1 1830 112 EFFECTS OF LONG-TERM ASPIRIN USE ON MOLECULAR ALTERATIONS IN PRECANCEROUS GASTRIC MUCOSA IN PATIENTS WITH AND WITHOUT GASTRIC CANCER. THE RISK OF GASTRIC CANCER (GC) REMAINS EVEN AFTER H. PYLORI ERADICATION; THUS, OTHER COMBINATION TREATMENTS, SUCH AS CHEMOPREVENTIVE DRUGS, ARE NEEDED. WE EVALUATED THE EFFECTS OF ASPIRIN ON GENETIC/EPIGENETIC ALTERATIONS IN PRECANCEROUS CONDITIONS, I.E., ATROPHIC MUCOSA (AM) AND INTESTINAL METAPLASIA (IM), IN PATIENTS WITH CHRONIC GASTRITIS WHO HAD TAKEN ASPIRIN FOR MORE THAN 3 YEARS. A TOTAL OF 221 BIOPSY SPECIMENS FROM 74 PATIENTS, INCLUDING ATROPHIC GASTRITIS (AG) CASES WITHOUT ASPIRIN USE (CONTROL), AG CASES WITH ASPIRIN USE (AG GROUP), AND GC CASES WITH ASPIRIN USE (GC GROUP), WERE ANALYZED. ASPIRIN USE WAS ASSOCIATED WITH A SIGNIFICANT REDUCTION OF CDH1 METHYLATION IN AM (OR: 0.15, 95% CI: 0.06-0.41, P = 0.0002), BUT WAS LESS EFFECTIVE IN REVERSING THE METHYLATION THAT OCCURRED IN IM. FREQUENT HYPERMETHYLATION INCLUDING THAT OF CDH1 IN AM INCREASED IN THE GC GROUP COMPARED TO THE AG GROUP, AND CDH1 METHYLATION WAS AN INDEPENDENT PREDICTIVE MARKER OF GC (OR: 8.50, 95% CI: 2.64-25.33, P = 0.0003). IN PATIENTS WITH LONG-TERM ASPIRIN USE, THE CHANGES OF MOLECULAR EVENTS IN AM BUT NOT IM MAY BE AN IMPORTANT FACTOR IN THE REDUCTION OF CANCER INCIDENCE. IN ADDITION, METHYLATION OF THE CDH1 GENE IN AM MAY BE A SURROGATE OF GC. 2017 2 487 28 ASPIRIN PROTECTS HUMAN CORONARY ARTERY ENDOTHELIAL CELLS AGAINST ATHEROGENIC ELECTRONEGATIVE LDL VIA AN EPIGENETIC MECHANISM: A NOVEL CYTOPROTECTIVE ROLE OF ASPIRIN IN ACUTE MYOCARDIAL INFARCTION. AIMS: L5 IS THE MOST NEGATIVELY CHARGED SUBFRACTION OF HUMAN LOW-DENSITY LIPOPROTEIN (LDL) AND IS THE ONLY SUBFRACTION OF LDL CAPABLE OF INDUCING APOPTOSIS IN CULTURED VASCULAR ENDOTHELIAL CELLS (ECS) BY INHIBITING FIBROBLAST GROWTH FACTOR-2 (FGF2) TRANSCRIPTION. WE EXAMINED WHETHER PLASMA L5 LEVELS ARE ELEVATED IN PATIENTS WITH ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION (STEMI) AND WHETHER ASPIRIN PROVIDES EPIGENETIC PROTECTION OF HUMAN CORONARY ARTERY ECS (HCAECS) EXPOSED TO L5. METHODS AND RESULTS: PLASMA L5 LEVELS WERE COMPARED BETWEEN PATIENTS WITH STEMI (N = 10) AND CONTROL SUBJECTS WITH CHEST PAIN SYNDROME BUT A NORMAL CORONARY ARTERIOGRAM (N = 5). L5 WAS ISOLATED FROM THE PLASMA OF STEMI PATIENTS AND CONTROL SUBJECTS, AND APOPTOSIS, FGF2 EXPRESSION, AND FGF2 PROMOTER METHYLATION WERE EXAMINED IN HCAECS TREATED WITH L5 AND ASPIRIN. PLASMA L5 LEVELS WERE SIGNIFICANTLY HIGHER IN STEMI PATIENTS THAN IN CONTROL SUBJECTS (P < 0.001). TREATMENT OF HCAECS WITH L5 RESULTED IN REDUCED SURVIVAL AND FGF2 EXPRESSION AND INCREASED CPG METHYLATION OF THE FGF2 PROMOTER. CO-TREATMENT OF HCAECS WITH L5 AND A PHYSIOLOGICALLY RELEVANT, LOW CONCENTRATION OF ASPIRIN (0.2 MM) ATTENUATED THE ADVERSE EFFECTS OF L5 ON HCAEC SURVIVAL, FGF2 EXPRESSION, AND FGF2 PROMOTER METHYLATION. IN CONTRAST, HIGH CONCENTRATIONS OF ASPIRIN (>/=1.0 MM) ACCENTUATED THE EFFECTS OF L5. CONCLUSIONS: OUR RESULTS SHOW THAT L5 LEVELS ARE SIGNIFICANTLY INCREASED IN STEMI PATIENTS. FURTHERMORE, L5 IMPAIRS HCAEC FUNCTION THROUGH CPG METHYLATION OF THE FGF2 PROMOTER, WHICH IS SUPPRESSED IN THE PRESENCE OF LOW-CONCENTRATION ASPIRIN. OUR RESULTS PROVIDE EVIDENCE OF A NOVEL MECHANISM OF ASPIRIN IN THE PREVENTION OF MI. 2013 3 6579 25 TREFOIL FACTORS AND HUMAN GASTRIC CANCER (REVIEW). TFF1/PS2, TFF2/SP AND TFF3/ITF ARE SOLUBLE PEPTIDES WITH TREFOIL DOMAIN(S) AND C-TERMINAL DIMERIZATION DOMAIN, WHICH ARE CONSERVED AMONG HUMAN, COW, MOUSE AND RAT. TFF1 MRNA IS EXPRESSED IN STOMACH (MUCOUS CELLS IN FUNDUS AND ANTRUM), TFF2 MRNA IN STOMACH (MUCOUS NECK CELLS IN FUNDUS AND BASAL CELLS IN ANTRAL AND PYLORIC GLANDS) AND DUODENUM (BRUNNER'S GLAND), TFF3 MRNA IN SMALL INTESTINE AND LARGE INTESTINE (GOBLET CELLS). EXPRESSION OF TFF1, TFF2 AND TFF3 MRNAS ARE DIFFERENTIALLY REGULATED BY FGF2/BFGF, FGF7/KGF, ESTROGEN, ASPIRIN, ARACHIDONIC ACID, X-RAY IRRADIATION, AND HYDROGEN PEROXIDE. GASTRIC CANCER IS CLASSIFIED INTO THE INTESTINAL TYPE AND THE DIFFUSE TYPE. TFF MRNAS ARE PREFERENTIALLY EXPRESSED IN DIFFUSE-TYPE GASTRIC CANCER CELLS. CUSTOM-MADE MICROARRAY (TFF MRNAS) AND ELISA (TFF PROTEINS) MIGHT BE APPLICABLE FOR SCREENING METHODS OF PERITONEAL AND BONE MARROW DISSEMINATION FROM DIFFUSE-TYPE GASTRIC CANCER. TFF1 AND TFF2 MRNAS ARE FREQUENTLY DOWN-REGULATED IN INTESTINAL-TYPE GASTRIC CANCER. TFF1 GENE, INACTIVATED BY DELETION, MISSENSE MUTATION AND PROMOTER HYPERMETHYLATION, IS A TUMOR SUPPRESSOR GENE IMPLICATED IN GASTRIC CANCER. TFF2 IS A CANDIDATE TUMOR SUPPRESSOR GENE; HOWEVER, GENETIC AND EPIGENETIC ALTERATIONS OF TFF2 GENE IN HUMAN GASTRIC CANCER REMAIN UNCLEAR. TFF1, TFF2 AND TFF3 PLAY KEY ROLES IN MUCOSAL PROTECTION THROUGH MUCOUS-BARRIER FORMATION, AND ALSO IN MUCOSAL REPAIR THROUGH PROMOTION OF RESTITUTION AFTER INJURY. PATIENTS WITH CHRONIC ATROPHIC GASTRITIS AND THOSE WITH ULCERATIVE COLITIS ARE AT RISK OF GASTRIC CANCER AND COLORECTAL CANCER, RESPECTIVELY. TFF1, TFF2 AND TFF3 PROTEINS MIGHT BE APPLICABLE FOR CHEMOPREVENTION OF GASTROINTESTINAL CANCER ASSOCIATED WITH CHRONIC PERSISTENT INFLAMMATION. 2003 4 6118 26 THE EPIGENETIC EFFECTS OF ASPIRIN: THE MODIFICATION OF HISTONE H3 LYSINE 27 ACETYLATION IN THE PREVENTION OF COLON CARCINOGENESIS IN AZOXYMETHANE- AND DEXTRAN SULFATE SODIUM-TREATED CF-1 MICE. COLORECTAL CANCER (CRC) IS THE THIRD MOST COMMON CANCER WORLDWIDE. CHRONIC INFLAMMATION APPEARS TO ENHANCE THE RISK OF CRC. EMERGING EVIDENCE HAS SUGGESTED THAT EPIGENETIC MECHANISMS PLAY AN IMPORTANT ROLE IN CRC. ASPIRIN [ACETYLSALICYLIC ACID (ASA)] HAS BEEN SHOWN TO PREVENT CRC; HOWEVER, THE EPIGENETIC MECHANISMS OF ITS ACTION REMAIN UNKNOWN. THIS STUDY INVESTIGATED THE PROTECTIVE ROLE OF ASA IN AZOXYMETHANE (AOM)-INITIATED AND DEXTRAN SULFATE SODIUM (DSS)-PROMOTED COLITIS-ASSOCIATED COLON CANCER (CAC) AND EXAMINED THE EPIGENETIC EFFECTS, PARTICULARLY ON HISTONE 3 LYSINE 27 ACETYLATION (H3K27AC), UNDERLYING THE PREVENTIVE EFFECT OF ASA. CF-1 MICE WERE FED WITH AIN-93M DIET WITH OR WITHOUT 0.02% ASA FROM 1 WEEK PRIOR TO AOM INITIATION UNTIL THE MICE WERE KILLED 20 WEEKS AFTER AOM INJECTION. OUR RESULTS SHOWED THAT AOM/DSS + ASA SIGNIFICANTLY SUPPRESSED INFLAMMATORY COLITIS SYMPTOMS AND TUMOR MULTIPLICITY. AOM/DSS + ASA REDUCED AOM/DSS-INDUCED PROTEIN EXPRESSION AND THE ACTIVITY OF HISTONE DEACETYLASES (HDACS) AND GLOBALLY RESTORED H3K27AC. FURTHERMORE, AOM/DSS + ASA INHIBITED AOM/DSS-INDUCED ENRICHMENT OF H3K27AC IN THE PROMOTERS OF INDUCIBLE NITRIC OXIDE SYNTHASE (INOS), TUMOR NECROSIS FACTOR ALPHA (TNF-ALPHA) AND INTERLEUKIN 6 (IL-6) THAT CORRESPONDED TO THE DRAMATIC SUPPRESSION OF THE MESSENGER RNA (MRNA) AND PROTEIN LEVELS. SURPRISINGLY, NO SIGNIFICANT CHANGES IN THE H3K27AC ABUNDANCE IN THE PROSTAGLANDIN-ENDOPEROXIDE SYNTHASE 2 (COX-2) PROMOTERS OR IN THE COX-2 MRNA AND PROTEIN EXPRESSION WERE OBSERVED. COLLECTIVELY, OUR RESULTS SUGGEST THAT A POTENTIAL NOVEL EPIGENETIC MECHANISM UNDERLIES THE CHEMOPREVENTIVE EFFECTS OF ASA, AND THIS MECHANISM ATTENUATES CAC IN AOM/DSS-INDUCED CF-1 MICE VIA THE INHIBITION OF HDACS AND THE MODIFICATION OF H3K27AC MARKS THAT SUPPRESS INOS, TNF-ALPHA AND IL-6. 2016 5 4671 33 NEW INSIGHTS INTO THE MECHANISM OF ACTION OF ASPIRIN IN THE PREVENTION OF COLORECTAL NEOPLASIA. THE RESULTS OF CLINICAL STUDIES HAVE SHOWN THAT THE CHRONIC ADMINISTRATION OF ASPIRIN, EVEN AT THE LOWDOSES (75-100 MG DAILY) RECOMMENDED FOR THE PREVENTION OF CARDIOVASCULAR DISEASE, IS ASSOCIATED WITH A REDUCTION OF CANCER INCIDENCE AND MORTALITY, IN PARTICULAR COLORECTAL CANCER (CRC). THE MECHANISM OF ACTION OF ASPIRIN AS AN ANTINEOPLASTIC AGENT REMAINS CONTROVERSIAL. HOWEVER, DATA OF CLINICAL PHARMACOLOGY AND SEVERAL FEATURES OF THE CHEMOPREVENTIVE EFFECT OF ASPIRIN, EMERGED FROM CLINICAL TRIALS, SUGGEST THAT THE ANTIPLATELET EFFECT OF ASPIRIN PLAYS A CENTRAL ROLE IN ITS ANTICANCER EFFECTS. IN ADDITION TO THEIR CONTRIBUTION TO TUMOR METASTASIS, PLATELETS MAY PLAY A ROLE IN THE EARLY PHASES OF TUMORIGENESIS. IN RESPONSE TO LIFESTYLE AND ENVIRONMENT FACTORS, INTESTINAL EPITHELIAL DAMAGE/ DYSFUNCTION MAY BE ASSOCIATED WITH PLATELET ACTIVATION, INITIALLY AS A MECHANISM TO REPAIR THE DAMAGE. HOWEVER, IF THE PLATELET RESPONSE IS UNCONSTRAINED, IT MAY CONTRIBUTE TO THE DEVELOPMENT OF CHRONIC INFLAMMATION. ALTOGETHER THESE EVENTS LEAD TO ALTER THE NORMAL FUNCTIONS OF INTESTINAL EPITHELIAL CELLS AND MAY TRANSLATE INTO CELLULAR TRANSFORMATION THROUGH SEVERAL MECHANISMS, INCLUDING THE OVEREXPRESSION OF CYCLOOXYGENASE(COX)-2 AND EPIDERMAL GROWTH FACTOR RECEPTOR (EGFR), WHICH ARE CONSIDERED EARLY EVENTS IN COLORECTAL TUMORIGENESIS. THUS, ANTIPLATELET AGENTS MAY PLAY A ROLE IN THE PREVENTION OF CRC BY MODIFYING EPIGENETIC EVENTS INVOLVED IN EARLY PHASES OF COLORECTAL TUMORIGENESIS. FINALLY, WE CARRIED OUT A CRITICAL REVIEW OF THE LITERATURE ON OFF-TARGET MECHANISMS OF ASPIRIN ACTION AS ANTICANCER DRUG. 2015 6 2607 28 EPIGENETICS/EPIGENOMICS AND PREVENTION BY CURCUMIN OF EARLY STAGES OF INFLAMMATORY-DRIVEN COLON CANCER. COLORECTAL CANCER (CRC) IS ASSOCIATED WITH SIGNIFICANT MORBIDITY AND MORTALITY IN THE US AND WORLDWIDE. CRC IS THE SECOND MOST COMMON CANCER-RELATED DEATH IN BOTH MEN AND WOMEN GLOBALLY. CHRONIC INFLAMMATION HAS BEEN IDENTIFIED AS ONE OF THE MAJOR RISK FACTORS OF CRC. IT MAY DRIVE GENETIC AND EPIGENETIC/EPIGENOMIC ALTERATIONS, SUCH AS DNA METHYLATION, HISTONE MODIFICATION, AND NON-CODING RNA REGULATION. CURRENT PREVENTION MODALITIES FOR CRC ARE LIMITED AND SOME TREATMENT REGIMENS SUCH AS USE THE NONSTEROIDAL ANTI-INFLAMMATORY DRUG ASPIRIN MAY HAVE SEVERE SIDE EFFECTS, NAMELY GASTROINTESTINAL ULCERATION AND BLEEDING. THEREFORE, THERE IS AN URGENT NEED OF DEVELOPING ALTERNATIVE STRATEGIES. RECENTLY, INCREASING EVIDENCE SUGGESTS THAT SEVERAL DIETARY CANCER CHEMOPREVENTIVE PHYTOCHEMICALS POSSESS ANTI-INFLAMMATION AND ANTIOXIDATIVE STRESS ACTIVITIES, AND MAY PREVENT CANCERS INCLUDING CRC. CURCUMIN (CUR) IS THE YELLOW PIGMENT THAT IS FOUND IN THE RHIZOMES OF TURMERIC (CURCUMA LONGA). MANY STUDIES HAVE DEMONSTRATED THAT CUR EXHIBIT STRONG ANTICANCER, ANTIOXIDATIVE STRESS, AND ANTI-INFLAMMATORY ACTIVITIES BY REGULATING SIGNALING PATHWAYS, SUCH AS NUCLEAR FACTOR ERYTHROID-2-RELATED FACTOR 2, NUCLEAR FACTOR-KAPPAB, AND EPIGENETICS/EPIGENOMICS PATHWAYS OF HISTONES MODIFICATIONS, AND DNA METHYLATION. IN THIS REVIEW, WE WILL DISCUSS THE LATEST EVIDENCE IN EPIGENETICS/EPIGENOMICS ALTERATIONS BY CUR IN CRC AND THEIR POTENTIAL CONTRIBUTION IN THE PREVENTION OF CRC. 2020 7 1798 33 EFFECT OF HELICOBACTER PYLORI INFECTION ON GATA-5 AND TFF1 REGULATION, COMPARISON BETWEEN PEDIATRIC AND ADULT PATIENTS. BACKGROUND: GATA FACTORS, WHICH CONSTITUTE A FAMILY OF TRANSCRIPTION REGULATORY PROTEINS, PARTICIPATE IN GASTROINTESTINAL DEVELOPMENT. TREFOIL FACTOR 1 (TFF1) PLAYS A CRUCIAL ROLE IN MUCOSAL DEFENSE AND HEALING, AND EVIDENCE SUGGESTS THAT GATA-5 MEDIATED ITS REGULATION. GASTRIC CANCER IS A MULTIPLE-STEP PROCESS TRIGGERED BY HELICOBACTER PYLORI AND IS CHARACTERIZED BY ACCUMULATION OF MOLECULAR AND EPIGENETIC ALTERATION. THE AIM OF THIS STUDY WAS TO EVALUATE THE EFFECT OF H. PYLORI INFECTION ON THE REGULATION OF GATA-5 AND TFF1 IN VITRO AND IN VIVO. RESULTS: INFECTED CELLS EXHIBITED UPREGULATION OF GATA-5 AND TFF1 AFTER 48 H. AN INCREASE IN GATA-5 AND TFF1 MRNA LEVELS WAS ALSO FOUND IN MICE SAMPLES AFTER 6 AND 12 MONTHS OF INFECTION, RESPECTIVELY. IN HUMAN SAMPLES, WE FOUND AN ASSOCIATION BETWEEN H. PYLORI INFECTION AND GATA-5 UPREGULATION. IN FACT, AMONG H. PYLORI-INFECTED PATIENTS, HYPERMETHYLATION WAS OBSERVED IN 45.5% OF PEDIATRIC SAMPLES, IN 62.6% OF CHRONIC GASTRITIS SAMPLES, AND IN 63% OF GASTRIC CANCER SAMPLES. REGARDING TFF1, THE EXPRESSION LEVELS WERE SIMILAR IN PEDIATRICS AND ADULTS PATIENTS, AND WERE INDEPENDENT OF H. PYLORI INFECTION, AND THE EXPRESSION OF THESE FACTORS WAS DOWNREGULATED IN GASTRIC CANCER SAMPLES. GATA-5 PROMOTER METHYLATION WAS ASSOCIATED WITH A DECREASE IN TFF1 MRNA LEVELS. CONCLUSIONS: OUR RESULTS SUGGEST THAT THE UPREGULATION OF GATA-5 AND TFF1 OBSERVED IN VITRO AND IN VIVO MAY BE CORRELATED WITH A PROTECTIVE EFFECT OF THE MUCOSA IN RESPONSE TO INFECTION. THE EPIGENETIC INACTIVATION OF GATA-5 OBSERVED IN HUMAN BIOPSIES FROM INFECTED PATIENTS MAY SUGGEST THAT THIS ALTERATION IS AN EARLY EVENT OCCURRING IN ASSOCIATION WITH H. PYLORI INFECTION. 2018 8 196 26 ACID REFLUX AND OESOPHAGEAL CANCER. BARRETT'S METAPLASIA IS ONE OF THE COMMONEST PREMALIGNANT LESIONS IN THE WESTERN WORLD FOLLOWING COLORECTAL ADENOMAS. ONE IN 50 OF THE ADULT POPULATION DEVELOPS BARRETT'S AS A CONSEQUENCE OF CHRONIC GASTRO-OESOPHAGEAL REFLUX. THE MUCOSAL INFLAMMATION SEEN WITHIN PATIENTS WITH GASTRO-OESOPHAGEAL REFLUX SEEMS LIKELY TO DRIVE THE GROWTH OF THE METAPLASTIC MUCOSA AND ALSO HELP DIRECT FURTHER ONCOLOGICAL CHANGE, YET THE MOLECULAR EVENTS THAT CHARACTERIZE THE PATHWAY FROM INFLAMMATION TO METAPLASIA TO DYSPLASIA AND ADENOCARCINOMA ARE POORLY UNDERSTOOD. THERE IS HOPE THAT UNDERSTANDING THE ROLE OF OESOPHAGEAL INFLAMMATION WILL PROVIDE IMPORTANT INSIGHT INTO THE DEVELOPMENT OF BARRETT'S METAPLASIA AND OESOPHAGEAL CANCER. THIS CHAPTER WILL DISCUSS THE INFLAMMATION SEEN WITHIN CONTEXT OF BARRETT'S OESOPHAGUS AND ALSO CLINICAL TRIALS WHICH HOPE TO ADDRESS THIS COMMON PREMALIGNANT DISEASE. THERE ARE SEVERAL ONGOING CLINICAL TRIALS WHICH ARE AIMING TO PROVIDE DATA USING ANTI-INFLAMMATORY THERAPIES TO TACKLE THIS IMPORTANT PREMALIGNANT CONDITION. THERE IS NEW DATA PRESENTED WHICH SUGGESTS THAT DATA FROM THE ASPIRIN ESOMEPRAZOLE CHEMOPREVENTION TRIAL (ASPECT) MAY HOLD THE CLUE TO DISEASE TREATMENT AND THAT THE CYTOKINE TNF-ALPHA SEEMS TO BE A KEY SIGNALLING MOLECULE IN THE METAPLASIA-DYSPLASIA-CARCINOMA SEQUENCE. SPECIFICALLY IT APPEARS THAT BOTH EPIGENETIC AND INHERITED GENETICS COOPERATE TO MODULATE THE PROGNOSIS. 2011 9 5864 22 SUPPRESSION OF ELF4 IN ULCERATIVE COLITIS PREDISPOSES HOST TO COLORECTAL CANCER. ULCERATIVE COLITIS (UC) IS A CHRONIC INFLAMMATORY BOWEL DISEASE, CHARACTERIZED BY RELAPSING AND REMITTING COLON MUCOSAL INFLAMMATION. FOR PATIENTS SUFFERING FROM UC, A HIGHER RISK OF COLON CANCER HAS BEEN WIDELY RECOGNIZED. HERE, WE FOUND THAT ELF4 (-/-) MICE DEVELOPED COLON TUMORS WITH 3 CYCLES OF DEXTRAN SULFATE SODIUM SALT (DSS) TREATMENT ALONE. WE FURTHER SHOWED THAT ELF4 SUPPRESSION WAS PREVALENT IN BOTH PATIENTS WITH UC AND DSS-INDUCED MICE MODELS, AND THIS SUPPRESSION WAS CAUSED BY PROMOTER REGION METHYLATION. ELF4, UPON PARYLATION BY PARP1, TRANSCRIPTIONALLY REGULATED MULTIPLE DNA DAMAGE REPAIR MACHINERY COMPONENTS. CONSISTENTLY, ELF4 DEFICIENCY LEADS TO MORE SEVERE DNA DAMAGE BOTH IN VITRO AND IN VIVO. ORAL ADMINISTRATION OF MONTMORILLONITE POWDER CAN PREVENT THE REDUCTION OF ELF4 IN DSS-INDUCED COLITIS MODELS AND LOWER THE RISK OF COLON TUMOR DEVELOPMENT DURING AZOXYMETHANE (AOM) AND DSS INDUCED COLITIS-ASSOCIATED CANCER (CAC). THESE DATA PROVIDED ADDITIONAL MECHANISM OF CAC INITIATION AND SUPPORTED THE "EPIGENETIC PRIMING MODEL OF TUMOR INITIATION". 2021 10 3222 45 HELICOBACTER PYLORI ASSOCIATED CHRONIC GASTRITIS, CLINICAL SYNDROMES, PRECANCEROUS LESIONS, AND PATHOGENESIS OF GASTRIC CANCER DEVELOPMENT. HELICOBACTER PYLORI (H. PYLORI) INFECTION IS WELL KNOWN TO BE ASSOCIATED WITH THE DEVELOPMENT OF PRECANCEROUS LESIONS SUCH AS CHRONIC ATROPHIC GASTRITIS (AG), OR GASTRIC INTESTINAL METAPLASIA (GIM), AND CANCER. VARIOUS MOLECULAR ALTERATIONS ARE IDENTIFIED NOT ONLY IN GASTRIC CANCER (GC) BUT ALSO IN PRECANCEROUS LESIONS. H. PYLORI TREATMENT SEEMS TO IMPROVE AG AND GIM, BUT STILL REMAINS CONTROVERSIAL. IN CONTRAST, MANY STUDIES, INCLUDING META-ANALYSIS, SHOW THAT H. PYLORI ERADICATION REDUCES GC. MOLECULAR MARKERS DETECTED BY GENETIC AND EPIGENETIC ALTERATIONS RELATED TO CARCINOGENESIS REVERSE FOLLOWING H. PYLORI ERADICATION. THIS INDICATES THAT THESE CHANGES MAY BE AN IMPORTANT FACTOR IN THE IDENTIFICATION OF HIGH RISK PATIENTS FOR CANCER DEVELOPMENT. PATIENTS WHO UNDERWENT ENDOSCOPIC TREATMENT OF GC ARE AT HIGH RISK FOR DEVELOPMENT OF METACHRONOUS GC. A RANDOMIZED CONTROLLED TRIAL FROM JAPAN CONCLUDED THAT PROPHYLACTIC ERADICATION OF H. PYLORI AFTER ENDOSCOPIC RESECTION SHOULD BE USED TO PREVENT THE DEVELOPMENT OF METACHRONOUS GC, BUT RECENT RETROSPECTIVE STUDIES DID NOT SHOW THE TENDENCY. PATIENTS WITH PRECANCEROUS LESIONS (MOLECULAR ALTERATIONS) THAT DO NOT REVERSE AFTER H. PYLORI TREATMENT, REPRESENT THE "POINT OF NO RETURN" AND MAY BE AT HIGH RISK FOR THE DEVELOPMENT OF GC. THEREFORE, EARLIER H. PYLORI ERADICATION SHOULD BE CONSIDERED FOR PREVENTING GC DEVELOPMENT PRIOR TO THE APPEARANCE OF PRECANCEROUS LESIONS. 2014 11 6871 26 [PATHOGENETIC IMPORTANCE OF HELICOBACTER PYLORI INFECTION]. H. PYLORI ARE ETIOLOGICAL FACTOR OF HUMAN ACUTE AND CHRONIC GASTRITIS. DEPENDING ON PATHOGENIC FACTORS OF MICROORGANISM AND POLYMORPHISM OF HUMAN GENES, CHRONIC GASTRITIS CAN BE A CAUSE FOR ULCERATIVE ENTERITIS OF THE DUODENUM OR STOMACH, GASTRIC ADENOCARCINOMA AND MALT-LYMPHOMA DEVELOPMENT. WE REVEALED GENETIC FEATURES OF BACTERIA, DETERMINED THE INTENSITY OF INFLAMMATION, SUCH AS PATHOGENIC FACTORS--CAG, PLASTIC REGION OF THE GENOME AND ADHESIN CODING GENES. EPIGENETIC CHANGES, FOR EXAMPLE THE METHYLATION OF E-CADHERIN GENE ASSOCIATED WITH H PYLORI, ARE CRUCIAL FOR CARCINOGENESIS. THEREBY, PREDISPOSITION OF CHRONIC GASTRITIS ASSOCIATED WITH H. PYLORI TO ULCERATIVE ENTERITIS OF THE DUODENUM, ULCERATIVE STOMACH DISEASE OR GASTRIC ADENOCARCINOMA DEPENDS ON TOPOGRAPHY, THE INTENSITY OF INFLAMMATION AND CHANGES OF ACID PRODUCTION IN THE STOMACH. 2012 12 5435 32 RELATIVE ROLE OF METHYLATOR AND TUMOR SUPPRESSOR PATHWAYS IN ULCERATIVE COLITIS-ASSOCIATED COLON CANCER. BACKGROUND: CHRONIC ULCERATIVE COLITIS (UC) IS ASSOCIATED WITH AN INCREASED COLORECTAL CANCER RISK WHICH MAY BE SECONDARY TO REPETITIVE MUCOSAL INJURY. BOTH EPIGENETIC METHYLATION AND THE CLASSIC ADENOMA-TO-CARCINOMA SEQUENCE HAVE BEEN IMPLICATED IN THIS MALIGNANT TRANSFORMATION, BUT THE UNDERLYING MOLECULAR MECHANISMS REMAIN POORLY DEFINED. THIS STUDY COMPARES THE MOLECULAR CHARACTERISTICS OF COLITIS-ASSOCIATED AND COMMON COLORECTAL CANCERS. METHODS: NINETEEN PATIENTS WITH COLORECTAL ADENOCARCINOMAS ARISING WITHIN UC WERE MATCHED FOR AGE AND CANCER SITE WITH 54 PATIENTS WITH SPORADIC ADENOCARCINOMAS. TUMOR TISSUE WAS EXAMINED FOR BRAF MUTATIONS, CPG ISLAND METHYLATOR PHENOTYPE (CIMP), AND MLH1 PROMOTER METHYLATION. MUTATIONS OF KRAS AND P53 WERE ASSESSED BY SEQUENCING. RESULTS: PATIENT DEMOGRAPHICS WERE SIMILAR FOR THE TWO GROUPS. CIMP WAS OBSERVED IN 22% OF SPORADIC COLORECTAL CANCERS AND IN 5% OF UC CANCERS (P = 0.162). RATES OF BRAF MUTATION (4% VS 5%, P = 1.0), MLH1 METHYLATION (9% VERSUS 5%, P = 0.682), AND KRAS MUTATIONS (24% VERSUS 32%, P = 0.552) WERE SIMILAR BETWEEN THE GROUPS. HOWEVER, COLITIS-ASSOCIATED COLORECTAL CANCERS WERE MORE LIKELY TO HAVE A P53 MUTATION COMPARED TO SPORADIC ADENOCARCINOMAS (95% VERSUS 53%, P = 0.001). THE DOMINANT MUTATION FOR COLITIS-ASSOCIATED CANCERS WAS A MUTATION IN CODON 4, REPRESENTING HALF OF THE MUTATIONS. FURTHERMORE, COLITIS-ASSOCIATED CANCERS HAD A HIGHER RATE OF MUTATION IN CODON 8 (48% VERSUS 6%, P < 0.001) THAN SPORADIC COUNTERPARTS. CONCLUSIONS: UNLIKE OTHER INFLAMMATORY GASTROINTESTINAL CANCERS, COLITIS-ASSOCIATED COLORECTAL CANCERS DO NOT PREFERENTIALLY ARISE VIA A METHYLATOR PATHWAY WHEN COMPARED TO SPORADIC COLORECTAL CANCERS. CHROMOSOMAL INSTABILITY REMAINS AN IMPORTANT ETIOLOGY, BUT WITH A UNIQUE P53 FREQUENCY AND MUTATION PATTERN. 2011 13 5181 27 PREMALIGNANT LESIONS IN GASTRIC CANCER. DESPITE A PLATEAU IN INCIDENCE, GASTRIC CANCER IS ONE OF THE MOST COMMON CANCERS WORLDWIDE AND CAUSES CONSIDERABLE MORBIDITY AND MORTALITY. PREMALIGNANT GASTRIC LESIONS ARE WELL KNOWN RISK FACTORS FOR THE DEVELOPMENT OF INTESTINAL-TYPE GASTRIC ADENOCARCINOMAS. IN THIS MULTISTEP MODEL OF GASTRIC CARCINOGENESIS, HELICOBACTER PYLORI CAUSES CHRONIC ACTIVE INFLAMMATION OF THE GASTRIC MUCOSA, WHICH SLOWLY PROGRESSES THROUGH THE PREMALIGNANT STAGES OF ATROPHIC GASTRITIS, INTESTINAL METAPLASIA, AND ADENOMA/DYSPLASIA TO GASTRIC CARCINOMA. THIS PROGRESSION IS PARALLELED BY A STEPWISE ACCUMULATION OF MULTIPLE GENETIC AND EPIGENETIC ABNORMALITIES. DETECTION, TREATMENT, AND MOLECULAR ANALYSES OF PREMALIGNANT LESIONS MAY THUS PROVIDE A BASIS FOR GASTRIC CANCER PREVENTION. THIS REVIEW DESCRIBES AN OVERVIEW OF CURRENT KNOWLEDGE ON PREMALIGNANT GASTRIC LESIONS. IT ALSO REVIEWS THE ISSUE OF SURVEILLANCE OF PATIENTS WITH PREMALIGNANT LESIONS IN ORDER TO IMPROVE THE SURVIVAL OF PATIENTS WITH GASTRIC CANCER. 2010 14 6746 29 WHOLE EXOME SEQUENCING OF ULCERATIVE COLITIS-ASSOCIATED COLORECTAL CANCER BASED ON NOVEL SOMATIC MUTATIONS IDENTIFIED IN CHINESE PATIENTS. BACKGROUND: CARCINOGENESIS IS A SEVERE CONSEQUENCE OF CHRONIC ULCERATIVE COLITIS. WE INVESTIGATED THE SOMATIC MUTATIONS AND PATHWAY ALTERATIONS IN ULCERATIVE COLITIS-ASSOCIATED COLORECTAL CANCER (CRC) IN CHINESE PATIENTS COMPARED WITH SPORADIC CRCS TO REVEAL POTENTIAL THERAPEUTIC TARGETS IN ULCERATIVE COLITIS-ASSOCIATED CRC. METHODS: WHOLE EXOME SEQUENCING WAS PERFORMED ON ARCHIVAL TUMOR TISSUES AND PAIRED ADJACENT NONDYSPLASTIC MUCOSA FROM 10 ULCERATIVE COLITIS-ASSOCIATED CRC PATIENTS AT A HIGH RISK OF CARCINOGENESIS. GENOMIC ALTERATION PROFILES FROM 223 PRIMARY CRCS FROM THE CANCER GENOME ATLAS SERVED AS SPORADIC CRC CONTROLS. A META-ANALYSIS WAS PERFORMED TO INVESTIGATE DIFFERENCES IN MAJOR GENETIC MUTATIONS BETWEEN ULCERATIVE COLITIS-ASSOCIATED AND CROHN'S DISEASE-ASSOCIATED CRCS. RESULTS: WE IDENTIFIED 44 NONSILENT RECURRENT SOMATIC MUTATIONS VIA WHOLE EXOME SEQUENCING, INCLUDING 25 DELETERIOUS MUTATIONS INVOLVED IN APOPTOSIS AND THE PI3K-AKT PATHWAY (COL6A3, FN1), AUTOPHAGY (ULK1), CELL ADHESION (PODXL, PTPRT, ZFHX4), AND EPIGENETIC REGULATION (ARID1A, NCOR2, KMT2D, NCOA6, MECP2, SUPT6H). IN TOTAL, 11 OF THE 25 MUTATED GENES SIGNIFICANTLY DIFFERED BETWEEN ULCERATIVE COLITIS-ASSOCIATED CRC AND SPORADIC CRC (APC, APOB, MECP2, NCOR2, NTRK2, PODXL, RABGAP1, SIK3, SUPT6H, ULK1, USP48). SOMATIC TP53 MUTATIONS OCCURRED IN 33% OF ULCERATIVE COLITIS-ASSOCIATED CRCS. SUBSEQUENT META-ANALYSIS REVEALED DISTINCT MUTATION PROFILES FOR CROHN'S DISEASE- AND ULCERATIVE COLITIS-ASSOCIATED CRCS. MUTATIONS INVOLVING THE NF-KB PATHWAY AND EPIGENETIC REGULATION WERE MORE COMMON IN ULCERATIVE COLITIS-ASSOCIATED CRCS THAN IN SPORADIC CRCS. CONCLUSION: DISTINCT GENOMIC ALTERATION PROFILES OF DELETERIOUS SOMATIC MUTATIONS WERE FOUND IN ULCERATIVE COLITIS-ASSOCIATED AND SPORADIC CRCS. MUTATIONS OF EPIGENETIC REGULATORS, SUCH AS KMT2D AND NCOA6, WERE COMMON, SUGGESTING AN EPIGENETIC PATHOMECHANISM FOR COLITIS-ASSOCIATED CARCINOMA IN CHINESE PATIENTS. 2019 15 4751 34 NOVEL RISK MARKERS FOR GASTRIC CANCER SCREENING: PRESENT STATUS AND FUTURE PROSPECTS. INITIAL IDENTIFICATION OF POPULATIONS AT HIGH RISK OF GASTRIC CANCER (GC) IS IMPORTANT FOR ENDOSCOPIC SCREENING OF GC. AS SERUM PEPSINOGEN (PG) TEST-POSITIVE SUBJECTS WITH PROGRESSION OF CHRONIC ATROPHIC GASTRITIS (CAG) SHOW A HIGH LIKELIHOOD OF FUTURE CANCER DEVELOPMENT, THIS POPULATION WARRANTS CAREFUL FOLLOW-UP OBSERVATION AS A HIGH-RISK GC GROUP. BY COMBINING THE PG TEST WITH HELICOBACTER PYLORI (HP) ANTIBODY TITERS, THE HP-RELATED CHRONIC GASTRITIS STAGE CAN BE CLASSIFIED, THUS IDENTIFYING NOT ONLY A GC HIGH-RISK GROUP BUT ALSO A LOW-RISK GROUP. AMONG PG TEST-NEGATIVE PATIENTS WITHOUT CAG, THOSE WITH HIGH SERUM PG II LEVELS AND HP ANTIBODY TITERS ARE THOUGHT TO HAVE SEVERE GASTRIC MUCOSAL INFLAMMATION AND THE RISK OF DIFFUSE-TYPE GC IS ALSO HIGH. MEANWHILE, IN GASTRIC MUCOSAE OBTAINED BY ENDOSCOPIC BIOPSY, HP INFECTION INDUCES ABERRANT DNA METHYLATION IN CPG ISLANDS IN MULTIPLE GENE REGIONS AND THE EXTENT OF METHYLATION CLEARLY CORRELATES WITH GC RISK. BY QUANTIFYING ABERRANT DNA METHYLATION IN SUITABLE GENE MARKERS, WE CAN DETERMINE THE EXTENT OF THE EPIGENETIC FIELD FOR CANCERIZATION. THESE NOVEL CONCEPTS AND RISK MARKERS WILL HAVE MANY CLINICAL APPLICATIONS IN GASTROINTESTINAL ENDOSCOPY, INCLUDING MORE EFFICIENT ENDOSCOPIC GC SCREENING AND A STRATEGIC APPROACH TO METACHRONOUS MULTIPLE GCS AFTER ENDOSCOPIC TREATMENT. 2010 16 1797 41 EFFECT OF HELICOBACTER PYLORI ERADICATION ON GASTRIC PRECANCEROUS LESIONS: A SYSTEMATIC REVIEW AND META-ANALYSIS. BACKGROUND: THE QUESTION OF WHETHER ERADICATION OF HELICOBACTER PYLORI (HP) CAN REVERSE GASTRIC PRECANCEROUS LESIONS, INCLUDING INTESTINAL METAPLASIA, REMAINS UNCERTAIN, LEADING TO ONGOING DEBATE. THEREFORE, A META-ANALYSIS WAS PERFORMED TO EVALUATE THE EFFECT OF HP ERADICATION ON GASTRIC PRECANCEROUS LESIONS. MATERIALS AND METHODS: PUBMED, EMBASE, COCHRANE LIBRARY, WEB OF SCIENCE, SCOPUS DATABASE, AND CLINICALTRIALS.GOV WERE SYSTEMATICALLY SEARCHED FROM INCEPTION TO APRIL 2023 FOR STUDIES THAT EXPLORED THE IMPACT OF HP ERADICATION ON GASTRIC PRECANCEROUS LESIONS. RISK RATIOS (RRS) AND THEIR 95% CONFIDENCE INTERVALS (95% CIS) WERE SELECTED AS THE EFFECT SIZE. WE USED THE RANDOM-EFFECTS MODEL TO ASSESS POOLED DATA. WE ALSO PERFORMED QUALITY ASSESSMENTS, SUBGROUP ANALYSES, AND SENSITIVITY ANALYSES. RESULTS: FIFTEEN STUDIES WERE INCLUDED. COMPARED WITH PLACEBO, HP ERADICATION COULD SIGNIFICANTLY PREVENT THE PROGRESSION OF GASTRIC PRECANCEROUS LESIONS (RR = 0.87, 95% CI: 0.81-0.94, P < 0.01) AND REVERSE THEM (RR = 1.32, 95% CI: 1.17-1.50, P < 0.01). THEN, SPECIFIC PRECANCEROUS LESIONS WERE FURTHER EXPLORED. THE PROGRESSION OF INTESTINAL METAPLASIA WAS SIGNIFICANTLY PREVENTED BY HP ERADICATION COMPARED TO PLACEBO OR NO TREATMENT (RR = 0.80, 95% CI: 0.69-0.94, P < 0.01). MOREOVER, COMPARED WITH PLACEBO OR NO TREATMENT, HP ERADICATION ALSO IMPROVED CHRONIC ATROPHIC GASTRITIS (RR = 1.84, 95% CI: 1.30-2.61, P < 0.01) AND INTESTINAL METAPLASIA (RR = 1.41, 95% CI: 1.15-1.73, P < 0.01). HOWEVER, IN TERMS OF PREVENTING DYSPLASIA PROGRESSION (RR = 0.86, 95% CI: 0.37-2.00) AND IMPROVING DYSPLASIA (RR = 0.89, 95% CI: 0.47-1.70), HP ERADICATION HAD NO ADVANTAGE COMPARED TO PLACEBO OR NO TREATMENT. CONCLUSIONS: HP ERADICATION THERAPY COULD PREVENT THE PROGRESSION OF GASTRIC PRECANCEROUS LESIONS AND REVERSE THEM. NOTABLY, INTESTINAL METAPLASIA CAN BE REVERSED, BUT THIS MAY ONLY BE APPROPRIATE FOR PATIENTS WITH EPIGENETIC ALTERATIONS AND MILDER LESIONS. 2023 17 3129 29 GIVINOSTAT: AN EMERGING TREATMENT FOR POLYCYTHEMIA VERA. INTRODUCTION: POLYCYTHEMIA VERA (PV), A PHILADELPHIA CHROMOSOME-NEGATIVE MYELOPROLIFERATIVE NEOPLASM, IS CHARACTERIZED BY PANMYELOSIS, PANCYTOSIS, AND A JAK2 MUTATION. PATIENTS ARE AT INCREASED RISK OF THROMBOHEMORRHAGIC EVENTS, AND PROGRESSION TO MYELOFIBROSIS OR ACUTE LEUKEMIA. CURRENT TREATMENTS INCLUDE ASPIRIN, PHLEBOTOMY, AND CYTOREDUCTIVE DRUGS (MOST COMMONLY HYDROXYUREA). GIVINOSTAT IS A POTENT, CLASS I/II HISTONE DEACETYLASE (HDAC) INHIBITOR THAT IS IN PHASE I/II CLINICAL TRIALS IN PV. GIVINOSTAT WAS WELL TOLERATED AND YIELDED PROMISING CLINICO-HEMATOLOGICAL RESPONSES. A PHASE III STUDY OF GIVINOSTAT VERSUS HYDROXYUREA IN HIGH-RISK PV PATIENTS IS PLANNED. AREAS COVERED: WE PRESENT AN OVERVIEW OF PV, CURRENT TREATMENT GUIDELINES, AND THE PUTATIVE MECHANISM(S) OF ACTION OF GIVINOSTAT. WE DISCUSS THE PRECLINICAL AND CLINICAL STUDIES OF GIVINOSTAT IN PV AND BRIEFLY REVIEW APPROVED AND INVESTIGATIONAL COMPETITOR COMPOUNDS. EXPERT OPINION: HDAC INHIBITORS HAVE LONG BEEN KNOWN TO BE ACTIVE IN PV, BUT CHRONIC TOXICITIES CAN BE CHALLENGING. GIVINOSTAT, HOWEVER, IS ACTIVE AND WELL TOLERATED, AND IS ENTERING A PIVOTAL PHASE III RANDOMIZED TRIAL. GIVINOSTAT OFFERS THE POSSIBILITY OF REPLACING HYDROXYUREA AS THE STANDARD FIRST-LINE CYTOREDUCTIVE CHOICE FOR PV PATIENTS. THIS WOULD COMPLETELY CHANGE THE CURRENT THERAPEUTIC PARADIGM AND GUIDELINES FOR PV MANAGEMENT. ALTHOUGH SURROGATE CLINICAL STUDY ENDPOINTS MAY SUFFICE FOR REGULATORY PURPOSES, THROMBOSIS REDUCTION AND PREVENTION OF DISEASE PROGRESSION REMAIN MOST IMPORTANT TO PATIENTS AND CLINICIANS. 2020 18 672 35 BRAF, KRAS AND HELICOBACTER PYLORI EPIGENETIC CHANGES-ASSOCIATED CHRONIC GASTRITIS IN EGYPTIAN PATIENTS WITH AND WITHOUT GASTRIC CANCER. WE AIMED TO STUDY MLH1 AND MGMT METHYLATION STATUS IN HELICOBACTER PYLORI-ASSOCIATED CHRONIC GASTRITIS IN EGYPTIAN PATIENTS WITH AND WITHOUT GASTRIC CANCER. 39 PATIENTS WERE INCLUDED IN OUR STUDY. THEY WERE DIVIDED INTO 2 GROUPS; PATIENTS WITHOUT (GROUP I) AND WITH GASTRIC ADENOCARCINOMA (GROUP II). PATIENTS WERE SUBJECTED TO CLINICAL EXAMINATION, ABDOMINAL ULTRASOUND AND UPPER ENDOSCOPY FOR GASTRIC BIOPSY. BIOPSIES WERE SUBJECTED TO UREASE TEST, HISTOLOGICAL EXAMINATION, AND DNA PURIFICATION. H. PYLORI, BRAF, KRAS, MLH1 AND MGMT METHYLATION WERE ASSESSED BY QUANTITATIVE PCR. DNA SEQUENCING WAS PERFORMED TO ASSESS BRAF AND KRAS GENES MUTATION. QPCR OF H. PYLORI WAS SIGNIFICANTLY HIGHER IN PATIENTS WITH ADENOCARCINOMA (GROUP II) THAN THOSE WITHOUT ADENOCARCINOMA (GROUP I); WITH A P < 0.001 AS WELL AS IN PATIENTS WITH AGE ABOVE 50 YEARS WITH A P VALUE = 0.008. BY APPLYING LOGISTIC REGRESSION ANALYSIS IT WAS REPORTED THAT THE H. PYLORI QPCR IS A SIGNIFICANT PREDICTOR TO THE ADENOCARCINOMA WITH OR = 1.025 (95 % CI: 1. 002-1.048), WITH SENSITIVITY OF 90 % AND SPECIFICITY OF 100 %. ADENOCARCINOMA PATIENTS HAD A SIGNIFICANTLY HIGHER MEAN AGE AND LEVELS OF H. PYLORI, BRAF, K-RAS, METHYLATED MGMT AND METHYLATED MLH1 THAN THOSE OF GASTRITIS PATIENTS. DNA SEQUENCE ANALYSIS OF BRAF (CODON 12) AND KRAS (CODON 600) HAD GENES MUTATION IN GASTRIC ADENOCARCINOMA VERSUS CHRONIC GASTRITIS. CONCLUSION: H. PYLORI MAY CAUSE EPIGENETIC CHANGES PREDISPOSING THE PATIENTS TO CANCER STOMACH. ESTIMATION OF H. PYLORI BY QPCR CAN BE A GOOD PREDICTOR TO ADENOCARCINOMA. BRAF AND KRAS GENES MUTATION WERE REVELED IN GASTRITIS AND ADENOCARCINOMA PATIENTS. 2016 19 5400 25 REDUCING TOBACCO-RELATED DISABILITY IN CHRONIC SMOKERS. TOBACCO CONSUMPTION (PREDOMINANTLY CIGARETTES) IS THE LEADING PREVENTABLE CAUSE OF MORTALITY WORLDWIDE. ALTHOUGH THE MAJOR FOCUS OF STRATEGIES TO REDUCE MORTALITY FROM TOBACCO MUST INCLUDE PREVENTION OF FUTURE GENERATIONS FROM INITIALLY GAINING ACCESS, SOME SMOKERS ARE UNWILLING OR UNABLE TO QUIT. CAN THE HIGHER RISK CHRONIC SMOKER BE IDENTIFIED AND CAN THEIR RISK BE REDUCED? THE RISK OF ADVERSE EVENTS IN CIGARETTE SMOKERS IS INFLUENCED BY THE INTENSITY AND DURATION OF CIGARETTE SMOKING OR SECONDHAND EXPOSURE, ASSOCIATED CONVENTIONAL RISK FACTORS, ENVIRONMENTAL STRESSORS, AND CERTAIN GENETIC VARIANTS AND EPIGENETIC MODIFIERS. RECENT DATA SUGGEST THAT INFLAMMATORY MARKERS SUCH AS HIGH-SENSITIVITY C-REACTIVE PROTEIN (HS CRP) AND TARGETED IMAGING CAN IDENTIFY SOME SMOKERS AT HIGHER RISK. AS SMOKING IS PROTHROMBOTIC, ASPIRIN INITIATION AND EXPANDED STATIN USE MIGHT REDUCE CARDIOVASCULAR RISK IN THOSE WHO DO NOT PRESENTLY MEET CRITERIA FOR THESE THERAPIES, BUT FURTHER STUDY IS REQUIRED. THUS, ALTHOUGH ADVOCACY FOR SMOKING CESSATION SHOULD ALWAYS BE THE PRIMARY APPROACH, INCREASED EFFORTS ARE NEEDED TO IDENTIFY AND POTENTIALLY TREAT THOSE WHO ARE UNABLE OR UNWILLING TO QUIT. 2020 20 6331 29 THE ROLE OF COX-2 IN INTESTINAL INFLAMMATION AND COLORECTAL CANCER. COLORECTAL CANCER (CRC) IS A HETEROGENEOUS DISEASE, INCLUDING AT LEAST THREE MAJOR FORMS: HEREDITARY, SPORADIC AND COLITIS-ASSOCIATED CRC. A LARGE BODY OF EVIDENCE INDICATES THAT GENETIC MUTATIONS, EPIGENETIC CHANGES, CHRONIC INFLAMMATION, DIET AND LIFESTYLE ARE THE RISK FACTORS FOR CRC. AS ELEVATED CYCLOOXYGENASE-2 (COX-2) EXPRESSION WAS FOUND IN MOST CRC TISSUE AND IS ASSOCIATED WITH WORSE SURVIVAL AMONG CRC PATIENTS, INVESTIGATORS HAVE SOUGHT TO EVALUATE THE EFFECTS OF NONSTEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDS) AND SELECTIVE COX-2 INHIBITORS (COXIBS) ON CRC. THE EPIDEMIOLOGICAL STUDIES, CLINICAL TRIALS AND ANIMAL EXPERIMENTS INDICATE THAT NSAIDS ARE AMONG THE MOST PROMISING CHEMOPREVENTIVE AGENTS FOR THIS DISEASE. NSAIDS EXERT THEIR ANTI-INFLAMMATORY AND ANTITUMOR EFFECTS PRIMARILY BY REDUCING PROSTAGLANDIN PRODUCTION BY INHIBITION OF COX-2 ACTIVITY. IN THIS REVIEW, WE HIGHLIGHT BREAKTHROUGHS IN OUR UNDERSTANDING OF THE ROLES OF COX-2 IN CRC AND INFLAMMATORY BOWEL DISEASE. THESE RECENT DATA PROVIDE A RATIONALE FOR RE-EVALUATING COX-2 AS BOTH THE PROGNOSTIC AND THE PREDICTIVE MARKER IN A WIDE VARIETY OF MALIGNANCIES AND FOR RENEWING THE INTEREST IN EVALUATING RELATIVE BENEFITS AND RISK OF COXIBS IN APPROPRIATELY SELECTED PATIENTS FOR CANCER PREVENTION AND TREATMENT. 2010