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Arsenic exposure is associated with DNA hypermethylation of the tumor suppressor gene p16



Occupational and environmental exposure to inorganic arsenic leads to development of cancer and represents a significant health hazard in more than 70 countries. The underlying mechanism for arsenic-induced carcinogenesis remains unclear. Laboratory studies suggest that arsenic is a poor mutagen but may cause epigenetic silencing of key tumor suppressor genes such as p16 through DNA hypermethylation. However, the evidence for an association between human arsenic exposure and abnormal DNA methylation of tumor suppressor genes is lacking.


Paired case–control studies were conducted involving 40 individuals with high arsenic exposure and arsenicosis, 40 individuals with similarly high exposure to arsenic but without arsenicosis, and 40 individuals with normal exposure to arsenic. DNA methylation status of p16 was determined using methylation-specific PCR. Conditional logistic regression analysis showed that DNA hypermethylation of p16 gene was significantly associated with high arsenic exposure (Odds Ratio = 10.0, P = 0.0019) independently of the development of arsenicosis (Odds Ratio = 2.0, P = 0.1343).


High exposure of arsenic in human is positively linked to DNA hypermethylation of p16 gene, suggesting that epigenetic silencing of key tumor suppressor may be an important mechanism by which arsenic promotes cancer initiation.



Inorganic arsenic is a widespread pollutant. Human exposure to arsenic can occur occupationally and environmentally. In many Asian developing countries, synthetic arsenates are commonly used as agricultural insecticides and poisons. In addition, contamination of arsenic in drinking water and through improper coal burning and disposal represents a major health concern, affecting over 137 million people in more than 70 countries [1]. Chronic arsenic exposure is associated with a range of adverse health outcomes, including skin lesions (hyperpigmentation, keratosis), neuropathy and cardiovascular diseases [2],[3]. In particular, high levels of arsenic exposure are associated with increased risks of cancers in skin, liver, kidney and bladder [4],[5]. However, the mechanism(s) underlying arsenic’s carcinogenic potential remain elusive.

Laboratory investigations using cell culture and animal models indicate that arsenic is a poor mutagen [6],[7], suggesting that genetic mutation may not be critically involved in arsenic-induced tumor development. In contrast, it is well-documented that after entering human body, arsenic is metabolized to monomethylarsonic acid and dimethylarsenic acid and such reactions rely on S-adenosylmethionine (SAM) as methyl donor [8]. SAM is an essential co-factor for cellular methyltransferases including DNA methyltransferases (DNMTs), which are responsible for the generation of 5-methylcytosine in DNA. It was hypothesized that by interfering with SAM metabolism, elevated arsenic levels might lead to abnormal DNA methylation. Indeed, treating cells with arsenic altered the global and local DNA methylation patterns [9]-[11]. Since DNA methylation at gene promoters is tightly linked to the regulation of gene expression [12], arsenic may facilitate tumor initiation and development through epigenetic modulation of key oncogenes and/or tumor suppressors.

p16 (also known as CDKN2A) is a well-established tumor suppressor. p16 serves as an important regulator of cell cycle during G1/S phase progression and represents a critical barriers for cellular transformation [13]. p16 is implicated in a variety of human cancers including dermatological malignancies [14]. Importantly, in addition to genetic deletion and mutation, p16 is frequently silenced in human tumors through DNA hypermethylation [15]. As an attempt to understand the mechanistic link between arsenic exposure and increased cancer risk, we determined whether high exposure to arsenic in human is associated with altered DNA methylation of p16 gene.


We conducted a paired case–control study approved by the Chinese PLA General Hospital review board. 40 case subjects were recruited from villages in Bameng, Inner Mongola of China where the drinking water is contaminated with high levels of arsenic (>0.05 mg/L, average = 0.6 mg/L). The selection criteria include a clear drinking history and a positive diagnosis of arsenic poisoning (arsenicosis). Two cohorts of control subjects, matched with respect to age, sex, ethnicity and socioeconomical status, were recruited including: 1) individuals from the same villages with high arsenic exposure but showed no clinical signs of arsenicosis; and 2) individuals from the neighboring villages where the drinking water is not contaminated with arsenic (<0.05 mg/L, average = 0.02 mg/L). Table 1 summarizes the descriptive characteristics of the study participants. None of the parameters is statistically significantly different between case and control groups.

Table 1 Descriptive characteristics of study subjects

Interviews were conducted between trained practitioners and study subjects with a structured epidemiological questionnaire including details about individual’s demographic factors, drinking water history and condition, smoking index, alcohol consumption, past medical history and current illness. 3 ml of vein blood were drawn from study subjects. Whole blood leukocytes were isolated through centrifugation and stored at −20°C. DNA was extracted for methylation-specific (MS) PCR reactions to determine the DNA methylation levels of p16 gene as described previously [16]. In brief, each sample was treated with bisulphite to convert unmethylated but not methylated cytosine to uracil. The samples were then amplified with two sets of primers targeting p16 promoter regions, one for unmethylated DNA (Forward 5′-TTATTAGAGGGTGGGGTGGATTGT-3′; Reverse 5′-CAACCCCAAACCACAACCATAA-3′) and one for methylated DNA (Forward 5′- TTATTAGAGGGTGGGGCGGATCGC-3′; Reverse 5′- GACCCCGAACCGCGACCGTAA-3′). The PCR products were analyzed by polyacrylamide gel electrophoresis and ethidium bromide staining. The appearance of a band of ~150 bp indicates the presence of p16 methylation in the blood. A representative result of the MS-PCR assay with positive and negative controls is shown in Additional file 1: Figure S1.

As shown in Table 2, 26 of 40 (65%) subjects in high arsenic exposure with arsenicosis group had p16 hypermethylation, while 19 of 40 (47.5%) subjects in high arsenic exposure without arsenicosis group were p16 methylation positive. In sharp contrast, only 9 of 40 (20%) subjects in low arsenic exposure group were p16 methylation positive (P < 0.01, Fisher’s Exact test). These results suggest that there is a significant correlation between p16 hypermethylation and arsenic exposure independent of the development of arsenicosis.

Table 2 Frequencies of p16 methylation in study groups

To extend our analysis, variables collected through interviews and MS-PCR results were assigned with quantified value as shown in Additional file 2: Table S1. Crude odds ratios (OR) and estimates of relative risk were calculated by univariate analysis. To identify variables that were independently associated with arsenic exposure, multivariate analyses were performed using conditional logistic regression methods. All P-values resulted from two-sided statistical tests. The FREQ and PHREG procedures in Statistical Package SAS 6.12 were employed.

We first compared case subjects (high exposure to arsenic with arsenicosis) to control subjects with minimal exposure to arsenic. 12 variables were included in the univariate logistic regression analysis and Table 3 summarizes the results of five of them. DNA hypermethylation of p16 showed a highly significant association with case subjects (OR = 10.0,P = 0.0019), while none of the other variables reached statistical significance.

Table 3 Logistic regression analysis results comparing cases to controls with low exposure to arsenic

We next compared case subjects to control subjects who are exposed to high arsenic levels without arsenicosis. 13 variables were included in the univariate logistic regression analysis and Table 4 summarizes the results of six of them. The only variables displaying significant association with case subjects were years of drinking contaminated water (OR = 1.192, P = 0.0154) and arsenic concentration in drinking water (OR = 4.2,P = 0.0039). None of the other variables, including p16 DNA methylation (OR = 2, P > 0.05), reached statistical significance.

Table 4 Logistic regression analysis results comparing cases to controls with high exposure to arsenic without arsenicosis

Collectively our analysis results suggest that p16 DNA hypermethylation is significantly associated with high arsenic exposure and such association is independent of whether the subjects develop arsenicosis. On the other hand, the water drinking history as well as the amount of arsenic in the drinking water represent critical risk factors for arsenic poisoning.


Despite significant efforts to eliminate arsenic from industrial processing and agricultural use, occupational and environmental exposures to toxic levels of arsenic are still common in developing countries. Therefore understanding the link between arsenic intake and adverse health effects such as cancer will exert significant public health benefit. The carcinogenic mechanism(s) of arsenic have been extensively studied in laboratories using animal and cell culture models. Intriguingly, in contrast to most chemical carcinogens, arsenic only weakly induces genetic mutation [7]. On the other hand, multiple groups have reported that arsenic can induce significant changes in DNA cytosine methylation. For example, Zhao et al. reported that chronic arsenic treatment in rat liver epithelial cells induced malignant transformation which was accompanied by global DNA hypomethylation [10]. Mass and Wang showed that exposing human lung A549 cells to sodium arsenite produced significant dose-responsive hypermethylation at the promoter of p53 tumor suppressor gene [9]. Furthermore, recently Cui et al. demonstrated that giving mice arsenic in the drinking water induced formation of lung adenocarcinoma with DNA hypermethylation of p16[11]. In the current study, we present data that human exposed to high levels of arsenic are significantly more likely to have p16 DNA hypermethylation. Our findings as well as others’ support the hypothesis that arsenic may act as a potent “epi-mutagen” to epigenetically modify key tumor suppressor genes. As DNA methylation at promoters can silence gene expression in a heritable manner, this could be a critical mechanism by which cells exposed to arsenic overcome barriers to malignant transformation.

Previously Chanda et al. examined human subjects exposed to arsenic-contaminated drinking water in West Bengal in India and found that DNA hypermethylation of p53 and p16 positively correlated with arsenic levels in drinking water [17]. Studies of individuals using arsenic-rich coal with indoor unventilated stoves in Guangzhou, China also found trends of increased p16 methylation and reduced protein expression [18]. Our results are consistent with these findings. In addition, we for the first time showed that p16 DNA methylation levels are not significantly different between subjects with high exposure to arsenic and arsenicosis and subjects with similar arsenic exposure without arsenicosis. This result excludes the possibility that p16 DNA hypermethylation is a secondary pathological consequence of arsenic poisoning. Furthermore, the result suggests that p16 hypermethylation precedes the development of clinical symptoms and may be an important risk factor for arsenic-related diseases such as cancer. This is consistent with clinical observations that loss of p16 through genetic or epigenetic inactivation is an early event in tumor progression [19]. A weakness of our study was the use of whole blood leukocytes for p16 methylation analysis. Although this approach has been successful to study disease-related epigenetic changes [20], samples from more relevant tissue types such as skin would potentially provide more information.

There are several limitations of current study. First, although the high sensitivity of MS-PCR assay allows us to measure p16 methylation with a limited amount of human blood sample, this assay is qualitative rather than quantitative. Future study with bisulfite sequencing will be required to validate our findings and to provide a quantitative assessment of the correlation between arsenic exposure and p16 methylation. Second, because our sampling sites are located in remote areas with no laboratory access which makes the preservation of RNA from blood very challenging, our study did not provide a measurement of p16 RNA and protein expression. Although the association between p16 promoter methylation and gene repression has been firmly established [21],[22], it would be important in the future to demonstrate that the epigenetic silencing of p16 affects its expression. In conclusion, our study demonstrates that arsenic exposure is associated with p16 DNA hypermethylation in human, which may be an important risk factor for arsenic-induced tumor development [23],[24]. Further investigations are needed to reveal how arsenic metabolism specifically alters cellular epigenetic state. As clinically approved drugs targeting DNMTs are available, our results suggest that pharmacological reversal of DNA hypermethylation at tumor suppressor genes may offer therapeutic benefits to arsenic exposed individuals.


Written informed consent was obtained from the patient for the publication of this report and any accompanying images.

Additional files





DNA methyltransferases


Methylation-specific PCR


  1. Abernathy CO, Liu YP, Longfellow D, Aposhian HV, Beck B, Fowler B, Goyer R, Menzer R, Rossman T, Thompson C, Waalkes M: Arsenic: health effects, mechanisms of actions, and research issues. Environ Health Perspect 1999, 107: 593–597. 10.1289/ehp.99107593

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  2. Rahman M, Tondel M, Chowdhury IA, Axelson O: Relations between exposure to arsenic, skin lesions, and glucosuria. Occup Environ Med 1999, 56: 277–281. 10.1136/oem.56.4.277

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  3. Engel RR, Hopenhayn-Rich C, Receveur O, Smith AH: Vascular effects of chronic arsenic exposure: a review. Epidemiol Rev 1994, 16: 184–209.

    CAS  PubMed  Google Scholar 

  4. Anetor JI, Wanibuchi H, Fukushima S: Arsenic exposure and its health effects and risk of cancer in developing countries: micronutrients as host defence. Asian Pac J Cancer Prev 2007, 8: 13–23.

    PubMed  Google Scholar 

  5. Bates MN, Smith AH, Hopenhayn-Rich C: Arsenic ingestion and internal cancers: a review. Am J Epidemiol 1992, 135: 462–476.

    CAS  PubMed  Google Scholar 

  6. Noda Y, Suzuki T, Kohara A, Hasegawa A, Yotsuyanagi T, Hayashi M, Sofuni T, Yamanaka K, Okada S: In vivo genotoxicity evaluation of dimethylarsinic acid in MutaMouse. Mutat Res 2002, 513: 205–212. 10.1016/S1383-5718(01)00313-8

    Article  CAS  PubMed  Google Scholar 

  7. Rossman TG, Stone D, Molina M, Troll W: Absence of arsenite mutagenicity in E coli and Chinese hamster cells. Environ Mutagen 1980, 2: 371–379. 10.1002/em.2860020307

    Article  CAS  PubMed  Google Scholar 

  8. Goering PL, Aposhian HV, Mass MJ, Cebrián M, Beck BD, Waalkes MP: The enigma of arsenic carcinogenesis: role of metabolism. Toxicol Sci 1999, 49: 5–14. 10.1093/toxsci/49.1.5

    Article  CAS  PubMed  Google Scholar 

  9. Mass MJ, Wang L: Arsenic alters cytosine methylation patterns of the promoter of the tumor suppressor gene p53 in human lung cells: a model for a mechanism of carcinogenesis. Mutat Res 1997, 386: 263–277. 10.1016/S1383-5742(97)00008-2

    Article  CAS  PubMed  Google Scholar 

  10. Zhao CQ, Young MR, Diwan BA, Coogan TP, Waalkes MP: Association of arsenic-induced malignant transformation with DNA hypomethylation and aberrant gene expression. Proc Natl Acad Sci U S A 1997, 94: 10907–10912. 10.1073/pnas.94.20.10907

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  11. Cui X, Wakai T, Shirai Y, Hatakeyama K, Hirano S: Chronic oral exposure to inorganic arsenate interferes with methylation status of p16INK4a and RASSF1A and induces lung cancer in A/J mice. Toxicol Sci 2006, 91: 372–381. 10.1093/toxsci/kfj159

    Article  CAS  PubMed  Google Scholar 

  12. Jones PA, Gonzalgo ML: Altered DNA methylation and genome instability: a new pathway to cancer? Proc Natl Acad Sci U S A 1997, 94: 2103–2105. 10.1073/pnas.94.6.2103

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  13. Serrano M, Lee H, Chin L, Cordon-Cardo C, Beach D, DePinho RA: Role of the INK4a locus in tumor suppression and cell mortality. Cell 1996, 85: 27–37. 10.1016/S0092-8674(00)81079-X

    Article  CAS  PubMed  Google Scholar 

  14. Nelson AA, Tsao H: Melanoma and genetics. Clin Dermatol 2009, 27: 46–52. 10.1016/j.clindermatol.2008.09.005

    Article  PubMed  Google Scholar 

  15. Licchesi JD, Westra WH, Hooker CM, Herman JG: Promoter hypermethylation of hallmark cancer genes in atypical adenomatous hyperplasia of the lung. Clin Cancer Res 2008, 14: 2570–2578. 10.1158/1078-0432.CCR-07-2033

    Article  CAS  PubMed  Google Scholar 

  16. Herman JG, Graff JR, Myöhänen S, Nelkin BD, Baylin SB: Methylation-specific PCR: a novel PCR assay for methylation status of CpG islands. Proc Natl Acad Sci U S A 1996, 93: 9821–9826. 10.1073/pnas.93.18.9821

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  17. Chanda S, Dasgupta UB, Guhamazumder D, Gupta M, Chaudhuri U, Lahiri S, Das S, Ghosh N, Chatterjee D: DNA hypermethylation of promoter of gene p53 and p16 in arsenic-exposed people with and without malignancy. Toxicol Sci 2006, 89: 431–437. 10.1093/toxsci/kfj030

    Article  CAS  PubMed  Google Scholar 

  18. Zhang AH, Bin HH, Pan XL, Xi XG: Analysis of p16 gene mutation, deletion and methylation in patients with arseniasis produced by indoor unventilated-stove coal usage in Guizhou, China. J Toxicol Environ Health A 2007, 70: 970–975. 10.1080/15287390701290808

    Article  CAS  PubMed  Google Scholar 

  19. Rocco JW, Sidransky D: p16(MTS-1/CDKN2/INK4a) in cancer progression. Exp Cell Res 2001, 264: 42–55. 10.1006/excr.2000.5149

    Article  CAS  PubMed  Google Scholar 

  20. Terry MB, Delgado-Cruzata L, Vin-Raviv N, Wu HC, Santella RM: DNA methylation in white blood cells: association with risk factors in epidemiologic studies. Epigenetics 2011, 6: 828–837. 10.4161/epi.6.7.16500

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  21. Xu R, Wang F, Wu L, Wang J, Lu C: A systematic review of hypermethylation of p16 gene in esophageal cancer. A systematic review of hypermethylation of p16 gene in esophageal cancer. Cancer Biomark 2013, 13: 215–226.

    PubMed  Google Scholar 

  22. Shima K, Nosho K, Baba Y, Cantor M, Meyerhardt JA, Giovannucci EL, Fuchs CS, Ogino S: Prognostic significance of CDKN2A (p16) promoter methylation and loss of expression in 902 colorectal cancers: Cohort study and literature review. Int J Cancer 2011, 128: 1080–1094. 10.1002/ijc.25432

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  23. Guo JX, Hu L, Yand PZ, Tanabe K, Miyatalre M, Chen Y: Chronic arsenic poisoning in drinking water in Inner Mongolia and its associated health effects. J Environ Sci Health A Tox Hazard Subst Environ Eng 2007, 42: 1853–1858. 10.1080/10934520701566918

    Article  CAS  PubMed  Google Scholar 

  24. Luo FJ, Luo ZD, Ma L: A study on the relationship between drinking water with high arsenic content and incidence of malignant tumour in Heihe Village, western part of Huhehot, Inner Mongolia. Zhonghua Liu Xing Bing Xue Za Zhi 1995, 16: 289–291.

    CAS  PubMed  Google Scholar 

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This work was supported by the National Natural Science Foundation of China (Grant No. 39800123, 71173231).

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Correspondence to Guangming Lu.

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The authors declare that they have no competing interests.

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All authors participated in the design, execution, and analysis of the study and the draft of the manuscript. All authors read and approved the final manuscript.

Guangming Lu, Huiwen Xu contributed equally to this work.

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Lu, G., Xu, H., Chang, D. et al. Arsenic exposure is associated with DNA hypermethylation of the tumor suppressor gene p16. J Occup Med Toxicol 9, 42 (2014).

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  • Arsenic
  • p16 gene
  • DNA methylation
  • Case–control study
  • Cancer