title: High thymidylate synthase expression in colorectal cancer with microsatellite instability: implications for chemotherapeutic strategies.
abstract: Colon cancers displaying microsatellite instability (MSI) are clinically less aggressive. Based on in vitro studies and recent clinical data, cancers displaying MSI do not respond to 5-fluorouracil (5-FU). The reasons why MSI tumors are clinically less aggressive and do not respond to 5-FU-based therapies have not been fully elucidated.
  
  
  OBJECTIVE
  We investigated biomolecular markers in an attempt to explain the different clinical behavior and chemotherapeutic responses of MSI and non-MSI colon cancers.
  
  
  METHODS
  One hundred ninety-two sporadic colon cancers were tested for MSI with five mononucleotide markers and methylation of the hMLH1 promoter. Slides were stained for thymidylate synthase (TS), p53, MDM2, p21(WAF1/CIP1), beta-catenin, vascular endothelial growth factor, hMLH1, hMSH2, and hMSH6. Tumors were regarded as having wild-type, functional p53 (Fp53) if reduced expression of p53 and positive MDM2 and p21(WAF1/CIP1) expressions were found.
  
  
  RESULTS
  Of the cases, 12.5% were MSI-H (at least two markers mutated). Of MSI-H cases, 83.3% were characterized by a complete loss of at least one of the mismatch repair proteins, in particular loss of hMLH1 by promoter hypermethylation. MSI-H colon cancers showed higher expression of TS compared with MSS (no mutated markers)/MSI-L (one mutated marker) colon cancers (66.6% for MSI-H versus 14.8% MSS/MSI-L; P < 0.0001); 20.8% of MSI-H cases showed high expression of the vascular endothelial growth factor, compared with 45.8% MSS/MSI-L colon cancers (P = 0.0005); 45.8% MSI-H cases had Fp53 compared 11.9% MSS/MSI-L cases (P < 0.0001).
  
  
  CONCLUSIONS
  About 12% of colon cancers display MSI mostly due to lack of hMLH1 resulting from promoter hypermethylation. These tumors have high expression of TS and retain fully functional p53 system. Thus, these data suggest why sporadic hMLH1-defective colon cancers often do not respond to 5-FU.
authors.affiliation: Department of Internal Medicine and Gastroenterology, University of Bologna, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Ricciardiello
authors.forename: Claudio
authors.initials: C
authors.lastname: Ceccarelli
authors.forename: Graziella
authors.initials: G
authors.lastname: Angiolini
authors.forename: Milena
authors.initials: M
authors.lastname: Pariali
authors.forename: Pasquale
authors.initials: P
authors.lastname: Chieco
authors.forename: Paola
authors.initials: P
authors.lastname: Paterini
authors.forename: Guido
authors.initials: G
authors.lastname: Biasco
authors.forename: Giuseppe N
authors.initials: GN
authors.lastname: Martinelli
authors.forename: Enrico
authors.initials: E
authors.lastname: Roda
authors.forename: Franco
authors.initials: F
authors.lastname: Bazzoli
mesh_terms: D048868:Adaptor Proteins, Signal Transducing; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002352:Carrier Proteins; D018797:Cell Cycle Proteins / Q000096:biosynthesis; D015179:Colorectal Neoplasms / Q000235:genetics / Q000378:metabolism / Q000473:pathology*; D050759:Cyclin-Dependent Kinase Inhibitor p21; D003598:Cytoskeletal Proteins / Q000096:biosynthesis; D019175:DNA Methylation; D004268:DNA-Binding Proteins / Q000096:biosynthesis; D004358:Drug Therapy / Q000379:methods; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D018895:Microsatellite Repeats / Q000235:genetics; D008875:Middle Aged; D000070957:MutL Protein Homolog 1; D051718:MutS Homolog 2 Protein; D009363:Neoplasm Proteins / Q000096:biosynthesis / Q000235:genetics; D009687:Nuclear Proteins / Q000096:biosynthesis / Q000235:genetics; D011401:Promoter Regions, Genetic / Q000235:genetics; D011518:Proto-Oncogene Proteins / Q000096:biosynthesis; D051736:Proto-Oncogene Proteins c-mdm2; D013940:Thymidylate Synthase / Q000096:biosynthesis*; D015534:Trans-Activators / Q000096:biosynthesis; D016159:Tumor Suppressor Protein p53 / Q000096:biosynthesis; D042461:Vascular Endothelial Growth Factor A / Q000096:biosynthesis; D051176:beta Catenin
chemical_list: D048868:Adaptor Proteins, Signal Transducing; C493956:CDKN1A protein, human; C495270:CTNNB1 protein, human; D002352:Carrier Proteins; D018797:Cell Cycle Proteins; D050759:Cyclin-Dependent Kinase Inhibitor p21; D003598:Cytoskeletal Proteins; D004268:DNA-Binding Proteins; C094443:G-T mismatch-binding protein; C501486:MLH1 protein, human; D009363:Neoplasm Proteins; D009687:Nuclear Proteins; D011518:Proto-Oncogene Proteins; D015534:Trans-Activators; D016159:Tumor Suppressor Protein p53; D042461:Vascular Endothelial Growth Factor A; D051176:beta Catenin; D013940:Thymidylate Synthase; C497206:MDM2 protein, human; D051736:Proto-Oncogene Proteins c-mdm2; C497172:MSH2 protein, human; D000070957:MutL Protein Homolog 1; D051718:MutS Homolog 2 Protein