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1.  Effects of Ginger Supplementation on Cell Cycle Biomarkers in the Normal-Appearing Colonic Mucosa of Patients at Increased Risk for Colorectal Cancer: Results from a Pilot, Randomized, Controlled Trial 
To estimate the effects of ginger on apoptosis, proliferation, and differentiation in the normal-appearing colonic mucosa, we randomized 20 people at increased risk for colorectal cancer to 2.0 g of ginger or placebo daily for 28 days in a pilot trial. Overall expression and distributions of Bax, Bcl-2, p21, hTERT and MIB-1 (Ki-67) in colorectal crypts in rectal mucosa biopsies were measured using automated immunohistochemistry and quantitative image analysis. Relative to placebo, Bax expression in the ginger group decreased 15.6% (p = 0.78) in the whole crypts, 6.6% (p = 0.95) in the upper 40% (differentiation zone) of crypts, and 21.7% (p = 0.67) in the lower 60% (proliferative zone) of crypts; however, there was a 19% increase (p = 0.14) in Bax expression in the upper 40% relative to the whole crypt. While p21 and Bcl-2 expression remained relatively unchanged, hTERT expression in the whole crypts decreased by 41.2% (p = 0.05); the estimated treatment effect on hTERT expression was larger in the upper 40% of crypts (−47.9%; p = 0.04). In the ginger group, MIB-1 expression decreased in the whole crypts, upper 40% of crypts, and lower 60% of crypts by 16.9% (p = 0.39), 46.8% (p = 0.39), and 15.3% (p = 0.41), respectively. These pilot study results suggest that ginger may reduce proliferation in the normal-appearing colorectal epithelium and increase apoptosis and differentiation relative to proliferation—especially in the differentiation zone of the crypts, and support a larger study to further investigate these results.
doi:10.1158/1940-6207.CAPR-12-0327
PMCID: PMC3618532  PMID: 23303903
Differentiation (p21waf1/cip1); Apoptosis (Bax and Bcl-2); Proliferation (MIB-1/Ki-67 and hTERT); Colorectal Cancer; Ginger
2.  Flaxseed-Derived Enterolactone Is Inversely Associated with Tumor Cell Proliferation in Men with Localized Prostate Cancer 
Journal of Medicinal Food  2013;16(4):357-360.
Abstract
Enterolactone and enterodiol, mammalian lignans derived from dietary sources such as flaxseed, sesame seeds, kale, broccoli, and apricots, may impede tumor proliferation by inhibiting activation of nuclear factor kappa B (NFκB) and vascular endothelial growth factor (VEGF). We examined the associations between urinary enterolactone and enterodiol with prostatic tumor expression of NFκB, VEGF, and Ki67 among 147 patients with prostate cancer who participated in a presurgical trial of flaxseed supplementation (30 g/day) for ∼30 days. Urinary enterolignans and tissue biomarkers were determined by high-performance liquid chromatography and immunohistochemistry, respectively. After supplementation, we observed significant correlations between intakes of plant lignan and urinary concentrations of total enterolignans (ρ=0.677, P<.0001), enterolactone (ρ=0.676, P<.0001), and enterodiol (ρ=0.628, P<.0001). Importantly, we observed that total urinary enterolignans and enterolactone were significantly and inversely correlated with Ki67 in the tumor tissue (ρ=−0.217, P=.011, and ρ=−0.230, P=.007, respectively), and a near-significant inverse association was observed for enterodiol (ρ=−0.159, P=.064). An inverse association was observed between enterolactone and VEGF (ρ=−0.143, P=.141), although this did not reach statistical significance. We did not observe an association between enterolignans and NFκB. In conclusion, flaxseed-derived enterolignans may hinder cancer cell proliferation via VEGF-associated pathways.
doi:10.1089/jmf.2012.0159
PMCID: PMC3624628  PMID: 23566060
diet; flaxseed; lignans; phytoestrogens; prostatic neoplasia
3.  A Mediterranean Dietary Intervention in Persons at High Risk of Colon Cancer: Recruitment and Retention to an Intensive Study Requiring Biopsies 
Contemporary clinical trials  2012;33(5):881-888.
This study recruited persons at increased risk of colon cancer to an intensive dietary intervention study that required biopsies of the colon by flexible sigmoidoscopy at baseline and after six months of intervention. A total of 1314 individuals contacted the study, and only 16 individuals indicated that the sigmoidoscopy procedure was an obstacle to study participation. A total of 270 individuals completed a screening visit and signed a screening consent form. Inquiries about the study tended to be fewer in the winter and late summer. Failure to return food records was the most common reason for exclusion. Dietary recall at enrollment indicated that subjects were consuming significantly more vegetables, lower sodium and a lower glycemic load on the day before starting the study versus during the eligibility phase which might have an impact on biomarker measures. This makes it important to capture dietary changes in the period between determination of eligibility and enrollment. Subjects (n=120) were randomized to follow a Healthy Eating or a Mediterranean Diet, each of which required substantial dietary record-keeping. The study completion rate was 78%, and subjects reported high satisfaction with study participation. Of the 93 individuals who completed the study, only one refused the flexible sigmoidoscopy at the final visit. These findings suggest that flexible sigmoidoscopy does not appear to be a barrier for recruitment of high-risk individuals to an intensive dietary intervention trial, but that completing food records can be.
doi:10.1016/j.cct.2012.05.006
PMCID: PMC3408796  PMID: 22640923
colon biopsy; recruitment; dietary intervention; cancer prevention
4.  EFFECT OF CYLOOXYGENASE GENOTYPE AND DIETARY FISH OIL ON COLONIC EICOSANOIDS IN MICE 
Dietary ω3 fatty acids can modulate substrate availability for cyclooxygenases and lipoxygenases, thus modulating downstream eicosanoid formation. This could be an alternative approach to using NSAIDs and other COX inhibitors for limiting PGE2 synthesis in colon cancer prevention. The aims of this study were to evaluate to what extent cyclooxygenase- and lipoxygenase-derived products could be modulated by dietary fish oil in normal colonic mucosa, and to evaluate the role of COX-1 and COX-2 in formation of these products. Mice (wild-type, COX-1 null, or COX-2 null) were fed a diet supplying a broad mixture of fatty acids present in European/American diets, supplemented with either olive oil (oleate control diet) or menhaden (fish) oil ad libitum for 9–11 wk. Colonic eicosanoid levels were measured by LC-MS/MS, and proliferation was assessed by Ki67 immunohistochemistry. Dietary alteration of colonic arachidonic acid: eicosapentaenoic ratios resulted in large shifts in formation of cyclooxygenase and lipoxygenase metabolites. COX-1 knockout virtually abolished PGE2 formation but interestingly 12-HETE and 15-HETE formation was increased. The large changes in eicosanoid profiles were accompanied by relatively small changes in colonic crypt proliferation, but such changes in eicosanoid formation might have greater biological impact upon carcinogen challenge. These results indicate that in normal colon, inhibition of COX-2 would have little effect on reducing PGE2 levels.
doi:10.1016/j.jnutbio.2011.05.003
PMCID: PMC3246564  PMID: 21937210
colon cancer; fish oil; cyclooxygenase; prostaglandin E2; hydroxyeicosatetraenoic acids; EPA
5.  Characterization of vitamin D receptor (VDR) in lung adenocarcinoma 
Purpose
The anti-proliferative effects of 1α,25-dihydroxyvitamin D3 (1,25-D3, calcitriol, the active form of vitamin D) are mediated by the nuclear vitamin D receptor (VDR). In the present study, we characterized VDR expression in lung adenocarcinoma (AC).
Experimental Design
We examined VDR mRNA expression using a quantitative real-time PCR (qRT-PCR) in 100 patients who underwent surgery for lung AC. In a subset of these patients (n = 89), we examined VDR protein expression using immunohistochemistry. We also examined the association of VDR protein expression with circulating serum levels of 25-hydroxyvitamin D3 (25-D3) and 1,25-D3. The antiproliferative effects and cell cycle arrest of 1,25-D3 were examined using lung cancer cell lines with high (SKLU-1) as well as low (A549) expression of VDR mRNA.
Results
Higher VDR expression correlates with longer survival after adjusting for age, sex, disease stage and tumor grade (HR 0.73, 95% CI 0.58–0.91). In addition, there was a positive correlation (r = 0.38) between serum 1,25-D3 and tumor VDR protein expression. A greater anti-proliferative effect of 1,25-D3 was observed in high compared to low VDR-expressing cell lines; these effects corresponded to G1 cell cycle arrest; this was associated with a decline in cyclin D1, S-phase kinase protein 2 (Skp2), retinoblastoma (Rb) and minichromosome maintenance 2 (MCM2) proteins involved in S-phase entry.
Conclusions
Increased VDR expression in lung AC is associated with improved survival. This may relate to a lower proliferative status and G1 arrest in high VDR-expressing tumors.
doi:10.1016/j.lungcan.2012.04.010
PMCID: PMC3396768  PMID: 22564539
VDR; Vitamin D; 1,25-D3; Lung Adenocarcinoma; Survival
6.  Increased plasma levels of the APC-interacting protein MAPRE1, LRG1 and IGFBP2 preceding a diagnosis of colorectal cancer in women 
Longitudinal blood collections from cohort studies provide the means to search for proteins associated with disease prior to clinical diagnosis. We investigated plasma samples from the Women’s Health Initiative (WHI) cohort to determine quantitative differences in plasma proteins between subjects subsequently diagnosed with colorectal cancer (CRC) and matched controls that remained cancer free during the period of follow-up. Proteomic analysis of WHI samples collected prior to diagnosis of CRC resulted in the identification of six proteins with significantly (p <0.05) elevated concentrations in cases compared to controls. Proteomic analysis of two colorectal cancer cell lines showed 5 of the 6 proteins were produced by cancer cells. MAPRE1, IGFBP2, LRG1 and CEA were individually assayed by enzyme linked immunosorbent assay (ELISA) in 58 pairs of newly diagnosed CRC samples and controls and yielded significant elevations (p <0.05) among cases relative to controls. A combination of these four markers resulted in an ROC with an AUC=0.841 and 57% sensitivity at 95% specificity. This combination rule was tested in an independent set of WHI samples collected within 7 months prior to diagnosis from cases and matched controls resulting in 41% sensitivity at 95% specificity. A panel consisting of CEA, MAPRE1, IGFBP2 and LRG1 has predictive value in pre-diagnostic colorectal cancer plasmas.
doi:10.1158/1940-6207.CAPR-11-0412
PMCID: PMC3419141  PMID: 22277732
colorectal cancer; risk markers; Pre-Diagnostic samples
7.  Microsatellite Instability and DNA Mismatch Repair Protein Deficiency in Lynch Syndrome Colorectal Polyps 
Colorectal cancers associated with Lynch syndrome (LS) are characterized by deficient DNA mismatch repair (MMR) function. Our aim was to evaluate the prevalence of microsatellite instability (MSI) and loss of MMR protein expression in LS-associated polyps. Sixty two colorectal polyps – 37 adenomas (APs), 23 hyperplastic polyps (HPs), and 2 sessile serrated polyps (SSPs) – from 34 subjects with germline MMR gene mutations were tested for MSI using a single pentaplex PCR for five mononucleotide repeat microsatellite markers, and also for expression of MLH1, MSH2, MSH6, and PMS2 proteins by immunohistochemistry (IHC). High-level MSI (MSI-H) was seen in 15/37 (41%) APs, 1/23 (4%) HPs, and 1/2 (50%) SSPs. Loss of MMR protein expression was seen in 18/36 (50%) APs, 0/21 HPs, and 0/2 SSPs. APs ≥8 mm were significantly more likely to demonstrate MSI-H (OR = 9.98, 95% CI: 1.52-65.65, p = 0.02) and deficient MMR protein expression (OR = 3.17, 95% CI: 1.20-8.37, p = 0.02) compared with those <8 mm. All (6/6) APs ≥10 mm demonstrated both MSI-H and loss of MMR protein expression by IHC. Our finding that the prevalence of MMR deficiency increases with the size of APs suggests that loss of MMR function is a late event in LS-associated colorectal neoplasia. Although testing large APs may be of value in the diagnostic evaluation of patients with suspected LS, the absence of an MMR deficient phenotype in an adenoma cannot be considered strong evidence against LS, as it is with colorectal carcinomas.
doi:10.1158/1940-6207.CAPR-11-0519
PMCID: PMC3461594  PMID: 22262812
Lynch Syndrome; adenomas; microsatellite instability
8.  Phase II study of the Effects of Ginger Root Extract on Eicosanoids in Colon Mucosa in People at Normal Risk for Colorectal Cancer 
Inhibitors of cyclooxygenase (COX) indicate that up-regulation of inflammatory eicosanoids produced by COX, and in particular prostaglandin E2 (PGE2), are early events in the development of colorectal cancer (CRC). Ginger has demonstrated down regulation of COX in vitro and decreased incidence/ multiplicity of adenomas in rats. This study was conducted to determine if 2.0 g/day of ginger could decrease the levels of PGE2, 13-hydroxy-octadecadienoic acids (13-HODE), and 5-, 12-, & 15-hydroxyeicosatetraenoic acid (5-, 12-, & 15-HETE), in the colon mucosa of healthy volunteers. To investigate this aim we randomized 30 subjects to 2.0 g/day ginger or placebo for 28 days. Flexible sigmoidoscopy at baseline and day 28 was used to obtain colon biopsies. A liquid chromatography mass spectrometry method was used to determine eicosanoid levels in the biopsies, and levels were expressed per protein or per free arachidonic acid. There were no significant differences in mean percent change between baseline and day 28 for any of the eicosanoids, when normalized to protein. There was a significant decrease in mean percent change in PGE2 (p=0.05) and 5-HETE (p=0.04), and a trend toward significant decreases in 12-HETE (p=0.09) and 15-HETE (p=0.06) normalized to free arachidonic acid. There was no difference between the groups in terms of total adverse events (AE) (p=0.55). Based on these results, it appears that Ginger has the potential to decrease eicosanoid levels, perhaps by inhibiting their synthesis from arachidonic acid. Ginger also appeared to be tolerable and safe. Further investigation in people at high risk for CRC seems warranted.
doi:10.1158/1940-6207.CAPR-11-0224
PMCID: PMC3208778  PMID: 21990307
Cancer Risk Reductive; Eicosanoids; Colorectal Cancer; Inflammation; and Ginger
9.  EFFECT OF FISH OIL ON LEVELS OF R- AND S-ENANTIOMERS OF 5-, 12- AND 15-HYDROXYEICOSATETRAENOIC ACIDS IN MOUSE COLONIC MUCOSA 
Nutrition and cancer  2011;64(1):163-172.
The balance of putative pro- and anti-inflammatory lipoxygenase (LOX)-derived S-hydroxyeicosatetraenoic acids (S-HETEs) in colon mucosa is a potential target for modulating colon cancer risk and progression. The biological effects of S-HETEs and R-HETEs (produced by distinct pathways) may differ, but levels of these compounds in colon are unknown. The objective of this study was to develop chiral methods to characterize HETE enantiomers in colonic mucosa and evaluate the effects of fish oil on HETE formation. C57BL/6 mice (COX-1 null, COX-2 null, wild-type) were fed a diet supplemented with either olive oil or menhaden oil for 11 weeks, and R/S-HETEs in colonic mucosa were quantified by chiral LC-MS/MS. The R-enantiomer comprised 60-72% of 5-HETE, 18-58% of 15-HETE and 1-16% of 12-HETE in colonic mucosa, suggesting that non-LOX sources contribute to HETE profiles. Fish oil reduced levels of both R- and S-HETEs, and increased the preponderance of the R-enantiomers (particularly 12- and 15-HETEs). There was apparent shunting of arachidonic acid to12/15-LOX in the COX-1 null animals. This is the first report of the enantiomeric composition of HETEs in the colon in vivo.
doi:10.1080/01635581.2012.630168
PMCID: PMC3410550  PMID: 22149144
experimental; lipoxygenase; hydroxyeicosatetraenoic acid; enantiomer; colon
11.  Regulatory Approval of Cancer Risk-reducing (Chemopreventive) Drugs: Moving What We Have Learned into the Clinic 
This paper endeavors to clarify the current requirements and status of regulatory approval for chemoprevention (risk reduction) drugs and discusses possible improvements to the regulatory pathway for chemoprevention. Covering a wide range of topics in as much depth as space allows, this report is written in a style to facilitate the understanding of non-scientists and to serve as a framework for informing the directions of experts engaged more deeply with this issue. Key topics we cover here are as follows: a history of definitive cancer chemoprevention trials and their influence on the evolution of regulatory assessments; a brief review of the long-standing success of pharmacologic risk reduction of cardiovascular diseases and its relevance to approval for cancer risk reduction drugs; the use and limitations of biomarkers for developing and the approval of cancer risk reduction drugs; the identification of individuals at a high(er) risk for cancer and who are appropriate candidates for risk reduction drugs; business models that should incentivize pharmaceutical-industry investment in cancer risk reduction; a summary of scientific and institutional barriers to development of cancer risk reduction drugs; and a summary of major recommendations that should help facilitate the pathway to regulatory approval for pharmacologic cancer risk reduction drugs.
doi:10.1158/1940-6207.CAPR-09-0014
PMCID: PMC3059243  PMID: 21372031
12.  CYP24A1 Is an Independent Prognostic Marker of Survival in Patients with Lung Adenocarcinoma 
Purpose
The active form of vitamin D, 1α,25-dihydroxyvitamin D3 (1,25-D3) exerts antiproliferative effects in cancers, including lung adenocarcinoma (AC). CYP24A1 is overexpressed in many cancers and catabolizes 1,25-D3. The purpose of our study was to assess CYP24A1 as a prognostic marker and to study its relevance to antiproliferative activity of 1,25-D3 in lung AC cells.
Experimental Design
Tumors and corresponding normal specimens from 86 patients with lung AC (stages I–III) were available. AffymetrixR array data and subsequent confirmation by quantitative real time-PCR were used to determine CYP24A1 mRNA expression. A subsequent validation set of 101 lung AC was used to confirm CYP24A1 mRNA expression and its associations with clinical variables. The antiproliferative effects of 1,25-D3 were examined using lung cancer cell lines with high as well as low expression of CYP24A1 mRNA.
Results
CYP24A1 mRNA was elevated 8–50 fold in lung AC (compared to normal nonneoplastic lung) and significantly higher in poorly-differentiated cancers. At 5 years of follow-up, the probability of survival was 42% (high CYP24A1, n = 29) versus 81% (low CYP24A1, n = 57) (P = 0.007). The validation set of 101 tumors showed that CYP24A1 was independently prognostic of survival (multivariate Cox model adjusted for age, gender and stage, P = 0.001). A549 cells (high CYP24A1) were more resistant to antiproliferative effects of 1,25-D3 compared with SKLU-1 cells (low CYP24A1).
Conclusions
CYP24A1 overexpression is associated with poorer survival in lung AC. This may relate to abrogation of antiproliferative effects of 1,25-D3 in high CYP24A1 expressing lung AC.
doi:10.1158/1078-0432.CCR-10-1789
PMCID: PMC3058389  PMID: 21169243
13.  Targeting Breast Stem Cells with the Cancer Preventive Compounds Curcumin and Piperine 
Background
The cancer stem cell hypothesis asserts that malignancies arise in tissue stem and/or progenitor cells through the dysregulation or acquisition of self-renewal. In order to determine whether the dietary polyphenols, curcumin and piperine, are able to modulate the self-renewal of normal and malignant breast stem cells, we examined the effects of these compounds on mammosphere formation, on expression of the breast stem cell marker aldehyde dehydrogenase (ALDH), and on Wnt signaling.
Design
Mammosphere formation assays were performed after curcumin, piperine and control treatment in unsorted normal breast epithelial cells and normal stem and early progenitor cells, selected by ALDH positivity. Wnt signaling was examined using a Topflash assay.
Results
Both curcumin and piperine inhibited mammosphere formation, serial passaging and percent of ALDH+ cells, by 50% at 5 μM and completely at 10 μM concentration in normal and malignant breast cells. There was no effect on cellular differentiation. Wnt signaling was inhibited by both curcumin and piperine by 50% at 5 μM and completely at 10μM.
Conclusion
Curcumin and piperine separately, and in combination, inhibit breast stem cell self renewal but do not cause toxicity to differentiated cells. These compounds could be potential cancer preventive agents. Mammosphere formation assays may be a quantifiable biomarker to assess cancer preventive agent efficacy and Wnt signaling assessment a mechanistic biomarker for use in human clinical trials.
doi:10.1007/s10549-009-0612-x
PMCID: PMC3039120  PMID: 19898931
14.  Repeat Dose Study of the Cancer Chemopreventive Agent Resveratrol in Healthy Volunteers: Safety, Pharmacokinetics and Effect on the Insulin-like Growth Factor Axis 
Cancer research  2010;70(22):9003-9011.
Resveratrol, a naturally occurring polyphenol, has cancer chemopreventive properties in preclinical models. It has been shown to downregulate levels of insulin-like growth factor-1 (IGF-1) in rodents. The purpose of the study was to assess its safety, pharmacokinetics and effects on circulating levels of IGF-1 and insulin-like growth factor binding protein-3 (IGFBP-3) after repeated dosing. Forty healthy volunteers ingested resveratrol at 0.5, 1.0, 2.5 or 5.0g daily for 29 days. Levels of resveratrol and its metabolites were measured by HPLC-UV in plasma obtained before and up to 24h after a dose between days 21 and 28. IGF-1 and IGFBP-3 were measured by enzyme-linked immunosorbent assay in plasma taken pre-dosing and on day 29. Resveratrol was safe, but the 2.5 and 5g doses caused mild to moderate gastrointestinal symptoms. Resveratrol-3-O-sulfate, resveratrol-4′-O-glucuronide and resveratrol-3-O-glucuronide were major plasma metabolites. Maximal plasma levels and areas under the concentration versus time curve (AUC) for the metabolites dramatically exceeded those for resveratrol, in the case of the AUC by up to 20.3-fold. Ingestion of resveratrol caused a decrease in circulating IGF-1 and IGFBP-3 (P<0.04 for both), respectively, compared to pre-dosing values, in all volunteers. At the 2.5g dose level the decrease was most marked. The results suggest that repeated administration of high doses of resveratrol generates micromolar concentrations of parent and much higher levels of glucuronide and sulfate conjugates in the plasma. The observed decrease in circulating IGF-1 and IGFBP-3 may contribute to cancer chemopreventive activity.
doi:10.1158/0008-5472.CAN-10-2364
PMCID: PMC2982884  PMID: 20935227
Resveratrol; chemoprevention; pharmacokinetics; pharmacodynamics
15.  Repeat Dose Study of the Cancer Chemopreventive Agent Resveratrol in Healthy Volunteers: Safety, Pharmacokinetics and Effect on the Insulin-like Growth Factor Axis 
Cancer research  2010;70(22):9003-9011.
Resveratrol, a naturally occurring polyphenol, has cancer chemopreventive properties in preclinical models. It has been shown to downregulate levels of insulin-like growth factor-1 (IGF-1) in rodents. The purpose of the study was to assess its safety, pharmacokinetics and effects on circulating levels of IGF-1 and insulin-like growth factor binding protein-3 (IGFBP-3) after repeated dosing. Forty healthy volunteers ingested resveratrol at 0.5, 1.0, 2.5 or 5.0g daily for 29 days. Levels of resveratrol and its metabolites were measured by HPLC-UV in plasma obtained before and up to 24h after a dose between days 21 and 28. IGF-1 and IGFBP-3 were measured by enzyme-linked immunosorbent assay in plasma taken pre-dosing and on day 29. Resveratrol was safe, but the 2.5 and 5g doses caused mild to moderate gastrointestinal symptoms. Resveratrol-3-O-sulfate, resveratrol-4′-O-glucuronide and resveratrol-3-O-glucuronide were major plasma metabolites. Maximal plasma levels and areas under the concentration versus time curve (AUC) for the metabolites dramatically exceeded those for resveratrol, in the case of the AUC by up to 20.3-fold. Ingestion of resveratrol caused a decrease in circulating IGF-1 and IGFBP-3 (P<0.04 for both), respectively, compared to pre-dosing values, in all volunteers. At the 2.5g dose level the decrease was most marked. The results suggest that repeated administration of high doses of resveratrol generates micromolar concentrations of parent and much higher levels of glucuronide and sulfate conjugates in the plasma. The observed decrease in circulating IGF-1 and IGFBP-3 may contribute to cancer chemopreventive activity.
doi:10.1158/0008-5472.CAN-10-2364
PMCID: PMC2982884  PMID: 20935227
Resveratrol; chemoprevention; pharmacokinetics; pharmacodynamics
16.  Clinical Pharmacology of Resveratrol and its Metabolites in Colorectal Cancer Patients 
Cancer research  2010;70(19):7392-7399.
Resveratrol is a phytochemical with chemopreventive activity in preclinical rodent models of colorectal carcinogenesis. Antiproliferation is one of many chemopreventive modes of action it has been shown to engage. Concentrations of resveratrol which can be achieved in human tissues after oral administration have not yet been defined. The purpose of this study was to measure concentrations of resveratrol and its metabolites in colorectal tissue of humans who ingested resveratrol. Twenty patients with histologically confirmed colorectal cancer consumed 8 daily doses of resveratrol at 0.5 or 1.0g prior to surgical resection. Resveratrol was found to be well tolerated. Normal and malignant biopsy tissue samples were obtained before dosing. Parent compound plus its metabolites resveratrol-3-O-glucuronide, resveratrol-4′-O-glucuronide, resveratrol-3-O-sulfate, resveratrol-4′-O-sulfate, resveratrol sulfate glucuronide and resveratrol disulfate were identified by high pressure liquid chromatography (HPLC) with UV or mass spectrometric detection in colorectal resection tissue. Quantitation was achieved by HPLC/UV. Cell proliferation, as reflected by Ki-67 staining, was compared in pre- and post-intervention tissue samples. Resveratrol and resveratrol-3-O-glucuronide were recovered from tissues at maximal mean concentrations of 674 and 86.0nmol/g, respectively. Levels of resveratrol and its metabolites were consistently higher in tissues originating in the right side of the colon compared to the left. Consumption of resveratrol reduced tumor cell proliferation by 5% (P=0.05). The results suggest that daily oral doses of resveratrol at 0.5 or 1.0g produce levels in the human gastrointestinal tract of an order of magnitude sufficient to elicit anti-carcinogenic effects. Resveratrol merits further clinical evaluation as a potential colorectal cancer chemopreventive agent.
doi:10.1158/0008-5472.CAN-10-2027
PMCID: PMC2948608  PMID: 20841478
Resveratrol; tissue levels; metabolism
17.  Quantitation of 6-, 8- and 10-Gingerols and 6-Shogaol in Human Plasma by High-Performance Liquid Chromatography with Electrochemical Detection 
Zingiber officinale is one of the most commonly used spices. We developed a method to determine the main pungent ginger constituents, 6-, 8- and 10-gingerols and 6-shogaol in human plasma. Quantitation was achieved using a reversed-phase C18 column using high-performance liquid chromatography with electrochemical detection. The assay was linear from 0.1 to 5.0 μg/mL. The within-day coefficients of variation for the assay at 5.0 μg/mL were ≤ 5% for all analytes. The recovery of all four analytes was ≥99% for at 5.0 μg/mL. The lower limit of quantitation was 0.1 μg/mL except for 10-gingerol which was 0.25 μg/mL. Currently, there is no analytical method for detecting pungent ginger constituents in human plasma. This HPLC method allows for the detection of all four of ginger’s pungent constituents simultaneously in a relatively short run time of 25 minutes. This method should be useful for determining plasma levels of 6-, 8-, 10-gingerol and 6-shogaol in phase I clinical trials.
PMCID: PMC2975369  PMID: 21072137
ginger; gingerols; shogaols; analytical methods; high performance liquid chromatography
18.  Quantitation of 6-, 8- and 10-Gingerols and 6-Shogaol in Human Plasma by High-Performance Liquid Chromatography with Electrochemical Detection 
Zingiber officinale is one of the most commonly used spices. We developed a method to determine the main pungent ginger constituents, 6-, 8- and 10-gingerols and 6-shogaol in human plasma. Quantitation was achieved using a reversed-phase C18 column using high-performance liquid chromatography with electrochemical detection. The assay was linear from 0.1 to 5.0 μg/mL. The within-day coefficients of variation for the assay at 5.0 μg/mL were ≤5% for all analytes. The recovery of all four analytes was ≥99% for at 5.0 μg/mL. The lower limit of quantitation was 0.1 μg/mL except for 10-gingerol which was 0.25 μg/mL. Currently, there is no analytical method for detecting pungent ginger constituents in human plasma. This HPLC method allows for the detection of all four of ginger’s pungent constituents simultaneously in a relatively short run time of 25 minutes. This method should be useful for determining plasma levels of 6-, 8-, 10-gingerol and 6-shogaol in phase I clinical trials.
PMCID: PMC2975369  PMID: 21072137
ginger; gingerols; shogaols; analytical methods; high performance liquid chromatography
19.  Breast cancer histology and receptor status characterization in Asian Indian and Pakistani women in the U.S. - a SEER analysis 
BMC Cancer  2010;10:191.
Background
Recent reports suggest increase in estrogen receptor (ER), progesterone receptor (PR) negative breast cancer yet little is known about histology or receptor status of breast cancer in Indian/Pakistani women.in the U.S.
Methods
We examined the United States National Cancer Institute's Surveillance Epidemiology and End Results (SEER) Cancer program to assess: a) frequency of breast cancer by age, b) histologic subtypes, c) receptor status of breast cancer and, d) survival in Indians/Pakistanis compared to Caucasians. There were 360,933 breast cancer cases diagnosed 1988-2006. Chi-Square analyses and Cox proportional hazards models, to estimate relative risks for breast cancer mortality after adjusting for confounders, were performed using Statistical Analysis Software 9.2.
Results
Among Asian Indian/Pakistani breast cancer patients, 16.2% were < 40 yrs. old compared to 6.23% in Caucasians (p < 0.0001). Asian Indian women had more invasive ductal carcinoma (69.1 vs. 65.7%, p < 0.0001), inflammatory cancer (1.4% vs. 0.8, p < 0.0001) and less invasive lobular carcinoma (4.2% vs. 8.1%, p < 0.0001) than Caucasians. Asian Indian/Pakistani women had more ER/PR negative breast cancer (30.6% vs. 21.8%, p = 0.0095) than Caucasians. Adjusting for stage at diagnosis, age, tumor grade, nodal status, and histology, Asian Indian/Pakistani women's survival was similar to Caucasians, while African Americans' was worse.
Conclusions
Asian Indian/Pakistani women have higher frequency of breast cancer (particularly in age < 40), ER/PR negative invasive ductal and inflammatory cancer than Caucasians.
doi:10.1186/1471-2407-10-191
PMCID: PMC2873947  PMID: 20459777
20.  Pancreatic Cancer Serum Detection Using A Lectin/Glyco-Antibody Array Method 
Journal of proteome research  2009;8(2):483-492.
Pancreatic cancer is a formidable disease and early detection biomarkers are needed to make inroads into improving the outcomes in these patients. In this work lectin antibody microarrays were utilized to detect unique glycosylation patterns of proteins from serum. Antibodies to four potential glycoprotein markers that were found in previous studies were printed on nitrocellulose coated glass slides and these microarrays were hybridized against patient serum to extract the target glycoproteins. Lectins were then used to detect different glycan structural units on the captured glycoproteins in a sandwich assay format. The biotinylated lectins used to assess differential glycosylation patterns were Aleuria aurentia lectin (AAL), Sambucus nigra bark lectin (SNA), Maackia amurensis lectin II (MAL), Lens culinaris agglutinin (LCA), and Concanavalin A (ConA). Captured glycoproteins were evaluated on the microarray in situ by on-plate digestion and direct analysis using MALDI QIT-TOF mass spectroscopy. Analysis was performed using serum from 89 normal controls, 35 chronic pancreatitis samples, 37 diabetic samples and 22 pancreatic cancer samples. We found that this method had excellent reproducibility as measured by the signal deviation of control blocks as on-slide standard and 41 pairs of pure technical replicates. It was possible to discriminate cancer from the other disease groups and normal samples with high sensitivity and specificity where the response of Alpha-1-β glycoprotein to lectin SNA increased by 69% in the cancer sample compared to the other non-cancer groups (95% confidence interval 53% to 86%). These data suggest that differential glycosylation patterns detected on high throughput lectin microarrays are a promising biomarker approach for the early detection of pancreatic cancer.
doi:10.1021/pr8007013
PMCID: PMC2637303  PMID: 19072160
Glycoproteins; Pancreatic cancer; Lectins; Antibody Array; Cancer Markers
21.  Standard Operating Procedures for Serum and Plasma Collection: Early Detection Research Network Consensus Statement Standard Operating Procedure Integration Working Group 
Journal of proteome research  2009;8(1):113-117.
Specimen collection is an integral component of clinical research. Specimens from subjects with various stages of cancers or other conditions, as well as those without disease, are critical tools in the hunt for biomarkers, predictors, or tests that will detect serious diseases earlier or more readily than currently possible. Analytic methodologies evolve quickly. Access to high-quality specimens, collected and handled in standardized ways that minimize potential bias or confounding factors, is key to the “bench to bedside” aim of translational research. It is essential that standard operating procedures, “the how” of creating the repositories, be defined prospectively when designing clinical trials. Small differences in the processing or handling of a specimen can have dramatic effects in analytical reliability and reproducibility, especially when multiplex methods are used. A representative working group, Standard Operating Procedures Internal Working Group (SOPIWG), comprised of members from across Early Detection Research Network (EDRN) was formed to develop standard operating procedures (SOPs) for various types of specimens collected and managed for our biomarker discovery and validation work. This report presents our consensus on SOPs for the collection, processing, handling, and storage of serum and plasma for biomarker discovery and validation.
doi:10.1021/pr800545q
PMCID: PMC2655764  PMID: 19072545
Consensus; Serum collection; Plasma collection; Standard Operating Procedures; Biomarkers; Sample handling
22.  Chromoendoscopy Detects More Adenomas than Colonoscopy using Intensive Inspection Without Dye Spraying 
Background & Aims
Conventional colonoscopy misses some neoplastic lesions. We compared the sensitivity of chromoendoscopy and colonoscopy with intensive inspection for detecting adenomatous polyps missed by conventional colonoscopy.
Methods
Fifty subjects with a history of colorectal cancer or adenomas underwent tandem colonoscopies at one of 5 centers of the Great-Lakes New England Clinical Epidemiology and Validation Center of the Early Detection Research Network. The first exam was a conventional colonoscopy with removal of all visualized polyps. The second exam was randomly assigned as either pan-colonic indigocarmine chromoendoscopy or standard colonoscopy with intensive inspection lasting ≥20 minutes. Size, histology, and numbers of polyps detected on each exam were recorded.
Results
Twenty-seven subjects were randomized to a second exam with chromoendoscopy and 23 underwent intensive inspection. Forty adenomas were identified on the first standard colonoscopies. The second colonoscopies detected 24 additional adenomas; 19 were found using chromoendoscopy and 5 using intensive inspection. Chromoendoscopy found additional adenomas in more subjects than intensive inspection (44% vs. 17%) and identified significantly more missed adenomas per subject (0.7 vs 0.2, p<0.01). Adenomas detected with chromoendoscopy were significantly smaller (mean size 2.66±0.97mm) and were more often right-sided. Chromoendoscopy was associated with more normal tissue biopsies and longer procedure times than intensive inspection. After controlling for procedure time, chromoendoscopy detected more adenomas and hyperplastic polyps compared with colonoscopy using intensive inspection alone.
Conclusions
Chromoendoscopy detected more polyps missed by standard colonoscopy than did intensive inspection. The clinical significance of these small missed lesions warrants further study.
doi:10.1158/1940-6207.CAPR-08-0096
PMCID: PMC2701380  PMID: 19139000
23.  Occurrence of Autoantibodies to Annexin I, 14-3-3 Theta and LAMR1 in Prediagnostic Lung Cancer Sera 
Journal of Clinical Oncology  2008;26(31):5060-5066.
Purpose
We have implemented a high throughput platform for quantitative analysis of serum autoantibodies, which we have applied to lung cancer for discovery of novel antigens and for validation in prediagnostic sera of autoantibodies to antigens previously defined based on analysis of sera collected at the time of diagnosis.
Materials and Methods
Proteins from human lung adenocarcinoma cell line A549 lysates were subjected to extensive fractionation. The resulting 1,824 fractions were spotted in duplicate on nitrocellulose-coated slides. The microarrays produced were used in a blinded validation study to determine whether annexin I, PGP9.5, and 14-3-3 theta antigens previously found to be targets of autoantibodies in newly diagnosed patients with lung cancer are associated with autoantibodies in sera collected at the presymptomatic stage and to determine whether additional antigens may be identified in prediagnostic sera. Individual sera collected from 85 patients within 1 year before a diagnosis of lung cancer and 85 matched controls from the Carotene and Retinol Efficacy Trial (CARET) cohort were hybridized to individual microarrays.
Results
We present evidence for the occurrence in lung cancer sera of autoantibodies to annexin I, 14-3-3 theta, and a novel lung cancer antigen, LAMR1, which precede onset of symptoms and diagnosis.
Conclusion
Our findings suggest potential utility of an approach to diagnosis of lung cancer before onset of symptoms that includes screening for autoantibodies to defined antigens.
doi:10.1200/JCO.2008.16.2388
PMCID: PMC2652098  PMID: 18794547
24.  Missed Adenomas During Colonoscopic Surveillance in Individuals with Lynch Syndrome (HNPCC) 
Background & Aims
Lynch syndrome (also known as hereditary nonpolyposis colon cancer, HNPCC) is associated with an increased risk for colorectal cancer, which can arise despite frequent colonoscopic exams. We evaluated the adenoma miss rate of conventional colonoscopy in patients with Lynch syndrome, and compared the sensitivity of chromoendoscopy versus intensive inspection for detecting polyps missed by conventional colonoscopy.
Methods
Fifty four subjects with Lynch Syndrome underwent tandem colonoscopies at four centers of the Great-Lakes New England Clinical Epidemiology and Validation Center (GLNE) of the Early Detection Research Network (EDRN). All participants first had a conventional colonoscopy with removal of all visualized polyps. The second endoscopy was randomly assigned as either pan-colonic indigocarmine chromoendoscopy or standard colonoscopy with intensive inspection lasting ≥20 minutes. Size, histology, and numbers of polyps detected on each exam were recorded.
Results
After undergoing standard colonoscopy, twenty-eight individuals were randomized to a second exam with chromoendoscopy and 26 underwent intensive inspection. The mean interval since last colonoscopy was 17.5 months. Seventeen polyps (10 adenomas and 7 hyperplastic polyps) were identified on the first standard colonoscopies. Twenty-three additional polyps (12 adenomas and 11 hyperplastic polyps) were found on the second exams, yielding an adenoma miss rate of 55%. Fifteen polyps (5 adenomas and 10 hyperplastic polyps) were found in subjects who had chromoendoscopy and 8 polyps (7 adenomas and 1 hyperplastic polyp) in those who had intensive inspection. Chromoendoscopy was associated with more normal tissue biopsies (11 vs. 5) and longer procedure times compared with intensive inspection (29.8 ±9.5 mins vs. 25.3±5.8 mins; p=0.04). Controlling for age, number of previous colonoscopies, procedure time, and prior colonic resection, chromoendoscopy detected more polyps (p=0.04), but adenoma detection was not significantly different compared with intensive inspection (p=0.27).
Conclusions
Small adenomas are frequently missed in Lynch Syndrome patients. Although chromoendoscopy did not detect more missed adenomas than intensive inspection in this pilot study, larger trials are needed to determine optimal surveillance techniques in this high risk population.
doi:10.1158/1940-6207.CAPR-08-0098
PMCID: PMC2671076  PMID: 19138994
25.  Plasma Glycoprotein Profiling for Colorectal Cancer Biomarker Identification by Lectin Glycoarray and Lectin Blot 
Journal of proteome research  2008;7(4):1693-1703.
Colorectal cancer (CRC) remains a major worldwide cause of cancer-related morbidity and mortality largely due to the insidious onset of the disease. The current clinical procedures utilized for disease diagnosis are invasive, unpleasant, and inconvenient; hence, the need for simple blood tests that could be used for the early detection of CRC. In this work, we have developed methods for glycoproteomics analysis to identify plasma markers with utility to assist in the detection of colorectal cancer (CRC). Following immunodepletion of the most abundant plasma proteins, the plasma N-linked glycoproteins were enriched using lectin affinity chromatography and subsequently further separated by nonporous silica reverse-phase (NPS-RP)-HPLC. Individual RP-HPLC fractions were printed on nitrocellulose coated slides which were then probed with lectins to determine glycan patterns in plasma samples from 9 normal, 5 adenoma, and 6 colorectal cancer patients. Statistical tools, including principal components analysis, hierarchical clustering, and Z-statistic analysis, were employed to identify distinctive glycosylation patterns. Patients diagnosed with colorectal cancer or adenomas were shown to have dramatically higher levels of sialylation and fucosylation as compared to normal controls. Plasma glycoproteins with aberrant glycosylation were identified by nano-LC–MS/MS, while a lectin blotting methodology was used to validate proteins with significantly altered glycosylation as a function of cancer progression. The potential markers identified in this study for diagnosis to distinguish colorectal cancer from adenoma and normal include elevated sialylation and fucosylation in complement C3, histidine-rich glycoprotein, and kininogen-1. These potential markers of colorectal cancer were subsequently validated by lectin blotting in an independent set of plasma samples obtained from 10 CRC patients, 10 patients with adenomas, and 10 normal subjects. These results demonstrate the utility of this strategy for the identification of N-linked glycan patterns as potential markers of CRC in human plasma, and may have the utility to distinguish different disease states.
doi:10.1021/pr700706s
PMCID: PMC2751808  PMID: 18311904
Plasma glycoproteomics; lectin affinity enrichment; lectin glycoarrays; lectin blot; nano-LC–MS/MS

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