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Shenker NS, Nangia S. Nonprofit human milk banking: On a challenging path to global equity. Matern Child Nutr 2024:e13623. [PMID: 38204285 DOI: 10.1111/mcn.13623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 12/19/2023] [Accepted: 12/21/2023] [Indexed: 01/12/2024]
Affiliation(s)
- Natalie S Shenker
- Department of Surgery and Cancer, Imperial College London, London, UK
- Human Milk Foundation, Rothamsted Institute, Hertfordshire, UK
| | - Sushma Nangia
- Vatsalya Maatri Amrit Kosh, National Comprehensive Lactation Management Centre, New Delhi, Delhi, India
- Department of Neonatology, Lady Hardinge Medical College & Kalawati Saran Children's Hospital, New Delhi, Delhi, India
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Shenker NS, Griffin S, Hamill‐Keays J, Thomson M, Simpson J, Weaver G. Understanding the current and future usage of donor human milk in hospitals: An online survey of UK neonatal units. Matern Child Nutr 2023; 19:e13526. [PMID: 37400943 PMCID: PMC10483937 DOI: 10.1111/mcn.13526] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 04/18/2023] [Accepted: 04/19/2023] [Indexed: 07/05/2023]
Abstract
The use of donor human milk (DHM) where there is a shortfall of maternal milk can benefit both infant and maternal outcomes but DHM supply is not always assured. This study aimed to understand current DHM usage in UK neonatal units and potential future demand to inform service planning. An online survey was disseminated to all UK neonatal units using Smart Survey or by telephone between February and April 2022 after development alongside neonatal unit teams. Surveys were completed by 55.4% of units (108/195) from all 13 Operational Delivery Networks. Only four units reported not using DHM, and another two units only if infants are transferred on DHM feeds. There was marked diversity in DHM implementation and usage and unit protocols varied greatly. Five of six units with their own milk bank had needed to source milk from an external milk bank in the last year. Ninety units (84.9%) considered DHM was sometimes (n = 35) or always (n = 55) supportive of maternal breastfeeding, and three units (2.9%) responded that DHM was rarely supportive of breastfeeding. Usage was predicted to increase by 37 units (34.9%), and this drive was principally a result of parental preference, clinical trials and improved evidence. These findings support the assumption that UK hospital DHM demand will increase after updated recommendations from the World Health Organization (WHO) and the British Association of Perinatal Medicine. These data will assist service delivery planning, underpinned by an ongoing programme of implementation science and training development, to ensure future equity of access to DHM nationally.
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Affiliation(s)
- Natalie S. Shenker
- Department of Surgery and CancerImperial College London, IRDBLondonUK
- The Human Milk Foundation, Daniel Hall BuildingRothamsted Institute, HertsHarpendenUK
| | - Samantha Griffin
- Department of Surgery and CancerImperial College London, IRDBLondonUK
| | - Jonathan Hamill‐Keays
- The Human Milk Foundation, Daniel Hall BuildingRothamsted Institute, HertsHarpendenUK
| | - Merran Thomson
- Neonatal UnitHillingdon Hospitals NHS Foundation TrustUxbridgeUK
| | - Judith Simpson
- Neonatal Intensive Care UnitRoyal Hospital for ChildrenGlasgowUK
| | - Gillian Weaver
- The Human Milk Foundation, Daniel Hall BuildingRothamsted Institute, HertsHarpendenUK
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Shenker NS, Perdones-Montero A, Burke A, Stickland S, McDonald JAK, Cameron SJS. Human Milk from Tandem Feeding Dyads Does Not Differ in Metabolite and Metataxonomic Features When Compared to Single Nursling Dyads under Six Months of Age. Metabolites 2022; 12:metabo12111069. [PMID: 36355152 PMCID: PMC9696481 DOI: 10.3390/metabo12111069] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 10/27/2022] [Accepted: 11/02/2022] [Indexed: 11/09/2022] Open
Abstract
Given the long-term advantages of exclusive breastfeeding to infants and their mothers, there is both an individual and public health benefit to its promotion and support. Data on the composition of human milk over the course of a full period of lactation for a single nursling is sparse, but data on human milk composition during tandem feeding (feeding children of different ages from different pregnancies) is almost entirely absent. This leaves an important knowledge gap that potentially endangers the ability of parents to make a fully informed choice on infant feeding. We compared the metataxonomic and metabolite fingerprints of human milk samples from 15 tandem feeding dyads to that collected from ten exclusively breastfeeding single nursling dyads where the nursling is under six months of age. Uniquely, our cohort also included three tandem feeding nursling dyads where each child showed a preferential side for feeding-allowing a direct comparison between human milk compositions for different aged nurslings. Across our analysis of volume, total fat, estimation of total microbial load, metabolite fingerprinting, and metataxonomics, we showed no statistically significant differences between tandem feeding and single nursling dyads. This included comparisons of preferential side nurslings of different ages. Together, our findings support the practice of tandem feeding of nurslings, even when feeding an infant under six months.
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Affiliation(s)
- Natalie S. Shenker
- Department of Surgery and Cancer, Imperial College London, London SW7 2AZ, UK
| | - Alvaro Perdones-Montero
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London SW7 2AZ, UK
| | - Adam Burke
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London SW7 2AZ, UK
| | - Sarah Stickland
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London SW7 2AZ, UK
| | - Julie A. K. McDonald
- MRC Centre for Molecular Bacteriology and Infection, Imperial College London, London SW7 2AZ, UK
| | - Simon J. S. Cameron
- Institute for Global Food Security, School of Biological Sciences, Queen’s University Belfast, Belfast BT9 5DL, UK
- Correspondence: ; Tel.: +44-(0)28-9097-6421
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Griffin S, Watt J, Wedekind S, Bramer S, Hazemi-Jebelli Y, Boyle R, Weaver G, Shenker NS. Establishing a novel community-focussed lactation support service: a descriptive case series. Int Breastfeed J 2022; 17:7. [PMID: 35033128 PMCID: PMC8760776 DOI: 10.1186/s13006-021-00446-5] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 12/26/2021] [Indexed: 11/24/2022] Open
Abstract
Background Although breastfeeding is widely acknowledged as protecting both infant and maternal health postnatally, a partial or complete shortfall of maternal milk can occur for a range of reasons. In this eventuality, the currently available options for feeding infants are screened donor human milk (DHM), infant formula or unscreened shared human milk. In the UK, DHM has only been widely available in specific clinical contexts for the last 40 years, mainly to reduce the risk of necrotising enterocolitis in extremely preterm infants alongside optimal support for maternal lactation and breastfeeding. The Hearts Milk Bank (HMB) was established in 2017 as an independent, non-profit human milk bank that aimed to ensure equitable, assured access to screened DHM for neonatal units. As a result of the generosity of mothers, a surplus of DHM rapidly became available and together with lactation support, has since been provided to families with a healthcare referral. This programme has now been formalised for families facing lactational challenges, and DHM stocks are permanently maintained to meet their needs. Case series This case series describes the clinical paths of four families who accessed lactation support and DHM from the HMB, along with a description of the process for community provision. To date, the HMB has supported over 300 families. Working collaboratively with key stakeholders, the HMB team has developed a prioritisation strategy based on utilitarian ethical models, protocols that ensure safe handling and appropriateness of use, broader donor recruitment parameters that maintain safety with a pragmatic approach for full term healthy infants, and a process to ensure parents or carers have access to the knowledge needed to give informed consent and use DHM appropriately. Conclusions Stakeholders, including parents, healthcare professionals, and milk banks, will need to discuss priorities for both DHM use and research gaps that can underpin the equitable expansion of services, in partnership with National Health Service (NHS) teams and third-sector organisations that support breastfeeding and maternal mental health.
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Affiliation(s)
- Samantha Griffin
- Department of Surgery and Cancer, Imperial College London, England, W12 0HS, UK
| | - Jo Watt
- The Human Milk Foundation, Rothamsted Institute, Hertfordshire, AL5 2JQ, UK
| | - Sophie Wedekind
- Department of Surgery and Cancer, Imperial College London, England, W12 0HS, UK
| | - Solange Bramer
- Imperial College London Medical School, St Mary's Hospital, London, W2 1NY, UK
| | | | - Robert Boyle
- Department of Paediatrics, Imperial College London, St Mary's Hospital, London, W2 1NY, UK
| | - Gillian Weaver
- The Human Milk Foundation, Rothamsted Institute, Hertfordshire, AL5 2JQ, UK
| | - Natalie S Shenker
- Department of Surgery and Cancer, Imperial College London, England, W12 0HS, UK. .,The Human Milk Foundation, Rothamsted Institute, Hertfordshire, AL5 2JQ, UK.
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Abstract
Humans have always coexisted with viruses, with both positive and negative consequences. Evolutionary pressure on mammals has selected intrinsic properties of lactation and milk to support the relatively immunocompromised neonate from environmental pathogens, as well as support the normal development of diverse immune responses. Human milk supports both adaptive and innate immunity, with specific constituents that drive immune learning and maturation, and direct protection against microorganisms. Viruses constitute one of the most ancient pressures on human evolution, and yet there is a lack of awareness by both public and healthcare professionals of the complexity of human milk as an adaptive response beyond the production of maternal antibodies. This review identifies and describes the specific antiviral properties of human milk and describes how maternal support of infants through lactation is protective beyond antibodies.
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Affiliation(s)
| | - Natalie S. Shenker
- Department of Surgery and Cancer, Imperial College London, London W12 0NN, UK;
- Human Milk Foundation, Daniel Hall Building, Rothamsted Institute, Harpenden AL5 2JQ, UK
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Affiliation(s)
- Natalie S Shenker
- Department of Surgery and Cancer, Imperial College London, London W12 0HS, UK; Human Milk Foundation, Rothamsted Institute, Hertfordshire, UK.
| | - Aleksandra Wesolowska
- Human Milk Bank Foundation, Warsaw, Poland; Regional Human Milk Bank, Holy Family Hospital, Department of Medical Biology, Medical University of Warsaw, Warsaw, Poland
| | - Johannes B van Goudoever
- National Human Milk Bank, Amsterdam, Netherlands; Universitair Medische Centra, Emma Children's Hospital, University of Amsterdam, Amsterdam, Netherlands
| | - Sushma Nangia
- National Human Milk Bank, Department of Neonatology, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, New Delhi, India
| | - Daniel Klotz
- Centre for Pediatrics, Division of Neonatology and Paediatric Intensive Care Medicine, Medical Centre and Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Biggs KV, Fidler KJ, Shenker NS, Brown H. Are the doctors of the future ready to support breastfeeding? A cross-sectional study in the UK. Int Breastfeed J 2020; 15:46. [PMID: 32434558 PMCID: PMC7238622 DOI: 10.1186/s13006-020-00290-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 05/11/2020] [Indexed: 01/15/2023] Open
Abstract
Background Currently there is no published data on the inclusion of breastfeeding education within the UK medical school curriculum. This study aims to address this knowledge gap and explore students’ perceptions of their readiness to support breastfeeding. Methods An online survey was used to collect data from 32 UK undergraduate medical schools and their students. All students in their final two years of study at the 30 universities offering a 5- or 6-year medicine course, were eligible. Results Curriculum data was obtained from 26 (81%) institutions. Compulsory breastfeeding education was provided by 85% (N = 22) institutions with 81% (n = 21) providing lecture-based teaching and 19% (n = 5) offering formal clinical education. Overall, 411 students from 22 institutions participated. A moderate ability to identify the benefits of breastfeeding was observed; however, self-rated confidence in practical skills was poor. Assisting with latching was the least confident skill, with confidence in only 3% (14/411) students. Most students (93%) viewed doctors as playing an important role in breastfeeding, with those interested in either women’s health, paediatrics or general practice perceiving the role of doctors as more important. Overall, 93% (381/411) students requested further breastfeeding education. Conclusions This study suggests UK medical schools are not adequately preparing students to support breastfeeding patients. Further studies should explore the competency of doctors to meet the needs of lactating women, and design optimal training for UK medical students.
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Affiliation(s)
- Kirsty V Biggs
- Royal Stoke University Hospital, Newcastle Road, Stoke-on-Trent, ST4 6QG, UK.
| | - Katy J Fidler
- Brighton and Sussex Medical School, Falmer, BN1 9PX, UK
| | - Natalie S Shenker
- Department of Surgery and Cancer, Imperial College London, IRDB Hammersmith Hospital, London, W12 0HS, UK
| | - Heather Brown
- Brighton and Sussex Medical School, Falmer, BN1 9PX, UK
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Flower KJ, Shenker NS, El-Bahrawy M, Goldgar DE, Parsons MT, Spurdle AB, Morris JR, Brown R, Flanagan JM. DNA methylation profiling to assess pathogenicity of BRCA1 unclassified variants in breast cancer. Epigenetics 2016; 10:1121-32. [PMID: 26727311 PMCID: PMC4844213 DOI: 10.1080/15592294.2015.1111504] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 12/26/2022] Open
Abstract
Germline pathogenic mutations in BRCA1 increase risk of developing breast cancer. Screening for mutations in BRCA1 frequently identifies sequence variants of unknown pathogenicity and recent work has aimed to develop methods for determining pathogenicity. We previously observed that tumor DNA methylation can differentiate BRCA1-mutated from BRCA1-wild type tumors. We hypothesized that we could predict pathogenicity of variants based on DNA methylation profiles of tumors that had arisen in carriers of unclassified variants. We selected 150 FFPE breast tumor DNA samples [47 BRCA1 pathogenic mutation carriers, 65 BRCAx (BRCA1-wild type), 38 BRCA1 test variants] and analyzed a subset (n=54) using the Illumina 450K methylation platform, using the remaining samples for bisulphite pyrosequencing validation. Three validated markers (BACH2, C8orf31, and LOC654342) were combined with sequence bioinformatics in a model to predict pathogenicity of 27 variants (independent test set). Predictions were compared with standard multifactorial likelihood analysis. Prediction was consistent for c.5194-12G>A (IVS 19-12 G>A) (P>0.99); 13 variants were considered not pathogenic or likely not pathogenic using both approaches. We conclude that tumor DNA methylation data alone has potential to be used in prediction of BRCA1 variant pathogenicity but is not independent of estrogen receptor status and grade, which are used in current multifactorial models to predict pathogenicity.
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Affiliation(s)
- Kirsty J Flower
- a Epigenetics Unit; Department of Surgery and Cancer; Imperial College London ; UK
| | - Natalie S Shenker
- a Epigenetics Unit; Department of Surgery and Cancer; Imperial College London ; UK
| | - Mona El-Bahrawy
- b Department of Histopathology ; Hammersmith Hospital; Imperial College London ; UK
| | - David E Goldgar
- c Huntsman Cancer Institute; University of Utah ; Salt Lake City , UT , USA
| | - Michael T Parsons
- d QIMR Berghofer Medical Research Institute ; Brisbane , QLD , Australia
| | | | | | - Amanda B Spurdle
- d QIMR Berghofer Medical Research Institute ; Brisbane , QLD , Australia
| | - Joanna R Morris
- f Genome Stability Unit; School of Cancer Sciences; University of Birmingham ; UK
| | - Robert Brown
- a Epigenetics Unit; Department of Surgery and Cancer; Imperial College London ; UK.,g Section of Molecular Pathology; Institute for Cancer Research ; Sutton , UK
| | - James M Flanagan
- a Epigenetics Unit; Department of Surgery and Cancer; Imperial College London ; UK
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Shenker NS, Flower KJ, Wilhelm-Benartzi CS, Dai W, Bell E, Gore E, El Bahrawy M, Weaver G, Brown R, Flanagan JM. Transcriptional implications of intragenic DNA methylation in the oestrogen receptor alpha gene in breast cancer cells and tissues. BMC Cancer 2015; 15:337. [PMID: 25927974 PMCID: PMC4424887 DOI: 10.1186/s12885-015-1335-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [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: 01/15/2015] [Accepted: 04/22/2015] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND DNA methylation variability regions (MVRs) across the oestrogen receptor alpha (ESR1) gene have been identified in peripheral blood cells from breast cancer patients and healthy individuals. In contrast to promoter methylation, gene body methylation may be important in maintaining active transcription. This study aimed to assess MVRs in ESR1 in breast cancer cell lines, tumour biopsies and exfoliated epithelial cells from expressed breast milk (EBM), to determine their significance for ESR1 transcription. METHODS DNA methylation levels in eight MVRs across ESR1 were assessed by pyrosequencing bisulphite-converted DNA from three oestrogen receptor (ER)-positive and three ER-negative breast cancer cell lines. DNA methylation and expression were assessed following treatment with DAC (1 μM), or DMSO (controls). ESR1 methylation levels were also assayed in DNA from 155 invasive ductal carcinoma biopsies provided by the Breast Cancer Campaign Tissue Bank, and validated with DNA methylation profiles from the TCGA breast tumours (n = 356 ER-pos, n = 109 ER-neg). DNA methylation was profiled in exfoliated breast epithelial cells from EBM using the Illumina 450 K (n = 36) and pyrosequencing in a further 53 donor samples. ESR1 mRNA levels were measured by qRT-PCR. RESULTS We show that ER-positive cell lines had unmethylated ESR1 promoter regions and highly methylated intragenic regions (median, 80.45%) while ER-negative cells had methylated promoters and lower intragenic methylation levels (median, 38.62%). DAC treatment increased ESR1 expression in ER-negative cells, but significantly reduced methylation and expression of ESR1 in ER-positive cells. The ESR1 promoter was unmethylated in breast tumour biopsies with high levels of intragenic methylation, independent of ER status. However, ESR1 methylation in the strongly ER-positive EBM DNA samples were very similar to ER-positive tumour cell lines. CONCLUSION DAC treatment inhibited ESR1 transcription in cells with an unmethylated ESR1 promoter and reduced intragenic DNA methylation. Intragenic methylation levels correlated with ESR1 expression in homogenous cell populations (cell lines and exfoliated primary breast epithelial cells), but not in heterogeneous tumour biopsies, highlighting the significant differences between the in vivo tumour microenvironment and individual homogenous cell types. These findings emphasise the need for care when choosing material for epigenetic research and highlights the presence of aberrant intragenic methylation levels in tumour tissue.
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MESH Headings
- Breast Neoplasms/genetics
- Breast Neoplasms/metabolism
- Carcinoma, Ductal, Breast/genetics
- Carcinoma, Ductal, Breast/metabolism
- Cell Line, Tumor
- DNA Methylation
- Epigenesis, Genetic
- Estrogen Receptor alpha/genetics
- Estrogen Receptor alpha/metabolism
- Female
- Gene Expression Regulation, Neoplastic
- Humans
- Mammary Glands, Human/metabolism
- Milk, Human/cytology
- Promoter Regions, Genetic
- Sequence Analysis, DNA
- Transcription, Genetic
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Affiliation(s)
- Natalie S Shenker
- Department of Surgery and Cancer, Epigenetics Unit, Division of Cancer, Faculty of Medicine, Imperial College London, 4th Floor IRDB, Hammersmith Campus, Du Cane Road, London, W12 0NN, UK.
| | - Kirsty J Flower
- Department of Surgery and Cancer, Epigenetics Unit, Division of Cancer, Faculty of Medicine, Imperial College London, 4th Floor IRDB, Hammersmith Campus, Du Cane Road, London, W12 0NN, UK.
| | - Charlotte S Wilhelm-Benartzi
- Department of Surgery and Cancer, Epigenetics Unit, Division of Cancer, Faculty of Medicine, Imperial College London, 4th Floor IRDB, Hammersmith Campus, Du Cane Road, London, W12 0NN, UK.
| | - Wei Dai
- Department of Surgery and Cancer, Epigenetics Unit, Division of Cancer, Faculty of Medicine, Imperial College London, 4th Floor IRDB, Hammersmith Campus, Du Cane Road, London, W12 0NN, UK.
- Current Address: The University of Hong Kong, Pokfulam, Hong Kong, P. R. China.
| | - Emma Bell
- Department of Surgery and Cancer, Epigenetics Unit, Division of Cancer, Faculty of Medicine, Imperial College London, 4th Floor IRDB, Hammersmith Campus, Du Cane Road, London, W12 0NN, UK.
| | - Edmund Gore
- Department of Surgery and Cancer, Epigenetics Unit, Division of Cancer, Faculty of Medicine, Imperial College London, 4th Floor IRDB, Hammersmith Campus, Du Cane Road, London, W12 0NN, UK.
| | - Mona El Bahrawy
- Department of Surgery and Cancer, Epigenetics Unit, Division of Cancer, Faculty of Medicine, Imperial College London, 4th Floor IRDB, Hammersmith Campus, Du Cane Road, London, W12 0NN, UK.
| | - Gillian Weaver
- Queen Charlotte and Chelsea Hospital Milk Bank, Du Cane Road, London, UK.
| | - Robert Brown
- Department of Surgery and Cancer, Epigenetics Unit, Division of Cancer, Faculty of Medicine, Imperial College London, 4th Floor IRDB, Hammersmith Campus, Du Cane Road, London, W12 0NN, UK.
| | - James M Flanagan
- Department of Surgery and Cancer, Epigenetics Unit, Division of Cancer, Faculty of Medicine, Imperial College London, 4th Floor IRDB, Hammersmith Campus, Du Cane Road, London, W12 0NN, UK.
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Shenker NS, Polidoro S, van Veldhoven K, Sacerdote C, Ricceri F, Birrell MA, Belvisi MG, Brown R, Vineis P, Flanagan JM. Epigenome-wide association study in the European Prospective Investigation into Cancer and Nutrition (EPIC-Turin) identifies novel genetic loci associated with smoking. Hum Mol Genet 2012; 22:843-51. [PMID: 23175441 DOI: 10.1093/hmg/dds488] [Citation(s) in RCA: 334] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
A single cytosine-guanine dinucleotide (CpG) site within coagulation factor II (thrombin) receptor-like 3 (F2RL3) was recently found to be hypomethylated in peripheral blood genomic DNA from smokers compared with former and non-smokers. We performed two epigenome-wide association studies (EWAS) nested in a prospective healthy cohort using the Illumina 450K Methylation Beadchip. The two populations consisted of matched pairs of healthy individuals (n = 374), of which half went on to develop breast or colon cancer. The association was analysed between methylation and smoking status, as well as cancer risk. In addition to the same locus in F2RL3, we report several loci that are hypomethylated in smokers compared with former and non-smokers, including an intragenic region of the aryl hydrocarbon receptor repressor gene (AHRR; cg05575921, P = 2.31 × 10(-15); effect size = 14-17%), an intergenic CpG island on 2q37.1 (cg21566642, P = 3.73 × 10(-13); effect size = 12%) and a further intergenic region at 6p21.33 (cg06126421, P = 4.96 × 10(-11), effect size = 7-8%). Bisulphite pyrosequencing validated six loci in a further independent population of healthy individuals (n = 180). Methylation levels in AHRR were also significantly decreased (P < 0.001) and expression increased (P = 0.0047) in the lung tissue of current smokers compared with non-smokers. This was further validated in a mouse model of smoke exposure. We observed an association with breast cancer risk for the 2q37.1 locus (P = 0.003, adjusted for the smoking status), but not for the other loci associated with smoking. These data show that smoking has a direct effect on the epigenome in lung tissue, which is also detectable in peripheral blood DNA and may contribute to cancer risk.
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Affiliation(s)
- Natalie S Shenker
- Epigenetics Unit, Department of Surgery and Cancer, Imperial College London, London W12 0NN, UK
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Harnaen EJ, Na AF, Shenker NS, Sourial M, Farmer PJ, Southwell BR, Hutson JM. The anatomy of the cremaster muscle during inguinoscrotal testicular descent in the rat. J Pediatr Surg 2007; 42:1982-7. [PMID: 18082692 DOI: 10.1016/j.jpedsurg.2007.08.012] [Citation(s) in RCA: 12] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2007] [Accepted: 08/08/2007] [Indexed: 11/29/2022]
Abstract
BACKGROUND Extrapolation of rat testicular descent studies to humans has been criticized because of anatomical differences of the cremaster muscle. Human cremaster is described as a thin strip rather than a large, complete sac as in rats, which is proposed to be more important in propelling the testis during descent. This study investigated cremaster muscle anatomy and ontogeny in both normal and cryptorchid rat models. METHODS Gubernacula from 4 groups of neonatal rats were sectioned longitudinally and transversely: normal Sprague-Dawley, capsaicin pretreated, flutamide pretreated, and congenital cryptorchid rats. Gubernacula were stained with hematoxylin-eosin, Masson trichrome, and desmin immunohistochemistry to study muscle development. RESULTS Myoblasts are more numerous at the gubernacular tip, whereas the most differentiated muscle is proximal. Rat cremaster develops as an elongated strip rather than a complete sac derived from abdominal wall muscles. Flutamide and capsaicin pretreatment disrupts development. CONCLUSION Rat cremaster muscle develops as a strip, bearing close resemblance to human cremaster muscle, permitting extrapolation of cremaster function to human testicular descent. The cremaster muscle appears to differentiate from the gubernacular tip during elongation to the scrotum, and requires intact sensory innervation and androgen.
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Affiliation(s)
- Efrant J Harnaen
- F. Douglas Stephens Surgical Research Laboratory, Murdoch Childrens Research Institute, Melbourne, Australia
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Abstract
Recent studies of testicular descent suggest not only that the gubernaculum does not initially attach to the scrotum, but also that it must migrate from the groin. Two findings suggest that the gubernaculum may behave like an embryonic limb bud during this phase. First, the active growth centre is at the distal tip of the gubernaculum. Secondly, the gubernaculum is loose in the subcutaneous tissues beneath Scarpa's fascia. The free protrusion of the gubernaculum from the abdominal wall was so reminiscent of a developing embryonic limb bud, we thought that the biological controls of both processus may be similar. This review examines what is known about vertebrate limb bud development, and compares the mechanisms to what has recently been discovered in the gubernaculum. The hypothesis that both processes may be similar is initially consistent with the current facts, encouraging us to investigate this further experimentally.
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Affiliation(s)
- Jenny Huynh
- F Douglas Stephens Surgical Research Laboratory, Murdoch Children's Research Institute, Melbourne, VIC, Australia
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Shenker NS, Huynh J, Farmer PJ, Hutson JM. A new role for androgen in testicular descent: permitting gubernacular cell proliferation in response to the neuropeptide, calcitonin gene-related peptide. J Pediatr Surg 2006; 41:407-12. [PMID: 16481260 DOI: 10.1016/j.jpedsurg.2005.11.019] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND/PURPOSE Cell proliferation at the gubernacular tip increases in response to exogenous calcitonin gene-related peptide (CGRP) during migration into the scrotum. Calcitonin gene-related peptide is contained in the masculinized sensory branches of the genitofemoral nerve. We tested the independent effects of chemical sensory nerve disruption and prenatal androgen blockade on the in vitro gubernacular proliferative response to CGRP. METHODS Neonatal Sprague-Dawley rats were injected with capsaicin, a sensory nerve toxin, and gubernacula dissected 2 days later (D2). Sprague-Dawley dams were injected with flutamide, an androgen receptor antagonist, between days 15 and 19 of gestation. Flutamide pretreated males, and normal neonatal rats, were dissected at D0 and D2. Gubernacula were cultured for 24 hours +/- CGRP, pulse-labelled for the last 4 hours of culture with bromodeoxyuridine, a thymidine analogue marker for DNA replication, sectioned, and stained using immunohistochemistry. The percentage of positively staining cells in the gubernacular tip was calculated from three separate counts by a blinded observer and compared using analysis of variance. RESULTS Normal D0 gubernacular tips showed a significant response of cell proliferation to exogenous CGRP (34% vs 9% in controls, P < .001), which resolved by day 2 (16% vs 12%, P > .05). Calcitonin gene-related peptide markedly increased cell proliferation in D2 capsaicin pretreated gubernacula compared with controls (25% vs 14%, P < .01) and normal D2 gubernacula cultured with CGRP (P < .01). D0 flutamide pretreated cultured with CGRP showed no increase in cell proliferation compared with controls (16% vs 11%), but a small response was seen by D2 (19% vs 9%, P < .05). There was no significant difference between proliferation rates in the control groups. CONCLUSIONS Sensory innervation interruption sensitises the gubernaculum to exogenous CGRP, suggesting upregulation of CGRP receptors. In contrast, androgen blockade abolishes the increased rate of cell proliferation within the gubernacular tip. We conclude that androgens are necessary to "preprogramme" the proliferative response of the gubernaculum to CGRP.
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Affiliation(s)
- Natalie S Shenker
- Department of General Surgery, Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria 3052, Australia
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Shenker NS, Haldar NA, Reilly JJ, Bunce M, Welsh KI, Marshall SE. The impact of endothelial nitric oxide synthase polymorphisms on long-term renal allograft outcome. Transpl Int 2003. [DOI: 10.1111/j.1432-2277.2003.tb00319.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Shenker NS, Haldar NA, Reilly JJ, Bunce M, Welsh KI, Marshall SE. The impact of endothelial nitric oxide synthase polymorphisms on long-term renal allograft outcome. Transpl Int 2003; 16:391-5. [PMID: 12819869 DOI: 10.1007/s00147-003-0557-7] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2001] [Revised: 01/03/2003] [Accepted: 01/08/2003] [Indexed: 11/25/2022]
Abstract
A major manifestation of chronic allograft failure (CAF) is the accelerated onset of atherosclerotic lesions within the graft. Polymorphisms in the endothelial nitric oxide synthase (eNOS) gene have been implicated in the pathogenesis of native atherosclerosis. This study tested the hypothesis that polymorphisms in eNOS are associated with susceptibility to CAF after cadaveric renal transplantation. The patient cohort comprised 140 renal transplant recipients who had received their transplants between 1985 and 1997 at the Oxford Transplant Centre and included 61 patients with biopsy-proven CAF and 79 with stable graft function for at least 10 years (long-term survivors, LTS). Genotyping for one polymorphism in the promoter region and two polymorphisms in the coding regions of the eNOS gene was performed by polymerase chain reaction with sequence-specific primers (PCR-SSP). No association was found between any genetic variant and the development of CAF, even after stratification for other known risk factors. Statistical analysis revealed that all three polymorphisms were closely linked. We conclude that recipient eNOS gene polymorphisms do not alter the risk of CAF after renal transplantation.
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Affiliation(s)
- Natalie S Shenker
- Somerville College, Woodstock Road, Oxford, Oxfordshire OX2 6HD, UK.
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