Breast cancer in Vitamin A's Points of View

By Kyle J. Norton

Vitamins form an important part in human diet. Epidemiological studies, linking vitamin A in reduced risk of breast cancer have produced uncleared result(1)(1a)(1b). But in certain studies, vitamin A in form of retinoids and carotenoids is effective in inhibition of breast cancer cell lines through many anti porfilerative and apoptotic pathways.

Vitamin A is a general term of Vitamin A Retinol, retinal, beta-carotene, alpha-carotene, gamma-carotene, and beta-cryptoxanthin best known for its functions for vision health and antioxidant scavenger and essential for growth and differentiation of a number of cells and tissues.
Recommended intakes of vitamin A, according to  the Institute of Medicine of the National Academies (formerly National Academy of Sciences) is 600 µg daily as extremely high doses (>9000 mg) can be toxicity as causes of dry, scaly skin, fatigue, nausea, loss of appetite, bone and joint pains, headaches, etc.

1. Retinols
Lack of the retinoic acid receptor beta (RAR beta) gene expression causes of abnormal regulation by retinoic acid (RA) are common features in human lung cancer and breast cancer cells(2)
Suggestion of using retinoids, the natural and synthetic vitamin A derivatives in chemoprevention because of its function in modification of abnormal dell growth in Cancer tissues(3) by exerting anticancer effects through its retinoid receptors, the RA receptors (RARs) and retinoid X receptors (RXRs)in regualating the target gene causes of the diseases(4). In SK-BR-3 and T47D human breast cancer cells, retinoid showed to be effectively in regulates mammary epithelial cell growth and differentiation through signaling via retinoic acid (RA) and retinoid X receptors (RARs and RXRs) leading to apoptosis in ER- SK-BR-3 and ER+ T47D breast cancer cells(5). All-trans retinoic acid(ATRA), a synthetic version of vitamin A, showed effectively in inhibition of  breast cancer stem cells, NCSCs and CSCs, through impairment of the self-renewing ability of CSCs and promotion of  CSCs to differentiate(6). In human breast cancer cell lines of MDA-MB-468 and MCF-7, ATRA inhibited the proliferation and the expression of BP1(expression of BP1 protein correlated with breast tumor progression and invasion) in breast cancer cells(7).
 In human breast cancer MDA-MB-231 cells, the synthetic retinoid 4-amino-2-tri-fluoromethyl-phenyl ester (ATPR) inhibited cells reduced migration and reduced phosphorylation of ERK(cellular proliferation, differentiation, and survival), JNK(cellular apoptosis) and p38(highly expressed in aggressive and invasive breast cancers) in breast cancer(8). Retinoic acid (RA), a vitamin A metabolite, induced breast cancer cell apoptosis through type I IFN autocrine (activation of T cells, B cells, and natural killer cells)signaling, caspase-8 and caspase-3(Cell apoptosis) activation, as well as TRAIL(induces the process of cell death) signaling(9). Taking to these accounts, Retinols may be beneficial as a potent agent in preventing and treating breast cancer.

2. Carotenoids(beta-carotene, alpha-carotene, gamma-carotene and beta-cryptoxanthin)
Carotenoids, plant pigments, converted to vitamin A after intake, though to play an important role in prevention and treatment of some diseases through it antioxidant effects.
In postmenopausal women, dietary beta-carotene intake is found to be effective in reduced risk of breast caner with or without high alcohol intake(11)(12)(13)(16). Other studies of circulating carotenoids, also showed that high levels of beta carotene circulation are associated to decreased risk of breast cancer(14).
In the risk of breast cancer by estrogen receptor (ER) and progesterone receptor (PR),  β-carotene intakes were inversely associated with the risk of ER-negative (ER-)but not ER- positive breast cancer cell lines(15). In genetic polymorphisms of NOS3, intake of β-carotene modified and protected against risk of breast cancer predominantly in individuals with the TG:TG diplotype of NOS3(17). In related with other supplements, intake of multivitamins including  beta-carotene, vitamin C, vitamin E and zinc for 10 Years or more may protect from developing breast cancer in postmenopausal women(18). biologically, the protection of antioxidants including β-carotene against breast cancer was associated to activation of  immune response in the course of the disease(19). In smokers, dietary alpha-carotene and beta-carotene are associated with reduced risk of breast cancer among women who do not use dietary supplements(20).
In estrogen receptor (ER) and progesterone receptor (PR) status, intakes of α-carotene was associated with reduced risk of ER-, but not ER+, breast cancer(15). In women with high mammographic density, using a computer-assisted thresholding method, total carotenoids were associated with a 50% reduction in breast cancer risk(21). In a total of 969 cases of breast cancer diagnosed after blood draw and prior to June 1, 1998, alpha carotene was inversely associated in reduced risk of breast cancer greater for invasive cancers with nodal metastasis(22). In invasive breast cancer, high consumption of carotenoids may reduce risk of of breast cancer in premenopausal but not postmenopausal women, particularly among smokers, including alpha-carotene(23). In comparison of blood concentrations of carotenoids and carotenoids assessed by dietary questionnaires, showed strong relationship between biomarkers and the reduced risk of breast cancer(24). In breast cancers defined by estrogen receptor (ER) and progesterone receptor (PR) status, dietary alpha-carotene was inversely associated with risk of ER+PR+breast cancer, but not with other breast cancer groups jointly defined by ER and PR status(25). In the study of gene O(6)-methylguanine DNA methyl-transferase (MGMT) involved in cellular defense against, dietary antioxidants are associated to inversely reduce risk of breast cancer through possible modulation of polymorphisms in MGMT(26).
In malignant melanoma, mammary carcinoma and lung adenocarcinoma cells growth, water and ethanol extracts from glaucophyte Cyanophora paradoxa (Cp) with Pheophorbide a, β-cryptoxanthin and zeaxanthin were found to significantly inhibit the growth of the three cancer cell lines mentioned above in vitro, at 100 µg · mL..(27). In the study of the associations of plasma levels of tocopherols, retinol, carotenoids with the risk of developing breast cancer among Chinese women, researcers found that high levels of plasma lycopene other than trans, 5- and 7-cis or trans alpha-cryptoxanthin were inversely associated with the risk of developing breast cancer(28).

Dietary vitamin A, includes retinol, retinal, retinoic acid, and several provitamin A carotenoids has been found significantly in reduced risk and treatment of  breast cancer through modification of malignant cell growth, expression of down-regulation of pro proliferative and up-regualtion of apoptotic pathway. Regardless to its anti-breast cancer effects, overdoses can lead to toxic symptoms. Please make sure you follow the guideline of the Institute of Medicine of the National Academies.

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References
(1) Vitamin supplement consumption and breast cancer risk: a review by Misotti AM, Gnagnarella P.(PubMed)
(1a) Vitamins C and E, retinol, beta-carotene and dietary fibre in relation to breast cancer risk: a prospective cohort study by Verhoeven DT, Assen N, Goldbohm RA, Dorant E, van 't Veer P, Sturmans F, Hermus RJ, van den Brandt PA.(PubMed)
(1b)Micronutrient intake and breast cancer characteristics among postmenopausal women by Roswall N, Olsen A, Christensen J, Dragsted LO, Overvad K, Tjønneland A.(PubMed)
(2) Retinoid receptors in human lung cancer and breast cancer by Zhang XK, Liu Y, Lee MO.(PubMed)
(3) Retinoids in cancer chemoprevention by Okuno M, Kojima S, Matsushima-Nishiwaki R, Tsurumi H, Muto Y, Friedman SL, Moriwaki H.(PubMed)
(4) Inhibition of trans-retinoic acid-resistant human breast cancer cell growth by retinoid X receptor-selective retinoids by Wu Q, Dawson MI, Zheng Y, Hobbs PD, Agadir A, Jong L, Li Y, Liu R, Lin B, Zhang XK.(PubMed)
(5) Activation of retinoic acid receptor alpha is sufficient for full induction of retinoid responses in SK-BR-3 and T47D human breast cancer cells by Schneider SM, Offterdinger M, Huber H, Grunt TW.(PubMed)
(6) [All-trans retinoic acid effectively inhibits breast cancer stem cells growth in vitro].

[Article in Chinese] by Zeng WG, Hu P, Wang JN, Liu RB.(PubMed)

(7) [Effects of all trans retinoic acid on the expression alterations of beta-protein 1 in human breast cancer cell lines of MDA-MB-468 and MCF-7].[Article in Chinese by Su J, Li MQ, Zhong GS.(PubMed)

(8) A novel all-trans retinoid acid derivatives inhibits the migration of breast cancer cell lines MDA-MB-231 via myosin light chain kinase involving p38-MAPK pathway by Wang B, Yan Y, Zhou J, Zhou Q, Gui S, Wang Y.(PubMed)

(9) Synergy between RA and TLR3 promotes type I IFN-dependent apoptosis through upregulation of TRAIL pathway in breast cancer cells by Bernardo AR, Cosgaya JM, Aranda A, Jiménez-Lara AM.(PubMed)
(10) Cis-retinol dehydrogenase: 9-cis-retinol metabolism and its effect on proliferation of human MCF7 breast cancer cells by Paik J, Blaner WS, Swisshelm K.(PubMed)
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(13) Dietary carotenoids and risk of breast cancer in Chinese women by Huang JP, Zhang M, Holman CD, Xie X.(PubMed)
(14) Circulating carotenoids and risk of breast cancer: pooled analysis of eight prospective studies by Eliassen AH, Hendrickson SJ, Brinton LA, Buring JE, Campos H, Dai Q, Dorgan JF, Franke AA, Gao YT, Goodman MT, Hallmans G, Helzlsouer KJ, Hoffman-Bolton J, Hultén K, Sesso HD, Sowell AL, Tamimi RM, Toniolo P, Wilkens LR, Winkvist A, Zeleniuch-Jacquotte A(PubMed)
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(18) Antioxidants and breast cancer risk- a population-based case-control study in Canada by Pan SY, Zhou J, Gibbons L, Morrison H, Wen SW; Canadian Cancer Registries Epidemiology Research Group [CCRERG].(PubMed).
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(20) Dietary carotenoids and risk of hormone receptor-defined breast cancer in a prospective cohort of Swedish women by Larsson SC, Bergkvist L, Wolk A.(PubMed)
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(23) Dietary carotenoids and the risk of invasive breast cancer by Mignone LI, Giovannucci E, Newcomb PA, Titus-Ernstoff L, Trentham-Dietz A, Hampton JM, Willett WC, Egan KM.(PubMed)
(24) Dietary compared with blood concentrations of carotenoids and breast cancer risk: a systematic review and meta-analysis of prospective studies by Aune D, Chan DS, Vieira AR, Navarro Rosenblatt DA, Vieira R, Greenwood DC, Norat T.(PubMed)
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(28) Plasma carotenoids, tocopherols, retinol and breast cancer risk: results from the Shanghai Women Health Study (SWHS) by Dorjgochoo T, Gao YT, Chow WH, Shu XO, Li H, Yang G, Cai Q, Rothman N, Cai H, Franke AA, Zheng W, Dai Q.(PubMed)