Journal Article

Effects of ALDH2 Genotype, PPI Treatment and L-Cysteine on Carcinogenic Acetaldehyde in Gastric Juice and Saliva after Intragastric Alcohol Administration

Shimosegawa, Tooru, Kaihovaara, Pertti, Salaspuro, Mikko, Imatani, Akira, Maejima, Ryuhei, Koike, Tomoyuki, Iijima, Katsunori, Hatta, Waku

2015

Overview

Acetaldehyde (ACH) associated with alcoholic beverages is Group 1 carcinogen to humans (IARC/WHO). Aldehyde dehydrogenase (ALDH2), a major ACH eliminating enzyme, is genetically deficient in 30-50% of Eastern Asians. In alcohol drinkers, ALDH2-deficiency is a well-known risk factor for upper aerodigestive tract cancers, i.e., head and neck cancer and esophageal cancer. However, there is only a limited evidence for stomach cancer. In this study we demonstrated for the first time that ALDH2 deficiency results in markedly increased exposure of the gastric mucosa to acetaldehyde after intragastric administration of alcohol. Our finding provides concrete evidence for a causal relationship between acetaldehyde and gastric carcinogenesis. A plausible explanation is the gastric first pass metabolism of ethanol. The gastric mucosa expresses alcohol dehydrogenase (ADH) enzymes catalyzing the oxidation of ethanol to acetaldehyde, especially at the high ethanol concentrations prevailing in the stomach after the consumption of alcoholic beverages. The gastric mucosa also possesses the acetaldehyde-eliminating ALDH2 enzyme. Due to decreased mucosal ALDH2 activity, the elimination of ethanol-derived acetaldehyde is decreased, which results in its accumulation in the gastric juice. We also demonstrate that ALDH2 deficiency, proton pump inhibitor (PPI) treatment, and L-cysteine cause independent changes in gastric juice and salivary acetaldehyde levels, indicating that intragastric acetaldehyde is locally regulated by gastric mucosal ADH and ALDH2 enzymes, and by oral microbes colonizing an achlorhydric stomach. Markedly elevated acetaldehyde levels were also found at low intragastric ethanol concentrations corresponding to the ethanol levels of many foodstuffs, beverages, and dairy products produced by fermentation. A capsule that slowly releases L-cysteine effectively eliminated acetaldehyde from the gastric juice of PPI-treated ALDH2-active and ALDH2-deficient subjects. These results provide entirely novel perspectives for the prevention of gastric cancer, especially in established risk groups.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Acetaldehyde / Acetaldehyde - analysis / Acetaldehyde - metabolism / Acetaldehyde - toxicity / Adult / Alcohol dehydrogenase / Alcohol Drinking / Alcohol use / Alcoholic beverages / Aldehyde dehydrogenase / Aldehyde Dehydrogenase - genetics / Aldehyde Dehydrogenase, Mitochondrial / Aldehydes / Beverage industry / Beverages / Cancer / Carcinogenesis / Carcinogens / Carcinogens - analysis / Carcinogens - metabolism / Carcinogens - toxicity / Cysteine / Cysteine - pharmacology / Cystine / Dairy products / Dehydrogenase / Enzymes / Esophageal cancer / Esophagus / Ethanol / Ethanol - analysis / Ethanol - metabolism / Fermentation / Gastric cancer / Gastric juice / Gastric Juice - metabolism / Gastric mucosa / Gastric Mucosa - drug effects / Gastric Mucosa - enzymology / Gastric Mucosa - metabolism / Genetic aspects / Genotype / Head / Head & neck cancer / Head and neck cancer / Health risks / Helicobacter pylori / Humans / Hydrogen-Ion Concentration / Male / Metabolism / Oxidation / Physiological aspects / Proton pump inhibitors / Proton Pump Inhibitors - administration & dosage / Risk factors / Risk groups / Saliva / Saliva - metabolism / Stomach / Stomach cancer / Substance abuse treatment / Thiols