Radiation Therapy Did Not Induce Long-Term Changes in Rectal Mucosa: Results From the Randomized Scandinavian Prostate Cancer Group 7 Trial.

PURPOSE: To investigate long-term changes in the rectal mucosa after curative external beam radiation therapy in the treatment of prostate cancer. METHODS AND MATERIALS: In the Scandinavian Prostate Cancer Group 7 trial, 880 men with locally advanced prostate cancer were randomized to hormonal therapy alone versus hormonal therapy plus radiation therapy to 70 Gy. A subcohort from this trial being randomized at our center (n=178) was invited to a study on late anorectal side effects during 2003-2005, approximately 5 years after treatment, including measuring health-reported quality of life and physician-assessed toxicity score by the Late Effects Normal Tissue Task Force/Subjective, Objective, Management, Analytic (LENT/SOMA) and European Organization for Research and Treatment of Cancer/Radiation Therapy Oncology Group score. Sixty-seven patients had a rectal mucosa biopsy. Sixty-four biopsies were included in the final analysis, of which 33 patients were randomized to hormonal treatment and 31 to hormonal treatment plus radiation therapy. The presence of fibrosis, number of capillaries, and lymphocyte infiltration was then evaluated by light microscopy. RESULTS: The group receiving radiation therapy had significantly higher LENT/SOMA and function/bother scale scores than the group that only received hormonal treatment, but there was no significant difference in the presence of fibrosis, ectasia, number of capillaries in the lamina propria, or lymphocyte infiltration between the groups. CONCLUSION: Radiation therapy to 70 Gy to the prostate does not induce long-term microscopic mucosal changes in the rectum 5 years after treatment. This is in contrast to the general assumption that structural changes, including fibrosis, seen after radiation therapy include the mucosa. We speculate that the main late effects of radiation therapy on the structure of the rectum are located in the deeper layers of the rectal wall than the mucosa.

Fatty acid desaturase expression in human leucocytes correlates with plasma phospholipid fatty acid status.

Associations between and changes in plasma phospholipid fatty acid (FA) concentrations and expression of delta 5 desaturase (D5D), delta 6 desaturase (D6D) and delta 9 desaturase (D9D) in leucocytes were investigated both before and during n-3 FA supplementation for 2 weeks in 20 healthy individuals. Participants were divided into two groups depending on fish intake: one fish meal or less per week and no marine FA supplement (Lowfish, n = 9) and more than one fish meal per week and/or daily oral marine FA supplement (Highfish, n = 11). Before starting supplementation (t = 0), concentrations of n-3 FAs were significantly lower in the Lowfish group compared to the Highfish group. During supplementation in both groups, n-3 FAs increased, whereas n-6 FAs decreased. D5D expression was significantly higher in Lowfish compared to Highfish at t = 0. No difference in D6D or D9D expression was observed. D5D expression was inversely correlated with EPA, DPA, DHA and total n-3 FA, and positively correlated with the ratio total n-6 FA/total n-3 FA at t = 0. Expression of D5D in the Lowfish group as well as D6D in both groups significantly decreased relative to the expression at t = 0 during the first day of supplement. PUFA concentration was generally predicted by its precursor FA and D5D or D6D expression. The correlations mentioned disappeared after 2 weeks of supplementation. This indicates that steady-state FA desaturase expression is associated with plasma phospholipid FA composition. Whether leucocyte desaturase expression may have potential as a marker of PUFA status merits further investigation.

The antiproliferative effect of EPA in HL60 cells is mediated by alterations in calcium homeostasis.

Studies show that n-3 polyunsaturated fatty acids (PUFA) inhibit proliferation and induce apoptosis in cancer cells. Recent reports indicate that this effect is due to activation of the unfolded protein response (UPR). However, what causes this activation has been unclear. We examined the effects of eicosapentaenoic acid (EPA) on the human leukemia cell line HL60 and the econazole (Ec) resistant HL60 clone E2R2. Ec depletes Ca(2+) from the ER and blocks Ca(2+) influx in mammalian cells, leading to activation of the UPR and apoptosis. EPA inhibited growth of HL60 cells strongly, while E2R2 cells were much less affected. Gene expression analysis of HL60 cells revealed extensive changes in transcripts related to the ER homeostasis, Ca(2+)-homeostasis and cell cycle/apoptosis. Protein levels of phosphorylated eIF2alpha, a selective translation inhibitor and UPR hallmark, activating transcription factor 4 (ATF4) and sequestosome-1 were moderately increased, whereas the cell cycle/progression protein cyclin D1 was decreased in HL60. In contrast, EPA concentrations that strongly inhibited and caused activation of the UPR in HL60 cells had no effect on the expression level of these UPR markers in E2R2 cells. Given that the only known difference between these cells is Ec-resistance, our results strongly suggest that the inhibitory effect of EPA on HL60 cells is initially meditated through alterations of the Ca(2+)-homeostasis followed by activation of the UPR.