EPA & FAP FAP Gene 6 th Annual Information & Family Day 26 - - PowerPoint PPT Presentation

EPA & FAP

FAP Gene 6th Annual Information & Family Day

26th March 2011

What is EPA?

• Eicosapentaenoic acid (EPA) is an omega-3 fatty acid
• A normal component of cells in the body
• Essential fatty acid (need to have it in the diet)
• Evidence for variety of benefits on cardiovascular health
• Communities with high intake of omega-3 fatty acids tend to

have lower incidence of bowel cancer

Sources of Omega-3 PUFAs

Salmon Herring Sardine

Why do we think EPA might have benefits in FAP?

How do polyps form?

Development of polyps

Controlling development of polyps

• Chance of developing cancer depends on the number, size and

nature of polyps

• This also influences doctor’s decision on what to do
• If we could stop polyps forming, it may have long term benefits

Effect of EPA on cells in the colon

In patients with sporadic polyps,

• EPA reduces formation of new cells

How best to deliver EPA to the intestine?

• EPA comes in different forms

– Triglyceride – Ethyl ester – Free fatty acid (FFA)

• Of these, the free fatty acid is much better absorbed
• EPA present in fish oil as a mixture with other fatty acids

– Would need large amount of fish oil to provide enough EPA

• Purified EPA –FFA has been formulated in capsules

– Enables larger dose of EPA to be given in fewer capsules – Coated to reduce fishy aftertaste etc.

What effect does EPA-FFA have on polyps?

• Clinical trial at St Mark’s Hospital
• Individuals with FAP having had colectomy and IRA

– invited to participate

• Endoscopy of rectum

– Select area with group of polyps and mark site – Video record of endoscopy

• Assigned to take

– EPA-FFA capsules for 6 months or – Dummy capsules (placebo) for 6 months – Doctor and patient ‘blind’ to treatment

• After 6 months, endoscopy repeated as before

Measurement of effects of EPA-FFA

• n polyps
• Compared identical views of marked area at 6 months

– Number of polyps and size measured from photographs – Video records of endoscopies compared by panel of experts

• Each subject asked to keep daily diary of any symptoms

Effects of EPA-FFA on number of polyps

• 25
• 20
• 15
• 10
• 5

5 10 15 Change in No of polyps (%) +9.7%

• 12.6%
• 22.4%

Placebo EPA-FFA Overall change P = 0.01

 Better Worse 

(West et al 2010; Gut 59:918-25)

Effects of EPA-FFA on size of polyps

Change in polyp size (%)

+17.3%

P = 0.03

• 12.6%
• 29.8%
• 40
• 30
• 20
• 10

10 20 Overall change EPA-FFA Placebo

 Better Worse 

(West et al 2010; Gut 59:918-25)

Effect of EPA-FFA on overall appearance at 6 month endoscopy

• 0.4
• 0.3
• 0.2
• 0.1

0.1 0.2 0.3 0.4 0.5

Placebo EPA-FFA Overall difference

• 0.34

+0.09 +0.42

 Worse

Better 

P = 0.011

(West et al 2010; Gut 59:918-25)

Conclusions

• EPA-FFA , 2 g/day reduced the number and size of

polyps in the marked area of rectum

• EPA-FFA capsules were well-tolerated

Next steps

• Discussions with medicines licensing authorities
• Further clinical trials