Caucasian American Patients Research Articles

FBXW7 as a Factor of the African American and White Breast Cancer Racial Disparity.

African American womenhave a breast cancer mortality rate 40% higher than Caucasian women. Many contributing factors account for this racial disparity, such as socioeconomic status and the age when women give birth, but even after considering such factors, studies have found that the racial disparity persists, suggesting that genetic factors may play a crucial role in this breast cancer racial inequality. This study utilizes the All of Us database, The Cancer Genome Atlas (TCGA), and an array of bioinformatics tools to integrate differentialmutation and gene expression analyses, aiming to identify genes potentially associated with this racial disparity. Although previous studies have identified genes associated with this breast cancer racial disparity through mutation or gene expression analysis, no studies have considered both simultaneously. Ultimately, this studyconsiders both mutation and gene expression to discovernovel genes linked to this racial disparity. Aftermutation analysis, this study identifiedFBXW7,a gene involved in the destruction of oncogenic proteins, as being associated with this racial inequality. FBXW7 was the only gene that presented differences in both mutation frequency and gene expression between African Americans and Caucasians. The other four candidate genes, such asCOL12A1,whose upregulation plays a critical role in tumor progression, may also be linked to this racial inequality. By combining both mutation and gene expression analysis, this research offers a unique perspective into this issue. Furthermore, the identification ofFBXW7provides insight into this racial disparity, which can contribute to the pursuit of more effective or personalized treatment for both Caucasian and African American breast cancer patients. Finally, the multi-level method presented could possibly apply to other racial disparities, providing a distinctive perspective that cannot be found with other methods.

Improved Cardiac Rehabilitation Referral Rate Utilizing a Multidisciplinary Quality Improvement Team.

Introduction Cardiac rehabilitation (CR) is an underutilized resource in patients with ischemic heart disease, despite being a Class IA recommendation. In this study, a multidisciplinary quality improvement (QI) team aimed to improve CR referrals by standardizing the ordering process at our hospital system. Method By using a collaborative approach involving the electronic medical record (EMR), medical provider education, and hospital protocols, our two-hospital healthcare system was able to successfully identify barriers to CR referral rates and implement interventions for these barriers. All physicians and medical providers, including ancillary staff, were educated on the EMR order sets to improve compliance by using automated order sets in the EMR. The CR referral order in the EMR included a statement regarding the application of evidence-based medicine, and a computerized provider order entry was included as a reminder to the ordering provider. The use of EMR was monitored monthly by the QI committee. Chi-square test and odds ratios were obtained for statistical analysis. Results Through provider-EMR education and patient education on discharge, CR referral rates significantly improved from 51.2 to 87.1% (p = 0.0001) in a 12-month period. The study included 1,499 patients in total. The improvement was statistically significant regardless of patient gender, race, or insurance coverage. Additionally, subgroup analysis in this study found that prior to standardization of the ordering process, African American patients were significantly less likely to be referred to CR compared to Caucasian patients. (51.2% vs. 41.0%, p=0.01). There was no statistically significant difference in the likelihood of CR referral between Caucasian and African American patients following the intervention (84.0% vs. 78.0%, p = 0.166). Conclusion This study shows that CR is an underutilized resource and that effective QI initiatives may not only increase CR referral rates but also close the gap between racial inequities in referral rates. Future research with multi-center randomized control trials is needed to further enhance its external generalizability to other institutions.

Abstract LB312: Subtype- and race-specific differences in immune landscape of breast cancer

Abstract Tumor mass comprises of not just the tumor cells but a variety of stromal cells. Immune cells residing within the tumor microenvironment modulate the growth and behavior of the tumor cells through a bi-directional crosstalk and affect the outcomes of cancer therapies. Breast cancer (BC) is a highly heterogeneous disease having four major molecular subtypes. Triple-negative breast cancer (TNBC) is the most aggressive subtype and has limited available therapeutic options. Further, it disproportionately affects African American (AA) women, with nearly two times higher incidence as compared to Caucasian American (CA) women. It is associated with an earlier onset and overall higher mortality of BC. Here, we investigated the differences in the immune landscape between TNBC and non-TNBC subtypes and examined if there existed any race-specific patterns. A total of 81 breast cancer samples with a distribution of 55 non-TNBC (28 CA and 27 AA) and 26 TNBC (12 CA and 14 AA) were selected after histopathologic analysis. Tissues were analysis using the NanoString nCounter® pancancer immune panel to determine tissue-specific immune cell populations. We observed a significantly higher presence of tumor-infiltrating lymphocytes in TNBC compared to non-TNBC, with a higher immune score for CD45+ (total lymphocytes), T-cells, B-cells and tumor-associated macrophages. Specifically, among the T-cell population, Treg cells, Th1 cells, and CD8+ cells were higher in TNBC samples. The pathway prediction indicated 'primary immunodeficiency' and 'cancer immunotherapy by PD-1 blockade' pathways being significantly up-regulated in TNBC samples. Overexpression of CTLA4, IDO1, PDL1 and PDL2 as well as Treg marker genes, such as FOXP3 and LAG3, which are involved in immunosuppressive pathways, was observed in TNBC. In race-wise comparisons of non-TNBC and TNBC sample between CA and AA patients, we found that AA non-TNBC tumors had higher Treg cell scores. On the other hand, CA TNBC samples had higher Th1 and CD8+ T-cell scores compared to AA TNBC. The pathway prediction from differentially expressed genes between CA and AA non-TNBC samples showed complement activation pathway to be down-regulated in AA patients, which could be associated with an increased presence of Treg cells. Further, when comparing CA vs AA TNBC samples, we found significant up-regulation of oncogene BMI1 and down-regulation of genes involved in T-cell activation such as CD47, CD44, FOS, and S100A8 in AA TNBC, supporting their more aggressive nature. In conclusion, our data show that TNBC patients have a higher infiltration of immune cells, which remain suppressed due to the presence of Treg cells and PD1 signaling pathway. The presence of higher Treg cells in AA non-TNBC and lower Th1 and CD8+ T-cells in AA TNBC samples suggests an overall immune suppressed microenvironment in AA patients compared to CA patients. Overall, our data suggest that TNBC could be good candidate for immune therapy. Citation Format: Amod Sharma, Kunwar Somesh Vikramdeo, Sarabjeet Kour Sudan, Mohammad Aslam Khan, Mohammad Tahir, James Elliot Carter, Cindy Nelson, Ajay P Singh, Seema Singh. Subtype- and race-specific differences in immune landscape of breast cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 2 (Late-Breaking, Clinical Trial, and Invited Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(7_Suppl):Abstract nr LB312.

Abstract 1014: Disparities of triple negative breast cancer in Mississippi

Abstract Background: Triple-negative breast cancer (TNBC) accounts for about 10-15% of all breast cancers nationwide with disparities of incidence and outcomes among races, geographic locations, and other factors. This study is aimed to analyze the differences in the rate of TNBC, patient conditions at time of diagnosis, and death from TNBC among women in Mississippi. Methods: A retrospective study was conducted to serially review breast cancer cases diagnosed in the University of Mississippi Medical Center during May 2016 to May 2023. The entire breast cancer population was then stratified by race. The rate of TNBC, age and BMI at time of diagnosis, the rate of expiration were compared between African American (AA) and Caucasian American (CA) women with breast cancer. Two-tailed Student’s T-test was used to calculate the difference in mean values, and Chi-Square Test was used to compare the difference in rates or percentages. The significant p value was set at p<0.05. Results: In total 291 women with breast cancer, AA patients were 195 (67.01%), CA patients were 88 (30.24%), and other were 8 (2.75%). The mean age of all patients was 58.3 years-old (ranged 24-97). The mean BMI was 31.19. The patients with TNBC were 109 (37.46%) in entire studied population. A total of 32 (1.6%) patients, including 14 TNBC and 18 non-TNBC were expired with an average age of 61.84 and an average survival time of 20 months from diagnosis to expiration. As compared to CA patient population, AA breast cancer patients had onset at younger age (58.08±0.88 vs. 59.18±1.36), had a higher BMI (31.79±0.62 vs. 28.25±1.05, p=0.017), higher percentage of TNBC (41.54% vs. 30.68%, p=0.082 and OR=1.605), and higher rate of expiration (11.28% vs, 9.1%). Also, as compared to CA expired patients with breast cancer, AA expired patients had higher BMI (29.57 vs. 28.61), shorter survival time (17.5 months vs. 19.4 months), and died at younger age (61.84-year old vs. 66.38-year old) with a higher proportion of TNBC subtype (54.6% vs 12.5%, p=0.045, OR=9.6). Conclusions: Breast cancer is greatly disparate racially between AA and CA and geographically between Mississippi and US national average. The disparities are manifested in the proportion of TNBC subtype, age at onset of breast cancer, BMI at time of diagnosis, and death rate. Citation Format: Navdeep Kaur, Javaria A. Khan, Jinghe Mao, Diva Melvin, Muhammad M. Hassan, Xinchun Zho. Disparities of triple negative breast cancer in Mississippi [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 1014.

Abstract C052: Effect of ginger extracts on hepatocellular carcinoma cell lines-derived from Caucasian, Asian, and African American patients

Abstract Hepatocellular Carcinoma (HCC) is a highly fatal disease with mortality running parallel to its incidence. For HCC, race/ethnicity plays a vital role in determining incidence, mortality, and survival rates. The incidence of HCC is highest in Asia and Africa. Furthermore, there is a statistically significant increase in incidence and mortality and a decrease in 5-year survival rates in African American (AA)/Black patients compared to non-Hispanic white patients. There is a knowledge gap in our understanding of the molecular mechanism underlying the HCC racial disparity between AA/Black, White, and Asian patients. To understand the underlying cause, we performed bioinformatics on existing gene expression data. We found that type I Interferon (IFN-I) signaling pathway showed statistically significant activation in AA/Black patients compared to white patients. Over 60% of Gen Xers/Millennials are taking a more holistic approach to their diet to prevent chronic diseases, including cancer. We hypothesized that dietary compounds exert anticancer effects on HCC, and because of their anti-inflammatory property, they might modulate the IFN-I signaling pathway. We tested ginger extracts on HCC derived from white (HepG2), Black (Hep3B and O/20), and Asian (Hu7) cancer patients. A dose-response of these extracts was used to determine IC50s on these cell lines using an MTT cell proliferation assay. Activation of INF-1-mediated downstream signaling proteins, including JAK1, TYK2, STAT1, and STAT2 phosphorylation status, was determined on a Western blot analysis using phospho-specific primary antibodies. The expression of Interferon Signaling Genes (ISGs), including Myxovirus resistance gene 1 (MX1), 2′,5′-oligoadenylate synthetase (OAS1), Interferon-alpha inducible protein 6 (IFI6), and Interferon stimulated gene 15 (ISG15) was assayed using a quantitative Real-Time Polymerase Chain Reaction (RT-PCR). Ginger has a significantly (P<0.05) lower IC50s (mg/ml) on cell lines from Black patients (Hep3B=156 ± 3, and O/20=162 ± 3) than cell lines from white (HepG2=176±5) or Asian (Hu7=174 ± 5) patients. Our data show that untreated cells exhibited phosphorylation/activation of IFN-1 downstream mediators, including JAK1, TYK2, STAT1, and STAT2 proteins. Ginger treatment reduced the phosphorylation of these IFN downstream mediators in all HCC cell lines. Furthermore, expression of MX1, ISG15, IF16, and OAS1 was also reduced in all HCC cells lines in a dose-dependent manner; however, the effects on gene expression were more sensitive to a lower concentration of ginger extract in Black patients derived HCC cell lines than other HCC cell lines. Currently, research is underway to identify the active chemical agent in ginger and test it on other patient-derived HCC lines and in an in vivo model. In conclusion, our data suggest that ginger can potentially attenuate IFN-mediated signaling pathways in HCC, and cells from Black HCC patients may be more sensitive to ginger (Funded: P20 CA264068-01). Citation Format: Sadia Kanwal, Eva Davis, Seung Lee, Milton Omar Faison, Devanand Sarkar, Rafat Ali Siddiqui. Effect of ginger extracts on hepatocellular carcinoma cell lines-derived from Caucasian, Asian, and African American patients [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr C052.

Abstract 14474: Racial Disparities in Arrhythmias Among Patients With Cardiac Sarcoidosis in the United States From 2016-2020

Background: Cardiac sarcoidosis (CS) is frequently associated with conduction abnormalities and arrhythmias. In this study, we aim to evaluate racial disparities in the frequency of arrhythmias, and associated co-morbidities, among patients with CS. Methods: Caucasian and African American (AA) patients with a diagnosis of CS were identified and compared from the 2016-2020 National Inpatient Sample (NIS) database whilst adjusting for confounders via logistic regression models. Results: A total of 8825 patients with cardiac sarcoidosis comprising 44.1% Caucasian and 45.8% AA patients were included. Both cohorts had a male preponderance (Caucasian males: 64.3% vs. AA males 55.2%, p<0.01). AA patients had a longer mean length of stay (7.74 vs. 6.64 days, p<0.01), a higher mean Charlson Comorbidity Index score (3.36 vs. 2.63, p<0.01), a greater prevalence of cirrhosis (3.2% vs. 2.1%, p<0.01), diabetes (44.7% vs. 31.2%, p<0.01), alcohol abuse (4.0% vs. 2.2%, p<0.01), smoking (37.4% vs. 26.8%, p<0.01), obesity (31.1% vs. 27.9%, p<0.01) and chronic kidney disease (40% vs. 28.1%, p<0.01). Caucasian patients had a greater history of hypertension (17.1% vs. 14.5%, p<0.01) and prior percutaneous coronary intervention (6.2% vs. 3.1%, p<0.01). Moreover, AA patients had a lower incidence of various cardiac arrhythmias (vs. Caucasians) such as atrial fibrillation (31.3% vs. 36.2% vs, p<0.01), ventricular tachycardia (29.8% vs. 37.9% p<0.01), ventricular fibrillation (5.3% vs. 7.2%, p<0.01) and complete atrioventricular block (AVB) (6.4% vs. 14.6%, p<0.01). However, a higher incidence of complications such as cardiogenic shock, acute kidney injury and death were reported among AA patients (Table 1). Conclusion: Our study demonstrates a higher incidence of cardiac arrhythmias among Caucasian patients but higher complications and mortality among AA patients with cardiac sarcoidosis. Keywords: Cardiac sarcoidosis, arrhythmias, racial disparities.

Multi-hospital retrospective study comparing gastric adenocarcinoma in Hispanic versus non-Hispanic patients.

e16027 Background: Gastric cancer is one of the most prevalent malignancies in the United States and carries a particularly high rate of mortality. In the United States, the overall gastric cancer rate continues to decline amongst Caucasian and African American patients; however, it remains static amongst Hispanic patients. While numerous studies have been conducted to better understand the underlying causes leading to the disproportionate incidence of gastric cancer among Hispanics, it is still not well understood. This retrospective study sought to compare the clinicopathological features and overall survival of Hispanic patients with gastric adenocarcinoma with non-Hispanic patients treated in three safety-net county hospitals in Southern California. Methods: This is a retrospective cohort study of 123 patients with newly diagnosed gastric adenocarcinoma who were treated at three safety-net county hospitals in Southern California between 2010 and 2022. The subjects were categorized as Hispanic and non-Hispanic. Clinical, pathological, and survival data were obtained from the patient chart and compared. Results: Of the 123 patients included in the study, 87 (71%) were Hispanic. At time of diagnosis, Hispanic patients were found to be significantly younger than non-Hispanics (55.4 +/- 13.5 vs 60.8 +/- 12.2, p-value 0.03). They were also more likely to be misdiagnosed (defined as greater than one prior encounter of misdiagnosis within six months) relative to non-Hispanics (26% vs 14%, p-value 0.007) despite no differences in insurance/PCP status. Hispanic patients were more likely to present with metastatic disease (65% vs 30%, p-value <0.001), and were found to have a higher rate of peritoneal carcinomatosis (30% vs 8%, p-value 0.01). Hispanics were also more likely to present with disease in the gastric antrum (47% vs 19%, p-value 0.004) and have a higher rate of diffuse subtype histology (32% vs 22%, p-value 0.05). Similar rates of Helicobacter pylori infection were found within the tissue biopsy sample using Warthin Starry stain amongst Hispanic and non-Hispanic patients (17% vs 17%). Lastly, the mortality rate was higher in Hispanics relative to non-Hispanics at time of last contact (65% vs 35%, p-value <0.001). Conclusions: Upon comparing clinicopathological features and mortality among gastric cancer patients who were treated in multiple safety net county hospitals, there were significant differences noticed in Hispanic American patients. Relative to non-Hispanics, Hispanic patients were more likely to be misdiagnosed, more likely to present with metastatic disease, and have higher rates of mortality despite no disparities in insurance and PCP status. Further investigation is warranted regarding possible risk factors including exposures to possible environmental triggers or if there is a genetic predisposition in Hispanic populations.

Evaluating the association between race and complications following pediatric upper extremity surgery.

Race can influence perioperative care and outcomes in adult and pediatric orthopedic surgery. However, no prior study has evaluated any associations between race and complications following upper extremity surgery in pediatric patients. Thus, the purpose of this study was to evaluate whether there are any differences in risks for complications, readmission, or mortality following upper extremity surgery between African American and Caucasian pediatric patients. Pediatric patients who had a primary upper extremity procedure from 2012 to 2019 were identified in the National Surgical Quality Improvement Program-Pediatric database. Patients were categorized into two cohorts: patients who were Caucasian and patients who were African American. Differences in demographics, comorbidities, and postoperative complications were assessed and compared between the two-patient population using bivariate and multivariable regression analyses. Of the 25 848 pediatric patients who underwent upper extremity surgeries, 21 693 (83.9%) were Caucasian, and 4155 (16.1%) were African American. Compared to Caucasian patients, African American patients were more likely to have a higher American Society of Anesthesiologists classification ( P < 0.001), as well as pulmonary comorbidities ( P < 0.001) and hematologic disorders ( P = 0.004). Following adjustment on multivariable regression analysis to control for baseline characteristics, there were no differences in any postoperative complications between Caucasian and African American patients. In conclusion, African American pediatric patients are not at an increased risk for postoperative complications compared to Caucasian patients following upper extremity surgery. Race should not be used independently when evaluating patient risk for postoperative complications. Level of Evidence: III.

Abstract A080: The immunological signatures of African American prostate cancer as biological determinants of disease disparity

Abstract Background: Prostate cancer (PCa) is currently the second leading cause of cancer-related deaths among men in the United States. African American men suffer the highest incidence of disease morbidity and mortality compared to other racial groups. Although socio-economic, cultural, epidemiological, and genomic factors have been described to contribute to cancer health disparities in African American men, there is a knowledge gap regarding how the tumor immune landscape shapes aggressive disease patterns in this patient population, and whether their tumor microenvironment (TME) is amenable to immune modulation. This study aims to identify distinct and targetable immunosuppressive phenotypes and immunological signatures in prostate tumors of AA patients. Methodology: Peripheral blood from consented African American (AA) and Caucasian American (CA) patients undergoing prostatectomy at Moffitt Cancer Center were analyzed by Luminex multiplex cytokine/chemokine assay and comprehensive immune profiling via multi-parameter flow cytometry. Also, multiparameter immune profiling of freshly resected PCa specimens obtained from these same patients after prostatectomy was performed. In addition, multiplex immunohistochemical staining was performed on prostate tumor tissue microarrays to compare the proportions and phenotypes of T cells in the prostate TME of AA and CA patients. Lastly, the immunomodulatory potential of AZD5153, a bivalent Bromodomain 4 (BRD4) inhibitor was investigated on orthotopic prostate tumor-bearing humanized mouse models under racially defined settings, followed by comprehensive flow cytometry immunophenotypic profiling of tumor-infiltrating immune cells in the resected mice prostate tumors at clinical endpoints. Results: Prostate tumors of AA patients harbored higher proportions of CD4+ regulatory T cells (Tregs) and lower proportions of CD8+ T cells relative to CA patients. Furthermore, the immunophenotypic analysis of T cells showed higher expression of immune checkpoint molecules in AA compared to CA patients. Serum analysis revealed cytokine and chemokine expression signatures that are skewed towards a more immunosuppressive profile in AA compared to CA patients. Treatment with AZD5153 led to an increase in the survival time and a more striking reduction in tumor volume of AA-matched prostate tumor-bearing humanized mice relative to CA-matched prostate tumor-bearing humanized mice. A decrease in the proportion of tumor-infiltrating Tregs and a reduction in the expression of immune checkpoint molecules were also observed in prostate tumors from AA-matched humanized mice relative to CA-matched humanized mice. Conclusion: Our findings support the contributory role of racially distinct immunophenotypes and immune signatures in PCa disparity, and highlight the potential immunotherapeutic benefits of BRD4 inhibitors, such as AZD5153 in AA PCa patients. Citation Format: Saheed O. Oseni, Arup Bag, Oluwaseyi Oluwatola, Natalie DeMars, Dennis Adeegbe. The immunological signatures of African American prostate cancer as biological determinants of disease disparity [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr A080.

Abstract C011: Markers of periodontitis in the setting of colon cancer in African American patients

Abstract Colorectal cancer (CRC) is the third most common cancer and the third leading cause of cancer death in the United States. Among all the racial/ethnic groups, African American (AA) patients have the highest incidence of CRC and mortality rate. Periodontitis is an oral chronic inflammatory disease that damages the soft tissue and bone that supports the tooth and is among the 10 most prevalent chronic diseases. AAs are more often diagnosed with periodontal disease than other racial or ethnic groups. A dysbiotic oral microbiome might induce local and systemic immune dysregulation that produces a pro-inflammatory environment that could lead to colon cancer. The human bacteria Fusobacterium nucleatum (Fn), which primarily inhabits the oral cavity, causes periodontal disease and also has been implicated in the development of colorectal cancer. This pro-inflammatory bacteria has been shown to be significantly higher in the colon tumors from AAs compared to Caucasian American patients. No studies have been published describing differences in levels of inflammatory proteins and bacterial communities between the right/left location of colon cancer in AA patients. This pilot study aimed to determine the feasibility of measuring serum cytokines and evaluating oral bacterium associated with periodontitis (Fn) in the setting of colon cancer. Methods: We assessed quantitative measurement of 20 human periodontal disease associated inflammatory cytokines (IL-1a, IL-1b, IL-2, IL-4, IL-6, IL-8, IL-10, IL-12, IL-17, IFNg, TNFa, and CRP); matrix metalloproteinases (MMP-9, and MMP-13) and their inhibitors (MIP-1a); bone metabolism related cytokines (OPG, OPN, RANK), osteoactivin, and TGFb1. Readings were taken using the Quantibody Human Periodontal Disease Array, which is a multiplexed sandwich using an enzyme-linked immunosorbent assay (ELISA)-based quantitative array platform on a glass slide. Quantitative polymerase chain reaction (qPCR) assays was used to detect Fn DNA in colon tumor tissues and measured the levels as compared to non-tumor tissues. Results: Right-sided colon cancer patients have increased levels of cytokines associated with periodontitis. Stage III patients have significantly elevated levels of OPG (p= 0.0157) and OPN (p= 0.0033) compared with early stages I-II. Fn is present in both tumor and non-tumor tissues. Conclusion: Circulating cytokines, like OPG and OPN, and oral pathogens associated with periodontitis (Fn), could be a potential indicator for location and stage of cancer when combined with other serological markers. Next step will be to evaluate the microbiome composition in tumor and non-tumor tissues from AA colon cancer patients using 16S rRNA amplicon sequencing. Citation Format: Sofia C. Tortora, Marzia Spagnardi, Jenny Paredes, Olalekan Lanipekun, Laura Martello-Rooney. Markers of periodontitis in the setting of colon cancer in African American patients [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr C011.

IL-1β enhances cell viability and decreases 5-FU sensitivity in novel colon cancer cell lines derived from African American patients.

In the U.S., African Americans (AAs) present with the highest incidence and mortality rates for Colorectal Cancer (CRC). When compared to Caucasian American (CA) patients, AAs also have reduced response to the first line standard of care chemotherapeutic agent 5-Fluorouracil (5-FU). Previously, we observed differential gene expression between the two populations, suggesting that colon tumors from AA patients display a decreased antitumor immune response and an increased expression of genes encoding proteins involved in inflammatory processes, such as Interleukin-1β (IL-1β). Here, we investigate the role of IL-1β in modifying chemotherapeutic response and altering expression of proteins in novel AA and well-established CA colon cancer cell lines. RNA sequencing analysis was performed to detect expression of genes involved in inflammation in AA and CA colon cancer cells. The effects of IL-1β on 5-FU response was evaluated by assessing cell viability (MTS assay) and apoptosis (flow cytometry analysis) following treatment with 5-FU alone or in combination with the cytokine. Further, we used an IL-1 receptor antagonist (IL-1Ra) to inhibit IL-1β-induced effects on 5-FU sensitivity and NF-kB pathway activation. AA colon cancer cell lines present significant increase in expression of genes IL1R2 (373-fold change (FC), IRAK1 (3.24 FC), IKBKB, (5.33 FC) NF-KB IA (5.95 FC), MYD88, (3.72 FC), IRAK3 (161 FC), TRAF5 (4.1 FC). A significant decrease in the response to 5-FU treatment, as well as a significant increase in phosphorylation of IκBα and secretion of IL-8, was seen following IL-1β treatment, in both AA and CA cell lines. Finally, treatment with IL-1Ra was able to reverse the effects induced by IL-1β, by increasing the cells sensitivity to 5-FU. IL-1Ra also inhibited phosphorylation of IκBα and IL-8 secretion. Our results suggest a differential expression of inflammatory genes and proteins that might regulate the different response to IL-1β between AA and CA colon cancer cell lines. Our data also demonstrates that IL-1β is involved in modulating 5-FU response in both AA and CA colon cancer cell lines. Further investigation of these mechanisms might help elucidate the differences seen in incidence, mortality and response to therapy in AA colon cancer patients.

Analysis of eyelid and eyebrow metrics in Iranian American adults

<h2>Summary</h2><h3>Background</h3> Achieving patient satisfaction after oculofacial surgery requires sensitivity to ethnic anthropometric variation. While differences between the Caucasian and East Asian eyelid configurations are often discussed, there is a relative paucity of discussion related to characteristics of the Middle Eastern eyelid and periocular region. This study aims to understand differences between the eyelids and periocular region of patients of mixed Iranian extraction, versus those of mixed European descent. <h3>Methods</h3> In this cross-sectional cohort study, external photographs were collected from a prospectively maintained database at an oculofacial plastic surgery practice. Ethnicity, age, gender, and photographic data were extracted from patient charts. Iranian-American patients were compared to Caucasian-American patients. From full-face photographs, brow position (pupil-to-brow, PTB), eyelid position (margin-to-reflex distance 1 and 2, MRD1 and MRD2), and tarsal platform show (TPS) were analyzed. Mixed effect ANOVA modeling was employed. <h3>Results</h3> The Iranian-American eyelid complex was found to maintain a lower MRD1 (-0.34 mm, p < 0.01), higher MRD2 (+0.48 mm, p < 0.01), and longer TPS (+0.74 mm, p < 0.01) compared to Caucasian-American patients. Further, pupil-to-brow (PTB) distance was noted to be 1.46 mm higher (p < 0.01) in Iranian-Americans. <h3>Conclusion</h3> Patients with Iranian-American ethnicity, compared to those of mixed European extraction, demonstrate distinctive eyelid anthropometric features. An understanding of these features may help to guide aesthetic surgical planning.

Clinical outcomes and echocardiographic characteristics between African American and Caucasian patients with acute pulmonary embolism.

Despite socioeconomic disparities, no association between clinical presentation and poor outcomes explains a higher mortality in African Americans with pulmonary embolism (PE). The objective is to identify the co-morbidities and echocardiographic characteristics associated with increased mortality in African American patients. This is a cross-sectional study of Caucasian or African American patients with PE diagnosed between October 2015 and December 2017 at University of Maryland Medical Center. The outcomes were in-hospital death, length of stay, and bleeding. There were 303 African Americans and 343 Caucasians. Caucasians were older (p = 0.007), males (p = 0.01) with history of coronary artery revascularization (CABG (p = 0.001), coronary stents (p = 0.001)), trauma (p = 0.007), and/or recent surgeries (p = 0.0001). African Americans exhibited higher rates of diabetes (p = 0.01), chronic kidney disease (p = 0.0005), and smoking (p = 0.04). Severity of PE was similar between groups and there was no difference in clot burden size. African Americans had more right ventricular strain on Computer Tomography (p = 0.001) and echocardiogram (p = 0.004); also, underfilled left ventricles (p = 0.02) and higher right ventricular systolic pressures (p = 0.001). There was no difference in hospital mortality (7.1% vs. 7.9%, p = 0.71), length of stay (13.1 ± 16.7 vs 12.8 ± 14.9, p = 0.80) and bleeding (9.0% vs.8.3%. p = 0.72). Mortality was higher in African Americans who received advanced therapies (3.8% vs. 18.8%, p = 0.02). The risk of death increased with age (OR 1.04; 95%CI 1.020-1.073) and with advanced therapies (OR 2.43; 95%CI 1.029-5.769). Differences in co-morbidities, radiologic findings, and echocardiographic characteristics that may contribute to higher mortality in African American patients, specifically those receiving advanced therapies.

Abstract P3099: Identification Of Hub Genes And Construction Of Protein-protein Interaction (PPI) Network Clusters Define Racially Distinct Signatures Of Ischemic Heart Failure

Cardiovascular diseases, including ischemic heart failure (IHF), are the leading cause of mortality worldwide; furthermore, African Americans (AA) have 30% higher mortality than Caucasian Americans (CA). Our recent study correlates racial differences in socioeconomic status with DNA methylation (DNAm), altered gene expression, and mortality in HF independent of etiology. The current analysis focused on etiology-specific differences in DNAm with a specific focus on IHF, the related changes in gene expression, within self-reported race. RNA-seq expression ( P &lt; 0.05, ±1.5-fold) and array-based methylation ( P &lt; 0.05, ±5%) profiles were examined using cardiac biopsies from non-IHF (NIHF) and IHF AA (n = 9/5) and CA (n = 10/5) male patients. Network clusters were identified with MCODE (v2.0) and top hub genes identified via Cytohubba (v0.1). Both AA and CA patients showed similar numbers of IHF-specific differentially expressed genes (DEG) (591/365 AA; 439/486 CA; up/down). However, CA-specific methylation changes (29703/22703; up/down) were more abundant compared to AA (2904/2897; up/down). PPI network construction of these changes identified clusters unique to each group. The AA-specific upregulated cluster included AGPAT2, PPARG, and 10 other DEG associated with the fatty acid metabolism, while BMP2, SMAD6, and 4 other DEG that regulate BMP signaling and SMAD phosphorylation were downregulated. The CA-specific upregulated cluster included EZH2, CCNA1, and 18 other DEG that regulate mitotic sister chromatic separation, while EGFR, TNF, and 12 other DEG important for chronic inflammatory response formed the top downregulated cluster. Consistent with greater changes in DNAm the majority of DEGs in CA-specific clusters were also differentially methylated (58%) while fewer were in AA-specific clusters (17%). Within AA-specific PPI networks, PPARG/BMP2 (up/down) were the top ranked hub genes and KIF20A/KIT (up/down) in CA-specific networks. These racially distinct hub genes suggest altered regulatory mechanisms. Our analysis identified racially distinct clusters associated with specific pathways, which may connect the regulators of DNAm to gene expression and IHF, supporting the potential to use this information as prognostic biomarkers.

Abstract 3805: Immunologic transcript and cell type evaluation of prostate tumors from a military cohort of African American and Caucasian American patients

Abstract Background: Health and racial disparities in prostate cancer place African American (AA) men at greater risk of developing and having a poorer outcome from the disease, especially at a younger age compared to Caucasian American (CA) men. This incidence is also reflected among active-duty service members, and patient biospecimens obtained from an equal access healthcare setting at the Walter Reed National Military Medical Center provide a valuable resource for the evaluation of cancer health disparities. The objectives of this study are to identify immunobiological differences influencing prostate cancer disparities and to elucidate the immune cell profiles of patient tumors associated with advanced disease. Methods: Patients provided written consent to both biospecimen and clinical database collection under IRB-approved protocols. Fresh frozen tumor biopsy tissues were collected ex vivo, following radical prostatectomy. Total tumor RNA was amplified by PCR-based multiplexed target enrichment, and barcode-tagged transcripts were quantified using NanoString technology. Raw and relative abundances of immune cells were determined using published deconvolution algorithms. Differential expression of immune-related genes and cell type contrasts were evaluated for correlation with clinico-pathologic features. Results: Genes regulating metabolism and innate immune responses were differentially expressed between AA and CA prostate tumors (AA n=26, CA n=25). Comparing high vs. low expression of each of these top genes, two were associated with biochemical recurrence (BCR)-free survival. Most immune cell subtypes did not differ significantly between AA and CA, but mast cells appeared to be enriched within AA tumors. When cell types were stratified by clinical and pathologic variables, we identified consistent trends in immune cell content that changed with increasing diagnostic age, PSA group, Grade Group, Gleason Sum, and with disease progression as defined by future development of BCR and/or metastasis. Conclusions: Attention should be directed toward observed immunobiological differences based on race and other clinico-pathologic factors at the time of radical prostatectomy. Patient-centered studies mindful of existing health disparities will aid in diagnostic and therapeutic strategies that are inclusive of an increasingly diverse US and US military population. Disclaimer: The contents of this publication are the sole responsibility of the authors and do not necessarily reflect the views, opinions or policies of the USUHS, HJF, the DoD or the Departments of the Army, Navy, or Air Force. Mention of trade names, commercial products, or organizations does not imply endorsement by the U.S. Government. IRB protocol: DBS.2019.032 (Ref Number 930187) Citation Format: Cara C. Schafer, Jiji Jiang, Sally Elsamanoudi, Darryl Nousome, Denise Young, Yingjie Song, Isabell Sesterhenn, Gregory Chesnut, Shyh-Han Tan. Immunologic transcript and cell type evaluation of prostate tumors from a military cohort of African American and Caucasian American patients [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 3805.

Abstract 2210: The study of age and race genetic signatures of prostate cancer with formalin fixed paraffin embedded (FFPE) samples

Abstract Objectives: Diagnosis with prostate cancer (PCa) at younger age is a serious challenge in Military Health System. PCa onset at younger age is more likely to be aggressive in African American (AA) population. Also, application of formalin fixed paraffin embedded (FFPE) tissue in RNA based study was significantly hindered due to poor quality/quantity of RNA in archived pathology slides. This study is aimed to examine age/race associated gene signatures in military cohort with high representation of AA and younger population in FFPE samples for potential genetic mechanisms of health disparities and broaden tissue sample availability. Methods: A cohort of 41 Caucasian American (CA) and 20 AA non-familial PCa patients from the biospecimen bank of CPDR, WRNMMC were used. Specimens donated by radical prostatectomy patients who provided written consent and protocols approved by Institutional Review Boards. Total RNA was extracted from tumor and the adjacent normal epithelium of whole-mount FFPE tissue of matched specimens. Differential gene expression, in tumor versus normal tissues, between younger and older AA and CA patients were analyzed by NanoString using a customized CodeSet of 151 probes. The panel designed to detect 135 target transcripts, compiled from 34 genes implicated/associated with PCa progression, 27 PCa specific gene fusions, 25 cancer-associated genes, and 5 genes encoding ETS-family of transcription factors. The 27 over-expressed genes and 17 under-expressed genes in PCa were included as comparison to matched, benign epithelium. Additionally, 5 prostate stroma or epithelium specific genes were selected as control and 11 housekeeping genes were included for biological normalization. Results: The differentially expressed genes related to tumor-normal differences between AA older (66-73 years) and younger (42-58 years) as well as CA older and younger PCa patients with moderate Gleason score (3+3 and 3+4) sum were identified. After controlling for false discovery rates, panel of nine genes (ANXA2, C-MYC, VEGFR1, ERG, NPY, PSMA/FOLH1, TWIST1, MAOA, MYCN) uniquely associated with age/race were identified. Tumor vs normal ratios of ANXA2 and C-MYC expression in prostate tumors of older and younger patients were significantly enhanced. We found a clear association of VEGFR1 gene expression with CA young and c-MYC gene with AA young PCa. Conclusions: Using age/race as endpoint, we identified ANXA2, c-MYC and VEGFR1 as age and race associated PCa gene. Our findings highlight distinct racial and age-related differences and addresses the clinical utility of available genetic tests across old and young AA and CA men, which needs to be further validated in lager cohort. Further, our study also highlighted the utilization of FFPE tissue for NanoString assay and subsequent genetic signature analyses. Citation Format: Shashwat Sharad, Darryl Nousome, Gregory T. Chesnut, Hua Li. The study of age and race genetic signatures of prostate cancer with formalin fixed paraffin embedded (FFPE) samples [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 2210.

Abstract 100: IL-1β pathway promotes cell proliferation and 5-FU resistance in African American colon cancer cell lines

Abstract Introduction: Colorectal Cancer (CRC) is the third most common cancer and third cause of cancer-related death in the US. When taking race and ethnicity into consideration, African Americans (AA) present with the highest incidence and mortality rates for CRC. Studies have found that AA patients, when compared to Caucasian American (CA) patients, have a lower response to the standard of care chemotherapeutic agent 5-Fluorouracil (5-FU) as well as lower frequency of MSI tumors, making them also less likely to respond to conventional immunotherapies. Our recent findings have shown that tumors from AA patients present higher expression of genes involved in pro-inflammatory processes as well as lower expression of genes promoting anti-tumoral activities. One of the genes that was found upregulated in AA tumors is IL1B, which encodes for the pro-inflammatory cytokine Interleukin-1β (IL-1β). Therefore, we investigated the role of the IL-1β pathway in novel AA colon cancer cell lines. Here, we evaluated changes in cell proliferation, apoptosis, 5-FU response, and activation of inflammatory pathways. Methods: Our approach includes analysis of gene expression in both AA and CA colon cancer cell lines by using RNA sequencing to evaluate pro-inflammatory genes differentially expressed among the cell lines. Furthermore, we used an MTS assay to detect viable cells following treatment with IL-1β, alone or in combination with different concentrations of 5-FU, as well as analyzing changes in apoptosis via Flow Cytometry. To better understand the mechanisms of IL-1β-induced effects, we used IL-1 Receptor Antagonist (IL-1Ra) to block the IL-1β pathway and evaluated changes in cell viability and 5-FU response via MTS assay, as well as activation of NF-kB pathway, via detection of phospho-IкB-α protein using Western Blot analysis. Results: Results from MTS assays indicated that cell proliferation in response to IL-1β differs between the AA and the CA colon cancer cell lines, with the AA colon cancer cells being more sensitive to lower concentrations of the cytokine when compared to CA cell lines. Further, we saw an increased expression of phospho-IкB-α following treatment with IL-1β. This expression was reduced when the cells were treated in combination with IL-1β and the IL-1Ra. The IL-1Ra also appears to reduce the pro-proliferative effects induced by IL-1β. Importantly, our results show that 5-FU sensitivity is drastically reduced in the presence of IL-1β for both AA and CA colon cancer cell lines, suggesting that IL-1β may play a role in defining resistance to the chemotherapeutic drug. Conclusions: Taken together, our results demonstrated a differential response to IL-1β for the AA colon cancer cell lines, suggesting a probable role played by the cytokine in driving inflammation-related cancer progression and reveals a possible new target to exploit in immunotherapy for this population. Citation Format: Marzia Spagnardi, Jenny Paredes, Jone Garai, Jovanny Zabaleta, Jennie Williams, Laura Martello-Rooney. IL-1β pathway promotes cell proliferation and 5-FU resistance in African American colon cancer cell lines [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 100.

Race-specific genomic determinants of therapeutic response in African American NSCLC patients.

e21015 Background: African American (AA) individuals are disproportionately affected by lung cancer in terms of incidence and mortality, despite lower tobacco exposure compared to Caucasian Americans (CA). Since molecular profiling is critically important to guide therapy selection in non-small cell lung cancer (NSCLC), we compared treatment-relevant molecular data in a cohort of AA and CA patients with EGFR or KRAS-driven NSCLC. Methods: This is a retrospective study using a clinicogenomic electronic medical record database from health systems in the United States designed to evaluate outcomes in advanced stage NSCLC. Eligibility criteria for analysis included a diagnosis of NSCLC between 2010 and 2020, stage III or IV, available race/ethnicity data, and identification of common KRAS or EGFR activating variant within 60 days of diagnosis. The primary objective was to define the type of EGFR or KRAS activating variant and determine the frequency of co-occurring alterations in NSCLC-associated genes by cohort (AA and CA). Secondary objectives included examining the timing of genetic testing and use of targeted therapy in these cohorts. Results: A total of 642 NSCLC patients with KRAS (15.0% AA; 81.6% CA) and 348 patients with EGFR oncogenic mutations (13.8% AA; 70.1% CA) met inclusion criteria. Mean time from diagnosis to first molecular test result was 20.9 days for AA vs. 19.9 days for CA (p = 0.5). The EGFR G719S variant was more prevalent in the AA cohort (6.3% AA v 0.4%) with no significant differences observed in the most common KRAS or EGFR variants tested (Table). A total of 100 KRAS-mutant patients (16 AA, 86 CA) had a reported result in at least one co-mutation of interest. The most frequent co-mutations were TP53 (81.3% AA v 65% CA, p = 0.92); KEAP1 (18.8% AA v 8.3% CA, p = 0.52); ATM (18.8% AA v 9.5% CA, p = 0.54); and PTEN (0% AA v 8.3% CA, p = 0.5). A total of 35 EGFR-mutant patients (4 AA, 31 CA) had a co-mutation reported in TP53 (75% AA v 65% CA, p = 0.77). EGFR targeted therapy was reported in 47.9% of AA and 52.9% of CA (p = 0.639). In the KRAS-mutant cohort, delivery of immune checkpoint inhibitors (ICIs) was reported in 29.2% of AA and 39.3% of CA (p = 0.08); chemotherapy was reported in 36.5% AA and 45.2% of CA (p = 0.14). Delivery of both ICI and chemotherapy was reported in 13.5% of AA and 21.9% of CA (p = 0.08). Conclusions: In a real-world cohort of NSCLC patients, we found similar frequencies of common KRAS and EGFR variants in AA and CA, but higher rates of EGFR G719S variant in AA patients. A more comprehensive analysis is needed to further evaluate the trends in co-mutations observed in our analysis, to determine the race-specific impact of these alterations in EGFR and KRAS-driven NSCLC.[Table: see text]

PD16-12 AGE AND RACE SPECIFIC GENE SIGNATURE: AN INDEPENDENT PREDICTOR OF PROSTATE CANCER IN RACIALLY DIVERSE MILITARY COHORT OF AFRICAN AND CAUCASIAN AMERICAN PATIENTS

You have accessJournal of UrologyCME1 May 2022PD16-12 AGE AND RACE SPECIFIC GENE SIGNATURE: AN INDEPENDENT PREDICTOR OF PROSTATE CANCER IN RACIALLY DIVERSE MILITARY COHORT OF AFRICAN AND CAUCASIAN AMERICAN PATIENTS Shashwat Sharad, Darryl Nousome, Gregory Chesnut, and Hua Li Shashwat SharadShashwat Sharad More articles by this author , Darryl NousomeDarryl Nousome More articles by this author , Gregory ChesnutGregory Chesnut More articles by this author , and Hua LiHua Li More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002548.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Age and Racial disparities in prostate cancer (PCa) is a serious challenge and the PCa mortality rates are nearly three times higher in African American (AA) men younger than age 65 than White Caucasian American (CA) men. Young age prostate cancer is more likely to be an aggressive cancer commonly seen in AA population. The objective of this study is to examine the age and racial disparities associated gene signatures for disease progression, patient stratification and targeted therapeutic options. METHODS: Specimens collected from radical prostatectomy patients (41 CA and 20 AA) who provided written consent under protocols (#393738, #GT90CM/385525 and #908925) approved by the Institutional Review Boards of the Walter Reed National Military Medical Center (WRNMMC) and the Uniformed Services University of the Health Sciences (USUHS). We used a cohort of non-familial PCa patients of AA and CA origin. Total RNA was extracted from tumor, and adjacent normal epithelium of formalin-fixed-paraffin-embedded (FFPE) specimens by Laser capture microdissection (LCM). Differential gene expression in tumor versus normal tissues between young and old AA and CA patients were analyzed by NanoString using a customized CodeSet of 151 probes sets. The panel was designed to detect 135 target transcripts, which were compiled from 34 genes implicated in or associated with prostate cancer progression, 27 prostate cancer specific gene fusions, 25 cancer associated genes, five genes encoding the ETS-family of transcription factors and genes over-expressed (27) or under-expressed (17) in PCa compared to matched benign epithelium. In addition, five prostate stroma or epithelium specific genes were selected as control and 11 housekeeping genes were included for biological normalization. RESULTS: The differentially expressed genes related to tumor-normal differences between the old (66–73 yrs) and young (42–58 yrs) AA and CA prostate cancer patients with Gleason (3+3 and 3+4) were identified. After controlling for false discovery rates, we identified a panel of nine genes (ANXA2, C-MYC, VEGFR1, ERG, NPY, PSMA/FOLH1, TWIST1, MAOA, MYCN) uniquely associated with the age and race. The tumor vs. normal ratios of ANXA2 and c-MYC expression in prostate tumors of old and young patients were found to be significant. We found a clear association of VEGFR1 gene expression with CA young and c-MYC gene with AA young PCa. Our study highlights the potential of using FFPE tissue as a source for the analysis of prognostic biomarkers for PCa. CONCLUSIONS: An unmet challenge in PCa is the identification of biomarkers for early detection of aggressive disease. Effective biomarkers with high specificity will provide early treatment options for high-risk patients. Using Age and Race as the endpoint, we identified ANXA2, c-MYC and VEGFR1 as age and race associated PCa gene which needs to be further validated in the lager cohort. Our findings clearly highlight distinct racial and age-related differences and addresses the clinical utility of available genetic tests across old and young AA and CA men. Source of Funding: This study was supported by CPDR, USUHS, HU0001-10-2-0002 © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e273 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Shashwat Sharad More articles by this author Darryl Nousome More articles by this author Gregory Chesnut More articles by this author Hua Li More articles by this author Expand All Advertisement PDF DownloadLoading ...

Microbiome and colorectal carcinogenesis: Linked mechanisms and racial differences.

Various studies have shown the interplay between the intestinal microbiome, environmental factors, and genetic changes in colorectal cancer (CRC) development. In this review, we highlight the various gut and oral microbiota associated with CRC and colorectal adenomas, and their proposed molecular mechanisms in relation to the processes of “the hallmarks of cancer”, and differences in microbial diversity and abundance between race/ethnicity. Patients with CRC showed increased levels of Bacteroides, Prevotella, Escherichia coli, enterotoxigenic Bacteroides fragilis, Streptococcus gallolyticus, Enterococcus faecalis, Fusobacterium nucleatum (F. nucleatum) and Clostridium difficile. Higher levels of Bacteroides have been found in African American (AA) compared to Caucasian American (CA) patients. Pro-inflammatory bacteria such as F. nucleatum and Enterobacter species were significantly higher in AAs. Also, AA patients have been shown to have decreased microbial diversity compared to CA patients. Some studies have shown that using microbiome profiles in conjunction with certain risk factors such as age, race and body mass index may help predict healthy colon vs one with adenomas or carcinomas. Periodontitis is one of the most common bacterial infections in humans and is more prevalent in Non-Hispanic-Blacks as compared to Non-Hispanic Whites. This condition causes increased systemic inflammation, immune dysregulation, gut microbiota dysbiosis and thereby possibly influencing colorectal carcinogenesis. Periodontal-associated bacteria such as Fusobacterium, Prevotella, Bacteroides and Porphyromonas have been found in CRC tissues and in feces of CRC patients. Therefore, a deeper understanding of the association between oral and gastrointestinal bacterial profile, in addition to identifying prevalent bacteria in patients with CRC and the differences observed in ethnicity/race, may play a pivotal role in predicting incidence, prognosis, and lead to the development of new treatments.