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Institute of Clinical Pharmacology [I. C., J. B., J. G., C. M., I. R.], Department of Oto-Rhino-Laryngology [S. H.], and Department of Surgery [J. M. M.], University Medical Center Charité, Humboldt University of Berlin, 10098 Berlin, Germany, and Department of Pneumology, Lungenklinik Heckeshorn, 14109 Berlin, Germany [R. L.]
| ABSTRACT |
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| INTRODUCTION |
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The MPO gene is known to be polymorphic. Amino acid exchanges R569W (9) , Y173C (2) , and M251T (10) were discovered in cases with almost complete MPO deficiency. A -463G/A polymorphism was detected by Austin et al. (11) in the promoter region among leukemia patients. Findings of another study have suggested that this -463G/A transition strongly reduces mRNA expression: this was concluded because the polymorphic site was found to be located in an Alu hormone-responsive element, which results in the loss of a SP1 transcription factor binding site (12) . On the basis of this observation and the implication of MPO in the metabolic activation of aromatic organic compounds, polymorphic MPO may also act as a susceptibility factor for those malignant diseases that are etiologically associated with exposure to precarcinogens. The genetically lower MPO activity in carriers of the A allele may represent a protecting host factor. This hypothesis was supported by a recent study by London et al. (13) among lung-cancer patients, in which homozygous mutant A/A carriers were shown to be significantly less frequent than in controls. The objective of our study was to investigate the prevalence of the -463G/A mutation in three large samples of patients suffering from cancer of the aerodigestive tract, namely cancers of the lung, larynx, and pharynx.
| MATERIALS AND METHODS |
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Total cigarette consumption is expressed in pack-years (1 pack-year = consumption of one pack of 20 cigarettes per day for 1 year). Alcohol consumption was recorded as low (no to occasional) or high (daily, extensive) consumption. Occupational exposure followed the consensus of risk occupations in head and neck cancer (14) . An additional reference group of 270 healthy volunteers (263 males and 7 females; median age, 28 years; age range, 1849 years) was selected for evaluation of any bias in the control groups. Patients and healthy volunteers were selected during the time period from 19941998; they gave their informed consent, and the study was approved by the Ethics Committee of the Charité University Medical Center. To avoid confounding by ethnicity, only subjects of German extraction were included, as defined by their names and place of birth.
Genotyping Procedure.
DNA was isolated from leukocytes by standard phenol/chloroform
extraction. MPO-mutations were characterized by RFLP after PCR
according to the method of London et al. (13)
.
For determination of the G-463A exchange, a 350-bp DNA fragment was
amplified using 1 unit of Taq polymerase (Perkin-Elmer, Weiterstadt,
Germany), 10 µmol/liter of primers MPOF (5'-CGGTATAGGCACACAATGGTGAG)
and MPOR (5'-GCAATGGTTCAAGCGATTCTTC; TIB Molbiol, Berlin,
Germany), 0.2 mmol/liter deoxynucleotide triphosphate (Boehringer
Mannheim, Mannheim, Germany), and 1.5 mmol/liter
MgCl2 in a total volume of 25 µl. PCR
conditions were 32 cycles of 30 s at 94°C, 30 s at 56°C,
and 30 s at 72°C. Fifteen µl of the PCR product were digested
with 5 units of AciI (New England Biolabs, Schwalbach,
Germany), which produced three fragments (168, 121, and 61 bp) for
cases of the homozygous wild-type -463G/G, and two fragments (289 and
61 bp) for cases of -463A/A. Fragments were separated on a 2.5%
agarose gel stained by ethidium bromide (Fig. 1)
.
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Statistics.
The study was of a case-control design, with cases matched to controls
by age and gender. Expected genotype frequencies were calculated by the
Hardy-Weinberg equation from the allele frequencies. Odds ratios
appeared with 95% CIs and two-sided P, calculated by the
2 test. Crude odds ratios were calculated from
the ratio of mutant versus wild-type MPO genotypes in cases
compared to the ratio in controls, or other strata, respectively.
Relative risks were computed by logistic regression analysis, with
consideration of age, gender, MPO genotype, and smoking as confounding
factors. All tests were analyzed using the SPSS 7.5 program.
| RESULTS |
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In four of the samples investigated, electrophoresis revealed a RFLP
pattern, which could not be attributed to the -463G/A exchange (Fig. 1)
. Sequencing unveiled two sites of heterozygous G/A mutations within
the constitutive AciI (GCGG) recognition site:
(a) one site 297 bp (GCAG) upstream of exon 1;
and (b) another site 296 bp (GCGA) upstream of
exon 1 (Fig. 2)
. These samples displayed an additional 229-bp fragment due to the loss
of the AciI site. The PCR/RFLP results for the -463G/A
exchange could always be confirmed in these cases by DNA sequencing.
All cases were carriers of wild-type -463G/G.
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Stratification revealed no significant differences in the odds ratio of
males, females, and individuals younger or older than the median age of
63 years (Fig. 3)
. The extent of lifelong cigarette consumption failed to modulate
cancer risk as a factor of G-463A.
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Laryngeal Cancer.
The frequency of mutant MPO genotypes was significantly lower for
laryngeal cancer than controls (Table 1)
. The crude odds ratio was 0.63 (95% CI, 0.430.92;
P = 0.02). Relative risk, adjusted for age,
gender, and extent of smoking and calculated by logistic regression
analysis, was 0.66 (95% CI, 0.441.01; P = 0.054). Due to the small number of females, -463A genotypes were
significantly underrepresented only among males (Fig. 4)
. Considering age, significant differences were observed in patients,
older than the median age. Moreover, -463A genotype frequency tended
to decrease in cases with increasing extent of smoking (Fig. 4)
. Due to
the relatively small sample size, no subgroup reached a level of
statistical significance.
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Pharyngeal Cancer.
Among pharyngeal cancer cases, mutated genotypes were not statistically
different from controls. The crude odds ratio was 0.78 (95% CI,
0.541.13; P = 0.19; Table 1
). Adjusted
relative risk, as calculated by logistic regression analysis, was 0.75
(95% CI, 0.511.12; P = 0.16).
Stratification of cases and controls according to gender, age, or
smoking disclosed no differences (Fig. 5)
.
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| DISCUSSION |
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In contrast, the present study succeeded in demonstrating that in Caucasians, the G allele is indeed the wild-type genotype with a frequency of 78.5% in 270 healthy volunteers; however, this frequency was found to be increased in lung and laryngeal cancer patients. This finding is in the range of 76.6% reported in American Caucasians (13) . Among African Americans, G allele frequency is reportedly 70.1% (13) . The -463 G/A exchange is located 645 bp upstream of the translation start. The Alu region of the MPO gene is known to be highly relevant for promoter activity (18) because it comprises a hormone-responsive element, especially the binding site of transcription factor SP1 (12) . It was therefore assumed that the reportedly 25-fold activation of transcription activity of the G variant (leading to enhanced generation of toxic intermediates) would be one cause in the etiology of acute myelogenous leukemia. In comparison, the -463A variant demonstrated much lower activity.
Novel MPO Mutations.
The two novel G/A mutations at -297 and -296 nt in the 5' region of
the MPO gene were discovered by coincidence because they led to a loss
of the constitutive AciI (GCGG) recognition site. These
samples displayed an additional 229-bp fragment together with the
wild-type 121-bp fragment, which was able to be well distinguished from
the typical wild-type RFLP pattern (Fig. 2)
. The novel mutations did
not appear together with the -463G/A mutation. This theoretical
linkage would resolve in an uncut 350-bp fragment; however, this
phenomenon was not observed. The functional significance of these
mutations, located in an Alu sequence, is unclear.
Xenobiotics Metabolizing Enzymes.
In comparison to the intriguing results from this study, polymorphisms
of other arylamine-metabolizing enzymes showed partly weak associations
to malignancies. Mutant genotypes of arylamine
N-acetyltransferase (NAT2) are associated with
increased susceptibility only among smokers or with a history of risk
occupation (19)
. For lung and laryngeal cancer,
NAT2 has been found to be a susceptibility factor as a
homozygous rapid variant (20
, 21)
; the slow variant,
however, seems be overrepresented among older lung cancer patients
(22)
.
As catalyzed by MPO, benzo(a)pyrene can be transformed to highly reactive intermediates by cytochrome P4501A1 (CYP1A1). A variant of CYP1A1 has been shown to be associated with lung cancer in a Japanese sample (23) ; among Caucasians, results have diverged (24, 25, 26, 27, 28) . On the other hand, a lack of detoxification enzymes such as GSTM1, especially in combination with polymorphisms of CYP1A1, was also shown to be associated with an inclination to cancer (19 , 29, 30, 31) . It has been possible to demonstrate this especially for benzo(a)pyrene DNA adduct formation in accordance with GSTM1 and CYP1A1 genotypes (32) .
Lowered activation of aromatic compounds may therefore indeed reduce the risk of cancer with an etiology of gene-environmental interaction. London et al. (13) initially reported the association of the MPO polymorphism with cancer risk in Caucasians. Homozygous A carriers were significantly underrepresented among lung cancer cases in comparison to controls (odds ratio, 0.30). However, individuals heterozygous for -463A were equally distributed throughout cases and controls. In contrast, our study demonstrated that even an individual with one copy of the MPO -463A variant was at lower risk. Homozygous A carriers were rare in both groups, cases and controls, and did not differ significantly. It may therefore be assumed that there is a significant difference in MPO activity between G/G and G/A genotypes.
Impact of MPO.
The present study showed that the -463G/A polymorphism is an
unexpectedly strong genetic host factor, which suggests that the A
variant is a protective factor in the etiology of carcinomas of lung
and larynx. The modulation of pharyngeal cancer risk appears lower or
even negligible, signifying that activation of aromatic compounds may
play only a minor part in the etiology of pharyngeal cancer. The
significance of these results was strengthened by the fact that MPO
genotype distribution within the group of young healthy volunteers was
similar to that of the matched control group. A population-based random
sample would of course serve as an ideal control; however, the selected
hospital controls of the present study evidently demonstrated a
representative MPO genotype distribution.
Because MPO enhances the formation of
trans-7,8-dihydroxy-7,8-dihydro-benzo(a)pyrene
DNA adducts in lung tissue (5
, 7)
, it could be expected
that augmenting exposure to the precarcinogens contained in cigarette
smoke would be mirrored in an increased significance of the MPO
polymorphisms. Such a gene-environment interaction was indeed observed
in laryngeal cancer patients (Fig. 4)
, but not in our group of lung
cancer (Fig. 3)
and pharyngeal cancer patients (Fig. 5)
when compared
to controls. The reason for the differing observations in lung and
laryngeal cancer patients remains unclear.
In contrast to a severe deficiency in MPO activity, which leads to fatal diseases such as chronic granulomatous disease (33) , normal activity as elicited by the -463G variant may increase the risk of carcinogen-mediated malignancies. An interesting observation was an increased frequency of G/G variants in chronic granulomatous disease patients with gastrointestinal complications (1) . Eiserich et al. (34) debated a possible interaction with the formation of nitric oxide-derived inflammatory oxidants. Moreover, nitric oxide has also been reported to stimulate MPO activity (35) .
In conclusion, the -463G/A polymorphism of leukocyte MPO has been proved to represent an intriguing susceptibility factor that modulates an individuals risk of lung and laryngeal cancer. Its effect on the risk of various cancers of the pharynx is either much lower or nonexistent. The role of the rare new single-nt G/A polymorphisms at -297 and -296 nt remains unclear.
| FOOTNOTES |
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1 Supported by German Federal Ministry of
Education, Science, Research, and Technology Grant 01 EC 9408/0. ![]()
2 To whom requests for reprints should be
addressed, at Institut für Klinische Pharmakologie,
Universitätsklinikum Charité, Humboldt-Universität zu
Berlin, Schumannstrasse 20/21, D-10098 Berlin, Germany. Phone:
49-30-2802-3635; Fax: 49-30-2802-5153; E-mail: ingolf.cascorbi{at}charite.de ![]()
3 The abbreviations used are: MPO,
myeloperoxidase; CI, confidence interval; nt, nucleotide. ![]()
Received 8/ 6/99. Accepted 12/ 2/99.
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