Recent clinical evidence strongly suggests that only those colorectal cancer patients with wild type K-ras respond to the anti-EGFR monoclonal antibody, Cetuximab. As such K-ras mutation testing is now a pre-requisite for inclusion in forthcoming CRC clinical trials using Cetuximab and is a requirement for access through the Interim Access Program (IAP) operated by Merck. SJOG Pathology in West Australia has recently implemented K-ras mutation testing and performed 300 such tests on DNA extracted from fresh frozen material as part of creating a colorectal tissue bank within routine patient management. Approximately 32 % of cases were K-ras mutant. The results have been included in the routine histopathology report. The test is cheap and easy to perform. At the same time we have established a service for K-ras testing from archival cases using paraffin embedded samples. In contrast to the prospective cases this service has proven difficult to establish due to several reasons, the most important being that accessing archival material is relatively difficult. In addition, jurisdiction over tissue blocks and the time lapsed between the initial surgery and when the test is requested (often some years) creates significant logistical issues for sample retrieval and testing. In addition, a survey we conducted demonstrated a wide range of knowledge about the testing by oncologists and this contributed to delays in obtaining the test results. Given the increased likelihood of similar tests for other molecular markers (eg. Braf, MSI) and with an ever increasing array of targeted therapies in the pipeline we suggest that routine diagnostic pathology labs should harvest DNA from primary tumours as part of their routine practice. In this manner such tests may be optimally performed whilst at the same time avoiding double handling of samples and so reducing both the cost of and time taken to perform molecular tests.
The notion of a CpG island methylator phenotype (CIMP) was proposed to describe a subset of colorectal cancers (CRC) displaying frequent and concordant methylation of CpG islands located within gene promoter regions. Some workers have failed to observe associations between CIMP and specific clinicopathological features of CRC, possibly because of the choice of genes used to define this phenotype. The aim of the current study was to determine whether the aberrant methylation of 6 genes implicated in CRC development was associated with the same phenotypic features of this tumour type. The MethyLight assay was used to provide quantitative estimates of MLH1, P16, TIMP3, P14, DAPK and APC methylation levels in 199 unselected colorectal tumours. The methylation of MLH1, P16, TIMP3 and P14 was highly concordant (p < 0.0001 for each pair) but that of DAPK and APC was not. An inverse association was observed between the methylation of APC and TIMP3 (p = 0.004). Methylation of the MLH1, P16, TIMP3 and P14 genes was associated with tumour infiltrating lymphocytes (p < 0.05), microsatellite instability (p < 0.001), BRAF mutation (p < 0.0001) and elevated concentrations of the methyl group carriers tetrahydrofolate (THF) and 5,10-methylene THF (p < 0.05). In contrast, APC methylation was associated with wildtype BRAF (p = 0.003) and with lower concentrations of methyl group carriers (p < 0.05). These findings highlight the importance of gene selection in studies that aim to characterize the biological features and clinical behaviour of CIMP+ tumours.
The effects of 3-methylcholanthrene and phenobarbital treatment on the adult rat hepatic cytosolic glucocorticoid (GRc) receptor were investigated. Analyses of sucrose gradient profiles and equilibrium binding data of [3H]dexamethasone bound to the GRc revealed that administration of 3-methylcholanthrene (20-40 mg/kg daily i.p. for 2 days) to adult female Fischer F344 rats led to a significant decrease in the maximal binding capacity of the 5-7S GRc [Bmax = 209 +/- 3 (SE) fmol/mg of protein] compared to the vehicle-treated controls (Bmax = 277 +/- 13 fmol/mg) but had no significant influence on the affinity of the GRc (Kd = 0.9 +/- 0.1 nM). This response was not dependent upon the sex or rat strain (female F344 versus Sprague-Dawley). Phenobarbital treatment (80 mg/kg daily i.p. for 4 days) decreased Bmax and Kd values compared to the vehicle treated controls (P less than 0.05). 3-Methylcholanthrene treatment did not significantly alter the equilibrium parameters of [3H]methyltrienolone bound to the hepatic androgen receptor indicating that the effect was specific to the hepatic GRc. Our data suggest that carcinogens and tumor promoters cause a functional decrease of the cytosolic glucocorticoid receptor in vivo.
Etiological risk factors for proximal (right-sided) colon cancers may be different to those of distal colon and rectal (left-sided) cancers if these tumors develop along distinct pathways. The CpG Island Methylator Phenotype (CIMP+) occurs in approximately 15% of colorectal cancers (CRC) and predominantly in the proximal colon. CIMP+ tumors have frequent methylation of gene promoter regions and increased tissue folate levels. The aim here was to determine whether polymorphisms in 2 genes involved in cellular methyl group metabolism were associated with different risks for right- and left-sided CRC. This population-based case-control study involved 859 incident cases of CRC and 973 sex and age-matched controls. Information on dietary folate and alcohol intake was obtained from food frequency questionnaires and information on the anatomical site of tumors from pathology reports. DNA was collected using FTA cards and genotyping performed for the MTHFR C677T and DeltaDNMT3B C-149T polymorphisms. The MTHFR 677 T allele was associated with increased risk for proximal colon cancer (adjusted odds ratio, AOR = 1.29) but decreased risk for distal cancers (AOR = 0.87). The increased risk for proximal cancers was especially pronounced in older individuals (AOR = 1.49) and those with a low folate diet (AOR = 1.67) or high alcohol consumption (AOR = 1.90). The DeltaDNMT3B-149 TT genotype was protective against proximal colon cancers (AOR = 0.65), but showed no association with the risk of distal colon and rectal cancers (AOR = 1.02). Epidemiological studies on dietary and genetic risk factors for CRC should take into account these may confer different risks for right- and left-sided tumors.
We recently presented evidence for tumor site and gender-specificity in the survival benefit from adjuvant chemotherapy in Stage III colorectal cancer (CRC). In the current study, we examined whether p53 alteration or the microsatellite instability (MSI) phenotype provide additional predictive information in CRC patients.A retrospective series of 891 Stage III CRC patients with negative surgical margins was investigated. Thirty percent (270 of 891) received postoperative adjuvant chemotherapy with curative intent and comprising of 5-fluorouracil/levamisole. Adjuvant treatment and nontreatment patient groups were well matched for tumor site, grade, p53 alterations, and MSI. Surgical tumor specimens were investigated for p53 overexpression using immunohistochemistry and for p53 mutation and MSI using single-strand conformation polymorphism analysis. The predictive value of these markers was evaluated by comparing the survival of adjuvant-treated and nonadjuvant treated patients.A strong inverse correlation was observed between p53 alteration and MSI (P < 0.0001). In univariate analysis, the factors of sex, site, p53 alteration, and MSI were each strong predictors of a survival benefit from chemotherapy. Multivariate analysis revealed that chemotherapy provided maximal survival benefit for female patients (P = 0.005) and for patients whose tumors contained normal p53 (P = 0.041). Males whose tumors contained a p53 alteration and were negative for MSI appeared not to benefit from chemotherapy.Our findings suggest that p53 alteration and MSI could be clinically useful molecular predictive markers for the identification of CRC patients who might benefit from 5-fluorouracil-based chemotherapy.
The CpG-island methylator phenotype (CIMP+) in colorectal cancer (CRC) is characterised by frequent hypermethylation of promoter regions in tumour suppressor genes. Low level methylation of some CpG islands is also seen in the normal colonic mucosa and increases with age; however, it is still unclear what other factors regulate this phenomenon. The first aim of our study was to determine whether the level of promoter methylation is elevated in the normal colonic mucosa of patients with CIMP+ tumours. The second aim was to investigate whether common, functional polymorphisms in genes involved in methyl group metabolism are associated with the level of methylation in this tissue. CpG islands within the ERα, MYOD, P16(INK4A), MLH1, APC, P14(ARF), DAPK and TIMP3 genes were quantitatively evaluated for methylation in normal colonic mucosa from a large series of CRC patients using the MethyLight assay. Genotyping was carried out for polymorphisms in the MTHFR, TS, MS, MTHFD1 and DNMT3b genes. Methylation of ERα and MYOD in normal colonic mucosa increased with age and was higher in female subjects. Methylation of P16(INK4A), MLH1, TIMP3 and DAPK in normal mucosa occurred at a lower level than ERα and MYOD but also increased with age and was significantly higher in patients with CIMP+ tumours. The DNMT3b C46359T polymorphism was associated with significantly less methylation of MYOD and MLH1 and with trends for lower methylation in each of the other CpG islands examined. Our results demonstrate that age, gender and genetic factors can influence the methylation level of CpG islands in gene promoter regions of normal colonic mucosa. Further work is required to determine whether such methylation is associated with the development of CIMP+ CRC.
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