Caspase 9 promoter polymorphisms and risk of primary lung cancer

Caspase-9 (CASP-9) is an initiator CASP in the apoptosome-driven apoptosis pathway and plays an important role in the development and progression of cancer. Polymorphisms in the promoter region of the CASP-9 gene may influence the promoter activity of this gene, thereby modulating susceptibility to lung cancer. To test this hypothesis, we examined the association of four polymorphisms [-1263A > G, -905T > G, -712C > T and -293_-275delCGTGAGGTCAGTGCGGGGA (-293del)] in the CASP-9 promoter with the risk of lung cancer in a Korean population. The CASP-9 genotypes were determined in 432 lung cancer patients and 432 healthy controls that were frequency-matched for age and gender. The -1263 GG genotype was associated with a significantly decreased risk of lung cancer compared with the -1263 AA genotype or combined -1263 AA + AG genotype [adjusted odds ratio (OR) = 0.64, 95% confidence interval (95% CI) = 0.42-0.98, P = 0.04 and adjusted OR = 0.67, 95% Cl = 0.46-0.97, P = 0.01, respectively]. For the -712C > T polymorphism, individuals with at least one -712T allele were at a significantly increased risk of lung cancer compared with those harboring the -712 CC genotype (adjusted OR = 1.42, 95% Cl = 1.06-1.89, P = 0.02). Consistent with the results of genotype analyses, the -1263G/-712C (G-C) haplotype was associated with a significantly decreased risk of lung cancer [adjusted OR = 0.59, 95% Cl = 0.47-0.75, P and Bonferroni corrected P (PC) < 0.001]. Moreover, the risk of lung cancer decreased in a dose-dependent manner as the number of the G-C haplotypes increased (adjusted OR = 0.60, 95% Cl = 0.45-0.81, P = 0.0007 and P-c = 0.0014 for the G-C heterozygotes and adjusted OR = 0.34, 95% Cl = 0.17-0.68, P = 0.0023 and P-c = 0.0046 for the G-C homozygotes; P-trend < 0.001). The promoter assay revealed the G-C haplotype to have a significantly higher promoter activity than the -1263G/-712T and -1263A/-712C haplotypes. These results suggest that CASP-9 promoter polymorphisms affect CASP-9 expression and contribute to genetic susceptibility to lung cancer.