title: Can supplementation of phytoestrogens/insoluble fibers help the management of duodenal polyps in familial adenomatous polyposis?
abstract: Familial adenomatous polyposis (FAP) is an autosomal dominant inherited disorder, and prophylactic colectomy has been shown to decrease the incidence of colorectal cancer (CRC). Duodenal cancer and desmoids are now the leading causes of death in FAP. We evaluate whether 3 months of oral supplementation with a patented blend of phytoestrogens and indigestible insoluble fibers (ADI) help the management of FAP patients with ileal pouch-anal anastomosis (IPAA). In a prospective open label study, we enrolled 15 FAP patients with IPAA and duodenal polyps who underwent upper gastrointestinal endoscopy at baseline and after 3 months of treatment. The primary endpoint was the change in gene expression in polyp mucosa, whereas the secondary endpoint was the reduction in polyp number and size. After 3 months of ADI treatment, all patients showed a reduction in the number and size of duodenal polyps (P = 0.021). Analysis of the expression of CRC promoting/inhibiting genes in duodenal polyps biopsies demonstrated that different CRC-promoting genes (PCNA, MUC1 and COX-2) were significantly downregulated, whereas CRC-inhibiting genes (ER-β and MUC2) were significantly upregulated after ADI treatment. In conclusion, ADI proved to be safe and effective, and its long-term effects on FAP patients need further investigation. Judging from the results we observed on COX-2 and miR-101 expression, the short-term effects of ADI treatment could be comparable with those obtained using COX-2 inhibitors, with the advantage of being much more tolerable in chronic therapies and void of adverse events.
authors.affiliation: Department of Medicine and Surgery and carlo.calabrese2@unibo.it.
authors.forename: Carlo
authors.initials: C
authors.lastname: Calabrese
authors.affiliation: Department of Medicine and Surgery and.
authors.forename: Fernando
authors.initials: F
authors.lastname: Rizzello
authors.affiliation: Department of Medicine and Surgery and.
authors.forename: Paolo
authors.initials: P
authors.lastname: Gionchetti
authors.affiliation: Department of Medicine and Surgery and.
authors.forename: Andrea
authors.initials: A
authors.lastname: Calafiore
authors.affiliation: Department of Medicine and Surgery and.
authors.forename: Nico
authors.initials: N
authors.lastname: Pagano
authors.affiliation: Department of Biological, Geological and Environmental Sciences, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy and.
authors.forename: Luigia
authors.initials: L
authors.lastname: De Fazio
authors.affiliation: Department of Medicine and Surgery and Department of Biological, Geological and Environmental Sciences, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy and.
authors.forename: Maria Chiara
authors.initials: MC
authors.lastname: Valerii
authors.affiliation: Department of Medicine and Surgery and Department of Biological, Geological and Environmental Sciences, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy and.
authors.forename: Elena
authors.initials: E
authors.lastname: Cavazza
authors.affiliation: Department of Biological, Geological and Environmental Sciences, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy and.
authors.forename: Antonio
authors.initials: A
authors.lastname: Strillacci
authors.affiliation: ExPharma Limited, 21 Effie Road, Fulham Broadway, London SW61EN, UK.
authors.forename: Maria Cristina
authors.initials: MC
authors.lastname: Comelli
authors.affiliation: Department of Medicine and Surgery and.
authors.forename: Gilberto
authors.initials: G
authors.lastname: Poggioli
authors.affiliation: Department of Medicine and Surgery and.
authors.forename: Massimo
authors.initials: M
authors.lastname: Campieri
authors.affiliation: Department of Biological, Geological and Environmental Sciences, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy and.
authors.forename: Enzo
authors.initials: E
authors.lastname: Spisni
mesh_terms: D011125:Adenomatous Polyposis Coli / Q000150:complications / Q000178:diet therapy* / Q000235:genetics; D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D001003:Anal Canal / Q000601:surgery; D000714:Anastomosis, Surgical; D003082:Colectomy; D039021:Colonic Pouches / Q000473:pathology; D004043:Dietary Fiber / Q000008:administration & dosage / Q000627:therapeutic use*; D019587:Dietary Supplements; D005786:Gene Expression Regulation / Q000187:drug effects*; D006801:Humans; D007417:Intestinal Polyps / Q000178:diet therapy* / Q000235:genetics / Q000473:pathology; D008875:Middle Aged; D048789:Phytoestrogens / Q000008:administration & dosage / Q000627:therapeutic use*; D011446:Prospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D004043:Dietary Fiber; D048789:Phytoestrogens