title: Combined effect of NAT2, MTR and MTHFR genotypes and tobacco on bladder cancer susceptibility in Tunisian population.
abstract: BACKGROUND
  Cigarette smoking is the predominant risk factor for bladder cancer. This risk may be modified by polymorphisms in carcinogens metabolism genes; including those involving the N-acetyl transferase 2 (NAT2) which have been correlated with decreased enzyme activities. Moreover, folate insufficiency can induces carcinogenesis by decreasing DNA methylation. Methylenetetrahydrofolate reductase (MTHFR) and methionine synthase (MTR) are enzymes that play central roles in the folate metabolic pathway. The MTHFR 677*T and MTR 2756*G variants are associated with decreased enzyme activity.
  
  
  METHODS
  In this work, we have conducted a case-control study in order to assess the combined effect of tobacco, slow NAT2 variants, MTHFR 677*T and MTR 2756*G alleles on bladder cancer development in North Tunisia.
  
  
  RESULTS
  For MTR A2756G, alleles and genotypic distributions differed significantly between cases and controls (p = 0.00009, OR = 3.27, CI 95% 1.76-6.12). While, in non-smokers patients the slow NAT2 did not appear to influence bladder cancer susceptibility; our results suggested that it might act with an additive contribution with tobacco as well as with that determined by MTR 2756 AG or 2756 GG genotypes (p = 0.0008). Identical cumulative effect was detected for slow NAT2 and MTHFR 677*T variant (p = 0.0003; OR = 36.6; CI 95% 3.4-935.3).
  
  
  CONCLUSIONS
  The strongest result obtained by this study was for an additive effect between smoking status, slow NAT2 variants, MTR 2756*G and MTHFR 677*T alleles, in affecting bladder cancer risk.
authors: Laboratory of Genetic, Immunology and Human Pathology, Faculty of Sciences of Tunis, Tunisia. slah_ouerh@yahoo.fr
authors: Slah
authors: S
authors: Ouerhani
authors: Kamel
authors: K
authors: Rouissi
authors: Raja
authors: R
authors: Marrakchi
authors: Mohamed R
authors: MR
authors: Ben Slama
authors: Mohamed
authors: M
authors: Sfaxi
authors: Mohamed
authors: M
authors: Chebil
authors: Amel Benammar
authors: AB
authors: ElGaaied
mesh_terms: D013766:5-Methyltetrahydrofolate-Homocysteine S-Methyltransferase / Q000235:genetics*; D000368:Aged; D001191:Arylamine N-Acetyltransferase / Q000235:genetics*; D016022:Case-Control Studies; D019175:DNA Methylation; D005260:Female; D005787:Gene Frequency; D020022:Genetic Predisposition to Disease; D005838:Genotype; D006801:Humans; D008297:Male; D042965:Methylenetetrahydrofolate Reductase (NADPH2) / Q000235:genetics*; D008875:Middle Aged; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects*; D014416:Tunisia / Q000453:epidemiology; D001749:Urinary Bladder Neoplasms / Q000453:epidemiology / Q000209:etiology / Q000235:genetics*
chemical_list: D042965:Methylenetetrahydrofolate Reductase (NADPH2); D013766:5-Methyltetrahydrofolate-Homocysteine S-Methyltransferase; D001191:Arylamine N-Acetyltransferase; C478900:NAT2 protein, human