
[Cancer Research 60, 4678-4681, September 1, 2000]
© 2000 American Association for Cancer Research
Inhibition of Epidermal Growth Factor Receptor Tyrosine Kinase Fails to Suppress Adenoma Formation in ApcMin Mice but Induces Duodenal Injury1
Steve R. Ritland,
Sandra J. Gendler,
Lawrence J. Burgart,
David W. Fry,
James M. Nelson,
Alexander J. Bridges,
Larry Andress and
William E. Karnes, Jr.2
Tumor Biology Program, Mayo Clinic, Scottsdale, Arizona 85259 [S. R. R., S. J. G.]; Department of Cancer Research, Pfizer Global Research and Development, Ann Arbor, Michigan 48105 [D. W. F., J. M. N., A. J. B., L. A.]; and Department of Pathology [L. J. B.] and Gastrointestinal Research Unit [W. E. K.], Mayo Clinic, Rochester, Minnesota 55905
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ABSTRACT
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A highly selective, p.o. bioavailable irreversible inhibitor of
epidermal growth factor receptor (EGFR) tyrosine kinase,
N-[4-(3-chloro-4-fluoro-phenylamino)-quinazolin-6-yl]-acrylamide
(CFPQA), was evaluated for its ability to prevent intestinal adenoma
formation in ApcMin mice. Ten-week
continuous dietary exposure to CFPQA at doses sufficient to abolish
intestinal EGFR tyrosine phosphorylation failed to affect intestinal
tumor multiplicity or distribution but induced flat mucosal lesions in
the duodenum characteristic of chronic injury. Intestinal trefoil
factor, an intestinal peptide that mediates antiapoptotic effects
through an EGFR-dependent mechanism, was notably absent in adenomas but
was highly expressed in flat duodenal lesions. We conclude that chronic
inhibition of EGFR tyrosine kinase by CFPQA does not prevent adenomas
in ApcMin mice but may induce duodenal
injury.
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Introduction
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Because of its role in malignant transformation and growth,
EGFR3
is an attractive target for treatment and prevention of cancer
(1, 2, 3)
. Preclinical studies show that inhibition of EGFR
activation induces cytostasis and apoptosis in a variety of carcinoma
cell lines in vitro and has antitumor activity against
epidermoid, breast, ovarian, lung, and nasopharyngeal carcinoma
in vivo (4, 5, 6)
, and Phase I studies in humans
with advanced malignancies are under way .
Selective inhibitors of EGFR tyrosine kinase induce
caspase-dependent apoptosis in colon cancer and adenoma cell lines
(7, 8, 9)
, perhaps by preventing EGFR-mediated antiapoptotic
signals through the phosphatidylinositol 3'-kinase-Akt pathway
(10, 11, 12)
. ITF/TFF3 also activates this antiapoptotic
pathway and confers resistance of colon cancer cells to apoptosis
induced by DNA-damaging agents, serum deprivation, or ceramide through
an EGFR-dependent mechanism (13)
. Of particular interest
in colorectal cancer, EGFR and its family members interact with and
phosphorylate ß-catenin after activation by EGFR ligands or ITF/TFF3
(14, 15, 16)
. ß-Catenin accumulates early during colorectal
carcinogenesis, following functional loss of the adenomatous polyposis
coli (APC) gene product (17)
, and is
considered to mediate the transforming and antiapoptotic effects of Apc
loss through its actions as a transcriptional activator of
antiapoptotic genes when complexed with the Lef/Tcf family of
transcription factors (18
, 19)
. The impact of
EGFR signaling on the oncogenic function of ß-catenin
remains unknown. However, together, these observations suggest that
EGFR may play a central role in antiapoptotic signaling during
colorectal carcinogenesis generated by EGFR ligands, ITF/TTF3, and
perhaps ß-catenin. To determine whether EGFR-mediated signals are
critical for adenoma formation induced by Apc loss, we examined the
effects of a 10-week continuous exposure to a highly selective, p.o.
bioavailable inhibitor of EGFR tyrosine kinase activity, CFPQA
(PD179651; Ref. 20
), at three different oral doses on
tumor multiplicity and distribution in the
C57BL/6J-ApcMin mouse model of intestinal
tumorigenesis.
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Materials and Methods
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Mice.
The ApcMin mouse is a genetic model
of intestinal tumorigenesis driven by a germ-line mutation at codon 850
of the APC gene analogous to FAP in human (21)
.
Inbred C57BL/6J-ApcMin mice were produced
by breeding from stock animals purchased from The Jackson Laboratory
(Bar Harbor, ME) and screened for the Min/+ genotype using a
previously described PCR assay (22)
. Study mice were
housed in an AAALAC-approved specific pathogen-free
facility using forced air Thoren microisolator cages (three mice/cage),
monitored for health every 23 days, and weighed weekly. Mice were
weaned onto the AIN-93G powdered diet at 2530 days of age and
assigned systematically to drug treatment and control groups to
normalize the distribution of males and females and to avoid clustering
of individual mice from single litters. At the end of the study, an
intestinal tissue sample was taken from each animal and subjected to
Min/+ screening PCR to verify the Min/+ genotype
as described previously (22)
.
Diet and Drug Treatment.
The test drug, CFPQA, is a member of the quinazolin family of
irreversible selective inhibitors of EGFR tyrosine kinase
(1)
, and its structure, biochemical properties, and
selectivity are comparable to those of the well-characterized analogue
PD168393 (4
, 20)
. CFPQA has an IC50
of 0.75 nM against the isolated enzyme and an
IC50 of 3.1 nM against epidermal
growth factor-stimulated receptor phosphorylation in A431 epidermoid
cancer cells (20)
. Similar IC50
values have been determined against murine
EGFR.4
CFPQA has minimal activity against other receptor tyrosine kinases.
Like another closely related quinazolin, PD153035, CFPQA induces
cytostasis and apoptosis of colorectal cancer cell lines at
concentrations near its IC50 for inhibition of
EGFR tyrosine kinase activity (7)
. However, unlike
PD153035, CFPQA is well suited for in vivo chemopreventative
studies because it has greater aqueous solubility and is p.o.
bioavailable.
Food and water were freely available at all times for the duration of
the study. Study mice were fed either powdered AIN-93G rodent diet
alone (Dyets, Inc., Bethlehem, PA) or AIN-93G plus drug prepared
immediately before use by extensive manual mixing of milled drug with
powdered diet. Fresh diet was provided every 23 days, and all unused
AIN-93G diet was stored at 4°C for a period not exceeding 3 months
from the time of purchase. Both piroxicam and CFPQA are stable in dry
chow at 22°C for over a week
(22)
.4
All experimental groups were
treated continuously from the time of weaning (2530 days of age)
until the time of sacrifice (99111 days of age). Experimental groups
included an AIN-93G vehicle control (n = 13
mice), a piroxicam positive control (200 ppm piroxicam;
n = 6 mice; Ref. 23
), and three
CFPQA treatment groups (50, 200, and 500 ppm CFPQA;
n = 10 mice/group). Based on the average food
consumption per day and the average weight of mice in this study,
approximate dosage conversions were as follows: (a) 500 ppm
100 mg/kg/day; (b) 200 ppm
40 mg/kg/day; and
(c) 50 ppm
10 mg/kg/day. Three additional supplementary
studies were performed: (a) four
ApcMin mice were treated with 500 ppm CFPQA
for 80 days and then observed off treatment for 4 weeks before
sacrifice to assess the reversibility of CFPQA-induced duodenal lesions
(described in "Results"); (b) four
ApcMin mice were treated with 500 ppm CFPQA
for 80 days and then treated with 200 ppm piroxicam for 10 days before
sacrifice to assess the effects of piroxicam on CFPQA-induced duodenal
lesions; and (c) four wild-type C57BL/6J mice were treated
with 500 ppm CFPQA for 80 days before sacrifice to assess whether
duodenal lesions were dependent on the
ApcMin genotype.
Tumor Enumeration.
Methods used for determining intestinal tumor multiplicity and
distribution in ApcMin mice have been
described in detail (23)
. Briefly, the entire
gastrointestinal tract was dissected, washed extensively with PBS, and
fixed with methacarn (60% methanol, 30% chloroform, and 10% acetic
acid), and tumors were evaluated by dark-field microscopy. The smallest
tumors scored by this method were 0.2 mm in diameter, and the site of
each tumor was recorded using a calibrated stage micrometer (Klarmann
Rulings) to facilitate distribution analysis. For tumor distribution
analysis, duodenum, jejunum, ileum, and colon were each divided into
three equal segments.
Immunoprecipitation and Western Blot.
Frozen tissue was homogenized in 10 volumes of ice-cold lysis
buffer [50 mM HEPES (pH 7.5), 150 mM NaCl,
10% glycerol, 1 mM sodium EDTA, 1 mM sodium
EGTA, 1% Triton X-100, 1 mM sodium orthovanadate, 50
mM sodium fluoride, 10 µg/ml leupeptin, 10 µg/ml
aprotinin, and 1 mM phenylmethylsulfonyl fluoride], and
supernatant representing 1 mg of total protein was rotated at 4°C for
2 h with 2 µg of EGFR antibody (clone 1005; Santa Cruz
Biotechnology, Santa Cruz, CA). Fifty µl of protein A-Sepharose
(Amersham Pharmacia Biotech, Piscataway, NJ) were added and rotated
overnight at 4°C. Immune complexes were washed five times with
precipitate wash buffer [50 mM HEPES (pH 7.5), 150
mM NaCl, 10% glycerol, 0.1% Triton X-100, and 0.02%
sodium azide], resuspended with 30 µl of loading buffer (2% SDS and
30 mM ß-mercaptoethanol), heated to 100°C for 5 min,
and centrifuged. Thirty µl of the lysate were loaded and separated on
a 420% polyacrylamide gel, and the proteins were transferred
electrophoretically to nitrocellulose membrane. The membrane was washed
once in TNA and blocked overnight in TNA containing 5% BSA and 1%
ovalbumin. The membrane was blotted for 2 h with
antiphosphotyrosine antibody (1 µg/ml) in blocking buffer (Upstate
Biotechnology, Inc., Lake Placid, NY) and then washed twice in TNA,
washed once in TNA containing 0.05% Tween-20 and 0.05% NP40, and
washed twice in TNA. The membranes were then incubated for 2 h in
blocking buffer containing 0.1 µCi/ml
125I-protein A and then washed again as described
above. After the blots were dry, they were loaded into a film cassette
and exposed to XAR X-ray film for 17 days. Band intensities were
determined with a Molecular Dynamics laser densitometer.
Immunohistochemistry.
Expression of trefoil peptides was determined by
immunohistochemistry using rabbit polyclonal antibodies kindly provided
by Dr. Daniel Podolsky (Massachusetts General Hospital, Boston,
MA) raised against rat ITF/TFF3 and human SP (SP/TFF2), both
recognizing the murine forms. Sections (5 µm) of methacarn-fixed,
paraffin-embedded tissues were dewaxed and rehydrated, treated with 2%
hydrogen peroxide in 100% methanol for 10 min, and then rinsed in PBS
(pH 7.4). Slides were then blocked with 50% FCS/PBS for 3045 min,
followed by a 1-h incubation with 100200 µl of primary antibody
diluted in 15% FCS/PBS at a 1:100 ratio for ITF and a 1:500 ratio for
SP in a closed humidified chamber. Slides were then rinsed three times
in PBS and incubated with 100200 µl of antirabbit conjugated
to horseradish peroxidase secondary antibody (DAKO, Carpinteria,
CA) diluted 1:1000 in 15% FCS/PBS for 1 h in the chamber. After
three to four additional rinses in PBS, 200 µl of
3,3'-diaminobenzidine solution prepared according to the instructions
supplied with the 3,3'-diaminobenzidine substrate kit for peroxidase
(Vector Laboratories, Burlingame, CA) were added for 7 min. Slides were
then washed in water and stained with 200 µl of hematoxylin for
1530 s, followed by several washes with PBS. Slides were then
permount coverslipped and analyzed using a Zeiss Axiovert S100TV
microscope and a Spot digital camera (Diagnostic Instruments, Inc.,
Sterling Heights, MI). Images were batch-processed for consistent color
balance and contrast using Adobe Photoshop version 4.0.
Statistical Analysis.
End points for efficacy included intestinal tumor multiplicity
and distribution, body weight, serum drug levels, and EGFR
phosphorylation level in intestinal mucosa. Statistical comparisons of
tumor multiplicity between chemoprevention study groups were performed
using Wilcoxons rank-sum or two-sample t tests. All Ps
<0.05 were considered significant.
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Results
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CFPQA Steady-State Serum Levels and Effects on Intestinal EGFR
Tyrosine Phosphorylation.
Chronic oral administration of CFPQA to
ApcMin mice through a food/drug mixture
produced serum levels of 11.4 ± 2.5
nM (for 50 ppm), 105 ± 26 (for
200 ppm), and 282 ± 69 nM (for
500 ppm). Serum exposure levels attained for 200 and 500 ppm CFPQA were
sufficient to abolish detectable EGFR tyrosine phosphorylation in the
intestinal mucosa of ApcMin mice by
immunoprecipitation and Western blot (Fig. 1)
. Therefore, the 200 and 500 ppm doses of CFPQA produced exposure
levels sufficient to modulate the pharmacodynamic marker (EGFR
autophosphorylation) in the target tissue (intestinal mucosa).

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Fig. 1. Effects of 5-day treatment with 500 ppm CFPQA on
EGFR tyrosine phosphorylation in jejunal mucosa of
ApcMin mice. EGFR was immunoprecipitated
from tissue lysates, separated by SDS-PAGE, and analyzed by Western
analysis with antibodies specific for phosphotyrosine
(top) or EGFR (bottom) as described in
"Materials and Methods." Lane 1, animals fed the
AIN-93G diet alone; Lane 2, animals treated with 500 ppm
CFPQA; Lane 3, positive control lysate from
EGFR-overexpressing A431 epidermoid cancer cells. Molecular weight
markers are shown on the right. Bands representing the
Mr 180,000 EGFR are indicated by the
arrowheads.
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CFPQA Does Not Affect Adenoma Multiplicity or Distribution in
ApcMin Mice.
Despite adequate systemic exposure and confirmed modulation of
EGFR tyrosine phosphorylation, none of the tested doses of CFPQA caused
significant changes in intestinal tumor multiplicity or distribution in
ApcMin mice (Fig. 2, A and B)
. An apparent increase in tumor
multiplicity in the first portion of the duodenum (Fig. 2
B,
D1) was judged to be an artifact after histological analysis
revealed nonadenomatous mucosal lesions confined to the duodenum in the
CFPQA-treated animals (described below). In contrast, piroxicam
(positive control) dramatically reduced adenoma multiplicity in the
duodenum, jejunum, and ileum (>95% reduction; P < 0.01 versus the AIN-93G control group). These
findings suggest that adenoma multiplicity in the
ApcMin mouse is not dependent on EGFR
tyrosine kinase activity.

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Fig. 2. Effects of CFQPA on tumor multiplicity and distribution in
ApcMin mice. Tumors were counted in three
equal segments each of duodenum (D1, D2, and
D3), jejunum (J1, J2, and
J3), ileum (I1, I2, and
I3), and colon (C1, C2, and
C3) as described in "Materials and Methods."
A shows the average total number of tumors in each
treatment group (error bars, SD). B shows
the average number of tumors in each segment in each treatment group
(shown in the legend). The apparent increase in D1
tumors in CFPQA-treated animals is believed to be an artifact due to
the duodenal lesions described in "Results" and shown in Figs. 3
4
. Numbers of animals in each group are shown in
parentheses in the legend. Treatment
groups labeled CQ/50, CQ/200, and CQ/500 represent CFPQA at 50, 200,
and 500 ppm, respectively.
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CFPQA Induces Duodenal Lesions.
No significant differences in body weights or overall health
between any of the treatment groups were noted. However, all
ApcMin and wild-type mice treated with 200
or 500 ppm CFPQA for 10 weeks exhibited flat mucosal lesions restricted
to the duodenum. Histologically, the duodenal lesions exhibited absent
villi, expanded hyperchromatic proliferative zones with an increased
frequency of mitotic figures and glandular crowding, and underlying
Brunners gland hypertrophy without mucosal ulceration or erosion
(Fig. 3)
. The duodenal changes induced by CFPQA were reversible on cessation of
treatment (gross observation 4 weeks after the end of treatment) but
were not affected by simultaneous treatment with piroxicam (200 ppm;
data not shown). Taken together, these observations suggest that the
CFPQA-induced duodenal lesions develop independently of Apc
status and represent reactive rather than neoplastic changes.

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Fig. 3. Histology of duodenal lesions induced by CFQPA using H&E
staining. The left panel shows duodenal mucosa (segment
D1) from a representative ApcMin mouse after
10 weeks of treatment with AIN-93G diet alone. The right
panel shows flat lesion (F) and underlying
Brunners gland (B) in segment D1 from a representative
ApcMin mouse after 10 weeks of treatment
with 500 ppm CFPQA. x160.
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ITF/TFF3 Expression in Adenomas and Duodenal Lesions.
We then performed immunohistochemical analysis of adenomas,
normal intestinal mucosa, and the duodenal lesions of CFPQA-treated and
control mice for protein expression of ITF/TFF3, as well as SP
(SP/TFF2), a trefoil peptide expressed primarily in the neck cells of
gastric glands (24)
. Specific ITF/TFF3 (Fig. 4)
but not SP/TFF2 (data not shown) immunoreactivity was present in cells
of the crypts, rare villus goblet cells, and the overlying mucous layer
of normal intestinal mucosa of treated and untreated animals. Adenomas
exhibited no detectable immunoreactivity for either peptide (Fig. 4)
.
However, CFPQA-induced duodenal lesions showed strong ITF/TFF3
immunoreactivity of isolated cells throughout the entire thickness of
the lesions, consistent with the histological impression that these
lesions represent expanded regenerative crypts (Fig. 4)
. The absence of
ITF/TFF3 immunoreactivity in adenomas suggests that this peptide does
not play a role in ApcMin adenoma
development or in the resistance of adenomas to chemoprevention by
CFPQA.

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Fig. 4. ITF/TFF3 expression. Positive ITF/TFF3 immunostaining
shows as a brown color. Blue staining is
hematoxylin. x160. Images include duodenal mucosa
(left) and adenomas (A;
right) from representative
ApcMin mice after 10 weeks of treatment
with AIN-93G diet alone (top) or 500 ppm CFPQA
(bottom).
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Discussion
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In the present study, chronic dietary exposure to 200 and 500 ppm
of the selective EGFR tyrosine kinase inhibitor CFPQA achieved
steady-state serum concentrations well above the in vitro
IC50 for inhibition of EGFR tyrosine kinase
activity and abolished detectable EGFR tyrosine phosphorylation in
intestinal mucosa but had no effect on tumor multiplicity or
distribution of adenomas in ApcMin mice.
Similar concentrations of CFPQA or its closely related analogue,
PD153035, are sufficient to induce cytostasis and apoptosis in
EGFR-dependent colorectal cancer cell lines within 24 h
(7)
.4
Together, these results
suggest that EGFR-mediated proliferative and survival signals are not
critical for early stages of colorectal carcinogenesis. We speculate
that other signaling systems may be activated that compensate for or
protect against the antitumor effects of EGFR inhibition or that EGFR
is not involved in adenoma formation induced by Apc loss. Neither
ITF/TTF3 nor SP/TTF2 was expressed in adenomas, suggesting that these
antiapoptotic gut peptides (13)
are not involved in
adenoma formation and do not confer resistance of adenomas to
chemoprevention by CFPQA.
Although the ApcMin mouse is considered to
be a genetically relevant model of human colorectal carcinogenesis
triggered by APC loss, there are important phenotypic
differences between ApcMin mice and humans
with FAP. Compared with adenomas in FAP,
ApcMin adenomas infrequently progress to
frank carcinomas, they are distributed more densely in the small
intestine than in the colon, and they lack the genetic complexity and
instability of human colorectal neoplasms (25)
.
Furthermore, in contrast to reports that ITF/TFF3 is expressed in human
adenomas and colorectal cancers (26)
, we found no
detectable ITF/TFF3 expression in the adenomas of
ApcMin mice. Thus, the lack of antitumor
activity for CFPQA in the ApcMin model
cannot be generalized to human colorectal adenomas and carcinomas.
Although no gross toxicity was detected, doses of CFPQA sufficient to
abolish mucosal EGFR tyrosine phosphorylation induced
hyperproliferative duodenal lesions in both
ApcMin and wild-type C57Bl6/J mice. Unlike
adenomas, these lesions expressed ITF/TFF3, developed in wild-type mice
as well as ApcMin mice, and were reversible
in mice held from CFPQA treatment for 4 weeks before sacrifice,
suggesting that they are reactive and not neoplastic. The lesions
showed characteristics of a regenerative response to injury with absent
villi, glandular crowding, and expanded proliferative zone.
Interestingly, piroxicam, which depletes mucosal cytoprotective
prostaglandins through inhibition of cyclooxygenases I and II, did not
exacerbate these lesions. Future studies using any of the several
classes of EGFR tyrosine kinase inhibitors that are chemically distinct
from the quinazolones will help determine whether these lesions are a
response to a secondary (off-target) activity or to EGFR inhibition per se.
In summary, we have shown that the EGFR-selective tyrosine kinase
inhibitor CFPQA does not inhibit intestinal tumor formation in the
ApcMin mouse despite inhibition of the
target enzyme EGFR in intestinal mucosa. Although no gross toxicities
were detected, doses of CFPQA sufficient to abolish mucosal EGFR
tyrosine phosphorylation induced reversible duodenal lesions suggestive
of chronic injury in both ApcMin and
wild-type C57BL/6J mice. These findings may have important implications
regarding the role of EGFR-mediated signals in intestinal
carcinogenesis and for the future development of EGFR-targeted
therapies for chemoprevention of adenomas.
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ACKNOWLEDGMENTS
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We gratefully acknowledge the valuable contributions of Dr.
Daniel Podolsky (Massachusetts General Hospital, Boston, MA),
Anita Jennings (Mayo Clinic, Scottsdale, Histology Core), Dr.
Thomas Lidner (Mayo Clinic, Scottsdale, Pathology), and members of the
Mayo Clinic, Scottsdale, Transgenic Animal Core.
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FOOTNOTES
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The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked advertisement in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.
1 Supported by NIH Grants R29 CA7194 (to
W. E. K.), RO1 DK 56373-01 (to W. E. K.), and RO1 CA64389 (to
S. J. G.) and by the Mayo Foundation and the Mayo Comprehensive
Cancer Center. 
2 To whom requests for reprints should be
addressed, at 2-435 Alfred Gastrointestinal Research Unit, Saint
Marys Hospital, Mayo Clinic, 200 First Street SW, Rochester,
MN 55905. Phone: (507) 284-6635; E-mail: karnes.william{at}mayo.edu 
3 The abbreviations used are: EGFR, epidermal
growth factor receptor; CFPQA,
N-[4-(3-chloro-4-fluoro-phenylamino)-quinazolin-6-yl]-acrylamide;
ITF, intestinal trefoil factor; TFF, ; SP, spasmolytic peptide;
FAP, familial adenomatous polyposis; TNA, 10 mM Tris (pH
7.2), 150 mM NaCl, and 0.01% sodium azide. 
4 William E. Karnes, Jr., unpublished
observations. 
Received 4/27/00.
Accepted 7/19/00.
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