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DeSouza B, Georgiou D. Advances in Hereditary Colorectal Cancer: Opportunities and Challenges for Clinical Translation. CURRENT GENETIC MEDICINE REPORTS 2020. [DOI: 10.1007/s40142-020-00183-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Finding relationships among biological entities. LOGIC AND CRITICAL THINKING IN THE BIOMEDICAL SCIENCES 2020. [PMCID: PMC7499094 DOI: 10.1016/b978-0-12-821364-3.00005-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Confusion over the concepts of “relationships” and “similarities” lies at the heart of many battles over the direction and intent of research projects. Here is a short story that demonstrates the difference between the two concepts: You look up at the clouds, and you begin to see the shape of a lion. The cloud has a tail, like a lion’s tale, and a fluffy head, like a lion’s mane. With a little imagination the mouth of the lion seems to roar down from the sky. You have succeeded in finding similarities between the cloud and a lion. If you look at a cloud and you imagine a tea kettle producing a head of steam and you recognize that the physical forces that create a cloud and the physical forces that produced steam from a heated kettle are the same, then you have found a relationship. Most popular classification algorithms operate by grouping together data objects that have similar properties or values. In so doing, they may miss finding the true relationships among objects. Traditionally, relationships among data objects are discovered by an intellectual process. In this chapter, we will discuss the scientific gains that come when we classify biological entities by relationships, not by their similarities.
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von Holst S, Jiao X, Liu W, Kontham V, Thutkawkorapin J, Ringdahl J, Bryant P, Lindblom A. Linkage analysis revealed risk loci on 6p21 and 18p11.2-q11.2 in familial colon and rectal cancer, respectively. Eur J Hum Genet 2019; 27:1286-1295. [PMID: 30952955 PMCID: PMC6777498 DOI: 10.1038/s41431-019-0388-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 02/13/2019] [Accepted: 03/12/2019] [Indexed: 12/14/2022] Open
Abstract
Colorectal cancer (CRC) is one of the major cancer types in the western world including Sweden. However, known genetic risk factors could only explain a limited part of heritability of the disease. Moreover, colon and rectal cancers are habitually discussed as one entity, colorectal cancer, although different carcinogenesis has been recognized. A genome-wide linkage scan in 32 colon- and 56 rectal cancer families from Sweden was performed based on 475 non-FAP/HNPCC patients genotyped using SNP arrays. A maximum HLOD of 2.50 at locus 6p21.1-p12.1 and a HLOD of 2.56 at 18p11.2 was obtained for colon and rectal cancer families, respectively. Exome sequencing over the regions of interest in 12 patients from six families identified 22 and 25 candidate risk variants for colon and rectal cancer, respectively. Haplotype association analysis in the two regions was carried out between additional 477 familial CRC cases and 4780 controls and suggested candidate haplotypes possibly associated with CRC risk. This study suggested two new linkage regions for colon cancer and rectal cancer with candidate predisposing variants. Further studies are required to elucidate the pathogenic mechanism of these regions and to pinpoint the causative genes.
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Affiliation(s)
- Susanna von Holst
- Department of Molecular Medicine and Surgery, Karolinska Institutet, and Department of Clinical Genetics, Karolinska University Hospital, 171 76, Stockholm, Sweden
| | - Xiang Jiao
- Department of Molecular Medicine and Surgery, Karolinska Institutet, and Department of Clinical Genetics, Karolinska University Hospital, 171 76, Stockholm, Sweden
| | - Wen Liu
- Department of Molecular Medicine and Surgery, Karolinska Institutet, and Department of Clinical Genetics, Karolinska University Hospital, 171 76, Stockholm, Sweden
| | - Vinaykumar Kontham
- Department of Molecular Medicine and Surgery, Karolinska Institutet, and Department of Clinical Genetics, Karolinska University Hospital, 171 76, Stockholm, Sweden
| | - Jessada Thutkawkorapin
- Department of Molecular Medicine and Surgery, Karolinska Institutet, and Department of Clinical Genetics, Karolinska University Hospital, 171 76, Stockholm, Sweden
| | - Jenny Ringdahl
- Department of Molecular Medicine and Surgery, Karolinska Institutet, and Department of Clinical Genetics, Karolinska University Hospital, 171 76, Stockholm, Sweden
| | - Patrick Bryant
- Department of Molecular Medicine and Surgery, Karolinska Institutet, and Department of Clinical Genetics, Karolinska University Hospital, 171 76, Stockholm, Sweden
| | - Annika Lindblom
- Department of Molecular Medicine and Surgery, Karolinska Institutet, and Department of Clinical Genetics, Karolinska University Hospital, 171 76, Stockholm, Sweden.
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Sharafeldin N, Kawaguchi A, Sundaram A, Campbell S, Rudnisky C, Weis E, Tennant MTS, Damji KF. Review of economic evaluations of teleophthalmology as a screening strategy for chronic eye disease in adults. Br J Ophthalmol 2018; 102:1485-1491. [PMID: 29680803 DOI: 10.1136/bjophthalmol-2017-311452] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 03/07/2018] [Accepted: 03/31/2018] [Indexed: 11/03/2022]
Abstract
BACKGROUND/AIMS Teleophthalmology is well positioned to play a key role in screening of major chronic eye diseases. Economic evaluation of cost-effectiveness of teleophthalmology, however, is lacking. This study provides a systematic review of economic studies of teleophthalmology screening for diabetic retinopathy (DR), glaucoma and macular degeneration. METHODS Structured search of electronic databases and full article review yielded 20 cost-related articles. Sixteen articles fulfilled the inclusion criteria and were retained for a narrative review: 12 on DR, 2 on glaucoma and 2 on chronic eye disease. RESULTS Teleophthalmology for DR yielded the most cost savings when compared with traditional clinic examination. The study settings varied among urban, rural and remote settings, community, hospital and health mobile units. The most important determinant of cost-effectiveness of teleophthalmology was the prevalence of DR among patients screened, indicating an increase of cost savings with the increase of screening rates. The required patient pool size to be screened varied from 110 to 3500 patients. Other factors potentially influencing cost-effectiveness of teleophthalmology were older patient age, regular screening and full utilisation of the equipment. Teleophthalmology for glaucoma was more cost-effective compared with in-person examination. Similarly, increasing number of glaucoma patients targeted for screening yielded more cost savings. CONCLUSIONS This economic review provides supportive evidence of cost-effectiveness of teleophthalmology for DR and glaucoma screening potentially increasing screening accessibility especially for rural and remote populations. Special selection of the targeted screening population will optimise the cost-effectiveness of teleophthalmology.
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Affiliation(s)
- Noha Sharafeldin
- School of Public Health, University of Alberta, Edmonton, Canada.,Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Atsushi Kawaguchi
- School of Public Health, University of Alberta, Edmonton, Canada.,Department of Pediatrics, Pediatric Critical Care Medicine, University of Alberta, Edmonton, Canada
| | - Aishwarya Sundaram
- Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Canada
| | - Sandy Campbell
- JW Scott Library, Health Sciences Library, University of Alberta, Edmonton, Canada
| | - Chris Rudnisky
- Department of Ophthalmology and Visual Sciences, University of Alberta, Edmonton, Canada
| | - Ezekiel Weis
- Department of Ophthalmology and Visual Sciences, University of Alberta, Edmonton, Canada
| | - Matthew T S Tennant
- Department of Ophthalmology and Visual Sciences, University of Alberta, Edmonton, Canada
| | - Karim F Damji
- Department of Ophthalmology and Visual Sciences, University of Alberta, Edmonton, Canada
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Sharafeldin N, Slattery ML, Liu Q, Franco-Villalobos C, Caan BJ, Potter JD, Yasui Y. Multiple Gene-Environment Interactions on the Angiogenesis Gene-Pathway Impact Rectal Cancer Risk and Survival. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14101146. [PMID: 28956832 PMCID: PMC5664647 DOI: 10.3390/ijerph14101146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Revised: 09/06/2017] [Accepted: 09/23/2017] [Indexed: 12/25/2022]
Abstract
Characterization of gene-environment interactions (GEIs) in cancer is limited. We aimed at identifying GEIs in rectal cancer focusing on a relevant biologic process involving the angiogenesis pathway and relevant environmental exposures: cigarette smoking, alcohol consumption, and animal protein intake. We analyzed data from 747 rectal cancer cases and 956 controls from the Diet, Activity and Lifestyle as a Risk Factor for Rectal Cancer study. We applied a 3-step analysis approach: first, we searched for interactions among single nucleotide polymorphisms on the pathway genes; second, we searched for interactions among the genes, both steps using Logic regression; third, we examined the GEIs significant at the 5% level using logistic regression for cancer risk and Cox proportional hazards models for survival. Permutation-based test was used for multiple testing adjustment. We identified 8 significant GEIs associated with risk among 6 genes adjusting for multiple testing: TNF (OR = 1.85, 95% CI: 1.10, 3.11), TLR4 (OR = 2.34, 95% CI: 1.38, 3.98), and EGR2 (OR = 2.23, 95% CI: 1.04, 4.78) with smoking; IGF1R (OR = 1.69, 95% CI: 1.04, 2.72), TLR4 (OR = 2.10, 95% CI: 1.22, 3.60) and EGR2 (OR = 2.12, 95% CI: 1.01, 4.46) with alcohol; and PDGFB (OR = 1.75, 95% CI: 1.04, 2.92) and MMP1 (OR = 2.44, 95% CI: 1.24, 4.81) with protein. Five GEIs were associated with survival at the 5% significance level but not after multiple testing adjustment: CXCR1 (HR = 2.06, 95% CI: 1.13, 3.75) with smoking; and KDR (HR = 4.36, 95% CI: 1.62, 11.73), TLR2 (HR = 9.06, 95% CI: 1.14, 72.11), EGR2 (HR = 2.45, 95% CI: 1.42, 4.22), and EGFR (HR = 6.33, 95% CI: 1.95, 20.54) with protein. GEIs between angiogenesis genes and smoking, alcohol, and animal protein impact rectal cancer risk. Our results support the importance of considering the biologic hypothesis to characterize GEIs associated with cancer outcomes.
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Affiliation(s)
- Noha Sharafeldin
- School of Public Health, University of Alberta, Edmonton, AB T6G 2R3, Canada.
- Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
| | - Martha L Slattery
- Department of Internal Medicine, University of Utah Health Sciences Center, Salt Lake City, UT 84132, USA.
| | - Qi Liu
- School of Public Health, University of Alberta, Edmonton, AB T6G 2R3, Canada.
| | | | - Bette J Caan
- Division of Research, Kaiser Permanente Medical Care Program, Oakland, CA 94612, USA.
| | - John D Potter
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA.
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA 98195, USA.
- Centre for Public Health Research, Massey University, P.O. Box 756, Wellington 6140, New Zealand.
| | - Yutaka Yasui
- School of Public Health, University of Alberta, Edmonton, AB T6G 2R3, Canada.
- Department of Epidemiology & Cancer Control, St. Jude Children's Research Hospital, Memphis, TN 38105, USA.
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Orlando G, Law PJ, Palin K, Tuupanen S, Gylfe A, Hänninen UA, Cajuso T, Tanskanen T, Kondelin J, Kaasinen E, Sarin AP, Kaprio J, Eriksson JG, Rissanen H, Knekt P, Pukkala E, Jousilahti P, Salomaa V, Ripatti S, Palotie A, Järvinen H, Renkonen-Sinisalo L, Lepistö A, Böhm J, Mecklin JP, Al-Tassan NA, Palles C, Martin L, Barclay E, Tenesa A, Farrington S, Timofeeva MN, Meyer BF, Wakil SM, Campbell H, Smith CG, Idziaszczyk S, Maughan TS, Kaplan R, Kerr R, Kerr D, Buchanan DD, Win AK, Hopper J, Jenkins M, Lindor NM, Newcomb PA, Gallinger S, Conti D, Schumacher F, Casey G, Taipale J, Cheadle JP, Dunlop MG, Tomlinson IP, Aaltonen LA, Houlston RS. Variation at 2q35 (PNKD and TMBIM1) influences colorectal cancer risk and identifies a pleiotropic effect with inflammatory bowel disease. Hum Mol Genet 2016; 25:2349-2359. [PMID: 27005424 PMCID: PMC5081051 DOI: 10.1093/hmg/ddw087] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 02/05/2016] [Accepted: 03/14/2016] [Indexed: 01/07/2023] Open
Abstract
To identify new risk loci for colorectal cancer (CRC), we conducted a meta-analysis of seven genome-wide association studies (GWAS) with independent replication, totalling 13 656 CRC cases and 21 667 controls of European ancestry. The combined analysis identified a new risk association for CRC at 2q35 marked by rs992157 (P = 3.15 × 10-8, odds ratio = 1.10, 95% confidence interval = 1.06-1.13), which is intronic to PNKD (paroxysmal non-kinesigenic dyskinesia) and TMBIM1 (transmembrane BAX inhibitor motif containing 1). Intriguingly this susceptibility single-nucleotide polymorphism (SNP) is in strong linkage disequilibrium (r2 = 0.90, D' = 0.96) with the previously discovered GWAS SNP rs2382817 for inflammatory bowel disease (IBD). Following on from this observation we examined for pleiotropy, or shared genetic susceptibility, between CRC and the 200 established IBD risk loci, identifying an additional 11 significant associations (false discovery rate [FDR]) < 0.05). Our findings provide further insight into the biological basis of inherited genetic susceptibility to CRC, and identify risk factors that may influence the development of both CRC and IBD.
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Affiliation(s)
- Giulia Orlando
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London SW7 3RP, UK
| | - Philip J Law
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London SW7 3RP, UK
| | - Kimmo Palin
- Genome-Scale Biology Research Program, Research Programs Unit Department of Medical and Clinical Genetics, Medicum
| | - Sari Tuupanen
- Genome-Scale Biology Research Program, Research Programs Unit Department of Medical and Clinical Genetics, Medicum
| | - Alexandra Gylfe
- Genome-Scale Biology Research Program, Research Programs Unit Department of Medical and Clinical Genetics, Medicum
| | - Ulrika A Hänninen
- Genome-Scale Biology Research Program, Research Programs Unit Department of Medical and Clinical Genetics, Medicum
| | - Tatiana Cajuso
- Genome-Scale Biology Research Program, Research Programs Unit Department of Medical and Clinical Genetics, Medicum
| | - Tomas Tanskanen
- Genome-Scale Biology Research Program, Research Programs Unit Department of Medical and Clinical Genetics, Medicum
| | - Johanna Kondelin
- Genome-Scale Biology Research Program, Research Programs Unit Department of Medical and Clinical Genetics, Medicum
| | - Eevi Kaasinen
- Genome-Scale Biology Research Program, Research Programs Unit Department of Medical and Clinical Genetics, Medicum
| | - Antti-Pekka Sarin
- Institute for Molecular Medicine Finland, University of Helsinki, Helsinki 00014, Finland
| | - Jaakko Kaprio
- Institute for Molecular Medicine Finland, University of Helsinki, Helsinki 00014, Finland National Institute for Health and Welfare, Helsinki 00271, Finland
| | - Johan G Eriksson
- Folkhälsan Research Centre, Helsinki 00250, Finland Unit of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki 00014, Finland
| | - Harri Rissanen
- National Institute for Health and Welfare, Helsinki 00271, Finland
| | - Paul Knekt
- National Institute for Health and Welfare, Helsinki 00271, Finland
| | - Eero Pukkala
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki 00130, Finland School of Health Sciences, University of Tampere, Tampere 33014, Finland
| | - Pekka Jousilahti
- National Institute for Health and Welfare, Helsinki 00271, Finland
| | - Veikko Salomaa
- National Institute for Health and Welfare, Helsinki 00271, Finland
| | - Samuli Ripatti
- Institute for Molecular Medicine Finland, University of Helsinki, Helsinki 00014, Finland
| | - Aarno Palotie
- Institute for Molecular Medicine Finland, University of Helsinki, Helsinki 00014, Finland Analytic and Translational Genetics Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, USA Program in Medical and Population Genetics, The Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Heikki Järvinen
- Department of Surgery, Helsinki University Central Hospital, Hospital District of Helsinki and Uusimaa, Helsinki 00029, Finland
| | - Laura Renkonen-Sinisalo
- Department of Surgery, Abdominal Center, Helsinki University Hospital, Helsinki 00029, Finland
| | - Anna Lepistö
- Department of Surgery, Abdominal Center, Helsinki University Hospital, Helsinki 00029, Finland
| | - Jan Böhm
- Department of Pathology, Central Finland Central Hospital, Jyväskylä 40620, Finland
| | - Jukka-Pekka Mecklin
- Department of Surgery, Jyväskylä Central Hospital, University of Eastern Finland, Jyväskylä 40620, Finland
| | - Nada A Al-Tassan
- Department of Genetics, King Faisal Specialist Hospital and Research Center, Riyadh 12713, Saudi Arabia
| | - Claire Palles
- Wellcome Trust Centre for Human Genetics and NIHR Comprehensive Biomedical Research Centre, Oxford OX3 7BN, UK
| | - Lynn Martin
- Wellcome Trust Centre for Human Genetics and NIHR Comprehensive Biomedical Research Centre, Oxford OX3 7BN, UK
| | - Ella Barclay
- Wellcome Trust Centre for Human Genetics and NIHR Comprehensive Biomedical Research Centre, Oxford OX3 7BN, UK
| | - Albert Tenesa
- Colon Cancer Genetics Group, University of Edinburgh and MRC Human Genetics Unit, Western General Hospital, Edinburgh EH4 2XU, UK The Roslin Institute, University of Edinburgh, Easter Bush, Roslin EH25 9RG, UK
| | - Susan Farrington
- Colon Cancer Genetics Group, University of Edinburgh and MRC Human Genetics Unit, Western General Hospital, Edinburgh EH4 2XU, UK
| | - Maria N Timofeeva
- Colon Cancer Genetics Group, University of Edinburgh and MRC Human Genetics Unit, Western General Hospital, Edinburgh EH4 2XU, UK
| | - Brian F Meyer
- Department of Genetics, King Faisal Specialist Hospital and Research Center, Riyadh 12713, Saudi Arabia
| | - Salma M Wakil
- Department of Genetics, King Faisal Specialist Hospital and Research Center, Riyadh 12713, Saudi Arabia
| | - Harry Campbell
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh EH8 9AG, UK
| | - Christopher G Smith
- Institute of Cancer and Genetics, School of Medicine, Cardiff University, Cardiff CF14 4XN, UK
| | - Shelley Idziaszczyk
- Institute of Cancer and Genetics, School of Medicine, Cardiff University, Cardiff CF14 4XN, UK
| | - Timothy S Maughan
- CRUK/MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford OX3 7DQ, UK
| | - Richard Kaplan
- MRC Clinical Trials Unit, Aviation House, London WC2B 6NH, UK
| | - Rachel Kerr
- Department of Oncology, Oxford Cancer Centre, Churchill Hospital
| | - David Kerr
- Nuffield Department of Clinical Laboratory Sciences, John Radcliffe Hospital, University of Oxford, Oxford OX3 7LE, UK
| | - Daniel D Buchanan
- Colorectal Oncogenomics Group, Genetic Epidemiology Laboratory, Department of Pathology Centre for Epidemiology and Biostatistics, The University of Melbourne, Melbourne, Vic. 3010, Australia
| | - Aung Ko Win
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Melbourne, Vic. 3010, Australia
| | - John Hopper
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Melbourne, Vic. 3010, Australia
| | - Mark Jenkins
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Melbourne, Vic. 3010, Australia
| | - Noralane M Lindor
- Department of Health Sciences Research, Mayo Clinic, Scottsdale, AZ 85259, USA
| | - Polly A Newcomb
- Cancer Prevention Program, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA
| | - Steve Gallinger
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON M5G 1X5, Canada
| | - David Conti
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Fred Schumacher
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Graham Casey
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Jussi Taipale
- Genome-Scale Biology Research Program, Research Programs Unit Department of Medical and Clinical Genetics, Medicum Department of Biosciences and Nutrition, SciLife Center, Karolinska Institute, Stockholm, SE 141 83, Sweden
| | - Jeremy P Cheadle
- Genome-Scale Biology Research Program, Research Programs Unit Genome-Scale Biology Research Program, Research Programs Unit
| | - Malcolm G Dunlop
- Colon Cancer Genetics Group, University of Edinburgh and MRC Human Genetics Unit, Western General Hospital, Edinburgh EH4 2XU, UK
| | - Ian P Tomlinson
- Wellcome Trust Centre for Human Genetics and NIHR Comprehensive Biomedical Research Centre, Oxford OX3 7BN, UK
| | - Lauri A Aaltonen
- Genome-Scale Biology Research Program, Research Programs Unit Department of Medical and Clinical Genetics, Medicum
| | - Richard S Houlston
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London SW7 3RP, UK
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Sharafeldin N, Slattery ML, Liu Q, Franco-Villalobos C, Caan BJ, Potter JD, Yasui Y. A Candidate-Pathway Approach to Identify Gene-Environment Interactions: Analyses of Colon Cancer Risk and Survival. J Natl Cancer Inst 2015; 107:djv160. [PMID: 26072521 DOI: 10.1093/jnci/djv160] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 05/13/2015] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Genetic association studies have traditionally focused on associations between individual single nucleotide polymorphisms (SNPs) and disease. Standard analysis ignores interactions between multiple SNPs and environmental exposures explaining a small portion of disease heritability: the often-cited issue of "missing heritability." METHODS We present a novel three-step analytic framework for modeling gene-environment interactions (GEIs) between an angiogenesis candidate-gene pathway and three lifestyle exposures (dietary protein, smoking, and alcohol consumption) on colon cancer risk and survival. Logic regression was used to summarize the gene-pathway effects, and GEIs were modeled using logistic regression and Cox proportional hazards models. We analyzed data from 1541 colon cancer case patients and 1934 control subjects in the Diet, Activity and Lifestyle as a Risk Factor for Colon Cancer Study. RESULTS We identified five statistically significant GEIs for colon cancer risk. For risk interaction, odds ratios (ORINT) and 95% confidence intervals (CIs) were FLT1(rs678714) and BMP4(rs17563) and smoking (ORINT = 1.64, 95% CI = 1.11 to 2.41 and ORINT = 1.60, 95% CI = 1.10 to 2.32, respectively); FLT1(rs2387632 OR rs9513070) and protein intake (ORINT = 1.69, 95% CI = 1.03 to 2.77); KDR(rs6838752) and TLR2(rs3804099) and alcohol (ORINT = 1.53, 95% CI = 1.10 to 2.13 and ORINT = 1.59, 95% CI = 1.05 to 2.38, respectively). Three GEIs between TNF, BMP1, and BMPR2 genes and the three exposures were statistically significant at the 5% level in relation to colon cancer survival but not after multiple-testing adjustment. CONCLUSIONS Adopting a comprehensive biologically informed candidate-pathway approach identified GEI effects on colon cancer. Findings may have important implications for public health and personalized medicine targeting prevention and therapeutic strategies. Findings from this study need to be validated in other studies.
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Affiliation(s)
- Noha Sharafeldin
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada (NS, QL, CFV, YY); Department of Internal Medicine, University of Utah Health Sciences Center, Salt Lake City, UT (MLS); Division of Research, Kaiser Permanente Medical Care Program, Oakland, CA (BJC); Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA (JDP); Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA (JDP); Centre for Public Health Research, Massey University, Wellington, New Zealand (JDP)
| | - Martha L Slattery
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada (NS, QL, CFV, YY); Department of Internal Medicine, University of Utah Health Sciences Center, Salt Lake City, UT (MLS); Division of Research, Kaiser Permanente Medical Care Program, Oakland, CA (BJC); Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA (JDP); Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA (JDP); Centre for Public Health Research, Massey University, Wellington, New Zealand (JDP)
| | - Qi Liu
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada (NS, QL, CFV, YY); Department of Internal Medicine, University of Utah Health Sciences Center, Salt Lake City, UT (MLS); Division of Research, Kaiser Permanente Medical Care Program, Oakland, CA (BJC); Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA (JDP); Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA (JDP); Centre for Public Health Research, Massey University, Wellington, New Zealand (JDP)
| | - Conrado Franco-Villalobos
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada (NS, QL, CFV, YY); Department of Internal Medicine, University of Utah Health Sciences Center, Salt Lake City, UT (MLS); Division of Research, Kaiser Permanente Medical Care Program, Oakland, CA (BJC); Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA (JDP); Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA (JDP); Centre for Public Health Research, Massey University, Wellington, New Zealand (JDP)
| | - Bette J Caan
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada (NS, QL, CFV, YY); Department of Internal Medicine, University of Utah Health Sciences Center, Salt Lake City, UT (MLS); Division of Research, Kaiser Permanente Medical Care Program, Oakland, CA (BJC); Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA (JDP); Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA (JDP); Centre for Public Health Research, Massey University, Wellington, New Zealand (JDP)
| | - John D Potter
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada (NS, QL, CFV, YY); Department of Internal Medicine, University of Utah Health Sciences Center, Salt Lake City, UT (MLS); Division of Research, Kaiser Permanente Medical Care Program, Oakland, CA (BJC); Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA (JDP); Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA (JDP); Centre for Public Health Research, Massey University, Wellington, New Zealand (JDP)
| | - Yutaka Yasui
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada (NS, QL, CFV, YY); Department of Internal Medicine, University of Utah Health Sciences Center, Salt Lake City, UT (MLS); Division of Research, Kaiser Permanente Medical Care Program, Oakland, CA (BJC); Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA (JDP); Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA (JDP); Centre for Public Health Research, Massey University, Wellington, New Zealand (JDP).
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