Fish Oil Supplementation, Nutrigenomics and Colorectal Cancer Prevention

NCT01661764 | Completed Phase 2 Results DMC

• 2 other identifiers: 11165R01CA160938
• Study Type: interventional
• Target: 141
• Locations: 1 country
• Sites: 1

Brief Summary

Colorectal cancer is the second leading cause of cancer-related death within the United States. Animal models and observational studies have suggested that marine-derived n-3 polyunsaturated fatty acids \[PUFA\] such as eicosapentanoic acid \[EPA\] and docosahexanoic acid \[DHA\] may reduce the risk of colorectal cancer. In addition, it may be the relative proportion of n-3 to n-6 PUFAs that best determines the chemopreventive effects of fish oils. This ratio is important because the n-6 PUFA, arachidonic acid (ARA), is converted via the cyclo-oxygenase (COX) pathway to prostaglandin E2 (PGE2), an inflammatory eicosanoid overproduced in colorectal neoplasms while EPA is converted to the anti-inflammatory prostaglandin E3 (PGE3). While the ratio of n-6 to n-3 PUFAs can be altered through dietary changes, genetic factors may also influence this ratio. Recent genetic studies have demonstrated that much of the tissue levels of ARA is determined by differences in a gene called fatty acid desaturase 1 (FADS1). FADS1 is the rate-limiting enzyme in the conversion of linoleic acid, the most commonly consumed PUFA in the Western diet, to ARA, and one particular genetic variant caller rs174537 is associated with lower fatty acid desaturase activity and subsequently lower tissue levels of ARA. The study hypothesis is that individuals with genetically determined lower activity of FADS1 will derive greater benefit from fish oil supplementation than individuals with higher FADS1 activity because of lower tissue levels of ARA and subsequently a more favorable n-6 to n-3 PUFA ratio. To test this hypothesis the investigators will recruit 150 participants with recently identified adenomatous polyps and conduct a 6-month double blind 3 X 2 factorial randomized controlled trial. The first factor will be FADS1 genotype (GG, GT, and TT) and the second factor will be fish oil supplementation (fish oil versus placebo). The primary outcome will be the change in rectal epithelial cell growth and cell death. Secondary outcomes will include rectal epithelial cell expression of genes important in PGE2 production, rectal cell production of PGE2 and PGE3, rectal mucosal tissue levels of fatty acids, and changes in biomarkers of inflammation (C-reactive protein), adipokines (leptin, adiponectin), and markers of insulin sensitivity. The specific aims include: 1) to determine the efficacy of fish oil supplements on rectal epithelial cell proliferation indexes and markers of rectal crypt apoptosis, and 2) to determine the effect of genetically-determined fatty acid desaturase 1 activity on fish oil supplementation for colorectal cancer chemoprevention. The investigators long-term objectives are to determine genetic factors that might influence the efficacy of fish oil supplementation in order to conduct a more definitive adenoma recurrence trial using marine-derived n-3 PUFAs. The investigators anticipate that fish oil will have anti-neoplastic effect and individuals with low FADS1 activity will have a greater response compared to individuals with high FADS1 activity

Conditions

Colorectal Adenomatous Polyps

Keywords

Colorectal Neoplasm

Outcome Measures

Primary Outcomes (2)

• Rectal Epithelial Cell Proliferation

  The primary outcome of interest is rectal epithelial cell proliferation, as measured by Ki67 (mib-1) labeling. Expression of Ki-67 in colon epithelial cells will be detected following the standard IHC protocol of EnVision™+ System, HRP (DAKO).

  6 month

• Rectal Epithelial Cell Apoptosis

  The primary outcome of interest is rectal epithelial cell apoptosis as measured by TUNEL (TdT-mediated dUTP Nick-End Labeling). The TUNEL assay is conducted to measure apoptosis of colon epithelium using DeadEnd Colorimetric TUNEL System (Promega). After all fields of each sample are measured, the final immunoreaction indices are generated automatically by setting algorithms as ''total positive area / total nuclear area. Apoptotic activity is also scored using standard morphologic criteria applied to H\&E stained sections.

  6 months

Secondary Outcomes (4)

• Rectal Epithelial Cell COX-2 Expression

  6 months

• Rectal Epithelial Cell 15-PGDH Expression

  6 months

• Rectal Epithelial Cell Phospholipid Fatty Acid Content

  6 months

• Rectal Epithelial Cell Production of PGE2 and PGE3

  6 months

Other Outcomes (3)

• C-reactive Protein

  6 months

• Adipokines

  6 months

• Insulin Sensitivity

  6 months

Study Arms (6)

rs174535 (GG), fish oil supplements

ACTIVE COMPARATOR

Eicosapentanoic acid and docosahexanoic acid

Drug: Eicosapentanoic acid and docosahexanoic acid

rs174535 (GG), placebo

PLACEBO COMPARATOR

Oleic Acid

Drug: Oleic Acid

rs174535 (GT), fish oil supplements

ACTIVE COMPARATOR

Eicosapentanoic acid and docosahexanoic acid

Drug: Eicosapentanoic acid and docosahexanoic acid

rs174535 (GT), placebo

PLACEBO COMPARATOR

Oleic Acid

Drug: Oleic Acid

rs174535 (TT), fish oil supplement

ACTIVE COMPARATOR

Eicosapentanoic acid and docosahexanoic acid

Drug: Eicosapentanoic acid and docosahexanoic acid

rs174535 (TT), placebo

PLACEBO COMPARATOR

Oleic Acid

Drug: Oleic Acid

Interventions

Eicosapentanoic acid and docosahexanoic acid DRUG

1395 mg EPA plus 1125 mg DHA daily for 24 weeks

Also known as: Lovaza

rs174535 (GG), fish oil supplements; rs174535 (GT), fish oil supplements; rs174535 (TT), fish oil supplement

Oleic Acid DRUG

Placebo

rs174535 (GG), placebo; rs174535 (GT), placebo; rs174535 (TT), placebo

Eligibility Criteria

• Age: 40 Years - 79 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• ≥ 40 and \< 80 years of age
• History of 1 or more adenomatous polyps
• Consent to be contacted for future studies
• Participants with known genotype for rs174535 in FADS1
• Prior participation in the Tennessee Colorectal Polyp Study or the Personalized Prevention of Colorectal Cancer Trial

You may not qualify if:

• Previously resected colorectal cancer
• Coronary artery disease or congestive heart failure
• Current metabolic or life-threatening disease
• Currently taking fish oil supplements
• Inability or unwillingness to stop NSAIDs or ASA during the study
• Allergic to fish products
• Diagnosis of inflammatory bowel disease
• Diagnosis of any cancer (except non-melanoma skin cancer)
• Diagnosis of liver or kidney disease
• Pregnant or breast feeding

Sponsors & Collaborators

• Vanderbilt University: lead
• National Cancer Institute (NCI): collaborator

Study Sites (1)

Vanderbilt University Medical Center

Nashville, Tennessee, 37232, United States

Location

Related Publications (1)

• Murff HJ, Shrubsole MJ, Cai Q, Su T, Dooley JH, Cai SS, Zheng W, Dai Q. N-3 Long Chain Fatty Acids Supplementation, Fatty Acids Desaturase Activity, and Colorectal Cancer Risk: A Randomized Controlled Trial. Nutr Cancer. 2022;74(4):1388-1398. doi: 10.1080/01635581.2021.1955286. Epub 2021 Jul 22.

  PMID: 34291724 DERIVED

MeSH Terms

Conditions

Colorectal Neoplasms

Interventions

Eicosapentaenoic Acid; Omacor; Oleic Acid

Condition Hierarchy (Ancestors)

Intestinal Neoplasms; Gastrointestinal Neoplasms; Digestive System Neoplasms; Neoplasms by Site; Neoplasms; Digestive System Diseases; Gastrointestinal Diseases; Colonic Diseases; Intestinal Diseases; Rectal Diseases

Intervention Hierarchy (Ancestors)

Fatty Acids, Omega-3; Dietary Fats, Unsaturated; Dietary Fats; Fats; Lipids; Eicosanoids; Fatty Acids, Unsaturated; Fatty Acids; Fish Oils; Oils; Oleic Acids; Fatty Acids, Monounsaturated

Limitations and Caveats

Did not reach target accrual rate in T/T arm

Results Point of Contact

• Title: Harvey J Murff
• Organization: Vanderbilt University Medical Center

harvey.j.murff@vanderbilt.edu

615 936 8319

Study Officials

• Harvey J Murff, MD, MPH

  Vanderbilt University

  PRINCIPAL INVESTIGATOR

Publication Agreements

• PI is Sponsor Employee: No
• Restrictive Agreement: No

Study Design

• Study Type: interventional
• Phase: phase 2
• Allocation: RANDOMIZED
• Masking: QUADRUPLE
• Who Masked: PARTICIPANT, CARE PROVIDER, INVESTIGATOR, OUTCOMES ASSESSOR
• Purpose: PREVENTION
• Intervention Model: FACTORIAL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Associate Professor

Study Record Dates

• First Submitted: August 7, 2012
• First Posted: August 9, 2012
• Study Start: February 4, 2013
• Primary Completion: December 26, 2016
• Study Completion: January 23, 2018
• Last Updated: June 8, 2018
• Results First Posted: May 8, 2018

Record last verified: 2018-05

Locations

US (1)