Epithelial ovarian cancer is the most lethal gynecologic malignancy, with a 5-year survival rate of less than 40%. This is due in part to a lack of early detection markers and lack of specific symptoms during early disease. The laying hen is the only accessible animal model which develops epithelial ovarian cancer spontaneously, with features closely resembling the human disease. It has been estimated that approximately 30% of all cancers can be prevented with diet, exercise, and maintenance of an optimal weight, and the chronic low-grade inflammation that accompanies obesity is implicated as a causal factor in the development of cancer. Flaxseed, a rich plant source of anti-inflammatory omega-3 fatty acids and lignans which act as phytoestrogens and antioxidants, exhibits chemosuppressive effects against the development and progression of ovarian cancer. We have shown that a diet of 10% flaxseed reduces the incidence and severity of ovarian cancer when fed to laying hens over 4 years, due in part to the ability of flaxseed to suppress the production of proinflammatory PGE2 in the ovary by decreasing expression of COX enzymes. To investigate other potential specific mechanisms by which flaxseed acts to suppress ovarian cancer, we examined expression and activity of pathways known to be involved in the etiology and progression of human epithelial ovarian cancer in ovarian cancer in the laying hen, and determined whether flaxseed affected these pathways during cancer development. We investigated the effect of flaxseed and its individual components upon oxidative stress in the normal ovary and in ovarian cancer by analyzing expression of target genes of the NRF2 transcription factor. The NRF2 pathway is a "master switch" that regulates expression of ROS-responsive detoxification genes. Results revealed that expression of four genes was significantly downregulated in then ovaries of hens on the defatted flaxmeal (DFM) and whole flaxseed (WF) diets compared to hens on diets that are high in pro-inflammatory omega-6 fatty acids, suggesting that flaxseed decreases oxidative stress in the ovary. Conversely, one target gene was upregulated in ovarian cancer compared to normal ovaries, and this observation was not affected by flaxseed. Additionally, nuclear accumulation Nrf2 protein was not observed in tumor cells, suggesting that flaxseed does not exert chemosuppressive effects by modulating NRF2 signaling in ovarian cancer. To further investigate pathways potentially regulated by flaxseed, we performed a microarray with 44k features and found that a set of genes involved in branching morphogenesis was upregulated in ovarian cancer and significantly decreased by flaxseed, including E-cadherin and miR-200, suggesting that flaxseed impedes the activity of an aberrantly activated developmental program that controls gland formation during ovarian cancer progression. Lack of nuclear accumulation of ZEB1 protein in tumor cells suggests that this decrease in expression is likely not due to EMT. Finally, due to its known roles in controlling developmental programs such as EMT as well as regulating cell growth and proliferation, we performed a set of experiments to examine activity of the TGF-beta pathway. PCR array analysis revealed that SMAD target genes, ligands, receptors, and co-regulatory proteins were upregulated in ovarian tumors from hens on both diet groups, suggesting TGF-beta signaling is enhanced in ovarian cancer. However, expression of SMAD6 and SMAD7 was upregulated in tumors from hens on the flaxseed diet but not control diet, with SMAD7 protein being expressed in both epithelial tumor cells and intratumoral stromal cells. Additionally, immunohistochemical staining for pSMAD2/3 was decreased in epithelial tumor cells and absent from intratumoral stromal cells in tumors from hens on the flaxseed diet compared to tumors from hens on the control diet, and these data together suggest that flaxseed may inhibit pro-oncogenic TGF-beta signaling in ovarian cancer. Finally, flaxseed prevents the downregulation of expression of p15 and the upregulation of CCNA and CCNE in ovarian tumors, suggesting that flaxseed may slow cell cycle progression. Data from these studies provides preliminary evidence that flaxseed exerts pleiotropic effects upon gene expression to negatively regulate pathways driving the progression of ovarian cancer, including aberrant TGF-beta signaling and glandular development. These studies provide groundwork for in vitro studies to test the specific effects of flaxseed upon proteins involved in TGF-beta signaling and upon the expansion of tumor epithelia.

Ovarian cancer is a deadly gynecological disease that ranks fifth in all cancer-related deaths inwomen. The disease is often detected at an advanced stage and lack of sensitive predictive biomarkerscontribute to its poor prognosis, which is also responsible for the current five-year survival rate of only47%. Our laboratory has previously shown that a whole flaxseed supplemented diet decreases the onsetand severity of ovarian cancer in the laying hen, the only known animal model of spontaneous ovariancancer. Flaxseed is rich in omega-3 fatty acids (OM3FA), mostly α-Linoleic acid (ALA), which getsconverted to Docosahexaenoic acid (DHA) by the action of delta-6 desaturase enzyme. We have also shownthat the flaxseed diet in hens induces CYP1A1 expression in the liver while suppressing both CYP1B1 andCYP3A4 expressions. The upregulation of CYP1A1 parallels the increase in 2-hydroxyestradiol and the 2-methoxyestradiol (2MeOE2) level in the serum of the chickens. Flaxseed diet induces apoptosis to ovariantumors and not in the normal ovarian tissues. The current work explores the pro-apoptotic actions of oneof the biologically derived compounds of flaxseed diet, 2MeOE2, and describes one of its novel molecularactions. Our results indicate that 2MeOE2 -mediated pro-apoptotic actions are partly dependent on thecatalytic activation of protein kinase C delta (PKCd), which is responsible for key apoptotic histonemodifications and p38 MAPK (MAPK14) phosphorylation. Phosphorylated MAPK14, in turn, results inmore caspase-3 cleavage which activates more PKCd, therefore amplifying the apoptotic signal.The other part of this work explains one of the key anti-cancer actions of a flaxseed diet. Flaxseedreduces the number of endothelial cells and increases pericytes to endothelial cell ratio in ovarian tumorscompared to control diet-fed birds, indicating a reduction in tumor angiogenesis and an improvement inblood vessel maturation. Flaxseed decreases a-smooth muscle actin expression in ovarian tumors, whichmarks a decrease in cancer-associated fibroblasts (CAFs) in the tumor stroma. Flaxseed also reduces fibrosisin ovarian tumors. Flax -mediated reduction of ovarian fibrosis parallels an increased infiltration ofimmune cells in the preneoplastic ovaries and ovarian tumors. Therefore, this work describes how the flaxdiet differentially targets the ovarian tumor cells and the tumor stroma in preventing the incidence andseverity of ovarian cancer. Dietary supplementation with flaxseed can, therefore, be a healthy lifestylechoice as well as a potential adjuvant therapy for immunotherapy-based treatment modalities.