Maurizio Genuardi

Hereditary colorectal cancer in the general population: from cancer registration to molecular diagnosis

BACKGROUND Hereditary non-polyposis colorectal cancer (HNPCC) is one of the most common inherited disorders predisposing to cancer. The genes responsible for the disease have recently been cloned and characterised; their mutations induce a generalised genomic instability which is particularly evident at microsatellite loci (replication error (RER)+ phenotype). AIMS To investigate how to select individuals and families in the general population who should be screened for constitutional mutations predisposing to colorectal cancer. PATIENTS/METHODS Between 1984 and 1995, 1899 colorectal malignancies in 1831 patients were registered, and in 1721 of these (94%), family trees could be obtained. Patients and families were classified into five categories according to a more or less likely genetic basis: HNPCC; “suspected” HNPCC; juvenile cases; aspecific cancer aggregation; sporadic cases. In 18 families with HNPCC as well as in 18 with suspected HNPCC, microsatellite instability in tumour tissues and constitutional mutations of two DNA mismatch repair genes (MSH2 and MLH1) could be evaluated. RER status was studied with five markers (BAT40, D2S123,D18S57, D17S787, and BAT26) in paraffin embedded tissues. Germline mutations of MSH2 orMLH1 genes were assessed on DNA and RNA extracted from lymphomonocytic cells, using reverse transcription polymerase chain reaction, single strand conformation polymorphism analysis, and direct DNA sequencing. RESULTS HNPCC represented 2.6% and suspected HNPCC 4.6% of all registered colorectal neoplasms. Eleven out of 18 HNPCC families (61%) showed microsatellite instability as opposed to four (of 18) suspected HNPCC (22%; p<0.02). Three germline mutations (two inMSH2 and one inMLH1 gene) were found in three different large HNPCC families, whereas no mutations were detected in suspected HNPCC. CONCLUSIONS In this study of cancer genetic epidemiology, data from a tumour registry were analysed and this ultimately led to the identification and selection of families that should be tested for mutator gene mutations. With the use of a population based approach, the incidence of mutations was appreciably lower than previously reported and limited to families with full blown HNPCC. It is possible that in most families with a clinical spectrum of HNPCC (or suspected HNPCC) other DNA mismatch repair genes are involved in the pathogenesis of the disease.

Survival analysis in families affected by hereditary non‐polyposis colorectal cancer

Previous survival studies suggested a better prognosis of hereditary nonpolyposis colorectal cancer (HNPCC) patients compared with the sporadic counterpart. In the present study we evaluated the clinical outcome of HNPCC patients with respect to that of patients with colorectal cancer recorded in a population‐based cancer registry. We assessed survival of 85 colorectal cancer patients from 24 unrelated families defined as having HNPCC according to the criteria of the International Collaborative Group, for whom adequate information on subject‐ and tumor‐related parameters and a 5‐year follow‐up (cancer diagnosis from 1980‐1989) were available. Three hundred and seventy‐seven colorectal cancer patients, registered from 1984‐1986, with a 5‐year follow‐up, were used for comparison. Colorectal cancer‐specific 5‐year survival rates were 55.2% and 42.5% for HNPCC and non‐HNPCC, respectively. Using Cox regression analysis, tumor staging and location were independently associated with survival, whereas HNPCC diagnosis was not. Stage II HNPCC cases exhibited a better prognosis than non‐HNPCC patients. By Cox regression analysis, none of the variables were significantly related to survival. Both overall and stage II HNPCC cases showed a survival advantage in comparison with non‐HNPCC patients. However, the difference disappeared when clinical and pathological variables were controlled for with a Cox regression analysis. Int. J. Cancer 71:373‐376, 1997.

A split hand‐split foot (SHFM3) gene is located at 10Q24→25

The split hand-split foot (SHSF) malformation affects the central rays of the upper and lower limbs. It presents either as an isolated defect or in association with other skeletal or non-skeletal abnormalities. An autosomal SHSF locus (SHFM1) was previously mapped to 7q22.1. We report the mapping of a second autosomal SHSF locus to 10q24-->25. A panel of families was tested with 17 marker loci mapped to the 10q24-->25 region. Maximum lod scores of 3.73, 4.33 and 4.33 at a recombination fraction of zero were obtained for the loci D10S198, PAX2 and D10S1239, respectively. An 19 cM critical region could be defined by haplotype analysis and several genes with a potential role in limb morphogenesis are located in this region. Heterogeneity testing indicates the existence of at least one additional autosomal SHSF locus.

Genomic instability and target gene mutations in colon cancers with different degrees of allelic shifts

Two grades (high and low) of microsatellite instability (MSI) are known, depending on the number of mutated markers and the amount of allelic shifts. Forty‐two colorectal tumors, previously found to have high‐degree MSI at dinucleotidic repeat loci, were revisited with BAT26, a mononucleotide marker, and the number of shifted bases were counted. Seven tumors, all with local stages at diagnosis, had ≤6‐bp deletions and consistently displayed shorter shifts also with other intronic mononucleotide markers. Analysis of mononucleotide tracts in the coding regions of MSH3, MSH6, BAX, and TGFβRII in the groups with large (>6 bp) and short (≤6 bp) allelic shifts showed specific patterns of involvement for the individual genes: TGFβRII displayed a uniformly high rate of mutations, while MSH3, MSH6, and BAX were less frequently altered in tumors with short shifts. Our findings suggest that microsatellite instability arises gradually, evenly involving loci with similar features of length and repetition. However, target genes have a specific timing of mutation in this process: TGFβRII is involved in the early phases, while BAX and MSH6 are frequently associated with big size shifts and tumors with more advanced stages. Genes Chromosomes Cancer 27:424–429, 2000.

A founder MLH1 mutation in families from the districts of Modena and Reggio-Emilia in northern Italy with hereditary non-polyposis colorectal cancer associated with protein elongation and instability

Hereditary non-polyposis colorectal cancer (HNPCC), or Lynch syndrome, is an autosomal dominant condition predisposing to tumours of the large bowel and other sites. In HNPCC, cancer predisposition is usually inherited as a highly penetrant trait, with a tendency to the development of multiple tumours. Clinical diagnosis of HNPCC is based on the so-called modified “Amsterdam criteria”,1 which include: ( a ) the presence of at least three family members—one of whom must be a first degree relative to two other members—affected with carcinoma of the colon, rectum, endometrium, small bowel, or urothelium; ( b ) a direct transmission of the disease from parent to child; ( c ) the occurrence of at least one tumour before the patient reaches 50 years of age; and ( d ) the exclusion of a diagnosis of familial adenomatous polyposis. The genetic defects underlying most HNPCC cases are represented by constitutional point mutations of one of several genes encoding for proteins of the DNA mismatch repair complex. The vast majority of mutations are located in the major mismatch repair genes MSH2 and MLH1 (International Collaborative Group on HNPCC Mutation Database). The constitutional defects most commonly identified are nonsense, splice-site, or frameshift alterations, which all predict the synthesis of shorter, non-functional proteins. Tumours arising in carriers of mismatch repair gene mutations are characterised by a high frequency of insertion or deletion type somatic mutations within microsatellite repeats.2 These are the expression of mismatch repair deficiency, which arises when a second somatic mutation affecting the wild-type allele fully inactivates the gene locus already altered in the germline.3 Inactivation of a specific mismatch repair locus in a HNPCC tumour is often revealed by immunohistochemical methods, which show absence of nuclear staining following incubation with antibodies against the mismatch repair protein encoded by the mutant gene.4 In addition to genetic heterogeneity, HNPCC …

A mononucleotide markers panel to identify hMLH1/hMSH2 germline mutations

Hereditary NonPolyposis Colorectal Cancer (Lynch syndrome) is an autosomal dominant disease caused by germline mutations in a class of genes deputed to maintain genomic integrity during cell replication, mutations result in a generalized genomic instability, particularly evident at microsatellite loci (Microsatellite Instability, MSI). MSI is present in 85–90% of colorectal cancers that occur in Lynch Syndrome. To standardize the molecular diagnosis of MSI, a panel of 5 microsatellite markers was proposed (known as the “Bethesda panel”). Aim of our study is to evaluate if MSI testing with two mononucleotide markers, such as BAT25 and BAT26, was sufficient to identify patients with hMLH1/hMSH2 germline mutations. We tested 105 tumours for MSI using both the Bethesda markers and the two mononucleotide markers BAT25 and BAT26. Moreover, immunohistochemical evaluation of MLH1 and MSH2 proteins was executed on the tumours with at least one unstable microsatellite, whereas germline hMLH1/hMSH2 mutations were searched for all cases showing two or more unstable microsatellites. The Bethesda panel detected more MSI(+) tumors than the mononucleotide panel (49.5% and 28.6%, respectively). However, the mononucleotide panel was more efficient to detect MSI(+) tumours with lack of expression of Mismatch Repair proteins (93% vs 54%). Germline mutations were detected in almost all patients whose tumours showed MSI and no expression of MLH1/MSH2 proteins. No germline mutations were found in patients with MSI(+) tumour defined only through dinucleotide markers. In conclusion, the proposed mononucleotide markers panel seems to have a higher predictive value to identify hMLH1 and hMSH2 mutation-positive patients with Lynch syndrome. Moreover, this panel showed increased specificity, thus improving the cost/effectiveness ratio of the biomolecular analyses.