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Molecular Biology and Genetics |
Samuel Lunenfeld Research Institute [V. V., A. M., L. B., B. B.] and Department of Pathology and Laboratory Medicine, Mount Sinai Hospital [V. V., A. M., B. B.], Toronto, Ontario, M5G 1X5 Canada; University Health Network, The Princess Margaret Hospital [W. C.], Toronto, Ontario, M5G 2C4 Canada; and Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, Ontario, M5G 1L5 Canada [V. V., A. M., W. C., B. B.]
| ABSTRACT |
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| INTRODUCTION |
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MMR-deficient cells may also accumulate mutations in genes that are involved in key cellular pathways, further acquiring traits that are advantageous in the tumorigenic process. In this regard, genes in the DNA damage response pathway are good mutational candidates because of their importance in cell cycle regulation. A disruption in cell cycle regulation leads to the propagation of defective DNA and increased cellular proliferation, traits characteristic of cancer cells. For example, the evolutionarily conserved kinase ATR is activated in response to DNA damage and phosphorylates CHK1 and CHK2 (6, 7, 8) . Phosphorylation of CDC25C by CHK1 inhibits CDK1, resulting in G2 arrest and mitosis prevention. Because ATR, CHK1, and CDC25C function to maintain genomic integrity by preventing mitosis in response to DNA damage and also contain mononucleotide repeats in their coding regions, they are potential mutation targets in MSI+ cancer cells. ATR also phosphorylates and activates p53, BRCA1, and BRCA2 (8) , which are involved in cell cycle progression, centrosome duplication, DNA damage repair, cell growth, apoptosis, transcriptional activation, and repression (9) . BRCA1 and BRCA2 contain coding mononucleotide repeats and may be susceptible to incur alterations in MMR-deficient cells.
Several other genes are also involved in maintaining the integrity and stability of the genome (10) . DNA helicases unwind double-stranded DNA and play a role in DNA replication, recombination, and repair (11) . BLM, WRN, and RECQL are evolutionarily conserved members of the RecQ helicase family (10 , 12 , 13) , and alterations in these genes result in a strong predisposition to cancer. BLM, RECQL, and WRN contain coding mononucleotide repeats, and mutational inactivation of these genes in MMR-deficient cells may play a role in MSI+ tumorigenesis by possibly reducing defective DNA repair (12) .
Functional inactivation of many of these genes has been examined in MSI+ cancers, mainly colorectal cancers (3 , 14 , 15) ; however, their specific contributions to MMR-deficient EC and, in particular, premalignant uterine hyperplasias have not been systematically examined. In this study, we investigated candidate genes implicated in DNA repair pathways as possible targets of somatic mutations in MSI+ ECs and in adjacent premalignant hyperplasias to assess the contribution of such mutations to the initiation and progression of EC. We also examined the correlation between mutations in these pathways with respect to tumor histopathology. Our results suggest a contributory role of somatic mutations in DNA repair genes in MSI+ endometrial tumorigenesis and progression.
| MATERIALS AND METHODS |
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Histopathological Assessment.
Samples consisting of primary endometrial adenocarcinomas were cut into 5-µm sections, stained with H&E, and classified according to International Federation of Gynecologists and Obstetricians (FIGO) criteria (2)
. Grading and staging of tumors as well as the classification and extent of associated hyperplasias were assessed by W. C. (a pathologist with expertise in gynecologic pathology). Areas enriched (>70% cellularity) in normal, hyperplastic, and tumor cell populations were identified and marked for microdissection from 10-µm unstained sections; the samples were used for DNA extraction, and a final 5-µm H&E-stained section was used for the confirmation of proper alignment and histopathology with preceding sections.
MSI Analysis.
DNA was extracted from each cell population (normal, hyperplastic, and tumor) per previously described protocols (4)
and analyzed for MSI using the National Cancer Institute-recommended panel of five microsatellite markers for normal and tumor tissue and BAT-25 and BAT-26 markers for hyperplasias (4
, 16)
. MSI was defined by the presence of altered and/or additional alleles in the PCR-amplified product of tumor or premalignant DNA as compared with matched normal DNA. Tumors were classified as MSI+ if alterations were observed in at least 40% of the analyzed marker loci. Hyperplasias were designated as MSI+ if one of two or both analyzed loci showed instability.
Analysis of Candidate Genes.
Forty-eight MSI+ (38 MSI-H,
40% MSI; 10 MSI-low, <40% MSI) and 25 MSS endometrial adenocarcinomas were examined for somatic mutations in coding mononucleotide repeats of genes involved in DNA repair pathways including MMR, DNA damage response, and nucleotide excision repair. Sequences of candidate genes were obtained from GenBank,4
and primers were designed that span the coding mononucleotide repeat stretches, producing PCR amplicons of 57116 bp. One primer of each pair was end-labeled with [
-33P]ATP, and specimens were analyzed for alterations in candidate genes by PCR and gel electrophoresed as described previously (4)
. Primers and amplification conditions are described in Table 1
. Putative mutations were confirmed by manual DNA sequencing. For ECs harboring somatic mutations, associated hypeplasias were analyzed for the presence or absence of the same genetic alterations.
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Possible trends in the probabilities associated with the presence of mutations were tested with respect to tumor grade using Bartholomews test (17)
. The test is based on the following statistical formula:
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| RESULTS |
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Mutation Distribution in MSI+ EC and Statistical Analysis.
A significant association of grade and stage of EC with either overall mutation status or mutations in each pathway (Table 2)
was not observed by Fishers exact test, which is not surprising, given the limitations of our small sample size. However, the test for an increase in proportions (Bartholomews test) was significant (P < 0.05) in determining a trend with advancing tumor grade (Table 2C)
in the DNA damage response pathway.
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| DISCUSSION |
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Somatic mutations in hMSH3 and hMSH6 have been studied extensively in MSI+ colorectal, endometrial, and gastric cancer; however, a role for hMLH3 has only recently emerged in the context of MSI+ colorectal cancers (19)
. hMLH3 contains two coding mononucleotide repeats, and we found both of them to be mutated in EC. The (A)9 repeat had a higher mutational frequency than the (A)8 repeat of hMLH3 in both tumor and associated hyperplasia (Fig. 2A)
, suggesting that it may be preferentially targeted, followed by the (A)8 repeat. Furthermore, it is also possible that the multiple alterations in hMLH3 observed in the same tumor (Fig. 2A
, cases 101 and 124) are biallelic. Our study is the first to address the role of hMLH3 alterations in MSI+ EC and to further implicate somatic mutations of hMLH3, hMSH3, and hMSH6 genes in the early stages of MSI+ endometrial tumorigenesis by demonstrating their occurrence in associated hyperplasias adjacent to tumors harboring the mutations.
Response to DNA damage is crucial in the maintenance of genomic stability and cellular integrity. Our examination of genes in this pathway implicates CHK1 and BAX as early mutational targets in the development of EC because premalignant lesions harbored somatic mutations that were maintained in tumors. Somatic mutations of ATR and CDC25C were observed in tumors only, implicating them as mutational targets involved in the later stages of MSI+ EC in the same pathway.
Because MSI+ tumors display a high background of genetic instability, it is difficult to establish which alterations are likely to play a key role in carcinogenesis. Five criteria have recently been proposed to establish whether mutations occur preferentially in certain genes, and whether they are likely to contribute to MSI+ tumorigenesis (14)
. These criteria are as follows: (a) high mutational frequency; (b) biallelic inactivation; (c) role for the candidate target gene in a growth suppressor pathway; (d) occurrence of alterations within the same genes and/or same pathway in MSS tumors; and (e) in vitro or in vivo functional studies to support a role of mutations in functional inactivation of candidate genes. Based on our study, we propose the inclusion of one more criteria, the occurrence of somatic mutations in premalignant lesions, such as endometrial hyperplasias or colonic adenomas, in the same target genes. The progressive nature of genetic instability accumulation was clearly illustrated in one case by the presence of a single-base deletion in the coding (A)8 repeat of the hMSH3 gene in the hyperplasia, whereas the tumor contained a 2-bp deletion at the same site (Fig. 1B)
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Our findings agree with the haploinsufficiency model of the mutator phenotype that has been recently proposed by Yamamoto et al. (15) . According to this model, monoallelic mutations in several target genes that belong to the same pathway accumulate in cancer cells during tumor progression and inactivate the pathway. Six of 14 tumors (42%) accumulated somatic mutations in multiple genes in MMR and DNA damage response pathways. Because maintenance of genome stability depends on the cells ability to repair and properly respond to DNA damage, accumulation of heterozygous mutations in multiple genes whose products have synergistic roles at different points in a specific pathway reduces the homeostatic threshold amount of the corresponding proteins in the pathway.
We observed a significant relationship between mutation status and tumor grade only in the DNA damage response pathway. Given the progressive nature of mutation accumulation at coding region repeats of key target genes in MSI+ tumors, we expected to see that the more advanced tumors (higher grades) were associated with a higher number of such alterations. However, when the overall mutation status was assessed for such an association, we did not observe a significant increase in the number of mutations with advancing tumor grade and stage. Similarly, we did not observe an increased number of mutations in MMR genes with advancing tumor grade and stage. This does not indicate that these alterations are not important because mutations in MMR genes may play a role in the initiation rather than progression of MSI+ EC. It makes sense to have MMR genes mutated early because they can contribute to further genetic instability at microsatellites of regulatory genes, resulting in their inactivation and thereby providing cells with a growth advantage.
In summary, genes involved in MMR and DNA damage response pathways are important for the maintenance of the normal endometrium, and inactivation of these genes may contribute to the initiation and progression of EC with MSI.
| ACKNOWLEDGMENTS |
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| FOOTNOTES |
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1 Supported by a grant from Concern Foundation (to B. B.). ![]()
2 To whom requests for reprints should be addressed, at Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, 600 University Avenue, Toronto, Ontario, M5G 1X5 Canada. Phone: (416) 586-5175; Fax: (416) 586-8844; E-mail: bapat{at}mshri.on.ca ![]()
3 The abbreviations used are: EC, endometrial cancer; MSI, microsatellite instability; MMR, mismatch repair; MSI-H, MSI-high; MSS, microsatellite stable; SH, simple hyperplasia; AH, atypical hyperplasia. ![]()
Received 3/18/02. Accepted 5/ 9/02.
| REFERENCES |
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