4.7 Article

Polymorphisms in genes of the renin-angiotensin-aldosterone system and renal cell cancer risk: Interplay with hypertension and intakes of sodium, potassium and fluid

Journal

INTERNATIONAL JOURNAL OF CANCER
Volume 136, Issue 5, Pages 1104-1116

Publisher

WILEY
DOI: 10.1002/ijc.29060

Keywords

Diet; hypertension; polymorphism; renal cell cancer risk; renin-angiotensin-aldosterone system

Categories

Funding

  1. Dutch Cancer Society [UM 2009-4536]

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Hypertension is an established risk factor for renal cell cancer (RCC). The renin-angiotensin-aldosterone system (RAAS) regulates blood pressure and is closely linked to hypertension. RAAS additionally influences homeostasis of electrolytes (e.g. sodium and potassium) and fluid. We investigated single nucleotide polymorphisms (SNPs) in RAAS and their interactions with hypertension and intakes of sodium, potassium and fluid regarding RCC risk in the Netherlands Cohort Study (NLCS), which was initiated in 1986 and included 120,852 participants aged 55 to 69 years. Diet and lifestyle were assessed by questionnaires and toenail clippings were collected. Genotyping of toenail DNA was performed using the SEQUENOM (R) MassARRAY (R) platform for a literature-based selection of 13 candidate SNPs in seven key RAAS genes. After 20.3 years of follow-up, Cox regression analyses were conducted using a case-cohort approach including 3,583 subcohort members and 503 RCC cases. Two SNPs in AGTR1 were associated with RCC risk. AGTR1_rs1492078 (AA vs. GG) decreased RCC risk [hazard ratio (HR) (95% confidence interval (CI)): 0.70(0.49-1.00)], whereas AGTR1_rs5186 (CC vs. AA) increased RCC risk [HR(95%CI): 1.49(1.08-2.05)]. Associations were stronger in participants with hypertension. The RCC risk for AGT_rs3889728 (AG + AA vs. GG) was modified by hypertension (p interaction = 0.039). SNP-diet interactions were not significant, although HRs suggested interaction between SNPs in ACE and sodium intake. SNPs in AGTR1 and AGT influenced RCC susceptibility, and their effects were modified by hypertension. Sodium intake was differentially associated with RCC risk across genotypes of several SNPs, yet some analyses had probably inadequate power to show significant interaction. Results suggest that RAAS may be a candidate pathway in RCC etiology. What's new? The renin-angiotensin-aldosterone system (RAAS) regulates blood pressure and salt homeostasis in the kidney and may, therefore, reflect a mechanism potentially underlying associations between hypertension or sodium intake and risk of renal cell cancer (RCC). In this prospective cohort study, several polymorphisms in RAAS genes, specifically in AGT, AGTR1, and ACE, were found to be associated with RCC risk. For polymorphisms in AGT and AGTR1, associations may be modified by hypertension, while for variants in ACE, suggestive biologic interaction with sodium intake was observed.

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