A genetic model for colorectal tumorigenesis

Because most colorectal carcinomas appear to arise from adenomas, studies of different stages of colorectal neoplasia may shed light on the genetic alterations involved in tumor progression. We looked for four genetic alterations (ras-gene mutations and allelic deletions of chromosomes 5, 17, and 18) in 172 colorectal-tumor specimens representing various stages of neoplastic development. The specimens consisted of 40 predominantly early-stage adenomas from 7 patients with familial adenomatous polyposis, 40 adenomas (19 without associated foci of carcinoma and 21 with such foci) from 33 patients without familial polyposis, and 92 carcinomas resected from 89 patients. We found that ras-gene mutations occurred in 58 percent of adenomas larger than 1 cm and in 47 percent of carcinomas. However, ras mutations were found in only 9 percent of adenomas under 1 cm in size. Sequences on chromosome 5 that are linked to the gene for familial adenomatous polyposis were not lost in adenomas from the patients with polyposis but were lost in 29 to 35 percent of adenomas and carcinomas, respectively, from other patients. A specific region of chromosome 18 was deleted frequently in carcinomas (73 percent) and in advanced adenomas (47 percent) but only occasionally in earlier-stage adenomas (11 to 13 percent). Chromosome 17p sequences were usually lost only in carcinomas (75 percent). The four molecular alterations accumulated in a fashion that paralleled the clinical progression of tumors. These results are consistent with a model of colorectal tumorigenesis in which the steps required for the development of cancer often involve the mutational activation of an oncogene coupled with the loss of several genes that normally suppress tumorigenesis.

Genetic alterations during colorectal-tumor development.

Uncontrolled cell proliferation is the hallmark of cancer, and tumor cells have typically acquired damage to genes that directly regulate their cell cycles. Genetic alterations affecting p16(INK4a) and cyclin D1, proteins that govern phosphorylation of the retinoblastoma protein (RB) and control exit from the G1 phase of the cell cycle, are so frequent in human cancers that inactivation of this pathway may well be necessary for tumor development. Like the tumor suppressor protein p53, components of this "RB pathway," although not essential for the cell cycle per se, may participate in checkpoint functions that regulate homeostatic tissue renewal throughout life.

http://science.sciencemag.org/content/sci/274/5293/1672.full.pdf

Cancer Cell Cycles

Patterns of DNA methylation and chromatin structure are profoundly altered in neoplasia and include genome-wide losses of, and regional gains in, DNA methylation. The recent explosion in our knowledge of how chromatin organization modulates gene transcription has further highlighted the importance of epigenetic mechanisms in the initiation and progression of human cancer. These epigenetic changes -- in particular, aberrant promoter hypermethylation that is associated with inappropriate gene silencing -- affect virtually every step in tumour progression. In this review, we discuss these epigenetic events and the molecular alterations that might cause them and/or underlie altered gene expression in cancer.

The fundamental role of epigenetic events in cancer

Lessons from Hereditary Colorectal Cancer

A consideration of the world-wide incidences of childhood cancer and of hereditary subgroups leads to the conclusion that two successive mutations can initiate cancer cells and that such cells usually proceed to develop into detectable cancers in a period of time which is short compared with the time required for most adult cancers. Environmental carcinogens could hypothetically increase the rates at which these mutations occur, but they probably, in fact, contribute little to the incidences. Certain exceptions, notably leukemia and lymphoma, are noteworthy, and a viral origin for them has been widely hypothesized. If most solid tumors of childhood are indeed correctly attributable to mutations in germ and/or somatic cells, then the prospect for the prevention of childhood cancer becomes very dim. In fact, the incidence of the germinal forms may increase as treatment improves (18). In theory, one might be able to identify individuals harboring cancer genes germinally and even to identify them prenatally. But even if the burden of cancer attributable to the hereditary subgroups were elimanted, there would still remain the larger nonhereditary group resulting from somatic mutations. If this hypothesis is correct, then childhood cancer cannot be prevented. With this conclusion goes the admonition, however, that environmental mutagens might significantly increase the burden of childhood cancer. One such mutagen, therapeutic radiation, is known to increase the prospect that second tumors will occur in patients who carry a germinal cancer mutation. The major effort to reduce the incidence of childhood cancer by prevention should be spent in examining the possibility that leukemia and lymphoma are viral in origin. If the arguments presented are correct, then the main effort against childhood cancer must be that of early diagnosis and treatment. I realize that many have already argued for that strategy in the approach to cancer generally, but I now believe that it is particularly relevant to any program against cancer in children.

/pdf/genetics-and-the-etiology-of-childhood-cancer-17b7lkyssy.pdf

Genetics and the etiology of childhood cancer.

Neuroblastoma has a broad spectrum of clinical behavior, ranging from spontaneous regression to dissemination and fatality. The heterogeneity that has long puzzled many investigators has been shown by more recent studies to be closely correlated with various clinical and genetic factors. Tumor cell ploidy is one of the factors; diploid and near-triploid neuroblastomas show poor and excellent clinical outcomes, respectively. We offer a hypothesis that explains how the ploidy state of the tumor plays a fundamental role in this heterogeneity, and why various prognostic factors are correlated with each other. This hypothesis may be applicable to tumors other than neuroblastoma.

Mechanism and relevance of ploidy in neuroblastoma.

We previously concluded, from our analysis of the published data of other investigators, that the yield of germ-line and somatic mutations after exposure to ionizing radiation is parabolically related to the logarithm of the dose-rate at which a given dose is administered. Here we show that other data reveal a similarly parabolic relationship for other ionizing radiation-associated phenomena, namely, genetic recombination, chromosomal translocation, cell inactivation and lethality, and human leukemogenesis. Furthermore, the minima for all effects fall in a relatively narrow range of the dose-rate logarithms. Because the only mechanism common to all of these phenomena is the double-strand break (DSB) in DNA, we refer to our previous analysis of the endogenous production of DSBs, from which we concluded that ≈50 endogenous DSBs occur per cell cycle, although most are repaired without error. Comparison then reveals that their rate of production falls within the range of minima for the several end points pursuant to radiation-induced DSBs. We conclude that the results reflect a physiological principle whereby signals originating from induced DSBs elicit responses of maximal effectiveness when they are produced at a rate near that of the production of endogenous DSBs. We refer to this principle as “signaling resonance.”

https://www.pnas.org/content/pnas/103/47/17874.full.pdf

Radiation dose-rate effects, endogenous DNA damage, and signaling resonance

Germ-line mutations of tumor suppressor genes confer strong predisposition to tumor formation. In the rat, a form of dominantly inherited renal carcinoma (RC) results in multiple chromophobe cell tumors that resemble the human disease, and heterozygous carriers (RC/+) are highly susceptible to environmental agents (radiation and chemical carcinogens), making it a desirable model to study epithelial carcinogenesis. By linkage analysis, the locus of the inherited RC mutation was mapped to rat chromosomal band 10q12, near the protamine locus (logarithm of odds score = 17.96). Renal tumors also showed a loss of heterozygosity at this locus, lending support to the recessive nature of this putative tumor suppressor gene. Our result suggested that the human homolog of the RC gene may reside on human chromosome 16, not known to be altered commonly in human RC.

http://www.pnas.org/content/90/17/8038.full.pdf

Susceptibility to renal carcinoma in the Eker rat involves a tumor suppressor gene on chromosome 10

Both hereditary and environmental factors influence the risk of cancer. Four risk categories, or oncodemes, can exist for a particular kind of cancer, depending upon the presence of neither, one, or both factors: (1) spontaneous, or background; (2) hereditary; (3) environmental; (4) interactive. In the second, mutation imparts a high relative risk, but a generally low attributable risk; in the fourth, the opposite obtains. The second oncodeme contains genes that are also important for the non-hereditary forms of the same cancer. Probably all forms of cancer exist in a dominantly heritable form. Most of the genes are tumor suppressors, although a few are oncogenes or DNA repair genes. The mutations are in most, if not all cases, maintained in a population by an equilibrium between mutation and selection. Most of the cloned genes are expressed widely among tissues, yet there is typically some tumor specificity. Somatic mutations in second alleles at the relevant loci are necessary, but generally not sufficient for carcinogenesis, although they, in some instances, lead to the formation of benign precursor lesions. Further events are necessary for carcinogenesis. This is particularly true for carcinomas. The benign lesions appear to involve an increase in number of long-lived cells that can accumulate other mutations. For some tumors, physiologic events, such as tissue growth at puberty or proliferation of embryonic stem cells, may produce this effect. Mutations of DNA mismatch repair genes underscore the effect that changes in somatic mutation rates can have, especially in the risk for multi-event carcinomas. Conversely, these are the tumors that offer the greatest opportunity for prevention.

Alfred G. Knudson

Papers

Genetics and the etiology of childhood cancer.

Mechanism and relevance of ploidy in neuroblastoma.

Radiation dose-rate effects, endogenous DNA damage, and signaling resonance

Susceptibility to renal carcinoma in the Eker rat involves a tumor suppressor gene on chromosome 10

Hereditary Predisposition to Cancer