Prospective case-cohort study of intestinal colonization with enterococci that produce extracellular superoxide and the risk for colorectal adenomas or cancer.
OBJECTIVE
The aim of this study was to determine whether intestinal colonization with enterococci that produce extracellular superoxide (O2*-), a free radical implicated in the development of colorectal cancer, is associated with these lesions or their precursors.


METHODS
A prospective case-cohort study was performed by isolating enterococci from stools of consecutive patients undergoing colonoscopy who had no prior history of colonoscopy or colorectal cancer. A food frequency questionnaire was also administered to control for dietary factors known to affect the risk for these lesions.


RESULTS
Among 159 evaluable participants were 77 with no precancerous or cancerous pathology, 61 with adenomas <2 cm, 10 with adenomas > or =2 cm, and 11 with cancer. Regression analyses found no associations for those subjects with adenomas of any size or with cancer and colonization with O2*--producing enterococci, any nutrient, or age. For those patients with large adenomas > or = 2 cm or cancer, however, significant associations were noted for age (OR 1.94 per decade, 95% CI 1.2-3.5), beta-carotene (OR 0.44 per 500 microg/1000 kcal/day, 95% CI 0.2-0.8), vitamin A (OR 3.20 per 500 microg/1000 kcal/day, 95% CI 1.2-8.9), and vitamin E (OR 0.09 per 10 mg/ 1000 kcal/day, 95% CI 0.006-0.9), but not colonization with O2*--producing enterococci. Second stools collected 1 yr later, however, often contained dissimilar enterococcal flora, undermining an important study assumption.


CONCLUSIONS
Significant associations were found for those with large adenomas or cancer (but not small adenomas), with age, and with foods enriched for vitamin A, vitamin E, and beta-carotene. An association between colonization with O2*--producing enterococci and colorectal adenomas or cancer, however, could not be ascertained, possibly because intestinal enterococcal flora changes over time, leaving a potentially cohesive hypothesis of colon cancer and risk factors as yet unanswered.
Winters
M D
MD
Department of Medicine, University of Oklahoma Health Sciences Center, and Department of Veterans Affairs Medical Center, Oklahoma City 73104, USA.
Schlinke
T L
TL
Joyce
W A
WA
Glore
S R
SR
Huycke
M M
MM
D000236:Adenoma / Q000209:etiology*; D000368:Aged; D015331:Cohort Studies; D003113:Colonoscopy; D015169:Colony Count, Microbial; D015179:Colorectal Neoplasms / Q000209:etiology*; D016983:Enterococcus / Q000302:isolation & purification / Q000378:metabolism*; D005110:Extracellular Space / Q000378:metabolism*; D005260:Female; D006801:Humans; D007422:Intestines / Q000382:microbiology* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012044:Regression Analysis; D012307:Risk Factors; D013481:Superoxides / Q000378:metabolism*; D013997:Time Factors
D013481:Superoxides