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Celecoxib Treatment Alters the Gene Expression Profile of Normal Colonic Mucosa

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Celecoxib Treatment Alters the Gene Expression Profile of Normal Colonic Mucosa 1382 Celecoxib Treatment Alters the Gene Expression Profile of Normal Colonic Mucosa Oleg K. Glebov,1 Luz M. Rodriguez,1 Patrick Lynch,4 Sherri Patterson,4 Henry Lynch,5 Kenneth Nakahara,1 Jean Jenkins,1 Janet Cliatt,1 Casey-Jo Humbyrd,1 John DeNobile,3 Peter Soballe,3 Steven Gallinger,6 Aby Buchbinder,7 Gary Gordon,8 Ernest Hawk,2 and Ilan R. Kirsch1 1Genetics Branch, Center for Cancer Research; 2Division of Cancer Prevention, National Cancer Institute; 3Surgery Department, National Naval Medical Center, Bethesda, Maryland; 4University of Texas M.D. Anderson Cancer Center, Houston, Texas; 5Creighton University, Omaha, Nebraska; 6University of Toronto, Toronto, Ontario, Canada; 7Pharmacia, Peapack, New Jersey; and 8Ovation Pharma, Lincolnshire, Illinois Abstract A clinical trial was recently conducted to evaluate the safety Twenty-three of 25 pairs of colon biopsies taken before and efficacy of a selective inhibitor of cyclooxygenase-2 and after celecoxib treatment can be classified correctly (celecoxib) in hereditary nonpolyposis colon cancer by the pattern of gene expression in a leave-one-out patients. In a randomized, placebo-controlled phase I/II cross-validation. Immune response, particularly T- and B- multicenter trial, hereditary nonpolyposis colon cancer lymphocyte activation and early steps of inflammatory patients and gene carriers received either celecoxib at one reaction, cell signaling and cell adhesion, response to stress, of two doses or placebo. The goal was to evaluate the effects transforming growth factor-B signaling, and regulation of of these treatment arms on a number of endoscopic and apoptosis, are the main biological processes targeted by tissue-based biomarker end points after 12 months of celecoxib as shown by overrepresentation analysis of the treatment. As part of this trial, we analyzed gene expression distribution of celecoxib-affected genes across Gene Ontol- by cDNA array technology in normal descending (rectal) ogy categories. Analysis of possible cumulative effects of colonic mucosa of patients before and after treatment with celecoxib-induced changes in gene expression indicates that celecoxib or placebo. We found that treatment of patients in healthy colon, celecoxib may suppress the immune with celecoxib at recommended clinical doses (200 and 400 response and early steps of inflammation, inhibit formation mg p.o. bid), in contrast to treatment with placebo, leads to of focal contacts, and stimulate transforming growth factor- changes in expression of >1,400 genes in the healthy colon, B signaling. (Cancer Epidemiol Biomarkers Prev 2006; although in general, the magnitude of changes is <2-fold. 15(7):1382–91) Introduction Nonsteroidal anti-inflammatory drugs (NSAID) inhibit colo- maintenance of mucosal integrity in the healthy stomach as rectal carcinogenesis and decrease the risk of death from well (review ref. 7). colorectal cancer as shown in several epidemiologic studies Several lines of evidence suggest that COX-2 plays an (reviewed in refs. 1-4). Many of the NSAIDs inhibit the activity important role in carcinogenesis. It has been shown that the of cyclooxygenases (COX), which are involved in the synthesis concentration of prostaglandin E2, a major product of the of prostaglandins fromarachidonic acid (5). Two major prostaglandin synthesis pathway controlled by COX-1 and isoforms of COX have been identified: COX-1 is constitutively COX-2, is higher in various human and animal tumors expressed in most tissues and considered to be responsible for compared with adjacent normal tissue (8-11), and that some synthesis of prostaglandins that mediate normal physiologic prostaglandins (including prostaglandin E2) stimulate growth functions, including maintenance of colonic mucosal integrity. of colon tumor cells (12, 13). Importantly, prostaglandin levels COX-2 is usually not detectable under normal conditions in in tumor tissues correlate with increased expression of COX-2 most tissues but can be induced by a wide variety of growth but not COX-1 (10, 14, 15). In addition to stimulation of cell stimulatory and proinflammatory factors. COX-2 is thought to proliferation, prostaglandin E2 enhances cell motility and be mainly involved in inflammation, regulation of cell growth, angiogenesis and inhibits apoptosis and immune surveillance, apoptosis, and angiogenesis. However, it has also been shown phenomena that can be important for carcinogenesis (2, 16, 17). that COX-2 is expressed constitutively in several tissues, Prostaglandins act through prostanoid receptors, and homo- including healthy gastric mucosa (6). It is implicated in the zygous deletion of prostaglandin E2 receptor EP4 reduces formation of aberrant crypt foci (ACF), preneoplastic colon lesions, in azoxymethane-treated mice (18), whereas knockout of the genes encoding prostaglandin E2 receptors EP1 and EP2 decreases the number and size of intestinal polyps in mice Received 11/29/04; revised 9/2/05; accepted 1/20/06. Grant support: Intramural Research Program of the NIH, National Cancer Institute, Center for (19, 20) and inhibits polyp-related angiogenesis (21). Expres- Cancer Research. sion of COX-2 is increased in 40% of colon adenomas and The costs of publication of this article were defrayed in part by the payment of page charges. in about 90% of adenocarcinomas (11, 14). This article must therefore be hereby marked advertisement in accordance with 18 U.S.C. Section 1734 solely to indicate this fact. Several observational, case-control and, recently, double- Note: Supplementary data for this article are available at Cancer Epidemiology Biomarkers blinded placebo-controlled studies have shown a protective and Prevention Online (http://cebp.aacrjournals.org/). effect of NSAIDs on sporadic colorectal cancer occurrence and Requests for reprints: Ilan R. Kirsch, Oncology Research, Amgen, 1201 Amgen Court West, mortality; compelling evidence was obtained in clinical trials AW1-J4144, Seattle, WA 98119-3105. Phone: 206-265-7316; Fax: 206-216-5930. E-mail: [email protected] for patients with familial adenomatous polyposis (FAP) Copyright D 2006 American Association for Cancer Research. syndrome (reviewed in refs. 2, 22-26). It was shown in several doi:10.1158/1055-9965.EPI-04-0866 clinical trials that nonspecific NSAIDs aspirin and sulindac Cancer Epidemiol Biomarkers Prev 2006;15(7). July 2006 Downloaded from cebp.aacrjournals.org on September 26, 2021. © 2006 American Association for Cancer Research. Cancer Epidemiology, Biomarkers & Prevention 1383 and the COX-2-specific inhibitor celecoxib reduce the number of normal colonic mucosa were taken during colonoscopy at and size of colonic polyps in FAP patients (24, 27, 28). the beginning of the study (baseline or pretreatment samples) Particularly, it was found in a large, double blinded, placebo- and 12 months after celecoxib or placebo treatment (posttreat- controlled study that treatment of FAP patients for 6 months ment samples), flash frozen in liquid nitrogen, and stored at with 400 mg of celecoxib (twice daily) reduced the mean À80jC. More than 80% of the cells in standard colon pinch number of colorectal polyps by 28%, with no sign of adverse biopsies were colonic crypt cells as determined by H&E side effects (29). staining. Although we have studied almost all available The pathway of colorectal carcinogenesis in FAP patients is pretreatment biopsies from descending (rectum) and ascend- initiated by the loss of the wild-type allele of the APC gene and ing colon (from50 patients; ref. 40), we decided to analyze leads to abnormal activation of the Wingless/Wnt signaling posttreatment biopsies only from descending (rectum) colon pathway and to chromosomal instability (30-32). This pathway of randomly selected patients, and it seemed, after code is considered to account also for f85% of sporadic colorectal disclosure, that we have data for both pretreatment and cancer. Another major pathway of colorectal carcinogenesis is posttreatment biopsies of 39 patients. All but one patient have recognized by microsatellite instability and mostly pseudodi- germline mutationsin hMLH1, hMSH2, or PMS1; 14 patients ploid karyotypes of colorectal cancer and is thought to be were treated with placebo and 25 with celecoxib. responsible for the remaining 15% of sporadic colorectal cancer RNA Extraction and Amplification. Total RNA was (33, 34) and for most of the colorectal cancer in patients with isolated fromflash-frozen specimens(two standard pinch hereditary nonpolyposis colorectal cancer (HNPCC) or Lynch biopsies per one RNA sample), homogenized with a Dispos- syndrome (35-37). HNPCC is an autosomal dominant syn- able Generator and Micro-H Omni Homogenizer in lysis buffer drome characterized by a relatively small number of adeno- RLT (Qiagen, Chatsworth, CA), and purified using Qiagen’s mas, development of colorectal cancer at a relatively young RNeasy Mini kit columns (Qiagen) according to the manu- age, frequent occurrence of extracolonic tumors, and predom- facturer’s instructions. mRNA was amplified according to a inance of proximal colorectal cancer relative to distal colorectal modified Eberwine’s protocol (41). SuperScript II reverse cancer (38). Patients with HNPCC carry a germline mutation transcriptase (Life Technologies, Gaithersburg, MD) was used in one allele of any several DNA mismatch repair genes (most for first-strand cDNA synthesis, starting with 5 Ag of total frequently in hMSH2 or hMLH1, but in rare cases, in hPMS1, RNA. First-strand cDNA synthesis was done with an hPMS2,
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