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Aldoori J, Zulyniak MA, Toogood GJ, Hull MA. Fish oil supplement use modifies the relationship between dietary oily fish intake and plasma n-3 PUFA levels: an analysis of the UK Biobank. Br J Nutr 2024; 131:1608-1618. [PMID: 38220216 PMCID: PMC11043909 DOI: 10.1017/s0007114524000138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 12/17/2023] [Accepted: 01/08/2024] [Indexed: 01/16/2024]
Abstract
Observational evidence linking dietary n-3 PUFA intake and health outcomes is limited by a lack of robust validation of dietary intake using blood n-3 PUFA levels and potential confounding by fish oil supplement (FOS) use. We investigated the relationship between oily fish intake, FOS use and plasma n-3 PUFA levels in 121 650 UK Biobank (UKBB) participants. Ordinal logistic regression models, adjusted for clinical and lifestyle factors, were used to quantify the contribution of dietary oily fish intake and FOS use to plasma n-3 PUFA levels (measured by NMR spectroscopy). Oily fish intake and FOS use were reported by 38 % and 31 % of participants, respectively. Increasing oily fish intake was associated with a higher likelihood of FOS use (P < 0·001). Oily fish intake ≥ twice a week was the strongest predictor of high total n-3 PUFA (OR 6·7 (95 % CI 6·3, 7·1)) and DHA levels (6·6 (6·3, 7·1). FOS use was an independent predictor of high plasma n-3 PUFA levels (2·0 (2·0, 2·1)) with a similar OR to that associated with eating oily fish < once a week (1·9 (1·8, 2·0)). FOS use was associated with plasma n-3 PUFA levels that were similar to individuals in the next highest oily fish intake category. In conclusion, FOS use is more common in frequent fish consumers and modifies the relationship between oily fish intake and plasma n-3 PUFA levels in UKBB participants. If unaccounted for, FOS use may confound the relationship between dietary n-3 PUFA intake, blood levels of n-3 PUFAs and health outcomes.
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Affiliation(s)
- Joanna Aldoori
- Leeds Institute of Medical Research, University of Leeds, LeedsLS9 7TF, UK
- St James’s University Hospital, Leeds Teaching Hospitals NHS Trust, LeedsLS9 7TF, UK
| | | | - Giles J. Toogood
- Leeds Institute of Medical Research, University of Leeds, LeedsLS9 7TF, UK
- St James’s University Hospital, Leeds Teaching Hospitals NHS Trust, LeedsLS9 7TF, UK
| | - Mark A. Hull
- Leeds Institute of Medical Research, University of Leeds, LeedsLS9 7TF, UK
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Sun G, Fuller H, Fenton H, Race AD, Downing A, Williams EA, Rees CJ, Brown LC, Loadman PM, Hull MA. The effect of aspirin and eicosapentaenoic acid on urinary biomarkers of prostaglandin E 2 synthesis and platelet activation in participants of the seAFOod polyp prevention trial. Int J Cancer 2024; 154:873-885. [PMID: 37855394 PMCID: PMC10952676 DOI: 10.1002/ijc.34764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 09/25/2023] [Accepted: 09/27/2023] [Indexed: 10/20/2023]
Abstract
Urinary prostaglandin (PG) E metabolite (PGE-M) and 11-dehydro (d)-thromboxane (TX) B2 are biomarkers of cyclooxygenase-dependent prostanoid synthesis. We investigated (1) the effect of aspirin 300 mg daily and eicosapentaenoic acid (EPA) 2000 mg daily, alone and in combination, on urinary biomarker levels and, (2) whether urinary biomarker levels predicted colorectal polyp risk, during participation in the seAFOod polyp prevention trial. Urinary PGE-M and 11-d-TXB2 were measured by liquid chromatography-tandem mass spectrometry. The relationship between urinary biomarker levels and colorectal polyp outcomes was investigated using negative binomial (polyp number) and logistic (% with one or more polyps) regression models. Despite wide temporal variability in PGE-M and 11-d-TXB2 levels within individuals, both aspirin and, to a lesser extent, EPA decreased levels of both biomarkers (74% [P ≤ .001] and 8% [P ≤ .05] reduction in median 11-d-TXB2 values, respectively). In the placebo group, a high (quartile [Q] 2-4) baseline 11-d-TXB2 level predicted increased polyp number (incidence rate ratio [IRR] [95% CI] 2.26 [1.11,4.58]) and risk (odds ratio [95% CI] 3.56 [1.09,11.63]). A low (Q1) on-treatment 11-d-TXB2 level predicted reduced colorectal polyp number compared to placebo (IRR 0.34 [0.12,0.93] for combination aspirin and EPA treatment) compared to high on-treatment 11-d-TXB2 values (0.61 [0.34,1.11]). Aspirin and EPA both inhibit PGE-M and 11-d-TXB2 synthesis in keeping with shared in vivo cyclooxygenase inhibition. Colorectal polyp risk and treatment response prediction by 11-d-TXB2 is consistent with a role for platelet activation during early colorectal carcinogenesis. The use of urinary 11-d-TXB2 measurement for a precision approach to colorectal cancer risk prediction and chemoprevention requires prospective evaluation.
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Affiliation(s)
- Ge Sun
- Leeds Institute of Medical ResearchUniversity of LeedsLeedsUK
| | - Harriett Fuller
- Leeds Institute of Medical ResearchUniversity of LeedsLeedsUK
| | - Hayley Fenton
- Leeds Institute of Medical ResearchUniversity of LeedsLeedsUK
| | - Amanda D. Race
- Institute of Cancer TherapeuticsUniversity of BradfordBradfordUK
| | - Amy Downing
- Leeds Institute of Medical ResearchUniversity of LeedsLeedsUK
| | | | - Colin J. Rees
- Population Health Sciences InstituteNewcastle UniversityNewcastle upon TyneUK
| | | | - Paul M. Loadman
- Institute of Cancer TherapeuticsUniversity of BradfordBradfordUK
| | - Mark A. Hull
- Leeds Institute of Medical ResearchUniversity of LeedsLeedsUK
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Hull MA, Ow PL, Ruddock S, Brend T, Smith AF, Marshall H, Song M, Chan AT, Garrett WS, Yilmaz O, Drew DA, Collinson F, Cockbain AJ, Jones R, Loadman PM, Hall PS, Moriarty C, Cairns DA, Toogood GJ. Randomised, placebo-controlled, phase 3 trial of the effect of the omega-3 polyunsaturated fatty acid eicosapentaenoic acid (EPA) on colorectal cancer recurrence and survival after surgery for resectable liver metastases: EPA for Metastasis Trial 2 (EMT2) study protocol. BMJ Open 2023; 13:e077427. [PMID: 38030258 PMCID: PMC10689403 DOI: 10.1136/bmjopen-2023-077427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 10/26/2023] [Indexed: 12/01/2023] Open
Abstract
INTRODUCTION There remains an unmet need for safe and cost-effective adjunctive treatment of advanced colorectal cancer (CRC). The omega-3 polyunsaturated fatty acid eicosapentaenoic acid (EPA) is safe, well-tolerated and has anti-inflammatory as well as antineoplastic properties. A phase 2 randomised trial of preoperative EPA free fatty acid 2 g daily in patients undergoing surgery for CRC liver metastasis showed no difference in the primary endpoint (histological tumour proliferation index) compared with placebo. However, the trial demonstrated possible benefit for the prespecified exploratory endpoint of postoperative disease-free survival. Therefore, we tested the hypothesis that EPA treatment, started before liver resection surgery (and continued postoperatively), improves CRC outcomes in patients with CRC liver metastasis. METHODS AND ANALYSIS The EPA for Metastasis Trial 2 trial is a randomised, double-blind, placebo-controlled, phase 3 trial of 4 g EPA ethyl ester (icosapent ethyl (IPE; Vascepa)) daily in patients undergoing liver resection surgery for CRC liver metastasis with curative intent. Trial treatment continues for a minimum of 2 years and maximum of 4 years, with 6 monthly assessments, including quality of life outcomes, as well as annual clinical record review after the trial intervention. The primary endpoint is CRC progression-free survival. Key secondary endpoints are overall survival, as well as the safety and tolerability of IPE. A minimum 388 participants are estimated to provide 247 CRC progression events during minimum 2-year follow-up, allowing detection of an HR of 0.7 in favour of IPE, with a power of 80% at the 5% (two sided) level of significance, assuming drop-out of 15%. ETHICS AND DISSEMINATION Ethical and health research authority approval was obtained in January 2018. All data will be collected by 2025. Full trial results will be published in 2026. Secondary analyses of health economic data, biomarker studies and other translational work will be published subsequently. TRIAL REGISTRATION NUMBER NCT03428477.
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Affiliation(s)
- Mark A Hull
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | - Pei Loo Ow
- Leeds Cancer Research UK Clinical Trials Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Sharon Ruddock
- Leeds Cancer Research UK Clinical Trials Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Tim Brend
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | - Alexandra F Smith
- Leeds Cancer Research UK Clinical Trials Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Helen Marshall
- Leeds Cancer Research UK Clinical Trials Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Mingyang Song
- Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | - Andrew T Chan
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Wendy S Garrett
- Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | - Omer Yilmaz
- Koch Institute for Integrative Cancer Research at Massachusetts Institute of Technology, Boston, Massachusetts, USA
| | - David A Drew
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Fiona Collinson
- Leeds Cancer Research UK Clinical Trials Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | | | - Robert Jones
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - Paul M Loadman
- Institute of Cancer Therapeutics, University of Bradford, Bradford, UK
| | - Peter S Hall
- Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, UK
| | | | - David A Cairns
- Leeds Cancer Research UK Clinical Trials Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Giles J Toogood
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Madurasinghe VW, Knapp P, Eldridge S, Collier D, Treweek S, Rick J, Graffy J, Parker A, Salisbury C, Torgerson D, Jolly K, Sidhu MS, Fife-Schaw C, Hull MA, Sprange K, Brettell E, Bhandari S, Montgomery A, Bower P. Can we achieve better trial recruitment by presenting patient information through multimedia? Meta-analysis of 'studies within a trial' (SWATs). BMC Med 2023; 21:425. [PMID: 37940944 PMCID: PMC10634086 DOI: 10.1186/s12916-023-03081-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 09/14/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND People need high-quality information to make decisions about research participation. Providing information in written format alone is conventional but may not be the most effective and acceptable approach. We developed a structure for the presentation of information using multimedia which included generic and trial-specific content. Our aim was to embed 'Studies Within A Trial' (SWATs) across multiple ongoing trials to test whether multimedia presentation of patient information led to better rates of recruitment. METHODS Five trials included a SWAT and randomised their participants to receive a multimedia presentation alongside standard information, or standard written information alone. We collected data on trial recruitment, acceptance and retention and analysed the pooled results using random effects meta-analysis, with the primary outcome defined as the proportion of participants randomised following an invitation to take part. RESULTS Five SWATs provided data on the primary outcome of proportion of participants randomised. Multimedia alongside written information results in little or no difference in recruitment rates (pooled odds ratio = 0.96, 95% CI: 0.79 to 1.17, p-value = 0.671, I2 = 0%). There was no effect on any other outcomes. CONCLUSIONS Multimedia alongside written information did not improve trial recruitment rates. TRIAL REGISTRATION ISRCTN71952900, ISRCTN 06710391, ISRCTN 17160087, ISRCTN05926847, ISRCTN62869767.
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Affiliation(s)
- Vichithranie W Madurasinghe
- Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Roosevelt Drive, Oxford, OX3 7LF, UK
| | - Peter Knapp
- Department of Health Sciences, University of York & the Hull York Medical School, York, YO10 5DD, UK
| | - Sandra Eldridge
- Centre for Clinical Trials and Methodology, Institute of Population Health Sciences, Queen Mary University of London, 58 Turner Street, London, E1 2AB, UK
| | - David Collier
- Barts NIHR Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London, EC1M 6BQ, UK
| | - Shaun Treweek
- Health Services Research Unit, University of Aberdeen, 3Rd Floor, Health Sciences Building, Foresterhill, Aberdeen, AB25 2ZD, UK
| | - Jo Rick
- National Institute of Health Research School for Primary Care Research, Manchester Academic Health Science Centre, Centre for Primary Care, University of Manchester, Oxford Road, Manchester, M13 9PL, UK
| | - Jonathan Graffy
- General Practitioner Arbury Road Surgery 114, Arbury Road, Cambridge, CB4 2JG, UK
| | - Adwoa Parker
- York Trials Unit, Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - Chris Salisbury
- Centre for Academic Primary Care, Department of Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - David Torgerson
- Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK
| | - Kate Jolly
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Manbinder S Sidhu
- Health Services Management Centre, School of Social Policy, University of Birmingham, Edgbaston, Birmingham, B15 2RT, UK
| | | | - Mark A Hull
- Leeds Institute of Medical Research, University of Leeds, Leeds, LS9 7TF, UK
| | - Kirsty Sprange
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, NG7 2RD, UK
| | - Elizabeth Brettell
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, B15 2TT, UK
| | - Sunil Bhandari
- Department of Renal Medicine, Hull University Teaching Hospitals NHS Trust, and Hull York Medical School, Hull, East Yorkshire, HU3 2JZ, UK
| | - Alan Montgomery
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, NG7 2RD, UK
| | - Peter Bower
- NIHR School for Primary Care Research, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, M13 9PL, UK.
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Davies JR, Mell T, Fuller H, Harland M, Saleh RN, Race AD, Rees CJ, Brown LC, Loadman PM, Downing A, Minihane AM, Williams EA, Hull MA. Polymorphisms in Cyclooxygenase, Lipoxygenase, and TP53 Genes Predict Colorectal Polyp Risk Reduction by Aspirin in the seAFOod Polyp Prevention Trial. Cancer Prev Res (Phila) 2023; 16:621-629. [PMID: 37756582 PMCID: PMC10618644 DOI: 10.1158/1940-6207.capr-23-0111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 07/13/2023] [Accepted: 09/25/2023] [Indexed: 09/29/2023]
Abstract
Aspirin and eicosapentaenoic acid (EPA) reduce colorectal adenomatous polyp risk and affect synthesis of oxylipins including prostaglandin E2. We investigated whether 35 SNPs in oxylipin metabolism genes such as cyclooxygenase (PTGS) and lipoxygenase (ALOX), as well as 7 SNPs already associated with colorectal cancer risk reduction by aspirin (e.g., TP53; rs104522), modified the effects of aspirin and EPA on colorectal polyp recurrence in the randomized 2 × 2 factorial seAFOod trial. Treatment effects were reported as the incidence rate ratio (IRR) and 95% confidence interval (CI) by stratifying negative binomial and Poisson regression analyses of colorectal polyp risk on SNP genotype. Statistical significance was reported with adjustment for the false discovery rate as the P and q value. 542 (of 707) trial participants had both genotype and colonoscopy outcome data. Reduction in colorectal polyp risk in aspirin users compared with nonaspirin users was restricted to rs4837960 (PTGS1) common homozygotes [IRR, 0.69; 95% confidence interval (CI), 0.53-0.90); q = 0.06], rs2745557 (PTGS2) compound heterozygote-rare homozygotes [IRR, 0.60 (0.41-0.88); q = 0.06], rs7090328 (ALOX5) rare homozygotes [IRR 0.27 (0.11-0.64); q = 0.05], rs2073438 (ALOX12) common homozygotes [IRR, 0.57 (0.41-0.80); q = 0.05], and rs104522 (TP53) rare homozygotes [IRR, 0.37 (0.17-0.79); q = 0.06]. No modification of colorectal polyp risk in EPA users was observed. In conclusion, genetic variants relevant to the proposed mechanism of action on oxylipins are associated with differential colorectal polyp risk reduction by aspirin in individuals who develop multiple colorectal polyps. SNP genotypes should be considered during development of personalized, predictive models of colorectal cancer chemoprevention by aspirin. PREVENTION RELEVANCE Single-nucleotide polymorphisms in genes controlling lipid mediator signaling may modify the colorectal polyp prevention activity of aspirin. Further investigation is required to determine whether testing for genetic variants can be used to target cancer chemoprevention by aspirin to those who will benefit most.
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Affiliation(s)
- John R. Davies
- Leeds Institute of Medical Research, University of Leeds, Leeds, United Kingdom
| | - Tracey Mell
- Leeds Institute of Medical Research, University of Leeds, Leeds, United Kingdom
| | - Harriett Fuller
- Leeds Institute of Medical Research, University of Leeds, Leeds, United Kingdom
| | - Mark Harland
- Leeds Institute of Medical Research, University of Leeds, Leeds, United Kingdom
| | - Rasha N.M. Saleh
- Nutrition and Preventive Medicine, Norwich Medical School, University of East Anglia, Norwich, United Kingdom
- Department of Clinical and Chemical Pathology, Faculty of Medicine, Alexandria University, Egypt
| | - Amanda D. Race
- Institute of Cancer Therapeutics, University of Bradford, United Kingdom
| | - Colin J. Rees
- Population Health Science Institute, Newcastle University, United Kingdom
| | - Louise C. Brown
- MRC Clinical Trials Unit at University College, London, United Kingdom
| | - Paul M. Loadman
- Institute of Cancer Therapeutics, University of Bradford, United Kingdom
| | - Amy Downing
- Leeds Institute of Medical Research, University of Leeds, Leeds, United Kingdom
| | - Anne Marie Minihane
- Nutrition and Preventive Medicine, Norwich Medical School, University of East Anglia, Norwich, United Kingdom
- Norwich Institute of Health Ageing, Norwich, United Kingdom
| | | | - Mark A. Hull
- Leeds Institute of Medical Research, University of Leeds, Leeds, United Kingdom
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6
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Downing A, Fenton H, Nickerson C, Loadman PM, Williams EA, Rees CJ, Brown LC, Morris EJA, Hull MA. Colorectal polyp outcomes after participation in the seAFOod polyp prevention trial: Evidence of rebound elevated colorectal polyp risk after short-term aspirin use. Aliment Pharmacol Ther 2023; 58:562-572. [PMID: 37518954 DOI: 10.1111/apt.17646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/06/2023] [Accepted: 07/07/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND The seAFOod polyp prevention trial was a randomised, placebo-controlled, 2 × 2 factorial trial of aspirin 300 mg and eicosapentaenoic acid (EPA) 2000 mg daily in individuals who had a screening colonoscopy in the English Bowel Cancer Screening Programme (BCSP). Aspirin treatment was associated with a 20% reduction in colorectal polyp number at BCSP surveillance colonoscopy 12 months later. It is unclear what happens to colorectal polyp risk after short-term aspirin use. AIM To investigate colorectal polyp risk according to the original trial treatment allocation, up to 6 years after trial participation. METHODS All seAFOod trial participants were scheduled for further BCSP surveillance and provided informed consent for the collection of colonoscopy outcomes. We linked BCSP colonoscopy data to trial outcomes data. RESULTS In total, 507 individuals underwent one or more colonoscopies after trial participation. Individuals grouped by treatment allocation were well matched for clinical characteristics, follow-up duration and number of surveillance colonoscopies. The polyp detection rate (PDR; the number of individuals who had ≥1 colorectal polyp detected) after randomization to placebo aspirin was 71.1%. The PDR was 80.1% for individuals who had received aspirin (odds ratio [OR] 1.13 [95% confidence interval 1.02, 1.24]; p = 0.02). There was no difference in colorectal polyp outcomes between individuals who had been allocated to EPA compared with its placebo (OR for PDR 1.00 [0.91, 1.10]; p = 0.92). CONCLUSION Individuals who received aspirin in the seAFOod trial demonstrated increased colorectal polyp risk during post-trial surveillance. Rebound elevated neoplastic risk after short-term aspirin use has important implications for aspirin cessation driven by age-related bleeding risk. ISRCTN05926847.
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Affiliation(s)
- Amy Downing
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | - Hayley Fenton
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | | | - Paul M Loadman
- Institute of Cancer Therapeutics, University of Bradford, Bradford, UK
| | | | - Colin J Rees
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Louise C Brown
- MRC Clinical Trials Unit at University College, London, UK
| | - Eva J A Morris
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Mark A Hull
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK
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Fuller H, Race AD, Fenton H, Burke L, Downing A, Williams EA, Rees CJ, Brown LC, Loadman PM, Hull MA. Plasma and rectal mucosal oxylipin levels during aspirin and eicosapentaenoic acid treatment in the seAFOod polyp prevention trial. Prostaglandins Leukot Essent Fatty Acids 2023; 192:102570. [PMID: 37003144 DOI: 10.1016/j.plefa.2023.102570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 03/20/2023] [Accepted: 03/21/2023] [Indexed: 04/03/2023]
Abstract
BACKGROUND Aspirin and eicosapentaenoic acid (EPA) have colorectal polyp prevention activity, alone and in combination. This study measured levels of plasma and rectal mucosal oxylipins in participants of the seAFOod 2 × 2 factorial, randomised, placebo-controlled trial, who received aspirin 300 mg daily and EPA 2000 mg free fatty acid, alone and in combination, for 12 months. METHODS Resolvin (Rv) E1, 15-epi-lipoxin (LX) A4 and respective precursors 18-HEPE and 15-HETE (with chiral separation) were measured by ultra-high performance liquid chromatography-tandem mass spectrometry in plasma taken at baseline, 6 months and 12 months, as well as rectal mucosa obtained at trial exit colonoscopy at 12 months, in 401 trial participants. RESULTS Despite detection of S- and R- enantiomers of 18-HEPE and 15-HETE in ng/ml concentrations, RvE1 or 15‑epi-LXA4 were not detected above a limit of detection of 20 pg/ml in plasma or rectal mucosa, even in individuals randomised to both aspirin and EPA. We have confirmed in a large clinical trial cohort that prolonged (12 months) treatment with EPA is associated with increased plasma 18-HEPE concentrations (median [inter-quartile range] total 18-HEPE 0.51 [0.21-1.95] ng/ml at baseline versus 0.95 [0.46-4.06] ng/ml at 6 months [P<0.0001] in those randomised to EPA alone), which correlate strongly with respective rectal mucosal 18-HEPE levels (r = 0.82; P<0.001), but which do not predict polyp prevention efficacy by EPA or aspirin. CONCLUSION Analysis of seAFOod trial plasma and rectal mucosal samples has not provided evidence of synthesis of the EPA-derived specialised pro-resolving mediator RvE1 or aspirin-trigged lipoxin 15‑epi-LXA4. We cannot rule out degradation of individual oxylipins during sample collection and storage but readily measurable precursor oxylipins argues against widespread degradation.
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Affiliation(s)
- H Fuller
- Leeds Institute of Medical Research, University of Leeds, UK
| | - A D Race
- Institute of Cancer Therapeutics, University of Bradford, UK
| | - H Fenton
- Leeds Institute of Medical Research, University of Leeds, UK
| | - L Burke
- Institute of Cancer Therapeutics, University of Bradford, UK
| | - A Downing
- Leeds Institute of Medical Research, University of Leeds, UK
| | - E A Williams
- Department of Oncology and Metabolism, University of Sheffield, UK
| | - C J Rees
- Population Health Science Institute, Newcastle University, UK
| | - L C Brown
- MRC Clinical Trials Unit at University College, London, UK
| | - P M Loadman
- Institute of Cancer Therapeutics, University of Bradford, UK
| | - M A Hull
- Leeds Institute of Medical Research, University of Leeds, UK.
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Hampton JS, Koo S, Dobson C, Stewart CJ, Neilson LJ, Montague K, Mitra S, Whelpton J, Addison C, Kelly P, Rushton S, Hull MA, Sharp L, Rees CJ. The COLO-COHORT (Colorectal Cancer Cohort) study: Protocol for a multi-centre, observational research study and development of a consent-for-contact research platform. Colorectal Dis 2022; 24:1216-1226. [PMID: 35470953 PMCID: PMC9796014 DOI: 10.1111/codi.16160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/24/2022] [Accepted: 04/12/2022] [Indexed: 12/30/2022]
Abstract
AIM The COLO-COHORT study aims to produce a multi-factorial risk prediction model for colorectal neoplasia that can be used to target colonoscopy to those at greatest risk of colorectal neoplasia, ensuring that people are not investigated unnecessarily and maximizing the use of limited endoscopy resources. The study will also explore the link between neoplasia and the human gut microbiome. Additionally, the study aims to generate a cohort of colonoscopy patients who are 'research ready' through the development of a consent-for-contact (C4C) platform, to facilitate a range of colorectal cancer prevention studies to be conducted at scale and speed. METHODS AND ANALYSIS This is a multi-centre observational study involving sites across the UK. Recruitment is over a 6-year period (2019-2025). Patients recruited to the study are those attending for colonoscopy. Patients are recruited into two groups, namely observational group A (10 000 patients) and C4C group B (10 000 patients), known as COLO-SPEED (Colorectal Cancer Screening Prevention Endoscopy and Early Diagnosis; https://colospeed.uk). Patients complete a health questionnaire, provide anthropometric measurements and submit biosamples (blood and stool-depending on the part of the study they are recruited into). Patients' colonoscopy and histology findings are also recorded. Models of factors associated with the presence of neoplasia at colonoscopy will be developed using logistic or multinomial regression. For internal validation, model discrimination and calibration will be assessed and bootstrapping and cross-validation approaches used. To enable long-term follow-up for outcomes related to colorectal cancer and polyps, patients are asked to consent to follow-up through data linkage with national databases. DISSEMINATION In keeping with good research practice, following analysis by the study team the study investigators will make the anonymized dataset available to other researchers. The C4C platform will also be accessible to other researchers. The study findings will be submitted for publication in peer-reviewed journals and lay summaries will be disseminated to participants and the wider public.
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Affiliation(s)
- James S. Hampton
- Department of GastroenterologySouth Tyneside and Sunderland NHS Foundation TrustSouth ShieldsUK,Population Health Sciences InstituteNewcastle UniversityNewcastle upon TyneUK
| | - Sara Koo
- Population Health Sciences InstituteNewcastle UniversityNewcastle upon TyneUK
| | - Christina Dobson
- Population Health Sciences InstituteNewcastle UniversityNewcastle upon TyneUK
| | | | - Laura J. Neilson
- Department of GastroenterologySouth Tyneside and Sunderland NHS Foundation TrustSouth ShieldsUK
| | - Kyle Montague
- Computing and Information SciencesNorthumbria UniversityNewcastle upon TyneUK
| | - Suparna Mitra
- Leeds Institute of Medical ResearchUniversity of Leeds, St James's University HospitalLeedsUK
| | | | | | - Phil Kelly
- North East HubBowel Cancer Screening ProgrammeGatesheadUK
| | | | - Mark A. Hull
- Leeds Institute of Medical ResearchUniversity of Leeds, St James's University HospitalLeedsUK
| | - Linda Sharp
- Population Health Sciences InstituteNewcastle UniversityNewcastle upon TyneUK
| | - Colin J. Rees
- Department of GastroenterologySouth Tyneside and Sunderland NHS Foundation TrustSouth ShieldsUK,Population Health Sciences InstituteNewcastle UniversityNewcastle upon TyneUK
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9
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Lu L, Koo S, McPherson S, Hull MA, Rees CJ, Sharp L. Systematic review and meta-analysis: Associations between metabolic syndrome and colorectal neoplasia outcomes. Colorectal Dis 2022; 24:681-694. [PMID: 35156283 DOI: 10.1111/codi.16092] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 12/26/2021] [Accepted: 01/12/2022] [Indexed: 12/13/2022]
Abstract
AIM Metabolic syndrome (MetS) is a cluster of factors including obesity, hypertension, diabetes, hypercholesterolemia and hyperlipidaemia. It has been associated with an increased risk of colorectal neoplasia. This systematic review and meta-analysis assessed the association between MetS and (i) recurrence of adenomas or occurrence of CRC in patients with prior adenomas, and (ii) survival in patients with CRC. METHOD MEDLINE, Embase, Scopus and Web of Science were searched up to 22 November 2019. Two authors independently conducted title and abstract screening; full text of eligible studies was evaluated. Where ≥3 studies reported effect measures for a specific outcome, meta-analysis using random effects model was conducted. I2 was used to assess between-study heterogeneity. Quality appraisal was undertaken with the Newcastle-Ottawa Score. RESULTS The search identified 1,764 articles, 55 underwent full text screening, resulting in a total of 15 eligible studies. Five studies reported on metachronous neoplasia, with differing outcomes precluded a meta-analysis. No consistent relationship between MetS and metachronous neoplasia was found. Ten studies reported on survival outcomes. MetS was associated with poorer CRC-specific survival (HR = 1.8, 95% CI: 1.04-3.12, I2 = 92.7%, n = 3). Progression-free survival was also worse but this did not reach statistical significance (HR = 1.12, 95% CI: 0.89-1.42, I2 = 85.6%, n = 3). There was no association with overall survival (HR = 1.04, 95% CI: 0.94-1.15, I2 = 43.7%, n = 7). Significant heterogeneity was present but subgroup analysis did not account for this. CONCLUSION MetS is associated with poorer CRC-specific survival, but evidence is inconsistent on metachronous neoplasia. Further research is warranted to better understand the impact of MetS on the adenoma-carcinoma pathway.
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Affiliation(s)
- Liya Lu
- Newcastle University Centre for Cancer, Population Health Sciences Institute, Newcastle University, Newcastle, UK
| | - Sara Koo
- Newcastle University Centre for Cancer, Population Health Sciences Institute, Newcastle University, Newcastle, UK.,South Tyneside and Sunderland NHS Foundation Trust, South Shields, UK
| | - Stuart McPherson
- Newcastle Upon Tyne NHS Foundation Trust and Translational and Clinical Research Institute, Newcastle University, Newcastle, UK
| | - Mark A Hull
- Leeds Institute of Medical Research, St James's University Hospital, University of Leeds, Leeds, UK
| | - Colin J Rees
- Newcastle University Centre for Cancer, Population Health Sciences Institute, Newcastle University, Newcastle, UK.,South Tyneside and Sunderland NHS Foundation Trust, South Shields, UK
| | - Linda Sharp
- Newcastle University Centre for Cancer, Population Health Sciences Institute, Newcastle University, Newcastle, UK
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10
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Aldoori J, Cockbain AJ, Toogood GJ, Hull MA. Omega-3 polyunsaturated fatty acids: moving towards precision use for prevention and treatment of colorectal cancer. Gut 2022; 71:822-837. [PMID: 35115314 DOI: 10.1136/gutjnl-2021-326362] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 12/19/2021] [Indexed: 12/12/2022]
Abstract
Data from experimental studies have demonstrated that marine omega-3 polyunsaturated fatty acids (O3FAs) have anti-inflammatory and anticancer properties. In the last decade, large-scale randomised controlled trials of pharmacological delivery of O3FAs and prospective cohort studies of dietary O3FA intake have continued to investigate the relationship between O3FA intake and colorectal cancer (CRC) risk and mortality. Clinical data suggest that O3FAs have differential anti-CRC activity depending on several host factors (including pretreatment blood O3FA level, ethnicity and systemic inflammatory response) and tumour characteristics (including location in the colorectum, histological phenotype (eg, conventional adenoma or serrated polyp) and molecular features (eg, microsatellite instability, cyclooxygenase expression)). Recent data also highlight the need for further investigation of the effect of O3FAs on the gut microbiota as a possible anti-CRC mechanism, when used either alone or in combination with other anti-CRC therapies. Overall, these data point towards a precision approach to using O3FAs for optimal prevention and treatment of CRC based on mechanistic understanding of host, tumour and gut microbiota factors that predict anticancer activity of O3FAs.
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Affiliation(s)
- Joanna Aldoori
- Gastrointestinal & Surgical Sciences, Leeds Institute of Medical Research, University of Leeds, Leeds, UK.,Hepatobiliary Surgery, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Andrew J Cockbain
- Hepatobiliary Surgery, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Giles J Toogood
- Hepatobiliary Surgery, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Mark A Hull
- Gastrointestinal & Surgical Sciences, Leeds Institute of Medical Research, University of Leeds, Leeds, UK
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11
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Bradley C, Hee SW, Andronis L, Persaud K, Hull MA, Todd J, Taylor-Phillips S, Smith S, Constable R, Waugh N, Arasaradnam RP. REducing Colonoscopies in patients without significant bowEl DiseasE: the RECEDE Study - protocol for a prospective diagnostic accuracy study. BMJ Open 2022; 12:e058559. [PMID: 35354626 PMCID: PMC8968545 DOI: 10.1136/bmjopen-2021-058559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Demand for colonoscopies and CT colonography (CTC) is exceeding capacity in National Health Service Trusts. In many patients colonoscopies and CTCs show no significant bowel disease (SBD). Faecal Immunochemical Testing (FIT) is being introduced to prioritise patients for colonoscopies but is insufficient to identify non-SBD patients meaning colonoscopy and CTC demand remains high. The REducing Colonoscopies in patients without significant bowEl DiseasE (RECEDE) study aims to test urine volatile organic compound (VOC) analysis alongside FIT to improve detection of SBD and to reduce the number of colonoscopies and CTCs. METHODS AND ANALYSIS This is a multicentre, prospective diagnostic accuracy study evaluating whether stool FIT plus urine VOC compared with stool FIT alone improves detection of SBD in patients referred for colonoscopy or CTC due to persistent lower gastrointestinal symptoms. To ensure SBD is not missed, the dual test requires a high sensitivity, set at 97% with 95% CI width of 5%. Our assumption is that to achieve this sensitivity requires 200 participants with SBD. Further assuming 19% of all participants will have SBD and 55% of all participants will return both stool and urine samples we will recruit 1915 participants. The thresholds for FIT and VOC results diagnosing SBD have been pre-set. If either FIT or VOC exceeds the respective threshold, the participant will be classed as having suspected SBD. As an exploratory analysis we will be testing different thresholds. The reference comparator will be a complete colonoscopy or CTC. Secondary outcomes will look at optimising the FIT and VOC thresholds for SBD detection. An economic evaluation, using a denovo decision analytic model, will be carried out determine the costs, benefits and overall cost-effectiveness of FIT +VOC vs FIT followed by colonoscopy. ETHICS AND DISSEMINATION Ethical approval was obtained by Liverpool Central Research Ethics Committee (20/NW/0346). TRIAL REGISTRATION NUMBER RECEDE is registered on Clinicaltrials.gov NCT04516785 & ISRCTN14982373. This protocol was written and published before results of the trial were available.
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Affiliation(s)
- Christopher Bradley
- Research & Development, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Siew Wan Hee
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Lazaros Andronis
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Krishna Persaud
- Department of Chemical Engineering, The University of Manchester, Manchester, UK
| | - Mark A Hull
- School of Medicine, University of Leeds, Leeds, UK
| | - John Todd
- Research & Development, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | | | - Steve Smith
- Research & Development, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
- Bowel Cancer Screening Hub, NW Bowel Cancer Screening Hub, Hospital of St. Cross, Rugby, UK
| | - Rachel Constable
- Research & Development, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Norman Waugh
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Ramesh P Arasaradnam
- Research & Development, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
- Warwick Medical School, University of Warwick, Coventry, UK
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12
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Moon R, Moore JB, Hull MA, Zulyniak MA. Investigation of the Association between High Arachidonic Acid Synthesis and Colorectal Polyp Incidence within a Generally Healthy UK Population: A Mendelian Randomization Approach. Lifestyle Genom 2022; 15:107-110. [PMID: 35952636 DOI: 10.1159/000526447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 08/06/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Arachidonic acid (ARA) is associated with colorectal cancer (CRC), a major public health concern. However, it is uncertain if ARA contributes to the development of colorectal polyps which are pre-malignant precursors of CRC. OBJECTIVE The study aimed to investigate the association between lifelong exposure to elevated ARA and colorectal polyp incidence. METHODS Summary-level GWAS data from European, Singaporean, and Chinese cohorts (n = 10,171) identified 4 single-nucleotide polymorphisms (SNPs) associated with blood ARA levels (p < 5 × 10-8). After pruning, 1 SNP was retained (rs174547; p = 3.0 × 10-971) for 2-stage Mendelian randomization. RESULTS No association between ARA and colorectal polyp incidence was observed (OR = 1.00; 95% CI: 0.99, 1.00; p value = 0.50) within the UK Biobank (1,391 cases; 462,933 total). CONCLUSIONS Blood levels of ARA do not associate with colorectal polyp incidence in a general healthy population. Although not providing direct evidence, this work supports the contention that downstream lipid mediators, such as PGE2 rather than ARA itself, are key for polyp formation during early-stage colorectal carcinogenesis.
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Affiliation(s)
- Rachel Moon
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds, UK
| | - J Bernadette Moore
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds, UK
| | - Mark A Hull
- Leeds Institute of Medical Research, University of Leeds, St James's University Hospital, Leeds, UK
| | - Michael A Zulyniak
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds, UK
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13
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Nana G, Mitra S, Watson H, Young C, Wood HM, Perry SL, Race AD, Quirke P, Toogood GJ, Loadman PM, Hull MA. Luminal Bioavailability of Orally Administered ω-3 PUFAs in the Distal Small Intestine, and Associated Changes to the Ileal Microbiome, in Humans with a Temporary Ileostomy. J Nutr 2021; 151:2142-2152. [PMID: 34036331 PMCID: PMC8349127 DOI: 10.1093/jn/nxab113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 02/22/2021] [Accepted: 03/29/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Oral administration of purified omega-3 (ω-3) PUFAs is associated with changes to the fecal microbiome. However, it is not known whether this effect is associated with increased PUFA concentrations in the gut. OBJECTIVES We investigated the luminal bioavailability of oral ω-3 PUFAs (daily dose 1 g EPA and 1g DHA free fatty acid equivalents as triglycerides in soft-gel capsules, twice daily) and changes to the gut microbiome, in the ileum. METHODS Ileostomy fluid (IF) and blood were obtained at baseline, after first capsule dosing (median 2 h), and at a similar time after final dosing on day 28, in 11 individuals (median age 63 y) with a temporary ileostomy. Fatty acids were measured by LC-tandem MS. The ileal microbiome was characterized by 16S rRNA PCR and Illumina sequencing. RESULTS There was a mean 6.0 ± 9.8-fold and 6.6 ± 9.6-fold increase in ileal EPA and DHA concentrations (primary outcome), respectively, at 28 d, which was associated with increased RBC ω-3 PUFA content (P ≤ 0.05). The first oral dose did not increase the ileal ω-3 PUFA concentration except in 4 individuals, who displayed high luminal EPA and DHA concentrations, which reduced to concentrations similar to the overall study population at day 28, suggesting physiological adaptation. Bacteroides, Clostridium, and Streptococcus were abundant bacterial genera in the ileum. Ileal microbiome variability over time and between individuals was large, with no consistent change associated with acute ω-3 PUFA dosing. However, high concentrations of EPA and DHA in IF on day 28 were associated with higher abundance of Bacteroides (r2 > 0.86, P < 0.05) and reduced abundance of other genera, including Actinomyces (r2 > 0.94, P < 0.05). CONCLUSIONS Oral administration of ω-3 PUFAs leads to increased luminal ω-3 PUFA concentrations and changes to the microbiome, in the ileum of individuals with a temporary ileostomy. This study is registered on the ISRCTN registry as ISRCTN14530452.
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Affiliation(s)
- Gael Nana
- Leeds Institute of Medical Research, St James's University Hospital, University of Leeds, Leeds, United Kingdom
- Department of Hepatobiliary Surgery, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Suparna Mitra
- Leeds Institute of Medical Research, St James's University Hospital, University of Leeds, Leeds, United Kingdom
| | - Henry Watson
- Leeds Institute of Medical Research, St James's University Hospital, University of Leeds, Leeds, United Kingdom
- Department of Hepatobiliary Surgery, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Caroline Young
- Leeds Institute of Medical Research, St James's University Hospital, University of Leeds, Leeds, United Kingdom
| | - Henry M Wood
- Leeds Institute of Medical Research, St James's University Hospital, University of Leeds, Leeds, United Kingdom
| | - Sarah L Perry
- Leeds Institute of Medical Research, St James's University Hospital, University of Leeds, Leeds, United Kingdom
| | - Amanda D Race
- Institute of Cancer Therapeutics, University of Bradford, Bradford, United Kingdom
| | - Philip Quirke
- Leeds Institute of Medical Research, St James's University Hospital, University of Leeds, Leeds, United Kingdom
| | - Giles J Toogood
- Department of Hepatobiliary Surgery, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Paul M Loadman
- Institute of Cancer Therapeutics, University of Bradford, Bradford, United Kingdom
| | - Mark A Hull
- Leeds Institute of Medical Research, St James's University Hospital, University of Leeds, Leeds, United Kingdom
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14
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Faluyi OO, Hull MA, Markham AF, Bonifer C, Coletta PL. Reduction in the resident intestinal myelomonocytic cell population occurs during ApcMin/+ mouse intestinal tumorigenesis. Oncol Lett 2021; 21:263. [PMID: 33664826 PMCID: PMC7884874 DOI: 10.3892/ol.2021.12524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 11/11/2020] [Indexed: 02/06/2023] Open
Abstract
With its significant contribution to cancer mortality globally, advanced colorectal cancer (CRC) requires new treatment strategies. However, despite recent good results for mismatch repair (MMR)-deficient CRC and other malignancies, such as melanoma, the vast majority of MMR-proficient CRCs are resistant to checkpoint inhibitor (CKI) therapy. MMR-proficient CRCs commonly develop from precursor adenomas with enhanced Wnt-signalling due to adenomatous polyposis coli (APC) mutations. In melanomas with enhanced Wnt signalling due to stabilized β-catenin, immune anergy and resistance to CKI therapy has been observed, which is dependent on micro-environmental myelomonocytic (MM) cell depletion in melanoma models. However, MM populations of colorectal adenomas or CRC have not been studied. To characterize resident intestinal MM cell populations during the early stages of tumorigenesis, the present study utilized the ApcMin/+ mouse as a model of MMR-proficient CRC, using enhanced green fluorescent protein (EGFP) expression in the mouse lysozyme (M-lys) lys-EGFP/+ mouse as a pan-myelomonocytic cell marker and a panel of murine macrophage surface markers. Total intestinal lamina propria mononuclear cell (LPMNC) numbers significantly decreased with age (2.32±1.39×107 [n=4] at 33 days of age vs. 1.06±0.24×107 [n=8] at 109 days of age) during intestinal adenoma development in ApcMin/+ mice (P=0.05; unpaired Student's t-test), but not in wild-type littermates (P=0.35). Decreased total LPMNC numbers were associated with atrophy of intestinal lymphoid follicles and the absence of MM/lymphoid cell aggregates in ApcMin/+ mouse intestine, but not spleen, compared with wild-type mice. Furthermore, during the early stage of intestinal adenoma development, there was a two-fold reduction of M-lys expressing cells (P=0.05) and four-fold reduction of ER-HR3 (macrophage sub-set) expressing cells (P=0.05; two tailed Mann-Whitney U test) in mice with reduced total intestinal LPMNCs (n=3). Further studies are necessary to determine the relevance of these findings to immune-surveillance of colorectal adenomas or MMR-proficient CRC CKI therapy resistance.
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Affiliation(s)
- Olusola O Faluyi
- Section of Molecular Gastroenterology, Leeds Institute of Medical Research, University of Leeds, St. James's University Hospital, Leeds, Yorkshire LS9 7TF, UK.,Experimental Cancer Medicine Centre, Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral, Merseyside CH63 4JY, UK.,Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, Merseyside L69 3BX, UK
| | - Mark A Hull
- Section of Molecular Gastroenterology, Leeds Institute of Medical Research, University of Leeds, St. James's University Hospital, Leeds, Yorkshire LS9 7TF, UK
| | - Alexander F Markham
- Section of Molecular Gastroenterology, Leeds Institute of Medical Research, University of Leeds, St. James's University Hospital, Leeds, Yorkshire LS9 7TF, UK
| | - Constanze Bonifer
- Section of Experimental Haematology, Leeds Institute of Medical Research, University of Leeds, St. James's University Hospital, Leeds, Yorkshire LS9 7TF, UK
| | - P Louise Coletta
- Section of Molecular Gastroenterology, Leeds Institute of Medical Research, University of Leeds, St. James's University Hospital, Leeds, Yorkshire LS9 7TF, UK
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15
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Masi AC, Koo S, Lamb CA, Hull MA, Sharp L, Nelson A, Hampton JS, Rees CJ, Stewart CJ. Using faecal immunochemical test (FIT) undertaken in a national screening programme for large-scale gut microbiota analysis. Gut 2021; 70:429-431. [PMID: 32430347 DOI: 10.1136/gutjnl-2020-321594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 05/01/2020] [Indexed: 12/08/2022]
Affiliation(s)
- Andrea C Masi
- Gastroenterology, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
| | - Sara Koo
- Gastroenterology, South Tyneside General Hospital, South Shields, UK.,Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Christopher A Lamb
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK.,Gastroenterology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Mark A Hull
- Leeds Institute of Biomedical & Clinical Sciences, St James's University Hospital, Leeds, UK
| | - Linda Sharp
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Andrew Nelson
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - James S Hampton
- Gastroenterology, South Tyneside General Hospital, South Shields, UK.,Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Colin J Rees
- Gastroenterology, South Tyneside General Hospital, South Shields, UK .,Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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16
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Volpato M, Ingram N, Perry SL, Spencer J, Race AD, Marshall C, Hutchinson JM, Nicolaou A, Loadman PM, Coletta PL, Hull MA. Correction to: Cyclooxygenase activity mediates colorectal cancer cell resistance to the omega‑3 polyunsaturated fatty acid eicosapentaenoic acid. Cancer Chemother Pharmacol 2020; 87:879-880. [PMID: 33200275 DOI: 10.1007/s00280-020-04194-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Milene Volpato
- Leeds Institute of Medical Research at St James's, University of Leeds, St James's University Hospital, Leeds, LS9 7TF, UK.
| | - Nicola Ingram
- Leeds Institute of Medical Research at St James's, University of Leeds, St James's University Hospital, Leeds, LS9 7TF, UK
| | - Sarah L Perry
- Leeds Institute of Medical Research at St James's, University of Leeds, St James's University Hospital, Leeds, LS9 7TF, UK
| | - Jade Spencer
- Institute of Cancer Therapeutics, University of Bradford, Bradford, BD7 1DP, UK
| | - Amanda D Race
- Institute of Cancer Therapeutics, University of Bradford, Bradford, BD7 1DP, UK
| | - Catriona Marshall
- Leeds Institute of Medical Research at St James's, University of Leeds, St James's University Hospital, Leeds, LS9 7TF, UK
| | - John M Hutchinson
- Leeds Institute of Medical Research at St James's, University of Leeds, St James's University Hospital, Leeds, LS9 7TF, UK
| | - Anna Nicolaou
- Laboratory for Lipidomics and Lipid Biology, Division of Pharmacy and Optometry, School of Health Sciences, University of Manchester, Manchester, M13 9PT, UK
- Lydia Becker Institute of Immunology and Inflammation, University of Manchester, Manchester, M13 9PT, UK
| | - Paul M Loadman
- Institute of Cancer Therapeutics, University of Bradford, Bradford, BD7 1DP, UK
| | - P Louise Coletta
- Leeds Institute of Medical Research at St James's, University of Leeds, St James's University Hospital, Leeds, LS9 7TF, UK
| | - Mark A Hull
- Leeds Institute of Medical Research at St James's, University of Leeds, St James's University Hospital, Leeds, LS9 7TF, UK
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17
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Volpato M, Cummings M, Shaaban AM, Abderrahman B, Hull MA, Maximov PY, Broom BM, Hoppe R, Fan P, Brauch H, Jordan VC, Speirs V. Downregulation of 15-hydroxyprostaglandin dehydrogenase during acquired tamoxifen resistance and association with poor prognosis in ERα-positive breast cancer. Explor Target Antitumor Ther 2020; 1:355-371. [PMID: 33210098 PMCID: PMC7116369 DOI: 10.37349/etat.2020.00021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Aim: Tamoxifen (TAM) resistance remains a clinical issue in breast cancer. The authors previously reported that 15-hydroxyprostaglandin dehydrogenase (HPGD) was significantly downregulated in tamoxifen-resistant (TAMr) breast cancer cell lines. Here, the authors investigated the relationship between HPGD expression, TAM resistance and prediction of outcome in breast cancer. Methods: HPGD overexpression and silencing studies were performed in isogenic TAMr and parental human breast cancer cell lines to establish the impact of HPGD expression on TAM resistance. HPGD expression and clinical outcome relationships were explored using immunohistochemistry and in silico analysis. Results: Restoration of HPGD expression and activity sensitised TAMr MCF-7 cells to TAM and 17β-oestradiol, whilst HPGD silencing in parental MCF-7 cells reduced TAM sensitivity. TAMr cells released more prostaglandin E2 (PGE2) than controls, which was reduced in TAMr cells stably transfected with HPGD. Exogenous PGE2 signalled through the EP4 receptor to reduce breast cancer cell sensitivity to TAM. Decreased HPGD expression was associated with decreased overall survival in ERα-positive breast cancer patients. Conclusions: HPGD downregulation in breast cancer is associated with reduced response to TAM therapy via PGE2-EP4 signalling and decreases patient survival. The data offer a potential target to develop combination therapies that may overcome acquired tamoxifen resistance.
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Affiliation(s)
- Milene Volpato
- Leeds Institute of Medical Research, University of Leeds, St James's University Hospital, LS9 7TF Leeds, UK
| | - Michele Cummings
- Leeds Institute of Medical Research, University of Leeds, St James's University Hospital, LS9 7TF Leeds, UK
| | - Abeer M Shaaban
- Institute of Cancer and Genomic Sciences, University of Birmingham, B15 2TT Birmingham, UK
| | - Balkees Abderrahman
- Leeds Institute of Medical Research, University of Leeds, St James's University Hospital, LS9 7TF Leeds, UK.,Department of Breast Medical Oncology, UT MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Mark A Hull
- Leeds Institute of Medical Research, University of Leeds, St James's University Hospital, LS9 7TF Leeds, UK
| | - Philipp Y Maximov
- Department of Breast Medical Oncology, UT MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Bradley M Broom
- Department of Bioinformatics and Computational Biology, UT MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Reiner Hoppe
- Dr. Margarete Fischer-Bosch Institute of Clinical Pharmacology and University of Tübingen, Auerbachstr. 112, D-70376 Stuttgart, Germany.,Germany iFIT Cluster of Excellence, University of Tübingen, Auerbachstr. 112, D-70376 Stuttgart, Germany
| | - Ping Fan
- Department of Breast Medical Oncology, UT MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Hiltrud Brauch
- Dr. Margarete Fischer-Bosch Institute of Clinical Pharmacology and University of Tübingen, Auerbachstr. 112, D-70376 Stuttgart, Germany.,Germany iFIT Cluster of Excellence, University of Tübingen, Auerbachstr. 112, D-70376 Stuttgart, Germany.,German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
| | - V Craig Jordan
- Department of Bioinformatics and Computational Biology, UT MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Valerie Speirs
- Leeds Institute of Medical Research, University of Leeds, St James's University Hospital, LS9 7TF Leeds, UK.,Institute of Medical Sciences, University of Aberdeen, Foresterhill, AB25 2ZD Aberdeen, UK
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18
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Volpato M, Ingram N, Perry SL, Spencer J, Race AD, Marshall C, Hutchinson JM, Nicolaou A, Loadman PM, Coletta PL, Hull MA. Cyclooxygenase activity mediates colorectal cancer cell resistance to the omega-3 polyunsaturated fatty acid eicosapentaenoic acid. Cancer Chemother Pharmacol 2020; 87:173-184. [PMID: 33040178 PMCID: PMC7870614 DOI: 10.1007/s00280-020-04157-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 09/24/2020] [Indexed: 01/05/2023]
Abstract
Purpose The naturally-occurring omega-3 polyunsaturated fatty acid eicosapentaenoic acid (EPA) is safe, well-tolerated and inexpensive, making it an attractive anti-cancer intervention. However, EPA has only modest anti-colorectal cancer (CRC) activity, when used alone. Both cyclooxygenase (COX) isoforms metabolise EPA and are over-expressed in CRC cells. We investigated whether COX inhibition increases the sensitivity of CRC cells to growth inhibition by EPA. Methods A panel of 18 human and mouse CRC cell lines was used to characterize the differential sensitivity of CRC cells to the growth inhibitory effects of EPA. The effect of CRISPR-Cas9 genetic deletion and pharmacological inhibition of COX-1 and COX-2 on the anti-cancer activity of EPA was determined using in vitro and in vivo models. Results Genetic ablation of both COX isoforms increased sensitivity of CT26 mouse CRC cells to growth inhibition by EPA in vitro and in vivo. The non-selective COX inhibitor aspirin and the selective COX-2 inhibitor celecoxib increased sensitivity of several human and mouse CRC cell lines to EPA in vitro. However, in a MC38 mouse CRC cell tumour model, with dosing that mirrored low-dose aspirin use in humans, thereby producing significant platelet COX-1 inhibition, there was ineffective intra-tumoral COX-2 inhibition by aspirin and no effect on EPA sensitivity of MC38 cell tumours. Conclusion Cyclooxygenase inhibition by non-steroidal anti-inflammatory drugs represents a therapeutic opportunity to augment the modest anti-CRC activity of EPA. However, intra-tumoral COX inhibition is likely to be critical for this drug-nutrient interaction and careful tissue pharmacodynamic profiling is required in subsequent pre-clinical and human studies. Electronic supplementary material The online version of this article (10.1007/s00280-020-04157-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Milene Volpato
- Leeds Institute of Medical Research at St James's, University of Leeds, St James's University Hospital, Leeds, LS9 7TF, UK.
| | - Nicola Ingram
- Leeds Institute of Medical Research at St James's, University of Leeds, St James's University Hospital, Leeds, LS9 7TF, UK
| | - Sarah L Perry
- Leeds Institute of Medical Research at St James's, University of Leeds, St James's University Hospital, Leeds, LS9 7TF, UK
| | - Jade Spencer
- Institute of Cancer Therapeutics, University of Bradford, Bradford, BD7 1DP, UK
| | - Amanda D Race
- Institute of Cancer Therapeutics, University of Bradford, Bradford, BD7 1DP, UK
| | - Catriona Marshall
- Leeds Institute of Medical Research at St James's, University of Leeds, St James's University Hospital, Leeds, LS9 7TF, UK
| | - John M Hutchinson
- Leeds Institute of Medical Research at St James's, University of Leeds, St James's University Hospital, Leeds, LS9 7TF, UK
| | - Anna Nicolaou
- Laboratory for Lipidomics and Lipid Biology, Division of Pharmacy and Optometry, School of Health Sciences, University of Manchester, Manchester, M13 9PT, UK.,Lydia Becker Institute of Immunology and Inflammation, University of Manchester, Manchester, M13 9PT, UK
| | - Paul M Loadman
- Institute of Cancer Therapeutics, University of Bradford, Bradford, BD7 1DP, UK
| | - P Louise Coletta
- Leeds Institute of Medical Research at St James's, University of Leeds, St James's University Hospital, Leeds, LS9 7TF, UK
| | - Mark A Hull
- Leeds Institute of Medical Research at St James's, University of Leeds, St James's University Hospital, Leeds, LS9 7TF, UK
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19
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Abstract
The REDUCE-IT trial demonstrated that icosapent ethyl, an ethyl ester of eicosapentaenoic acid (EPA), reduced cardiovascular events in an at-risk population by a substantial degree. While the cardiovascular protective properties of this compound are now proven, several other potential uses are being actively explored in clinical studies. These areas of investigation include cancer, inflammatory bowel disease, infections, Alzheimer’s disease, dementia, and depression. The next decade promises to deepen our understanding of the beneficial effects that EPA may offer beyond cardiovascular risk reduction.
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Affiliation(s)
- Deepak L Bhatt
- Brigham and Women's Hospital, Heart & Vascular Center and Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Mark A Hull
- Division of Gastrointestinal and Surgical Sciences, Leeds Institute of Medical Research, St James's University Hospital, University of Leeds, Leeds, LS9 7TF, UK
| | - Mingyang Song
- Departments of Epidemiology and Nutrition, Harvard T.H. Chan School of Public Health, 665 Huntington Ave, Boston, MA 02115, USA.,Clinical and Translational Epidemiology Unit, Mongan Institute, Massachusetts General Hospital and Harvard Medical School, 100 Cambridge Street, Boston, MA 02114, USA.,Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, 50 Fruit Street, Boston, MA 02114, USA
| | - Carol Van Hulle
- University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Cindy Carlsson
- William S. Middleton Memorial Veterans Hospital, Madison VA Geriatric Research, Education and Clinical Center (GRECC), 2500 Overlook Terrace, Madison, WI 53705, USA.,Division of Geriatrics and Gerontology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,Wisconsin Alzheimer's Disease Research Center (ADRC), 600 Highland Ave, J5/1 Mezzanine, Madison, WI 53792, USA.,Wisconsin Alzheimer's Institute (WAI), 610 Walnut St Suite 957, Madison, WI 53726, USA
| | - M John Chapman
- Sorbonne University, 21, Rue de l'Ecole de Medicine, 75006 Paris, France.,Endocrinology-Metabolism Division, Pitie-Salpetriere University Hospital, 47-83, Boulevard de lopital, 75651 Paris Cedex, France
| | - Peter P Toth
- CGH Medical Center, 101 East Miller Road, Sterling, IL 61081, USA.,Cicarrone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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20
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Burr NE, Lord R, Hull MA, Subramanian V. Decreasing Risk of First and Subsequent Surgeries in Patients With Crohn's Disease in England From 1994 through 2013. Clin Gastroenterol Hepatol 2019; 17:2042-2049.e4. [PMID: 30583051 DOI: 10.1016/j.cgh.2018.12.022] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 10/31/2018] [Accepted: 12/07/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Gastrointestinal (GI) surgery is an important part of the treatment algorithm for patients with Crohn's disease (CD) that is complicated or does not respond to medical therapy. Cohort studies from Denmark and Canada have shown that the risk of primary surgery is decreasing but there is a lack of contemporary data on subsequent resections. We examined trends in first and second GI resections in patients with CD. METHODS We performed a retrospective cohort study using the United Kingdom primary care database ResearchOne, collecting data from patients with Crohn's disease from 1994 through 2013. We compared rates of first and second GI resections with etiological factors. RESULTS Among 3059 incident cases of CD, 13%, 21%, and 26% of the patients underwent surgical resections after 1, 5, and 10 years, respectively. Of patients with an initial resection, 20% required an additional operation when followed for 10 years after the initial resection. We found a significant reduction in first surgery, from 44% to 21% after 10 years of disease, from 1994 to 2003 (χ2 for trend, P < .05). There was a significant reduction in second resections, in a 10-year follow-up period, from 40% in 1994 to 17% in 2003 (χ2 for trend, P < .05). Duration of disease, younger age at diagnosis, smoking, and immunomodulator use were positively associated with first surgeries. Duration of disease was significantly associated with the risk of undergoing a second resection. CONCLUSION In a retrospective analysis of a United Kingdom primary care database, we observed a significant reduction in first and subsequent GI surgeries among patients with CD over the past 20 years in England.
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Affiliation(s)
- Nicholas E Burr
- Leeds Institute of Biomedical & Clinical Sciences, University of Leeds, Leeds, United Kingdom; Department of Gastroenterology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Richard Lord
- Leeds Institute of Biomedical & Clinical Sciences, University of Leeds, Leeds, United Kingdom; Department of Gastroenterology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Mark A Hull
- Leeds Institute of Biomedical & Clinical Sciences, University of Leeds, Leeds, United Kingdom; Department of Gastroenterology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Venkataraman Subramanian
- Leeds Institute of Biomedical & Clinical Sciences, University of Leeds, Leeds, United Kingdom; Department of Gastroenterology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom.
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21
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Abstract
The majority of evidence linking anti-colorectal cancer (CRC) activity with omega-3 polyunsaturated fatty acids (O3FAs) has focussed on decreased CRC risk (prevention). More recently, preclinical data and human observational studies have begun to make the case for adjuvant treatment of advanced CRC. Herein, we review latest data regarding the effect of O3FAs on post-diagnosis CRC outcomes, including mechanistic preclinical data, evidence that O3FAs have beneficial effects on efficacy and tolerability of CRC chemotherapy, and human epidemiological data linking dietary O3FA intake with CRC outcomes. We also highlight ongoing randomised controlled trials of O3FAs with CRC endpoints and discuss critical gaps in the evidence base, which include limited understanding of the effects of O3FAs on the tumour microenvironment, the host immune response to CRC, and the intestinal microbiome.
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Affiliation(s)
- Milene Volpato
- Leeds Institute of Biomedical and Clinical Sciences, St James's University Hospital, University of Leeds, Leeds, LS9 7TF, UK
| | - Mark A Hull
- Leeds Institute of Biomedical and Clinical Sciences, St James's University Hospital, University of Leeds, Leeds, LS9 7TF, UK.
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22
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Song M, Ou FS, Zemla TJ, Hull MA, Shi Q, Limburg PJ, Alberts SR, Sinicrope FA, Giovannucci EL, Van Blarigan EL, Meyerhardt JA, Chan AT. Marine omega-3 fatty acid intake and survival of stage III colon cancer according to tumor molecular markers in NCCTG Phase III trial N0147 (Alliance). Int J Cancer 2019; 145:380-389. [PMID: 30623420 DOI: 10.1002/ijc.32113] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Revised: 12/12/2018] [Accepted: 12/19/2018] [Indexed: 12/13/2022]
Abstract
Marine omega-3 polyunsaturated fatty acids (MO3PUFAs) have anticancer properties and may improve colon cancer survival. However, it remains unknown whether the benefit differs by tumor molecular subtype. We examined data from a phase III randomized trial of FOLFOX or FOLFOX + cetuximab among 1,735 stage III colon cancer patients who completed a dietary questionnaire at enrollment. Multivariable hazard ratios and 95% confidence intervals (CIs) were calculated for the association between MO3PUFA and disease-free survival (DFS) and overall survival according to KRAS and BRAFV600E mutations and DNA mismatch repair (MMR) status. Higher MO3PUFA intake was associated with improved 3-year DFS for KRAS wild-type tumors (77% vs. 73%; HR: 0.84; 95% CI: 0.67-1.05) but not KRAS-mutant tumors (64% vs. 70%; HR: 1.30; 95% CI: 0.97-1.73; Pinteraction = 0.02). Similar heterogeneity was found by MMR (Pinteraction = 0.14): higher MO3PUFA was associated with better 3-year DFS for tumors with deficient MMR (72% vs. 67%) but not proficient MMR (72% vs. 72%). No heterogeneity was found by BRAFV600E mutation. Similar findings were obtained for overall survival. In conclusion, we found a suggestive beneficial association between higher MO3PUFA intake and improved survival among stage III colon cancer patients with wild-type KRAS and deficient MMR. Given the relatively small number of cases with tumor molecular assessments, further studies, preferably through pooled analyses of multiples cohorts, are needed to validate our findings.
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Affiliation(s)
- Mingyang Song
- Department of Epidemiology and Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA.,Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA.,Division of Gastroenterology, Massachusetts General Hospital, Boston, MA
| | - Fang-Shu Ou
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN
| | - Tyler J Zemla
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN
| | - Mark A Hull
- Leeds Institute of Biomedical & Clinical Sciences, University of Leeds, St. James's University Hospital, Leeds, United Kingdom
| | - Qian Shi
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN
| | - Paul J Limburg
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | | | - Frank A Sinicrope
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN.,Department of Oncology, Mayo Clinic, Rochester, MN
| | - Edward L Giovannucci
- Department of Epidemiology and Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Erin L Van Blarigan
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA.,Department of Urology, University of California, San Francisco, CA
| | - Jeffrey A Meyerhardt
- Department of Medical Oncology, Dana-Farber/Partners Cancer Care and Harvard Medical School, Boston, MA
| | - Andrew T Chan
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA.,Division of Gastroenterology, Massachusetts General Hospital, Boston, MA.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.,Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA.,Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA
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23
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McFarlane M, Bhala N, China L, Alrubaiy L, Chedgy F, Disney BR, Farmer AD, Fogden E, Sadler G, Hull MA, McLaughlin J, Ellison H, Solomon J, Brookes MJ. Attitudes to out-of-programme experiences, research and academic training of gastroenterology trainees between 2007 and 2016. Frontline Gastroenterol 2019; 10:57-66. [PMID: 30651959 PMCID: PMC6319145 DOI: 10.1136/flgastro-2018-100993] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 05/23/2018] [Accepted: 05/27/2018] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE Academic medical training was overhauled in 2005 after the Walport report and Modernising Medical Careers to create a more attractive and transparent training pathway. In 2007 and 2016, national web-based surveys of gastroenterology trainees were undertaken to determine experiences, perceptions of and perceived barriers to out-of-programme research experience (OOP-R). DESIGN SETTING AND PATIENTS Prospective, national web-based surveys of UK gastroenterology trainees in 2007 and 2016. MAIN OUTCOME MEASURE Attitudes to OOP-R of two cohorts of gastroenterology trainees. RESULTS Response rates were lower in 2016 (25.8% vs 56.7%) (p<0.0001), although female trainees' response rates increased (from 28.8% to 37.6%) (p=0.17), along with higher numbers of academic trainees. Over 80% of trainees planned to undertake OOP-R in both surveys, with >50% having already undertaken it. Doctor of Philosophy/medical doctorate remained the most popular OOP-R in both cohorts. Successful fellowship applications increased in 2016, and evidence of gender inequality in 2007 was no longer evident in 2016. In the 2016 cohort, 91.1% (n=144) felt the development of trainee-led research networks was important, with 74.7% (n=118) keen to get involved. CONCLUSIONS The majority of gastroenterology trainees who responded expressed a desire to undertake OOP-R, and participation rates in OOP-R remain high. Despite smaller absolute numbers responding than in 2007, 2016 trainees achieved higher successful fellowship application rates. Reassuringly more trainees in 2016 felt that OOP-R would be important in the future. Efforts are needed to tackle potential barriers to OOP-R and support trainees to pursue research-active careers.
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Affiliation(s)
- Michael McFarlane
- Department of Gastroenterology, University Hospitals Coventry and Warwickshire, Coventry, UK
| | - Neeraj Bhala
- Department of Gastroenterology, University Hospital Birmingham, Birmingham, UK
| | - Louise China
- Division of Medicine, University College London, London, UK
| | | | - Fergus Chedgy
- Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth, UK
| | - Benjamin R Disney
- Department of Gastroenterology, University Hospitals Coventry and Warwickshire, Coventry, UK
| | - Adam D Farmer
- Department of Gastroenterology, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Edward Fogden
- Department of Gastroenterology, Sandwell and West Birmingham Hospitals, Birmingham, UK
| | - Gareth Sadler
- Department of Gastroenterology, St George’s University Hospitals NHS Trust, London, UK
| | - Mark A Hull
- Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK
| | - John McLaughlin
- School of Medical Sciences, The University of Manchester, Manchester, UK
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24
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Hull MA, Sprange K, Hepburn T, Tan W, Shafayat A, Rees CJ, Clifford G, Logan RF, Loadman PM, Williams EA, Whitham D, Montgomery AA. Eicosapentaenoic acid and aspirin, alone and in combination, for the prevention of colorectal adenomas (seAFOod Polyp Prevention trial): a multicentre, randomised, double-blind, placebo-controlled, 2 × 2 factorial trial. Lancet 2018; 392:2583-2594. [PMID: 30466866 PMCID: PMC6294731 DOI: 10.1016/s0140-6736(18)31775-6] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 07/25/2018] [Accepted: 07/26/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND The omega-3 polyunsaturated fatty acid eicosapentaenoic acid (EPA) and aspirin both have proof of concept for colorectal cancer chemoprevention, aligned with an excellent safety profile. Therefore, we aimed to test the efficacy of EPA and aspirin, alone and in combination and compared with a placebo, in individuals with sporadic colorectal neoplasia detected at colonoscopy. METHODS In a multicentre, randomised, double-blind, placebo-controlled, 2 × 2 factorial trial, patients aged 55-73 years who were identified during colonoscopy as being at high risk in the English Bowel Cancer Screening Programme (BCSP; ≥3 adenomas if at least one was ≥10 mm in diameter or ≥5 adenomas if these were <10 mm in diameter) were recruited from 53 BCSP endoscopy units in England, UK. Patients were randomly allocated (1:1:1:1) using a secure web-based server to receive 2 g EPA-free fatty acid (FFA) per day (either as the FFA or triglyceride), 300 mg aspirin per day, both treatments in combination, or placebo for 12 months using random permuted blocks of randomly varying size, and stratified by BCSP site. Research staff and participants were masked to group assignment. The primary endpoint was the adenoma detection rate (ADR; the proportion of participants with any adenoma) at 1 year surveillance colonoscopy analysed in all participants with observable follow-up data using a so-called at-the-margins approach, adjusted for BCSP site and repeat endoscopy at baseline. The safety population included all participants who received at least one dose of study drug. The trial is registered with the International Standard Randomised Controlled Trials Number registry, number ISRCTN05926847. FINDINGS Between Nov 11, 2011, and June 10, 2016, 709 participants were randomly assigned to four treatment groups (176 to placebo, 179 to EPA, 177 to aspirin, and 177 to EPA plus aspirin). Adenoma outcome data were available for 163 (93%) patients in the placebo group, 153 (85%) in the EPA group, 163 (92%) in the aspirin group, and 161 (91%) in the EPA plus aspirin group. The ADR was 61% (100 of 163) in the placebo group, 63% (97 of 153) in the EPA group, 61% (100 of 163) in the aspirin group, and 61% (98 of 161) in the EPA plus aspirin group, with no evidence of any effect for EPA (risk ratio [RR] 0·98, 95% CI 0·87 to 1·12; risk difference -0·9%, -8·8 to 6·9; p=0·81) or aspirin (RR 0·99 (0·87 to 1·12; risk difference -0·6%, -8·5 to 7·2; p=0·88). EPA and aspirin were well tolerated (78 [44%] of 176 had ≥1 adverse event in the placebo group compared with 82 [46%] in the EPA group, 68 [39%] in the aspirin group, and 76 [45%] in the EPA plus aspirin group), although the number of gastrointestinal adverse events was increased in the EPA alone group at 146 events (compared with 85 in the placebo group, 86 in the aspirin group, and 68 in the aspirin plus placebo group). Six upper-gastrointestinal bleeding events were reported across the treatment groups (two in the EPA group, three in the aspirin group, and one in the placebo group). INTERPRETATION Neither EPA nor aspirin treatment were associated with a reduction in the proportion of patients with at least one colorectal adenoma. Further research is needed regarding the effect on colorectal adenoma number according to adenoma type and location. Optimal use of EPA and aspirin might need a precision medicine approach to adenoma recurrence. FUNDING Efficacy and Mechanism Evaluation Programme, a UK Medical Research Council and National Institute for Health Research partnership.
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Affiliation(s)
- Mark A Hull
- Institute of Biomedical and Clinical Sciences, University of Leeds, St James's University Hospital, Leeds, UK.
| | - Kirsty Sprange
- Nottingham Clinical Trials Unit, School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - Trish Hepburn
- Nottingham Clinical Trials Unit, School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - Wei Tan
- Nottingham Clinical Trials Unit, School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - Aisha Shafayat
- Nottingham Clinical Trials Unit, School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - Colin J Rees
- Northern Institute for Cancer Research, Newcastle University, Newcastle-upon-Tyne, UK
| | - Gayle Clifford
- South Tyneside NHS Foundation Trust, South Tyneside District Hospital, Tyne and Wear, UK
| | - Richard F Logan
- Nottingham Digestive Diseases Centre, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - Paul M Loadman
- School of Pharmacy and Medical Sciences, Institute of Cancer Therapeutics, University of Bradford, Bradford, UK
| | | | - Diane Whitham
- Nottingham Clinical Trials Unit, School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - Alan A Montgomery
- Nottingham Clinical Trials Unit, School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK
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25
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Affiliation(s)
- Mark A Hull
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK.
| | - Sheraz R Markar
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Eva J A Morris
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK
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26
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Watson H, Mitra S, Croden FC, Taylor M, Wood HM, Perry SL, Spencer JA, Quirke P, Toogood GJ, Lawton CL, Dye L, Loadman PM, Hull MA. A randomised trial of the effect of omega-3 polyunsaturated fatty acid supplements on the human intestinal microbiota. Gut 2018; 67:1974-1983. [PMID: 28951525 DOI: 10.1136/gutjnl-2017-314968] [Citation(s) in RCA: 266] [Impact Index Per Article: 44.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 08/22/2017] [Accepted: 08/23/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Omega-3 polyunsaturated fatty acids (PUFAs) have anticolorectal cancer (CRC) activity. The intestinal microbiota has been implicated in colorectal carcinogenesis. Dietary omega-3 PUFAs alter the mouse intestinal microbiome compatible with antineoplastic activity. Therefore, we investigated the effect of omega-3 PUFA supplements on the faecal microbiome in middle-aged, healthy volunteers (n=22). DESIGN A randomised, open-label, cross-over trial of 8 weeks' treatment with 4 g mixed eicosapentaenoic acid/docosahexaenoic acid in two formulations (soft-gel capsules and Smartfish drinks), separated by a 12-week 'washout' period. Faecal samples were collected at five time-points for microbiome analysis by 16S ribosomal RNA PCR and Illumina MiSeq sequencing. Red blood cell (RBC) fatty acid analysis was performed by liquid chromatography tandem mass spectrometry. RESULTS Both omega-3 PUFA formulations induced similar changes in RBC fatty acid content, except that drinks were associated with a larger, and more prolonged, decrease in omega-6 PUFA arachidonic acid than the capsule intervention (p=0.02). There were no significant changes in α or β diversity, or phyla composition, associated with omega-3 PUFA supplementation. However, a reversible increased abundance of several genera, including Bifidobacterium, Roseburia and Lactobacillus was observed with one or both omega-3 PUFA interventions. Microbiome changes did not correlate with RBC omega-3 PUFA incorporation or development of omega-3 PUFA-induced diarrhoea. There were no treatment order effects. CONCLUSION Omega-3 PUFA supplementation induces a reversible increase in several short-chain fatty acid-producing bacteria, independently of the method of administration. There is no simple relationship between the intestinal microbiome and systemic omega-3 PUFA exposure. TRIAL REGISTRATION NUMBER ISRCTN18662143.
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Affiliation(s)
- Henry Watson
- Institute of Biomedical and Clinical Sciences, St James's University Hospital, University of Leeds, Leeds, UK
| | - Suparna Mitra
- Institute of Biomedical and Clinical Sciences, Leeds General Infirmary, University of Leeds, Leeds, UK
| | - Fiona C Croden
- Human Appetite Research Unit (Nutrition and Behaviour Research Group), School of Psychology, University of Leeds, Leeds, UK
| | - Morag Taylor
- Institute of Cancer and Pathology, St James's University Hospital, University of Leeds, Leeds, UK
| | - Henry M Wood
- Institute of Cancer and Pathology, St James's University Hospital, University of Leeds, Leeds, UK
| | - Sarah L Perry
- Institute of Biomedical and Clinical Sciences, St James's University Hospital, University of Leeds, Leeds, UK
| | - Jade A Spencer
- Institute of Cancer Therapeutics, University of Bradford, Bradford, UK
| | - Phil Quirke
- Institute of Cancer and Pathology, St James's University Hospital, University of Leeds, Leeds, UK
| | - Giles J Toogood
- Department of Hepatobiliary Surgery, St James's University Hospital, Leeds, UK
| | - Clare L Lawton
- Human Appetite Research Unit (Nutrition and Behaviour Research Group), School of Psychology, University of Leeds, Leeds, UK
| | - Louise Dye
- Human Appetite Research Unit (Nutrition and Behaviour Research Group), School of Psychology, University of Leeds, Leeds, UK
| | - Paul M Loadman
- Institute of Cancer Therapeutics, University of Bradford, Bradford, UK
| | - Mark A Hull
- Institute of Biomedical and Clinical Sciences, St James's University Hospital, University of Leeds, Leeds, UK
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27
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Nakanishi M, Hanley MP, Zha R, Igarashi Y, Hull MA, Mathias G, Sciavolino F, Grady JJ, Rosenberg DW. A novel bioactive derivative of eicosapentaenoic acid (EPA) suppresses intestinal tumor development in ApcΔ14/+ mice. Carcinogenesis 2018; 39:429-438. [PMID: 29206907 DOI: 10.1093/carcin/bgx136] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 11/27/2017] [Indexed: 12/28/2022] Open
Abstract
Familial adenomatous polyposis (FAP) is a genetic disorder characterized by the development of hundreds of polyps throughout the colon. Without prophylactic colectomy, most individuals with FAP develop colorectal cancer at an early age. Treatment with EPA in the free fatty acid form (EPA-FFA) has been shown to reduce polyp burden in FAP patients. Since high-purity EPA-FFA is subject to rapid oxidation, a stable form of EPA compound has been developed in the form of magnesium l-lysinate bis-eicosapentaenoate (TP-252). We assessed the chemopreventive efficacy of TP-252 on intestinal tumor formation using ApcΔ14/+ mice and compared it with EPA-FFA. TP-252 was supplemented in a modified AIN-93G diet at 1, 2 or 4% and EPA-FFA at 2.5% by weight and administered to mice for 11 weeks. We found that administration of TP-252 significantly reduced tumor number and size in the small intestine and colon in a dose-related manner and as effectively as EPA-FFA. To gain further insight into the cancer protection afforded to the colon, we performed a comprehensive lipidomic analysis of total fatty acid composition and eicosanoid metabolites. Treatment with TP-252 significantly decreased the levels of arachidonic acid (AA) and increased EPA concentrations within the colonic mucosa. Furthermore, a classification and regression tree (CART) analysis revealed that a subset of fatty acids, including EPA and docosahexaenoic acid (DHA), and their downstream metabolites, including PGE3 and 14-hydroxy-docosahexaenoic acid (HDoHE), were strongly associated with antineoplastic activity. These results indicate that TP-252 warrants further clinical development as a potential strategy for delaying colectomy in adolescent FAP patients.
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Affiliation(s)
- Masako Nakanishi
- Center for Molecular Oncology, University of Connecticut Health, Farmington, CT, USA
| | - Matthew P Hanley
- Center for Molecular Oncology, University of Connecticut Health, Farmington, CT, USA.,Thetis Pharmaceuticals, Branford, CT, USA
| | - Ruochen Zha
- Center for Molecular Oncology, University of Connecticut Health, Farmington, CT, USA.,Connecticut Institute for Clinical and Translational Science, University of Connecticut, Farmington, CT, USA
| | - Yuichi Igarashi
- Center for Molecular Oncology, University of Connecticut Health, Farmington, CT, USA
| | - Mark A Hull
- Leeds Institute of Biomedical & Clinical Sciences, University of Leeds, Leeds, UK
| | | | | | - James J Grady
- Center for Molecular Oncology, University of Connecticut Health, Farmington, CT, USA.,Connecticut Institute for Clinical and Translational Science, University of Connecticut, Farmington, CT, USA
| | - Daniel W Rosenberg
- Center for Molecular Oncology, University of Connecticut Health, Farmington, CT, USA
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Subramanian V, Burr NE, Hull MA. Reply. Clin Gastroenterol Hepatol 2018; 16:1680-1681. [PMID: 29909124 DOI: 10.1016/j.cgh.2018.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 06/08/2018] [Indexed: 02/07/2023]
Affiliation(s)
- Venkataraman Subramanian
- Department of Gastroenterology, St. James University Hospital, Leeds and, Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, United Kingdom
| | - Nicholas E Burr
- Department of Gastroenterology, St. James University Hospital, Leeds and, Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, United Kingdom
| | - Mark A Hull
- Department of Gastroenterology, St. James University Hospital, Leeds and, Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, United Kingdom
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Aravani A, Downing A, Thomas JD, Lagergren J, Morris EJA, Hull MA. Obesity surgery and risk of colorectal and other obesity-related cancers: An English population-based cohort study. Cancer Epidemiol 2018; 53:99-104. [PMID: 29414638 PMCID: PMC5865073 DOI: 10.1016/j.canep.2018.01.002] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 12/18/2017] [Accepted: 01/02/2018] [Indexed: 12/13/2022]
Abstract
The association between obesity surgery (OS) and cancer risk remains unclear. Colorectal cancer (CRC) risk is increased in obese individuals. No evidence of increased CRC risk after OS in this English population study. Reduced breast cancer risk was apparent after OS. Renal and endometrial cancer risk is elevated in obese patients.
Background The association between obesity surgery (OS) and cancer risk remains unclear. We investigated this association across the English National Health Service. A population-based Swedish study has previously suggested that OS may increase the risk of developing colorectal cancer (CRC). Methods A retrospective observational study of individuals who underwent OS (surgery cohort) or diagnosed with obesity, but had no OS (no-surgery cohort) (1997–2013) were identified using Hospital Episode Statistics. Subsequent diagnosis of CRC, breast, endometrial, kidney and lung cancer, as well as time ‘at risk’, were determined by linkage to National Cancer Registration & Analysis Service and Office of National Statistics data, respectively. Standardised incidence ratios (SIR) in relation to OS were calculated. Results 1 002 607 obese patients were identified, of whom 3.9% (n = 39 747) underwent OS. In the no-surgery obese population, 3 237 developed CRC (SIR 1.12 [95% CI 1.08–1.16]). In those who underwent OS, 43 developed CRC (SIR 1.26 [95% CI 0.92–1.71]). The OS cohort demonstrated decreased breast cancer risk (SIR 0.76 [95% CI 0.62–0.92]), unlike the no surgery cohort (SIR 1.08 [95% CI 1.04–1.11]). Increased risk of endometrial and kidney cancer was observed in surgery and no-surgery cohorts. Conclusions CRC risk is increased in individuals diagnosed as obese. Prior obesity surgery was not associated with an increased CRC risk. However, the OS population was small, with limited follow-up. Risk of breast cancer after OS is reduced compared with the obese no-surgery population, while the risk of endometrial and kidney cancers remained elevated after OS.
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Affiliation(s)
- Ariadni Aravani
- Leeds Institute of Cancer & Pathology, University of Leeds, Worsley Building, Leeds, LS2 9NL, United Kingdom.
| | - Amy Downing
- Leeds Institute of Cancer & Pathology, University of Leeds, Worsley Building, Leeds, LS2 9NL, United Kingdom.
| | - James D Thomas
- Public Health England, Blenheim House, Duncombe St., Leeds, West Yorkshire, LS1 4PL, United Kingdom.
| | - Jesper Lagergren
- Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, 17176 Stockholm, Sweden; Division of Cancer Studies, King's College London, WC2R 2LS, United Kingdom.
| | - Eva J A Morris
- Leeds Institute of Cancer & Pathology, University of Leeds, Worsley Building, Leeds, LS2 9NL, United Kingdom.
| | - Mark A Hull
- Leeds Institute of Biomedical & Clinical Sciences, University of Leeds, Wellcome Trust Brenner Building, St. James's University Hospital, Leeds LS9 7TF, United Kingdom.
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30
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Volpato M, Perry SL, Marston G, Ingram N, Cockbain AJ, Burghel H, Mann J, Lowes D, Wilson E, Droop A, Randerson-Moor J, Coletta PL, Hull MA. Changes in plasma chemokine C-C motif ligand 2 levels during treatment with eicosapentaenoic acid predict outcome in patients undergoing surgery for colorectal cancer liver metastasis. Oncotarget 2018; 7:28139-50. [PMID: 27058904 PMCID: PMC5053715 DOI: 10.18632/oncotarget.8579] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 03/18/2016] [Indexed: 12/16/2022] Open
Abstract
The mechanism of the anti-colorectal cancer (CRC) activity of the omega-3 fatty acid eicosapentaenoic acid (EPA) is not understood. We tested the hypothesis that EPA reduces expression of chemokine C-C motif ligand 2 (CCL2), a pro-inflammatory chemokine with known roles in metastasis.We measured CCL2 in clinical samples from a randomized trial of EPA in patients undergoing liver surgery for CRC liver metastasis (LM) and preclinical models. Genome-wide transcriptional profiling of tumors from EPA-treated patients was performed.EPA decreased CCL2 synthesis by CRC cells in a dose-dependent manner. CCL2 was localized to malignant epithelial cells in human CRCLM. EPA did not reduce CCL2 content in human or mouse tumors compare to control. However, EPA treatment was associated with decreased plasma CCL2 levels compared with controls (P=0.04). Reduction in plasma CCL2 following EPA treatment predicted improved disease-free survival (HR 0.32; P=0.003). Lack of 'CCL2 response' was associated with a specific CRCLM gene expression signature.In conclusion, reduction in plasma CCL2 in patients with CRCLM treated with EPA predicts better clinical outcome and a specific tumor gene expression profile. Further work is needed to validate CCL2 as a therapeutic response biomarker for omega-3 fatty acid treatment of CRC patients.
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Affiliation(s)
- Milene Volpato
- Leeds Institute of Biomedical & Clinical Sciences, Wellcome Trust Brenner Building, St James's University Hospital, Leeds LS9 7TF, United Kingdom
| | - Sarah L Perry
- Leeds Institute of Biomedical & Clinical Sciences, Wellcome Trust Brenner Building, St James's University Hospital, Leeds LS9 7TF, United Kingdom
| | - Gemma Marston
- Leeds Institute of Biomedical & Clinical Sciences, Wellcome Trust Brenner Building, St James's University Hospital, Leeds LS9 7TF, United Kingdom
| | - Nicola Ingram
- Leeds Institute of Biomedical & Clinical Sciences, Wellcome Trust Brenner Building, St James's University Hospital, Leeds LS9 7TF, United Kingdom
| | - Andrew J Cockbain
- Leeds Institute of Biomedical & Clinical Sciences, Wellcome Trust Brenner Building, St James's University Hospital, Leeds LS9 7TF, United Kingdom
| | - Heather Burghel
- Leeds Institute of Biomedical & Clinical Sciences, Wellcome Trust Brenner Building, St James's University Hospital, Leeds LS9 7TF, United Kingdom
| | - Jake Mann
- Leeds Institute of Biomedical & Clinical Sciences, Wellcome Trust Brenner Building, St James's University Hospital, Leeds LS9 7TF, United Kingdom
| | - David Lowes
- Leeds Institute of Biomedical & Clinical Sciences, Wellcome Trust Brenner Building, St James's University Hospital, Leeds LS9 7TF, United Kingdom
| | - Erica Wilson
- Leeds Institute of Cancer Studies and Pathology, Wellcome Trust Brenner Building, St James's University Hospital, Leeds LS9 7TF, United Kingdom
| | - Alastair Droop
- Leeds Institute of Cancer Studies and Pathology, Wellcome Trust Brenner Building, St James's University Hospital, Leeds LS9 7TF, United Kingdom.,MRC Medical Bioinformatics Centre, University of Leeds, Leeds, LS2 9NL, UK
| | - Juliette Randerson-Moor
- Leeds Institute of Cancer Studies and Pathology, Wellcome Trust Brenner Building, St James's University Hospital, Leeds LS9 7TF, United Kingdom
| | - P Louise Coletta
- Leeds Institute of Biomedical & Clinical Sciences, Wellcome Trust Brenner Building, St James's University Hospital, Leeds LS9 7TF, United Kingdom
| | - Mark A Hull
- Leeds Institute of Biomedical & Clinical Sciences, Wellcome Trust Brenner Building, St James's University Hospital, Leeds LS9 7TF, United Kingdom
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Lawler M, Alsina D, Adams RA, Anderson AS, Brown G, Fearnhead NS, Fenwick SW, Halloran SP, Hochhauser D, Hull MA, Koelzer VH, McNair AGK, Monahan KJ, Näthke I, Norton C, Novelli MR, Steele RJC, Thomas AL, Wilde LM, Wilson RH, Tomlinson I. Critical research gaps and recommendations to inform research prioritisation for more effective prevention and improved outcomes in colorectal cancer. Gut 2018; 67:179-193. [PMID: 29233930 PMCID: PMC5754857 DOI: 10.1136/gutjnl-2017-315333] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 10/24/2017] [Accepted: 10/25/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Colorectal cancer (CRC) leads to significant morbidity/mortality worldwide. Defining critical research gaps (RG), their prioritisation and resolution, could improve patient outcomes. DESIGN RG analysis was conducted by a multidisciplinary panel of patients, clinicians and researchers (n=71). Eight working groups (WG) were constituted: discovery science; risk; prevention; early diagnosis and screening; pathology; curative treatment; stage IV disease; and living with and beyond CRC. A series of discussions led to development of draft papers by each WG, which were evaluated by a 20-strong patient panel. A final list of RGs and research recommendations (RR) was endorsed by all participants. RESULTS Fifteen critical RGs are summarised below: RG1: Lack of realistic models that recapitulate tumour/tumour micro/macroenvironment; RG2: Insufficient evidence on precise contributions of genetic/environmental/lifestyle factors to CRC risk; RG3: Pressing need for prevention trials; RG4: Lack of integration of different prevention approaches; RG5: Lack of optimal strategies for CRC screening; RG6: Lack of effective triage systems for invasive investigations; RG7: Imprecise pathological assessment of CRC; RG8: Lack of qualified personnel in genomics, data sciences and digital pathology; RG9: Inadequate assessment/communication of risk, benefit and uncertainty of treatment choices; RG10: Need for novel technologies/interventions to improve curative outcomes; RG11: Lack of approaches that recognise molecular interplay between metastasising tumours and their microenvironment; RG12: Lack of reliable biomarkers to guide stage IV treatment; RG13: Need to increase understanding of health related quality of life (HRQOL) and promote residual symptom resolution; RG14: Lack of coordination of CRC research/funding; RG15: Lack of effective communication between relevant stakeholders. CONCLUSION Prioritising research activity and funding could have a significant impact on reducing CRC disease burden over the next 5 years.
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Affiliation(s)
- Mark Lawler
- Centre for Cancer Research and Cell Biology, Queen’s University Belfast, Belfast, UK
| | | | | | - Annie S Anderson
- Research into Cancer Prevention and Screening, University of Dundee, Dundee, UK
| | - Gina Brown
- Department of Radiology, Royal Marsden Hospital, Sutton, UK
| | | | - Stephen W Fenwick
- Hepatobiliary Surgery Unit, Aintree University Hospital, Liverpool, UK
| | - Stephen P Halloran
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Daniel Hochhauser
- Department of Oncology, University College London Cancer Institute, London, UK
| | - Mark A Hull
- Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK
| | - Viktor H Koelzer
- Molecular and Population Genetics Laboratory, University of Oxford, Oxford, UK
| | - Angus G K McNair
- Centre for Surgical Research, University of Bristol, Bristol, UK
| | - Kevin J Monahan
- Family History of Bowel Cancer Clinic, Imperial College London, London, UK
| | - Inke Näthke
- School of Life Sciences, University of Dundee, Dundee, UK
| | - Christine Norton
- Florence Nightingale Faculty of Nursing and Midwifery, King’s College London, London, UK
| | - Marco R Novelli
- Research Department of Pathology, University College London Medical School, London, UK
| | - Robert J C Steele
- Research into Cancer Prevention and Screening, University of Dundee, Dundee, UK
| | - Anne L Thomas
- Leicester Cancer Research Centre, University of Leicester, Leicester, UK
| | - Lisa M Wilde
- Bowel Cancer UK, London, UK
- Atticus Consultants Ltd, Croydon, UK
| | - Richard H Wilson
- Centre for Cancer Research and Cell Biology, Queen’s University Belfast, Belfast, UK
| | - Ian Tomlinson
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
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Abstract
Background Obesity surgery involves mechanical and physiological changes of the gastrointestinal tract that might promote colorectal cancer progression. Thus, we hypothesised that obesity surgery is associated with poorer prognosis in patients with colorectal cancer. Methods This nationwide population-based cohort study included all patients with an obesity diagnosis who subsequently developed colorectal cancer in Sweden from 1980 to 2012. The exposure was obesity surgery, and the main and secondary outcomes were disease-specific mortality and all-cause mortality, respectively. Cox proportional hazard survival models were used to calculate hazard ratios (HRs) with 95% confidence intervals (CIs), adjusted for sex, age, calendar year and education level. Results The exposed and unexposed cohort included 131 obesity surgery and 1332 non-obesity surgery patients with colorectal cancer. There was a statistically significant increased rate of colorectal cancer deaths following obesity surgery (disease-specific HR 1.50, 95% CI 1.00–2.19). When analysed separately, the mortality rate was more than threefold increased in rectal cancer patients with prior obesity surgery (disease-specific HR 3.70, 95% CI 2.00–6.90), while no increased mortality rate was found in colon cancer patients (disease-specific HR 1.10, 85% CI 0.67–1.70). Conclusion This population-based study among obese individuals found a poorer prognosis in colorectal cancer following obesity surgery, which was primarily driven by the higher mortality rate in rectal cancer.
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Affiliation(s)
- Wenjing Tao
- Upper Gastrointestinal Surgery, Department of Molecular medicine and Surgery, Karolinska Institutet, Norra Stationsgatan 67, 171 76, Stockholm, Sweden.
| | - Peter Konings
- Upper Gastrointestinal Surgery, Department of Molecular medicine and Surgery, Karolinska Institutet, Norra Stationsgatan 67, 171 76, Stockholm, Sweden
| | - Mark A Hull
- Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, St James's University Hospital, Leeds, UK
| | - Hans-Olov Adami
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA.,Department of Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Fredrik Mattsson
- Upper Gastrointestinal Surgery, Department of Molecular medicine and Surgery, Karolinska Institutet, Norra Stationsgatan 67, 171 76, Stockholm, Sweden
| | - Jesper Lagergren
- Upper Gastrointestinal Surgery, Department of Molecular medicine and Surgery, Karolinska Institutet, Norra Stationsgatan 67, 171 76, Stockholm, Sweden.,Division of Cancer Studies, King's College London, London, UK
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Hull MA, Cuthbert RJ, Ko CWS, Scott DJ, Cartwright EJ, Hawcroft G, Perry SL, Ingram N, Carr IM, Markham AF, Bonifer C, Coletta PL. Paracrine cyclooxygenase-2 activity by macrophages drives colorectal adenoma progression in the Apc Min/+ mouse model of intestinal tumorigenesis. Sci Rep 2017; 7:6074. [PMID: 28729694 PMCID: PMC5519705 DOI: 10.1038/s41598-017-06253-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 06/12/2017] [Indexed: 01/29/2023] Open
Abstract
Genetic deletion or pharmacological inhibition of cyclooxygenase (COX)-2 abrogates intestinal adenoma development at early stages of colorectal carcinogenesis. COX-2 is localised to stromal cells (predominantly macrophages) in human and mouse intestinal adenomas. Therefore, we tested the hypothesis that paracrine Cox-2-mediated signalling from macrophages drives adenoma growth and progression in vivo in the ApcMin/+ mouse model of intestinal tumorigenesis. Using a transgenic C57Bl/6 mouse model of Cox-2 over-expression driven by the chicken lysozyme locus (cLys-Cox-2), which directs integration site-independent, copy number-dependent transgene expression restricted to macrophages, we demonstrated that stromal macrophage Cox-2 in colorectal (but not small intestinal) adenomas from cLys-Cox-2 x ApcMin/+ mice was associated with significantly increased tumour size (P = 0.025) and multiplicity (P = 0.025), compared with control ApcMin/+ mice. Transgenic macrophage Cox-2 expression was associated with increased dysplasia, epithelial cell Cox-2 expression and submucosal tumour invasion, as well as increased nuclear β-catenin translocation in dysplastic epithelial cells. In vitro studies confirmed that paracrine macrophage Cox-2 signalling drives catenin-related transcription in intestinal epithelial cells. Paracrine macrophage Cox-2 activity drives growth and progression of ApcMin/+ mouse colonic adenomas, linked to increased epithelial cell β-catenin dysregulation. Stromal cell (macrophage) gene regulation and signalling represent valid targets for chemoprevention of colorectal cancer.
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Affiliation(s)
- Mark A Hull
- Section of Molecular Gastroenterology, Leeds Institute of Biomedical & Clinical Sciences, University of Leeds, St James's University Hospital, Leeds, LS9 7TF, United Kingdom.
| | - Richard J Cuthbert
- Section of Molecular Gastroenterology, Leeds Institute of Biomedical & Clinical Sciences, University of Leeds, St James's University Hospital, Leeds, LS9 7TF, United Kingdom
| | - C W Stanley Ko
- Section of Molecular Gastroenterology, Leeds Institute of Biomedical & Clinical Sciences, University of Leeds, St James's University Hospital, Leeds, LS9 7TF, United Kingdom
| | - Daniel J Scott
- Section of Molecular Gastroenterology, Leeds Institute of Biomedical & Clinical Sciences, University of Leeds, St James's University Hospital, Leeds, LS9 7TF, United Kingdom
| | - Elizabeth J Cartwright
- Section of Molecular Gastroenterology, Leeds Institute of Biomedical & Clinical Sciences, University of Leeds, St James's University Hospital, Leeds, LS9 7TF, United Kingdom
| | - Gillian Hawcroft
- Section of Molecular Gastroenterology, Leeds Institute of Biomedical & Clinical Sciences, University of Leeds, St James's University Hospital, Leeds, LS9 7TF, United Kingdom
| | - Sarah L Perry
- Section of Molecular Gastroenterology, Leeds Institute of Biomedical & Clinical Sciences, University of Leeds, St James's University Hospital, Leeds, LS9 7TF, United Kingdom
| | - Nicola Ingram
- Section of Molecular Gastroenterology, Leeds Institute of Biomedical & Clinical Sciences, University of Leeds, St James's University Hospital, Leeds, LS9 7TF, United Kingdom
| | - Ian M Carr
- Section of Translational Medicine, Leeds Institute of Biomedical & Clinical Sciences, University of Leeds, St James's University Hospital, Leeds, LS9 7TF, United Kingdom
| | - Alexander F Markham
- Section of Translational Medicine, Leeds Institute of Biomedical & Clinical Sciences, University of Leeds, St James's University Hospital, Leeds, LS9 7TF, United Kingdom
| | - Constanze Bonifer
- Section of Experimental Haematology, Leeds Institute of Cancer and Pathology, University of Leeds, St James's University Hospital, Leeds, LS9 7TF, United Kingdom
| | - P Louise Coletta
- Section of Molecular Gastroenterology, Leeds Institute of Biomedical & Clinical Sciences, University of Leeds, St James's University Hospital, Leeds, LS9 7TF, United Kingdom
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Volpato M, Spencer JA, Race AD, Munarini A, Belluzzi A, Cockbain AJ, Hull MA, Loadman PM. A liquid chromatography-tandem mass spectrometry method to measure fatty acids in biological samples. J Chromatogr B Analyt Technol Biomed Life Sci 2017; 1055-1056:125-134. [PMID: 28467947 DOI: 10.1016/j.jchromb.2017.04.030] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 04/16/2017] [Indexed: 01/07/2023]
Abstract
As pre-clinical and clinical research interest in ω-3 polyunsaturated fatty acids (PUFA) increases, so does the need for a fast, accurate and reproducible analytical method to measure fatty acids (FA) in biological samples in order to validate potential prognostic and predictive biomarkers, as well as establishing compliance in ω-3 PUFA intervention trials. We developed a LC-ESI-MS/MS method suitable for high throughput development to measure FAs and validated it in the context of treatment with the ω-3 PUFA eicosapentaenoic acid (EPA). Uniquely we directly compared the LC-ESI-MS/MS method to a GC-MS protocol. We demonstrated the LC-ESI-MS/MS method is accurate and reproducible, with coefficients of variation consistently below 15% for each PUFA analysed. The relative FA content values correlated well with those obtained by GC-MS (r2=0.94, p<0.001 for EPA) in vitro. The data obtained following analysis of FA content of liver tissues from mice fed an eicosapentaenoic acid enriched diet showed similar results to that of published studies in which GC-MS was used. The LC-ESI-MS/MS method allows concomitant analysis of unesterified (free, unbound) and esterified (bound) FAs in biological samples, allowing investigation of different PUFA pools in cells and tissues.
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Affiliation(s)
- Milene Volpato
- Section of Molecular Gastroenterology, Leeds Institute of Biomedical & Clinical Sciences, St James's University Hospital, Leeds LS9 7TF, United Kingdom
| | - Jade A Spencer
- Experimental Cancer Medicine Centre, Institute of Cancer Therapeutics, University of Bradford, Bradford BD7 1DP, United Kingdom
| | - Amanda D Race
- Experimental Cancer Medicine Centre, Institute of Cancer Therapeutics, University of Bradford, Bradford BD7 1DP, United Kingdom
| | - Alessandra Munarini
- Center for Applied Biomedical Research, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Andrea Belluzzi
- Department of Gastroenterology, S.Orsola Malpighi Hospital, University of Bologna, Bologna 40138, Italy
| | - Andrew J Cockbain
- Section of Molecular Gastroenterology, Leeds Institute of Biomedical & Clinical Sciences, St James's University Hospital, Leeds LS9 7TF, United Kingdom; Department of Hepatobiliary Surgery, Leeds Teaching Hospitals NHS Trust, St James's University Hospital, Leeds LS9 7TF, United Kingdom
| | - Mark A Hull
- Section of Molecular Gastroenterology, Leeds Institute of Biomedical & Clinical Sciences, St James's University Hospital, Leeds LS9 7TF, United Kingdom
| | - Paul M Loadman
- Experimental Cancer Medicine Centre, Institute of Cancer Therapeutics, University of Bradford, Bradford BD7 1DP, United Kingdom.
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35
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Watson H, Cockbain AJ, Spencer J, Race A, Volpato M, Loadman PM, Toogood GJ, Hull MA. Measurement of red blood cell eicosapentaenoic acid (EPA) levels in a randomised trial of EPA in patients with colorectal cancer liver metastases. Prostaglandins Leukot Essent Fatty Acids 2016; 115:60-66. [PMID: 27914515 DOI: 10.1016/j.plefa.2016.10.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 10/05/2016] [Accepted: 10/06/2016] [Indexed: 12/12/2022]
Abstract
We investigated red blood cell (RBC) PUFA profiles, and the predictive value of RBC EPA content for tumour EPA exposure and clinical outcomes, in the EMT study, a randomised trial of EPA in patients awaiting colorectal cancer (CRC) liver metastasis surgery (Cockbain et al., 2014) [8]. There was a significant increase in RBC EPA in the EPA group (n=43; median intervention 30 days; mean absolute 1.26[±0.14]% increase; P<0.001), but not in the placebo arm (n=45). EPA incorporation varied widely in EPA users and was not explained by treatment duration or compliance. There was little evidence of 'contamination' in the placebo group. The EPA level predicted tumour EPA content (r=0.36; P=0.03). Participants with post-treatment EPA≥1.22% (n=49) had improved OS compared with EPA <1.22% (n=29; HR 0.42[95%CI 0.16-0.95]). RBC EPA content should be evaluated as a biomarker of tumour exposure and clinical outcomes in future EPA trials in CRC patients.
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Affiliation(s)
- Henry Watson
- Leeds Institute of Biomedical & Clinical Sciences, University of Leeds, St James's University Hospital, Leeds LS9 7TF, United Kingdom; Department of Hepatobiliary Surgery, Leeds Teaching Hospitals NHS Trust, St James's University Hospital, Leeds LS9 7TF, United Kingdom
| | - Andrew J Cockbain
- Leeds Institute of Biomedical & Clinical Sciences, University of Leeds, St James's University Hospital, Leeds LS9 7TF, United Kingdom; Department of Hepatobiliary Surgery, Leeds Teaching Hospitals NHS Trust, St James's University Hospital, Leeds LS9 7TF, United Kingdom
| | - Jade Spencer
- Institute of Cancer Therapeutics, University of Bradford, Bradford BD7 1DP, United Kingdom
| | - Amanda Race
- Institute of Cancer Therapeutics, University of Bradford, Bradford BD7 1DP, United Kingdom
| | - Milene Volpato
- Leeds Institute of Biomedical & Clinical Sciences, University of Leeds, St James's University Hospital, Leeds LS9 7TF, United Kingdom
| | - Paul M Loadman
- Institute of Cancer Therapeutics, University of Bradford, Bradford BD7 1DP, United Kingdom
| | - Giles J Toogood
- Department of Hepatobiliary Surgery, Leeds Teaching Hospitals NHS Trust, St James's University Hospital, Leeds LS9 7TF, United Kingdom
| | - Mark A Hull
- Leeds Institute of Biomedical & Clinical Sciences, University of Leeds, St James's University Hospital, Leeds LS9 7TF, United Kingdom.
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36
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Walsh E, Rees CJ, Gill M, Parker CE, Bevan R, Perry SL, Bury Y, Mills S, Bradburn DM, Bramble M, Hull MA. Are there biological differences between screen-detected and interval colorectal cancers in the English Bowel Cancer Screening Programme? Br J Cancer 2016; 115:261-5. [PMID: 27219017 PMCID: PMC4947694 DOI: 10.1038/bjc.2016.159] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 04/27/2016] [Accepted: 04/29/2016] [Indexed: 01/10/2023] Open
Abstract
Background: We measured biomarkers of tumour growth and vascularity in interval and screen-detected colorectal cancers (CRCs) in the English Bowel Cancer Screening Programme in order to determine whether rapid tumour growth might contribute to interval CRC (a CRC diagnosed between a negative guaiac stool test and the next scheduled screening episode). Methods: Formalin-fixed, paraffin-embedded sections from 71 CRCs (screen-detected 43, interval 28) underwent immunohistochemistry for CD31 and Ki-67, in order to measure the microvessel density (MVD) and proliferation index (PI), respectively, as well as microsatellite instability (MSI) testing. Results: Interval CRCs were larger (P=0.02) and were more likely to exhibit venous invasion (P=0.005) than screen-detected tumours. There was no significant difference in MVD or PI between interval and screen-detected CRCs. More interval CRCs displayed MSI-high (14%) compared with screen-detected tumours (5%). A significantly (P=0.005) higher proportion (51%) of screen-detected CRC resection specimens contained at least one polyp compared with interval CRC (18%) resections. Conclusions: We found no evidence of biological differences between interval and screen-detected CRCs, consistent with the low sensitivity of guaiac stool testing as the main driver of interval CRC. The contribution of synchronous adenomas to occult blood loss for screening requires further investigation.
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Affiliation(s)
- Elizabeth Walsh
- Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, St James's University Hospital, Leeds LS9 7TF, UK
| | - Colin J Rees
- South Tyneside NHS Foundation Trust, South Tyneside District Hospital, South Shields NE34 0PL, UK.,School of Medicine, Pharmacy and Health, University of Durham, Durham, UK
| | - Michael Gill
- South Tyneside NHS Foundation Trust, South Tyneside District Hospital, South Shields NE34 0PL, UK
| | - Clare E Parker
- South Tyneside NHS Foundation Trust, South Tyneside District Hospital, South Shields NE34 0PL, UK
| | - Roisin Bevan
- South Tyneside NHS Foundation Trust, South Tyneside District Hospital, South Shields NE34 0PL, UK
| | - Sarah L Perry
- Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, St James's University Hospital, Leeds LS9 7TF, UK
| | - Yvonne Bury
- Newcastle upon Tyne Teaching Hospitals NHS Foundation Trust, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP, UK
| | - Sarah Mills
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields NE29 8NH, UK
| | - D Michael Bradburn
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields NE29 8NH, UK
| | - Michael Bramble
- School of Medicine, Pharmacy and Health, University of Durham, Durham, UK
| | - Mark A Hull
- Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, St James's University Hospital, Leeds LS9 7TF, UK.,Centre for Digestive Diseases, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds LS9 7TF, UK
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Burr NE, Hull MA, Subramanian V. Does aspirin or non-aspirin non-steroidal anti-inflammatory drug use prevent colorectal cancer in inflammatory bowel disease? World J Gastroenterol 2016; 22:3679-3686. [PMID: 27053860 PMCID: PMC4814654 DOI: 10.3748/wjg.v22.i13.3679] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 02/09/2016] [Accepted: 03/02/2016] [Indexed: 02/06/2023] Open
Abstract
AIM: To determine whether aspirin or non-aspirin non-steroidal anti-inflammatory drugs (NA-NSAIDs) prevent colorectal cancer (CRC) in patients with inflammatory bowel disease (IBD).
METHODS: We performed a systematic review and meta-analysis. We searched for articles reporting the risk of CRC in patients with IBD related to aspirin or NA-NSAID use. Pooled odds ratios (OR) and 95%CIs were determined using a random-effects model. Publication bias was assessed using Funnel plots and Egger’s test. Heterogeneity was assessed using Cochran’s Q and the I2 statistic.
RESULTS: Eight studies involving 14917 patients and 3 studies involving 1282 patients provided data on the risk of CRC in patients with IBD taking NA-NSAIDs and aspirin respectively. The pooled OR of developing CRC after exposure to NA-NSAIDs in patients with IBD was 0.80 (95%CI: 0.39-1.21) and after exposure to aspirin it was 0.66 (95%CI: 0.06-1.39). There was significant heterogeneity (I2 > 50%) between the studies. There was no change in the effect estimates on subgroup analyses of the population studied or whether adjustment or matching was performed.
CONCLUSION: There is a lack of high quality evidence on this important clinical topic. From the available evidence NA-NSAID or aspirin use does not appear to be chemopreventative for CRC in patients with IBD.
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Affiliation(s)
- Mark A Hull
- Leeds Institute of Biomedical & Clinical Sciences, St James's University Hospital, Leeds, UK
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Cockbain AJ, Volpato M, Race AD, Munarini A, Fazio C, Belluzzi A, Loadman PM, Toogood GJ, Hull MA. Anticolorectal cancer activity of the omega-3 polyunsaturated fatty acid eicosapentaenoic acid. Gut 2014; 63:1760-8. [PMID: 24470281 DOI: 10.1136/gutjnl-2013-306445] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Abstract
BACKGROUND Oral administration of the omega-3 fatty acid eicosapentaenoic acid (EPA), as the free fatty acid (FFA), leads to EPA incorporation into, and reduced growth of, experimental colorectal cancer liver metastases (CRCLM). DESIGN We performed a Phase II double-blind, randomised, placebo-controlled trial of EPA-FFA 2 g daily in patients undergoing liver resection surgery for CRCLM. The patients took EPA-FFA (n=43) or placebo (n=45) prior to surgery. The primary end-point was the CRCLM Ki67 proliferation index (PI). Secondary end-points included safety and tolerability of EPA-FFA, tumour fatty acid content and CD31-positive vascularity. We also analysed overall survival (OS) and disease-free survival (DFS). RESULTS The median (range) duration of EPA-FFA treatment was 30 (12-65) days. Treatment groups were well matched with no significant difference in disease burden at surgery or preoperative chemotherapy. EPA-FFA treatment was well tolerated with no excess of postoperative complications. Tumour tissue from EPA-FFA-treated patients demonstrated a 40% increase in EPA content (p=0.0008), no difference in Ki67 PI, but reduced vascularity in 'EPA-naïve' individuals (p=0.075). EPA-FFA also demonstrated antiangiogenic activity in vitro. In the first 18 months after CRCLM resection, EPA-FFA-treated individuals obtained OS benefit compared with placebo, although early CRC recurrence rates were similar. CONCLUSIONS EPA-FFA therapy is safe and well tolerated in patients with advanced CRC undergoing liver surgery. EPA-FFA may have antiangiogenic properties. Remarkably, limited preoperative treatment may provide postoperative OS benefit. Phase III clinical evaluation of prolonged EPA-FFA treatment in CRCLM patients is warranted. TRIAL IDENTIFIER ClinicalTrials.gov NCT01070355.
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Affiliation(s)
- Andrew J Cockbain
- Section of Molecular Gastroenterology, Leeds Institute of Biomedical & Clinical Sciences, St James's University Hospital, Leeds, UK Department of Hepatobiliary Surgery, Leeds Teaching Hospitals NHS Trust, St James's University Hospital, Leeds, UK
| | - Milene Volpato
- Section of Molecular Gastroenterology, Leeds Institute of Biomedical & Clinical Sciences, St James's University Hospital, Leeds, UK
| | - Amanda D Race
- Yorkshire Experimental Cancer Medicine Centre, Institute of Cancer Therapeutics, University of Bradford, Bradford, UK
| | - Alessandra Munarini
- Department of Gastroenterology, Sant'Orsola Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Chiara Fazio
- Department of Gastroenterology, Sant'Orsola Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Andrea Belluzzi
- Department of Gastroenterology, Sant'Orsola Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Paul M Loadman
- Yorkshire Experimental Cancer Medicine Centre, Institute of Cancer Therapeutics, University of Bradford, Bradford, UK
| | - Giles J Toogood
- Department of Hepatobiliary Surgery, Leeds Teaching Hospitals NHS Trust, St James's University Hospital, Leeds, UK
| | - Mark A Hull
- Section of Molecular Gastroenterology, Leeds Institute of Biomedical & Clinical Sciences, St James's University Hospital, Leeds, UK
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Gill MD, Bramble MG, Hull MA, Mills SJ, Morris E, Bradburn DM, Bury Y, Parker CE, Lee TJW, Rees CJ. Screen-detected colorectal cancers are associated with an improved outcome compared with stage-matched interval cancers. Br J Cancer 2014; 111:2076-81. [PMID: 25247322 PMCID: PMC4260027 DOI: 10.1038/bjc.2014.498] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2014] [Revised: 07/19/2014] [Accepted: 08/16/2014] [Indexed: 12/28/2022] Open
Abstract
Background: Colorectal cancers (CRCs) detected through the NHS Bowel Cancer Screening Programme (BCSP) have been shown to have a more favourable outcome compared to non-screen-detected cancers. The aim was to identify whether this was solely due to the earlier stage shift of these cancers, or whether other factors were involved. Methods: A combination of a regional CRC registry (Northern Colorectal Cancer Audit Group) and the BCSP database were used to identify screen-detected and interval cancers (diagnosed after a negative faecal occult blood test, before the next screening round), diagnosed between April 2007 and March 2010, within the North East of England. For each Dukes' stage, patient demographics, tumour characteristics, and survival rates were compared between these two groups. Results: Overall, 322 screen-detected cancers were compared against 192 interval cancers. Screen-detected Dukes' C and D CRCs had a superior survival rate compared with interval cancers (P=0.014 and P=0.04, respectively). Cox proportional hazards regression showed that Dukes' stage, tumour location, and diagnostic group (HR 0.45, 95% CI 0.29–0.69, P<0.001 for screen-detected CRCs) were all found to have a significant impact on the survival of patients. Conclusions: The improved survival of screen-detected over interval cancers for stages C and D suggest that there may be a biological difference in the cancers in each group. Although lead-time bias may have a role, this may be related to a tumour's propensity to bleed and therefore may reflect detection through current screening tests.
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Affiliation(s)
- M D Gill
- 1] Northern Colorectal Cancer Audit Group, North East England, UK [2] School of Medicine, Pharmacy and Health, University of Durham, Durham, UK [3] Northern Region Endoscopy Group, North East England, UK
| | - M G Bramble
- 1] School of Medicine, Pharmacy and Health, University of Durham, Durham, UK [2] Northern Region Endoscopy Group, North East England, UK
| | - M A Hull
- Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - S J Mills
- 1] Northern Colorectal Cancer Audit Group, North East England, UK [2] Northern Region Endoscopy Group, North East England, UK
| | - E Morris
- Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - D M Bradburn
- 1] Northern Colorectal Cancer Audit Group, North East England, UK [2] Northern Region Endoscopy Group, North East England, UK
| | - Y Bury
- Royal Victoria Infirmary, Newcastle, UK
| | - C E Parker
- 1] Northern Region Endoscopy Group, North East England, UK [2] South Tyneside Foundation Trust, South Tyneside, UK
| | - T J W Lee
- 1] Northern Region Endoscopy Group, North East England, UK [2] North Tyneside General Hospital, Northumbria Healthcare NHS Foundation Trust, Northumberland, UK
| | - C J Rees
- 1] School of Medicine, Pharmacy and Health, University of Durham, Durham, UK [2] Northern Region Endoscopy Group, North East England, UK [3] South Tyneside Foundation Trust, South Tyneside, UK
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Piazzi G, D'Argenio G, Prossomariti A, Lembo V, Mazzone G, Candela M, Biagi E, Brigidi P, Vitaglione P, Fogliano V, D'Angelo L, Fazio C, Munarini A, Belluzzi A, Ceccarelli C, Chieco P, Balbi T, Loadman PM, Hull MA, Romano M, Bazzoli F, Ricciardiello L. Eicosapentaenoic acid free fatty acid prevents and suppresses colonic neoplasia in colitis-associated colorectal cancer acting on Notch signaling and gut microbiota. Int J Cancer 2014; 135:2004-13. [PMID: 24676631 DOI: 10.1002/ijc.28853] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Accepted: 03/06/2014] [Indexed: 12/12/2022]
Abstract
Inflammatory bowel diseases are associated with increased risk of developing colitis-associated colorectal cancer (CAC). Epidemiological data show that the consumption of ω-3 polyunsaturated fatty acids (ω-3 PUFAs) decreases the risk of sporadic colorectal cancer (CRC). Importantly, recent data have shown that eicosapentaenoic acid-free fatty acid (EPA-FFA) reduces polyp formation and growth in models of familial adenomatous polyposis. However, the effects of dietary EPA-FFA are unknown in CAC. We tested the effectiveness of substituting EPA-FFA, for other dietary fats, in preventing inflammation and cancer in the AOM-DSS model of CAC. The AOM-DSS protocols were designed to evaluate the effect of EPA-FFA on both initiation and promotion of carcinogenesis. We found that EPA-FFA diet strongly decreased tumor multiplicity, incidence and maximum tumor size in the promotion and initiation arms. Moreover EPA-FFA, in particular in the initiation arm, led to reduced cell proliferation and nuclear β-catenin expression, whilst it increased apoptosis. In both arms, EPA-FFA treatment led to increased membrane switch from ω-6 to ω-3 PUFAs and a concomitant reduction in PGE2 production. We observed no significant changes in intestinal inflammation between EPA-FFA treated arms and AOM-DSS controls. Importantly, we found that EPA-FFA treatment restored the loss of Notch signaling found in the AOM-DSS control and resulted in the enrichment of Lactobacillus species in the gut microbiota. Taken together, our data suggest that EPA-FFA is an excellent candidate for CRC chemoprevention in CAC.
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Affiliation(s)
- Giulia Piazzi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy; Center for Applied Biomedical Research (CRBA), S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
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Kant P, Perry SL, Dexter SP, Race AD, Loadman PM, Hull MA. Mucosal biomarkers of colorectal cancer risk do not increase at 6 months following sleeve gastrectomy, unlike gastric bypass. Obesity (Silver Spring) 2014; 22:202-10. [PMID: 23625552 DOI: 10.1002/oby.20493] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Revised: 04/05/2013] [Accepted: 04/05/2013] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The hypothesis that sleeve gastrectomy (SG) is not associated with an increase in mucosal colorectal cancer (CRC) biomarkers, unlike Roux-en-Y gastric bypass (RYGB), was tested. DESIGN AND METHODS Rectal mucosa, blood, and urine were obtained from morbidly obese patients (n = 23) before and after (median 28 months) SG, as well as from nonobese controls (n = 20). Rectal epithelial cell mitosis and apoptosis, crypt size/fission, and pro-inflammatory gene expression were measured, as well as systemic inflammatory biomarkers, including C-reactive protein (CRP). RESULTS The mean pre-operative body mass index in SG patients was 65.7 kg/m2 (24.7 kg/m2 in controls). Mean excess weight loss post-SG was 38.2%. There was a significant increase in mitosis frequency, crypt size, and crypt fission (all P < 0.01) in SG patients versus controls, as well as evidence of a chronic inflammatory state (raised CRP and mononuclear cell p65 NFκB binding), but there was no significant change in these biomarkers after SG, except CRP reduction. Macrophage migration inhibitory factor mRNA levels were increased by 39% post-SG (P = 0.038). CONCLUSIONS Mucosal biomarkers of CRC risk do not increase at 6 months following SG, unlike RYGB. Biomarkers of rectal crypt proliferation and systemic inflammation are increased in morbidly obese patients compared with controls.
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Verghese ET, Drury R, Green CA, Holliday DL, Lu X, Nash C, Speirs V, Thorne JL, Thygesen HH, Zougman A, Hull MA, Hanby AM, Hughes TA. MiR-26b is down-regulated in carcinoma-associated fibroblasts from ER-positive breast cancers leading to enhanced cell migration and invasion. J Pathol 2013; 231:388-99. [PMID: 23939832 PMCID: PMC4030585 DOI: 10.1002/path.4248] [Citation(s) in RCA: 93] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Revised: 08/02/2013] [Accepted: 08/08/2013] [Indexed: 02/06/2023]
Abstract
Carcinoma-associated fibroblasts (CAFs) influence the behaviour of cancer cells but the roles of microRNAs in this interaction are unknown. We report microRNAs that are differentially expressed between breast normal fibroblasts and CAFs of oestrogen receptor-positive cancers, and explore the influences of one of these, miR-26b, on breast cancer biology. We identified differentially expressed microRNAs by expression profiling of clinical samples and a tissue culture model: miR-26b was the most highly deregulated microRNA. Using qPCR, miR-26b was confirmed as down-regulated in fibroblasts from 15 of 18 further breast cancers. Next, we examined whether manipulation of miR-26b expression changed breast fibroblast behaviour. Reduced miR-26b expression caused fibroblast migration and invasion to increase by up to three-fold in scratch-closure and trans-well assays. Furthermore, in co-culture with MCF7 breast cancer epithelial cells, fibroblasts with reduced miR-26b expression enhanced both MCF7 migration in trans-well assays and MCF7 invasion from three-dimensional spheroids by up to five-fold. Mass spectrometry was used to identify expression changes associated with the reduction of miR-26b expression in fibroblasts. Pathway analyses of differentially expressed proteins revealed that glycolysis/TCA cycle and cytoskeletal regulation by Rho GTPases are downstream of miR-26b. In addition, three novel miR-26b targets were identified (TNKS1BP1, CPSF7, COL12A1) and the expression of each in cancer stroma was shown to be significantly associated with breast cancer recurrence. MiR-26b in breast CAFs is a potent regulator of cancer behaviour in oestrogen receptor-positive cancers, and we have identified key genes and molecular pathways that act downstream of miR-26b in CAFs. © 2013 The Authors. Journal of Pathology published by John Wiley & Sons Ltd on behalf of Pathological Society of Great Britain and Ireland.
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Affiliation(s)
- Eldo T Verghese
- Leeds Institute of Molecular Medicine, University of Leeds, Leeds, UK; Department of Histopathology, St James's University Hospital, Leeds, UK
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Burr N, Hull MA. Commentary: the association between low-dose aspirin use and the incidence of colorectal cancer. Aliment Pharmacol Ther 2013; 38:653-4. [PMID: 23964734 DOI: 10.1111/apt.12437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Accepted: 07/10/2013] [Indexed: 12/26/2022]
Affiliation(s)
- N Burr
- Leeds Institute of Biomedical & Clinical Sciences, University of Leeds, Leeds, UK
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Ingram N, Northwood EL, Perry SL, Marston G, Snowden H, Taylor JC, Scott N, Bishop DT, Coletta PL, Hull MA. Reduced type II interleukin-4 receptor signalling drives initiation, but not progression, of colorectal carcinogenesis: evidence from transgenic mouse models and human case-control epidemiological observations. Carcinogenesis 2013; 34:2341-9. [PMID: 23784081 PMCID: PMC3786383 DOI: 10.1093/carcin/bgt222] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
We investigated the role of interleukin (IL)-4 receptor (IL-4R) signalling during mouse carcinogen-induced colorectal carcinogenesis and in a case–control genetic epidemiological study of IL-4Rα single nucleotide polymorphisms (SNPs). Azoxymethane-induced aberrant crypt focus (ACF; 6 weeks) and tumours (32 weeks) were analysed in wild-type (WT) BALB/c mice, as well as in IL-4Rα−/−, IL-13−/− and ‘double-knockout’ (DKO) animals. Colorectal cancer (CRC) cases (1502) and controls (584) were genotyped for six coding IL-4Rα SNPs. The association with CRC risk and CRC-specific mortality was analysed by logistic regression. Lack of IL-4Rα expression was associated with increased ACFs [median 8.5 ACFs per mouse (IL-4Rα−/−) versus 3 (WT); P = 0.007], but no difference in the number of colorectal tumours [mean 1.4 per mouse (IL-4Rα−/−) versus 2 (WT)], which were smaller and demonstrated reduced nuclear/cytoplasmic β-catenin translocation compared with WT tumours. Tumour-bearing IL-4Rα−/− mice had fewer CD11b+/Gr1+ myeloid-derived suppressor splenocytes than WT animals. IL-13−/− mice developed a similar number of ACFs to IL-4Rα−/− and DKO mice. There was a significant increase in CRC risk associated with the functional SNP Q576R [odds ratio 1.54 (95% confidence interval 0.94–2.54), Ptrend 0.03 for the minor G allele]. There was no effect of IL-4Rα genotype on either CRC-specific or all-cause mortality. These combined pre-clinical and human data together demonstrate that reduced IL-4R signalling has stage-specific effects on colorectal carcinogenesis (increased CRC initiation and risk but reduced tumour progression and no effect on CRC mortality). These results should prompt evaluation of the effect of pharmacological manipulation of IL-4R signalling on future CRC risk and for CRC treatment.
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Affiliation(s)
- Nicola Ingram
- Section of Molecular Gastroenterology, Leeds Institute of Biomedical and Clinical Sciences, Wellcome Trust Brenner Building, St James's University Hospital, Leeds, LS9 7TF, UK
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Young AL, Chalmers CR, Hawcroft G, Perry SL, Treanor D, Toogood GJ, Jones PF, Hull MA. Regional differences in prostaglandin E₂ metabolism in human colorectal cancer liver metastases. BMC Cancer 2013; 13:92. [PMID: 23442768 PMCID: PMC3598740 DOI: 10.1186/1471-2407-13-92] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Accepted: 02/19/2013] [Indexed: 12/20/2022] Open
Abstract
Background Prostaglandin (PG) E2 plays a critical role in colorectal cancer (CRC) progression, including epithelial-mesenchymal transition (EMT). Activity of the rate-limiting enzyme for PGE2 catabolism (15-hydroxyprostaglandin dehydrogenase [15-PGDH]) is dependent on availability of NAD+. We tested the hypothesis that there is intra-tumoral variability in PGE2 content, as well as in levels and activity of 15-PGDH, in human CRC liver metastases (CRCLM). To understand possible underlying mechanisms, we investigated the relationship between hypoxia, 15-PGDH and PGE2 in human CRC cells in vitro. Methods Tissue from the periphery and centre of 20 human CRCLM was analysed for PGE2 levels, 15-PGDH and cyclooxygenase (COX)-2 expression, 15-PGDH activity, and NAD+/NADH levels. EMT of LIM1863 human CRC cells was induced by transforming growth factor (TGF) β. Results PGE2 levels were significantly higher in the centre of CRCLM compared with peripheral tissue (P = 0.04). There were increased levels of 15-PGDH protein in the centre of CRCLM associated with reduced 15-PGDH activity and low NAD+/NADH levels. There was no significant heterogeneity in COX-2 protein expression. NAD+ availability controlled 15-PGDH activity in human CRC cells in vitro. Hypoxia induced 15-PGDH expression in human CRC cells and promoted EMT, in a similar manner to PGE2. Combined 15-PGDH expression and loss of membranous E-cadherin (EMT biomarker) were present in the centre of human CRCLM in vivo. Conclusions There is significant intra-tumoral heterogeneity in PGE2 content, 15-PGDH activity and NAD+ availability in human CRCLM. Tumour micro-environment (including hypoxia)-driven differences in PGE2 metabolism should be targeted for novel treatment of advanced CRC.
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Affiliation(s)
- Alastair L Young
- Section of Molecular Gastroenterology, Leeds Institute of Molecular Medicine, University of Leeds, St James's University Hospital, Leeds LS9 7TF, UK
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Lee TJW, Hull MA, Rajasekhar PT, Clifford GM, Ritchie M, James P, McNally RJQ, Rutter MD, Rees CJ. Aspirin users attending for NHS bowel cancer screening have less colorectal neoplasia: chemoprevention or false-positive faecal occult blood testing? Digestion 2012; 85:278-81. [PMID: 22538301 DOI: 10.1159/000334372] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2011] [Accepted: 10/11/2011] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The NHS Bowel Cancer Screening Programme (BCSP) uses faecal occult blood (FOB) testing to select patients aged 60-69 years for colonoscopy. AIM To examine the association between aspirin use and the detection of colorectal neoplasia in screened patients undergoing colonoscopy. METHODS Data were collected prospectively on individuals who underwent colonoscopy following a positive FOB test in the South of Tyne area between February 2007 and 2009. The relationship between the presence of colorectal neoplasia and age, gender, body mass index (BMI) and current aspirin use were evaluated using logistic regression analysis. RESULTS 701 individuals underwent colonoscopy. 414 (59.1%) were male and 358 (51.1%) aged over 65 years. Males had a higher incidence of colorectal neoplasia (relative risk 2.26, 95% CI 1.65-3.10, p < 0.001). Current aspirin use was associated with a lower neoplasia detection rate (relative risk 0.79, 95% CI 0.50-0.98, p = 0.039). Increased age and BMI were not significantly associated with higher neoplasia detection. CONCLUSION Amongst individuals undergoing colonoscopy following a positive FOB test in the BCSP, current aspirin use was associated with a lower incidence of colorectal neoplasia. This may represent the chemopreventative effect of aspirin or increased false positivity of FOB testing. Further work is needed to clarify the contribution of each and could reduce the number of unnecessary colonoscopies.
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Affiliation(s)
- Thomas J W Lee
- Tees Bowel Cancer Screening Centre, University Hospital of North Tees, Stockton on Tees, UK
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Hawcroft G, Volpato M, Marston G, Ingram N, Perry SL, Cockbain AJ, Race AD, Munarini A, Belluzzi A, Loadman PM, Coletta PL, Hull MA. The omega-3 polyunsaturated fatty acid eicosapentaenoic acid inhibits mouse MC-26 colorectal cancer cell liver metastasis via inhibition of PGE2-dependent cell motility. Br J Pharmacol 2012; 166:1724-37. [PMID: 22300262 DOI: 10.1111/j.1476-5381.2012.01882.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND AND PURPOSE The omega-3 polyunsaturated fatty acid (PUFA) eicosapentaenoic acid (EPA) has antineoplastic activity at early stages of colorectal carcinogenesis, relevant to chemoprevention of colorectal cancer (CRC). We tested the hypothesis that EPA also has anti-CRC activity at later stages of colorectal carcinogenesis, relevant to treatment of metastatic CRC, via modulation of E-type PG synthesis. EXPERIMENTAL APPROACH A BALB/c mouse model, in which intrasplenic injection of syngeneic MC-26 mouse CRC cells leads to development of liver metastases, was used. Dietary EPA was administered in the free fatty acid (FFA) form for 2 weeks before and after ultrasound-guided intrasplenic injection of 1 × 10(6) MC-26 cells (n= 16 each group). KEY RESULTS Treatment with 5% (w w(-1)) EPA-FFA was associated with a reduced MC-26 mouse CRC cell liver tumour burden compared with control animals (median liver weight 1.03 g vs. 1.62 g; P < 0.034). Administration of 5% EPA-FFA was also linked to a significant increase in tumour EPA incorporation and lower intratumoural PGE(2) levels (with concomitant increased production of PGE(3)). Liver tumours from 5% EPA-FFA- treated mice demonstrated decreased 5-bromo-2-deoxyuridine-positive CRC cell proliferation and reduced phosphorylated ERK 1/2 expression at the invasive edge of tumours. A concentration-dependent reduction in MC-26 CRC cell Transwell® migration following EPA-FFA treatment (50-200 µM) in vitro was rescued by exogenous PGE(2) (10 µM) and PGE(1)-alcohol (1 µM). CONCLUSIONS AND IMPLICATIONS EPA-FFA inhibits MC-26 CRC cell liver metastasis. EPA incorporation is associated with a 'PGE(2) to PGE(3) switch' in liver tumours. Inhibition of PGE(2)-EP(4) receptor-dependent CRC cell motility probably contributes to the antineoplastic activity of EPA.
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Affiliation(s)
- G Hawcroft
- Section of Molecular Gastroenterology, Leeds Institute of Molecular Medicine, St James's University Hospital, UK
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Tomlinson DC, Baxter EW, Loadman PM, Hull MA, Knowles MA. FGFR1-induced epithelial to mesenchymal transition through MAPK/PLCγ/COX-2-mediated mechanisms. PLoS One 2012; 7:e38972. [PMID: 22701738 PMCID: PMC3373505 DOI: 10.1371/journal.pone.0038972] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Accepted: 05/14/2012] [Indexed: 12/17/2022] Open
Abstract
Tumour invasion and metastasis is the most common cause of death from cancer. For epithelial cells to invade surrounding tissues and metastasise, an epithelial-mesenchymal transition (EMT) is required. We have demonstrated that FGFR1 expression is increased in bladder cancer and that activation of FGFR1 induces an EMT in urothelial carcinoma (UC) cell lines. Here, we created an in vitro FGFR1-inducible model of EMT, and used this model to identify regulators of urothelial EMT. FGFR1 activation promoted EMT over a period of 72 hours. Initially a rapid increase in actin stress fibres occurred, followed by an increase in cell size, altered morphology and increased migration and invasion. By using site-directed mutagenesis and small molecule inhibitors we demonstrated that combined activation of the mitogen activated protein kinase (MAPK) and phospholipase C gamma (PLCγ) pathways regulated this EMT. Actin stress fibre formation was regulated by PLCγ activation, and was also important for the increase in cell size, migration and altered morphology. MAPK activation regulated migration and E-cadherin expression, indicating that combined activation of PLCγ and MAPK is required for a full EMT. We used expression microarrays to assess changes in gene expression downstream of these signalling cascades. COX-2 was transcriptionally upregulated by FGFR1 and caused increased intracellular prostaglandin E(2) levels, which promoted migration. In conclusion, we have demonstrated that FGFR1 activation in UC cells lines promotes EMT via coordinated activation of multiple signalling pathways and by promoting activation of prostaglandin synthesis.
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Affiliation(s)
- Darren C. Tomlinson
- Section of Experimental Oncology, Leeds Institute of Molecular Medicine, St. James’s University Hospital, Leeds, United Kingdom
| | - Euan W. Baxter
- Section of Experimental Oncology, Leeds Institute of Molecular Medicine, St. James’s University Hospital, Leeds, United Kingdom
| | - Paul M. Loadman
- Instititue of Cancer Therapeutics, University of Bradford, Richmond Road, Bradford, United Kingdom
| | - Mark A. Hull
- Section of Molecular Gastroenterology, Leeds Institute of Molecular Medicine, St. James’s University Hospital, Leeds, United Kingdom
| | - Margaret A. Knowles
- Section of Experimental Oncology, Leeds Institute of Molecular Medicine, St. James’s University Hospital, Leeds, United Kingdom
- * E-mail:
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50
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Hull MA, Yiannakou Y, Gower J, Ryder SD, Bloom SL, Rees CR. Getting involved in clinical trials research in the UK: how can Clinical Research Networks help? Frontline Gastroenterol 2012; 3:66-71. [PMID: 28839636 PMCID: PMC5517261 DOI: 10.1136/flgastro-2011-100083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/13/2011] [Indexed: 02/04/2023] Open
Abstract
The Clinical Research Networks of the National Institute of Health Research have transformed clinical research in the UK, leading to a doubling in the number of patients involved in clinical research studies over the past 3 years. This has been achieved by streamlining the trials approvals process, by providing local infrastructure such as research nurse support for clinical trials recruitment and through recognition of the time and funding necessary for clinicians to contribute to clinical research. Here, we describe the structure and roles of the Comprehensive Clinical Research Networks in gastrointestinal disease and hepatology, particularly in England. We will explain how the networks have already accelerated clinical research in gastrointestinal and liver disease, as well as provide a simple guide about how individual clinicians can contribute to ongoing studies via the networks.
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Affiliation(s)
- Mark A Hull
- Lead for Gastrointestinal Research, West Yorkshire Comprehensive Local Research Network, Leeds Institute of Molecular Medicine, University of Leeds, St James's University Hospital, Leeds, UK
| | - Yan Yiannakou
- Lead for Gastrointestinal Research, County Durham and Tees Valley Comprehensive Local Research Network, County Durham and Darlington NHS Foundation Trust, Durham, UK
| | - Jonathan Gower
- Comprehensive Clinical Research Network, National Institute for Health Research Clinical Research Network Coordinating Centre, Leeds, UK
| | - Stephen D Ryder
- Hepatology National Specialty Group, Comprehensive Clinical Research Network, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Stuart L Bloom
- Gastrointestinal National Specialty Group, Comprehensive Clinical Research Network, University College Hospital, London,UK
| | - Colin R Rees
- Chair, Northern Region Endoscopy Group, Department of Gastroenterology, South Tyneside Hospital, Newcastle, UK
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