title: Polymorphisms in metabolic genes, their combination and interaction with tobacco smoke and alcohol consumption and risk of gastric cancer: a case-control study in an Italian population.
abstract: BACKGROUND
  The distribution and the potential gene-gene and gene-environment interaction of selected metabolic genetic polymorphisms was investigated in relation to gastric cancer risk in an Italian population.
  
  
  METHODS
  One hundred and seven cases and 254 hospital controls, matched by age and gender, were genotyped for CYP1A1, CYP2E1, mEH, GSTM1, GSTT1, NAT2 and SULT1A1 polymorphisms. Haplotype analysis was performed for EPHX1 exons 3 and 4, as well as CYP2E1 RsaI (*5 alleles) and CYP2E1 DraI (*5A or *6 alleles). The effect modification by alcohol and cigarette smoking was tested with the heterogeneity test, while the attributable proportion (AP) was used to measure the biological interaction from the gene-gene interaction analysis.
  
  
  RESULTS
  Gastric cancer risk was found to be associated with the inheritance of GSTT1 null genotype (OR = 2.10, 95%CI: 1.27-3.44) and the SULT1A1 His/His genotype (OR = 2.46, 95%CI: 1.03-5.90). No differences were observed for the haplotype distributions among cases and controls. For the first time an increased risk was detected among individuals carrying the *6 variant allele of CYP2E1 if ever-drinkers (OR = 3.70; 95%CI: 1.45-9.37) with respect to never-drinkers (OR = 0.18; 95% CI: 0.22-1.46) (p value of heterogeneity among the two estimates = 0.001). Similarly, the effect of SULT1A1 variant genotype resulted restricted to ever-smokers, with an OR of 2.58 (95%CI: 1.27-5.25) for the carriers of His allele among smokers, and an OR of 0.86 (95%CI: 0.45-1.64) among never-smokers (p value of heterogeneity among the two estimates = 0.03). The gene-gene interaction analyses demonstrated that individuals with combined GSTT1 null and NAT2 slow acetylators had an additional increased risk of gastric cancer, with an OR of 3.00 (95%CI: 1.52-5.93) and an AP of 52%.
  
  
  CONCLUSIONS
  GSTT1, SULT1A1 and NAT2 polymorphisms appear to modulate individual's susceptibility to gastric cancer in this Italian population, particularly when more than one unfavourable genotype is present, or when combined with cigarette smoke. The increased risk for the carriers of CYP2E1*5A or *6 alleles among drinkers need to be confirmed by larger prospective studies.
authors.affiliation: Genetic Epidemiology and Molecular Biology Unit, Institute of Hygiene, Università Cattolica del Sacro Cuore, Rome, Italy. sboccia@rm.unicatt.it
authors.forename: Stefania
authors.initials: S
authors.lastname: Boccia
authors.forename: Fakhredin A
authors.initials: FA
authors.lastname: Sayed-Tabatabaei
authors.forename: Roberto
authors.initials: R
authors.lastname: Persiani
authors.forename: Francesco
authors.initials: F
authors.lastname: Gianfagna
authors.forename: Stefano
authors.initials: S
authors.lastname: Rausei
authors.forename: Dario
authors.initials: D
authors.lastname: Arzani
authors.forename: Antonio
authors.initials: A
authors.lastname: La Greca
authors.forename: Domenico
authors.initials: D
authors.lastname: D'Ugo
authors.forename: Giuseppe
authors.initials: G
authors.lastname: La Torre
authors.forename: Cornelia M
authors.initials: CM
authors.lastname: van Duijn
authors.forename: Gualtiero
authors.initials: G
authors.lastname: Ricciardi
mesh_terms: D000368:Aged; D000428:Alcohol Drinking; D001191:Arylamine N-Acetyltransferase / Q000235:genetics; D015239:Arylsulfotransferase / Q000235:genetics; D014408:Biomarkers, Tumor / Q000235:genetics*; D016022:Case-Control Studies; D019363:Cytochrome P-450 CYP1A1 / Q000235:genetics; D019392:Cytochrome P-450 CYP2E1 / Q000235:genetics; D015252:Deoxyribonucleases, Type II Site-Specific / Q000378:metabolism; D005260:Female; D020022:Genetic Predisposition to Disease; D005838:Genotype; D005982:Glutathione Transferase / Q000235:genetics; D006801:Humans; D008297:Male; D008875:Middle Aged; D011110:Polymorphism, Genetic / Q000235:genetics*; D012307:Risk Factors; D012907:Smoking; D013274:Stomach Neoplasms / Q000235:genetics*
chemical_list: D001191:Arylamine N-Acetyltransferase; D015239:Arylsulfotransferase; D014408:Biomarkers, Tumor; D019363:Cytochrome P-450 CYP1A1; D019392:Cytochrome P-450 CYP2E1; D015252:Deoxyribonucleases, Type II Site-Specific; D005982:Glutathione Transferase; C478900:NAT2 protein, human; C413545:glutathione S-transferase T1; C117544:SULT1A1 protein, human