Abstract
Background Colorectal carcinoma (CRC) is the most common gastrointestinal malignancy in the world, and there are suggestions of a particularly high incidence in the Middle East, including those of African origin. Defects in DNA mismatch repair (MMR) systems are involved in the carcinogenesis of both sporadic and inherited human cancers. We assessed colonic cancers in an attempt to identify tumors with DNA MMR deficiency and microsatellite instability (MSI). Additionally, we tested the ability of cell cycle regulator p16 that effects cell proliferation and can be abrogated by hypermethylation of the promoter region. Methods We reviewed the charts of 756 patients who were referred to the Oman major colonoscopy unit of the Sultan Qaboos University Hospital and Royal Hospital from the years 2000 to 2004. Colon cancer tissue was assayed using immunohistochemistry for expression of hMLH1 and hMSH2, and a panel of five pairs of microsatellite primers (NR21, NR22, NR24, BAT25, and BAT26) for MSI-H analysis and additional dinucleotide markers (D17S250, D5S346, and D2S123) used for MSI-L. The expression status of MMR genes and MSI was correlated with cancer stage, location, and histology. A total of 49 tumors were analyzed for histopathology, MSI, and hMLH1/hMSH2 protein expression analysis. The methylation status of the p16 promoter was determined by methylation-specific polymerase chain reaction (PCR). Results The mean age for the carcinomas was 52.2 years and 53% of the patients were male. The majority of the tumors were left-sided. The information currently available indicates that there is an incidence of 4.7% colon cancer (49/1036) and 12.1% (126/1290) colon adenoma among the cases who underwent colonoscopy at these centers. The rate of MSI-H was 12.2% (n = 6), which appears to be the same as previously reported in literature. Eight of 49 tumors (16.3%) were MMR defective by IHC. Defects in the mismatch repair genes hMLH1 and hMSH2 were found in four (66.7%) and two (33.3%) of CRCs MSI-H cases, respectively. Defects in hMLH1 expression in tumors were commonly associated with moderate differentiation. The p16 promoter was methylated in 4% of tumors. Conclusion This is the first genetic study of CRC in this region of the world to demonstrate the incidence of MSI, p16 methylation, and hMLH1 and MSH2 expression in the Omani population. In addition, a relatively high frequency of CRC in younger age groups was noted, which is an important observation. The left-sided preponderance of MMR defective tumors was mostly associated with hMLH1, and with possible loss of hMSH2 expression, an observation that differs from studies on other populations. In conclusion, although the overall rate of CRC is unknown in this region, the frequency of MSI in CRC in this region appears to be the same as in Caucasians in the USA.
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Abbreviations
- MSI-H:
-
Microsatellite instability-high
- MSS:
-
Microsatellite stable
- MSI-L:
-
Microsatellite instability-low
- MMR:
-
Mismatch repair
- HNPCC:
-
Hereditary nonpolyposis colorectal cancer
- TNM:
-
Tumor nodes metastasis
- 5FU:
-
5-Fluorouracil
References
Luis J, Rowold D, Regueiro M, Caeiro B, Cinnioglu C, Roseman C, Underhill P, Cavalli-Sforza L, Herrera R (2004) The Levant versus the Horn of Africa: evidence for bidirectional corridors of human migrations. Am J Hum Genet 74:532–544
Teebi A (1997) Introductory chapter. New York and Oxford, Oxford Monographs on Medical Genetics
Teebi A, Farag T (1997) Genetic disorders among the bedouins. New York and Oxford, Oxford Monographs on Medical Genetics
Jemal A, Thomas A, Murray T, Thun M (2002) Cancer statistics. CA Cancer J Clin 52:23–47
Mohammed A, Al-Lawati J, Jaffar M, Chandrashekar S, Al-Siyabi N, Al-Dahli Y (2002) Cancer incidence in Oman. In Ministry of Health (ed)
Moosa ABM (2003) Annual health report. In, Ministry of Health in Oman:7
Troisi RJ, Freedman AN, Devesa SS (1999) Incidence of colorectal carcinoma in the US: an update of trends by gender, race, age, subsite, and stage, 1975–1994. Cancer 85:1670–1676
Hsu HS, Wen CK, Tang YA, Lin RK, Li WY, Hsu WH, Wang YC (2005) Promoter hypermethylation is the predominant mechanism in hMLH1 and hMSH2 deregulation and is a poor prognostic factor in nonsmoking lung cancer. Clin Cancer Res 11:5410–5416
Maekawa M, Sugano K, Ushiama M, Fukayama N, Nomoto K, Kashiwabara H, Fujita S, Kakizoe T (2001) Heterogeneity of DNA methylation status analyzed by bisulfite-PCR-SSCP and correlation with clinico-pathological characteristics in colorectal cancer. Clin Chem Lab Med 39:121–128
Dietmaier W, Wallinger S, Bocker T, Kullmann F, Fishel R, Ruschoff J (1997) Diagnostic microsatellite instability: definition and correlation with mismatch repair protein expression. Cancer Res 57:4749–4756
Thibodeau SN, French AJ, Cunningham JM, Tester D, Burgart LJ, Roche PC, McDonnell SK, Schaid DJ, Vockley CW, Michels VV, Farr GH Jr, O’Connell MJ (1998) Microsatellite instability in colorectal cancer: different mutator phenotypes and the principal involvement of hMLH1. Cancer Res 58:1713–1718
Lindor N, Burgart L, Leontovich O, Goldberg R, Cunningham J, Sargent D, Walsh-Vockley C, Petersen G, Walsh M, Leggett B, Young J, Barker M, Jass J, Hopper J, Gallinger S, Bapat B, Redston M, Thibodeau S (2002) Immunohistochemistry versus microsatellite instability testing in phenotyping colorectal tumors. J Clin Oncol 20:1043–1048
Kane MF, Loda M, Gaida GM, Lipman J, Mishra R, Goldman H, Jessup JM, Kolodner R (1997) Methylation of the hMLH1 promoter correlates with lack of expression of hMLH1 in sporadic colon tumors and mismatch repair-defective human tumor cell lines. Cancer Res 57:808–811
Cunningham JM, Christensen ER, Tester DJ, Kim CY, Roche PC, Burgart LJ, Thibodeau SN (1998) Hypermethylation of the hMLH1 promoter in colon cancer with microsatellite instability. Cancer Res 58:3455–3460
Ashktorab H, Smoot DT, Farzanmehr H, Fidelia-Lambert M, Momen B, Hylind L, Iacosozio-Dononue C, Carethers MJ, Goel A, Boland CR, Giardiello FM (2005) Clinicopathological features and msi in colorectal cancers from African Americans. Int J Cancer 116(6):914–919
Ashktorab H, Smoot DT, Carethers JM, Rahmanian M, Kittles R, Vosganian G, Doura M, Nidhiry E, Naab T, Momen B, Shakhani S, Giardiello FM (2003) High incidence of microsatellite instability in colorectal cancer from African Americans. Clin Cancer Res 9:1112–1117
Suraweera N, Duval A, Reperant M, Vaury C, Furlan D, Leroy K, Seruca R, Iacopetta B, Hamelin R (2002) Evaluation of tumor microsatellite instability using five quasimonomorphic mononucleotide repeats and pentaplex PCR. Gastroenterology 123:1804–1811
Boland CR, Thibodeau SN, Hamilton SR, Sidransky D, Eshleman JR, Burt RW, Meltzer SJ, Rodriguez-Bigas MA, Fodde R, Ranzani GN, Srivastava S (1998) A National Cancer Institute Workshop on Microsatellite Instability for cancer detection and familial predisposition: development of international criteria for the determination of microsatellite instability in colorectal cancer. Cancer Res 58:5248–5257
Wiggers T, Arends JW, Schutte B, Volovics L, Bosman FT (1988) A multivariate analysis of pathologic prognostic indicators in large bowel cancer. Cancer 61:386–395
Cravo ML, Fidalgo PO, Lage PA, Albuquerque CM, Chaves PP, Claro I, Gomes T, Gaspar C, Soares JO, Nobre-Leitao C (1999) Validation and simplification of Bethesda guidelines for identifying apparently sporadic forms of colorectal carcinoma with microsatellite instability. Cancer 85:779–785
Carethers JM, Chauhan DP, Fink D, Nebel S, Bresalier RS, Howell SB, Boland CR (1999) Mismatch repair proficiency and in vitro response to 5-fluorouracil. Gastroenterology 117:123–131
Kim H, Jen J, Vogelstein B, Hamilton SR (1994) Clinical and pathological characteristics of sporadic colorectal carcinomas with DNA replication errors in microsatellite sequences. Am J Pathol 145:148–156
Lothe RA, Peltomaki P, Meling GI, Aaltonen LA, Nystrom-Lahti M, Pylkkanen L, Heimdal K, Andersen TI, Moller P, Rognum TO et al (1993) Genomic instability in colorectal cancer: relationship to clinicopathological variables and family history. Cancer Res 53:5849–5852
Risio M, Reato G, di Celle PF, Fizzotti M, Rossini FP, Foa R (1996) Microsatellite instability is associated with the histological features of the tumor in nonfamilial colorectal cancer. Cancer Res 56:5470–5474
Carethers JM, Smith EJ, Behling CA, Nguyen L, Tajima A, Doctolero RT, Cabrera BL, Goel A, Arnold CA, Miyai K, Boland CR (2004) Use of 5-fluorouracil and survival in patients with microsatellite-unstable colorectal cancer. Gastroenterology 126:394–401
Aaltonen LA, Peltomaki P, Leach FS, Sistonen P, Pylkkanen L, Mecklin JP, Jarvinen H, Powell SM, Jen J, Hamilton SR et al (1993) Clues to the pathogenesis of familial colorectal cancer. Science 260:812–816
Gryfe R, Gallinger S (2001) Microsatellite instability, mismatch repair deficiency, and colorectal cancer. Surgery 130:17–20
Aaltonen LA, Salovaara R, Kristo P, Canzian F, Hemminki A, Peltomaki P, Chadwick RB, Kaariainen H, Eskelinen M, Jarvinen H, Mecklin JP, de la Chapelle A (1998) Incidence of hereditary nonpolyposis colorectal cancer and the feasibility of molecular screening for the disease. N Engl J Med 338:1481–1487
Jass JR (2007) Classification of colorectal cancer based on correlation of clinical, morphological and molecular features. Histopathology 50:113–130
Nakagawa H, Nuovo GJ, Zervos EE, Martin EW Jr, Salovaara R, Aaltonen LA, de la Chapelle A (2001) Age-related hypermethylation of the 5′ region of MLH1 in normal colonic mucosa is associated with microsatellite-unstable colorectal cancer development. Cancer Res 61:6991–6995
Breivik J, Lothe RA, Meling GI, Rognum TO, Borresen-Dale AL, Gaudernack G (1997) Different genetic pathways to proximal and distal colorectal cancer influenced by sex-related factors. Int J Cancer 74:664–669
DeCosse JJ, Ngoi SS, Jacobson JS, Cennerazzo WJ (1993) Gender and colorectal cancer. Eur J Cancer Prev 2:105–115
Ward R, Meagher A, Tomlinson I, O’Connor T, Norrie M, Wu R, Hawkins N (2001) Microsatellite instability and the clinicopathological features of sporadic colorectal cancer. Gut 48:821–829
Westra JL, Schaapveld M, Hollema H, de Boer JP, Kraak MM, de Jong D, ter Elst A, Mulder NH, Buys CH, Hofstra RM, Plukker JT (2005) Determination of TP53 mutation is more relevant than microsatellite instability status for the prediction of disease-free survival in adjuvant-treated stage III colon cancer patients. J Clin Oncol 23:5635–5643
Niv Y (2005) Biologic behavior of microsatellite-unstable colorectal cancer and treatment with 5-fluorouracil. Isr Med Assoc J 7:520–524
Fleisher AS, Esteller M, Wang S, Tamura G, Suzuki H, Yin J, Zou TT, Abraham JM, Kong D, Smolinski KN, Shi YQ, Rhyu MG, Powell SM, James SP, Wilson KT, Herman JG, Meltzer SJ (1999) Hypermethylation of the hMLH1 gene promoter in human gastric cancers with microsatellite instability. Cancer Res 59:1090–1095
Arnold CN, Goel A, Boland CR (2003) Role of hMLH1 promoter hypermethylation in drug resistance to 5-fluorouracil in colorectal cancer cell lines. Int J Cancer 106:66–73
Samowitz WS, Albertsen H, Herrick J, Levin TR, Sweeney C, Murtaugh MA, Wolff RK, Slattery ML (2005) Evaluation of a large, population-based sample supports a CpG island methylator phenotype in colon cancer. Gastroenterology 129:837–845
Lubomierski N, Plotz G, Wormek M, Engels K, Kriener S, Trojan J, Jungling B, Zeuzem S, Raedle J (2005) BRAF mutations in colorectal carcinoma suggest two entities of microsatellite-unstable tumors. Cancer 104:952–961
Deng G, Bell I, Crawley S, Gum J, Terdiman JP, Allen BA, Truta B, Sleisenger MH, Kim YS (2004) BRAF mutation is frequently present in sporadic colorectal cancer with methylated hMLH1, but not in hereditary nonpolyposis colorectal cancer. Clin Cancer Res 10:191–195
Nagasaka T, Sasamoto H, Notohara K, Cullings HM, Takeda M, Kimura K, Kambara T, MacPhee DG, Young J, Leggett BA, Jass JR, Tanaka N, Matsubara N (2004) Colorectal cancer with mutation in BRAF, KRAS, and wild-type with respect to both oncogenes showing different patterns of DNA methylation. J Clin Oncol 22:4584–4594
Acknowledgements
This work was supported by Grant #CA102681, funded by the National Cancer Institute, NIH and Marcia Johnson award from Howard University. The authors would like to thank Howard University and the Fulbright program for their support of this research project, and the College of Medicine, Health Sciences of Sultan Qaboos University and Royal Hospital in Muscat for access to patient materials and records, and provision of the laboratory facility. Authors’ contributions: HA, SR, and MA designed the project; HB, KA, RA, and MA performed the MSI, IHC, and validation experiments; SSG performed the statistical analysis and consensus sequence matching; AD and MA performed the pathology section of the study for the stage of the tumor end microdissection; HA, DTS, and MK reviewed and contributed to the discussion of the genetic data. All authors contributed to the writing of the manuscript and have read and approved its revised and final drafts.
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Ashktorab, H., Brim, H., Al-Riyami, M. et al. Sporadic Colon Cancer: Mismatch Repair Immunohistochemistry and Microsatellite Instability in Omani Subjects. Dig Dis Sci 53, 2723–2731 (2008). https://doi.org/10.1007/s10620-007-0189-3
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DOI: https://doi.org/10.1007/s10620-007-0189-3