Vitamin and antioxidant rich diet increases MLH1 promoter DNA methylation in DMT2 subjects
© Switzeny et al.; licensee BioMed Central Ltd. 2012
Received: 9 July 2012
Accepted: 14 September 2012
Published: 1 October 2012
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© Switzeny et al.; licensee BioMed Central Ltd. 2012
Received: 9 July 2012
Accepted: 14 September 2012
Published: 1 October 2012
Oxidative stress may lead to an increased level of unrepaired cellular DNA damage, which is discussed as one risk for tumor initiation. Mismatch repair (MMR) enzymes act as proofreading complexes that maintain the genomic integrity and MMR-deficient cells show an increased mutation rate. One important gene in the MMR complex is the MutL homolog 1 (MLH1) gene. Since a diet rich in antioxidants has the potential to counteract harmful effects by reactive oxygen species (ROS), we investigated the impact of an antioxidant, folate, and vitamin rich diet on the epigenetic pattern of MLH1. These effects were analyzed in individuals with non-insulin depended diabetes mellitus type 2 (NIDDM2) and impaired fasting glucose (IFG).
In this post-hoc analysis of a randomized trial we analyzed DNA methylation of MLH1, MSH2, and MGMT at baseline and after 8 weeks of intervention, consisting of 300 g vegetables and 25 ml plant oil rich in polyunsaturated fatty acids per day. DNA methylation was quantified using combined bisulfite restriction enzyme analysis (COBRA) and pyrosequencing. MLH1 and DNMT1 mRNA expression were investigated by qRT-PCR. DNA damage was assessed by COMET assay. Student’s two-tailed paired t test and one-way ANOVA with Scheffé corrected Post hoc test was used to determine significant methylation and expression differences. Two-tailed Pearson test was used to determine correlations between methylation level, gene expression, and DNA strand break amount.
The intervention resulted in significantly higher CpG methylation in two particular MLH1 promoter regions and the MGMT promoter. DNA strand breaks and methylation levels correlated significantly. The expression of MLH1, DNMT1, and the promoter methylation of MSH2 remained stable. CpG methylation levels and gene expression did not correlate.
This vitamin and antioxidant rich diet affected the CpG methylation of MLH1. The higher methylation might be a result of the ROS scavenging antioxidant rich diet, leading to lower activity of DNA demethylating enzymes. Our results suggest the hypothesis of CpG demethylation via DNA repair enzymes under these circumstances. NIDDM2 and IFG patients benefit from this simple dietary intervention involving epigenetic and DNA repair mechanisms.
Diabetes mellitus type 2 (T2DM) is a multifactorial disease characterized by hyperlipidemia, visceral obesity, hypercoagulability, microalbuminuria and hypertension based on genetic predisposition and environmental factors resulting in insulin resistance and hyperglycemia. Diabetic patients have often been described as being under enhanced oxidative stress [1, 2]. Long-term dietary patterns and status have a large impact on the risk developing non-communicable diseases like T2DM. Chronic exposure to elevated amounts in particular of free fatty acids and palmitate (C16 saturated fatty acid) leads to a higher reactive oxygen species (ROS) burden, while long chain polyunsaturated fatty acids such as docosahexaenoic acid (DHA) has the opposite effect [3, 4]. The phenotype of chronic hyperglycemia leads to increased production of ROS also originating from the substrate overwhelmed electron transport system in the mitochondria and the plasma membrane nicotinamide adenine dinucleotide phosphate (NADPH) oxidase . Further, the NADPH oxidase-dependent ROS production is directly proportional to accumulated body fat, although the mechanisms behind this are still not entirely clear [6, 7].
In healthy cells, ROS does not implicate harmful effects per se; when consistently regulated, ROS has an intracellular signaling role . This vital balance can be disrupted by an excess of ROS and/or lack of antioxidants (AO) leading to cytotoxic and genotoxic oxidative stress, resulting in DNA strand breaks . The ROS-induced spontaneous deamination of cytosine to uracil (unmethylated cytosine) and 5-hydroxyuracil (methylated cytosine) results in a G:C to A:T transition mutation, since they both preferentially pair with adenosine during DNA replication . Likewise, guanine can be oxidized to 8-oxo-7,8 dihydroguanine (8-oxoG) and leads to a G:C to T:A transition mutation, due to its mispairing with adenosine .
In order to ensure DNA integrity, especially in diabetic patients, DNA repair enzymes are crucial. The mismatch repair (MMR) enzyme complex (MLH1 and MSH2 appear to play a key role) acts as a proofreading system during DNA synthesis and repairs 8-oxoG lesions [10, 11]. MGMT removes alkyl adducts from the DNA especially O6-methylguanine, which is read as an adenine by the DNA polymerase. Evidence shows that AO are able to increase DNA repair enzyme activities [12, 13]. MLH1 and MGMT promoter are inactivated by hypermethylation, and a promoter methylation-dependent downregulation of the corresponding gene expression in some cancer tissues has been found .
Environmental factors have a significant impact upon the epigenetic program of gene expression. Dietary factors have been found to alter DNA methylation both globally, and locus-specifically, leading to a changed expression of genes [15–17]. These modifications can be epigenetically inherited through DNA methylation to the next generation .
Numerous epidemiological studies have shown that nutritional folate, by providing one-carbon units, and AO play an important role for both DNA methylation and nucleotide biosynthesis reactions [19, 20], and as a consequence, for DNA repair. Folic acid deficiency causes epigenetic changes by diminishing remethylation of s-adenosyl-homocysteine (SAH) to s-adenosylmethionine (SAM) in the methionine cycle, which causes cytosine demethylation, global DNA hypomethylation, and chromosomal instability . In addition, inadequate dietary folate increases uracil misincorporation, rate of DNA strand breaks, and chromosome breaks. Furthermore, folic acid deficiency affects DNA repair by the inhibition of thymidine and purine biosynthesis .
Therefore, our primary aim was to assess the impact of the antioxidant- and vitamin-rich diet on the epigenetic pattern of MLH1 in non-insulin-dependent T2DM (NIDDM2) and patients with impaired fasting glucose (IFG). In this study, we show that a changed diet rich in AO and vitamins (especially folate) has the ability to alter DNA methylation, and compensate ROS-induced epigenetic lesions.
Characteristics of the study population
66.30 ± 5.89
69.0 ± 2.35
26.50 ± 1.77
33.8 ± 6.46
27.7 ± 4.14
21.2 ± 1.55
Briefly, the aim of the DIAPLANT study was to investigate the positive effects of a dietary intervention with 300 g vegetables and 25 ml walnut oil per day, comprising approximately 73% polyunsaturated fatty acids (PUFA) and 18% monounsaturated fatty acids (MUFA), for 8 weeks, on the risk factors for late diabetic complications in T2DM subjects. The focus was on antioxidant and vitamins (especially folate), and rich green vegetables (broccoli, zucchini, brussels sprouts, green beans, cabbage turnip, maize, carrots, peas, cauliflower, soya beans, cos lettuce and spinach).
Subjects were recruited from a local diabetic clinic (Diabetes outpatient Clinic, Health Centre South, Vienna, Austria) during their annual health assessment. All subjects receiving the intervention had to have stable metabolic control (constant medication regarding glucose, lipid and uric acid metabolism), glycated hemoglobin (HbA1c) concentration < 9.5%, serum total cholesterol (TC) < 300 mg/dl (< 7.76 mmol/l), serum triglycerides (TG) < 500 mg/dl (< 5.7 mmol/l) and serum creatinine < 2.5 mg/dl (< 221 μmol/l). Only subjects with stable body weight, constant dietary habits and physical activity levels for at least four weeks before entry to the study were included. Subjects who intended to change dietary habits, frequency of physical activity or body weight within the study period were not allowed to participate. Exclusion criteria also included smoking, intake of fish oil capsules and other fatty acids. All medical therapies of subjects were continued unchanged throughout the study. Results of the DIAPLANT study will be reported elsewhere. The study protocol was approved by the Ethical Committee of the City of Vienna (EK09-218-VK_NZ). All participants gave their written consent.
The calculated mean ± SD of folate contained in the intervention vegetables was 153.00 μg ± 82.32 μg per 300 g. Oral folate intake, assessed by 24-h recalls, was significantly increased after the intervention compared to baseline values (127.66 μg ± 195.27, P = 0.024).
The BstUI restriction site (CGCG) in the MLH1 promoter analyzed by combined bisulfite restriction analysis (COBRA) was hypomethylated at all time points and possible minor methylation shifts were not detectable (see Additional file 1) . DNA methylation differences between baseline (T0) and after 8 weeks of the intervention (T1) were not significantly different in the intervention groups.
MLH1 region 1 group-specific methylation levels for each CpG, mean methylation over the seven CpGs, and paired t -test of methylation changes from baseline to eight weeks
This region is situated 300 bp upstream of the other two MLH1 pyrosequenced regions (see Figure 2.). The methylation levels were very low (0% to 2%) and remained stable over time (Figure 4). No group-specific pattern could be found.
MGMT group-specific methylation levels for each CpG and the mean methylation over the ten CpGs
Quantitative analysis of MSH2 promoter (see Additional file 3) methylation did not reveal any aberrant methylation in the investigated samples. The percentages of methylated cytosine were generally low (≤ 5%). The methylation level remained stable over time. Neither a group-specific pattern nor a correlation of CpG methylation with the MLH1 expression could be found.
Changes in MLH1 and DNMT1 gene expression in response to the intervention were quantified by quantitative real-time reverse-transcriptase (qRT)-PCR. Melting curve analysis showed specific product peaks at 87.26°C, 89.34°C, and 83.67°C for GAPDH, DNMT1, and MLH1, respectively. Neither a significant expression shift between the two time points, nor a correlation with methylation levels of CpGs or DNA damage could be found. MLH1 and DNMT1 expressions were not affected by the intervention (P = 0.306 and P = 0.932, respectively).
While several studies have found that higher ROS levels induce aberrant DNA hypomethylation [25, 26], this study is among the first to report that a changed diet can reverse this effect. Our DNA methylation and gene expression studies reveal a link between specific MLH1 promoter CpG methylations and an optimized diet in IFG and NIDDM2 patients, but no group-specific DNA methylation differences between baseline and T1 could be found. A novel finding is the identification of three variable CpG methylation positions situated in the MLH1 promoter, which to our knowledge has not been published before. Due to the AO- and folate-rich dietary intervention, the methylation levels of these CpGs were higher compared to the baseline. Our analysis was not intended to show differences in methylation variability between NIDDM2/IFG patients and lean control subjects. Nevertheless, there is clear evidence of a negative correlation between methylation levels and age in our study population.
Chang et al. demonstrated that non-cytotoxic levels of H2O2 significantly reduced the activity of the MMR system in repairing single-base and insertion/deletion loop mismatches in a dose-dependent manner. The different MMR activity was not a result of altered expression levels, but based on posttranslational enzyme degradations by H2O2. They further propose that ROS-induced stress reduces MMR function and may play a role in the low frequency of microsatellite instability (MSI) detected in inflamed tissues . Therefore, our gene expression data may not reflect MMR activity. Nevertheless, we showed that the variable MLH1 promoter methylation levels are not affecting its expression, hence not affecting MMR activity.
The detected MLH1 methylation levels were consistently low (0% to 12%), independently from the time point. Contrary to findings in cancer studies , the expression of MLH1 was not affected by the methylation levels. This suggests that the expression is not regulated by the methylation levels of the analyzed sites in non-cancer patients. Consistent with other findings [29, 30], increases in methylation are not explained by higher DNMT1 expressions. Although the oral intake of folate had increased significantly after the intervention, it had no effect on the DNMT1 expression. This may indicate that no folate- or methyldonor-deficiency was present before the intervention .
Possible histone modification involved in the regulation of MLH1 expression and its effect on DNA methylation [32–34] do not offer explanations for our results. Histone modifications such as H3K9me3, H3K27me2, and H3K27me3, apparently do not directly affect MLH1 expression but may serve to index the promoter region for additional epigenetic control . We cannot rule out the involvement of histone modifications leading to higher methylation levels, but in stark contrast we hypothesize that the intervention did not directly induce higher methylation levels, but suppresses the evident loss of methylation before the intervention. CpG-relevant ROS-induced DNA damages are 8-oxoguanine and the conversion of 5-methyl-cytosine (5mC) to 5-hydroxymethylcytosine (5hmC) and 5-hydroxymethyluracil (5hmU), predominantly repaired through the MMR, base excision repair (BER), and nucleotide excision repair (NER) pathway, respectively [36, 37]. So far it remains unclear how exactly CpG methylation marks are removed from the DNA, even though active mechanisms have been discussed . Evidence is provided for both direct and indirect demethylation [39, 40]. Barreto et al. propose that active and direct DNA demethylation is accomplished through a GADD45-dependent process of DNA repair (NER and BER) that involves nucleotide exchange, replacing 5-methyl-cytosine with unmodified cytosine, and it is possible that this is the physiological mechanism that operates typically in vivo. In vitro, GADD45 knockdown resulted in similar methylation differences to our results (see Barreto et al. Figure 3c-d) . Different enzymes (for example TET, AID/APOBEC) have been found to modify the methylated cytosine (by hydroxylation, deamination, oxidation, or a combination of these modifications), leading to its replacement by DNA repair. They act indirectly to mediate DNA demethylation. TET1, 2, and 3 catalyze the conversion of 5mC to 5hmC, which is then replaced with an unmethylated cytosine by the BER enzymes via DNA repair .
Based on these findings we propose that the low initial methylation levels on MLH1 and MGMT are the result of increased oxidative stress, which causes DNA lesions resulting in increased DNA repair activity. The latter leads to a loss of methylation marks by direct and/or indirect demethylation. The nutritional intervention might have led to a lower ROS burden and diminished the demethylating effects, resulting in higher overall methylation levels, and helped to maintain crucial and tissue-specific methylation marks with possible regulatory function. This finding need to be further investigated to reveal the exact underlying mechanisms behind the ROS-induced demethylation in relation to MSI and cancer-relevant promoter demethylation of oncogene, leading to initiation of tumors.
Blood was sampled before (T0) and after 8 weeks of dietary intervention (T1) using PAXgene Blood DNA tubes and the PAXgene Blood RNA tubes (Qiagen, Hilden, Germany). The samples were stored until analyses at −20°C.
On the day before blood sampling, 24-h recalls of food intake were obtained from the subjects. The dietary composition of the vegetables and 24-h recalls were evaluated using the nutritional software NUT.S (BLS II.3.1., Karlsruhe, Germany).
DNA was extracted using the PAXgene Blood DNA Kit (Qiagen, Hilden, Germany) according to the manufacturer’s instructions. For methylation analysis, all samples were bisulfite-converted with the EpiTectBisulfite Kit (Qiagen, Hilden, Germany), resulting in the deamination of unmethylated cytosine to uracil, whereas methylated cytosine remain unchanged. The EpiTect Whole Bisulfitome Kit (Qiagen, Hilden, Germany) was used to amplify 2 μl converted DNA. The concentration of DNA was measured on a Pico100 (Picodrop Limited, Hinxton, UK). All reactions were carried out according to manufacturer’s protocols. Samples were stored at −20°C.
Total RNA was extracted from blood samples using the PAXgene Blood RNA Kit (Qiagen, Hilden, Germany) following the producer’s handbook. The random primers (hexamers) of the Phusion RT-PCR Kit (Finnzymes, Vantaa, Finland) were used to reverse-transcribe 5 μl of total RNA into single-stranded DNA. The concentration of cDNA was measured on a Pico100 (Picodrop Limited, Hinxton, UK). The samples were stored at −20°C.
Primers used for PCR methods
Number of CpGs
PyroMark CpG assay kits (Qiagen, Hilden, Germany)
GeneGlobe Catalogue number
Sequence to analyze 5′-3′
Number of CpGs
The mRNA level of MLH1, DNMT1, and GAPDH as an endogenous control gene for normalization was analyzed in triplicates on a StepOne Plus real-time PCR system (Applied Biosystems, Vienna, Austria) using the SYBR Green approach. Each reaction mix consisted of 5 μl SensiFAST SYBRgreen (Bioline GmbH, London, UK), 300nM primers (Table 4), and 100 ng cDNA to a total volume of 10 μl. PCR conditions were 95°C for 2 minutes, 40 cycles of 95°C for 30 s, 60°C for 10 s, and 72°C for 5 s, followed by a melt curve analysis. The efficiency for DNMT1, MLH1, and GAPDH, was 103.5%, 106.7%, and 109.4%, respectively. Calculations were performed using the comparative Ct method.
A Comet assay was performed based on the protocol published by Azqueta . For the evaluation of DNA damage, Komet 5.5 image analysis software (Kinetic Imaging Limited, Nottingham, UK) was used, which was linked to a fluorescent microscope. For every sample two gels with 50 cells each were randomly scored. The percentage of DNA in the tail (% tail DNA) was determined and the mean was calculated.
Methylation levels and expression data of 23 paired samples were analyzed with SPSS 20 (IBM, Armonk, NY). The Kolmogorov-Smirnov test was used to test for normality of the distributions. The Student’s two-tailed paired t-test and one-way analysis of variance (ANOVA) with the Scheffé post hoc correction test were used to determine significant differences. The two-tailed Pearson test was used to determine correlations between methylation level, gene expression, and amount of DNA strand break. All statistics were tested for possible associations with age and sex; no significant associations were found. A P-value < 0.05 was considered statistically significant. All data shown are mean ± SD unless otherwise indicated.
one-way analysis of variance
base excision repair
combined bisulfite restriction analysis
impaired fasting glucose
monounsaturated fatty acids
nicotinamide adenine dinucleotide phosphate
nucleotide excision repair
polyunsaturated fatty acids
quantitative real-time reverse-transcriptase polymerase chain reaction
reactive oxygen species
tris-acetate ethylenediaminetetraacetic acid
diabetes mellitus type 2
This work was funded by the EU (grant N° N00039), through the cross-border cooperation programme Slovakia-Austria 2007–2013 (http://www.sk-eu.at) and the Austrian Ministry of Health.
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