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SCTR Scientific Retreat on Health Disparities November 9, 2016 The molecular implications of lifestyle associated metabolites (AGEs) to cancer disparity = + Sugar Protein David Turner PhD Assistant Professor, Hollings Cancer Center, Medical University of South Carolina AGEs Cancer Disparity Advanced Glycation end-products -AGEs + HC=O NH2 Protein crosslinks Proteolytic degradation DNA damage Cell signaling AGE Formation Maillard reaction Reducing sugars + Amino acids DNA Schiff's base Amadori products Oxidation Glycolytic intermediates Reactive carbonyl species Oxidation Amino acids - Glyoxal, methylglyoxyl 3-deoxyglucosone Perpetual chronic activation of stress repsonse pathways Oxidation Reactive oxygen species Lipids NAPDH oxidase Immune cell recruitment/activation AGEs (CML, CEL Pentoside Glucosepane) NFkB, TNF, HIF1, cytokines, chemokines Endogenous & Exogenous AGEs High fat/ high sugar diet Sedentary lifestyle Fried/grilled foods Processed foods Low income Socioeconomic & Environmental Risk Factors Exogenous AGE pool Protein AGEs Endogenous AGE pool Tumor Specific Biology Glycolysis Renal & enzymatic clearance = + Sugar Endogenous production & exogenous intake Stress response Ancestry HyperGlucose glycemia metabolism Imbalance in this “steady state” leads to increased AGE accumulation, accelerated aging and earlier disease onset and complications Health Disparity Exogenous AGE - lifestyle Source: J. Am. Dietetic Ass. 2010:p911-916 • • Consuming foods that are high in sugar/fat or are highly processed substantially increases the levels of AGEs in our bodies Dietary AGE’s are naturally present in raw animal-derived foods but grilling, broiling, roasting, searing, and frying propagate and accelerate new AGE formation • Smoking and consumption of alcohol increase AGE levels in the body • A sedentary lifestyle may increase AGE accumulation in the body. Moderate exercise can maintain a constant AGE level and may even lower it Bacon 91,577 AGE kU/100g Carrots 10 AGE kU/100g Big Mac 7,801 AGE kU/100g Raw chicken 800 AGE kU/100g Fried chicken Poached chicken 1,000 AGE kU/100g 8,000 AGE kU/100g VS Dietary-AGE affect mammary development AGE H&E H&E AGEs inhibit chemotherapy MCF7 & T47D breast cancer cells A B - Phosphorylation of Era at S167 is associated with tamoxifen resistance C D C MCF7 T47D AGE levels are increased in cancer patients ELISA of circulating AGE levels in serum AGE levels are increased in tumors Control Non-cancer EA-LG AA-LG EA-HG AA-HG N=8 IHC staining of tumor AGE levels AGEs increase cancer associated pathways AGES and cancer prevention Tumor Biology Increased glycolysis, Hyperglycemia Elevated stress responses Sugar + Lifestyle intervention Protein = AGEs AGE targeted therapies Chronic diseases Health Disparity Factors Race, Poor diet, Obesity Sedentary lifestyle, Alcohol, Smoking = Increased AGE pool in tissues and organs = aberrant cell signaling Target AGE signaling pathway Cancer Associated Pathways Lifestyle intervention Antioxidant procyanidin complex Dr. Michael Lilly Mary Berkaw Marvella Ford Gayenell Magwood Lindsay Peterson (Wash U) Matt Gregoski Liz Garret-Mayer Kent Armeson Measures We Can All Take!! • Avoid/cut down on foods high in protein, sugar and fat as well as processed foods • Increase intake of natural whole grains, fresh fruit and vegetables • Change how we cook foods: Cook foods at lower temperatures for longer periods of time (slow cookers are great for lowering A.G.E.s and maintaining flavor) Cook over ceramic surfaces instead of metal, which will lower A.G.E. formation during cooking Use a food thermometer to ensure you don’t overcook meats X • When preparing dishes that call for browning meat, such as stews or roasts, skip the browning step Substitute high-sugar, oil-based marinades with lemon juice, vinegar, and tomato juice and experiment with different spices and rubs for flavor SUMMARY • AGES are lifestyle linked metabolites which are associated with many if not all chronic diseases • In relation to cancer our studies indicate that AGEs: - alter mammary gland development in mice - promote resistance to chemotherapeutic drugs - are elevated in African American men with PCa - promote cancer associated pathways - Both lifestyle and pharmacological intervention may are effective strategies to reduce AGE levels in patients Multidisciplinary, collaborative research teams are needed involving behavioral intervention experts, dieticians as well as basic, translational and population scientists in order to fully comprehend the link between lifestyle, chronic disease and AGE accumulation Acknowledgements Co-investigators Michael Lilly Steve Savage Thomas Keane Laura Spruill Victoria Findlay Marvella Ford Gayenell Magwood Lindsay Peterson (Wash U) Liz Garret-Mayer Kent Armeson Stefan Ambs (NCI) Scott Cramer (U of Colorado) Jaime Uribarri (Mount Sinai) Funding – NIH/NCI P20 CA157071 NIH/NCI R21 CA194469 (provocative question) NIH/NCI R21 CA176135 NIH/NCI R21 CA176135 supplement HCC disparities research pilot project Students/Technicians Lourdes Nogueira Danzell Smith Brad Krisanits Narges Anbardar Jamie Randise Katie Walter Dion Foster Van Phan Gleb Fedarovich Lifestyle Metabolism Sugar + AGEs Protein