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EPA & FAP FAP Gene 6 th Annual Information & Family Day 26 - PowerPoint PPT Presentation

Jan 10, 2023 •342 likes •521 views

EPA & FAP FAP Gene 6 th Annual Information & Family Day 26 th March 2011 What is EPA? Eicosapentaenoic acid (EPA) is an omega-3 fatty acid A normal component of cells in the body Essential fatty acid (need to have it in the

  1. EPA & FAP FAP Gene 6 th Annual Information & Family Day 26 th March 2011

  2. What is EPA? • Eicosapentaenoic acid (EPA) is an omega-3 fatty acid • A normal component of cells in the body • Essential fatty acid (need to have it in the diet) • Evidence for variety of benefits on cardiovascular health • Communities with high intake of omega-3 fatty acids tend to have lower incidence of bowel cancer

  3. Sources of Omega-3 PUFAs Herring Sardine Salmon

  4. Why do we think EPA might have benefits in FAP?

  5. How do polyps form?

  6. Development of polyps

  7. Controlling development of polyps • Chance of developing cancer depends on the number, size and nature of polyps • This also influences doctor’s decision on what to do • If we could stop polyps forming, it may have long term benefits

  8. Effect of EPA on cells in the colon In patients with sporadic polyps, - EPA reduces formation of new cells

  9. How best to deliver EPA to the intestine? • EPA comes in different forms – Triglyceride – Ethyl ester – Free fatty acid (FFA) • Of these, the free fatty acid is much better absorbed • EPA present in fish oil as a mixture with other fatty acids – Would need large amount of fish oil to provide enough EPA • Purified EPA – FFA has been formulated in capsules – Enables larger dose of EPA to be given in fewer capsules – Coated to reduce fishy aftertaste etc.

  10. What effect does EPA-FFA have on polyps? • Clinical trial at St Mark’s Hospital • Individuals with FAP having had colectomy and IRA – invited to participate • Endoscopy of rectum – Select area with group of polyps and mark site – Video record of endoscopy • Assigned to take – EPA-FFA capsules for 6 months or – Dummy capsules (placebo) for 6 months – Doctor and patient ‘blind’ to treatment • After 6 months, endoscopy repeated as before

  11. Measurement of effects of EPA-FFA on polyps • Compared identical views of marked area at 6 months – Number of polyps and size measured from photographs – Video records of endoscopies compared by panel of experts • Each subject asked to keep daily diary of any symptoms

  12. Effects of EPA-FFA on number of polyps Change in No of polyps (%) P = 0.01 15  Better Worse  +9.7% 10 5 0 -5 -10 -15 -12.6% -20 -22.4% -25 Placebo EPA-FFA Overall change (West et al 2010; Gut 59:918-25)

  13. Effects of EPA-FFA on size of polyps Change in polyp size (%) P = 0.03 20  Better Worse  +17.3% 10 0 -10 -12.6% -20 -30 -29.8% -40 Placebo EPA-FFA Overall change (West et al 2010; Gut 59:918-25)

  14. Effect of EPA-FFA on overall appearance at 6 month endoscopy 0.5 +0.42 Better  0.4 0.3 0.2 +0.09 0.1 0 -0.1  Worse -0.2 P = 0.011 -0.3 -0.34 -0.4 Placebo EPA-FFA Overall difference (West et al 2010; Gut 59:918-25)

  15. Conclusions • EPA-FFA , 2 g/day reduced the number and size of polyps in the marked area of rectum • EPA-FFA capsules were well-tolerated

  16. Next steps • Discussions with medicines licensing authorities • Further clinical trials

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