title: Externalization of saw-tooth architecture in small serrated polyps implies the presence of methylation of IGFBP7.
abstract: BACKGROUND
  Serrated polyps have been considered to be precursors of colorectal cancer with microsatellite instability. However, the biological and/or morphological changes which occur during the course of serrated polyp to cancer remain to be elucidated.
  
  
  METHODS
  Twenty-eight colorectal serrated polyps including five mixed polyps (MP) from 20 patients were observed by chromoendoscopy with magnification, and subsequently resected endoscopically. The presence of mutations in two genes (K-ras and BRAF) and the methylation status of six genes (MLH1-A, MLH1-C, ESR1, P16, SOCS1, and IGFBP7) were examined.
  
  
  RESULTS
  The 28 polyps included 32 histological serrated lesions (22 sessile serrated adenomas [SSA], six hyperplastic polyps [HP], and four traditional serrated adenoma [TSA]-like lesions). BRAF mutation was frequently observed in SSAs (19/22), while K-ras mutation was dominant in HPs (5/6). The externalization of saw-tooth architecture in serrated polyps was endoscopically observed more frequently in those with high levels of IGFBP7 methylation (P = 0.03). Moreover, the endoscopic finding was observed in five of six small serrated lesions (<10 mm) which contained both BRAF mutation and high levels of IGFBP7 methylation. TSA-like lesions in small MPs demonstrated the endoscopic finding with no or little MLH1 methylation, while the counterparts in the mixed polyps had high levels of MLH1 methylation with relatively low levels of IGFBP7 methylation.
  
  
  CONCLUSIONS
  Our data suggests two distinct pathways may be involved in the early stages of the serrated pathway: one where MLH1 is primarily methylated, and a second where methylated IGFBP7 is associated with an externalization of saw-tooth architecture.
authors.affiliation: Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-Cho, Kita-Ku, Okayama 700-8558, Japan. eisukekaji@yahoo.co.jp
authors.forename: Eisuke
authors.initials: E
authors.lastname: Kaji
authors.forename: Toshio
authors.initials: T
authors.lastname: Uraoka
authors.forename: Jun
authors.initials: J
authors.lastname: Kato
authors.forename: Sakiko
authors.initials: S
authors.lastname: Hiraoka
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Suzuki
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Akita
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Saito
authors.forename: Takehiro
authors.initials: T
authors.lastname: Tanaka
authors.forename: Nobuya
authors.initials: N
authors.lastname: Ohara
authors.forename: Kazuhide
authors.initials: K
authors.lastname: Yamamoto
mesh_terms: D048868:Adaptor Proteins, Signal Transducing / Q000235:genetics*; D000236:Adenoma / Q000235:genetics / Q000473:pathology; D000368:Aged; D003111:Colonic Polyps / Q000235:genetics / Q000473:pathology; D015179:Colorectal Neoplasms / Q000235:genetics / Q000473:pathology; D019175:DNA Methylation; D016099:Endoscopy, Gastrointestinal / Q000379:methods; D047628:Estrogen Receptor alpha / Q000235:genetics; D005260:Female; D019942:Genes, p16; D011905:Genes, ras; D055106:Genome-Wide Association Study; D006801:Humans; D018969:Insulin-Like Growth Factor Binding Proteins / Q000235:genetics*; D008297:Male; D053842:Microsatellite Instability; D008875:Middle Aged; D000070957:MutL Protein Homolog 1; D009154:Mutation; D009687:Nuclear Proteins / Q000235:genetics*; D048493:Proto-Oncogene Proteins B-raf / Q000235:genetics*; D000071222:Suppressor of Cytokine Signaling 1 Protein; D050826:Suppressor of Cytokine Signaling Proteins
chemical_list: D048868:Adaptor Proteins, Signal Transducing; C506487:ESR1 protein, human; D047628:Estrogen Receptor alpha; D018969:Insulin-Like Growth Factor Binding Proteins; C501486:MLH1 protein, human; D009687:Nuclear Proteins; C108944:SOCS1 protein, human; D000071222:Suppressor of Cytokine Signaling 1 Protein; D050826:Suppressor of Cytokine Signaling Proteins; C102529:insulin-like growth factor binding protein-related protein 1; C482119:BRAF protein, human; D048493:Proto-Oncogene Proteins B-raf; D000070957:MutL Protein Homolog 1