Robin M. Bostick, MD, MPH

Professor, Department of Epidemiology Professor, Department of Hematology & Oncology

Dr. Roberd ("Robin") M. Bostick is Professor of Epidemiology and of Hematology & Oncology (Joint) at Emory University where he heads a developing program, "Cancer Molecular Epidemiology, Biomarkers, and Chemoprevention" in the Division of Cancer Prevention & Control in the Winship Cancer Institute.

Research Goals: The goals of our research are to determine the causes of colon and prostate cancer in humans and how to prevent them. Our program emphasizes the role of lifestyle - especially diet and nutrition - and the development of simple tests to determine who is at risk for developing these cancers, why they are risk, what they can do about it, and whether their efforts are having results that accurately indicates that they are being protected against ever getting these cancers.

Current Research Projects: My current and future research directions can be described as "predictive oncology" for cancer prevention in individuals and populations. The goal of my current and proposed research projects is to enable clinicians to identify who is at risk for colon or prostate cancer, why they are at risk, what they can do to reduce their risk, and whether their efforts to reduce their risk are having the desired results. The primary reason that cardiovascular disease has dramatically decreased in this country to the point that it is no longer the leading cause of death (cancer is now in first place) is that 20 to 30 years ago we identified blood lipids (total, HDL, and LDL cholesterols, etc), blood sugars, and blood pressures as "biomarkers of risk" for cardiovascular disease. Treating persons with values for these biomarkers that are above normal ranges with lifestyle and pharmacologic agents so that their levels returned to normal has been dramatically successful in lowering individual risk for cardiovascular disease and our public health burden due to the disease. There have been no such biomarkers of risk for cancer. However, in my Cancer Molecular Epidemiology and Biomarkers Research Laboratory at the WCI, we have developed a panel of molecular phenotypic biomarkers of risk for colorectal cancer, and have shown in preliminary clinical studies that our biomarkers can be used to distinguish between persons at high and low risk. We are currently testing whether our biomarkers can be treated using calcium and/or vitamin D supplementation in patients at high risk for colorectal cancer, and whether biomarker response to treatment predicts who will develop colonic neoplasms. We are also evaluating genotypic biomarkers of risk for colon and prostate cancers, focusing on investigating whether vitamin D-related genes (eg, VDR) or genes involved in protection against oxidative stress (eg, MnSOD), regulation of inflammation (eg, COX-2, PPARy), and regulation of DNA damage repair (eg, XRCC1) determine who can reduce their risk for colon and prostate cancers using various lifestyle (eg, dietary change, exercise) and/or nutritional supplements (eg, calcium, vitamin D, vitamin E, lycopene) and/or pharmacologic agents (eg, non-steroidal anti-inflammatory drugs).

The methods we are currently using to measure biomarkers of risk for colon cancer have been effective in identifying and quantifying these biomarkers in the research setting. However, we recently began work to improve our methods using nanotechnology, which should make them more practical, accurate, and reliable. Our current methods involve immunohistochemistry, which is somewhat cumbersome and expensive. The new nanotechnology, involving Quantum Dots, should enable us to use fewer error prone steps in our assays, and to analyze multiple biomarkers on the same slides, thus reducing the amount of tissue and cost of measuring our biomarker profile.

Future Research Directions: Another limitation of our current methods of assessing biomarkers of risk for colorectal cancer is that they are tissue-based, meaning that patients must undergo rectal biopsies in a procedure similar to obtaining Pap smears for detecting early cervical cancer. If we can develop biomarkers that can be measured in blood or urine samples, more people will likely undergo testing and benefit from our biomarkers. So, we have begun work to solicit funding for testing whether the biomarkers that we are detecting in the tissue where colon cancer forms (ie, the colon epithelium) can also be detected in blood or urine samples and whether the levels detected in these surrogate samples reflect the levels found in the colon epithelium.

We also plan to move the evaluation of promising genotypic markers, alone and in interaction with lifestyle and other exposures, from our colon and prostate case-control studies to large prospective cohort studies including a Georgia "multi-Framingham" cohort study that was just funded by the Georgia Cancer Coalition.

Finally, using our new biomarkers of risk, we will test various new preventive interventions designed to treat our biomarkers.

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