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- Title
Proliferative Changes in the Bronchial Epithelium of Former Smokers Treated With Retinoids.
- Authors
Hittelman, Walter N.; Liu, Diane D.; Kurie, Jonathan M.; Lotan, Reuben; Jin Soo Lee; Fadlo Khuri; Ibarguen, Heladio; Morice, Rodolfo C.; Walsh, Garrett; Roth, Jack A.; Minna, John; Ro, Jae Y.; Broxson, Anita; Waun Ki Hong; Lee, J. Jack
- Abstract
Background Retinoids have shown antiproliferative and chemopreventive activity. We analyzed data from a randomized, placebo-controlled chemoprevention trial to determine whether a 3-month treatment with either 9-cis-retinoic acid (RA) or 13-cis-RA and α-tocopherol reduced Ki-67, a proliferation biomarker, in the bronchial epithelium. Methods Former smokers (n = 225) were randomly assigned to receive 3 months of daily oral 9-cis-RA (100 mg), 13-cis-RA (1 mg/kg) and α-tocopherol (1200 IU), or placebo. Bronchoscopic biopsy specimens obtained before and after treatment were immunohistochemically assessed for changes in the Ki-67 proliferative index (i.e., percentage of cells with Ki-67-positive nuclear staining) in the basal and parabasal layers of the bronchial epithelium. Per-subject and per-biopsy site analyses were conducted. Multicovariable analyses, including a mixed-effects model and a generalized estimating equations model, were used to investigate the treatment effect (Ki-67 labeling index and percentage of bronchial epithelial biopsy sites with a Ki-67 index ≥ 5%) with adjustment for multiple covariates, such as smoking history and metaplasia. Coefficient estimates and 95% confidence intervals (Cls) were obtained from the models. All statistical tests were two-sided. Results In per-subject analyses, Ki-67 labeling in the basal layer was not changed by any treatment; the percentage of subjects with a high Ki-67 labeling in the parabasal layer dropped statistically significantly after treatment with 13-cis-RA and α-tocopherol treatment (P = .04) compared with placebo, but the drop was not statistically significant after 9-cis-RA treatment (P= .17). A similar effect was observed in the parabasal layer in a per-site analysis; the percentage of sites with high Ki-67 labeling dropped statistically significantly after 9-cis-RA treatment (coefficient estimate = -0.72, 95% CI = -1.24 to -0.20; P= .007) compared with placebo, and after 13-cis-RA and α-tocopherol treatment (coefficient estimate = -0.66, 95% CI = -1.15 to -0.17; P = .008). Conclusions In per-subject analyses, treatment with 13-cis-RA and α-tocopherol, compared with placebo, was statistically significantly associated with reduced bronchial epithelial cell proliferation; treatment with 9-cis-RA was not. In per-site analyses, statistically significant associations were obtained with both treatments.
- Subjects
BRONCHIAL diseases; RETINOIDS; CIGARETTE smokers; EPITHELIUM; MEDICAL research; MEDICAL care; THERAPEUTICS
- Publication
JNCI: Journal of the National Cancer Institute, 2007, Vol 99, Issue 21, p1603
- ISSN
0027-8874
- Publication type
Article
- DOI
10.1093/jnci/djm205