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INTRODUCTION
Several studies concluded that childhood leukaemia may arise before birth suggesting
that maternal and perinatal exposures such as chemical or infectious agents during pregnancy
may increase risk of childhood cancer (Greaves and Wiemels, 2003; McHale and Smith,
2004 and Ma et al, 2002). The exact causes of childhood leukaemia remain largely unknown
however several environmental exposures have been proposed to be causal in the
development of childhood leukaemia including radiation, maternal smoking, maternal alcohol
consumption and maternal nutrient status all being suggested to influence cancer risk in the
offspring (Belson et al, 2007; Davis et al, 2004; Pufulete et al, 2005).
Figure 1.1 Metabolic pathways involving folate and vitamin B12 (taken from Fenech et al,
2001). Commented [NA2]:
folate intake during pregnancy has been suggested to influence the risk of leukaemia
development in children. Study by Bailey et al (2012) reported a possible protective effects of Commented [NA4]: Folate intake during pregnancy has been
found to be associated with ALL
folate in maternal with higher folate and vitamin B12 intake during pregnancy and
–Thompson et al, Lancet (2001) 8;358(9297):1935-40
association with decreased risk of ALL in the offspring. In addition, Thompson et al (2001) –Amigou et al, Cancer Causes Control (2012) 23(8):1265-77
–Bailey et al, Nutr Cancer (2012) 64(7):1122-30
also presented similar finding whereby folate supplement administered in mothers during
pregnancy reduces acute lymphoblastic leukaemia risk in the offspring. Furthermore, it was
found an inverse association between maternal folic acid supplementation before and during
pregnancy with risk of ALL in the child (Amigou et al, 2012). Commented [NA5]:
Folate is a water-soluble vitamin that can be found mainly in fortified cereals, citrus
fruits and juices, asparagus, baked beans, lentils and others (Tapiero et al, 2001). It is
important in maintaining DNA stability and provides one-carbon methyl groups for the one-
carbon metabolic pathway which is involved in nucleic acid synthesis and cell division,
regulation of gene expression DNA synthesis and repair mechanisms as well as in the
methylation pathway. Folate is important for providing 5-MTHF for the methylation of
homocysteine to methionine which is then converted to S-adenosylmethionine (SAM), the
universal methyl donor essential for the methylation of biomolecules including DNA (Figure
1.1) (Bailey et al, 2012 and Langie et al, 2013). Variation of dietary intake of this methyl-
group source and others involved in this pathway including vitamin B12 (Figure 1.1) could
therefore potentially affect patterns of DNA methylation and therefore influence cancer risk
susceptibility via altered gene expression (Davis et al, 2004).
DNA methylation is one of an epigenetic series mechanism which can affect the
expression of genes without altering the genomic sequence. It can be defined as addition of a
methyl group to cytosine bases at the carbon 5’ position in CpG dinucleotide site (Davis et al,
2004). CpG island characterized by cluster of methylated CpG sites and associated with
transcriptional repression (Lilycrop et al, 2005). Commented [NA6]:
DNA methylation patterns are established during development in utero and early life
and can influences specific gene expression via transcriptional regulation (McKay et al,
2011). In general, it is assume that methylated promoter region leads to gene silencing while
unmethylated promoter region is associated with gene expression (Figure 1.2). Commented [NA7]:
In one of the first examples of this, Cooney et al (2002) showed that the offspring of
female mice that were fed with methyl-supplemented diet influenced the changes in the
molecular marks including DNA methylation which consequently influenced phenotypic
changes in the pups whereby they present difference in colour coat. This suggested that in Commented [NA8]:
utero exposure to maternal nutritional status could influence epigenetic markings of the genes
in the offspring leading to a clear phenotypic consequence (Davis et al, 2004). Whilst this
example described a dietary change involving multiple methyl-donors, changes in folate
intake alone during pregnancy have been observed to alter DNA methylation in the offspring.
These observations suggested that maternal folate status during pregnancy and
potentially other vitamins involved in one carbon metabolism including vitamin B12 is
significantly associated with epigenetic patterns in the offspring therefore this may
potentially modulate risk of childhood leukaemia as maternal folate status could alter DNA
methylation patterns (potential mechanism in the causal pathway to cancers). Therefore it is
highly plausible that DNA methylation might be one mechanism by which maternal folate
status during pregnancy is associated with development of childhood leukaemia.
hypothesis that low maternal folate status may potentially influence childhood leukaemia risk
via changes in DNA methylation. Folate and vitamin B12 status in the mothers during
pregnancy were previously measured as well as for the infants therefore correlate these data
in association with changes in DNA methylation. Commented [NA12]:
1.1 Hypothesise
Primary: Maternal folate status during pregnancy contributes in the development of
childhood leukaemia through alteration in DNA methylation of disease-associated
genes.
Secondary: Infant folate status may be associated with DNA methylation in the
offspring
Secondary: Maternal and infant B12 status influences the degree of DNA methylation
in the infant.
1.2 Objectives