Fiber and colon cancer: the weight of the evidence

Influence of diet, vitamins and chemotherapeutic agents on gastrointestinal cancer

Dietary influences play a major role in the pathogenesis of most gastrointestinal malignancies. However, it has been difficult to define which dietary components will be most significant for any given individual. In this article we discuss the methodological challenges to research in this field as well as recent observations that have been made on the role of dietary factors in specific digestive tract neoplasms.

Effects of short-chain fatty acids on human rectosigmoid mucosal colonocyte brush-border enzymes

Short-chain fatty acids produced by bacterial fermentation of dietary fiber may provide a tonic stimulus to colonocyte differentiation that contributes to the protective effect of fiber against colorectal malignancy. Since brush-border enzymes are common markers of colonocytic differentiation, we compared the effects of equimolar (10 mmol/L) concentrations of the three most common short-chain fatty acids, acetate, butyrate, and propionate, on the alkaline phosphatase and dipeptidyl dipeptidase specific activity of human colonic mucosal biopsies obtained from normal volunteers. Only butyrate significantly stimulated alkaline phosphatase specific activity (50.4% +/- 18.6%, P < .05). Short-chain fatty acid stimulation of dipeptidyl dipeptidase did not achieve statistical significance. Fibers yielding high colonic butyrate levels could have different effects on human colonic mucosal differentiation.

Regulation of human colonic cell line proliferation and phenotype by sodium butyrate

Colonic butyrate may maintain mucosal differentiation and oppose carcinogenesis. We characterized butyrate effects on differentiation, proliferation, and matrix interactions in Caco-2 and SW620 human colonic cells. Differentiation was assessed by brush border enzyme activity and doubling time by serial cell counts. Motility across matrix proteins was quantitated by monolayer expansion and correlated with adhesiveness to matrix. Integrin subunit surface pools were measured by immunoprecipitation. Butyrate-stimulated differentiation inhibited proliferation and was significantly more potent than acetate in this regard. Butyrate also inhibited motility across collagen I, collagen IV, and laminin, as well as decreasing adhesiveness to these matrices and beta 1, alpha 1, and alpha 2 integrin subunit surface expression. Butyrate acts in cultured cells at clinically relevant concentrations to oppose classical malignant behavior, inhibiting proliferation and motility while promoting differentiation. Since butyrate is derived from fermentation of dietary fiber, such mechanisms may contribute to the apparent protective action of fiber against colon carcinogenesis.

Effects of dietary fibre on dimethylhydrazine-induced changes in prostanoid concentrations in rat colonic mucosa

1. This study was designed to elucidate the effects of guar gum, a dietary fibre, on changes in prostanoid contents induced by 1,2-dimethylhydrazine, a carcinogenic agent, in rat colonic mucosa. 2. Prostanoid contents were determined using high performance liquid chromatography; five prostanoids, namely 6-keto-prostaglandin F1 alpha, prostaglandin F2 alpha, prostaglandin E2, prostaglandin D2 and thromboxane B2, were detected. 3. Four subcutaneous injections of dimethylhydrazine, 60 mg/kg every 6 days, increased the mucosal concentrations of prostaglandin E2 and thromboxane B2 by approximately 50%. Other prostanoids did not change significantly throughout the experiments. 4. In rats treated with dimethylhydrazine and a fibre diet a significant increase in thromboxane B2 content was not observed, although a significant increase in prostaglandin E2 content was observed. These effects were observed in rats fed with fibre diet over 20 days but not observed in rats fed with fibre diet over 10 days. 5. From these results and the report that aspirin use at low doses is effective in the reduction of the risk of fatal colonic cancer, inhibiting thromboxane B2 synthesis by fibre diet might be involved in the protective effect against the occurrence of colonic cancer.

Colorectal cancer: lessons for genetic counselling and care for families

Cancers of the colon and the rectum are the second leading cause of malignancy in European countries with similar incidence rates for men and women and, therefore, one of the major health concerns. Emphasis is placed on the early detection of a developing neoplasm in order to improve the life expectancy of patients and their quality of life. Colorectal cancer (CRC) is an excellent model for studying the etiology and pathogenesis of a common malignancy and the complex multistage process of carcinogenesis. Abundant clinical and pathological evidence suggests that CRC arises from benign adenomas that proceed through a series of steps to metastatic carcinomas. Following the discovery of oncogenes and, more importantly tumor suppressor genes, Fearon & Vogelstein (1990) proposed a scheme of genetic events which are associated with colorectal tumorigenesis. Genetic linkage studies have recently identified another type of gene for colon cancer susceptibility that seems to act by destabilising the genome.

Fatty-acid metabolism and the pathogenesis of hepatocellular carcinoma: review and hypothesis

Despite increasing understanding of the genetic control of cell growth and the identification of several involved chemical and infectious factors, the pathogenesis of clinical and experimental hepatocellular carcinoma remains unknown. Available evidence is consistent with the possibility that selected changes in the hepatocellular metabolism of long-chain fatty acids may contribute significantly to this, process. Specifically, studies of the peroxisome proliferators, a diverse group of xenobiotics that includes the fibrate class of hypolipidemic drugs, suggest that increased fatty acid oxidation by way of extramitochondrial pathways (i.e., omega-oxidation in the smooth endoplasmic reticulum and beta-oxidation in the peroxisomes) results in a corresponding increase in the generation of hydrogen peroxide and, thus, oxidative stress. This in turn leads to alterations in gene expression and in DNA itself. We also review evidence supporting a potentially decisive influence of particular aspects of hepatocellular fatty acid metabolism in determining the activity of the extramitochondrial pathways. Moreover, certain intermediates of extramitochondrial fatty acid oxidation (e.g., the long-chain dicarboxylic fatty acids) impair mitochondrial function and are implicated as modulators of gene expression through their interaction with the peroxisome proliferator-activated receptor. Finally, the occurrence of hepatic tumors in type I glycogen storage disease (glucose-6-phosphatase deficiency) may exemplify this general mechanism, which may also contribute to nonneoplastic liver injury and to tumorigenesis in other tissues.

Familial and genetic aspects of colorectal carcinogenesis

There is abundant clinical and pathological evidence which suggests that colorectal cancer arises in a sequential manner through a series of events that can be followed during the progression of the disease from early adenoma through to metastatic disease. The molecular events that are associated with the initiation and progression of the disease are gradually being unravelled. As the molecular characterisation of colorectal cancer continues, new mechanisms by which the disease progresses are becoming evident. In this short review, a brief description of current knowledge of colorectal cancer development is presented.