It is important to note at the outset that an association betweenDNA damage and disease established from case–control studies,however well conducted, is only an association. It is impossible tosay whether elevated DNA damage is a cause or an effect of thedisease. It appears that inflammation and oxidative stressassociated with colorectal cancer progression cause increases inDNA damage (8-oxoguanine as well as ethenoadducts), but alsoaffect repair enzyme activities, in both tumour and normal tissues,in complex ways [113,114]. To establish causality, prospectivestudies need to be conducted, determining whether individualswith a high level of DNA damage go on to show a higher risk of aparticular disease. Such investigations have not been carried outfor DNA damage measured with the comet assay – in contrast tothe studies showing significantly higher mortality and cancer riskin individuals with high levels of chromosome aberrations [4] orMN [5,76].Oxidative stOxidative stress seems to play a major role in the pathogenesisof neurodegeneration and higher levels of oxidised purines werefound in the PBMC or leukocytes of Alzheimer’s [115,116] andParkinson’s disease patients [117]. Oxidised DNA bases can beuseful markers in many chronic diseases where oxidative stress isimplicated either as cause or effect, such as diabetes, rheumatoidor vascular diseases [118]. Several studies have demonstratedincreased levels of DNA oxidation in Down’s syndrome patients
[119,120], and increased sensitivity of cells to DNA-damaging
agents.
Rheumatoid arthritis (RA) has been shown to be associated with
increased DNA damage and impaired DNA repair in PBMC
[118,121,122]. An increased level of DNA damage was also found
with the comet assay in neutrophils from systemic lupus
erythematosus patients, together with an impaired ability to
repair oxidised DNA lesions [123,124].
The greatest number of comet assay studies of chronic disease
(around 30) have been conducted on diabetic patients, most ofthem
showing elevated levels of DNA damage associated with the disease.
Higher levels of SBs or oxidised lesions were found in PBMC oftype II
diabetics and patients with neuropathy [125–132]. FPG-sensitive
sites seem to represent changes specifically related to hyperglycemia,
anda strong correlation withserumglucose concentrations was
confirmed in several studies [125,129,130,132]. Diabetic patients
displayed higher susceptibility to H2O2 and to doxorubicin, and
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