Vitamin D Genes & Exposure in Relation to Kidney Cancer by Sara
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Vitamin D Genes & Exposure in Relation to Kidney Cancer by Sara Karami B.S., Biology, James Madison University, 2002 M.P.H, Epidemiology, The George Washington University, 2004 A Dissertation submitted to The Faculty of The Columbian College of Arts and Science of The George Washington University in partial fulfillment of the requirements for the degree of Doctor of Philosophy August 31, 2009 Dissertation directed by Katherine L. Hunting Professor of Environmental and Occupational Health and of Epidemiology and Biostatistics and Lee E. Moore Epidemiological Investigator, NIH, NCI The Columbian College of Arts and Science of The George Washington University certifies that Sara Karami has passed the Final Examination for the degree of Doctor of Philosophy as of August 12, 2009. This is the final and approved form of the dissertation. Vitamin D Genes & Exposure in Relation to Kidney Cancer Sara Karami Dissertation Research Committee: Katherine L. Hunting, Professor of Environmental and Occupational Health and of Epidemiology and Biostatistics, Dissertation Director Lee E. Moore, Epidemiological Investigator, NIH, NCI, Co-Director Paul H. Levine, Professor of Epidemiology and Biostatistics, Committee Member Yinglei Lai, Assistant Professor of Statistics, Committee Member ii © Copyright 2009 by Sara Karami All rights reserved iii Dedication The author wishes to thank everyone involved in the dissertation process for their guidance and support. Special thanks to Dr. Lee Moore, Dr. Katherine Hunting, Dr. Paul Levine, Dr. Yinglei Lai, Dr. Sean Cleary, and Dr. Donte Verme. iv Acknowledgement The author wishes to acknowledge the National Cancer Institute, the International Agency for Research on Cancer, and the School of Public Health and Health Services of The George Washington University for their assistance. v Abstract of Dissertation Vitamin D Genes & Exposure in Relation to Kidney Cancer Introduction : Vitamin D may have anti-carcinogenic properties that include inhibition of clonal tumor cell proliferation, induction of immune cell differentiation, and decreased angiogenesis. Within the kidney, vitamin D is metabolized to its active form. Since the incidence of renal cell carcinoma (RCC) and prevalence of vitamin D deficiency have increased over the past few decades, this study hypothesized that increased vitamin D exposure (via occupational ultraviolet exposure or dietary intake) was associated with decreased RCC risk and that genetic variations within the vitamin D pathway modified risk. Methods : Cases (N=1,097) and controls (N=1,476) in a hospital-based case-control study in Central Europe were interviewed to collect data on demographics and lifetime occupational histories. Genomic DNA was also collected from a subset of participants. Results : Significant reduction in RCC risk was observed with occupational ultraviolet exposure among male participants. No association between ultraviolet exposure and RCC risk was observed among females. Analyses stratified by latitude showed a stronger reduction in risk among males at the highest latitude study site, Russia. Analyses of eight vitamin D pathway genes revealed significant associations between RCC risk and the vitamin D receptor ( VDR ) and retinoid-X-receptor-alpha (RXRA ) genes. Across VDR , three haplotypes within two regions were associated with increased risk. Across RXRA , RCC risk was higher among participants with one particular haplotype located downstream of the coding region. Dietary analyses showed increased RCC risk with increasing intake frequency of yogurt for foods rich in calcium, while decreased risk was vi observed with eggs for foods rich in vitamin D. Additional evaluation of RXRA and VDR , revealed RXRA variants, 3 ′ of the coding sequence, modified associations between RCC risk and intake frequency of vitamin D rich foods, specifically eggs. Conversely, RXRA variants in introns 1 and 4 modified associations between calcium rich foods. Furthermore, increased RCC risk was observed with increasing occupational ultraviolet exposure among males with one specific VDR haplotype, centered on intron two. Conclusion : Results suggest that vitamin D is associated with RCC risk. Genetic variants across VDR and RXRA genes may be associated with RCC risk and may modify associations between RCC risk and vitamin D. vii Table of Contents Dedication iv Acknowledgments v Abstract of Dissertation vi Table of Contents viii List of Figures ix List of Tables x List of Symbols / Nomenclature xii Chapter 1: Cancer & Vitamin D 1 Chapter 2: Study Hypothesis, Specific Aims and the Central & Eastern 33 European Renal Cell Carcinoma (CEERCC) Study Chapter 3: Occupational Sunlight Exposure and Risk of Renal Cell Carcinoma 55 Chapter 4: Analysis of SNPs and Haplotypes in VDR Pathway Genes and Renal 81 Cancer Risk Chapter 5: Effect of VDR pathway genes on vitamin D intake and exposure 129 and Renal Cancer Risk Chapter 6: Past, Present and Future of Vitamin D and Cancer Risk Studies 157 References 186 Appendices 238 viii List of Figures Figure 1: Worldwide kidney cancer incidence rates from 1998 to 2000 2 Figure 2: U.S. incidence and mortality rates for kidney cancer from 1975 4 to 2001 Figure 3: Synthesis of vitamin D in the body from diet & sunlight exposure 9 Figure 4: Genes involved in the vitamin D pathway 29 Figure 5: Power calculations to detect an OR of 1.3-1.5 fold increase in RCC 52 risk with 900 cases and 900 controls Figure 6: Power calculations to detect an OR of 1.3-1.5 fold increase in RCC 53 risk with 1,100 cases and 1,100 controls Figure 7: HaploWalk and Haploview analysis for the group specific 250 component ( GC ) vitamin D binding protein gene Figure 8: HaploWalk and Haploview analysis for the signal transducer and 252 activator of transcription ( STAT1 ) gene ix List of Tables Table 1: Epidemiological studies of dietary exposures and RCC risk 5 Table 2: Dietary Intake for Vitamin D Recommended by the National 18 Academy of Science Table 3: Common VDR variants and risk of prostate cancer 24 Table 4: Common VDR variants and risk of breast cancer 27 Table 5: General characteristics of participants in the CEERCC study 41 Table 6: Power to detect a two-fold interaction with 900 cases and 900 controls 54 Table 7: Tissue that express VDR 169 Table 8: SEER Skin Cancer (excluding Basal and Squamous) Rates from 184 2001-2005 Table 9: Risk of renal cell carcinoma and exposure to occupational sunlight 239 by body mass index Table 10: Risk of renal cell carcinoma and exposure to occupational sunlight 240 by body mass index among male participants Table 11: Risk of renal cell carcinoma and exposure to occupational sunlight 241 by body mass index among female participants Table 12: Risk of renal cell carcinoma and exposure to occupational sunlight 243 by hypertensive status Table 13: Risk of renal cell carcinoma and exposure to occupational sunlight 244 by hypertensive status among male participants Table 14: Risk of renal cell carcinoma and exposure to occupational sunlight 245 by hypertensive status among female participants x Table 15: Risk of renal cell carcinoma and exposure to occupational sunlight 247 by dietary intake of calcium rich foods among female participants Table 16: Haplotype associations with genes in the vitamin D pathway 251 Table 17: Gene-gene analyses for vitamin D pathway genes and RCC risk 254 Table 18: Joint effect of vitamin D pathway genes and dietary intake 256 frequency of total vitamin D on renal cancer risk Table 19: Joint effect of vitamin D pathway genes and dietary intake 258 frequency of total calcium on renal cancer risk Table 20: Joint effect of vitamin D pathway genes and cumulative 260 occupational UV exposure on renal cancer risk Table 21: Population attributable risk among participants occupationally 263 exposed to sunlight Table 22: Population attributable risk for dietary intake frequency of total 264 vitamin D Table23: Population attributable risk among VDR genotyped participants 265 xi List of Symbols / Nomenclature 1. 1,25(OH) 2D: 1,25 dihydroxycholecalciferol or calcitriol 2. 1,25(OH) 2: 1,25-dihydroxy 3. 19-nor-1,25-dihydroxyvitamin D 2: paricacitol 4. 25(OH): 25-hydroxy 5. 7DHC: 7-dehydrocholesterol 6. 95% CI: 95% confidence interval 7. AIPC: androgen-independent prostate cancer 8. BMI: body mass index 9. CEERCC: Central & Eastern European Renal Cell Carcinoma 10. CGF: Core Genotyping Facility 11. CYP24A1 : cytochrome P450, family 24, subfamily A, polypeptide 1 or 24- dehydroxylase 12. DNA: deoxyribonucleic acid 13. DRIP : vitamin D receptor interacting protein 14. FDR: false discovery rate 15. GC : group specific component 16. HCC: hepatocellular carcinoma 17. IARC: International Agency for Research on Cancer 18. ICD-O: International Classification of Diseases for Oncology 19. ISCO: International Standard Classification of Occupation 20. IU: International Units 21. JEM: job exposure matrix xii 22. LD: linkage disequilibrium 23. MAF: minor allele frequency 24. Min-P: minimum-p-value permutation 25. mRNA: messenger ribonucleic acid 26. NACE: Statistical Classification of Economic Activities of the European Community 27. NCI: National Cancer Institute 28. NHANES: National Health and Nutrition Examination Survey 29. NHL: non-Hodgkin lymphoma 30. OPA: Oligo Pool All 31. OR: odds ratio 32. PAR: Population Attributable Risk 33. PCR: polymerase chain reaction 34. PSA: prostate specific antigen 35. PTH: parathyroid hormone 36. RCC: renal cell carcinoma 37. RFLP: restriction-fragment length polymorphism 38. RR: relative risk 39. RXR :