
Clinical Cancer Research Vol. 6, 230-236, January 2000
© 2000 American Association for Cancer Research
Experimental Therapeutics, Preclinical Pharmacology |
The Potential of Soybean Foods as a Chemoprevention Approach for Human Urinary Tract Cancer1
Shu-Jem Su,
Trai-Ming Yeh,
Huan-Yao Lei and
Nan-Haw Chow2
Departments of Microbiology and Immunology [S-J. S., T-M. Y., H-Y. L.], Medical Technology [T-M. Y.], and Pathology [N-H. C.], College of Medicine, National Cheng Kung University, Tainan, Taiwan 70101, Republic of China
 |
ABSTRACT
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Isoflavones
are excreted in human urine and can be modulated by soy-rich diets.
Recently, isoflavones were suggested to have protective effects against
bladder cancer cells. We sought to determine the efficacy of the
antitumorigenic effects of isoflavones at concentrations found in the
range of human urine excretion and compare normal urothelium and
bladder cancer cells for differential cytotoxicity. A total of
seven human bladder cancer cell lines and an immortalized uroepithelial
cell line were used to examine the effects of genistein, daidzein, and
biochanin-A, either individually or as an equal-proportion mixture
regimen, on cell growth, DNA synthesis, alterations of cell cycle
distribution, and induction of apoptosis. The role of cyclin B1 and
cdc2 kinase in cell cycle arrest was analyzed. In addition, severe
combined immunodeficient mice were used to confirm the anticancer
effects of isoflavones in vivo. Cooperative action of
isoflavones was more effective in growth inhibition and apoptosis
induction than any single compound. Genistein tends to cause a
dose-dependent induction of G2-M cell cycle arrest and an
inhibition of cdc2 kinase activity. However, both daidzein and
biochanin-A directly induced apoptosis without altering cell cycle
distribution. The IC50 values in non-transformed cells were
higher than those in most cancer cell lines, and the IC50
of the mixture regimen was within reach of the levels observed in
urine after a soy challenge. Furthermore, both genistein and
combined isoflavones exhibited a significant tumor suppressor effect
in vivo (P < 0.05). The results
justify the potential use of soybean foods as a practical
chemoprevention approach for patients with urinary tract cancer.
 |
INTRODUCTION
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Transitional cell carcinoma is the most important cancer of the
urinary tract and occurs in the renal pelvis, ureter, urinary bladder,
and urethra. The incidence of this cancer and the number of deaths from
this cancer are generally increasing, notably in economically developed
societies. It is well known that field cancerization is an important
characteristic of tran-sitional cell carcinoma and may affect the
natural course of disease progression. For example, enhanced
expression of tumor-associated antigens could be shown in
normal-appearing urothelium (1, 2, 3)
, and the degree of
epithelial dysplasia predicts the risk of disease progression
(4)
. As a result, it is imperative to modulate
carcinogenesis as early as from the initiated cells in the field
mucosa.
A number of epidemiological studies have reported that increased soy
consumption is associated with a reduced risk of breast, colon, and
prostate cancer for peoples living in Asia as compared with peoples
living in America and Western Europe (5)
. Further support
for the potential of isoflavones as natural chemopreventives is the
dose-dependent response of urinary isoflavone excretion to soy
consumption from low to higher doses (6
, 7)
. Animal
studies also found that soybean feeding has a protective effect on
bladder carcinogenesis in Swiss albino mice (8)
and on a
transplantable murine tumor (9)
. A recent report showed
that genistein (5,7,4'-trihydroxyisoflavone), daidzein
(7,4'-dihydroxyisoflavone), biochanin-A, and phytochemical concentrate
tend to cause a dose-dependent inhibition of proliferation in
J82 human cancer cells (9)
. A
G2-M-phase cell cycle arrest could be
demonstrated in both the J82 and UM-UC-3 cell lines. Because
isoflavones are excreted in human urine, and the levels are positively
associated with the frequency of soy intake (10)
, this
group of compounds deserves investigation in the context of dietary
chemopreventives for urinary tract cancer. This study was performed to
address the following questions: (a) do the cancer
protective effects apply to bladder cancer of various histological
grades? (b) is there any toxicity to normal urothelium if
isoflavones are used as treatment? and (c) what is the
biological efficacy of mixed soy isoflavones at concentrations found in
the range of human urine excretion?
 |
MATERIALS AND METHODS
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Cell Culture and in Vitro Growth Evaluation and
Reversibility of Growth Inhibition.
The human bladder cancer cell lines RT4, J82, HT1376, and T24 were
obtained from the American Type Culture Collection (Manassas, VA). Both
TSGH8301 and BFTC905 were established locally and have been reported in
detail previously (11
, 12)
. The E6 cell line was an
immortalized human uroepithelium (13)
.
To examine the efficacy of growth inhibition induced by isoflavones,
genistein (Life Technologies, Inc.), daidzein (Calbiochem-Novabiochem),
and biochanin-A (Sigma) were dissolved in DMSO (Sigma) for in
vitro study and animal experiments. The cell number was counted
using the crystal violet elution method (14)
.
[3H]Thymidine Incorporation.
To evaluate the rate of DNA synthesis, cells (1 x
103) that had been treated with isoflavones and
[3H]thymidine (0.2 mCi/well) for 18 h were
counted.
DNA Fragmentation Analysis.
The DNA fragmentation study was basically performed as described
previously (15)
. Briefly, cells were lysed with lysis
buffer [20 mM Tris (pH 8.6), 1 mM EDTA, and
0.4% Triton X-100], and the supernatants were collected by
centrifugation at 10,000 x g for 10 min. After
precipitation, DNA samples were separated by 1% or 1.5% agarose gel
electrophoresis and visualized by ethidium bromide staining.
Cell Cycle Analysis and Measurement of Apoptosis.
The cell cycle distribution was estimated by flow cytometric DNA
analysis according to standard procedures (15)
. Briefly,
1 x 106 cells were cultured and treated
with or without different concentrations of isoflavones. These cells
were then stained with fluorochrome DNA staining solution and analyzed
using a FACSsort cytometer (Becton Dickinson, San Jose, CA). The
percentage of cells in different cell cycle phases
(G0-G1, S phase, and
G2-M phase) was calculated using Lysis II
Software. The sub-G0-G1
peaks were considered apoptosis.
Cyclin B Protein Estimation.
The amount of cyclin B protein was estimated as described
previously (16)
. Cell extracts were prepared by the
addition of SDS loading buffer [50 mM Tris-HCl (pH 6.8),
2% SDS, 10% glycerol, and 100 mM DTT], 1 mM
phenylmethylsulfonyl fluoride, and 1x mixture of protease inhibitors
(Sigma) for 10 min. After boiling, the extracts were put on ice and
centrifuged (12,000 rpm, 4°C) for 20 min. The protein sample (500
µg) was resolved by 12% SDS-PAGE, blotted to nitrocellulose paper,
and immunoblotted with antihuman cyclin B1 monoclonal antibody (Santa
Cruz Biotechnology). The immune complexes were visualized using an
enhanced chemiluminescence detection system (Amersham Life Science).
cdc2 Kinase Assay.
cdc2 kinase activity was estimated according to the procedure described
previously (17
, 18)
. Protein quantitation was performed
using the BCA assay (Pierce, IL). Each cell line (100 µg) was
incubated with anti-cdc2 kinase monoclonal antibody (2 µg; Santa Cruz
Biotechnology), followed by a protein A-Sepharose reaction on a
rotator. The resulting immune complexes were assayed for kinase
activity in reaction buffer containing 2.4 µg of histone H1, 10
Ci/mmol of [
-32P]ATP, and 0.3% DMSO or
genistein (5, 10, and 20 µg/ml). Then reaction was stopped and
resolved by 12% SDS-PAGE. The phosphorylated H1 proteins were
visualized by autoradiography.
SCID3
Mice Xenograft
Model.
TSGH8301 cells (1 x 107) were injected s.c.
into the backs of 6-week-old male mice, as described previously
(19)
. Engrafted tumors were then treated with 0.025%
DMSO, 50 µg of genistein, or a mixture regimen (20 µg of genistein,
daidzein, and biochanin-A) every 3 days (n = 6
for each group). The largest diameter of the tumor was measured, and
tumor volumes were calculated.
Statistical Analysis.
Unpaired Students t test (two- sided) was used to
determine the differences in IC50 values and cell
cycle distribution among the cell lines tested, and mean tumor size of
mice in different study groups was analyzed by Statworks
(Cricket Software, Inc.). The levels of significance were set at
P < 0.05.
 |
RESULTS
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Effect of Isoflavones on the Cell Growth of Human Bladder Cancer.
The effects of genistein, daidzein, and biochanin-A were tested on
bladder cancer cell lines individually at various concentrations or as
a mixture regimen. A dose-dependent inhibition of cell growth by each
isoflavone was observed in all cell lines tested (Fig. 1)
. Although the sensitivity of each cell
line varied, genistein was the most potent growth inhibitor, followed
by biochanin-A and then daidzein. The mixture regimen had a greater
inhibitory effect than any single compound. As summarized in Table 1
, there was a trend toward positive
correlation between IC50 for genistein and
histological grading of cancer cells. Except for HT1376 cells, the
IC50 value was higher in E6 control cells than in
most cancer cell lines (P < 0.05, respectively).

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Fig. 1. The inhibition of isoflavones on cell growth.
Different concentrations of isoflavones were incubated with cancer
cells (1 x 104) for 3 days. After treatment, cell
numbers were counted in triplicate and expressed as a percentage
(mean ± SD) compared with controls. G+B+D,
genistein + biochanin-A + daidzein.
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The reversibility test showed that the ability to recover from
isoflavone inhibition was inversely related to the dosage,
i.e., the higher the doses of isoflavone, the less chance of
recovery from inhibition (data not shown). The results suggest that
isoflavones are cytostatic at dosages lower than the
IC50 but become cytotoxic at higher dosages. Each
cell line had its own cutoff value for irreversible inhibition. The
values for the J82 cell line, for example, were 20 µg/ml genistein,
30 µg/ml biochanin-A, and 50 µg/ml daidzein, respectively (Fig. 2)
. The thymidine incorporation study
found a dose-dependent inhibition of DNA synthesis by isoflavones in
all cell lines in the range of 1050 µg/ml (data not shown).

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Fig. 2. Reversibility of growth inhibition by
isoflavones. J82 cells (5 x 103) were treated with
appropriate concentrations of isoflavones dissolved in DMSO (less than
0.5% v/v) for 3 days, and cell counts were measured after incubation
with DMEM for 2 days. The values were expressed as the means of three
experiments. DMSO was used as control. G, genistein;
BA, biochanin-A; D, daidzein.
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Apoptosis Induction by Isoflavones.
DNA fragmentation was used to test the occurrence of apoptosis after
isoflavone treatment. Variable degrees of DNA ladder could be verified
in most cancer cell lines, supporting the apoptosis-inducing ability of
isoflavones. Typical results from TSGH8301, BFTC905, and T24 cells are
shown in Fig. 3
.

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Fig. 3. DNA fragmentation induced by isoflavones.
Exponentially growing cells were treated with isoflavones for 4872 h.
DNA samples were electrophoresed by 1% or 1.5% agarose gel.
a, TSGH8301; b, BFTC905;
c, T24. Lane M, molecular weight markers;
Lane C, DMSO-treated cells;
Lane G50, genistein (50 µg/ml);
Lane B-A50, biochanin-A (50 µg/ml); Lane
D50, daidzein (50 µg/ml).
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Effect of Isoflavones on Cell Cycle Progression.
Flow cytometric analysis showed that there was no apparent cell cycle
arrest if isoflavones were lower than 5 µg/ml (data not shown).
High-grade cancer cells (TSGH8301, T24, and J82) were found to have a
significant dose-dependent reduction of G1 phase
together with an increased G2-M phase when
genistein reached concentrations of 10 or 20 µg/ml (P < 0.05, respectively). However, there was no alteration of cell cycle
distribution in the E6 and RT4 cell lines (Table 2)
. Representative results from J82 cells
are shown in Fig. 4
. The apoptosis
induction by genistein appears to be dose dependent and kinetic
dependent, but biochanin-A and daidzein induced apoptosis without any
alterations in cell cycle distribution (Fig. 4)
.

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Fig. 4. Effects of isoflavones on cell cycle
progression and apoptosis induction. J82 cells (1 x
106) were grown in the absence or presence of isoflavones
at 10 µg/ml or 50 µg/ml for 24 and 48 h, respectively. The
cell cycle distribution was analyzed by flow cytometry.
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Biochemical Target of Cell Cycle Arrest Induced by Genistein.
To elucidate the mechanism through which genistein induces
G2-M cell cycle arrest, both cdc2 kinase activity
and cyclin B1 protein expression were evaluated in each cell line.
There was no apparent difference in cyclin B1 expression in relation to
genistein treatment (Fig. 5)
. However, a
dose-dependent inhibition of the cdc2 kinase activity, corresponding to
the observed cell cycle arrest effect, was observed in most bladder
cancer cell lines, except E6 and RT4 (Fig. 6)
.

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Fig. 5. Effect of genistein on cyclin B1 expression.
Human bladder cancer cells were treated with genistein of 10
(G10), or 20 (G20) µg/ml for 24 h.
Representative results of cyclin B1 expression from TSGH8301, T24, and
J82 cells are shown.
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Fig. 6. Effect of genistein on cdc2 kinase activity.
Human bladder cancer cell extracts were treated with or without
genistein of 5 (G5), 10 (G10), or 20
(G20) µg/ml. Representative results from E6, RT4,
TSGH8301, T24, and J82 cell lines are shown.
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The Anticancer Effects of Isoflavones in
Vivo.
To verify the anticancer effects of isoflavones in vivo,
engrafted TSGH8301 cells in SCID mice were treated with genistein or
the mixture regimen. The 5070-fold increase in tumor size observed
over a 23-week period in animals treated with DMSO was significantly
decreased when genistein or the isoflavone combination was injected
s.c. (P < 0.05, respectively; Fig. 7
). However, there was no apparent
difference between the mice treated with genistein and those treated
with the combination regimen (P > 0.1). Moreover, no
significant cancer protection was noticed when isoflavones at the same
dosages were injected directly into the i.p. cavity (data not shown).
No metastasis was seen in any mouse during the study period
(data not shown).

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Fig. 7. Effects of genistein or combined
isoflavones on the growth of TSGH8301 cells in SCID mice. Tumor cells
(1 x 107) were injected s.c. into SCID mice.
Experiments began when the appropriate nodule size was reached. DMSO or
isoflavones were given every 3 days and compared for their anticancer
potency. DMSO (0.025%) was used as a control.
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DISCUSSION
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Recent advances in molecular biology demonstrate that a loss of
genetic material on multiple chromosomal loci is required for
transformation of normal epithelium to frank cancer (20)
.
Mucosa field changes and their prognostic significance support that
early transformed cells are present in the urothelium of patients with
transitional cell carcinoma. Because continued exposure to carcinogenic
stimuli may induce additional genetic alterations that lead to tumor
recurrence/progression, systemic therapy to the field mucosa may be the
most practical way to halt or reverse the carcinogenic process.
In this study, we demonstrate that genistein induces a dose-dependent
G2-M-phase cell cycle arrest; but both daidzein
and biochanin-A directly induce apoptosis without altering cell cycle
distribution. In addition, the cooperative action of isoflavones is
more effective in the inhibition of cell growth, DNA synthesis, and
apoptosis induction than any single compound. Our data thus support
that part of the antitumorigenic effects of isoflavones may be derived
from G2-M-phse cell cycle arrest and/or apoptosis
induction. Further support for the clinical relevance of isoflavones
comes from the differential cytostatic/cytotoxic effects between E6 and
most cancer cell lines. Actually, the IC50 values
of the mixture regimen (35 µg/ml or 7.913.2 µM) in
most cancer cell lines are within reach of the urine levels of daidzein
(14.7 µM) and genistein (8.4 µM) after a
soy challenge (12)
, confirming the potential of soybean
foods in prevention of urinary cancer.
Several biochemical targets have been proposed to explain the
cancer-preventive effect of isoflavones (21)
. For example,
genistein is a specific inhibitor of tyrosine kinases, DNA
topoisomerases I and II, and ribosomal S6 kinase. Furthermore, high
concentrations of isoflavones could inhibit angiogenesis and scavenge
DNA reactive agents (22)
. We provide evidence that
down-regulation of cdc2 kinase activity is one of the molecular
mechanisms responsible for the cell cycle arrest induced by genistein.
Nevertheless, daidzein and biochanin-A were found to induce apoptosis
without alterating cell cycle progression, suggesting that multiple
mechanisms may be responsible for the anticancer effects of
isoflavones.
The purpose of chemoprevention is to defer the progression of
disease. If the occurrence of cancer is deferred for one or more
decades (for example, from age 60 years to 80 years), then the
"prevention" is very substantial and worthwhile. The current study
suggests that isoflavone excretion in human urine could inhibit or
retard the progression of bladder carcinogenesis. The hypothesis, if
verified by randomized, controlled trials, may be of great clinical
impact. Because urinary isoflavones are increased only on the first day
after challenge and will recover to prechallenge levels on the second
or third day (12)
, regular soy-based diets could be
recommended as a chemoprevention approach for patients with urinary
tract cancer or for those individuals with high-risk occupations. Taken
together with the fact that diets high in vegetables and fruits are the
most effective means of preventing bladder cancer (23
, 24)
, dietary change can be considered a practical strategy in
confronting urinary tract cancer.
 |
ACKNOWLEDGMENTS
|
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We thank Lien-Ping Kao and Wei-Ber Liu for technical assistance
and Prof. Min-Der Lai for his kindness in providing some of the bladder
cancer cell lines used in this study.
 |
FOOTNOTES
|
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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.
1 Supported by Grants NSC88-2314-B-006-051 and
NSC88-2314-B-006-079 from the National Science Council, Taiwan,
Republic of China and Grant NCKUH-88-037 from the National Cheng Kung
University Hospital, Tainan, Taiwan, Republic of China. 
2 To whom requests for reprints should be
addressed, at Department of Pathology, National Cheng Kung University
Hospital, 138 Sheng-Li Road, Tainan, Taiwan 70428, Republic of China.
Phone: 886-6-2741928; Fax: 886-6-2383678; E-mail: chownh{at}mail.ncku.edu.tw 
3 The abbreviation used is: SCID, severe combined
immunodeficient. 
Received 6/14/99;
revised 10/ 4/99;
accepted 10/ 6/99.
 |
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133(7):
2367 - 2376.
[Abstract]
[Full Text]
[PDF]
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C.-L. Sun, J.-M. Yuan, K. Arakawa, S.-H. Low, H.-P. Lee, and M. C. Yu
Dietary Soy and Increased Risk of Bladder Cancer: the Singapore Chinese Health Study
Cancer Epidemiol. Biomarkers Prev.,
December 1, 2002;
11(12):
1674 - 1677.
[Abstract]
[Full Text]
[PDF]
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H.-L. Cheng, B. Trink, T.-S. Tzai, H.-S. Liu, S.-H. Chan, C.-L. Ho, D. Sidransky, and N.-H. Chow
Overexpression of c-met as a Prognostic Indicator for Transitional Cell Carcinoma of the Urinary Bladder: A Comparison With p53 Nuclear Accumulation
J. Clin. Oncol.,
March 15, 2002;
20(6):
1544 - 1550.
[Abstract]
[Full Text]
[PDF]
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