Inactivating mutation in the prostaglandin transporter gene, SLCO2A1, associated with familial digital clubbing, colon neoplasia, and NSAID resistance.
HPGDand SLCO2A1 genes encode components of the prostaglandin catabolic pathway, with HPGD encoding the degradative enzyme 15-hydroxyprostaglandin dehydrogenase (15-PGDH), and SLCO2A1 encoding the prostaglandin transporter PGT that brings substrate to 15-PGDH. HPGD-null mice show increased prostaglandin E2 (PGE2), marked susceptibility to developing colon tumors, and resistance to colon tumor prevention by nonsteroidal anti-inflammatory drugs (NSAID). But in humans, HPGD and SLCO2A1 mutations have only been associated with familial digital clubbing. We, here, characterize a family with digital clubbing and early-onset colon neoplasia. Whole-exome sequencing identified a heterozygous nonsense mutation (G104X) in the SLCO2A1 gene segregating in 3 males with digital clubbing. Two of these males further demonstrated notably early-onset colon neoplasia, 1 with an early-onset colon cancer and another with an early-onset sessile serrated colon adenoma. Two females also carried the mutation, and both these women developed sessile serrated colon adenomas without any digital clubbing. Males with clubbing also showed marked elevations in the levels of urinary prostaglandin E2 metabolite, PGE-M, whereas, female mutation carriers were in the normal range. Furthermore, in the male proband, urinary PGE-M remained markedly elevated during NSAID treatment with either celecoxib or sulindac. Thus, in this human kindred, a null SLCO2A1 allele mimics the phenotype of the related HPGD-null mouse, with increased prostaglandin levels that cannot be normalized by NSAID therapy, plus with increased colon neoplasia. The development of early-onset colon neoplasia in male and female human SLCO2A1 mutation carriers suggests that disordered prostaglandin catabolism can mediate inherited susceptibility to colon neoplasia in man.
Division of General Medical Sciences-Oncology, Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine;
Kishore
K
Guda
Division of Hematology and Oncology, Departments of.
Stephen P
SP
Fink
Division of Clinical Pharmacology.
Ginger L
GL
Milne
Genetics and Genome Sciences and.
Neil
N
Molyneaux
Division of Hematology and Oncology, Departments of.
Lakshmeswari
L
Ravi
Genetics and Genome Sciences and.
Susan M
SM
Lewis
Department of Medicine, Weill Cornell Medical College, New York, New York; and.
Andrew J
AJ
Dannenberg
Arthritis and Clinical Immunology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma.
Courtney G
CG
Montgomery
Pathology.
Shulin
S
Zhang
Pathology, Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine; University Hospitals Case Medical Center, Cleveland, Ohio;
Joseph
J
Willis
Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, Tennessee;
Georgia L
GL
Wiesner
Division of Hematology and Oncology, Departments of Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine; University Hospitals Case Medical Center, Cleveland, Ohio; sxm10@cwru.edu.
Sanford D
SD
Markowitz
D000328:Adult; D000465:Algorithms; D000483:Alleles; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D003110:Colonic Neoplasms / Q000235:genetics*; D015232:Dinoprostone / Q000378:metabolism / Q000652:urine; D004351:Drug Resistance; D059472:Exome; D005260:Female; D020022:Genetic Predisposition to Disease; D014644:Genetic Variation; D006579:Heterozygote; D006801:Humans; D008297:Male; D008875:Middle Aged; D009154:Mutation; D027361:Organic Anion Transporters / Q000235:genetics* / Q000378:metabolism; D010004:Osteoarthropathy, Primary Hypertrophic / Q000235:genetics*; D010375:Pedigree; D010641:Phenotype; D011453:Prostaglandins / Q000378:metabolism; D017422:Sequence Analysis, DNA
D000894:Anti-Inflammatory Agents, Non-Steroidal; D027361:Organic Anion Transporters; D011453:Prostaglandins; C503526:SLCO2A1 protein, human; D015232:Dinoprostone