color of origin, with adaptation to northern environs resulting in lighter skin. Although intense sunlight in sub-Saharan Africa may compensate for low sun absorption through skin, an urban or western lifestyle may result in less synthesis of vitamin D with higher skin pigmentation. Laboratory and preclinical data indicate that vitamin D is involved in preventing breast carcinogenesis and progression. Vitamin D receptor (VDR) knock-out mice are more likely to develop tumors that are ER-negative, and we have shown that serum levels of 25OHD are lowest among EA women with triple-negative tumors (negative for ER, PR and HER2); and among non-cancer patients, vitamin D levels are lower in AAs than in EAs. Thus, it is plausible to hypothesize that low vitamin D levels could be associated with the higher prevalence of more aggressive tumors among AA women. In this paper, we review the current literature on vitamin D and aggressive breast cancer subtypes, discuss vitamin D in AA women from a perspective of evolution and adaption, and examine the potential role of vitamin D in cancer racial disparities. We present our recently published data showing two single nucleotide polymorphisms in vitamin D catabolic enzyme CYP24A1 associated with higher risk of estrogen ER-negative risk in AA than in EA women. The relationship of vitamin D with breast cancer risk may be subtype-specific, with emerging evidence of stronger effects of vitamin D for more aggressive breast cancer, particularly in women of African ancestry.
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Affiliation(s)
- Song Yao
- Department of Cancer Prevention and Control, Roswell Park Cancer Institute, Elm & Carlton Streets, Buffalo, NY 14263, United States
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Grubbs SS, Polite BN, Carney J, Bowser W, Rogers J, Katurakes N, Hess P, Paskett ED. Eliminating racial disparities in colorectal cancer in the real world: it took a village. J Clin Oncol 2013; 31:1928-30. [PMID: 23589553 DOI: 10.1200/jco.2012.47.8412] [Citation(s) in RCA: 143] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Eichholzer M, Platz EA, Bienstock JL, Monsegue D, Akereyeni F, Hollis BW, Horst R, Rifai N, Pollak MN, Barbir A, Agurs-Collins T, Rohrmann S. Racial variation in vitamin D cord blood concentration in white and black male neonates. Cancer Causes Control 2013; 24:91-8. [PMID: 23139102 PMCID: PMC3529856 DOI: 10.1007/s10552-012-0093-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Accepted: 10/29/2012] [Indexed: 01/22/2023]
Abstract
AIM The aim of this study is to evaluate racial variation in umbilical cord blood concentration of vitamin D and to explore its correlation with markers of the insulin-like growth factor axis (IGFs) and sex steroid hormones in white and black male neonates. METHODS In 2004-2005, venous umbilical cord blood samples were collected from 75 black and 38 white male neonates, along with maternal and birth characteristics from two hospitals in Maryland, United States. 25-Hydroxyvitamin D [25(OH)D] and 1,25-dihydroxyvitamin D [1,25(OH)(2)D] were measured by radioimmunoassay and testosterone, estradiol, and sex hormone-binding globulin (SHBG) by immunoassay and IGF-1, IGF-2, and IGF-binding protein-3 by ELISA. Crude and multivariable-adjusted geometric mean concentrations were computed. RESULTS Mean 25(OH)D levels were lower in black than in white neonates (11.44; 95 % CI 10.10-12.95 ng/mL vs. 18.24; 95 % CI 15.32-21.72 ng/mL; p < 0.0001). Black neonates were at higher risk of suboptimal vitamin D levels [25(OH)D < 20 ng/mL] than whites (84 vs. 63 %). 25(OH)D concentrations varied by season in whites but not in blacks and were significantly inversely correlated with mother's parity (number of live births) in blacks but not in whites. Mean concentration of 1,25(OH)(2)D did not differ by race. 25(OH)D and 1,25(OH)(2)D did not correlate with IGFs, sex steroid hormones, and SHBG. CONCLUSIONS Suboptimal vitamin D levels were prevalent especially in blacks and influenced by mother's parity and by season. The observed vitamin D differences between black and white neonates warrant further evaluation of the etiology of the disparity in chronic diseases in adulthood.
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Affiliation(s)
- Monika Eichholzer
- Division of Cancer Epidemiology and Prevention, Institute of Social and Preventive Medicine, University of Zurich, Hirschengraben 84, Zürich, Switzerland.
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Guerrieri-Gonzaga A, Gandini S. Vitamin D and overall mortality. Pigment Cell Melanoma Res 2012; 26:16-28. [PMID: 23045997 DOI: 10.1111/pcmr.12036] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Accepted: 10/04/2012] [Indexed: 02/06/2023]
Abstract
Vitamin D is a steroid molecule, mainly produced in the skin that regulates the expression of a large number of genes. Several meta-analyses of epidemiological studies support the evidence that low vitamin D serum level, which is highly prevalent worldwide, could be a 'new' risk factor for many chronic diseases including cancer, and for all-cause mortality. A meta-analysis in healthy subjects suggested that current doses of vitamin D supplements could be associated with decrease in total mortality rates. However, these associations are insufficient to establish causality between vitamin D and all-cause mortality. Furthermore, long-term health effects of high doses of vitamin D, that is, prolonged supplementation and association with different baseline vitamin D levels, remain to be investigated. Several trials are ongoing but population-based, placebo-controlled randomized trials with total mortality as the main endpoint should be planned to confirm a real beneficial effect of vitamin D for non-skeletal diseases and to prove causality.
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Grünhage F, Hochrath K, Krawczyk M, Höblinger A, Obermayer-Pietsch B, Geisel J, Trauner M, Sauerbruch T, Lammert F. Common genetic variation in vitamin D metabolism is associated with liver stiffness. Hepatology 2012; 56:1883-91. [PMID: 22576297 DOI: 10.1002/hep.25830] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2011] [Accepted: 05/02/2012] [Indexed: 12/12/2022]
Abstract
UNLABELLED Recently, genome-wide studies identified genetic variants that affect serum 25-hydroxyvitamin D levels in healthy populations (rs12785878, near dehydrocholesterol reductase, DHCR7; rs10741657, at CYP2R1; and rs7041, at vitamin D binding protein, GC). Because vitamin D deficiency is associated with advanced liver disease, we hypothesized that these variants are associated with 25(OH)-vitamin D levels and liver fibrosis. Overall, 712 Caucasian patients with chronic liver diseases were included. Liver fibrosis was assessed by transient elastography (TE) and/or histology. Serum levels of 25(OH)-vitamin D were correlated with TE and fibrosis stages. Genotypes were determined using TaqMan assays and tested for association with vitamin D and liver stiffness. Serum 25(OH)-vitamin D levels were inversely correlated with liver stiffness and histology (P < 0.001). Homozygous carriers of the rare DHCR7 allele or the common CYP2R1 allele presented with reduced 25(OH)-vitamin D levels (P < 0.05). The variant rs12785878 in the DHCR7 locus was associated with liver stiffness in both patients with TE <7.0 kPa and TE between 7.0 and 9.5 kPa. 25(OH)-vitamin D levels correlated with sunshine hours at the time of inclusion (P < 0.001). CONCLUSION Common variation in 25(OH)-vitamin D metabolism is associated with liver stiffness in patients presenting with low to moderately increased elasticity. Although the susceptible DHCR7 genotype confers small risk, we speculate that the observed stiffness differences indicate a stronger influence of 25(OH)-vitamin D on initiation rather than progression of hepatic fibrosis.
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Affiliation(s)
- Frank Grünhage
- Department of Medicine II, Saarland University Medical Center, Homburg, Germany.
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Grant WB, Peiris AN. Differences in vitamin D status may account for unexplained disparities in cancer survival rates between African and white Americans. DERMATO-ENDOCRINOLOGY 2012; 4:85-94. [PMID: 22928063 PMCID: PMC3427205 DOI: 10.4161/derm.19667] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Considerable disparities in cancer survival rates exist between African Americans (AAs) and white Americans (WAs). Various factors such as differences in socioeconomic status (SES), cancer stage at time of diagnosis, and treatment—which this analysis considers primary explanatory factors—have accounted for many of these differences. An additional factor not usually considered is vitamin D. Previous studies have inversely correlated higher solar ultraviolet-B (UVB) doses and serum 25-hydroxyvitamin D (25(OH)D) concentrations with incidence and/or mortality rates for about 20 types of cancer and improved survival rates for eight types of cancer. Because of darker skin pigmentation, AAs have 40% lower serum 25(OH)D concentrations than WAs. This study reviews the literature on disparities in cancer survival between AAs and WAs. The journal literature indicates that there are disparities for 13 types of cancer after consideration of SES, stage at diagnosis and treatment: bladder, breast, colon, endometrial, lung, ovarian, pancreatic, prostate, rectal, testicular, and vaginal cancer; Hodgkin lymphoma and melanoma. Solar UVB doses and/or serum 25(OH)D concentrations have been reported inversely correlated with incidence and/or mortality rates for all of these cancers. This finding suggests that future studies should consider serum 25(OH)D concentrations in addressing cancer survival disparities through both measurements of serum 25(OH)D concentrations and increasing serum 25(OH)D concentrations of those diagnosed with cancer, leading to improved survival rates and reduced disparities.
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Tsai CJ, Giovannucci EL. Hyperinsulinemia, insulin resistance, vitamin D, and colorectal cancer among whites and African Americans. Dig Dis Sci 2012; 57:2497-503. [PMID: 22562539 DOI: 10.1007/s10620-012-2198-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2011] [Accepted: 04/14/2012] [Indexed: 12/11/2022]
Abstract
African Americans have the highest incidence and mortality rates of colorectal cancer among all US racial and ethnic groups. Dietary factors, lifestyle factors, obesity, variability in screening rates, socioeconomic differences, barriers to screening, and differences in access to health care may be contributory factors to racial and ethnic disparities. African Americans are more likely to demonstrate microsatellite instability in their colorectal tumors leading to malignancy. However, these differences do not completely explain all the variances. Ample evidence implicates insulin resistance and its associated conditions, including elevated insulin and insulin-like growth factor-1 (IGF-1), in colorectal carcinogenesis. African Americans have a high risk for and a high prevalence of insulin resistance and subsequent overt type 2 diabetes. Recent clinical studies revealed that ethnic differences between whites and African Americans in early diabetes-related conditions including hyperinsulinemia already exist during childhood. African Americans have a much higher prevalence of vitamin D deficiency than whites throughout their life spans. Vitamin D deficiency has been associated with higher rates of diabetes and colorectal cancer, particularly in individuals with high serum insulin and IGF-1 levels. Moreover, African Americans have lower insulin sensitivity in tissues, independent of obesity, fat distribution, and inflammation. Further development of measures of biomarkers of tumor biology and host susceptibility may provide further insight on risk stratification in African Americans.
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Affiliation(s)
- Chung-Jyi Tsai
- Department of Gastroenterology and Hepatology, Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
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Paskett ED. Cancer health [corrected] disparities: moving from why they occur to how they can be prevented. J Clin Oncol 2011; 30:354-6. [PMID: 22184382 DOI: 10.1200/jco.2011.39.5947] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Kupfer SS, Anderson JR, Ludvik AE, Hooker S, Skol A, Kittles RA, Keku TO, Sandler RS, Ruiz-Ponte C, Castellvi-Bel S, Castells A, Carracedo A, Ellis NA. Genetic associations in the vitamin D receptor and colorectal cancer in African Americans and Caucasians. PLoS One 2011; 6:e26123. [PMID: 22046258 PMCID: PMC3203108 DOI: 10.1371/journal.pone.0026123] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2011] [Accepted: 09/20/2011] [Indexed: 02/07/2023] Open
Abstract
Low vitamin D levels are associated with an increased incidence of colorectal cancer (CRC) and higher mortality from the disease. In the US, African Americans (AAs) have the highest CRC incidence and mortality and the lowest levels of vitamin D. Single nucleotide polymorphisms (SNPs) in the vitamin D receptor (VDR) gene have been previously associated with CRC, but few studies have included AAs. We studied 795 AA CRC cases and 985 AA controls from Chicago and North Carolina as well as 1324 Caucasian cases and 990 Caucasian controls from Chicago and Spain. We genotyped 54 tagSNPs in VDR (46586959 to 46521297 Mb) and tested for association adjusting for West African ancestry, age, gender, and multiple testing. Untyped markers were imputed using MACH1.0. We analyzed associations by gender and anatomic location in the whole study group as well as by vitamin D intake in the North Carolina AA group. In the joint analysis, none of the SNPs tested was significantly associated with CRC. For four previously tested restriction fragment length polymorphisms, only one (referred to as ApaI), tagged by the SNP rs79628898, had a nominally significant p-value in AAs; none of these polymorphisms were associated with CRC in Caucasians. In the North Carolina AAs, for whom we had vitamin D intake data, we found a significant association between an intronic SNP rs11574041 and vitamin D intake, which is evidence for a VDR gene-environment interaction in AAs. In summary, using a systematic tagSNP approach, we have not found evidence for significant associations between VDR and CRC in AAs or Caucasians.
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Affiliation(s)
- Sonia S. Kupfer
- Section of Gastroenterology, Department of Medicine, University of Chicago Medical Center, Chicago, Illinois, United States of America
| | - Jeffrey R. Anderson
- Section of Gastroenterology, Department of Medicine, University of Chicago Medical Center, Chicago, Illinois, United States of America
| | - Anton E. Ludvik
- Section of Gastroenterology, Department of Medicine, University of Chicago Medical Center, Chicago, Illinois, United States of America
| | - Stanley Hooker
- Section of Genetic Medicine, Department of Medicine, University of Chicago Medical Center, Chicago, Illinois, United States of America
| | - Andrew Skol
- Section of Genetic Medicine, Department of Medicine, University of Chicago Medical Center, Chicago, Illinois, United States of America
| | - Rick A. Kittles
- Department of Medicine, Institute of Human Genetics, University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - Temitope O. Keku
- Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Robert S. Sandler
- Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Clara Ruiz-Ponte
- Galician Public Foundation of Genomic Medicine (FPGMX), CIBERER, Genomic Medicine Group, Hospital Clinico, University of Santiago de Compostela, Santiago de Compostela, Galicia, Spain
| | - Sergi Castellvi-Bel
- Department of Gastroenterology, Hospital Clinic, CIBERehd, IDIBAPS, University of Barcelona, Barcelona, Catalonia, Spain
| | - Antoni Castells
- Department of Gastroenterology, Hospital Clinic, CIBERehd, IDIBAPS, University of Barcelona, Barcelona, Catalonia, Spain
| | - Angel Carracedo
- Galician Public Foundation of Genomic Medicine (FPGMX), CIBERER, Genomic Medicine Group, Hospital Clinico, University of Santiago de Compostela, Santiago de Compostela, Galicia, Spain
| | - Nathan A. Ellis
- Department of Pediatrics, Institute of Human Genetics, University of Illinois at Chicago, Chicago, Illinois, United States of America
- * E-mail:
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Shea MK, Houston DK, Tooze JA, Davis CC, Johnson MA, Hausman DB, Cauley JA, Bauer DC, Tylavsky F, Harris TB, Kritchevsky SB. Correlates and prevalence of insufficient 25-hydroxyvitamin D status in black and white older adults: the health, aging and body composition study. J Am Geriatr Soc 2011; 59:1165-74. [PMID: 21668915 PMCID: PMC3282467 DOI: 10.1111/j.1532-5415.2011.03476.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To determine the prevalence and correlates of vitamin D insufficiency in black and white older adults. DESIGN Cross-sectional. SETTING Health, Aging and Body Composition Study. PARTICIPANTS Nine hundred seventy-seven black and 1,604 white adults aged 70 to 81. MEASUREMENTS Logistic regression and classification and regression tree analysis were used to identify correlates of vitamin D insufficiency (25-hydroxyvitamin D (25(OH)D) <30 ng/mL) separately in blacks and whites. RESULTS The prevalence of 25(OH)D insufficiency was 84% in blacks and 57% in whites. Seventy-six percent of blacks and 56% of whites did not take a multivitamin; those who did not take a multivitamin were more likely to be vitamin D insufficient (odds ratio (OR)=5.17 (95% confidence interval (CI)=3.47-7.70) for blacks; OR=2.56, 95% CI=2.05-3.19 for white). Additional risk factors for vitamin D insufficiency were vitamin D-containing supplement use, female sex, and obesity in blacks; and winter season, low dietary vitamin D intake, obesity, type 2 diabetes mellitus, and female sex in whites. CONCLUSION Vitamin D insufficiency was more prevalent in blacks than whites. Not consuming a multivitamin increased the odds of vitamin D insufficiency in blacks and whites. Knowledge of additional risk factors such as dietary intake and comorbid conditions may help identify older adults who are likely to be vitamin D insufficient.
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Affiliation(s)
- M Kyla Shea
- Department of Internal Medicine, School of Medicine, Wake Forest University, Winston-Salem, NC 27157, USA.
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