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Jastrząb R, Tomecki R, Jurkiewicz A, Graczyk D, Szczepankowska AK, Mytych J, Wolman D, Siedlecki P. The strain-dependent cytostatic activity of Lactococcus lactis on CRC cell lines is mediated through the release of arginine deiminase. Microb Cell Fact 2024; 23:82. [PMID: 38481270 PMCID: PMC10938756 DOI: 10.1186/s12934-024-02345-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 02/20/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Colorectal cancer (CRC) is one of the most commonly diagnosed cancers, posing a serious public health challenge that necessitates the development of new therapeutics, therapies, and prevention methods. Among the various therapeutic approaches, interventions involving lactic acid bacteria (LAB) as probiotics and postbiotics have emerged as promising candidates for treating and preventing CRC. While human-isolated LAB strains are considered highly favorable, those sourced from environmental reservoirs such as dairy and fermented foods are also being recognized as potential sources for future therapeutics. RESULTS In this study, we present a novel and therapeutically promising strain, Lactococcus lactis ssp. lactis Lc4, isolated from dairy sources. Lc4 demonstrated the ability to release the cytostatic agent - arginine deiminase (ADI) - into the post-cultivation supernatant when cultured under conditions mimicking the human gut environment. Released arginine deiminase was able to significantly reduce the growth of HT-29 and HCT116 cells due to the depletion of arginine, which led to decreased levels of c-Myc, reduced phosphorylation of p70-S6 kinase, and cell cycle arrest. The ADI release and cytostatic properties were strain-dependent, as was evident from comparison to other L. lactis ssp. lactis strains. CONCLUSION For the first time, we unveil the anti-proliferative properties of the L. lactis cell-free supernatant (CFS), which are independent of bacteriocins or other small molecules. We demonstrate that ADI, derived from a dairy-Generally Recognized As Safe (GRAS) strain of L. lactis, exhibits anti-proliferative activity on cell lines with different levels of argininosuccinate synthetase 1 (ASS1) expression. A unique feature of the Lc4 strain is also its capability to release ADI into the extracellular space. Taken together, we showcase L. lactis ADI and the Lc4 strain as promising, potential therapeutic agents with broad applicability.
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Affiliation(s)
- Rafał Jastrząb
- Institute of Biochemistry and Biophysics, Polish Academy of Sciences, Adolfa Pawińskiego 5A, Warsaw, 02-106, Poland
- Olimp Laboratories, Pustynia 84F, Debica, 39-200, Poland
| | - Rafał Tomecki
- Institute of Biochemistry and Biophysics, Polish Academy of Sciences, Adolfa Pawińskiego 5A, Warsaw, 02-106, Poland
- Faculty of Biology, University of Warsaw, Miecznikowa 1, Warsaw, 02-089, Poland
| | - Aneta Jurkiewicz
- Institute of Biochemistry and Biophysics, Polish Academy of Sciences, Adolfa Pawińskiego 5A, Warsaw, 02-106, Poland
| | - Damian Graczyk
- Institute of Biochemistry and Biophysics, Polish Academy of Sciences, Adolfa Pawińskiego 5A, Warsaw, 02-106, Poland
| | - Agnieszka K Szczepankowska
- Institute of Biochemistry and Biophysics, Polish Academy of Sciences, Adolfa Pawińskiego 5A, Warsaw, 02-106, Poland
| | | | - Damian Wolman
- Olimp Laboratories, Pustynia 84F, Debica, 39-200, Poland
| | - Pawel Siedlecki
- Institute of Biochemistry and Biophysics, Polish Academy of Sciences, Adolfa Pawińskiego 5A, Warsaw, 02-106, Poland.
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Saeed H, Leibowitz BJ, Zhang L, Yu J. Targeting Myc-driven stress addiction in colorectal cancer. Drug Resist Updat 2023; 69:100963. [PMID: 37119690 DOI: 10.1016/j.drup.2023.100963] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 04/06/2023] [Accepted: 04/17/2023] [Indexed: 05/01/2023]
Abstract
MYC is a proto-oncogene that encodes a powerful regulator of transcription and cellular programs essential for normal development, as well as the growth and survival of various types of cancer cells. MYC rearrangement and amplification is a common cause of hematologic malignancies. In epithelial cancers such as colorectal cancer, genetic alterations in MYC are rare. Activation of Wnt, ERK/MAPK, and PI3K/mTOR pathways dramatically increases Myc levels through enhanced transcription, translation, and protein stability. Elevated Myc promotes stress adaptation, metabolic reprogramming, and immune evasion to drive cancer development and therapeutic resistance through broad changes in transcriptional and translational landscapes. Despite intense interest and effort, Myc remains a difficult drug target. Deregulation of Myc and its targets has profound effects that vary depending on the type of cancer and the context. Here, we summarize recent advances in the mechanistic understanding of Myc-driven oncogenesis centered around mRNA translation and proteostress. Promising strategies and agents under development to target Myc are also discussed with a focus on colorectal cancer.
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Affiliation(s)
- Haris Saeed
- UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, 5117 Centre Ave., Pittsburgh, PA 15213, USA; Dept. of Pathology, University of Pittsburgh School of Medicine, 5117 Centre Ave., Pittsburgh, PA 15213, USA
| | - Brian J Leibowitz
- UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, 5117 Centre Ave., Pittsburgh, PA 15213, USA; Dept. of Pathology, University of Pittsburgh School of Medicine, 5117 Centre Ave., Pittsburgh, PA 15213, USA
| | - Lin Zhang
- UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, 5117 Centre Ave., Pittsburgh, PA 15213, USA; Dept. of Chemical Biology and Pharmacology, University of Pittsburgh School of Medicine, 5117 Centre Ave., Pittsburgh, PA 15213, USA
| | - Jian Yu
- UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, 5117 Centre Ave., Pittsburgh, PA 15213, USA; Dept. of Pathology, University of Pittsburgh School of Medicine, 5117 Centre Ave., Pittsburgh, PA 15213, USA; Dept. of Radiation Oncology, University of Pittsburgh School of Medicine, 5117 Centre Ave., Pittsburgh, PA 15213, USA.
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Zell JA, Taylor TH, Albers CG, Carmichael JC, McLaren CE, Wenzel L, Stamos MJ. Phase IIa Clinical Biomarker Trial of Dietary Arginine Restriction and Aspirin in Colorectal Cancer Patients. Cancers (Basel) 2023; 15:2103. [PMID: 37046763 PMCID: PMC10093153 DOI: 10.3390/cancers15072103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 03/29/2023] [Accepted: 03/29/2023] [Indexed: 04/03/2023] Open
Abstract
After potentially curative treatment, colorectal cancer (CRC) patients remain at high risk for recurrence, second primary CRC, and high-risk adenomas. In combination with existing data, our previous findings provide a rationale for reducing tissue polyamines as tertiary prevention in non-metastatic CRC patients. The goal of this study was to demonstrate rectal tissue polyamine reduction in optimally treated stage I-III CRC patients after intervention with daily oral aspirin + dietary arginine restriction. A single-institution phase IIa clinical trial was conducted. Patients were treated with aspirin 325 mg/day and an individualized dietary regimen designed to reduce arginine intake by ≥30% over a 12-week study period. Dietary intake, endoscopy with rectal biopsies, and phlebotomy were performed pre- and post-intervention. The primary endpoint was to demonstrate ≥50% decrease in rectal tissue putrescine levels from baseline as a measure of polyamine reduction in the target tissue. Twenty eligible patients completed the study. After study intervention, mean dietary arginine intake decreased from 3.7 g/day ± 1.3 SD to 2.6 g/day ± 1.2 SD (29.7% decrease, p < 0.02 by Sign test). Mean plasma arginine levels decreased from 46.0 ng/mL ± 31.5 SD at baseline to 35 ng/mL ± 21.7 SD (p < 0.001). Rectal tissue putrescine levels were 0.90 nMol/mg-protein pre-intervention and 0.99 nMol/mg-protein post-intervention (p < 0.64, NS). No significant differences were observed for the other tissue polyamines investigated: spermidine (p < 0.13), spermine (p < 0.21), spermidine:spermine ratio (p < 0.71). Among CRC survivors, treatment with daily oral aspirin and an individualized dietary arginine restriction intervention resulted in lower calculated dietary arginine intake and plasma arginine levels but did not affect rectal tissue polyamine levels.
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Affiliation(s)
- Jason A. Zell
- Division of Hematology/Oncology, Department of Medicine, University of California Irvine Medical Center, Orange, CA 92868, USA
- Chao Family Comprehensive Cancer Center, University of California Irvine Medical Center, Orange, CA 92868, USA
| | - Thomas H. Taylor
- Department of Epidemiology & Biostatistics, University of California Irvine, Irvine, CA 92697, USA
| | - C. Gregory Albers
- Division of Gastroenterology, Department of Medicine, University of California Irvine Medical Center, Orange, CA 92868, USA
| | - Joseph C. Carmichael
- Division of Colorectal Surgery, Department of Surgery, University of California Irvine Medical Center, Orange, CA 92868, USA
| | - Christine E. McLaren
- Chao Family Comprehensive Cancer Center, University of California Irvine Medical Center, Orange, CA 92868, USA
- Department of Medicine, University of California Irvine Medical Center, Orange, CA 92868, USA
| | - Lari Wenzel
- Chao Family Comprehensive Cancer Center, University of California Irvine Medical Center, Orange, CA 92868, USA
- Department of Medicine, University of California Irvine Medical Center, Orange, CA 92868, USA
| | - Michael J. Stamos
- Division of Colorectal Surgery, Department of Surgery, University of California Irvine Medical Center, Orange, CA 92868, USA
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Guo J, Pan Y, Chen J, Jin P, Tang S, Wang H, Su H, Wang Q, Chen C, Xiong F, Liu K, Li Y, Su M, Tang T, He Y, Sheng J. Serum metabolite signatures in normal individuals and patients with colorectal adenoma or colorectal cancer using UPLC-MS/MS method. J Proteomics 2023; 270:104741. [PMID: 36174955 DOI: 10.1016/j.jprot.2022.104741] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 08/19/2022] [Accepted: 09/06/2022] [Indexed: 02/01/2023]
Abstract
Colorectal cancer (CRC) is one of the main causes of cancer-related deaths worldwide. Sporadic CRC develops from normal mucosa via adenoma to adenocarcinoma, which provides a long screening window for clinical detection. However, early diagnosis of sporadic colorectal adenoma (CRA) and CRC using serum metabolic screening remains unclear. The purpose of this study was to identify some promising signatures for distinguishing the different pathological metabolites of colorectal mucosal malignant transformation. A total of 238 endogenous metabolites were elected. We found that CRA and CRC patients had 72 and 73 different metabolites compared with healthy controls, respectively. There were 20 different metabolites between CRA and CRC patients. The potential metabolites of tumor growth (including patients with CRA and CRC) were found, such as A-d-glucose, D-mannose, N-acetyl-D-glucosamine, L-cystine, Sarcosine, TXB 2, 12-Hete, and chenodeoxycholic acid. Compared with CRA, 3,4,5-trimethoxybenzoic acid was significantly higher in CRC patients. There results prompt us to use the potential serum signatures to screen CRC as the novel strategy. Serum metabolite screening is useful for early detection of mucosal intestinal malignancy. We will further investigate the roles of these promising biomarkers during intestinal tumorigenesis in future. SIGNIFICANCE: CRC is one of the main causes of cancer-related deaths worldwide. Sporadic CRC develops from normal mucosa via adenomas to adenocarcinoma, which provides a long screening window for about 5-10 years. We adopt the metabolic analysis of extensive targeted metabolic technology. The main purpose of the metabolic group analysis is to detect and screen the different metabolites, thereby performing related functional prediction and analysis of the differential metabolites. In our study, 30 samples are selected, divided into 3 groups for metabolic analysis, and 238 metabolites are elected. In 238 metabolites, we find that CRA patients have 72 different metabolites compared with health control. Compared with health control, CRC have 73 different metabolites. Compared with CRA and CRC patients, there are 20 different metabolites. The annotation results of the significantly different metabolites are classified according to the KEGG pathway type. The potential metabolites of tumor growth stage (including patients with CRA and CRC) are found, such as A-d-glucose, D-mannose, N-acetyl-D-glucosamine, L-cystine, sarcosine, TXB 2, 12-Hete and chenodeoxycholic acid. Compared with CRA patients, CRC patients had significantly higher 3,4,5-trimethoxybenzoic acid level. It is prompted to use serum different metabolites to screen CRC to provide new possibilities.
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Affiliation(s)
- Jiachi Guo
- Chinese PLA General Hospital, No. 28, Fuxing Road Haidian District, Beijing 100853, China; Department of Gastroenterology, The Seventh Medical Center of Chinese PLA General Hospital, No. 5 Nanmencang, Dongcheng District, Beijing 100700, China
| | - Yuanming Pan
- Cancer Research Center, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, No. 9 Beiguan Street, Tongzhou District, Beijing 101149, China
| | - Jigui Chen
- Department of Colorectal and Anal Surgery Wuhan, No. 8 Hospital. No. 1307 Zhongshan Avenue, Jiang'an District, Hankou, Wuhan City, Hubei 430010, China
| | - Peng Jin
- Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, No. 28, Fuxing Road Haidian District, Beijing 100853, China; Department of Gastroenterology, The Seventh Medical Center of Chinese PLA General Hospital, No. 5 Nanmencang, Dongcheng District, Beijing 100700, China
| | - Shan Tang
- Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, No. 28, Fuxing Road Haidian District, Beijing 100853, China; Department of Gastroenterology, The Seventh Medical Center of Chinese PLA General Hospital, No. 5 Nanmencang, Dongcheng District, Beijing 100700, China
| | - Haihong Wang
- Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, No. 28, Fuxing Road Haidian District, Beijing 100853, China; Department of Gastroenterology, The Seventh Medical Center of Chinese PLA General Hospital, No. 5 Nanmencang, Dongcheng District, Beijing 100700, China
| | - Hui Su
- Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, No. 28, Fuxing Road Haidian District, Beijing 100853, China; Department of Gastroenterology, The Seventh Medical Center of Chinese PLA General Hospital, No. 5 Nanmencang, Dongcheng District, Beijing 100700, China
| | - Qian Wang
- Department of Colorectal and Anal Surgery Wuhan, No. 8 Hospital. No. 1307 Zhongshan Avenue, Jiang'an District, Hankou, Wuhan City, Hubei 430010, China
| | - Chao Chen
- Department of Colorectal and Anal Surgery Wuhan, No. 8 Hospital. No. 1307 Zhongshan Avenue, Jiang'an District, Hankou, Wuhan City, Hubei 430010, China
| | - Fei Xiong
- Department of Colorectal and Anal Surgery Wuhan, No. 8 Hospital. No. 1307 Zhongshan Avenue, Jiang'an District, Hankou, Wuhan City, Hubei 430010, China
| | - Kejia Liu
- DHC Mediway Technology Co., Ltd., 14F, Zijin Digital Park, Zhongguancun, Haidian District, Beijing 100190, China
| | - Yansheng Li
- DHC Mediway Technology Co., Ltd., 14F, Zijin Digital Park, Zhongguancun, Haidian District, Beijing 100190, China
| | - Mingliang Su
- DHC Mediway Technology Co., Ltd., 14F, Zijin Digital Park, Zhongguancun, Haidian District, Beijing 100190, China
| | - Tang Tang
- Wuhan Metwell Biotechnology Co., Ltd., Building B7/B8, Biological Industry Innovation Base, 666 Gaoxin Avenue, Donghu New Technology Development Zone, Wuhan City, Hubei 430075, China
| | - Yuqi He
- Department of Gastroenterology, The Seventh Medical Center of Chinese PLA General Hospital, No. 5 Nanmencang, Dongcheng District, Beijing 100700, China; The Second School of Clinical Medicine, Southern Medical University, 253 Middle Industrial Avenue, Guangzhou City, Guangdong 510280, China; Department of Gastroenterology, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, No. 9 Beiguan Street, Tongzhou District, Beijing 101149, China.
| | - Jianqiu Sheng
- Chinese PLA General Hospital, No. 28, Fuxing Road Haidian District, Beijing 100853, China; Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, No. 28, Fuxing Road Haidian District, Beijing 100853, China; Department of Gastroenterology, The Seventh Medical Center of Chinese PLA General Hospital, No. 5 Nanmencang, Dongcheng District, Beijing 100700, China.
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Liu T, Wang X, Jia P, Liu C, Wei Y, Song Y, Li S, Liu L, Wang B, Shi H. Association between serum arginine levels and cancer risk: A community-based nested case-control study. Front Nutr 2022; 9:1069113. [PMID: 36466394 PMCID: PMC9712959 DOI: 10.3389/fnut.2022.1069113] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 11/02/2022] [Indexed: 01/10/2024] Open
Abstract
OBJECTIVE The effect of arginine on tumors appears to be bidirectional. The association of serum arginine with the risk of incident cancer remains uncovered at present. We aimed to investigate the prospective relationship of baseline serum arginine concentrations with the risk of incident cancer in hypertensive participants. MATERIALS AND METHODS A nested, case-control study with 1,389 incident cancer cases and 1,389 matched controls was conducted using data from the China H-Type Hypertension Registry Study (CHHRS). Conditional logistic regression analyses were performed to evaluate the association between serum arginine and the risk of the overall, digestive system, non-digestive system, and site-specific cancer. RESULTS Compared with matched controls, cancer patients had higher levels of arginine (21.41 μg/mL vs. 20.88 μg/mL, p < 0.05). When serum arginine concentrations were assessed as quartiles, compared with participants in the lowest arginine quartile, participants in the highest arginine quartile had a 32% (OR = 1.32, 95% CI: 1.03 to 1.71), and 68% (OR = 1.68, 95% CI: 1.09 to 2.59) increased risk of overall and digestive system cancer, respectively, in the adjusted models. In the site-specific analysis, each standard deviation (SD) increment of serum arginine was independently and positively associated with the risk of colorectal cancer (OR = 1.35, 95% CI: 1.01 to 1.82) in the adjusted analysis. CONCLUSION We found that hypertensive individuals with higher serum arginine levels exhibited a higher risk of overall, digestive system, and colorectal cancer.
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Affiliation(s)
- Tong Liu
- Department of Gastrointestinal Surgery/Clinical Nutrition, Capital Medical University Affiliated Beijing Shijitan Hospital, Beijing, China
- Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, China
- Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, China
| | - Xiaomeng Wang
- Department of Education, Capital Medical University Affiliated Beijing Shijitan Hospital, Beijing, China
| | - Pingping Jia
- Department of Gastrointestinal Surgery/Clinical Nutrition, Capital Medical University Affiliated Beijing Shijitan Hospital, Beijing, China
- Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, China
- Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, China
| | - Chenan Liu
- Department of Gastrointestinal Surgery/Clinical Nutrition, Capital Medical University Affiliated Beijing Shijitan Hospital, Beijing, China
- Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, China
- Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, China
| | - Yaping Wei
- Key Laboratory of Precision Nutrition and Food Quality, Ministry of Education, Department of Nutrition and Health, College of Food Sciences and Nutritional Engineering, China Agricultural University, Beijing, China
| | - Yun Song
- Shenzhen Evergreen Medical Institute, Shenzhen, China
| | - Shuqun Li
- Shenzhen Evergreen Medical Institute, Shenzhen, China
| | - Lishun Liu
- Shenzhen Evergreen Medical Institute, Shenzhen, China
| | - Binyan Wang
- Shenzhen Evergreen Medical Institute, Shenzhen, China
| | - Hanping Shi
- Department of Gastrointestinal Surgery/Clinical Nutrition, Capital Medical University Affiliated Beijing Shijitan Hospital, Beijing, China
- Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, China
- Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, China
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Li QZ, Zuo ZW, Zhou ZR, Ji Y. Polyamine homeostasis-based strategies for cancer: The role of combination regimens. Eur J Pharmacol 2021; 910:174456. [PMID: 34464603 DOI: 10.1016/j.ejphar.2021.174456] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 08/14/2021] [Accepted: 08/26/2021] [Indexed: 01/07/2023]
Abstract
Spermine, spermidine and putrescine polyamines are naturally occurring ubiquitous positively charged amines and are essential metabolites for biological functions in our life. These compounds play a crucial role in many cell processes, including cellular proliferation, growth, and differentiation. Intracellular levels of polyamines depend on their biosynthesis, transport and degradation. Polyamine levels are high in cancer cells, which leads to the promotion of tumor growth, invasion and metastasis. Targeting polyamine metabolism as an anticancer strategy is considerably rational. Due to compensatory mechanisms, a single strategy does not achieve satisfactory clinical effects when using a single agent. Combination regimens are more clinically promising for cancer chemoprevention because they work synergistically with causing little or no adverse effects due to each individual agent being used at lower doses. Moreover, bioactive substances have advantages over single chemical agents because they can affect multiple targets. In this review, we discuss anticancer strategies targeting polyamine metabolism and describe how combination treatments and effective natural active ingredients are promising therapies. The existing research suggests that polyamine metabolic enzymes are important therapeutic targets and that combination therapies can be more effective than monotherapies based on polyamine depletion.
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Affiliation(s)
- Qi-Zhang Li
- National "111" Center for Cellular Regulation and Molecular Pharmaceutics, Key Laboratory of Industrial Fermentation (Ministry of Education), Institute of Biomedical and Pharmaceutical Sciences, Hubei Key Laboratory of Industrial Microbiology, Hubei University of Technology, Wuhan, Hubei, 430068, PR China.
| | - Zan-Wen Zuo
- National "111" Center for Cellular Regulation and Molecular Pharmaceutics, Key Laboratory of Industrial Fermentation (Ministry of Education), Institute of Biomedical and Pharmaceutical Sciences, Hubei Key Laboratory of Industrial Microbiology, Hubei University of Technology, Wuhan, Hubei, 430068, PR China
| | - Ze-Rong Zhou
- National "111" Center for Cellular Regulation and Molecular Pharmaceutics, Key Laboratory of Industrial Fermentation (Ministry of Education), Institute of Biomedical and Pharmaceutical Sciences, Hubei Key Laboratory of Industrial Microbiology, Hubei University of Technology, Wuhan, Hubei, 430068, PR China
| | - Yan Ji
- National "111" Center for Cellular Regulation and Molecular Pharmaceutics, Key Laboratory of Industrial Fermentation (Ministry of Education), Institute of Biomedical and Pharmaceutical Sciences, Hubei Key Laboratory of Industrial Microbiology, Hubei University of Technology, Wuhan, Hubei, 430068, PR China
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Vernia F, Longo S, Stefanelli G, Viscido A, Latella G. Dietary Factors Modulating Colorectal Carcinogenesis. Nutrients 2021; 13:nu13010143. [PMID: 33401525 PMCID: PMC7824178 DOI: 10.3390/nu13010143] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 12/28/2020] [Accepted: 12/29/2020] [Indexed: 12/14/2022] Open
Abstract
The development of colorectal cancer, responsible for 9% of cancer-related deaths, is favored by a combination of genetic and environmental factors. The modification of diet and lifestyle may modify the risk of colorectal cancer (CRC) and prevent neoplasia in up to 50% of cases. The Western diet, characterized by a high intake of fat, red meat and processed meat has emerged as an important contributor. Conversely, a high intake of dietary fiber partially counteracts the unfavorable effects of meat through multiple mechanisms, including reduced intestinal transit time and dilution of carcinogenic compounds. Providing antioxidants (e.g., vitamins C and E) and leading to increased intraluminal production of protective fermentation products, like butyrate, represent other beneficial and useful effects of a fiber-rich diet. Protective effects on the risk of developing colorectal cancer have been also advocated for some specific micronutrients like vitamin D, selenium, and calcium. Diet-induced modifications of the gut microbiota modulate colonic epithelial cell homeostasis and carcinogenesis. This can have, under different conditions, opposite effects on the risk of CRC, through the production of mutagenic and carcinogenic agents or, conversely, of protective compounds. The aim of this review is to summarize the most recent evidence on the role of diet as a potential risk factor for the development of colorectal malignancies, as well as providing possible prevention dietary strategies.
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Association Between Intake of Red and Processed Meat and Survival in Patients With Colorectal Cancer in a Pooled Analysis. Clin Gastroenterol Hepatol 2019; 17:1561-1570.e3. [PMID: 30476588 PMCID: PMC6533164 DOI: 10.1016/j.cgh.2018.11.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 11/14/2018] [Accepted: 11/16/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Red and processed meat intake is associated with colorectal cancer (CRC) incidence, but it is not clear if intake is associated with patient survival after diagnosis. METHODS We pooled data from 7627 patients with stage I-IV CRC from 10 studies in the International Survival Analysis in Colorectal Cancer Consortium. Cox proportional hazards regression models were used to evaluate the associations of intake of red and processed meat before diagnosis with overall and CRC-specific survival. RESULTS Among 7627 patients with CRC, 2338 died, including 1576 from CRC, over a median follow-up time of 5.1 years. In multivariable-adjusted analyses, higher intake of red or processed meat was not associated with overall survival of patients with stage I-III CRC: Q4 vs Q1 red meat hazard ratio [HR], 1.08 (95% CI, 0.93-1.26) and Q4 vs Q1 processed meat HR, 1.10 (95% CI, 0.93-1.32) or with CRC-specific survival: Q4 vs Q1 red meat HR, 1.09 (95% CI, 0.89-1.33) and Q4 vs Q1 processed meat HR, 1.11 (95% CI, 0.87-1.42). Results were similar for patients with stage IV CRC. However, patients with stage I-III CRC who reported an intake of processed meat above the study-specific medians had a higher risk of death from any cause (HR, 1.12; 95% CI, 1.01-1.25) than patients who reported eating at or less than the median. CONCLUSION In this large consortium of CRC patient cohorts, intake of red and processed meat before a diagnosis of CRC was not associated with shorter survival time after diagnosis, although a possible weak adverse association cannot be excluded. Studies that evaluate dietary data from several time points before and after cancer diagnosis are required to confirm these findings.
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Sun P, Zhu X, Shrubsole MJ, Ness RM, Hibler EA, Cai Q, Long J, Chen Z, Li G, Hou L, Smalley WE, Edwards TL, Giovannucci E, Zheng W, Dai Q. Genetic variation in SLC7A2 interacts with calcium and magnesium intakes in modulating the risk of colorectal polyps. J Nutr Biochem 2017; 47:35-40. [PMID: 28501704 PMCID: PMC5583031 DOI: 10.1016/j.jnutbio.2017.04.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 04/17/2017] [Accepted: 04/25/2017] [Indexed: 12/29/2022]
Abstract
Solute carrier family 7, member 2 (SLC7A2) gene encodes a protein called cationic amino acid transporter 2, which mediates the transport of arginine, lysine and ornithine. l-Arginine is necessary for cancer development and progression, including an important role in colorectal cancer pathogenesis. Furthermore, previous studies found that both calcium and magnesium inhibit the transport of arginine. Thus, calcium, magnesium or calcium:magnesium intake ratio may interact with polymorphisms in the SLC7A2 gene in association with colorectal cancer. We conducted a two-phase case-control study within the Tennessee Colorectal Polyps Study. In the first phase, 23 tagging single-nucleotide polymorphisms in the SLC7A2 gene were included for 725 colorectal adenoma cases and 755 controls. In the second phase conducted in an independent set of 607 cases and 2113 controls, we replicated the significant findings in the first phase. We observed that rs2720574 significantly interacted with calcium:magnesium intake ratio in association with odds of adenoma, particularly multiple/advanced adenoma. In the combined analysis, among those with a calcium:magnesium intake ratio below 2.78, individuals who carried GC/CC genotypes demonstrated higher odds of adenoma [OR (95% CI):1.36 (1.11-1.68)] and multiple/advanced adenoma [OR (95% CI): 1.68 (1.28, 2.20)] than those who carried the GG genotype. The P values for interactions between calcium:magnesium intake ratio and rs2720574 were .002 for all adenomas and <.001 for multiple/advanced adenoma. Among those with the GG genotype, a high calcium:magnesium ratio was associated with increased odds of colorectal adenoma [OR (95% CI): 1.73 (1.27-2.36)] and advanced/multiple adenomas [1.62 (1.05-2.50)], whereas among those with the GC/CC genotypes, high calcium:magnesium ratio was related to reduced odds of colorectal adenoma [0.64 (0.42-0.99)] and advanced/multiple adenomas [0.55 (0.31-1.00)].
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Affiliation(s)
- Pin Sun
- Department of Occupational Health and Toxicology, School of Public Health, Fudan University, Shanghai, China 200032
| | - Xiangzhu Zhu
- Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN 37203; Geriatric, Research, Education and Clinical Center (GRECC), Department of Veterans Affairs, Tennessee Valley Healthcare System, Nashville, TN 37212
| | - Martha J Shrubsole
- Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN 37203; Geriatric, Research, Education and Clinical Center (GRECC), Department of Veterans Affairs, Tennessee Valley Healthcare System, Nashville, TN 37212
| | - Reid M Ness
- Division of Gastroenterology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN 37203
| | - Elizabeth A Hibler
- Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN 37203
| | - Qiuyin Cai
- Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN 37203
| | - Jirong Long
- Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN 37203
| | - Zhi Chen
- Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN 37203
| | - Guoliang Li
- Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN 37203
| | - Lifang Hou
- Institute for Public Health and Medicine, Northwestern University, Chicago, IL
| | - Walter E Smalley
- Geriatric, Research, Education and Clinical Center (GRECC), Department of Veterans Affairs, Tennessee Valley Healthcare System, Nashville, TN 37212; Division of Gastroenterology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN 37203
| | - Todd L Edwards
- Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN 37203; Geriatric, Research, Education and Clinical Center (GRECC), Department of Veterans Affairs, Tennessee Valley Healthcare System, Nashville, TN 37212
| | - Edward Giovannucci
- Departments of Nutrition and Epidemiology, Harvard School of Public Health, Boston, MA
| | - Wei Zheng
- Department of Occupational Health and Toxicology, School of Public Health, Fudan University, Shanghai, China 200032; Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN 37203
| | - Qi Dai
- Department of Occupational Health and Toxicology, School of Public Health, Fudan University, Shanghai, China 200032; Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN 37203.
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10
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Takahashi K, Ito H, Hashimoto M, Mita K, Asakawa H, Hayashi T, Fujino K. Does antithrombotic therapy improve survival with colorectal cancer? World J Surg Oncol 2017; 15:161. [PMID: 28836988 PMCID: PMC5571652 DOI: 10.1186/s12957-017-1235-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 08/05/2017] [Indexed: 12/21/2022] Open
Abstract
Background The study aimed to evaluate the prognosis for patients with colorectal cancer who underwent surgery while receiving antithrombotic therapy (ATT) across all disease stages and for patients at disease stages 0–III. Methods This retrospective cohort study included 710 Japanese patients who underwent surgery for colorectal cancer between January 2009 and November 2015 at our institution. Approximately 35% of these patients received ATT. Of these, 199 (28.0%) received antiplatelet therapy, and 76 (10.7%) received anticoagulant therapy. We investigated the prognosis among patients with colorectal cancer receiving ATT, antiplatelet therapy, or anticoagulant therapy in all-stage and stage 0–III cancers. Results For all disease stages combined, no benefit was observed for ATT, antiplatelet therapy, and anticoagulant therapy groups in the overall survival rates (ATT: 87.8 vs. 78.4%, P = 0.23; antiplatelet therapy: 87.8 vs. 78.6%, P = 0.25; and anticoagulant therapy: 92.2 vs. 80.2%, P = 0.26). However, overall survival rates of patients with stage 0–III colorectal cancer undergoing ATT, antiplatelet therapy, and anticoagulant therapy significantly improved. (ATT: 98.5 vs. 92.7%, P = 0.01; antiplatelet therapy: 98.3 vs. 91.1%, P = 0.02; and anticoagulant therapy: 100 vs. 92.1%, P = 0.00). Conclusion Receiving ATT significantly improves overall survival rates in patients with stage 0–III colorectal cancer.
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Affiliation(s)
- Kodai Takahashi
- Department of Surgery, New-Tokyo Hospital, 1271 Wanagaya, Matsudo-city, Chiba, 270-2232, Japan.
| | - Hideto Ito
- Department of Surgery, New-Tokyo Hospital, 1271 Wanagaya, Matsudo-city, Chiba, 270-2232, Japan
| | - Masatoshi Hashimoto
- Department of Surgery, New-Tokyo Hospital, 1271 Wanagaya, Matsudo-city, Chiba, 270-2232, Japan
| | - Kazuhito Mita
- Department of Surgery, New-Tokyo Hospital, 1271 Wanagaya, Matsudo-city, Chiba, 270-2232, Japan
| | - Hideki Asakawa
- Department of Surgery, New-Tokyo Hospital, 1271 Wanagaya, Matsudo-city, Chiba, 270-2232, Japan
| | - Takashi Hayashi
- Department of Surgery, New-Tokyo Hospital, 1271 Wanagaya, Matsudo-city, Chiba, 270-2232, Japan
| | - Keiichi Fujino
- Department of Surgery, New-Tokyo Hospital, 1271 Wanagaya, Matsudo-city, Chiba, 270-2232, Japan
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11
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Hammerling U, Bergman Laurila J, Grafström R, Ilbäck NG. Consumption of Red/Processed Meat and Colorectal Carcinoma: Possible Mechanisms Underlying the Significant Association. Crit Rev Food Sci Nutr 2016; 56:614-34. [PMID: 25849747 DOI: 10.1080/10408398.2014.972498] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Epidemiology and experimental studies provide an overwhelming support of the notion that diets high in red or processed meat accompany an elevated risk of developing pre-neoplastic colorectal adenoma and frank colorectal carcinoma (CRC). The underlying mechanisms are disputed; thus several hypotheses have been proposed. A large body of reports converges, however, on haem and nitrosyl haem as major contributors to the CRC development, presumably acting through various mechanisms. Apart from a potentially higher intestinal mutagenic load among consumers on a diet rich in red/processed meat, other mechanisms involving subtle interference with colorectal stem/progenitor cell survival or maturation are likewise at play. From an overarching perspective, suggested candidate mechanisms for red/processed meat-induced CRC appear as three partly overlapping tenets: (i) increased N-nitrosation/oxidative load leading to DNA adducts and lipid peroxidation in the intestinal epithelium, (ii) proliferative stimulation of the epithelium through haem or food-derived metabolites that either act directly or subsequent to conversion, and (iii) higher inflammatory response, which may trigger a wide cascade of pro-malignant processes. In this review, we summarize and discuss major findings of the area in the context of potentially pertinent mechanisms underlying the above-mentioned association between consumption of red/processed meat and increased risk of developing CRC.
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Affiliation(s)
- Ulf Hammerling
- a Cancer Pharmacology & Computational Medicine, Department of Medical Sciences, Uppsala University and Uppsala Academic Hospital , Uppsala , Sweden
| | - Jonas Bergman Laurila
- b Sahlgrenska Biobank, Gothia Forum, Sahlgrenska University Hospital , Gothenburg , Sweden
| | - Roland Grafström
- c Institute of Environmental Medicine, The Karolinska Institute , Stockholm , Sweden.,d Knowledge Intensive Products and Services, VTT Technical Research Centre of Finland , Turku , Finland
| | - Nils-Gunnar Ilbäck
- e Clinical Microbiology & Infectious Medicine, Department of Medical Sciences, Uppsala University and Uppsala Academic Hospital , Uppsala , Sweden
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12
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Jacobs S, Harmon BE, Ollberding NJ, Wilkens LR, Monroe KR, Kolonel LN, Le Marchand L, Boushey CJ, Maskarinec G. Among 4 Diet Quality Indexes, Only the Alternate Mediterranean Diet Score Is Associated with Better Colorectal Cancer Survival and Only in African American Women in the Multiethnic Cohort. J Nutr 2016; 146:1746-55. [PMID: 27511927 PMCID: PMC4997287 DOI: 10.3945/jn.116.234237] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 07/05/2016] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Colorectal cancer (CRC) is the second leading cause of cancer-related death in the United States, with a 5-y survival rate of ∼65%. Therefore, the identification of modifiable health factors to improve CRC survival is crucial. OBJECTIVE We investigated the association of 4 prediagnostic a priori diet quality indexes with CRC-specific and all-cause mortality in the Multiethnic Cohort (MEC). METHODS The MEC included >215,000 African-American, Native Hawaiian, Japanese-American, Latino, and white adults living in Hawaii and California who completed a validated quantitative food-frequency questionnaire in 1993-1996. CRC cases and deaths were identified through linkages to cancer registries and to state and national vital registries. Sex-specific HRs and 95% CIs were estimated for the Healthy Eating Index (HEI) 2010, the Alternative HEI (AHEI) 2010, the alternate Mediterranean Diet (aMED) score, and the Dietary Approaches to Stop Hypertension (DASH) index with CRC-specific and overall mortality as the primary outcomes. Ethnicity-specific analyses were the secondary outcomes. RESULTS Among 4204 MEC participants diagnosed with invasive CRC through 2010, 1976 all-cause and 1095 CRC-specific deaths were identified. A higher aMED score was associated with lower CRC-specific mortality in women [HR continuous pattern score divided by its respective SD (HR1SD): 0.86; 95% CI: 0.77, 0.96] but not in men (HR1SD: 1.01; 95% CI: 0.92, 1.11). A higher aMED score was also associated with lower all-cause mortality in women (HR1SD: 0.88; 95% CI: 0.81, 0.96) but not in men (HR1SD: 1.00; 95% CI: 0.93, 1.07). The HEI-2010, AHEI-2010, and DASH index were not significantly associated with CRC-specific or with all-cause mortality. The inverse relation for the aMED score was limited to African Americans and to colon (compared with rectal) cancer. CONCLUSIONS The aMED score was related to lower mortality only in African-American women (1 of 5 ethnic groups studied). The results should be interpreted with caution due to the small numbers of cases within ethnic groups and the issue of multiple testing.
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Affiliation(s)
| | - Brook E Harmon
- School of Public Health, University of Memphis, Memphis, TN
| | | | | | - Kristine R Monroe
- University of Southern California, Health Sciences Campus, Los Angeles, CA
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13
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Arginine intake is associated with oxidative stress in a general population. Nutrition 2016; 33:211-215. [PMID: 27641673 DOI: 10.1016/j.nut.2016.07.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 07/15/2016] [Accepted: 07/17/2016] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The aim of this study was to assess the association between protein and arginine from meat intake and oxidative stress in a general population. METHODS Data came from the Health Survey for Sao Paulo (ISA-Capital), a cross-sectional population-based study in Brazil (N = 549 adults). Food intake was estimated by a 24-h dietary recall. Oxidative stress was estimated by malondialdehyde (MDA) concentration in plasma. Analyses were performed using general linear regression models adjusted for some genetic, lifestyle, and biochemical confounders. RESULTS MDA levels were associated with meat intake (P for linear trend = 0.031), protein from meat (P for linear trend = 0.006), and arginine from meat (P for linear trend = 0.044) after adjustments for confounders: age, sex, body mass index, smoking, physical activity, intake of fruit and vegetables, energy and heterocyclic amines, C-reactive protein levels, and polymorphisms in GSTM1 (glutathione S-transferase Mu 1) and GSTT1 (glutathione S-transferase theta 1) genes. Results were not significant for total protein and protein from vegetable intake (P > 0.05). CONCLUSIONS High protein and arginine from meat intake were associated with oxidative stress independently of genetic, lifestyle, and biochemical confounders in a population-based study. Our results suggested a novel link between high protein/arginine intake and oxidative stress, which is a major cause of age-related diseases.
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14
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Ward HA, Norat T, Overvad K, Dahm CC, Bueno-de-Mesquita HB, Jenab M, Fedirko V, van Duijnhoven FJB, Skeie G, Romaguera-Bosch D, Tjønneland A, Olsen A, Carbonnel F, Affret A, Boutron-Ruault MC, Katzke V, Kühn T, Aleksandrova K, Boeing H, Trichopoulou A, Lagiou P, Bamia C, Palli D, Sieri S, Tumino R, Naccarati A, Mattiello A, Peeters PH, Weiderpass E, Åsli LA, Jakszyn P, Ramón Quirós J, Sánchez MJ, Dorronsoro M, Huerta JM, Barricarte A, Jirström K, Ericson U, Johansson I, Gylling B, Bradbury KE, Khaw KT, Wareham NJ, Stepien M, Freisling H, Murphy N, Cross AJ, Riboli E. Pre-diagnostic meat and fibre intakes in relation to colorectal cancer survival in the European Prospective Investigation into Cancer and Nutrition. Br J Nutr 2016; 116:316-25. [PMID: 27193442 PMCID: PMC5570524 DOI: 10.1017/s0007114516001859] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Improvements in colorectal cancer (CRC) detection and treatment have led to greater numbers of CRC survivors, for whom there is limited evidence on which to provide dietary guidelines to improve survival outcomes. Higher intake of red and processed meat and lower intake of fibre are associated with greater risk of developing CRC, but there is limited evidence regarding associations with survival after CRC diagnosis. Among 3789 CRC cases in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort, pre-diagnostic consumption of red meat, processed meat, poultry and dietary fibre was examined in relation to CRC-specific mortality (n 1008) and all-cause mortality (n 1262) using multivariable Cox regression models, adjusted for CRC risk factors. Pre-diagnostic red meat, processed meat or fibre intakes (defined as quartiles and continuous grams per day) were not associated with CRC-specific or all-cause mortality among CRC survivors; however, a marginal trend across quartiles of processed meat in relation to CRC mortality was detected (P 0·053). Pre-diagnostic poultry intake was inversely associated with all-cause mortality among women (hazard ratio (HR)/20 g/d 0·92; 95 % CI 0·84, 1·00), but not among men (HR 1·00; 95 % CI 0·91, 1·09) (P for heterogeneity=0·10). Pre-diagnostic intake of red meat or fibre is not associated with CRC survival in the EPIC cohort. There is suggestive evidence of an association between poultry intake and all-cause mortality among female CRC survivors and between processed meat intake and CRC-specific mortality; however, further research using post-diagnostic dietary data is required to confirm this relationship.
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Affiliation(s)
| | | | - Kim Overvad
- 2Section for Epidemiology,Department of Public Health,Aarhus University,Bartholins Allé 2 - Building 1260,DK-8000 Aarhus C,Denmark
| | - Christina C Dahm
- 2Section for Epidemiology,Department of Public Health,Aarhus University,Bartholins Allé 2 - Building 1260,DK-8000 Aarhus C,Denmark
| | | | - Mazda Jenab
- 6International Agency for Research on Cancer (WHO-IARC),150 Cours Albert Thomas,69372 Lyon CEDEX 08,France
| | - Veronika Fedirko
- 7Department of Epidemiology,Rollins School of Public Health,Emory University,201 Dowman Drive, Atlanta, GA 30322,USA
| | | | - Guri Skeie
- 10UiT The Arctic University of Norway,Postboks 6050, Langnes, 9037 Tromsø,Norway
| | | | - Anne Tjønneland
- 13Danish Cancer Society Research Center,Strandboulevarden 49, DK-2100 København Ø,Denmark
| | - Anja Olsen
- 13Danish Cancer Society Research Center,Strandboulevarden 49, DK-2100 København Ø,Denmark
| | - Franck Carbonnel
- 14Center for Research in Epidemiology and Population Health (CESP),U1018,Lifestyle, Genes and Health: Integrative Trans-Generational Epidemiology,Institut National de la Santé et de la Recherche Médicale,F-94805 Villejuif,France
| | - Aurélie Affret
- 14Center for Research in Epidemiology and Population Health (CESP),U1018,Lifestyle, Genes and Health: Integrative Trans-Generational Epidemiology,Institut National de la Santé et de la Recherche Médicale,F-94805 Villejuif,France
| | - Marie-Christine Boutron-Ruault
- 14Center for Research in Epidemiology and Population Health (CESP),U1018,Lifestyle, Genes and Health: Integrative Trans-Generational Epidemiology,Institut National de la Santé et de la Recherche Médicale,F-94805 Villejuif,France
| | - Verena Katzke
- 17German Cancer Research Center (DKFZ),Division of Cancer Epidemiology,Im Neuenheimer Feld 280, 69120 Heidelberg,Germany
| | - Tilman Kühn
- 17German Cancer Research Center (DKFZ),Division of Cancer Epidemiology,Im Neuenheimer Feld 280, 69120 Heidelberg,Germany
| | - Krassimira Aleksandrova
- 18Department of Epidemiology,German Institute of Human Nutrition (DIfE),Arthur-Scheunert-Allee 114-116, 14558 Bergholz-Rehbrücke,Germany
| | - Heiner Boeing
- 18Department of Epidemiology,German Institute of Human Nutrition (DIfE),Arthur-Scheunert-Allee 114-116, 14558 Bergholz-Rehbrücke,Germany
| | - Antonia Trichopoulou
- 19Hellenic Health Foundation,Kaisareias 13 & Alexandroupoleos, GR-115 27, Athens,Greece
| | - Pagona Lagiou
- 19Hellenic Health Foundation,Kaisareias 13 & Alexandroupoleos, GR-115 27, Athens,Greece
| | - Christina Bamia
- 19Hellenic Health Foundation,Kaisareias 13 & Alexandroupoleos, GR-115 27, Athens,Greece
| | - Domenico Palli
- 22ISPO - Cancer Research and Prevention Institute,Clinical and Descriptive Epidemiology Unit,Via delle Oblate 2, 50141,Florence, Italy
| | - Sabina Sieri
- 23Epidemiology and Prevention Unit,Fondazione IRCCS Istituto Nazionale dei Tumouri,Via Giacomo Venezian 1, 20133 Milan,Italy
| | - Rosario Tumino
- 24Cancer Registry and Histopathology Unit,'Civic-M.P.Arezzo' Hospital,ASP, Via Dante No. 109, Ragusa 97100,Italy
| | - Alessio Naccarati
- 25Molecular and Genetic Epidemiology Unit,Human Genetics Foundation (HuGeF),Via Nizza 52, 10126 Torino,Italy
| | - Amalia Mattiello
- 26Dipartimento di Medicina Clinica e Chirurgia,Federico II University,Via Pansini, 5-80131 - Naples,Italy
| | | | - Elisabete Weiderpass
- 28Department of Community Medicine, Faculty of Health Sciences,University of Tromsø - The Arctic University of Norway,Postboks 6050 Langnes, 9037 Tromsø,Norway
| | - Lene Angell Åsli
- 28Department of Community Medicine, Faculty of Health Sciences,University of Tromsø - The Arctic University of Norway,Postboks 6050 Langnes, 9037 Tromsø,Norway
| | - Paula Jakszyn
- 32Unit of Nutrition, Environment and Cancer,Catalan Institute of Oncology,Avda Gran Via 199-203, 08908 L'Hospitalet de Llobregat, Barcelona,Spain
| | - J Ramón Quirós
- 33Public Health Directorate,Asturias, Ciriaco Miguel Vigil St 9,Oviedo 33006,Spain
| | - María-José Sánchez
- 34Escuela Andaluza de Salud Pública,Instituto de Investigación Biosanitaria ibs,Hospitales Universitarios de Granada/Universidad de Granada,Cuesta del Observatorio, 4, Campus Universitario de Cartuja,Granada 18080,Spain
| | - Miren Dorronsoro
- 36Basque Regional Health Department,Public Health Direction and Biodonostia Research Institute - CIBERESP,Avenida de Navarra, 4, 20013 Donostia-San Sebastián,Spain
| | - José-María Huerta
- 35CIBER de Epidemiología y Salud Pública (CIBERESP),Melchor Fernández Almagro,3-5, Madrid 28029,Spain
| | - Aurelio Barricarte
- 35CIBER de Epidemiología y Salud Pública (CIBERESP),Melchor Fernández Almagro,3-5, Madrid 28029,Spain
| | - Karin Jirström
- 40Department of Clinical Sciences,Division of Oncology and Pathology,Lund University,Box 117, SE-221 00 Lund,Sweden
| | - Ulrika Ericson
- 41Diabetes and Cardiovascular Disease - Genetic Epidemiology,Department of Clinical Sciences,Lund University,Box 117, SE-221 00 Lund,Sweden
| | | | - Björn Gylling
- 43Department of Pathology,Umeå University, SE-901 87 Umeå,Sweden
| | - Kathryn E Bradbury
- 44Cancer Epidemiology Unit,Nuffield Department of Population Health, University of Oxford,Richard Doll Building, Oxford OX3 7LF,UK
| | - Kay-Tee Khaw
- 45Department of Public Health and Primary Care,University of Cambridge, Addenbrooke's Hospital, Hills Rd,Cambridge CB2 0SP,UK
| | - Nicholas J Wareham
- 46Medical Research Council Epidemiology Unit,University of Cambridge, Institute of Metabolic Science,Box 285, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ,UK
| | - Magdalena Stepien
- 6International Agency for Research on Cancer (WHO-IARC),150 Cours Albert Thomas,69372 Lyon CEDEX 08,France
| | - Heinz Freisling
- 6International Agency for Research on Cancer (WHO-IARC),150 Cours Albert Thomas,69372 Lyon CEDEX 08,France
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15
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Carr PR, Jansen L, Walter V, Kloor M, Roth W, Bläker H, Chang-Claude J, Brenner H, Hoffmeister M. Associations of red and processed meat with survival after colorectal cancer and differences according to timing of dietary assessment. Am J Clin Nutr 2016; 103:192-200. [PMID: 26607936 DOI: 10.3945/ajcn.115.121145] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 10/07/2015] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Little is known about the prognostic impact of red and processed meat intake or about changes in consumption after a diagnosis of colorectal cancer (CRC). OBJECTIVES We investigated associations of baseline red and processed meat with survival outcomes and explored changes in intake among CRC survivors 5 y after diagnosis. DESIGN A total of 3122 patients diagnosed with CRC between 2003 and 2010 were followed for a median of 4.8 y [DACHS (Darmkrebs: Chancen der Verhütung durch Screening) study]. Patients provided information on diet and other factors in standardized questionnaires at baseline and at the 5-y follow-up. Cox proportional hazards regression models were used to estimate HRs and 95% CIs. RESULTS Among patients with stage I-III CRC, baseline red and processed meat intake was not associated with overall (>1 time/d compared with <1 time/d; HR: 0.85; 95% CI: 0.67, 1.09), CRC-specific (HR: 0.83; 95% CI: 0.61, 1.14), cardiovascular disease-specific (HR: 0.92; 95% CI: 0.51, 1.68), non-CRC-specific (HR: 0.88; 95% CI: 0.59, 1.30), and recurrence-free (HR: 1.03; 95% CI: 0.80, 1.33) survival; results among stage IV patients were comparable. An association with worse overall survival was found among patients with Kirsten rat sarcoma viral oncogene homolog (KRAS)-mutated CRC (HR: 1.99; 95% CI: 1.10, 3.56) but not with microsatellite instability or CpG island methylator phenotype (CIMP) positivity. A much lower proportion of survivors reported daily consumption of red and processed meat at the 5-y follow-up than at baseline (concordance rate: 39%; κ-value: 0.10; 95% CI: 0.07, 0.13). CONCLUSIONS Our findings suggest that baseline red and processed meat intake is not associated with poorer survival among patients with CRC. The potential interaction with KRAS mutation status warrants further evaluation. Major changes in consumption measured at the 5-y follow-up may have had an impact on our survival estimates.
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Affiliation(s)
| | - Lina Jansen
- Divisions of Clinical Epidemiology and Aging Research
| | - Viola Walter
- Divisions of Clinical Epidemiology and Aging Research
| | | | - Wilfried Roth
- Unit of Molecular Tumor Pathology; and Pathology, Institute of Pathology, University of Heidelberg, Heidelberg, Germany; and
| | - Hendrik Bläker
- Institute of Pathology, Charité University Medicine, Berlin, Germany
| | | | - Hermann Brenner
- Divisions of Clinical Epidemiology and Aging Research, Preventive Oncology; German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
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16
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Hawkins NA, Berkowitz Z, Rodriguez JL. Awareness of Dietary and Alcohol Guidelines Among Colorectal Cancer Survivors. Am J Prev Med 2015; 49:S509-17. [PMID: 26590646 PMCID: PMC5833984 DOI: 10.1016/j.amepre.2015.08.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 08/04/2015] [Accepted: 08/19/2015] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Although dietary habits can affect colorectal cancer (CRC) survivors' health, it is unclear how familiar survivors are with dietary guidelines, what they believe about healthy eating and alcohol consumption, and what hinders healthy dietary habits after cancer. This study assessed CRC survivors' familiarity with dietary guidelines, their eating and drinking habits, and perceived facilitators and barriers to healthy eating after cancer, including social support and self-efficacy for maintaining a healthy diet and limiting alcohol. METHODS A total of 593 individuals (50% female; mean age, 74 years) diagnosed with CRC approximately 6 years prior to study entry in early 2010 were identified through California Cancer Registry records and participated in a cross-sectional mailed survey assessing health behavior after cancer (46% adjusted response rate). Analyses were conducted in 2014-2015. RESULTS Survivors were most familiar with-and most likely to follow-recommendations to choose low-fat foods; 15% had never heard of recommendations to limit alcohol. Survivors were more aware of recommendations involving messages to limit/avoid versus approach/choose certain foods. The most common barrier to a healthy diet involved the effort required (26%). Survivors received more family/friend support and provider recommendations for healthy eating than limiting alcohol. CONCLUSIONS Results provide an overview of awareness of and adherence to dietary recommendations among CRC survivors, highlighting the need for increasing awareness of recommendations that are especially relevant for survivors. Suggestions are made for modifying diet-related messages to facilitate comprehension and recall among CRC survivors, and increasing awareness among groups with the lowest awareness levels.
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Affiliation(s)
- Nikki A Hawkins
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia.
| | - Zahava Berkowitz
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
| | - Juan L Rodriguez
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
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17
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LeGendre-McGhee S, Rice PS, Wall RA, Sprute KJ, Bommireddy R, Luttman AM, Nagle RB, Abril ER, Farrell K, Hsu CH, Roe DJ, Gerner EW, Ignatenko NA, Barton JK. Time-serial Assessment of Drug Combination Interventions in a Mouse Model of Colorectal Carcinogenesis Using Optical Coherence Tomography. CANCER GROWTH AND METASTASIS 2015; 8:63-80. [PMID: 26396545 PMCID: PMC4562605 DOI: 10.4137/cgm.s21216] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 07/05/2015] [Accepted: 07/07/2015] [Indexed: 02/07/2023]
Abstract
Optical coherence tomography (OCT) is a high-resolution, nondestructive imaging modality that enables time-serial assessment of adenoma development in the mouse model of colorectal cancer. In this study, OCT was utilized to evaluate the effectiveness of interventions with the experimental antitumor agent α-difluoromethylornithine (DFMO) and a nonsteroidal anti-inflammatory drug sulindac during early [chemoprevention (CP)] and late stages [chemotherapy (CT)] of colon tumorigenesis. Biological endpoints for drug interventions included OCT-generated tumor number and tumor burden. Immunochistochemistry was used to evaluate biochemical endpoints [Ki-67, cleaved caspase-3, cyclooxygenase (COX)-2, β-catenin]. K-Ras codon 12 mutations were studied with polymerase chain reaction-based technique. We demonstrated that OCT imaging significantly correlated with histological analysis of both tumor number and tumor burden for all experimental groups (P < 0.0001), but allows more accurate and full characterization of tumor number and burden growth rate because of its time-serial, nondestructive nature. DFMO alone or in combination with sulindac suppressed both the tumor number and tumor burden growth rate in the CP setting because of DFMO-mediated decrease in cell proliferation (Ki-67, P < 0.001) and K-RAS mutations frequency (P = 0.04). In the CT setting, sulindac alone and DFMO/sulindac combination were effective in reducing tumor number, but not tumor burden growth rate. A decrease in COX-2 staining in DFMO/sulindac CT groups (COX-2, P < 0.01) confirmed the treatment effect. Use of nondestructive OCT enabled repeated, quantitative evaluation of tumor number and burden, allowing changes in these parameters to be measured during CP and as a result of CT. In conclusion, OCT is a robust minimally invasive method for monitoring colorectal cancer disease and effectiveness of therapies in mouse models.
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Affiliation(s)
| | - Photini S Rice
- Department of Biomedical Engineering, University of Arizona, Tucson, AZ, USA
| | - R Andrew Wall
- College of Optical Sciences, University of Arizona, Tucson, AZ, USA
| | - Kyle J Sprute
- Department of Biomedical Engineering, University of Arizona, Tucson, AZ, USA
| | | | - Amber M Luttman
- College of Optical Sciences, University of Arizona, Tucson, AZ, USA
| | - Raymond B Nagle
- Department of Pathology, University of Arizona, Tucson, AZ, USA
| | - Edward R Abril
- University of Arizona Cancer Center, University of Arizona, Tucson, AZ, USA
| | - Katrina Farrell
- Department of Chemistry and Biochemistry, University of Arizona, Tucson, AZ, USA
| | - Chiu-Hsieh Hsu
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Denise J Roe
- University of Arizona Cancer Center, University of Arizona, Tucson, AZ, USA. ; Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Eugene W Gerner
- Department of Cellular and Molecular Medicine, University of Arizona, Tucson, AZ, USA
| | - Natalia A Ignatenko
- University of Arizona Cancer Center, University of Arizona, Tucson, AZ, USA. ; Department of Cellular and Molecular Medicine, University of Arizona, Tucson, AZ, USA
| | - Jennifer K Barton
- Department of Biomedical Engineering, University of Arizona, Tucson, AZ, USA. ; College of Optical Sciences, University of Arizona, Tucson, AZ, USA. ; University of Arizona Cancer Center, University of Arizona, Tucson, AZ, USA
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Lee J, Jeon JY, Meyerhardt JA. Diet and lifestyle in survivors of colorectal cancer. Hematol Oncol Clin North Am 2015; 29:1-27. [PMID: 25475570 DOI: 10.1016/j.hoc.2014.09.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Much research supports the association between diet and lifestyle in the development of colorectal cancer. Recent studies have demonstrated an association between various energy balance host factors (obesity, physical inactivity, and certain dietary factors) and outcomes. This review summarizes the impact of modifiable lifestyle factors, including prediagnosis and postdiagnosis adiposity, physical activity, and diet, on the prognosis of patients with colorectal cancer. The article focuses on associations of these factors in survivors of stage I to III colorectal cancer, and summarizes the possible mechanisms for the association between modifiable lifestyle factors and the prognosis of patients with colorectal cancer.
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Affiliation(s)
- Junga Lee
- Exercise Medicine Center for Cancer and Diabetes Patients, Department of Sport and Leisure Studies, 50 Yonsei-ro, Yonsei University, Seoul 120-749, Korea
| | - Justin Y Jeon
- Exercise Medicine Center for Cancer and Diabetes Patients, Department of Sport and Leisure Studies, 50 Yonsei-ro, Yonsei University, Seoul 120-749, Korea
| | - Jeffrey A Meyerhardt
- Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA.
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Vargas AJ, Ashbeck EL, Wertheim BC, Wallace RB, Neuhouser ML, Thomson CA, Thompson PA. Dietary polyamine intake and colorectal cancer risk in postmenopausal women. Am J Clin Nutr 2015; 102:411-9. [PMID: 26135350 PMCID: PMC4515861 DOI: 10.3945/ajcn.114.103895] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 06/01/2015] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Putrescine, spermidine, and spermine (i.e., polyamines) are small cationic amines synthesized by cells or acquired from the diet or gut bacteria. Polyamines are required for both normal and colorectal cancer (CRC) cell growth. OBJECTIVE We investigated the association between dietary polyamines and risk of CRC incidence and mortality. DESIGN The study was a prospective analysis in 87,602 postmenopausal women in the Women's Health Initiative Observational Study. Multivariate Cox regression was used to calculate HRs and 95% CIs. RESULTS Total dietary polyamine intake (mean ± SD: 289.2 ± 127.4 μmol/d) was not positively associated with CRC in fully adjusted models. Instead, intake ≥179.67 μmol/d was associated with reduced risk of CRC [HR (95% CI): 0.82 (0.68, 1.00), 0.81 (0.66, 0.99), 0.91 (0.74, 1.12), and 0.80 (0.62, 1.02) for quintiles 2-5, respectively, compared with quintile 1]. Reduced risk was not significant across all quintiles. Polyamines were not significantly associated with CRC-specific mortality in fully adjusted models. When stratified by risk factors for CRC, only body mass index (BMI) and fiber intake significantly modified the association between polyamine intake and CRC. In women with BMI (in kg/m²) ≤25 or fiber consumption above the median, polyamine intake was associated with significantly lower risk of CRC. CONCLUSIONS No positive association between dietary polyamines and CRC or CRC-specific mortality risk in women was observed. Instead, a protective effect of dietary polyamines was suggested in women with some CRC risk-lowering behaviors in particular. These results are consistent with emerging evidence that exogenous polyamines may be beneficial in colon health and warrant additional study.
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Affiliation(s)
| | | | | | - Robert B Wallace
- University of Iowa College of Public Health, University of Iowa, Iowa City, IA; and
| | - Marian L Neuhouser
- Cancer Prevention Program, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Cynthia A Thomson
- Departments of Nutritional Sciences, College of Public Health, The University of Arizona, Tucson, AZ; The University of Arizona Cancer Center, Tucson, AZ
| | - Patricia A Thompson
- Departments of Nutritional Sciences, Molecular and Cellular Biology, and The University of Arizona Cancer Center, Tucson, AZ
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20
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Holcombe RF, Martinez M, Planutis K, Planutiene M. Effects of a grape-supplemented diet on proliferation and Wnt signaling in the colonic mucosa are greatest for those over age 50 and with high arginine consumption. Nutr J 2015; 14:62. [PMID: 26085034 PMCID: PMC4472174 DOI: 10.1186/s12937-015-0050-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 06/10/2015] [Indexed: 12/13/2022] Open
Abstract
A diet rich in fruits and vegetables, and a grape-derived compound, resveratrol, have been linked to a reduced incidence of colon cancer. In vitro and in vivo, resveratrol suppresses Wnt signaling, a pathway constitutively activated in over 85 % of colon cancers. Thirty participants were placed on a low resveratrol diet and subsequently allocated to one of three groups ingesting 1/3-to-1 lb (0.15–0.45 kg) of grapes per day for 2 weeks. Dietary information was collected via 24-h recall. Colon biopsies for biomarker analysis were obtained pre- and post-grape and evaluated for the expression of Wnt pathway target genes and for markers of proliferation by RT-PCR and immunohistochemistry. Participants lost an average of 2 · 6 lb (1.2 kg, p = 0 · 0018) during the period of grape ingestion. The expression of CyclinD1 (p < 0 · 01), AXIN2, CD133 (p = 0 · 02) and Ki67 (p = 0 · 002) were all reduced after grape ingestion. Individuals over 50 years of age and those with high dietary arginine consumption had increased basal expression of CyclinD1, AXIN2, cMYC and CD133 (p value range 0 · 04 to <0 · 001) that, following grape ingestion, were reduced to levels seen in younger participants. The reduction in Wnt signaling and mucosal proliferation seen following short-term ingestion of 1/3–1 lb (0.15–0.45 kg) of grapes per day may reduce the risk of mutational events that can facilitate colon carcinogenesis. The potential benefit is most marked for high-risk older individuals and individuals whose diet is high in arginine intake. Dietary grape supplementation may play a role in colon cancer prevention for high-risk individuals.
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Affiliation(s)
- Randall F Holcombe
- Division of Hematology & Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, One Gustav L. Levy Place, Box 1128, New York, NY, 10029, USA.
| | | | - Kestutis Planutis
- Division of Hematology & Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, One Gustav L. Levy Place, Box 1128, New York, NY, 10029, USA
| | - Marina Planutiene
- Division of Hematology & Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, One Gustav L. Levy Place, Box 1128, New York, NY, 10029, USA
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21
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Vargas AJ, Ashbeck EL, Thomson CA, Gerner EW, Thompson PA. Dietary polyamine intake and polyamines measured in urine. Nutr Cancer 2014; 66:1144-53. [PMID: 25204413 DOI: 10.1080/01635581.2014.949801] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Dietary polyamines have recently been associated with increased risk of pre-malignant colorectal lesions. Because polyamines are synthesized in cells and taken up from dietary sources, development of a biomarker of exposure is challenging. Excess polyamines are primarily excreted in the urine. This pilot study seeks to identify dietary correlates of excreted urinary polyamines as putative biomarkers of exposure. Dietary polyamines/other nutrients were estimated from a food frequency questionnaire (FFQ) and correlated with urinary levels of acetylated polyamines in 36 men using 24-h urine samples. Polyamines, abundant in cheese and citrus, were highly positively correlated with urinary N(8)-acetylspermidine (correlation coefficient; r = 0.37, P = 0.03), but this correlation was attenuated after adjustment for total energy intake (r = 0.07, P = 0.68). Dietary energy intake itself was positively correlated with urinary total acetylated polyamine output (r = .40, P = 0.02). In energy-adjusted analyses, folic acid and folate from food were associated with urinary N(1),N(12)-diacetylspermine (r = 0.34, P = 0.05 and r = -0.39, P = 0.02, respectively). Red meat negatively correlated with total urinary acetylated polyamines (r = -0.42, P = 0.01). Our findings suggest that energy, folate, folic acid, saturated fat, and red meat intake, as opposed to FFQ-estimated dietary polyamines, are correlated with urinary polyamines.
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Affiliation(s)
- Ashley J Vargas
- a Department of Nutritional Sciences , University of Arizona , Tucson , Arizona , USA
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22
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LINSALATA MICHELE, ORLANDO ANTONELLA, RUSSO FRANCESCO. Pharmacological and dietary agents for colorectal cancer chemoprevention: Effects on polyamine metabolism (Review). Int J Oncol 2014; 45:1802-12. [DOI: 10.3892/ijo.2014.2597] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 07/04/2014] [Indexed: 11/06/2022] Open
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Dietary lifestyle and colorectal cancer onset, recurrence, and survival: myth or reality? J Gastrointest Cancer 2013; 44:1-11. [PMID: 22878898 DOI: 10.1007/s12029-012-9425-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND PURPOSE Interest in the possibility that diet might help to reduce the risk of colorectal cancer dates back to 1970 based on both the large variation in rates of specific cancers in different countries and the impressive changes observed in the incidence of cancer in migrants from low- to high-risk areas. Here, we report the state of art of literature data about this topic. METHODS Three sections have been separately considered: chemoprevention of first tumor onset, chemoprevention of recurrence after surgery, and chemoprevention of polyp recurrence in the course of the follow-up of subjects with elevated risk. A particular attention has been pointed to dietary factors and survival, whose relevance is showing a growing interest. RESULTS The relationship between diet and colorectal cancer has been extensively studied about the onset, sometimes with controversial results. Its influence on recurrence and survival has been examined in only few studies. CONCLUSIONS Literature data are convincing for a protective role on the onset of preneoplastic and neoplastic lesions for some foods such as fibers, vitamin A and D, folic acid, calcium, antioxidants, and promising perspectives for some substances such as phyto-estrogens. Less evidence-based data are available on the possibility to avoid the recurrence of the disease or to affect its mortality with dietary habits. Future perspectives will be directed be not only to identify new dietary style able to prevent the onset of neoplastic lesion of the colon but also to realize an effective chemoprevention.
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van Meer S, Leufkens AM, Bueno-de-Mesquita HB, van Duijnhoven FJB, van Oijen MGH, Siersema PD. Role of dietary factors in survival and mortality in colorectal cancer: a systematic review. Nutr Rev 2013; 71:631-41. [PMID: 24032367 DOI: 10.1111/nure.12042] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The role of dietary factors in the outcome of colorectal cancer (CRC) has been the subject of many studies, but results are inconclusive. Presented here are the results of a systematic review of studies published on dietary factors and CRC outcome in the English literature between March 2002 and March 2012. Studies were subdivided into survival studies in CRC patients and CRC mortality studies in the general population. Sixteen of the 636 studies identified--5 on survival and 11 on mortality--met the predefined inclusion criteria. No consistent association between individual dietary components and CRC outcome was detected in the survival studies. In the mortality studies, an association between meat intake and increased CRC mortality was found in two ecologic studies; however, two prospective cohort studies did not confirm this association. An inverse association between cereal intake and CRC mortality was found in two ecologic studies. In conclusion, published studies investigating dietary factors and outcome in CRC are heterogeneous in design and findings. No dietary component was conclusively and consistently associated with survival in CRC patients. The results of mortality studies seem to indicate that meat intake has an adverse effect on CRC mortality, while cereal intake may be protective.
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Affiliation(s)
- Suzanne van Meer
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
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25
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McCullough ML, Gapstur SM, Shah R, Jacobs EJ, Campbell PT. Association between red and processed meat intake and mortality among colorectal cancer survivors. J Clin Oncol 2013; 31:2773-82. [PMID: 23816965 DOI: 10.1200/jco.2013.49.1126] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
PURPOSE Red and processed meat intake is convincingly associated with colorectal cancer (CRC) incidence, but its impact on prognosis after CRC diagnosis is unknown. We examined associations of red and processed meat consumption, self-reported before and after cancer diagnosis, with all-cause and cause-specific mortality among men and women with invasive, nonmetastatic CRC. PATIENTS AND METHODS Participants in the Cancer Prevention Study II Nutrition Cohort reported information on diet and other factors at baseline in 1992-1993, 1999, and 2003. Participants with a verified CRC diagnosis after baseline and up to June 30, 2009, were observed for mortality through December 31, 2010. RESULTS Among 2,315 participants diagnosed with CRC, 966 died during follow-up (413 from CRC and 176 from cardiovascular disease [CVD]). In multivariable-adjusted Cox proportional hazards regression models, red and processed meat intake before CRC diagnosis was associated with higher risks of death as a result of all causes (top v bottom quartile, relative risk [RR], 1.29; 95% CI, 1.05 to 1.59; Ptrend = .03) and from CVD (RR, 1.63; 95% CI, 1.00 to 2.67; Ptrend = .08) but not CRC (RR, 1.09; 95% CI, 0.79 to 1.51; Ptrend = 0.54). Although red and processed meat consumption after CRC diagnosis was not associated with mortality, survivors with consistently high (median or higher) intakes before and after diagnosis had a higher risk of CRC-specific mortality (RR, 1.79; 95% CI, 1.11 to 2.89) compared with those with consistently low intakes. CONCLUSION This study suggests that greater red and processed meat intake before diagnosis is associated with higher risk of death among patients with nonmetastatic CRC.
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Affiliation(s)
- Marjorie L McCullough
- Epidemiology Research Program, American Cancer Society, Atlanta, GA 30303-1002, USA.
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26
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Mohammed A, Janakiram NB, Brewer M, Vedala K, Steele VE, Rao CV. Multitargeted low-dose GLAD combination chemoprevention: a novel and promising approach to combat colon carcinogenesis. Neoplasia 2013; 15:481-90. [PMID: 23633920 PMCID: PMC3638351 DOI: 10.1593/neo.13282] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2013] [Revised: 02/12/2013] [Accepted: 02/15/2013] [Indexed: 01/01/2023]
Abstract
Preclinical studies have shown that gefitinib, licofelone, atorvastatin, and α-difluoromethylornithine (GLAD) are promising colon cancer chemopreventive agents. Because low-dose combination regimens can offer potential additive or synergistic effects without toxicity, GLAD combination was tested for toxicity and chemopreventive efficacy for suppression of intestinal tumorigenesis in adenomatous polyposis coli (APC)(Min/+) mice. Six-week-old wild-type and APC(Min/+) mice were fed modified American Institute of Nutrition 76A diets with or without GLAD (25 + 50 + 50 + 500 ppm) for 14 weeks. Dietary GLAD caused no signs of toxicity based on organ pathology and liver enzyme profiles. GLAD feeding strongly inhibited (80-83%, P < .0001) total intestinal tumor multiplicity and size in APC(Min/+) mice (means ± SEM tumors for control vs GLAD were 67.1 ± 5.4 vs. 11.3 ± 1.1 in males and 72.3 ± 8.9 vs 14.5 ± 2.8 in females). Mice fed GLAD had >95% fewer polyps with sizes of >2 mm compared with control mice and showed 75% and 85% inhibition of colonic tumors in males and females, respectively. Molecular analyses of polyps suggested that GLAD exerts efficacy by inhibiting cell proliferation, inducing apoptosis, decreasing β-catenin and caveolin-1 levels, increasing caspase-3 cleavage and p21, and modulating expression profile of inflammatory cytokines. These observations demonstrate that GLAD, a novel cocktail of chemopreventive agents at very low doses, suppresses intestinal tumorigenesis in APC(Min/+) mice with no toxicity. This novel strategy to prevent colorectal cancer is an important step in developing agents with high efficacy without unwanted side effects.
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Affiliation(s)
- Altaf Mohammed
- Center for Cancer Prevention and Drug Development, Hematology-Oncology Section, Department of Medicine, PC Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
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Abstract
Adenomatous polyposis coli (APC) is best known for its crucial role in colorectal cancer suppression. Rodent models with various Apc mutations have enabled experimental validation of different Apc functions in tumors and normal tissues. Since the development of the first mouse model with a germline Apc mutation in the early 1990s, 20 other Apc mouse and rat models have been generated. This article compares and contrasts currently available Apc rodent models with particular emphasis on providing potential explanations for their reported variation in three areas: (i) intestinal polyp multiplicity, (ii) intestinal polyp distribution, and (iii) extraintestinal phenotypes.
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Affiliation(s)
- Maged Zeineldin
- Department of Molecular Biosciences, University of Kansas, 1200 Sunnyside Ave. Lawrence, KS 66045 USA
| | - Kristi L. Neufeld
- Department of Molecular Biosciences, University of Kansas, 1200 Sunnyside Ave. Lawrence, KS 66045 USA
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28
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Raj KP, Zell JA, Rock CL, McLaren CE, Zoumas-Morse C, Gerner EW, Meyskens FL. Role of dietary polyamines in a phase III clinical trial of difluoromethylornithine (DFMO) and sulindac for prevention of sporadic colorectal adenomas. Br J Cancer 2013; 108:512-8. [PMID: 23340449 PMCID: PMC3593561 DOI: 10.1038/bjc.2013.15] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background: The polyamine-inhibitory regimen difluoromethylornithine (DFMO)+sulindac has marked efficacy in preventing metachronous colorectal adenomas. Polyamines are synthesised endogenously and obtained from dietary sources. Here we investigate dietary polyamine intake and outcomes in the DFMO+sulindac colorectal adenoma prevention trial. Methods: Dietary polyamine data were available for 188 of 267 patients completing the study. Total dietary polyamine content was derived by the sum of dietary putrescine, spermine and spermidine values and categorised into two groups: highest (>75–100%) vs the lower three quartiles (0–25, 25–50 and 50–75%). Baseline tissue polyamine concentration and ODC1 genotype were determined. Logistic regression models were used for risk estimation. Results: A significant interaction was detected between dietary polyamine group and treatment with regard to adenoma recurrence (P=0.012). Significant metachronous adenoma risk reduction was observed after DFMO+sulindac treatment in dietary polyamine quartiles 1–3 (risk ratio (RR) 0.19; 95% confidence interval (CI) 0.08–0.42; P<0.0001) but not in quartile 4 (RR 1.51; 95% CI 0.53–4.29; P=0.44). However, a lower number of events in the placebo group within dietary quartile 4 confound the aforementioned risk estimates. Conclusion: These preliminary findings reveal complex relationships between diet and therapeutic prevention, and they support further clinical trial-based investigations where the dietary intervention itself is controlled.
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Affiliation(s)
- K P Raj
- Chao Family Comprehensive Cancer Center, University of California, Irvine, CA 92697, USA
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29
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Zell JA, Lin BS, Ziogas A, Anton-Culver H. Meat consumption, ornithine decarboxylase gene polymorphism, and outcomes after colorectal cancer diagnosis. J Carcinog 2012; 11:17. [PMID: 23233821 PMCID: PMC3516190 DOI: 10.4103/1477-3163.104004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Accepted: 09/16/2012] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Dietary arginine and meat consumption are implicated in colorectal cancer (CRC) progression via polyamine-dependent processes. Polymorphism in the polyamine-regulatory gene, ornithine decarboxylase 1 (Odc1, rs2302615) is prognostic for CRC-specific mortality. Here, we examined joint effects of meat consumption and Odc1 polymorphism on CRC-specific mortality. MATERIALS AND METHODS The analytic cohort was comprised of 329 incident stage I-III CRC cases diagnosed 1994-1996 with follow- up through March 2008. Odc1 genotyping was conducted using primers that amplify a 172-bp fragment containing the polymorphic base at +316. Dietary questionnaires were administered at cohort entry. Multivariate Cox proportional hazards regression analysis for CRC-specific mortality was stratified by tumor, node, metastasis (TNM) stage, and adjusted for clinically relevant variables, plus meat consumption (as a continuous variable, i.e., the number of medium-sized servings/week), Odc1 genotype, and a term representing the meat consumption and Odc1 genotype interaction. The primary outcome was the interaction of Odc1 and meat intake on CRC-specific mortality, as assessed by departures from multiplicative joint effects. RESULTS Odc1 genotype distribution was 51% GG, 49% GA/AA. In the multivariate model, there was a significant interaction between meat consumption and Odc1 genotype, P-int = 0.01. Among Odc1 GA/AA CRC cases in meat consumption Quartiles 1-3, increased mortality risk was observed when compared to GG cases (adjusted hazards ratio (HR) = 7.06 [95% CI 2.34-21.28]) - a difference not found among cases in the highest dietary meat consumption Quartile 4. CONCLUSIONS Effects of meat consumption on CRC-specific mortality risk differ based on genetic polymorphism at Odc1. These results provide further evidence that polyamine metabolism and its modulation by dietary factors such as meat may have relevance to CRC outcomes.
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Affiliation(s)
- Jason A Zell
- Department of Epidemiology, California, University of California, USA ; Genetic Epidemiology Research Institute, University of California, Irvine, California, USA ; Chao Family Comprehensive Cancer Center, University of California, Irvine, California, USA ; Division of Hematology/Oncology, University of California, Irvine, California, USA
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30
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Vargas AJ, Wertheim BC, Gerner EW, Thomson CA, Rock CL, Thompson PA. Dietary polyamine intake and risk of colorectal adenomatous polyps. Am J Clin Nutr 2012; 96:133-41. [PMID: 22648715 PMCID: PMC3374737 DOI: 10.3945/ajcn.111.030353] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Putrescine, spermidine, and spermine are the polyamines required for human cell growth. The inhibition of ornithine decarboxylase (ODC), which is the rate-limiting enzyme of polyamine biosynthesis, decreases tumor growth and the development of colorectal adenomas. A database was developed to estimate dietary polyamine exposure and relate exposure to health outcomes. OBJECTIVE We hypothesized that high polyamine intake would increase risk of colorectal adenoma and that the allelic variation at ODC G>A +316 would modify the association. DESIGN Polyamine exposure was estimated in subjects pooled (n = 1164) from the control arms of 2 randomized trials for colorectal adenoma prevention [Wheat Bran Fiber low-fiber diet arm (n = 585) and Ursodeoxycholic Acid placebo arm (n = 579)] by using baseline food-frequency questionnaire data. All subjects had to have a diagnosis of colorectal adenoma to be eligible for the trial. RESULTS A dietary intake of polyamines above the median amount in the study population was associated with 39% increased risk of colorectal adenoma at follow-up (adjusted OR: 1.39; 95% CI: 1.06, 1.83) in the pooled sample. In addition, younger participants (OR: 1.94; 95% CI: 1.23, 3.08), women (OR: 2.43; 95% CI: 1.48, 4.00), and ODC GG genotype carriers (OR: 1.59; 95% CI: 1.00, 2.53) had significantly increased odds of colorectal adenoma if they consumed above-median polyamine amounts. CONCLUSIONS This study showed a role for dietary polyamines in colorectal adenoma risk. Corroboration of these findings would confirm a previously unrecognized, modifiable dietary risk factor for colorectal adenoma.
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Affiliation(s)
- Ashley J Vargas
- Department of Nutritional Sciences, University of Arizona, Tucson, AZ, USA.
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Ignatenko NA, Gerner EW, Besselsen DG. Defining the role of polyamines in colon carcinogenesis using mouse models. J Carcinog 2011; 10:10. [PMID: 21712957 PMCID: PMC3122100 DOI: 10.4103/1477-3163.79673] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Accepted: 02/05/2011] [Indexed: 12/05/2022] Open
Abstract
Genetics and diet are both considered important risk determinants for colorectal cancer, a leading cause of death in the US and worldwide. Genetically engineered mouse (GEM) models have made a significant contribution to the characterization of colorectal cancer risk factors. Reliable, reproducible, and clinically relevant animal models help in the identification of the molecular events associated with disease progression and in the development of effictive treatment strategies. This review is focused on the use of mouse models for studying the role of polyamines in colon carcinogenesis. We describe how the available mouse models of colon cancer such as the multiple intestinal neoplasia (Min) mice and knockout genetic models facilitate understanding of the role of polyamines in colon carcinogenesis and help in the development of a rational strategy for colon cancer chemoprevention.
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Affiliation(s)
- Natalia A Ignatenko
- Department of Cell Biology and Anatomy, Arizona Cancer Center, 1515 N. Campbell Ave., Tucson, Arizona 85724, USA
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Zell JA. Clinical trials update: Tertiary prevention of colorectal cancer. J Carcinog 2011; 10:8. [PMID: 21483656 PMCID: PMC3072658 DOI: 10.4103/1477-3163.78271] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2011] [Accepted: 02/15/2011] [Indexed: 12/19/2022] Open
Affiliation(s)
- Jason A Zell
- Department of Medicine and Epidemiology, School of Medicine, Chao Family Comprehensive Cancer Center, University of California, Irvine, CA 92697, USA
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Abstract
Polyamines are organic cations shown to control gene expression at the transcriptional, posttranscriptional, and translational levels. Multiple cellular oncogenic pathways are involved in regulation of transcription and translation of polyamine-metabolizing enzymes. As a consequence of genetic alterations, expression levels and activities of polyamine-metabolizing enzymes change rapidly during tumorigenesis resulting in high levels of polyamines in many human epithelial tumors. This review summarizes the mechanisms of polyamine regulation by canonical tumor suppressor genes and oncogenes, as well as the role of eukaryotic initiation factor 5A (EIF5A) in cancer. The importance of research utilizing pharmaceutical inhibitors and cancer chemopreventive strategies targeting the polyamine pathway is also discussed.
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Affiliation(s)
- Edwin A Paz
- Cancer Biology Interdisciplinary Graduate Program, Arizona Cancer Center, University of Arizona, Tucson, Arizona, USA
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Vrieling A, Kampman E. The role of body mass index, physical activity, and diet in colorectal cancer recurrence and survival: a review of the literature. Am J Clin Nutr 2010. [DOI: 10.3945/ajcn.2009.29005] [Citation(s) in RCA: 104] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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Zell JA, Ziogas A, Bernstein L, Clarke CA, Deapen D, Largent JA, Neuhausen SL, Stram DO, Ursin G, Anton-Culver H. Meat consumption, nonsteroidal anti-inflammatory drug use, and mortality among colorectal cancer patients in the California Teachers Study. Cancer Prev Res (Phila) 2010; 3:865-75. [PMID: 20551290 DOI: 10.1158/1940-6207.capr-09-0262] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
A low-meat diet and regular use of nonsteroidal anti-inflammatory drugs (NSAID) have been associated with decreased mortality among colorectal cancer (CRC) patients. Here, we investigated the association between prediagnosis usual meat consumption and CRC-specific mortality, and whether meat consumption modifies the previously noted association between NSAID use and CRC-specific mortality among women in the California Teachers Study cohort. Women joining the California Teachers Study in 1995-1996 without prior CRC diagnosis, diagnosed with incident CRC during follow-up through December 2007, were eligible for inclusion. Meat intake (frequency and serving size) and NSAID use (aspirin or ibuprofen use) were ascertained via self-administered questionnaires before diagnosis. Vital status and cause of death were determined by linkage with mortality files. Multivariable Cox proportional hazards regression models were used to estimate hazard ratios for death and 95% confidence intervals. Prediagnosis meat consumption was not associated with CRC-specific mortality among 704 CRC patients (and 201 CRC-specific deaths), comparing patients in the lowest consumption tertile (0-5.4 medium-sized servings/wk) to those in the higher consumption tertiles. Regular NSAID use (1-3 times/wk, 4-6 times/wk, daily) versus none was associated with decreased CRC-specific mortality among patients in the lowest meat consumption tertile (hazard ratio, 0.22; 95% CI, 0.06-0.82), but not among patients in the higher meat intake tertiles. The previously observed mortality risk reduction among female CRC patients associated with regular NSAID use was restricted to patients who reported low meat intake before diagnosis. These findings have implications for CRC survivorship and tertiary CRC prevention.
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Affiliation(s)
- Jason A Zell
- Genetic Epidemiology Research Institute, Department of Epidemiology, University of California at Irvine, 92697, USA.
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Zell JA, Ziogas A, Bernstein L, Clarke CA, Deapen D, Largent JA, Neuhausen SL, Stram DO, Ursin G, Anton-Culver H. Nonsteroidal anti-inflammatory drugs: effects on mortality after colorectal cancer diagnosis. Cancer 2010; 115:5662-71. [PMID: 19827153 DOI: 10.1002/cncr.24705] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Nonsteroidal anti-inflammatory drug (NSAID) use has been associated with a decreased colorectal cancer (CRC) risk. However, to the best of the authors' knowledge, the effects of NSAID on clinical outcomes after CRC diagnosis are not well defined. The authors investigated the association between prediagnosis NSAID use and mortality after CRC diagnosis among women in the California Teachers Study cohort. METHODS Women aged <85 years participating in the California Teachers Study, without a prior CRC diagnosis at baseline (1995-1996), and who were diagnosed with CRC during follow-up through December 2005, were eligible for analysis of the association between prediagnosis NSAID use and mortality. NSAID use (including aspirin and ibuprofen) was collected through a self-administered questionnaire. Cancer occurrence was identified through California Cancer Registry linkage. Multivariate Cox proportional hazards regression models were used to estimate hazards ratios (HR) for death and 95% confidence intervals (95% CIs). RESULTS Among 621 CRC patients who were identified, 64% reported no prediagnosis regular NSAID use, 17% reported use of 1 to 6 days/week, and 20% reported daily use. A duration of NSAID use <5 years was reported by 17% of patients and a use of >or=5 years was reported by 18%. Regular prediagnosis NSAID use (1-3 days/week, 4-6 days/week, and daily) versus none was associated with improved overall survival (OS) (HR, 0.71; 95% CI, 0.53-0.95) and CRC-specific survival (HR, 0.58; 95% CI 0.40-0.84) after adjustment for clinically relevant factors. Prediagnosis NSAID use >or=5 years (vs none) was found to be associated with improved OS (HR, 0.55; 95% CI, 0.37-0.84) and CRC-specific survival (HR, 0.40; 95% CI, 0.23-0.71) in adjusted analyses. CONCLUSIONS When used regularly or over a prolonged duration before CRC diagnosis, NSAIDs are associated with decreased mortality among female CRC patients.
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Affiliation(s)
- Jason A Zell
- Genetic Epidemiology Research Institute and Department of Epidemiology, University of California at Irvine, Irvine, California 92697-7550, USA.
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Polyamines as mediators of APC-dependent intestinal carcinogenesis and cancer chemoprevention. Essays Biochem 2009; 46:111-24. [PMID: 20095973 DOI: 10.1042/bse0460008] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Combination chemoprevention for cancer was proposed a quarter of a century ago, but has not been implemented in standard medical practice owing to limited efficacy and toxicity. Recent trials have targeted inflammation and polyamine biosynthesis, both of which are increased in carcinogenesis. Preclinical studies have demonstrated that DFMO (difluoromethylornithine), an irreversible inhibitor of ODC (ornithine decarboxylase) which is the first enzyme in polyamine biosynthesis, combined with NSAIDs (non-steroidal anti-inflammatory drugs) suppresses colorectal carcinogenesis in murine models. The preclinical rationale for combination chemoprevention with DFMO and the NSAID sulindac, was strengthened by the observation that a SNP (single nucleotide polymorphism) in the ODC promoter was prognostic for adenoma recurrence in patients with prior sporadic colon polyps and predicted reduced risk of adenoma in those patients taking aspirin. Recent results from a phase III clinical trial showed a dramatic reduction in metachronous adenoma number, size and grade. Combination chemoprevention with DFMO and sulindac was not associated with any serious toxicity. A non-significant trend in subclinical ototoxicity was detected by quantitative audiology in a subset of patients identified by a genetic marker. These preclinical, translational and clinical data provide compelling evidence for the efficacy of combination chemoprevention. DFMO and sulindac is a rational strategy for the prevention of metachronous adenomas, especially in patients with significant risk for colorectal cancer. Toxicities from this combination may be limited to subsets of patients identified by either past medical history or clinical tests.
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Zell JA, Ziogas A, Ignatenko N, Honda J, Qu N, Bobbs AS, Neuhausen SL, Gerner EW, Anton-Culver H. Associations of a polymorphism in the ornithine decarboxylase gene with colorectal cancer survival. Clin Cancer Res 2009; 15:6208-16. [PMID: 19789310 DOI: 10.1158/1078-0432.ccr-09-0592] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Activity of ornithine decarboxylase (ODC), the first enzyme in polyamine synthesis, is required for normal growth and is elevated in many cancers, including colorectal cancer. We examined associations of the +316 ODC1 single nucleotide polymorphism (SNP) with colorectal cancer-specific survival among colorectal cancer cases, and then investigated its functional significance in colon cancer cells. EXPERIMENTAL DESIGN The study included 400 incident stage I-III colorectal cancer cases from the population-based University of California Irvine Gene-Environment Study of Familial Colorectal Cancer (diagnosed from 1994 to 1996 with follow-up through March 2008). The primary outcome was colorectal cancer-specific survival dependent on ODC1 (rs2302615) genotype (GG versus GA/AA). In human colon cancer cell lines, ODC1 allele-specific binding of E-box transcription factors was determined via Western blotting and chromatin immunoprecipitation assays. ODC1 allele-specific promoter activity was determined using promoter constructs in combination with vectors expressing either the transcriptional activator c-MYC or the repressor MAD1. RESULTS Genotype-specific survival differences were observed among colorectal cancer cases: compared with cases with the ODC1 GG genotype (hazards ratio, 1; reference) the adjusted colorectal cancer-specific survival hazards ratio was 2.02 (95% confidence interval, 1.17-3.50) for ODC1 GA/AA cases (P = 0.012). In colon cancer cells, the ODC1 SNP, flanked by two E-boxes, predicts ODC1 promoter activity. The E-box activator c-MYC and repressors MAD1 and MAD4 preferentially bind to ODC1 minor A-alleles, compared with major G-alleles, in cultured cells. CONCLUSIONS These results have implications for conditional regulation of polyamine homeostasis and suggest a model in which the ODC1 SNP may be protective for colon adenoma recurrence and detrimental for survival after colon cancer diagnosis.
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Affiliation(s)
- Jason A Zell
- Department of Epidemiology, University of California, Irvine, California 92697, USA.
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Verginelli F, Bishehsari F, Napolitano F, Mahdavinia M, Cama A, Malekzadeh R, Miele G, Raiconi G, Tagliaferri R, Mariani-Costantini R. Transitions at CpG dinucleotides, geographic clustering of TP53 mutations and food availability patterns in colorectal cancer. PLoS One 2009; 4:e6824. [PMID: 19718455 PMCID: PMC2730577 DOI: 10.1371/journal.pone.0006824] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2009] [Accepted: 07/14/2009] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Colorectal cancer is mainly attributed to diet, but the role exerted by foods remains unclear because involved factors are extremely complex. Geography substantially impacts on foods. Correlations between international variation in colorectal cancer-associated mutation patterns and food availabilities could highlight the influence of foods on colorectal mutagenesis. METHODOLOGY To test such hypothesis, we applied techniques based on hierarchical clustering, feature extraction and selection, and statistical pattern recognition to the analysis of 2,572 colorectal cancer-associated TP53 mutations from 12 countries/geographic areas. For food availabilities, we relied on data extracted from the Food Balance Sheets of the Food and Agriculture Organization of the United Nations. Dendrograms for mutation sites, mutation types and food patterns were constructed through Ward's hierarchical clustering algorithm and their stability was assessed evaluating silhouette values. Feature selection used entropy-based measures for similarity between clusterings, combined with principal component analysis by exhaustive and heuristic approaches. CONCLUSION/SIGNIFICANCE Mutations clustered in two major geographic groups, one including only Western countries, the other Asia and parts of Europe. This was determined by variation in the frequency of transitions at CpGs, the most common mutation type. Higher frequencies of transitions at CpGs in the cluster that included only Western countries mainly reflected higher frequencies of mutations at CpG codons 175, 248 and 273, the three major TP53 hotspots. Pearson's correlation scores, computed between the principal components of the datamatrices for mutation types, food availability and mutation sites, demonstrated statistically significant correlations between transitions at CpGs and both mutation sites and availabilities of meat, milk, sweeteners and animal fats, the energy-dense foods at the basis of "Western" diets. This is best explainable by differential exposure to nitrosative DNA damage due to foods that promote metabolic stress and chronic inflammation.
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Affiliation(s)
- Fabio Verginelli
- Department of Oncology and Neurosciences, “G. d'Annunzio” University, and Center of Excellence on Aging (CeSI), “G. d'Annunzio” University Foundation, Chieti, Italy
| | - Faraz Bishehsari
- Department of Oncology and Neurosciences, “G. d'Annunzio” University, and Center of Excellence on Aging (CeSI), “G. d'Annunzio” University Foundation, Chieti, Italy
- Digestive Disease Research Center (DDRC), Shariati Hospital, University of Tehran, Tehran, Iran
| | - Francesco Napolitano
- Department of Mathematics and Informatics, University of Salerno, Salerno, Italy
| | - Mahboobeh Mahdavinia
- Department of Oncology and Neurosciences, “G. d'Annunzio” University, and Center of Excellence on Aging (CeSI), “G. d'Annunzio” University Foundation, Chieti, Italy
- Digestive Disease Research Center (DDRC), Shariati Hospital, University of Tehran, Tehran, Iran
| | - Alessandro Cama
- Department of Oncology and Neurosciences, “G. d'Annunzio” University, and Center of Excellence on Aging (CeSI), “G. d'Annunzio” University Foundation, Chieti, Italy
| | - Reza Malekzadeh
- Digestive Disease Research Center (DDRC), Shariati Hospital, University of Tehran, Tehran, Iran
| | - Gennaro Miele
- Department of Physical Sciences, University of Naples, Naples, Italy
| | - Giancarlo Raiconi
- Department of Mathematics and Informatics, University of Salerno, Salerno, Italy
| | - Roberto Tagliaferri
- Department of Mathematics and Informatics, University of Salerno, Salerno, Italy
| | - Renato Mariani-Costantini
- Department of Oncology and Neurosciences, “G. d'Annunzio” University, and Center of Excellence on Aging (CeSI), “G. d'Annunzio” University Foundation, Chieti, Italy
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Khatami M. Inflammation, aging, and cancer: tumoricidal versus tumorigenesis of immunity: a common denominator mapping chronic diseases. Cell Biochem Biophys 2009; 55:55-79. [PMID: 19672563 DOI: 10.1007/s12013-009-9059-2] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2009] [Accepted: 06/30/2009] [Indexed: 12/18/2022]
Abstract
Acute inflammation is a highly regulated defense mechanism of immune system possessing two well-balanced and biologically opposing arms termed apoptosis ('Yin') and wound healing ('Yang') processes. Unresolved or chronic inflammation (oxidative stress) is perhaps the loss of balance between 'Yin' and 'Yang' that would induce co-expression of exaggerated or 'mismatched' apoptotic and wound healing factors in the microenvironment of tissues ('immune meltdown'). Unresolved inflammation could initiate the genesis of many age-associated chronic illnesses such as autoimmune and neurodegenerative diseases or tumors/cancers. In this perspective 'birds' eye' view of major interrelated co-morbidity risk factors that participate in biological shifts of growth-arresting ('tumoricidal') or growth-promoting ('tumorigenic') properties of immune cells and the genesis of chronic inflammatory diseases and cancer will be discussed. Persistent inflammation is perhaps a common denominator in the genesis of nearly all age-associated health problems or cancer. Future challenging opportunities for diagnosis, prevention, and/or therapy of chronic illnesses will require an integrated understanding and identification of developmental phases of inflammation-induced immune dysfunction and age-associated hormonal and physiological readjustments of organ systems. Designing suitable cohort studies to establish the oxido-redox status of adults may prove to be an effective strategy in assessing individual's health toward developing personal medicine for healthy aging.
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Affiliation(s)
- Mahin Khatami
- The National Cancer Institute, The National Institutes of Health, Bethesda, MD, USA.
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Gerner EW, Meyskens FL. Combination chemoprevention for colon cancer targeting polyamine synthesis and inflammation. Clin Cancer Res 2009; 15:758-61. [PMID: 19188144 DOI: 10.1158/1078-0432.ccr-08-2235] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Increased polyamine synthesis and inflammation have long been associated with colon carcinogenesis in both preclinical models and in humans. Recent experimental studies suggest that polyamines may be mechanistically involved in colonic inflammatory processes. Genetic epidemiology results indicate that a single nucleotide polymorphism influencing the expression of a polyamine biosynthetic gene is associated with both risk of colon polyp occurrence and recurrence, and the response to aspirin as a polyp preventive agent. A prospective, randomized, placebo-controlled clinical trial of combination difluoromethylornithine, a selective inhibitor of polyamine synthesis, and sulindac, a nonsteroidal anti-inflammatory drug, found that the 3-year treatment was associated with a 70% reduction of recurrence of all adenomas, and over a 90% reduction of recurrence of advanced and/or multiple adenomas, without evidence of serious toxicities. This proof-of-principle trial indicates that targeting polyamine synthesis and inflammation can be an effective strategy for preventing the occurrence of the advanced and/or multiple adenomas that are most closely associated with the development of colon cancers in humans.
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Affiliation(s)
- Eugene W Gerner
- The University of Arizona, Arizona Cancer Center, Tucson, Arizona 85724, USA.
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Serebruany VL. Aggressive chronic platelet inhibition with prasugrel and increased cancer risks: revising oral antiplatelet regimens? Fundam Clin Pharmacol 2009; 23:411-7. [PMID: 19500152 DOI: 10.1111/j.1472-8206.2009.00710.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The TRITON-TIMI 38 was a head-to-head trial to assess the efficacy and safety of the experimental antiplatelet agent prasugrel vs. standard care with clopidogrel on top of aspirin. Besides some ischemic protection at expense of overwhelming bleeding disadvantage, prasugrel treated patients experienced three times higher rate of colonic neoplasms then after clopidogrel, and this difference was significant. Importantly, known gastrointestinal bleeding preceded the diagnosis of colonic neoplasms only in half of the patients. Three potential mechanisms responsible for such harmful association are reviewed, namely: (i) direct hazard of the experimental drug on cancer occurrence and progression; (ii) indirect modulation of tumor growth; and (iii) enhanced metastatic dissemination due to instability of platelet-tumor cell aggregates, or/and inability to keep the disease locally due by much more potent long-term platelet inhibition should be considered. Significant excess of cancer after prasugrel is alarming, and can be reasonably explained, with critical clinical implications not only for prasugrel further development, but also for existing and future chronic antiplatelet strategies. If the hypothesis that oral aggressive platelet inhibition cause higher cancer risks will turn out to be true, then intensity of platelet inhibition, and especially duration of chronic antiplatelet therapy should be reconsidered. More delicate platelet inhibition, and shorter exposure to oral antiplatelet agents will prevail.
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Affiliation(s)
- Victor L Serebruany
- HeartDrug Research Laboratories, Johns Hopkins University, Osler Medical Building, Towson, 21204 MD, USA.
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Ignatenko NA, Besselsen DG, Stringer DE, Blohm-Mangone KA, Cui H, Gerner EW. Combination chemoprevention of intestinal carcinogenesis in a murine model of familial adenomatous polyposis. Nutr Cancer 2009; 60 Suppl 1:30-5. [PMID: 19003578 DOI: 10.1080/01635580802401317] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Familial adenomatous polyposis (FAP) is an autosomal dominantly inherited syndrome in humans. The Apc(Min/+) mouse, which expresses a mutant homolog of the adenomatous polyposis coli gene, is a model of FAP in humans. Treatment with the nonsteroidal anti-inflammatory drugs (NSAIDS) sulindac or celecoxib can suppress polyp development in FAP patients, but responses are generally transient and incomplete. Combination chemoprevention with the ornithine decarboxylase inhibitor difluoromethylornithine (DFMO) and either celecoxib or sulindac was evaluated in the Apc(Min/+) mouse. Combinations of DFMO and either NSAID reduced intestinal tumor number by more than 80% (P < 0.0001) compared to untreated controls. In addition to the dramatic reduction in tumor number, the combination of DFMO and sulindac reduced the development of high-grade intestinal adenomas compared to sulindac alone (P = 0.003). The fraction of high-grade intestinal adenomas remaining after treatment was similar for the combination of DFMO and celecoxib and celecoxib alone. Only combinations of DFMO plus sulindac reduced total intestinal polyamine contents compared to untreated mice. These data support the rationale for treatment of FAP patients postcolectomy with DFMO combined with either celecoxib or sulindac but indicate that sulindac may be more effective than celecoxib in reducing intestinal polyamine contents and the incidence of high-grade intestinal adenomas when combined with DFMO.
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Affiliation(s)
- Natalia A Ignatenko
- The University of Arizona, Arizona Cancer Center, 1515 N. Campbell Avenue, Tucson, AZ 85724, USA.
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Zell JA, Honda J, Ziogas A, Anton-Culver H. Survival after colorectal cancer diagnosis is associated with colorectal cancer family history. Cancer Epidemiol Biomarkers Prev 2009; 17:3134-40. [PMID: 18990755 DOI: 10.1158/1055-9965.epi-08-0587] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Colorectal cancer (CRC) family history is a known risk factor for CRC development; however, effects of CRC family history on survival after CRC diagnosis are less well-defined. Our population-based analysis investigates whether familial CRC cases exhibit improved survival compared with sporadic CRC cases. METHODS Cases enrolled in the University of California Irvine Gene-Environment Study of Familial Colorectal Cancer from 1994 to 1996 were analyzed, with follow-up through December 2006. Cases were categorized as familial or sporadic based on self-reported CRC family history in a first-degree relative. Univariate and multivariate survival analyses with Cox proportional hazards ratios were done for overall survival (OS) and CRC-SS (CRC-SS). RESULTS One thousand one hundred fifty-four CRC cases were analyzed, including 781 colon cancer and 373 rectal cancer cases. Nineteen percent of colon cases had family history of CRC in a first-degree relative, compared with 16% of rectal cancer cases. No statistically significant differences between familial and sporadic colon or rectal cancer cases were detected for age, gender, ethnicity, stage, tumor location, histology, tumor grade, or stage-specific treatment rendered. Among colon cancer cases, family history of CRC (versus no family history as a reference group) was associated with improved OS (adjusted hazard ratio, 0.760; 95% confidence interval, 0.580-0.997), but not with CRC-SS (hazard ratio, 0.880; 95% confidence interval, 0.621-1.246). No OS or CRC-SS differences were detected for rectal cancer cases. CONCLUSIONS CRC cases with family history of the disease have improved overall survival compared with sporadic CRC cases, a finding that is independent of other relevant clinical factors.
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Affiliation(s)
- Jason A Zell
- Chao Family Comprehensive Cancer Center, Division of Hematology/Oncology, Department of Medicine, University of California, Irvine, Irvine, CA 92697, USA.
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Zell JA, McEligot AJ, Ziogas A, Holcombe RF, Anton-Culver H. Differential effects of wine consumption on colorectal cancer outcomes based on family history of the disease. Nutr Cancer 2008; 59:36-45. [PMID: 17927500 DOI: 10.1080/01635580701413926] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Potentially favorable effects of wine consumption on colorectal cancer (CRC) incidence have been reported, but effects on clinical outcomes are unknown. This case-only analysis was designed to investigate outcomes among familial (n = 141) and sporadic (n = 358) CRC patients enrolled in the University of California Irvine CRC gene-environment study during 1994-1996 based on their reported frequency of wine consumption in the year prior to diagnosis. Cases were categorized as either regular or infrequent wine consumers. Univariate survival rate analyses were estimated using the Kaplan and Meier method and log-rank test. Multivariate survival analyses were performed using Cox proportional hazards ratios (HRs). Earlier stage at presentation (P = 0.034) was noted for familial (but not sporadic) CRC cases reporting regular wine consumption. An overall survival (OS) benefit was observed for familial (but not sporadic) CRC cases that were regular (10-yr OS = 75%) versus infrequent wine consumers (10-yr OS = 47%; P = 0.002). This survival improvement for familial CRC cases remained after adjustment for age, stage, treatment, and other clinically relevant factors (HR = 0.50, 95% confidence interval = 0.25-0.99). Our findings implicate favorable effects of wine consumption on stage at presentation and survival in CRC, selectively among familial CRC cases.
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Affiliation(s)
- Jason A Zell
- Genetic Epidemiology Research Institute, University of California (UC) Irvine, Irvine, CA 92697, USA.
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Gerner EW. Impact of dietary amino acids and polyamines on intestinal carcinogenesis and chemoprevention in mouse models. Biochem Soc Trans 2007; 35:322-5. [PMID: 17371270 PMCID: PMC2848482 DOI: 10.1042/bst0350322] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Colon cancer in humans is influenced by both genetic and dietary risk factors. The majority of colon cancers have somatic mutations in the APC (adenomatous polyposis coli) tumour-suppressor gene. Dietary arginine enhances the risk of APC-dependent colon carcinogenesis in mouse models by a mechanism involving NOS2 (nitric oxide synthase 2), as elimination of NOS2 alleles suppresses this phenotype. DFMO (difluoromethylornithine), a specific inhibitor of polyamine synthesis, also inhibits dietary arginine-induced colon carcinogenesis in C57BL/6J-Apc(Min)/J mice. The primary consequence of dietary arginine is to increase the adenoma grade in these mice. Either loss of NOS2 alleles or inhibition of polyamine synthesis suppresses the arginine-induced increase in adenoma grade. In addition to promoting intestinal carcinogenesis, polyamines can also reduce the efficacy of certain intestinal cancer chemopreventive agents. The NSAID (non-steroidal anti-inflammatory drug) sulindac is a potent inhibitor of intestinal carcinogenesis in the C57BL/6J-Apc(Min)/J mouse model and is used to treat humans with FAP (familial adenomatous polyposis). Dietary putrescine reduces the ability of sulindac to suppress intestinal tumorigenesis in the mouse model. These data suggest that reducing polyamine metabolism and dietary polyamine levels may enhance strategies for colon cancer chemoprevention.
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Affiliation(s)
- E W Gerner
- Department of Cell Biology and Anatomy, The University of Arizona, Arizona Cancer Center, Tucson, AZ 85724, USA.
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Gerner EW, Meyskens FL, Goldschmid S, Lance P, Pelot D. Rationale for, and design of, a clinical trial targeting polyamine metabolism for colon cancer chemoprevention. Amino Acids 2007; 33:189-95. [PMID: 17396214 DOI: 10.1007/s00726-007-0515-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2006] [Accepted: 02/01/2007] [Indexed: 11/27/2022]
Abstract
Polyamine metabolic genes are downstream targets of several genes commonly mutated in colon adenomas and cancers. Inhibitors of ornithine decarboxylase, such as difluoromethylornithine (DFMO), and agents that stimulate polyamine acetylation and export, such as non-steroidal anti-inflammatory drugs (NSAIDS), act at least additively to arrest growth in human cell models and suppress intestinal carcinogenesis in mice. These preclinical studies provided the rationale for colon cancer prevention trials in humans. A Phase IIb clinical study comparing the combination of DFMO and the NSAID sulindac versus placebo was conducted. Endpoints were colorectal tissue polyamine and prostaglandin E2 contents and overall toxicity to participants. Participants in the Phase IIb study served as a vanguard for a randomized, placebo-controlled prospective Phase III trial of the combination of DFMO and sulindac with the primary study endpoint the prevention of colon polyps. Seventy percent of participants will have completed the three years of treatment in December 2006.
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Affiliation(s)
- E W Gerner
- Arizona Cancer Center, Department of Cell Biology and Anatomy, The University of Arizona, Tucson, AZ 85724, USA.
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