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Jiang H, Chen H, Wang Y, Qian Y. Novel Molecular Subtyping Scheme Based on In Silico Analysis of Cuproptosis Regulator Gene Patterns Optimizes Survival Prediction and Treatment of Hepatocellular Carcinoma. J Clin Med 2023; 12:5767. [PMID: 37762710 PMCID: PMC10531788 DOI: 10.3390/jcm12185767] [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: 02/04/2023] [Revised: 03/11/2023] [Accepted: 07/20/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND The liver plays an important role in maintaining copper homeostasis. Copper ion accumulation was elevated in HCC tissue samples. Copper homeostasis is implicated in cancer cell proliferation and angiogenesis. The potential of copper homeostasis as a new theranostic biomarker for molecular imaging and the targeted therapy of HCC has been demonstrated. Recent studies have reported a novel copper-dependent nonapoptotic form of cell death called cuproptosis, strikingly different from other known forms of cell death. The correlation between cuproptosis and hepatocellular carcinoma (HCC) is not fully understood. MATERIALS AND METHODS The transcriptomic data of patients with HCC were retrieved from the Cancer Genome Atlas-Liver Hepatocellular Carcinoma (TCGA-LIHC) and were used as a discovery cohort to construct the prognosis model. The gene expression data of patients with HCC retrieved from the International Cancer Genome Consortium (ICGC) and Gene Expression Omnibus (GEO) databases were used as the validation cohort. The Least Absolute Shrinkage and Selection Operator (LASSO) regression analysis was used to construct the prognosis model. A principal component analysis (PCA) was used to evaluate the overall characteristics of cuproptosis regulator genes and obtain the PC1 and PC2 scores. Unsupervised clustering was performed using the ConsensusClusterPlus R package to identify the molecular subtypes of HCC. Cox regression analysis was performed to identify cuproptosis regulator genes that could predict the prognosis of patients with HCC. The receiver operating characteristics curve and Kaplan-Meier survival analysis were used to understand the role of hub genes in predicting the diagnosis and prognosis of patients, as well as the prognosis risk model. A weighted gene co-expression network analysis (WGCNA) was used for screening the cuproptosis subtype-related hub genes. The functional enrichment analysis was performed using Metascape. The 'glmnet' R package was used to perform the LASSO regression analysis, and the randomForest algorithm was performed using the 'randomForest' R package. The 'pRRophetic' R package was used to estimate the anticancer drug sensitivity based on the data retrieved from the Genomics of Drug Sensitivity in Cancer database. The nomogram was constructed using the 'rms' R package. Pearson's correlation analysis was used to analyze the correlations. RESULTS We constructed a six-gene signature prognosis model and a nomogram to predict the prognosis of patients with HCC. The Kaplan-Meier survival analysis revealed that patients with a high-risk score, which was predicted by the six-gene signature model, had poor prognoses (log-rank test p < 0.001; HR = 1.83). The patients with HCC were grouped into three distinct cuproptosis subtypes (Cu-clusters A, B, and C) based on the expression pattern of cuproptosis regulator genes. The patients in Cu-cluster B had poor prognosis (log-rank test p < 0.001), high genomic instability, and were not sensitive to conventional chemotherapeutic treatment compared to the patients in the other subtypes. Cancer cells in Cu-cluster B exhibited a higher degree of the senescence-associated secretory phenotype (SASP), a marker of cellular senescence. Three representative genes, CDCA8, MCM6, and NCAPG2, were identified in patients in Cu-cluster B using WGCNA and the "randomForest" algorithm. A nomogram was constructed to screen patients in the Cu-cluster B subtype based on three genes: CDCA8, MCM6, and NCAPG2. CONCLUSION Publicly available databases and various bioinformatics tools were used to study the heterogeneity of cuproptosis in patients with HCC. Three HCC subtypes were identified, with differences in the survival outcomes, genomic instability, senescence environment, and response to anticancer drugs. Further, three cuproptosis-related genes were identified, which could be used to design personalized therapeutic strategies for HCC.
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Affiliation(s)
- Heng Jiang
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
| | - Hao Chen
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
- Department of Emergency Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
| | - Yao Wang
- Department of Digestive Endoscopy, The First Affiliated Hospital with Nanjing Medical University, Nanjing 210029, China
| | - Yeben Qian
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
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The Anti-Inflammatory Properties of Licorice ( Glycyrrhiza glabra)-Derived Compounds in Intestinal Disorders. Int J Mol Sci 2022; 23:ijms23084121. [PMID: 35456938 PMCID: PMC9025446 DOI: 10.3390/ijms23084121] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 03/22/2022] [Accepted: 03/23/2022] [Indexed: 12/12/2022] Open
Abstract
Intestinal diseases, such as inflammatory bowel diseases (IBDs) and colorectal cancer (CRC), are a significant source of morbidity and mortality worldwide. Epidemiological data have shown that IBD patients are at an increased risk for the development of CRC. IBD-associated cancer develops against a background of chronic inflammation and oxidative stress, and their products contribute to cancer development and progression. Therefore, the discovery of novel drugs for the treatment of intestinal diseases is urgently needed. Licorice (Glycyrrhiza glabra) has been largely used for thousands of years in traditional Chinese medicine. Licorice and its derived compounds possess antiallergic, antibacterial, antiviral, anti-inflammatory, and antitumor effects. These pharmacological properties aid in the treatment of inflammatory diseases. In this review, we discuss the pharmacological potential of bioactive compounds derived from Licorice and addresses their anti-inflammatory and antioxidant properties. We also discuss how the mechanisms of action in these compounds can influence their effectiveness and lead to therapeutic effects on intestinal disorders.
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Chen S, He Y, Yan M, Zhou Y, He Q, Tan J, Yang B. The interaction effects of FEN1 rs174538 polymorphism and polycyclic aromatic hydrocarbon exposure on damage in exon 19 and 21 of EGFR gene in coke oven workers. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2021; 28:60692-60703. [PMID: 34164787 DOI: 10.1007/s11356-021-15013-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 06/16/2021] [Indexed: 06/13/2023]
Abstract
Polycyclic aromatic hydrocarbon (PAH) exposure and genetic susceptibility were conductive to genotoxic effects including gene damage, which can increase mutational probability. We aimed to explore the dose-effect associations of PAH exposure with damage of exons of epidermal growth factor receptor (EGFR) and breast cancer susceptibility gene 1 (BRCA1), as well as their associations whether modified by Flap endonuclease 1 (FEN1) genotype. Two hundred eighty-eight coke oven male workers were recruited, and we detected the concentration of 1-hydroxypyrene (1-OH-pyr) as PAH exposure biomarker in urine and examined base modification in exons of EGFR and BRCA1 respectively, and genotyped FEN1 rs174538 polymorphism in plasma. We found that the damage indexes of exon 19 and 21 of EGFR (EGFR-19 and EGFR-21) were both significantly associated with increased urinary 1-OH-pyr (both Ptrend < 0.001). The levels of urinary 1-OH-pyr were both significantly associated with increased EGFR-19 and EGFR-21 in both smokers and nonsmokers (both P < 0.001). Additionally, we observed that the urinary 1-OH-pyr concentrations were linearly associated with both EGFR-19 and EGFR-21 only in rs174538 GA+AA genotype carriers (both P < 0.001). Moreover, FEN1rs rs174538 showed modifying effects on the associations of urinary 1-OH-pyr with EGFR-19 and EGFR-21 (both Pinteraction < 0.05). Our findings revealed the linear dose-effect association between exon damage of EGFR and PAH exposure and highlight differences in genetic contributions to exon damage and have the potential to identify at-risk subpopulations who are susceptible to adverse health effects induced by PAH exposure.
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Affiliation(s)
- Siqin Chen
- Guangzhou Key Laboratory of Enhanced Recovery after Abdominal Surgery, Innovation Center for Advanced Interdisciplinary Medicine, The Fifth Affiliated Hospital of Guangzhou Medical University, 621 Gangwan Rd, Guangzhou, 510700, Guangdong, China
| | - Yuefeng He
- School of Public Health, Kunming Medical University, Kunming, Yunnan, China
| | - Maosheng Yan
- Guangdong Province Hospital for Occupational Disease Prevention and Treatment, Guangzhou, Guangdong, China
| | - Yun Zhou
- School of Public Health, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Qinghua He
- Guangzhou Key Laboratory of Enhanced Recovery after Abdominal Surgery, Innovation Center for Advanced Interdisciplinary Medicine, The Fifth Affiliated Hospital of Guangzhou Medical University, 621 Gangwan Rd, Guangzhou, 510700, Guangdong, China
| | - Jingwen Tan
- School of Public Health, Kunming Medical University, Kunming, Yunnan, China
| | - Binyao Yang
- Guangzhou Key Laboratory of Enhanced Recovery after Abdominal Surgery, Innovation Center for Advanced Interdisciplinary Medicine, The Fifth Affiliated Hospital of Guangzhou Medical University, 621 Gangwan Rd, Guangzhou, 510700, Guangdong, China.
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Møller P, Stopper H, Collins AR. Measurement of DNA damage with the comet assay in high-prevalence diseases: current status and future directions. Mutagenesis 2021; 35:5-18. [PMID: 31294794 DOI: 10.1093/mutage/gez018] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 06/19/2019] [Indexed: 12/12/2022] Open
Abstract
The comet assay is widely used in studies on genotoxicity testing, human biomonitoring and clinical studies. The simple version of the assay detects a mixture of DNA strand breaks and alkali-labile sites; these lesions are typically described as DNA strand breaks to distinguish them from oxidatively damaged DNA that are measured with the enzyme-modified comet assay. This review assesses the association between high-prevalence diseases in high-income countries and DNA damage measured with the comet assay in humans. The majority of case-control studies have assessed genotoxicity in white blood cells. Patients with coronary artery disease, diabetes, kidney disease, chronic obstructive pulmonary disease and Alzheimer's disease have on average 2-fold higher levels of DNA strand breaks compared with healthy controls. Patients with coronary artery disease, diabetes, kidney disease and chronic obstructive pulmonary disease also have 2- to 3-fold higher levels of oxidatively damaged DNA in white blood cells than controls, although there is not a clear difference in DNA damage levels between the different diseases. Case-control studies have shown elevated levels of DNA strand breaks in patients with breast cancer, whereas there are only few studies on colorectal and lung cancers. At present, it is not possible to assess if these neoplastic diseases are associated with a different level of DNA damage compared with non-neoplastic diseases.
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Affiliation(s)
- Peter Møller
- Department of Public Health, Section of Environmental Health, University of Copenhagen, Copenhagen H, Denmark
| | - Helga Stopper
- Institute of Pharmacology and Toxicology, University of Wuerzburg, Wuerzburg, Germany
| | - Andrew R Collins
- Department of Nutrition, Institute for Basic Medical Sciences, University of Oslo, Oslo, Norway
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The Interactions of DNA Repair, Telomere Homeostasis, and p53 Mutational Status in Solid Cancers: Risk, Prognosis, and Prediction. Cancers (Basel) 2021; 13:cancers13030479. [PMID: 33513745 PMCID: PMC7865496 DOI: 10.3390/cancers13030479] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 01/18/2021] [Accepted: 01/23/2021] [Indexed: 12/12/2022] Open
Abstract
The disruption of genomic integrity due to the accumulation of various kinds of DNA damage, deficient DNA repair capacity, and telomere shortening constitute the hallmarks of malignant diseases. DNA damage response (DDR) is a signaling network to process DNA damage with importance for both cancer development and chemotherapy outcome. DDR represents the complex events that detect DNA lesions and activate signaling networks (cell cycle checkpoint induction, DNA repair, and induction of cell death). TP53, the guardian of the genome, governs the cell response, resulting in cell cycle arrest, DNA damage repair, apoptosis, and senescence. The mutational status of TP53 has an impact on DDR, and somatic mutations in this gene represent one of the critical events in human carcinogenesis. Telomere dysfunction in cells that lack p53-mediated surveillance of genomic integrity along with the involvement of DNA repair in telomeric DNA regions leads to genomic instability. While the role of individual players (DDR, telomere homeostasis, and TP53) in human cancers has attracted attention for some time, there is insufficient understanding of the interactions between these pathways. Since solid cancer is a complex and multifactorial disease with considerable inter- and intra-tumor heterogeneity, we mainly dedicated this review to the interactions of DNA repair, telomere homeostasis, and TP53 mutational status, in relation to (a) cancer risk, (b) cancer progression, and (c) cancer therapy.
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de Oliveira CTP, Colenci R, Pacheco CC, Mariano PM, do Prado PR, Mamprin GPR, Santana MG, Gambero A, de Oliveira Carvalho P, Priolli DG. Hydrolyzed Rutin Decreases Worsening of Anaplasia in Glioblastoma Relapse. CNS & NEUROLOGICAL DISORDERS-DRUG TARGETS 2019; 18:405-412. [DOI: 10.2174/1871527318666190314103104] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 02/15/2019] [Accepted: 03/07/2019] [Indexed: 12/14/2022]
Abstract
Background:
Gliomas are aggressive and resilient tumors. Progression to advanced stages
of malignancy, characterized by cell anaplasia, necrosis, and reduced response to conventional surgery
or therapeutic adjuvant, are critical challenges in glioma therapy. Relapse of the disease poses a considerable
challenge for management. Hence, new compounds are required to improve therapeutic response.
As hydrolyzed rutin (HR), a compound modified via rutin deglycosylation, as well as some
flavonoids demonstrated antiproliferative effect for glioblastoma, these are considered potential epigenetic
drugs.
Objective:
The purpose of this study was to determine the antitumor activity and evaluate the potential
for modifying tumor aggressivity of rutin hydrolysates for treating both primary and relapsed glioblastoma.
Methods:
The glioblastoma cell line, U251, was used for analyzing cell cycle inhibition and apoptosis
and for establishing the GBM mouse model. Mice with GBM were treated with HR to verify antitumor
activity. Histological analysis was used to evaluate HR interference in aggressive behavior and
glioma grade. Immunohistochemistry, comet assay, and thiobarbituric acid reactive substance
(TBARS) values were used to evaluate the mechanism of HR action.
Results:
HR is an antiproliferative and antitumoral compound that inhibits the cell cycle via a p53-
independent pathway. HR reduces tumor growth and aggression, mainly by decreasing mitosis and necrosis
rates without genotoxicity, which is suggestive of epigenetic modulation.
Conclusion:
HR possesses antitumor activity and decreases anaplasia in glioblastoma, inhibiting progression
to malignant stages of the disease. HR can improve the effectiveness of response to conventional
therapy, which has a crucial role in recurrent glioma.
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Affiliation(s)
- Carlos Tadeu Parisi de Oliveira
- Medical School Sao Francisco University, Av Sao Francisco de Assis, 218, Braganca Paulista, Sao Paulo, CEP 12916-900, Brazil
| | - Renato Colenci
- Medical School Sao Francisco University, Av Sao Francisco de Assis, 218, Braganca Paulista, Sao Paulo, CEP 12916-900, Brazil
| | - Cesar Cozar Pacheco
- Medical School Sao Francisco University, Av Sao Francisco de Assis, 218, Braganca Paulista, Sao Paulo, CEP 12916-900, Brazil
| | - Patrick Moro Mariano
- Medical School Sao Francisco University, Av Sao Francisco de Assis, 218, Braganca Paulista, Sao Paulo, CEP 12916-900, Brazil
| | - Paula Ribeiro do Prado
- Medical School Sao Francisco University, Av Sao Francisco de Assis, 218, Braganca Paulista, Sao Paulo, CEP 12916-900, Brazil
| | - Gustavo Pignatari Rosas Mamprin
- Medical School Sao Francisco University, Av Sao Francisco de Assis, 218, Braganca Paulista, Sao Paulo, CEP 12916-900, Brazil
| | - Maycon Giovani Santana
- Nurse School Sao Francisco University, Av Sao Francisco de Assis, 218, Braganca Paulista, Sao Paulo, CEP 12916-900, Brazil
| | - Alessandra Gambero
- Medical School Sao Francisco University, Av Sao Francisco de Assis, 218, Braganca Paulista, Sao Paulo, CEP 12916-900, Brazil
| | - Patrícia de Oliveira Carvalho
- Medical School Sao Francisco University, Av Sao Francisco de Assis, 218, Braganca Paulista, Sao Paulo, CEP 12916-900, Brazil
| | - Denise Gonçalves Priolli
- Medical School Sao Francisco University, Av Sao Francisco de Assis, 218, Braganca Paulista, Sao Paulo, CEP 12916-900, Brazil
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Vacante M, Borzì AM, Basile F, Biondi A. Biomarkers in colorectal cancer: Current clinical utility and future perspectives. World J Clin Cases 2018; 6:869-881. [PMID: 30568941 PMCID: PMC6288499 DOI: 10.12998/wjcc.v6.i15.869] [Citation(s) in RCA: 96] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 10/30/2018] [Accepted: 11/07/2018] [Indexed: 02/05/2023] Open
Abstract
Colorectal cancer (CRC) is a major cause of cancer death worldwide. CRC has poor prognosis and there is a crucial need for new diagnostic and prognostic biomarkers to avoid CRC-related deaths. CRC can be considered a sporadic disease in most cases (75%-80%), but it has been suggested that crosstalk between gene mutations (i.e., mutations of BRAF, KRAS, and p53 as well as microsatellite instability) and epigenetic alterations (i.e., DNA methylation of CpG island promoter regions) could play a pivotal role in cancer development. A number of studies have focused on molecular testing to guide targeted and conventional treatments for patients with CRC, sometimes with contrasting results. Some of the most useful innovations in the management of CRC include the possibility to detect the absence of KRAS, BRAF, NRAS and PIK3CA gene mutations with the subsequent choice to administer targeted adjuvant therapy with anti-epidermal growth factor receptor antibodies. Moreover, CRC patients can benefit from tests for microsatellite instability and for the detection of loss of heterozygosity of chromosome 18q that can be helpful in guiding therapeutic decisions as regards the administration of 5-FU. The aim of this review was to summarize the most recent evidence on the possible use of genetic or epigenetic biomarkers for diagnosis, prognosis and response to therapy in CRC patients.
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Affiliation(s)
- Marco Vacante
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania 95123, Italy
| | - Antonio Maria Borzì
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania 95123, Italy
| | - Francesco Basile
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania 95123, Italy
| | - Antonio Biondi
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania 95123, Italy
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Zarkavelis G, Boussios S, Papadaki A, Katsanos KH, Christodoulou DK, Pentheroudakis G. Current and future biomarkers in colorectal cancer. Ann Gastroenterol 2017; 30:613-621. [PMID: 29118555 PMCID: PMC5670280 DOI: 10.20524/aog.2017.0191] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 08/24/2017] [Indexed: 12/12/2022] Open
Abstract
Colorectal cancer (CRC), one of the leading causes of death among cancer patients, is a heterogeneous disease and is characterized by diversions in multiple molecular pathways throughout its evolutionary process. To date, specific mutations in RAS and RAF genes are tested in everyday clinical practice along with mismatch repair gene deficiency, serving either as prognostic or predictive biomarkers, providing information for patient risk stratification and the choice of appropriate therapy. However, ongoing studies are focusing on the potential role of recently discovered genetic and epigenetic alterations in the management of CRC patients and their potential prognostic or predictive value. To overcome the problem of tumor heterogeneity as well as the practical obstacles of access to tumor tissue, and to achieve real-time monitoring of disease and therapy efficacy, liquid biopsies constitute a novel technology worth exploring. CRC screening and management is entering a new era where molecular testing will be applied to genomic material extracted from easily accessible bodily fluids.
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Affiliation(s)
- George Zarkavelis
- Department of Medical Oncology, Medical School, University of Ioannina (George Zarkavelis, Stergios Boussios, Alexandra Papadaki, George Pentheroudakis), Greece.,Society for Study of the Clonal Heterogeneity of Neoplasia, Ioannina, Greece (George Zarkavelis, Stergios Boussios, Alexandra Papadaki, George Pentheroudakis), Greece
| | - Stergios Boussios
- Department of Medical Oncology, Medical School, University of Ioannina (George Zarkavelis, Stergios Boussios, Alexandra Papadaki, George Pentheroudakis), Greece.,Society for Study of the Clonal Heterogeneity of Neoplasia, Ioannina, Greece (George Zarkavelis, Stergios Boussios, Alexandra Papadaki, George Pentheroudakis), Greece
| | - Alexandra Papadaki
- Department of Medical Oncology, Medical School, University of Ioannina (George Zarkavelis, Stergios Boussios, Alexandra Papadaki, George Pentheroudakis), Greece.,Society for Study of the Clonal Heterogeneity of Neoplasia, Ioannina, Greece (George Zarkavelis, Stergios Boussios, Alexandra Papadaki, George Pentheroudakis), Greece
| | - Konstantinos H Katsanos
- Department of Gastroenterology, University Hospital of Ioannina, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina (Konstantinos H. Katsanos, Dimitrios K. Christodoulou), Greece
| | - Dimitrios K Christodoulou
- Department of Gastroenterology, University Hospital of Ioannina, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina (Konstantinos H. Katsanos, Dimitrios K. Christodoulou), Greece
| | - George Pentheroudakis
- Department of Medical Oncology, Medical School, University of Ioannina (George Zarkavelis, Stergios Boussios, Alexandra Papadaki, George Pentheroudakis), Greece.,Society for Study of the Clonal Heterogeneity of Neoplasia, Ioannina, Greece (George Zarkavelis, Stergios Boussios, Alexandra Papadaki, George Pentheroudakis), Greece
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Abstract
The presence of asbestos fibres (AFs) in drinking water could be linked with gastrointestinal cancers. However, it is not regulated in several countries due to conflicting evidence. Areas covered: Some reports mainly associated AF ingestion with gastric and colorectal cancer. Experimental evidence suggested a role for timing and extent of exposure, and showed that ingested AFs induce toxic effects on the stomach, ileum and colon, histological alterations and negative effects at a molecular level, cross the placenta and enter foetal organs (including the liver), and seem able to act as a co-carcinogen agent. Occupational studies suggest associations between asbestos exposure and intrahepatic cholangiocarcinoma, and observations exist indicating the possibility that AFs could enter the liver and bile through enteric absorption. Expert commentary: A risk threshold (AF concentration in drinking water) for digestive cancers has not been convincingly identified so far and regulations, where adopted, have weak scientific basis and may not be adequate. With further and more definitive studies, evidence might become sufficient to justify monitoring plans, persuade countries with no current limits to set a maximum level of AFs in drinking water and might induce a revision of the existing legislations, pointing to efficient primary prevention policies.
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Affiliation(s)
- Agostino Di Ciaula
- a Division of Internal Medicine , Hospital of Bisceglie , Bisceglie (BAT) , Italy
- b International Society of Doctors for Environment (ISDE) , Arezzo , Italy
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