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Background  The distribution and the potential gene-gene and gene-environment interaction of selected metabolic genetic polymorphisms was investigated in relation to gastric cancer risk in an Italian population.    Methods  One hundred and seven cases and 254 hospital controls, matched by age and gender, were genotyped for  CYP1A1 ,  CYP2E1 ,  mEH ,  GSTM1 ,  GSTT1 ,  NAT2  and  SULT1A1  polymorphisms. Haplotype analysis was performed for  EPHX1  exons 3 and 4, as well as  CYP2E1 Rsa I ( *5  alleles) and  CYP2E1 Dra I ( *5A  or  *6  alleles). The effect modification by alcohol and cigarette smoking was tested with the heterogeneity test, while the attributable proportion (AP) was used to measure the biological interaction from the gene-gene interaction analysis.    Results  Gastric cancer risk was found to be associated with the inheritance of  GSTT1  null genotype (OR = 2.10, 95%CI: 1.27–3.44) and the  SULT1A1  His/His genotype (OR = 2.46, 95%CI: 1.03–5.90). No differences were observed for the haplotype distributions among cases and controls. For the first time an increased risk was detected among individuals carrying the *6 variant allele of  CYP2E1  if ever-drinkers (OR = 3.70; 95%CI: 1.45–9.37) with respect to never-drinkers (OR = 0.18; 95% CI: 0.22–1.46) ( p  value of heterogeneity among the two estimates = 0.001). Similarly, the effect of  SULT1A1  variant genotype resulted restricted to ever-smokers, with an OR of 2.58 (95%CI: 1.27–5.25) for the carriers of His allele among smokers, and an OR of 0.86 (95%CI: 0.45–1.64) among never-smokers ( p  value of heterogeneity among the two estimates = 0.03). The gene-gene interaction analyses demonstrated that individuals with combined  GSTT1  null and  NAT2  slow acetylators had an additional increased risk of gastric cancer, with an OR of 3.00 (95%CI: 1.52–5.93) and an AP of 52%.    Conclusion   GSTT1 ,  SULT1A1  and  NAT2  polymorphisms appear to modulate individual's susceptibility to gastric cancer in this Italian population, particularly when more than one unfavourable genotype is present, or when combined with cigarette smoke. The increased risk for the carriers of  CYP2E1 * 5A  or * 6  alleles among drinkers need to be confirmed by larger prospective studies.

bmc cancer

Polymorphisms in metabolic genes, their combination and interaction with tobacco smoke and alcohol consumption and risk of gastric cancer: a case-control study in an Italian population