title: Eicosapentaenoic acid (EPA) efficacy for colorectal aberrant crypt foci (ACF): a double-blind randomized controlled trial.
abstract: BACKGROUND
  Colorectal cancer (CRC) is one of the most commonly occurring neoplasms and a leading cause of cancer death worldwide, and new preventive strategies are needed to lower the burden of this disease. Eicosapentaenoic acid (EPA), the omega-3 polyunsaturated fatty acid that is widely used in the treatment of hyperlipidemia and prevention of cardiovascular disease, has recently been suggested to have a suppressive effect on tumorigenesis and cancer cell growth. In CRC chemoprevention trials, in general, the incidence of polyps or of the cancer itself is set as the study endpoint. Although the incidence rate of CRC would be the most reliable endpoint, use of this endpoint would be unsuitable for chemoprevention trials, because of the relatively low occurrence rate of CRC in the general population and the long-term observation period that it would necessitate. Moreover, there is an ethical problem in conducting long-term trials to determine whether a test drug might be effective or harmful. Aberrant crypt foci (ACF), defined as lesions containing crypts that are larger in diameter and stain more darkly with methylene blue than normal crypts, are considered as a reliable surrogate biomarker of CRC. Thus, we devised a prospective randomized controlled trial as a preliminary study prior to a CRC chemoprevention trial to evaluate the chemopreventive effect of EPA against colorectal ACF formation and the safety of this drug, in patients scheduled for polypectomy.
  
  
  METHODS
  This study is a multicenter, double-blind, placebo-controlled, randomized controlled trial to be conducted in patients with both colorectal ACF and colorectal polyps scheduled for polypectomy. Eligible patients shall be recruited for the study and the number of ACF in the rectum counted at the baseline colonoscopy. Then, the participants shall be allocated randomly to either one of two groups, the EPA group and the placebo group. Patients in the EPA group shall receive oral 900-mg EPA capsules thrice daily (total daily dose, 2.7 g per day), and those in the placebo group shall receive oral placebo capsules thrice daily. After one month's treatment with EPA/placebo, colonoscopic examination and polypectomy will be performed to evaluate the formation of ACF, and the cell-proliferative activity and cell-apoptotic activity in normal colorectal mucosa and colorectal polyps.
  
  
  CONCLUSIONS
  This is the first study proposed to explore the effect of EPA against colorectal ACF formation in humans.This trial has been registered in the University hospital Medical Information Network (UMIN) Clinical Trials Registry as UMIN000008172.
authors.affiliation: Division of Gastroenterology, Yokohama City University School of Medicine, 3-9 Fuku-ura, Kanazawa-ku, Yokohama 236-0004, Japan.
authors.forename: Takuma
authors.initials: T
authors.lastname: Higurashi
authors.forename: Kunihiro
authors.initials: K
authors.lastname: Hosono
authors.forename: Hiroki
authors.initials: H
authors.lastname: Endo
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Takahashi
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Iida
authors.forename: Takashi
authors.initials: T
authors.lastname: Uchiyama
authors.forename: Akiko
authors.initials: A
authors.lastname: Ezuka
authors.forename: Shiori
authors.initials: S
authors.lastname: Uchiyama
authors.forename: Eiji
authors.initials: E
authors.lastname: Yamada
authors.forename: Hidenori
authors.initials: H
authors.lastname: Ohkubo
authors.forename: Eiji
authors.initials: E
authors.lastname: Sakai
authors.forename: Shin
authors.initials: S
authors.lastname: Maeda
authors.forename: Satoshi
authors.initials: S
authors.lastname: Morita
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Natsumeda
authors.forename: Hajime
authors.initials: H
authors.lastname: Nagase
authors.forename: Atsushi
authors.initials: A
authors.lastname: Nakajima
mesh_terms: D058739:Aberrant Crypt Foci / Q000188:drug therapy* / Q000517:prevention & control; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018890:Chemoprevention; D003106:Colon / Q000187:drug effects / Q000473:pathology; D003111:Colonic Polyps / Q000188:drug therapy* / Q000517:prevention & control; D015179:Colorectal Neoplasms / Q000188:drug therapy* / Q000517:prevention & control; D004311:Double-Blind Method; D015118:Eicosapentaenoic Acid / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012007:Rectum / Q000187:drug effects / Q000473:pathology; D016896:Treatment Outcome
chemical_list: D015118:Eicosapentaenoic Acid