Background
Hyperinsulinemia resulting from obesity and insulin resistance is associated with increased risk of many cancers, but the biology underlying this risk is unclear. We hypothesized that increased mRNA levels of the insulin-like growth factor 1 receptor (IGF1R) versus the insulin receptor (IR) or elevated ratio of IR-A:IR-B isoforms in normal rectal mucosa would predictadenoma risk, particularly in individuals with high body mass index (BMI) or plasma insulin.
Methods
Biopsies from normal rectal mucosa were obtained from consenting patients undergoing routine colonoscopy at UNC Hospitals. Subjects with colorectal adenomas were classified as cases (n = 100) and were matched to adenoma-free controls (n = 98) based on age, sex and BMI. IGF1R and IR mRNA levels were assessed by qRT-PCR, and IR-A:IR-B mRNA ratios by standard PCR. Plasma insulin and crypt apoptosis were measured by ELISA and TUNEL, respectively. Logistic regression models examined relationships between receptor mRNAs, BMI, plasma insulin and adenoma risk.
Results
Unexpectedly, cases were significantly more likely to have lower IGF1R mRNA levels than controls. No overall differences in total IR mRNA or IR-A:IR-B ratios were observed between cases and controls. Interestingly, in patients with high plasma insulin, increased IR-A:IR-B ratio was associated with increased likelihood of having adenomas.
Conclusions
Our work shows novel findings that reduced IGF1R mRNA and, during high plasma insulin, increased IR-A:IR-B ratios in normal rectal mucosa are associated with colorectal adenoma risk.
Impact
Our work provides evidence supporting a link between IGF1R and IR isoform expression levels and colorectal adenoma risk.