Selenium and glutathione peroxidase levels in patients with epidermoid carcinoma of the oral cavity and oropharynx

Selenium in global food systems

Food systems need to produce enough of the essential trace element Se to provide regular adult intakes of at least 40 μg/d to support the maximal expression of the Se enzymes, and perhaps as much as 300 μg/d to reduce risks of cancer. Deprivation of Se is associated with impairments in antioxidant protection, redox regulation and energy production as consequences of suboptimal expression of one or more of the Se-containing enzymes. These impairments may not cause deficiency signs in the classical sense, but instead contribute to health problems caused by physiological and environmental oxidative stresses and infections. At the same time, supranutritional intakes of Se, i.e. intakes greater than those required for selenocysteine enzyme expression, appear to reduce cancer risk. The lower, nutritional, level is greater than the typical intakes of many people in several parts of the world, and few populations have intakes approaching the latter, supranutritional, level. Accordingly, low Se status is likely to contribute to morbidity and mortality due to infectious as well as chronic diseases, and increasing Se intakes in all parts of the world can be expected to reduce cancer rates.

Selenium Accumulation in Prostate Tissue During a Randomized, Controlled Short-term Trial of l-Selenomethionine: a Southwest Oncology Group Study

PURPOSE

Epidemiologic and clinical data suggest that selenium could prevent prostate cancer, but it has not been shown that supplemental selenium leads to an increased concentration of selenium in prostate tissue compared with adjacent tissue.

EXPERIMENTAL DESIGN

We conducted a randomized, controlled, short-term trial of l-selenomethionine (SeMet) versus observation in men with organ-confined prostate cancer. The primary endpoint was the measurement of selenium concentration in prostate tissue and seminal vesicle (SV). We assessed baseline selenium levels in serum and in toenail specimens (reflecting long-term intake) and post-intervention selenium levels in serum, and in prostate and SV tissues using hydride generation atomic fluorescence spectroscopy.

RESULTS

Sixty-six eligible patients were randomly assigned to the SeMet (n = 34) or observation (n = 32) arm; both arms had similar baseline patient characteristics. Baseline serum selenium was similar in the two groups (P = 0.64). Baseline toenail selenium levels were slightly higher in the SeMet group than in the control group (P = 0.07). After the intervention, the mean serum selenium level increased 15% in the SeMet arm and was higher than in the observation arm (P = 0.001). The selenium concentration in prostate tissue was 22% higher in the SeMet arm (n = 26) than in the observation arm (n = 25; 1.80 versus 1.47 ppm; P = 0.003, Wilcoxon rank sum test) and remained significantly higher after adjusting for chronic selenium intake (P = 0.021, ANCOVA). SV selenium concentration was similar in both groups (P = 0.384) and was lower than in prostate tissue.

CONCLUSIONS

The present study is the first to show that selenium taken as oral supplementation accumulates preferentially in the human prostate gland as opposed to the SV. These findings support the hypothesis that oral selenium supplementation may contribute to the cancer preventive effects of selenium.

Chemoprevention of squamous cell carcinoma of the oral cavity

Squamous cell carcinoma of the oral cavity has long been seen as an attractive candidate for chemoprevention strategies. Because of the poor out-comes associated with the disease, the presence of identifiable premalignant lesions, and the failure of local preventive therapies, such as surgery, many investigators have hoped to find an effective chemopreventive compound. Initial enthusiasm surrounding high-dose retinoids gave way to concerns regarding toxicity and short duration of response. Although many of the other agents discussed above have shown promise, as yet none have been proven safe and effective in large-scale randomized trials. Much has been learned,however, about the molecular process of oral carcinogenesis from studies of these agents. Ongoing and future studies of chemopreventive agents in oral cancer hopefully will be able to exploit our expanding knowledge of these molecular pathways.

The role of folates in squamous cell carcinoma of the head and neck

The primary objective of this review is to explore the hypothesis that folate insufficiency may be important in the pathogenesis of squamous cell carcinomas of the head and neck (SCCHN) and that folate repletion may be an effective component of chemoprevention. The main results are that folate insufficiency disrupts DNA global and specific gene methylation patterns such that the activity of certain tumor suppressor genes such as p16 and possibly p53 may be lost. Folate pool imbalance and impaired repair mechanisms may contribute to DNA instability and strand breaks. Sensitive methods exist for identification of individuals with folate insufficiency in contrast to the relatively insensitive conventional serum or red cell folate assays with broad "normal" ranges. The impact of folate supplementation can thus be quantified. Folate imbalance may result from alterations in folate cellular uptake by the reduced folate carrier (RFC) and/or the folate receptor (FR) and polymorphisms in enzymes important in folate retention such as folylpolyglutamate synthetase and in folate modification such as methylene tetrahydrofolate reductase (MTHFR). Known predisposing factors for SCCHN such as alcohol and tobacco carcinogens may influence folate balance. Folate supplementation may reduce primary or secondary risk of cancer. Formal studies of folate sufficiency in persons at risk for or diagnosed and treated for SCCHN are needed to define the role of folate supplementation in the prevention of these cancers.

Advances in Chemoprevention of Head and Neck Cancer

Head and neck squamous cell carcinoma is a devastating disease with a poor outcome in advanced stages, accounting for approximately 3% of all malignancies, with an estimated 37200 new cases and 11000 deaths annually in the U.S. Second primary tumors are estimated to occur at an annual rate of 3%-10% and are significant threats to long-term survivors. Chemoprevention is an appealing strategy, and its success has been demonstrated in breast cancer and familial adenomatous polyposis. High-dose retinoids have been shown to be active against oral premalignant lesions and in prevention of second primary tumors in the head and neck. New targets include the epidermal growth factor receptor, cyclooxygenase-2, and other molecular targets. Challenges in future head and neck cancer chemoprevention investigations include achieving long-lasting efficacy with retinoids and/or new agents, and determining the optimal dose and duration of therapy while maintaining acceptable toxicities.

Augmented expression of peroxiredoxin I in lung cancer

Comparative proteome analysis was performed between human normal (BEAS 2B) and malignant (A549) lung epithelial cells in an attempt to identify novel biomarkers of lung cancer. Approximately 500 protein spots could be separated by mini two-dimensional electrophoresis and visualized with Coomassie blue R-250. Among those relatively abundant proteins, eight spots were changed more than twofold reproducibly and identified by peptide mass fingerprints using mass spectrometry and database search. The increased proteins in A549 were aldehyde dehydrogenase, peroxiredoxin I, fatty acid binding protein, aldoketoreductase, and destrin, whereas the decreased proteins were galectin-1, transgelin, and stathmin. Since human lung is exposed to continuous oxidative stress, antioxidant enzyme peroxiredoxin I was selected for further investigation and its augmented expression was confirmed in cancer tissues compared to normal tissues from lung cancer patients, suggesting peroxiredoxin I as a potential biomarker of lung cancer.

Glutathione and its metabolizing enzymes in patients with different benign and malignant diseases

OBJECTIVES

Evaluation of glutathione (GSH) system in different tumors to reveal its potential usefulness in a clinical setting.

DESIGN AND METHODS

In addition to 10 normal controls, blood and tissue samples (85 benign and 109 malignant) from patients with breast, ovarian, prostatic, and liver neoplasms were investigated. The GSH concentration, glutathione S-transferase, glutathione peroxidase, and glutathione reductase activities were biochemically measured.

RESULTS

Whereas all the components of the GSH system increased in patients with breast tumors, few components were significantly changed in patients with malignant ovarian, prostatic as well as metastatic liver diseases. GSH had the highest Z scores in ovarian and breast tumors. It was correlated (p < 0.05) with both glutathione S-transferase, glutathione peroxidase in breast cancer and with glutathione S-transferase only in prostate cancer. No correlation could be found in the expression of the GSH system in the blood and tissues of the same group of patients.

CONCLUSION

This work revealed that measurement of some and/or all components of the GSH system might be of clinical value in some malignant cases.

Peroxiredoxin I expression in oral cancer: a potential new tumor marker

This study investigates the applicability of the novel antioxidant protein, peroxiredoxin (Prx) I as a marker for tumor status in oral squamous cell carcinoma (SCC). Samples from 53 patients with SCC in the oral cavity were examined by immunohistochemistry. Correlations between the expression level of Prx I and proliferating cell nuclear antigen (PCNA), the clinical features of tumors, and their histopathological classifications were statistically analyzed. Cases exhibiting low Prx I expression level included significantly more with larger tumor mass cases (T-category, P=0.004), positive lymph node metastasis (N-category, P=0.015), advanced stage (P=0.002), and poorly differentiated cells (P=0.020). There was no significant difference between Prx I expression and the other indices.

Mutagenic activity of 4-nitroquinoline-N-oxide in upper aerodigestive tissue in lacZ mice (MutaMouse) and the effects of 1, 4-phenylenebis(methylene)selenocyanate

4-Nitroquinoline-N-oxide (4-NQO) was administered to lacZ mice at a concentration of 20 microg/ml in drinking water for 2 weeks, and the mutagenic fractions in a number of organs were assayed. The mutant fractions in tongue, esophagus and other pooled oral tissues were, respectively, 117+/-26, 73+/-15, and 48+/-15 mutants/10(5) plaque-forming units (pfu) (ca. 15-40xbackground). 4-NQO was not mutagenic in lung, liver or colon at conditions used here. We had previously demonstrated that the synthetic organoselenium compound, 1,4-phenylenebis(methylene)selenocyanate (p-XSC), an established chemopreventive agent, greatly reduced carcinogenicity in 4-NQO in rat tongue, and we observed here that administration of p-XSC (10 ppm se) in the diet for 6 weeks (2 weeks before, during, and 2 weeks after 4-NQO) resulted in a 33% decrease in mutagenesis in oral tissue, a 17% decrease in esophagus, and a slight increase in tongue. Only the decrease in oral tissue reached statistical significance (p<0.04). The results reported here demonstrate that 4-NQO was extremely mutagenic in lacZ mouse tongue, with lower, but highly significant activities in esophagus and other pooled oral tissues. The high activity of 4-NQO in lacZ mouse tongue is consistent with the organ specificity of 4-NQO in the rat. Inhibition of 4-NQO-induced mutagenesis by p-XSC was observed mainly in pooled oral tissues, other than tongue. Possible reasons for the difference between inhibition of mutagenesis and carcinogenesis in tongue are discussed, as well as advantages and disadvantages of in vivo mutagenesis assays as surrogates for carcinogenicity assays in chemoprevention studies.

Blood selenium and glutathione peroxidase status in patients with colorectal cancer

PURPOSE

It is still controversial whether a low selenium level and a reduced activity of the selenium-dependent enzyme, glutathione peroxidase, in blood are associated with an increased risk and poor prognosis of cancer in humans. This study evaluates whether colorectal cancer patients have lower serum selenium and glutathione peroxidase levels than a gender-matched and age-matched control group and whether there is a correlation to clinical data and prognosis.

METHODS

In a retrospective study, serum selenium and glutathione peroxidase activity of 106 patients with colorectal cancer were determined. Clinical data were provided by our long-term follow-up program for colorectal cancer patients.

RESULTS

Patients with a selenium level <70 microg/l had a significantly lower mean survival time and a lower cumulative cancer-related survival rate than patients with a selenium level >70 microg/l (P = 0.0009). When considering the different tumor stages, a decline of the mean selenium level in the T4 carcinoma group was found in the analysis of variance (P < 0.05). The lowest selenium level was found for patients with advanced tumor disease and in a preoperative situation, ie., high tumor burden. In comparison with the control group, the cancer group showed a significant reduction of serum glutathione peroxidase activity (P < 0.01) but no significant difference in selenium level.

CONCLUSIONS

These results support the hypothesis of an association between low selenium level and advanced tumor disease. From our data, it cannot be decided whether this phenomenon is more likely to be a consequence or a causative factor for development and course of the disease.

Glutathione peroxidase and glutathione reductase activities in cancerous and non-cancerous human kidney tissues

Selenium-dependent (Se-GSH-Px), selenium-independent (non-Se-GSH-Px) glutathione peroxidase and glutathione reductase (GSSG-Rx) activities have been determined in cancerous and non-cancerous human adult kidney. Large inter-individual variation in the activities of all enzymes tested were found in both tumour and non-tumour specimens. In general a significant decrease in the activities of the three enzymes was found in tumours. When a comparison was made between cancerous and non-cancerous tissues of the same individual, Se-GSH-Px activity was found to be lower in tumour in 17 cases out of 29, and the non-Se-GSH-Px activity in 20. In 20 cases out of 29 GSSG-Rx was found to be lower in tumour. It was concluded that changes in the factors involved in the anti-oxidative protection actually occur in human kidney tumour.

Levels of selenium in plasma and glutathione peroxidase in erythrocytes and the risk of breast cancer. A case-control study

Plasma selenium and glutathione peroxidase in erythrocytes were analyzed in a case-control study encompassing 441 cases with breast cancer and 191 controls with benign breast disease. No difference in mean serum selenium level between cases and controls on supplementary selenium intake was seen. If only individuals without supplementary intake, 278 cases and 135 controls, were considered a preventive effect was found increasing with selenium level. This finding was significant among women 50 years old or more with Mantel-Haenszel odds ratio = 0.16 for individuals with serum selenium > 1.21 mumol/L. Also for subjects with serum selenium in the range 1.00-1.21 mumol/L a significant preventive effect was seen with odds ratio = 0.38. For women under 50 years of age a nonsignificant preventive effect was seen. Glutathione peroxidase in erythrocytes did not correlate well with serum selenium and was not a marker for the risk of breast cancer.

A case-control study of oral cancer and pre-diagnostic concentrations of selenium and zinc in nail tissue

A case-control study of oral cancer was conducted in western Washington state between 1983 and 1987. Cases (n = 379) were identified through a population-based registry, and controls (n = 514) were selected by telephone using random digit dialing. Subjects participated in a personal interview, completed a food-frequency questionnaire, and submitted clippings from the nails of each great toe for the determination of selenium and zinc concentrations. The odds ratio (OR) for low selenium levels in nail tissue (lowest 25% of the distribution compared to the upper 75%) was 1.4 (95% confidence interval (CI) 1.0-2.2). Likewise, the odds ratio for low zinc levels in nails was 1.6 (95% CI 1.0-2.3), but for low dietary zinc was 1.0 (95% CI 0.7-1.7). Men with oral cancer had lower nail selenium levels than did the controls (OR = 1.9), but women with oral cancer did not (OR = 0.6). Individuals 20 to 39 years of age with oral cancer, in particular, were more likely to have lower selenium levels in nail tissue than controls (OR = 16.4). There was a significant interaction between selenium and ascorbic acid levels which could not be explained by cigarette use. Subjects at greatest risk had low levels of both nutrients (OR = 3.8 for smokers and OR = 5.7 for non-smokers). However, since the elements were deposited in the nail matrix close to the date of diagnosis, the differences in the element concentrations between cases and controls may have been a result of the disease. Further etiologic studies of selenium, vitamin intake and oral carcinoma are warranted.

Diet, nutritional status, and cancer risk in American blacks

About 35% (10-70%) of all cancers may be associated with nutritional causes (1). However, while natural or added substances in foods may be carcinogenic, nutritional deficiencies or excesses may promote carcinogenesis. We compared data from blacks and whites using dietary and nutritional status surveys in the United States to determine whether the poorer dietary patterns and nutritional status of American blacks may be associated with their higher incidence and mortality from certain cancers (compared with whites). Our review indicates that blacks eat more nitrate and animal foods and not enough fiber in relation to protein, fat, and carbohydrate. Blacks also have poorer nutritional status with respect to getting enough thiamine, riboflavin, vitamins A and C, and iron, to being obese (females), and to being underweight (males). This is in agreement with hypotheses regarding the interactions between diet and cancer (associations found in whites) and dose-response relationships reported for some cancers for which blacks have a higher incidence and mortality than whites. More large-scale prospective case-control and cohort studies are needed in both blacks and whites to elucidate the contribution of specific dietary and nutritional factors to the risk of specific cancers in these population groups. However, such studies must be preceded by methodological research to obtain more valid measures of dietary and nutritional status.

Selenium and other mineral elements in populations at risk for esophageal cancer

The current study tested the hypothesis that deficiencies of certain mineral elements are risk factors for esophageal cancer (EC). In rural blacks living in areas with moderate to high EC incidence rates in southern Africa, the whole blood selenium (Se) levels were found to be significantly (P less than 0.0005) lower (58 to 71 ng/ml) than those of rural and urban populations living in low EC rate areas (114 to 177 ng/ml). No significant differences were found in the plasma levels of the other mineral elements examined, including zinc, copper, and magnesium. Within a high EC rate area occupants of households with previously recorded EC cases had significantly (P less than 0.0025) lower levels of Se (64 ng/ml), but not of other mineral elements, than subjects from households without known cases (77 ng/ml). Mean Se levels of subjects with premalignant or malignant esophageal cytological changes (54 ng/ml) were significantly (P less than 0.0025) lower than those of subjects without such lesions (68 ng/ml). An inverse relationship was found between Se status and the degree of cytologic abnormality. These findings suggest that Se deficiency may play a role in the development of EC. The potential value of whole blood Se determinations and esophageal cytologic examinations in the early detection and of Se supplementation in the prevention of EC merits further investigation.

Plasma selenium levels in patients with advanced upper gastrointestinal cancer

Plasma selenium levels were determined at various intervals during hospitalization of 71 patients with upper gastrointestinal and other malignancies. These patients often require frequent nutritional as well as surgical or medical intervention. Attempts were made to identify, evaluate, and compensate for numerous confounding variables at each of the 374 plasma selenium determinations. Selenium levels in stable patients who were neither receiving aggressive antineoplastic therapy, nor septic, nor taking corticosteroids and who had no clinically significant metabolic imbalance were then separately analyzed. In 55 stable patients selenium levels were 28% lower than those found in 20 normal controls (mean 61.8 micrograms/L, P less than 0.0005). An analysis of all the readings showed that selenium levels were substantially decreased by recent radiotherapy or sepsis, by regional tumor spread and increased tumor burden, and by intravenous and/or enteral hyperalimentation and intravenous lipids. In contrast to these findings, levels were relatively higher in patients with an adequate oral diet or with a lesser tumor burden. The comparison between selenium levels in stable and in aggressively treated or septic patients supports the importance of the relationship of nutrition to selenium levels in cancer patients.

Inhibition of hamster tongue carcinogenesis by selenium and retinoic acid

The inhibitory effect of selenium, 13-cis-retinoic acid, and their combination was studied in an animal model in which squamous cell carcinoma of the tongue was induced by 0.5% 9,10 dimethyl-1,2 benzanthracene (DMBA). A controlled, blinded experiment was carried out using 60 Syrian hamsters divided into four groups of 15 each. When compared to controls, the mean day of carcinoma onset was delayed 3 weeks for animals given selenium, 6 weeks for animals given retinoic acid, and 5.5 weeks for animals given selenium plus retinoic acid. The differences between each experimental group and the control group are statistically significant. We conclude that both selenium and retinoic acid inhibit the development of DMBA-induced squamous cell carcinoma of the tongue in hamsters. The dose of retinoic acid used produces a stronger inhibitory effect, but is associated with significant toxicity. At the doses used, combined inhibitory effect is no greater than that for retinoic acid alone.

Selenium inhibition of chemical carcinogenesis in the upper aerodigestive tract of hamsters

Evidence suggests that ingestion of selenium compounds may inhibit carcinogenesis. We studied this in hamsters in which squamous cell carcinoma of the tongue was induced with 0.5% dimethylbenzanthracene (DMBA). Forty-five hamsters, divided into three groups of 15 each, were fed a low-selenium diet and the left lateral border of the tongue was painted with DMBA three times a week. Control animals were given deionized water, while water for animals in groups 1 and 2 contained 3 and 6 ppm selenium, respectively. All sufficiently long-lived animals developed leukoplakia of the tongue and floor of the mouth that progressed to dysplasia and papillary or ulcerative carcinoma. Carcinomas were seen less frequently on the palate and in the pyriform sinuses. Carcinoma metastasized to neck lymph nodes in two hamsters. Data indicate a 2-week delay in leukoplakia incidence for the selenium groups; a higher survival rate was also noted, although this was not statistically significant. We conclude that this model is similar to tobacco-induced squamous cell carcinoma of the upper aerodigestive tract in humans and that ingestion of supplemental selenium produces a modest inhibitory effect on leukoplakia.