Flaxseed Consumption Inhibits Chemically Induced Lung Tumorigenesis and Modulates Expression of Phase II Enzymes and Inflammatory Cytokines in A/J Mice

Tobacco smoke contains over 5,000 compounds of which 73 are carcinogenic in laboratory animals and/or humans (1). Among these, 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK) is one of the most potent carcinogens closely associated with lung carcinogenesis in smokers and in A/J mice independent of the route of administration (1–3). The occurrence of early-onset DNA lesions such as mutations in KRAS oncogene and molecular processes underlying tumor development are similar in humans and NNK-treated A/J mice (4). Like NNK, benzo [alpha] pyrene (BαP), a polycyclic aromatic hydrocarbon (PAH), is a tobacco carcinogen and has been extensively used by investigators over the years as the archetypal PAH. It is ubiquitous in the environment and a very potent carcinogen (5). BαP induces lung cancer in mice, rats, hamsters, and in humans (6, 7). Therefore, NNK and BαP are commonly studied in the A/J mouse model to assess the chemopreventive potential of various agents for lung cancer.

Several plant-derived phytochemicals have shown lung chemopreventive effects. Phytochemicals such as polyphenon E (green tea; ref. 8), PEITC (9, 10) and indole-3-carbinol (cruciferous vegetables; ref. 11), and kavalactones (kava; refs. 12, 13) inhibit development of NNK-induced lung tumors in A/J mice. Their tumor growth-inhibitory properties are attributed to altered expression of phase I cytochrome P450 and phase II detoxifying enzymes involved in NNK activation and detoxification (9, 10); suppressed NF-κB (12), AKT (11), c-Jun (8), and ERK (8)-mediated signaling pathways, which regulate aberrant cell proliferation; activated caspase-3, and PARP-mediated apoptosis (12); and decreased VEGF-mediated angiogenesis (11). This suggests that plant-derived phytochemicals hold promise for lung cancer chemoprevention.

Flaxseed is a whole-grain oilseed ranging in color from golden yellow to dark brown and grown across Canada and North Dakota. It is rich in omega-3 fatty acid (α-linolenic acid), lignans (predominantly secoisolariciresinol diglucoside), protein, and fiber. Flaxseed has a nutty taste and can be found in breads, crackers, and other bakery products, or incorporated into the diet by adding to cereal, drinks, yogurt, salads, or soups. The antioxidant and anti-inflammatory components of flaxseed are associated with numerous health benefits including cardiovascular benefits.

The chemopreventive properties of flaxseed are documented in several epidemiologic, preclinical, and clinical studies of breast (14–18), colon (19, 20), and prostate cancers (21–23). Flaxseed-supplemented diets decrease tumor incidence, size, volume, and multiplicity by suppressing cell proliferation (15, 22), inducing cell-cycle arrest (23), and inhibiting angiogenesis (14, 18). However, the chemopreventive potential of flaxseed has not been investigated in lung.

There is evidence that flaxseed intake ameliorates oxidative stress and inflammation, precursors of carcinogenesis, in mouse models of acute and chronic lung injury (24, 25). In addition, flaxseed significantly alters the expression of genes involved in apoptosis, cell proliferation, inflammation-associated cytokine signaling, oxidative stress, and phase I and phase II detoxification pathways in healthy mouse lung tissue (26). We have earlier shown that enterolactone (EL), a flaxseed-derived mammalian lignan, inhibits lung cancer cell proliferation by inducing G₁-phase cell-cycle arrest (27), and suppressing cell motility and invasion by altering FAK–Src signaling (28).

We hypothesized that flaxseed inhibits chemically induced lung tumorigenesis in A/J mice by modulating genes promoting inflammation and oxidative stress. To test this hypothesis, we studied the effect of 10% flaxseed consumption on inhibition of NNK or BαP-induced lung tumor incidence in A/J mice. We employed RNA sequencing (RNA-Seq) to identify underlying mechanisms associated with the chemopreventive effects of flaxseed in lung.

NNK was purchased from Toronto Research Chemicals, Inc. and dissolved in saline solution immediately before use. Mouse diets in pellet form were obtained from TestDiet and kept under cool (2°C), dry conditions for long-term storage. The control diet was AIN-93G, and the treatment diet was AIN-93G supplemented with 10% flaxseed. These isocaloric diets were prepared according to the composition shown in Supplementary Table S1.

Five- to 6-week-old male A/J mice (n = 24) procured from The Jackson Laboratory were housed in the Animal Nutrition and Physiology Center at North Dakota State University (NDSU, Fargo, ND). The mice were kept in individual solid-bottomed polycarbonate cages with ALPHA-Dri bedding in a pathogen-free, humidified (50%–70%), and temperature-controlled (22–25°C) environment with a 12-hour light/dark cycle. The mice were fed ad libitum control diet for 1 week prior to the start of the experiment. The study protocol was approved by NDSU's Institutional Animal Care and Use Committee.

After acclimation, mice were assigned into a control group or 10% flaxseed group (n = 12) with similar average mouse weights between groups. All mice received weekly intraperitoneal injection of NNK (50 mg/kg bodyweight) for 4 weeks. Immediately after the first NNK injection, the treatment group mice were switched to 10% flaxseed-supplemented AIN 93G diet, while the control group mice continued feeding on the AIN 93G diet (Fig. 1A). Three mice in the treatment group were removed from the study when they did not readily accept the 10% flaxseed diet. One mouse from the control group was euthanized at 23 weeks to confirm the onset of lung tumor development. The remaining mice, 11 in control group and 9 in 10% flaxseed group, were maintained on their respective diets for 26 weeks. Food consumption was regularly monitored, and fresh diet and water was provided ad libitum. Mice were weighed once a month for 6 months. At the end of the study, the mice were euthanized under anesthesia using ketamine/xylazine, followed by cervical dislocation. Lung tissues were harvested, weighed, and imaged using a camera attached to an inverted microscope (Zeiss Lumar, V12 stereo motorized microscope). Subsequent to imaging, the left lung from each mouse was snap frozen in liquid nitrogen and stored at −80°C for further molecular analysis, and the right lung was perfused with freshly prepared 10% buffered formaldehyde solution for fixation.

A/J mice (n = 5/treatment group) were exposed to a total of 4 mg of BαP via sequential 1 mg BαP intraperitoneal injections administered once every 7 days. Control and flaxseed diets were administered either 3 weeks prior to the initial BαP exposure or simultaneously starting with the initial BαP exposure. Mice were euthanized at 5 months following the initial BαP exposure, and lungs were histologically evaluated for tumor formation. This study protocol was approved by the University of Pennsylvania's Institutional Animal Care and Use Committee.

The enterodiol (ED) and EL levels in lung tissue of control-fed (n = 11) and 10% flaxseed-fed mice (n = 9) and their levels in circulating blood plasma in control-fed (n = 3) and 10% flaxseed-fed mice (n = 7) were determined by LC/MS-MS using commercially available standards (Chromadex) as described previously (24). Briefly, lignans were separated using the ACQUITY UPLC I-Class System (Waters) and gradient elution with 0.2% formic acid in acetonitrile and 0.2% formic acid in water. The flow rate was 0.3 mL/minute over a C18 column and the runtime was 4 minutes. An AB Sciex 4000 triple quadrupole mass spectrometer equipped with Turbo Ionspray was used for sample analysis. Lignans were monitored by negative ion electrospray tandem mass spectrometry.

Formaldehyde-fixed paraffin-embedded lung tissue samples were used to prepare 5-μm thick sections on poly-L-lysine–coated slides. Tissue sections were stained with hematoxylin and eosin (H&E) for histopathologic observation of the incidence, multiplicity, and size of surface lung tumor nodule in each mouse. Tumor incidence was defined as the number of mice in each group bearing one or more tumor nodules divided by the total number of mice examined. Lung tumor nodules were microscopically examined and quantified by 4 independent researchers blinded to control and treatment groups. Classification of lung tumors as adenomas or adenocarcinomas was performed by a pathologist according to guidelines previously published (29).

Quantitative morphometric analysis was performed on H&E-stained serial lung sections, with an incremental depth of 20 μm, from control and 10% flaxseed-fed mice (n = 4/group). Image analysis was performed using the Aperio ScanScope SC (Leica Biosystems, Inc.), Aperio ImageScope, and Aperio Genie Histology Pattern Recognition Software. The glass slides with H&E-stained lung sections were scanned and the images created at ×20 magnification. Using the Genie software, a unique algorithm was created on the basis of pattern recognition to separate: (i) tumor nodules; (ii) benign lung tissue; and (iii) glass background. The slides were visualized with Aperio ImageScope for quality control and quantitative measurement of the area occupied by tumor in the digital images. Tumor burden was calculated as percent tumor area with respect to total lung area.

Western blotting was performed as described elsewhere (28). Briefly, 5 mg of normal lung tissue from control mice (n = 11) and 10% flaxseed-fed mice (n = 9) were lysed, proteins were separated on 10% SDS-polyacrylamide gels, and transferred to nitrocellulose membranes before probing with primary antibodies (1:1,000; p-AKT, t-AKT, p-ERK, t-ERK, p-JNK, and t-JNK). Anti-rabbit HRP-conjugated secondary antibodies (1:1,000) and SuperSignal West Pico Chemiluminescent Substrate (Thermo Fisher Scientific) were used to detect bands, and the images were captured using the MultiImage Light Cabinet (Alpha Innotech). The densitometry results were obtained using ImageJ software. p-AKT, p-ERK, and p-JNK protein levels were normalized to their corresponding total proteins.

RNA from normal lung tissue and lung tumor nodules of control and 10% flaxseed group mice (n = 3/group) was extracted using TRIzol reagent (Life Technologies). Briefly, 5 mg of tissue was homogenized in 1 mL of TRIzol. After incubating the homogenate at room temperature for 15 minutes, 50 μL of BCP was added. The tube was shaken vigorously for 30 seconds, incubated again at room temperature for 3 minutes, and then centrifuged at 12,000 × g for 15 minutes at 4°C. The supernatant was transferred to a fresh tube, and total RNA was precipitated by adding 1.5 volumes of 100% ethanol. The precipitated RNA sample was transferred to RNeasy Mini spin column (Qiagen), and RNA purification was performed using the manufacturer's protocol.

Three micrograms of total RNA from three mice in each group: normal lung tissue from control group (CN), tumor lung nodule from control group (CT), normal lung tissue from 10% flaxseed group (FN), and tumor lung nodule from 10% flaxseed group (FT) was sent for sequencing to the University of Minnesota Genomics Center (Minneapolis, MN). Six barcoded libraries were created and sequenced on Illumina HiSeq 2500. Single-end reads of 50 base pairs (bp) were obtained and mapped to the Mus musculus genome (Build: Mus_musculus.GRCm38) downloaded from Ensembl. The raw fastq were subjected to quality trimming using Sickle, for a minimum length of 50. HISAT2 (30) was used to map the reads on the genome. SAMtools (31) and BAMtools (32) were used to convert and sort the BAM files. HTSeq (33) was used to count the reads.

Regularized log-transformed (rlog) data were obtained using the method implemented in the Bioconductor DESeq2 package(v1.14.1). Fragment per kilobase of exon per million fragments mapped (FPKM) were calculated for each gene by normalizing the read count data to both the length of the gene and the total number of mapped reads in the sample. FPKM values were used to plot the heatmaps. Differential gene expression analysis was performed using the DESeq2 package. An adjusted P value (q-value) threshold of ≤0.1 using the Benjamini and Hochberg method and log₂ fold change ≥1 were used as the statistical cut-off criteria to further study the differentially expressed genes.

qRT-PCR was used to confirm expression changes for select genes found differentially expressed by RNA-Seq. The validation of RNA-Seq results was done using RNA from normal lung tissue of 11 mice in the control group and 9 mice in the flaxseed-fed group, and RNA from lung tumor nodules of 11 mice in the control group and 7 mice in the flaxseed-fed group. Total RNA was isolated from tissues using Fisher SurePrep Kit as per the manufacturer's instructions. cDNA was synthesized using 50 ng of total RNA and the qScript cDNA Synthesis Kit (Quanta Biosciences). Primers for genes listed in Supplementary Table S2 were designed using Primer Express software (version 2.0, Applied Biosystems) and were synthesized by Sigma-Aldrich. Steady-state mRNA levels were evaluated by qPCR using methods described elsewhere (34). The relative change in gene expression was calculated using 2^−ΔΔC_t method using housekeeping genes 18S rRNA and β-actin as internal controls.

Mice in both diet groups were weighed every 4 weeks, over the 6-month period, and their body mass was determined. Prior to the first NNK administration, the average body weight of mice in the control and flaxseed-fed groups was 20.0 and 20.1 g, respectively. During the study, mice on the 10% flaxseed diet showed a slightly reduced average body mass, with statistically significant differences observed at 2, 4, and 6 months of the study (Fig. 1B). At the end of the study, the average body weight of mice in the control group (26.3 ± 0.8 g) was significantly higher than that of the 10% flaxseed group (25.0 ± 1.6 g; P ≤ 0.05). The flaxseed-fed mice were slow to transition to their new diet and consumed less food in the first 2 months compared with the control-fed mice (Fig. 1C). The reduced food consumption in the flaxseed-fed mice likely explains the difference observed in average body weight throughout the study.

The lungs from NNK-treated control-fed mice (n = 11) and flaxseed-fed mice (n = 9) were weighed at the conclusion of the study, and the average lung mass was 0.23 and 0.18 g, respectively. This difference was statistically significant (P ≤ 0.05; Fig. 1D). The control mice had 100% incidence of lung adenocarcinoma formation with a range of 2 to 36 surface lung tumor nodules per mouse, and an average of 10.2 ± 5.7 lung tumor nodules per lung. Strikingly, the 10% flaxseed diet reduced adenocarcinoma incidence to 78%, and the number of surface lung tumor nodules per mouse was significantly (P ≤ 0.05) less, ranging from 0 to 15, with an average of 2.7 ± 2.3 lung tumor nodules per lung (Fig. 1E and F). On H&E-stained lung tissue sections, tumor nodules ranged from 1 to 8, with an average of 3.9 ± 2.6 per lung in control mice. Flaxseed-fed mice exhibited a significant (P ≤ 0.05) decrease in the number of lung tumor nodules ranging from 0 to 2, with an average of 1.0 ± 0.93 per lung (Fig. 1G and H). Pathologic classification of H&E-stained lung tumors revealed significantly fewer adenocarcinomas in the flaxseed-fed group (average of 0.25/lung) compared with the control-fed group (average of 0.41/lung). The adenoma to carcinoma ratio was 3:1 in flaxseed-fed mice compared with 1.4:1 in control-fed mice (Table 1). Finally, tumor morphometry data showed flaxseed-fed mice had significantly decreased tumor burden as compared with control group mice (0.0–5.4 vs. 0.7%–10.2% of total lung area; Fig. 1I). These findings suggest that 10% flaxseed intake reduces NNK-induced lung tumor development, multiplicity, and tumor burden in A/J mice and has the potential to prevent lung tumors from progressing to more advanced disease.

The chemopreventive properties of flaxseed were also evaluated in a BαP-induced A/J mouse model. Body weights for control and flaxseed-fed mice were similar for the early time points, but show elevated weight in flaxseed-fed mice at the end of the study (Fig. 2A and B). Lung tumor formation was decreased among mice fed a flaxseed diet that was initiated 3 weeks prior to BαP exposure (31 lung tumor nodules among mice fed a flaxseed diet compared with 43 lung tumor nodules among mice fed a control diet; Fig. 2C). The average number of tumor nodules per lung (Fig. 2D) was also decreased among mice fed a flaxseed diet (6.2 ± 1.7 lung tumor nodules among mice fed a flaxseed diet compared with 8.6 ± 1.9 lung tumor nodules among mice fed a control diet). Furthermore, the average tumor nodule size (Fig. 2E and F) was significantly decreased (P = 0.005) among mice fed a flaxseed diet (12.3 ± 0.4 μmol/L) compared with a control diet (27.7 ± 3.9 μmol/L). Total tumor area per lung (Fig. 2G) was also significantly decreased (P < 0.05) among mice fed a flaxseed diet (121.0 ± 36.6 μmol/L) compared with a control diet (256.7 ± 58.7 μmol/L). Finally, the percent of lung area infiltrated by tumor (Fig. 2H) was significantly (P < 0.05) reduced in flaxseed-fed mice (1.9 ± 0.8%) compared with control-fed mice (4.6 ± 0.7%).

The amount of flaxseed-derived mammalian lignans ED and EL were quantified in lung tissues of control and 10% flaxseed-fed mice. As expected, ED, the first mammalian lignan to appear after consumption of flaxseed, was not detected in lung tissues of control group mice, while 5 of 9 flaxseed-fed mice showed ED levels ranging from 19.5 to 106 ng/g, with an average of 31.70 ng/g of tissue. Surprisingly, EL was not detected in the lung tissues from either diet group.

Circulating levels of ED and EL were detected in blood plasma of both diet groups. Minor amounts of ED, ranging from 1.8 to 4.7 ng/mL, with an average of 2.8 ng/mL were detected in control group mice, while levels of ED ranging from 16.9 to 4,360 ng/mL, with an average of 1,539.6 ng/mL were detected in the 10% flaxseed group mice. EL was not detected in blood plasma of control-fed mice, while it was found to be 0 to 68.4 ng/mL, with an average of 20.8 ng/mL in blood plasma of 10% flaxseed-fed mice.

Sustained phosphorylation leading to activation of PI3K/AKT signaling (35) and MAPK signaling such as ERK (36) and JNK (37), which are downstream substrates of KRAS, play a role in NNK-induced lung carcinogenesis in A/J mice. Therefore, we investigated the effect of 10% flaxseed on phosphorylation status of these proteins in normal lung tissue. Reduced phosphorylation of AKT, ERK, and JNK protein kinases was detected in 10% flaxseed-fed mouse lung tissue compared with control group mice (Fig. 3A–F). These results suggest that 10% flaxseed reduces the incidence of lung tumor development by inhibiting aberrant activation of AKT, ERK, and JNK signaling molecules that play a role in cancer cell survival and proliferation.

To identify the gene expression changes contributing to the chemopreventive effects of flaxseed in mouse lungs, RNA-Seq was performed on RNA isolated from three mice each from CN, CT, FN, and FT tissues (explained in Materials and Methods). Principal component analysis (PCA) showed that gene expression analysis for CN and CT tissues clustered close to one another, showing strong intergroup correlation of gene expression. However, the gene expression analysis from FN and FT tissues segregated in two distinct clusters, indicating different intergroup gene expression but a strong intragroup correlation (Fig. 3A). In addition, the PCA plot indicated intergroup variation exists in the gene expression signature between FN versus CN and FT versus CT tissues.

We compared the transcriptomes of FN with CN and FT with CT to identify differentially expressed genes. A total of 16,837 gene transcripts were detected in FN versus CN and FT versus CT lung tissues. A cut-off criterion, mentioned in Materials and Methods, was used to generate a list of significantly differentially expressed transcripts. Compared with the control-group, 10% flaxseed-supplementation resulted in significant differential expression of 5,951 (35.3%; q ≤ 0.10) genes in the normal lung tissue, of which 2,094 (35.1%) transcripts had >1 log₂ fold change (upregulated), while 547 (9.1%) had <1 log₂ fold change (downregulated). Similarly, in the lung tumor nodules, 10% flaxseed supplementation resulted in significant differential expression of 3,096 (18.3%; q ≤ 0.10) genes, of which 1,329 (42.9%) transcripts had >1 log₂ fold change (upregulated), while 151 (4.8%) had <1 log₂ fold change (downregulated).

Data analysis using Reactome software revealed that the differentially expressed genes are categorized into diverse molecular pathways. The RNA-Seq data analysis for FN versus CN lung tissues identified genes belonging to pathways regulating (i) phase I and II xenobiotic metabolism; (ii) cell proliferation involving MAPK and PI3K/AKT signaling pathways; (iii) immune system via cytokines; (iv) detoxification of reactive oxygen species; (v) cell death; (vi) cellular response to stress and hypoxia; (vii) cell cycle; and (viii) DNA repair (Table 2). Similarly, Table 3 lists pathways differentially regulated between the FT versus CT lung tissues. The heatmaps in Fig. 4B and C, generated using FPKM values, display differentially expressed genes for FN versus CN and FT versus CT lung tissues. A list of these genes along with their average log₂ fold change for 3 mice in each group has been provided in Supplementary Tables S3 and S4.

To confirm differential expression by RNA-Seq, we used qRT-PCR to validate selected genes involved in signal transduction, xenobiotic metabolism, transcriptional regulation, and tumor suppression. qRT-PCR results largely supported the RNA-Seq results for the subset of genes we chose to validate (Fig. 5A and B). For example, PP2R, CYP2A5, ELGN3, HIF3a, IL12a, and TP63 were elevated in flaxseed normal and tumor tissue relative to control tissues for both RNA-Seq and qRT-PCR. Western blotting confirmed elevated TP63 protein expression in the majority of flaxseed-fed mouse lungs compared with control-fed animals (Supplementary Fig. S1). Occasional inconsistencies in the expression of interleukins were observed between RNA-Seq and qRT-PCR and may result from a small RNA-Seq sample size (n = 3) in our study.

Most lung cancers are caused by exposure to tobacco smoke carcinogens. A dietary intervention with potential to protect against chemically induced lung tumorigenesis would be extremely useful, as lung cancer has one of the lowest 5-year survival rates among cancer patients. Previous studies indicate phytochemicals such as polyphenon E (8), PEITC (9, 10), and indole-3-carbinol (11) inhibit development of NNK-induced lung tumors in A/J mice. The current study investigated the effects of flaxseed on formation of chemically induced lung tumors and the molecular mechanisms associated with the observed lung chemopreventive properties of flaxseed. Our results suggest dietary flaxseed can inhibit NNK or BαP lung tumor development and progression to more advanced disease regardless of when the flaxseed diet was initiated (3 weeks prior to or simultaneous to the initial BαP exposure).

Previous evidence suggests that flaxseed supplementation ameliorates oxidative stress and inflammation in lung injury models (24, 25) and significantly alters gene expression associated with apoptosis, cell proliferation, inflammation-associated cytokine signaling, oxidative stress, and phase I and phase II detoxification pathways in healthy mouse lung tissue (26). Similarly, we found flaxseed was associated with gene expression changes for signal transduction pathways, such as PI3K/AKT and MAPK, apoptosis, cell-cycle regulation, cellular response to hypoxia and stress, cytokine response in immune system, development biology, extracellular matrix organization, transcription regulation by TP53, and xenobiotics metabolism. Most transcriptomics studies similar to ours evaluated gene expression changes only in the tumor tissue from control versus treatment animals. Here, we also compared normal tissue from control and flaxseed-fed animals and found that gene expression patterns were similar for FN versus CN and FT versus CT tissues. This suggests that the gene transcription changes happening in normal tissues are a good indicator for what is also happening in the tumor tissues.

At the end of the study, we detected levels of ED and EL in lung tissue and in blood plasma of 10% flaxseed group mice. This suggests that even though initially the flaxseed group mice were reluctant to eat the fortified diet, they became accustomed to it and consumed it as well as the control diet during the majority of the study. The flaxseed-fed mice had lower average body weight at the end of the study, which could be attributed to (i) reduced food consumption in the first 2 months of the study; (ii) reduced fat digestibility (38); and/or (iii) altered adipogenesis gene regulation (39). The decrease in average weight of lungs in the flaxseed fed mice as compared with control group mice suggests tumor burden may be a contributing factor. Flaxseeds contain approximately 30% dietary fibers, consumption of which has been shown to reduce fat digestibility and bodyweight gain in rats (38). In addition, flaxseed lignan secoisolariciresinol diglucoside exerts a suppressive effect on bodyweight gain in mice by altering lipid metabolism (39). Our result is in line with the effect of flaxseed on bodyweight gain reported earlier in rodents.

High levels of phosphorylated AKT and ERK are observed in bronchial preneoplastic lesions (40–42), which are precursors of lung adenoma and adenocarcinoma (8). In addition, NNK-induced murine lung lesions also exhibit increased activation of AKT (35) and ERK (36); therefore, suppression of these signaling pathways may be critical for improved lung cancer inhibition. We observed decreased phosphorylation of AKT and ERK protein kinases in normal lung tissue from NNK-treated flaxseed-fed mice. Our findings are in line with other reports showing decreased phosphorylation of AKT and ERK protein kinases after treatment with chemopreventive agents such as, degeulin (43), indole-3-carbinol (11), myoinositol (40), and metformin (44) in NNK-induced mouse models of lung tumorigenesis.

AKT is negatively regulated by protein phosphatase-2alpha (PP2A). Our RNA-Seq data showed that the expression levels of PP2A were significantly increased in lung tissues from flaxseed-fed mice. The PP2A gene encodes a major cellular serine-threonine phosphatase and is a potential tumor suppressor due to its negative regulation on kinase-driven intracellular signaling pathways in several cancers, including lung cancer. This suggests that dephosphorylation of AKT observed in healthy lung tissue of flaxseed-fed mice may be due to increased expression of PP2A. Furthermore, enhanced AKT signaling directly correlates with increased rates of aerobic glycolysis in cancer cells (45). Inhibition of AKT signaling may inhibit glycolysis and elevate reactive oxygen species, leading to preferential killing of cancer cells through oxidative stress (46).

In addition to AKT and ERK signaling pathways, deregulation of another pivotal kinase, JNK, promotes development of tobacco smoke–induced lung tumors (47). Genetic ablation of JNK1 alone is associated with reduced tobacco smoke–induced lung tumor multiplicity and size (37). In this study, we observed that NNK-treated 10% flaxseed-fed mice exhibited decreased phosphorylation of JNK protein kinase in normal lung tissue. These findings together with our observations suggest that inhibiting AKT, ERK, and JNK activity might be a valuable approach to suppress/delay the effects of NNK-induced lung tumorigenesis.

NNK has been shown to upregulate proinflammatory cytokines and downregulate anti-inflammatory cytokines, which contribute to immunosuppression and lung tumor development. NNK upregulated proinflammatory IL6 (48) and IL8 (49), leading to increased cell proliferation, neovascularization, and tumor development. IL1α binding to IL1 receptor enhanced the production of IL8 in human airway epithelial cells, indicating that suppression of IL1α production may reduce IL8-mediated lung inflammation (50). Our RNA-Seq data showed a significant decrease in IL6, IL1α, and IL8 mRNA expression in lung tumors in response to flaxseed consumption. NNK inhibits the production of the anti-inflammatory cytokine IL12α by alveolar macrophages and increases the risk of developing lung cancer by suppressed activation of natural killer cells (51). We found IL12α was significantly elevated in flaxseed-fed mice, which may have contributed to reduced lung tumor formation in these animals. Our findings suggest that flaxseed may suppress lung carcinogenesis by mitigating NNK-induced lung immunosuppression by reducing expression of proinflammatory cytokines (IL1α, IL6, IL8, and IL9) and increasing the expression of anti-inflammatory cytokine (IL12α).

Plant-derived phytochemicals exert chemopreventive effects at the initiation level by (i) inhibiting the expression and/or activity of phase I enzymes [cytochrome P450 (CYP)] that activate procarcinogens such as NNK, and/or (ii) inducing phase II enzymes [glutathione S-transferases (GST) and UDP-glucuronosyltransferase (UGT)] that detoxify electrophilic metabolites generated by phase I enzymes (9, 10). In our study, the RNA-Seq data showed that 10% flaxseed altered expression of several CYPs, GSTs, and UGTs. This indicates that chemopreventive property of 10% flaxseed may be dependent on its ability to induce expression of phase II enzymes (GSTs and UGTs), which are responsible for detoxification of NNK.

In summary, we found flaxseed consumption protects against chemically induced (both NNK and BαP) lung tumor formation in mice. Flaxseed influenced gene expression in normal lung and lung tumor tissues, including upregulating the expression of phase II enzymes, anti-inflammatory cytokines and tumor suppressors, and downregulating the expression of proinflammatory cytokines, which may explain the antitumor effects of flaxseed in this model. Further work is needed to identify the potential for flaxseed to impact gene expression in airways of a human population exposed to tobacco smoke carcinogens.

M. Christofidou-Solomidou reports receiving other commercial research support from, has ownership interest (including patents) in, and is a consultant/advisory board member for LignaMed, LLC. No potential conflicts of interest were disclosed by the other authors,

Conception and design: S. Chikara, R. Pietrofesa, G. Moorthy, M. Christofidou-Solomidou, K.M. Reindl

Development of methodology: S. Chikara, R. Pietrofesa, A. Zuppa, G. Moorthy, M. Christofidou-Solomidou, K.M. Reindl

Acquisition of data (provided animals, acquired and managed patients, provided facilities, etc.): S. Chikara, R. Pietrofesa, G. Moorthy, M. Christofidou-Solomidou, K.M. Reindl

Analysis and interpretation of data (e.g., statistical analysis, biostatistics, computational analysis): S. Chikara, S. Mamidi, A. Sreedasyam, K. Chittem, R. Pietrofesa, G. Moorthy, N. Dyer, M. Christofidou-Solomidou, K.M. Reindl

Writing, review, and/or revision of the manuscript: S. Chikara, S. Mamidi, A. Sreedasyam, K. Chittem, R. Pietrofesa, A. Zuppa, G. Moorthy, M. Christofidou-Solomidou, K.M. Reindl

Administrative, technical, or material support (i.e., reporting or organizing data, constructing databases): S. Chikara, A. Zuppa, G. Moorthy, K.M. Reindl

Study supervision: S. Chikara, G. Moorthy, M. Christofidou-Solomidou, K.M. Reindl

The authors wish to thank Dr. C.C. Solomides for histopathologic evaluation of the lung sections.

Funding for this pilot project was made possible by NIH grant numbers P30 GM103332 and P20 GM109024 (to K.M. Reindl) from the National Institute of General Medicine (NIGMS). Additional funding to support the work was provided by NIH grant number P42 ES023720 (to M. Christofidou-Solomidou) from the National Institute of Environmental Health Sciences.

The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked advertisement in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.