The detection of adducts in human cervix tissue DNA using 32P-postlabelling: a study of the relationship with smoking history and oral contraceptive use

Association of Combined Tobacco Smoking and Oral Contraceptive Use With Cervical Intraepithelial Neoplasia 2 or 3 in Korean Women

Background

Cigarette smoking and oral contraceptive (OC) use have been associated with cervical neoplasia, and the combination of smoking and OC use could influence cervical carcinogenesis. We aimed to assess the joint effect of smoking and OC use on the risk of cervical intraepithelial neoplasia (CIN).

Methods

From a cohort of human papillomavirus-positive subjects recruited from 6 hospitals in Korea from March 2006 to November 2012, a total of 678 subjects (411 control, 133 CIN 1, and 134 CIN 2 or 3 cases) were selected for this study (mean age, 43 years). The risk of CIN associated with smoking and OC use on additive and multiplicative scales was estimated via multinomial logistic regression after adjustment for potential confounding factors. The relative excess risk due to interaction (RERI) and the synergy index (S) were used to evaluate the additive interaction.

Results

OC users (odds ratio [OR] 1.98; 95% confidence interval [CI], 1.07–3.69) and long-term OC use (≥20 months; OR 2.71; 95% CI, 1.11–6.59) had a higher risk of CIN 2/3, but had no association with CIN 1, compared to non-OC users. Smokers and heavy smoking (≥8 cigarettes/day) were not associated with any CIN grade. Combined smoking and OC use (OR 4.91; 95% CI, 1.68–14.4; RERI/S, 3.77/27.4; P for multiplicative interaction = 0.003) and combined heavy smoking and long-term OC use (OR 11.5; 95% CI, 1.88–70.4; RERI/S, 9.93/18.8; P for multiplicative interaction = 0.009) had a higher risk of CIN 2/3 but had no association with CIN 1 compared to combined non-smoking and non-OC use.

Conclusions

OC use and smoking acted synergistically to increase the risk of CIN 2 or 3 in Korean women.

N7-methyldeoxyguanosine levels in DNA isolated from cervical cytology samples are associated with smoking

Smoking has been associated, in epidemiological studies, with an increased risk of cervical neoplasia. This may be in part due to the presence of tobacco-specific nitrosamines in cervical mucous of smokers, which may result in carcinogenic DNA damage. We have thus examined whether cervical DNA contains alkylation damage arising from exposure to methylating agents (N7-methyldeoxyguanosine, N7-MedG). DNA was extracted from cervical cytology samples and N7-MedG levels were measured using an immunoslotblot assay. Ninety percentage of the DNA samples were alkylated and N7-MedG levels (mean, 95% CI) in ever-smokers (1.27, 0.90-1.81 micromol/mol dG) were significantly higher than those in nonsmokers (0.42, 0.20-0.91 micromol/mol dG: p = 0.005). N7-MedG adduct levels were significantly correlated with number of cigarettes smoked per day and pack years of cigarette smoking in current smokers. There was no association with N7-MedG levels and cervical intraepithelial neoplasia status, age, parity or contraception use. Our study suggests that cervical DNA contains alkylation damage that can arise from exposure to cigarette smoke.

Tubal sterilization and use of an IUD and risk of cervical cancer

The relationship of tubal sterilization and use of an intrauterine device (IUD) to the risk of invasive squamous cell cervical cancer was evaluated in a case-control study carried out in Shandong, China, from 1989 to 1991. Patients (cases) were 272 women aged 30-77 years with newly diagnosed invasive squamous cell cervical cancer in Shandong Province Tumor Hospital. Controls were 893 randomly selected screened women matched to the cases by age (within 2 years) and county. A decrease in risk was observed in uses of an IUD, especially in long-term users under age 33. A nonsignificant decrease in risk in women under age 33 who had had a tubal ligation was also observed, especially in the first 10 years since the procedure. Tubal ligation and IUD insertion and removal provide opportunities to screen women for cervical cancer and reduce the risk of invasive disease.

The role of DNA adducts in chemical carcinogenesis

The reaction of chemical carcinogens with DNA appears to be one of the earliest events in the initiation phase of cancer. These DNA reactions can be base- and position-specific, are affected by sequence context, and are repaired at different rates depending on whether or not they are on the transcribed or nontranscribed strand of DNA and which nucleotide sequence is modified. Thus, measurement of total genomic DNA reaction of carcinogens is only a crude first step in dissecting out which are the critical lesions for cancer initiation. On the other hand, we know that DNA adducts, which have been primarily characterised in experimental studies, appear to have similar structures in human DNA arising from occupational or environmental exposures. A number of different methods have been developed to detect and measure DNA adducts in man. These include physico-chemical methods such as mass spectrometry, 32P-postlabelling, fluorescence and accelerator mass spectrometry (AMS) and biological methods such as immunoassay. All these methods have their strengths and weaknesses. Human studies, using 32P-postlabelling, demonstrate that this method can be used to examine the effect of potential chemoprotective agents on DNA adduct level. AMS has been used to measure DNA adducts in human tissue after patients have ingested trace quantities of the food mutagens 2-amino-3,8-dimethylimidazo[4,5-f]quinoxaline, a heterocyclic amine formed during the cooking of meat and the naturally occurring mycotoxin, aflatoxin B1. These studies can assist in assessing the risks associated with low-level exposure to food genotoxins.

Stability of benzo[a]pyrene DNA adducts in rat tissues during their long-term storage at -20 degrees C or -80 degrees C

The aim of this study was to examine whether the storage of tissues at -80 degrees C or -20 degrees C affects the benzo[a]pyrene (B[a]P)-derived DNA adduct pattern and levels in rat tissues. Three rats were treated orally with a single dose of 100 mg B[a]P/kg b.w. and killed 24 h later. White blood cells (WBC) were isolated from the fresh blood. Livers, lungs and hearts were immediately removed, dissected into small fragments and were pooled for each organ. Pooled samples were proportionally divided into 7 aliquots. DNA from the first aliquot was immediately isolated (time 0). The other aliquots were frozen and stored at -20 degrees C or at -80 degrees C. DNA was isolated from the frozen samples at 1, 5 and 10 months later. 32P-postlabeling analysis was performed at the beginning and at the end of study with the whole set of samples. Two B[a]P-derived adducts were detected in all tissues but with different intensities for different tissue types. One of the adducts was found predominantly in WBC (approximately 85%) and liver (approximately 68%), while heart and lung accounted only for approximately 43% and approximately 39%, respectively. This adduct was tentatively identified as benzo[a]pyrene diol-epoxide-N2 adduct (BPDE-N2-dG) based on TLC and HPLC analyses of 32P-postlabeled adducts. The highest total DNA adduct level (sum of 2 spots) was found in lung (4.90 adducts/10(8) nucleotides) compared with heart, liver and WBC (3.55, 2.37 and 2.32 adducts/10(8) nucleotides, respectively). The analysis of variance provided evidence that storage of tissues at -20 degrees C or at -80 degrees C up to 10 months did not significantly affect B[a]P DNA adduct levels and patterns in the rat lung, heart and liver. Our study indicates that properly stored tissues can be used for DNA adduct analysis with confidence.

32P-postlabeling analysis of DNA adducts in different populations

Blood samples were obtained from different populations exposed occupationally or by lifestyle habits to polycyclic aromatic hydrocarbons (PAH). DNA adducts were determined by 32P-postlabeling assay either in white blood cells (WBC) or lymphocytes. The level of DNA adducts ranged from 1.5 per 10(9) nucleotides in one of the control groups up to 7.1 per 10(9) nucleotides in one group of PAH-exposed workers. Comparison of the adduct thin layer chromatography (TLC) profiles revealed individual variation in both pattern and level of DNA adducts. Significant differences of adduct levels were detected between one group of PAH-exposed coke-oven workers and the corresponding control group. Only a weak influence of the smoking habits on the amount of adducts was detectable in occupationally exposed or unexposed individuals.