MUCDHL est une cadhérine atypique encore peu étudiée. Les données obtenues à ce jour suggèrent que ce gène joue un rôle suppresseur de tumeurs dans l’intestin, notamment par son interaction et son effet inhibiteur sur la β-caténine, et que son expression est fréquemment diminuée dans les cancers colorectaux (CCR). Parallèlement à cette fonction anti-oncogénique, d’autres travaux ont suggéré que MUCDHL est impliquée dans la structuration de la bordure en brosse (BB) intestinale, en contribuant à la formation d’un complexe d’interaction inter-microvillositaire. Notre objectif était de déterminer la fonction et le mode d’action de MUCDHL dans le système digestif. Par la caractérisation détaillée de l’interaction avec la β-caténine, nous avons montré que le mode d’action anti-oncogénique de MUCDHL est plus complexe qu’une simple séquestration membranaire de la β-caténine. De plus, nous avons confirmé le rôle suppresseur de tumeurs de MUCDHL sur une cohorte importante de CCR humains et montré pour la première fois que sa perte amplifie la tumorigenèse intestinale dans un model murin. Par ailleurs, l’étude phénotypique des souris Mucdhl-/- a démontré son importance dans l’homéostasie du système digestif. En effet, l’absence de MUCDHL cause des altérations morphologiques de la BB intestinale, mais également de nombreuses perturbations métaboliques. Ces travaux apportent donc des informations inédites sur la fonction et le mode d’action de MUCDHL dans le système digestif. / MUCDHL is an atypical cadherin that has been poorly studied. The data obtained so far suggest that this gene has tumor suppressive activity in the intestine, namely by its interaction and inhibitory effect on β-catenin, and that its expression is frequently decreased in colorectal cancers (CCR). In parallel to this anti-oncogenic function, other studies have suggested that MUCDHL is involved in the assembly of the intestinal brush border (BB), by contributing to the formation of an inter-microvilli interaction complex. Our objective was to determine the function and mode of action of MUCDHL in the digestive system, Through a detailed characterization of the interaction with β-catenin, we showed that the anti-oncogenic mode of action of MUCDHL is more complex than a simple membrane sequestration of β-catenin. In addition, we confirmed the tumor suppressive function of MUCDHL on a very large cohort of human CCR and showed for the first time that its loss amplifies intestinal tumorigenesis in a murine model. Moreover, the study of the phenotype of Mucdhl-/- mice allowed us to demonstrate the importance of MUCDHL in the homeostasis of the digestive system. Indeed, the absence of MUCDHL causes morphological alterations of the intestinal BB, but also numerous metabolic disturbances. Thus, this work provides new information on the function and mode of action of MUCDHL in the digestive system.

Par sa fréquence et sa gravité, le cancer colorectal (CCR) demeure un problème de santé publique. Notre objectif global est de mieux comprendre les mécanismes impliqués dans l'homéostasie intestinale au travers de Mucdhl, une cadhérine atypique méconnue mais qui semble jouer un rôle très particulier dans l'épithélium intestinal et être impliquée dans les CCR. De manière intéressante, son expression semble fréquemment perdue dans les CCR, tandis que son maintien dans les cellules cancéreuses coliques diminue leur potentiel tumoral.Pour mieux appréhender le mode d'action de Mucdhl, une caractérisation fonctionnelle de son interaction avec β-caténine oncogénique a été réalisée et de nouveaux partenaires ont été identifiés dans les cellules intestinales. Afin de comprendre le rôle de Mucdhl dans la physiologie intestinale, encore inconnu à ce jour, un modèle murin déficient pour Mucdhl a été étudié. L'analyse des conséquences de la perte d'expression de Mucdhl indique qu'il est impliqué dans la structure et le fonctionnement de l'intestin chez la souris, mais également au niveau de processus métaboliques. De plus, cette perte d'expression de Mucdhl augmente la sensibilité des souris au développement de certaines tumeurs intestinales. Ces travaux ont donc permis de générer des informations inédites sur les fonctions physiopathologiques de Mucdhl, une cadhérine atypique encore mal connue, mais potentiellement impliquée dans les CCR. / Because of its frequency and severity, Colorectal Cancer (CRC) remains an important public health issue. Our objective is to understand mechanisms contributing to intestinal homeostasis through Mucdhl, a poorly characterized atypical cadherin that may play a unusual role in the intestinal , epithelium and be implicated in CRC. lnterestingly, its expression seems to be frequently reduced in CRC, while its retention in colon cancer cells decreases their tumorigenic potential.To better apprehend the mode of action of Mucdhl, a functional characterization of its interaction with oncogen,iç β-catenin was performed and new partners have been identified in intestinal cells.To understand the role of Mucdhl in intestinal physiology, mice genetically-invalidated at the Mucdhl locus were studied. Analysis of the consequences of Mucdhl loss of expression indicates that it is involved in the morphology and function of the mouse intestine, but also in metabolic processes. Moreover, Mucdhl loss of expression increases the sensibility of mice to the development of certain intestinal tumors. Thus, we generated new information on the physiopathological functions of Mucdhl, an intriguing atypical cadherin potentially involved in CRC.

La chimiorésistance est un enjeu majeur dans la prise en charge des patients atteints de cancers digestifs et peut se manifester par l’efflux de molécules cytotoxiques via la surexpression des transporteurs ABC. Le facteur de transcription CDX2 est un régulateur important de l’identité intestinale et agit comme gène suppresseur de tumeur dans le côlon. Il pourrait être impliqué dans des phénomènes de chimiorésistance des cancers colorectaux (CCR) car le transporteur MDR1/ABCB1 correspond à un de ses gènes cibles. Nous avons confirmé le rôle de CDX2 dans la chimiorésistance des CCR. Nous avons montré par une approche translationnelle, que la surexpression de CDX2 était impliquée dans la résistance au 5-fluorouracile (5-FU) dans les CCR. Le transporteur du 5-FU ABCC11 a été identifié comme gène cible de CDX2 dont l’activité contribue à la résistance au 5-FU des cellules cancéreuses coliques. L’expression d’ABCC11 corrèle avec celle de CDX2 dans les CCR humains mais également avec celle de la DYPD, enzyme impliquée dans le catabolisme du 5-FU. Cette étude montre pour la première fois que CDX2 contribue à la chimiorésistance au 5-FU en impliquant des mécanismes régulant son métabolisme. / Chemoresistance represents a major drawback in digestive cancers’ management and may be achieved particularly through active efflux of the drug through overexpression of ABC transporters The transcription factor CDX2 is a master regulator of intestinal identity that acts as a tumor suppressor in the colon and may be important for drug resistance in colorectal cancer (CRC) as MDR1/ABCB1 was recently identified as one of its target genes. Here, we confirmed the role of CDX2 in the chemoresistance of CRC. We showed through a translational approach that CDX2 overexpression is implicated in 5-fluorouracil (5-FU) chemoresistance in CRC and described the molecular mechanisms implicated in this finding. We identified the 5-FU transporter ABCC11 as a new transcriptional target of CDX2 whose activity contributes to the 5-FU-chemoresistance of colon cancer cells. Remarkably, CDX2 expression correlates with the expression of ABCC11 in human colon tumors, but also with the one of the DPYD, enzyme involved in the 5-FU break down. Thus, our study links for the first time CDX2 to the 5-FU metabolism and provides a molecular mechanism for its impact on 5-FU-based chemotherapy.

Prior work by our research group showed that the total Western diet (TWD), a rodent diet which models the typical American diet, promoted the development of colon tumors when fed to mice. Other researchers previously showed that vancomycin, an antibiotic that changes the gut microbiome composition, causes differential changes in the severity of colon inflammation and CRC. Our goal was to determine the combined effects of feeding the TWD and vancomycin treatment on colitis and CRC, and if these factors interact. We hypothesized that vancomycin treatment would mitigate colitis and CRC in mice fed the TWD. To this end, mice were fed either a healthy diet or the TWD. Mice were also given either vancomycin in their drinking water, or plain water. Colon inflammation and tumor development was induced in mice by treating them with a gut irritant and a chemical carcinogen. Contrary to our hypothesis, mice fed the TWD and treated with vancomycin experienced more severe intestinal inflammation and had greater tumor burden compared to mice fed a standard diet. Furthermore, vancomycin treatment decreased the number of bacteria l species present in the fecal microbiome and altered the relative abundance of the taxa that were present. Rather than the diet consumed, vancomycin was the driving force in determining the bacterial community composition. Overall, these results suggest that vancomycin-induced changes to the gut microbiome may be associated with increased development of colon tumors, particularly in the context of a Western dietary pattern.

La Chimiothérapie IntraPéritonnéale (CIP) est utilisée couramment pour traiter le cancer colorectal métastatique. Cependant il n'existe pas de protocole standardisé.Le but de ce projet a été de modéliser cette chimiothérapie in vitro et de comprendre le rôle de l'hypotonie dans ce modèle et son impact sur la mort des cellules cancéreuses.Nous avons déterminé les conditions optimales de traitement sur les cellules cancéreuses coliques humaines HCT116 à savoir une exposition des cellules pendant 30 minutes à 400µM d'oxaliplatine en conditions hypotoniques (G2.5%) à 37°C. Ces résultats ont été validés sur différentes lignées cancéreuses coliques humaines et murine. Nous avons également montré que ces conditions de traitements étaient également capables d’augmenter la cytotoxixité d’autres dérivés du platine comme le cisplatine et le carboplatine.La mort cellulaire induite par ce traitement en hypotonie est de type apoptotique, Et peut s’expliquer par une augmentation de l’incorporation intracellulaire d'oxaliplatine, en partie due à l'activation et à la trimérisation du transporteur du cuivre CTR1.Le traitement par l'oxaliplatine et le cisplatine (mais pas par le carboplatine) en hypotonie entraine également les stigmates de la mort immunogène, à savoir l'exposition de la calréticuline à la membrane, la libération d'ATP et le relargage d'HMGB1, suggérant que l'hypotonie permettrait d'entrainer la mort immunogène et une réponse du système immunitaire lors de cette modélisation de CIP.Enfin, in vivo nous avons pu mettre en évidence que le traitement de métastases intrapéritonéales de souris Balb/c par une injection intrapéritonéale d'oxaliplatine en hypotonie permettait un ralentissement de l’apparition de nodules tumoraux et une augmentation de la survie des souris.Ainsi, nous avons pu mettre en évidence dans ce travail que l'hypotonie est un des paramètres fondamentaux de la CIP et suggère que son utilisation pourrait permettre d'augmenter l’efficacité de la CIP et de prolonger la survie des patients. / IntraPeritoneal Chemotherapy (IPEC) is commonly used to treat colorectal cancer metastases. However there is no standardized protocol.The aim of this work was to model this chemotherapy in vitro and to understand the role of hypotonic conditions in this model and its impact on cell death.We determined that the optimal treatment parameters on HCT116 human colon cancer cells, were an exposure of the cells for 30 minutes to 400μM of oxaliplatin under hypotonic conditions (G2.5%) at 37 °C. These results have been validated on various human and murine colic cancer cell lines. We have also shown that these treatment conditions are also able to increase the cytotoxicity of other platinum derivatives such as cisplatin and carboplatin.The cell death induced by this treatment in hypotonia is apoptosis, and can be explained by an increase in the intracellular incorporation of oxaliplatin, partly due to the activation and trimerization of the CTR1 copper transporter.Treatment with oxaliplatin and cisplatin (but not carboplatin) in hypotonia also leads to the stigmata of immunogenic death, e.i. exposure of calreticulin at the membrane, release of ATP and HMGB1 in the supernatant, suggesting that hypotonia would entail immunogenic death and an immune system response during this IPEC modeling.Finally, we have been able to demonstrate in vivo that the treatment of intraperitoneal metastases of Balb/c mice by an intraperitoneal injection of oxaliplatin in hypotonia slowed down tumor nodules appearance and increased survival of the mice.Thus, in this work we highlighted that hypotonia is one of the fundamental parameters of IPEC which suggests that its use could make it possible to increase the efficacy of IPEC and maybe to prolong the survival of patients.

This thesis examines the benefits and costs of screening for colorectal cancer in the context of an organised population screening programme. It uses microsimulation modelling to derive an optimally cost-effective screening protocol for various combinations of the available screening tests. ¶ First a mathematical model for the natural history of colorectal cancer is derived, based on analyses of Australian population and hospital-based cancer registries combined with data from published studies. Then a model for population based screening is derived based mainly on data from published screening studies, including the four major published randomised controlled trials of faecal occult blood test (FOBT) screening. These two models are used to simulate the application of a screening programme to the Australian population. The simulations are applied to a period of 40 years following 1990 (the study’s base year), with both costs and benefits discounted back to the base year at an annual rate of 3%.¶ The models are applied to simulating a population screening programme based on FOBT with a colonoscopy follow up of positive tests. This simulation suggests that the optimal application of such a programme would be to offer annual screening to people aged 50 to 84 years. Such a programme would lead to a cumulative fall in years of life lost to colorectal cancer (YLL) of 28.5% at a cost per year of life saved (YLS) of $8,987. These costs and benefits are consistent with those arising from other currently funded health interventions. They are also consistent with the cost per YLS which Australian governments appear willing to pay for health interventions when justified on the basis of cost-effectiveness. The fall in colorectal cancer deaths from this screening programme should be first detectable by a national monitoring system after around three years of screening. However the full benefits from screening would not be realised before around 30 years of screening.¶ These simulations are based on the standard guaiac FOBT, but the results suggest that significant cost-effective gains could be made by using the newer immunochemical FOBT. Further cost-effect gains could be made by offering sigmoidoscopy every five years in addition to annual FOBT.¶ The models are then applied to simulating population screening programmes using colonoscopy and sigmoidoscopy as primary screening tools. Offering colonoscopy every ten years to all people aged from 45 to 85 leads to an overall fall in cumulative YLL of 37.6%, at a cost of $15,585 per YLS. Offering sigmoidoscopy every three years to all people aged 40 to 85 leads to an overall fall in cumulative YLL of 29.1%, at a cost of $4,862 per YLS. Both of these cost and benefit results are also consistent with the cost per YLS which Australian governments appear willing to pay. The fall in deaths with colonoscopy screening would also be detectable after three years of screening but the fall with sigmoidoscopy screening would not be detectable until after six years of screening. Sigmoidoscopy would need around 35 years of screening to reach its potential gains while colonoscopy screening would not reach its full potential during the 40 year screening period.¶ Finally the models are applied to targeting people at higher risk of cancer. The results show that offering colonoscopy every five years to people at higher risk because of a family history of colorectal cancer is a cost-effective addition to the annual FOBT screening programme.¶ An earlier version of chapter two of this thesis has been published as Stevenson CE 1995. Statistical models for cancer screening. Statistical Methods in Medical Research; 4: 19–23.¶ An expanded version of chapter two, along with parts of chapter one, has been published as Stevenson CE 1998. Models of screening. In: Encyclopedia of Biostatistics. Armitage P, Colton T, eds. John Wiley and Sons Ltd, pp 3999–4022.

The number of patients who suffer from colorectal cancer in Thailand has increased during the last three decades as a result of the change to a Westem-style diet. Due to many patients presenting at a late stage and the location of tumours in the rectum, patients have a higher probability of needing a colostomy. This study explores the experiences, coping strategies and the factors that influence coping strategies over a sixmonth period in a group of Thai colorectal cancer patients who have a colostomy. The conceptual framework used in this study was based on the Moos and Schaefer conceptual model of the stress and coping process. A case study methodology was employed to collect both quantitative and qualitative data from eleven participants at three points in time: within one month after the operation to create a colostomy, three months and six months after the operation. Data were collected from structured interviews, which followed the Coping Responses Inventory (CRI), the Ostomy Adjustment Scale (OAS), the Personal Resources Questionnaire 2000 (PRQ 2000), the Life Orientation Test-Revised (LOT-R), and the Functional Assessment Cancer Therapy- Colon (FACT-C). These data provided information on the participants' levels of coping strategies, adjustment to a colostomy, social support, optimism and quality of life. Indepth interviews with open-ended questions provided a deeper understanding of the participants' experiences in relation to their colostomy. Findings from quantitative data showed statistically significant changes in the participants' quality of life over time, particularly in their physical and functional wellbeing. An examination of the coping focus used (approach and avoidance) indicated that participants utilised both approach and avoidance coping at the same time, although approach coping was more common. Changes in the most frequently and the least frequently used coping subtypes at six months after the operation were observed. Correlation tests showed various relationships between the levels of quality of life domains and coping subtypes as time passed. Multidimensional scaling procedures uncovered a consistent pattern of coping which involved 'problem solving' and 'seeking guidance and support'. Six major qualitative themes emerged through content analysis of the in-depth interview data. The themes described how participants' psychological and emotional concerns changed over time; the steady improvements in physical health after the operation; the difficulties of adjusting to life with a stoma; facing up to the reality of the new circumstances; the spiritual aspects of their lives; and the level of social support experienced. Religious beliefs such as the 'Law of Kanna', as well as a variety of religious rituals and other practices such as Buddhist chanting and "making merit" played important roles in coping. The findings from the quantitative and qualitative data were used in a complementary and confirmatory manner to provide a richer understanding of the participants' experiences as they coped with this life changing event. The findings of the study are significant as they provide important indicators for improvements in nursing service, particularly the development of nursing procedures to enhance the psychological aspects of care. In addition, they offer important indicators for improvement of the nursing curriculum and directions for further research in Thai culture and the health care system.

Colorectal cancer (CRC) is a major problem in affluent countries worldwide. In Australia it is the second most commonly diagnosed malignancy with approximately 13,000 new cases diagnosed each year. This disease is also the leading cause of cancer related death in Australia with approximately 4,500 fatalities each year. Epidemiological studies have shown geographical variation in the incidence of disease, with diet considered to be a key contributing factor to CRC risk. In particular, diets high in fibre and low in fat have been demonstrated to reduce the risk of developing CRC. Fibre is heterogeneous in nature and can be categorised into different subtypes. Resistant starch is a component of fibre which remains largely intact throughout the gastrointestinal tract until it reaches the colon. Here it undergoes bacterial fermentation to produce the short chain fatty acids (SCFAs) acetate, propionate and butyrate (BuA). Each of the SCFAs are bioactive in the colon, with the most active being BuA. The beneficial effects of fibre have been linked to BuA’s ability to induce colon cancer cell differentiation, reduce proliferation and initiate apoptosis. Interestingly, in normal cells BuA is utilised as the preferential energy source and has been shown to promote proliferation. With an apparent “paradoxical effect” on normal and cancerous cells BuA has been the subject of much investigation as a potential anticancer agent. Despite numerous studies investigating BuA actions, the exact biological mechanisms remain largely undefined. This thesis explored a possible mechanism for BuA-induced apoptosis and inhibition of proliferation. In 2003, two publications provided evidence that SCFAs, including BuA, were ligands to two members of a previously orphan family of G-protein coupled receptors (GPCRs); GPCR41 and 43. Of the two receptors BuA had the strongest effect on GPCR43. Consequently this thesis investigated the possibility that BuA acts to decrease CRC proliferation and induce apoptosis by binding to and activating GPCR43 on CRC cells. It was hypothesised that GPCR43 acted as a “BuA sensor” on the surface of the cell to mediate the effects of BuA. This experimental work utilised PCR, Q-PCR, measures of apoptosis, proliferation and differentiation and RNAi knockdown. The key areas of investigation included: (1) Determining if GPCR43 was present on a range of CRC cell lines with a cell line to represent adenocarcinoma, carcinoma and metastatic stage of disease. (2) Investigating the expression of GPCR43 with manipulated nutrient media and different levels of cell confluence. (3) Exploring GPCR43 expression in normal and malignant human patient biopsies. (4) Determining if the inhibition of G-protein function using inhibitors influenced BuAinduced changes to apoptosis and proliferation. (5) Using RNAi, investigating the effect that GPCR43 knockdown would have on BuA-induced changes to proliferation and apoptosis. The key findings from this work included: (1) Presence of GPCR43 on some but not all CRC cell lines. (2) Modulation of GPCR43 expression with exposure to BuA and altered glucose concentrations in the media. (3) An influence of G-protein inhibition on BuA-induced apoptosis but not proliferation in some cell lines. (4) GPCR43 knockdown using RNAi indicated that GPCR43 is not exclusively required for BuA to regulate apoptosis and proliferation. The results from this work indicate that GPCR43 is not likely to exclusively mediate BuA’s effects, but opens up new areas of research into the exact role of GPCR43 on CRC cells. / Thesis (Ph.D.) - University of Adelaide, School of Molecular and Biomedical Science, 2008

Due to the costly and technically challenging nature of genetic testing, methods have been developed to target more specifically those who are at increased risk of carrying the Hereditary Non-Polyposis Colorectal Cancer (HNPCC) mutation. HNPCC is an inherited colorectal cancer syndrome. Testing of tumour material (which has previously been removed during surgery) for features of HNPCC has been found to be an effective and economic method of identifying those at higher risk of having a mutation. Only those at higher risk of having a mutation will undergo genetic testing. This practice of “tumour testing” has become widespread. / There is currently no clarity about requirements for consent prior to testing of stored tumour tissue. The person giving consent to tumour testing does not always have an appointment with a genetics service prior to giving consent. This can be contrasted to genetic testing on blood samples where laws and guidelines state that informed consent is required prior to genetic testing and that comprehensive genetic counselling and support should be provided as part of this process. Protocols for genetic testing have been developed as a result of extensive research around the impact and implications of genetic testing. / Consumer opinion and participation through research is an important aspect of health policy and guideline development. Accordingly the purpose of this study was to contribute to such development by gaining insight into the experiences, understandings, decision making processes and opinions of those who had given consent to have their own or their relatives tumour tested. Seventeen people who had given consent for tumour testing either for themselves, or on behalf of a deceased relative were recruited through a Familial Cancer Centre and in-depth interviews conducted. The interviews were transcribed and analysed using thematic analysis. / Some participants had no memory of consenting to tumour testing. Others remembered basic concepts. Negative implications of testing were unknown or viewed as unimportant. Participants did not understand the difference between tumour testing and germline testing. Despite lack of memory or understanding participants did not want additional or more detailed pre-test information although they did want more follow-up and support after receipt of results. The decision to consent to testing was made as soon as participants were informed of the availability of tumour testing - the major reason being to provide information for the family that would aid in cancer prevention. Participants were more concerned with accessibility to testing than pre test information and counselling. / Findings in this study indicated participants made decisions heuristically rather than systematically and this as well as participants’ opinions and other decision-making research has implications for the traditional view of informed consent around genetic related decisions. This in turn has implications for policy and guidelines in the area. Implications for current practise as a result of findings from this study include ensuring participants understand negative implications of testing and follow up and support of those with negative as well as positive results to tumour testing.

<p>The Notch signalling pathway is an evolutionary conserved pathway, named after the Notch receptors, Notch1-4 in mammals, which upon cell-cell contact and ligand binding releases the intracellular domain (NICD). NICD translocates into the nucleus where it binds the transcriptional repressor RBP-Jk, which together with co-activators belonging to the Mastermind-like family of proteins form a transcriptional activation complex. This complex activates genes controlling cell fate decision, embryonic development, proliferation, differentiation, adult homeostasis and stem cell maintenance. On the other hand, disrupted Notch signalling may result in pathological conditions like cancer, although the mechanisms behind the disruption are often complex and in many cases largely unknown.</p><p>Notch1 drives the lymphocyte differentiation towards a T-cell fate and activating mutations in the gene have been suggested to be involved in T-cell lymphoma. In <em>paper I, </em>genetic alterations in <em>Notch1 </em>and the Notch1 regulating gene <em>CDC4 </em>were investigated in tumours from murine T-cell lymphoma induced with phenolphthalein, 1,3-butadiene or 2’,3’-dideoxycytidine. We identified activating <em>Notch1</em> mutations in 39% of the lymphomas, suggesting that <em>Notch1 </em>is<em> </em>an important target gene for mutations in chemically induced lymphomas.<em></em></p><p>While it is known that constitutively activated Notch signalling has a clear oncogenic function in several solid malignancies as well, the molecular mechanisms are less known in this context. Unpublished data of our lab, together with other recent studies, suggest that mutations of Notch and Notch-related genes <em>per se</em> are uncommon in solid malignancies including colorectal cancer, while a growing body of evidence indicates that aberrant Wnt/b-catenin signalling may result in pro-tumoural Notch activation in these contexts. In <em>paper II</em>, we therefore investigated potential transcriptional interactions between the Notch and Wnt signalling pathways in colorectal cancer cell lines. The proximal Notch and Wnt pathway gene promoters were bioinformatically identified and screened for putative TCF/LEF1 and RBP-Jk sites. In canonical Wnt signalling, Apc negatively regulates b-catenin leading to repression of TCF/LEF1 target genes. Upon repression of the Wnt pathway we observed that several genes in the Notch pathway, including <em>Notch2</em>, were transcriptionally downregulated. We also confirmed binding of Lef1 to <em>Notch2</em> as well as other Notch pathway gene promoters and luciferase assays showed an increased activity for at least one LEF1/TCF-site in the <em>Notch2</em> promoter upon co-transfection of HT29 or HCT116 cells with mutated b-catenin. HT29 cell lines were also treated with the g-secretase inhibitor DAPT, leading to inactivation of the Notch pathway by preventing release of NICD. However, results showed no effects on Apc, b-catenin or their target <em>cyclin D1</em>. Taken together, these results indicate that the Wnt pathway may function as a regulator of the Notch pathway through the TCF/LEF1 target gene program in colon cancer cell lines.</p><p>In summary, Notch pathway deregulation is of importance in both murine T-cell lymphoma and human colorectal cancer, although the mechanisms differ. The current results give new insights in Notch pathway alterations as well as the signalling networks in which the Notch pathway interacts, and thus increase the understanding of Notch’s involvement in malignant diseases.</p> / Studies on molecular genetic alterations in colorectal cancer