Colorectal cancer (CRC) is one of the most common forms of neoplasia in Western populations but is uncommon in sub-Saharan Africa. In developing countries such as South Africa, differences in lifestyles and environment exist between the various population groups. These differences and the diverse patterns of cancer that exist, provide an ideal opportunity to study the pathogenesis of colorectal cancer. In South Africa, the incidence of CRC in black patients is approximately ten fold lower than that of white South African patients. The majority of black South African CRC patients presents with tumours without macroscopic polyps. Recently five genes involved in DNA mismatch repair (MMR) have been implicated in hereditary nonpolyposis colorectal cancer (HNPCC). In this retrospective study, paraffin-embedded normal and tumour tissues from 109 black, and 110 Caucasian CRC patients were studied. To screen for the possible involvement of DNA mismatch repair genes, the presence of microsatellite instability (MSI) was investigated. In total 40 patients presented with MSI-H tumours, 27/109 (24,8%) tumours from black patients and 13/110 (11,8%) tumours from Caucasian patients. The proportion of MSI-H tumours from black patients attending Chris Hani Baragwanath Hospital (CHB) (12,2%; 5/41) and that of Caucasian patients is in accordance to published results on sporadic tumours. However the finding that 32,4% of black patients attending Kalafong and Pretoria Academic Hospitals, have tumours with MSI-H is much higher than is commonly reported in Western populations and is significantly higher than that of the Caucasian patients (p = 0.002; χ2-test). It has been observed that patients who present at CHB live mainly in urban Johannesburg/Soweto, in comparison to those seen at KPH who are mostly from peri-urban and rural areas. Failure of PCR amplification, owing to the absence of high quality tissue, allowed 32 of the 40 MSI-H tumours to be fully screened for mutations in hMLH1 and hMSH2 using exon-by-exon PCR single strand conformation polymorphism (SSCP) analysis. Sixteen pathogenic mutations were found in 14 tumours, 10/22 (45%) from black patients and 4/10 (40%) from caucasian patients. Five tumours presented with two mutations each, one is a compound heterozygote and the other four tumours are double heterozygotes. Ten of the sixteen mutations identified, are novel. Five (5/32; 16%) of the pathogenic mutations are germline in origin, four (4/22; 18%) of which were detected in tumours from black patients. Thus HNPCC was diagnosed in ~0,93% (1/107) of Caucasian and 3,85% (4/104) of black patients via germline mutations. The frequency of recognised DNA repair gene mutations in black patients with HNPCC is four times higher than that in Caucasian patients with HNPCC. This is consistent with the notion that penetrance of HNPCC cancer is independent of environmental factors which is true as the frequency of HNPCC in a low incidence population (black South Africans) is much higher than that of a high incidence population (Caucasian South Africans). A missense mutation in hMSH2 (codon 127) was identified in three black patients. It is listed in the ICG-HNPCC database as a pathogenic mutation (in a Nigerian family). However, further investigation demonstrated that this is a polymorphic change exclusive to black Africans. Somatic mutations were detected in 6 (27%) tumours from black and 3 (30%) tumours from Caucasian patients. In conclusion, the observed microsatellite instability and mutations in hMLH1 and hMSH2 thus clearly implicate the involvement of DNA mismatch repair genes in the pathogenesis of colorectal cancers of black and Caucasian South African patients. This study represents the first investigation of DNA mismatch repair genes in tumours from both population groups. It is also the first report of black South Africans with HNPCC. / Dissertation (MSc (Human Genetics))--University of Pretoria, 2005. / Genetics / unrestricted

DNR pažaidų atitaisymas ir apoptozė - dvi pagrindinės grandys, palaikančios žmogaus genomo vientisumą. Sutrikus šiems procesams, ląstelė išgyvena, nepaisant susikaupusių DNR pažaidų ir sudaromas pagrindas tolesnei transformacijai. Tyrimu įvertinome DNR pažaidų atitaisymo funkcijoje dalyvaujančių (hMLH1, MGMT) ir su apoptoze susijusių (DAPK-1, CASP8) genų epigenetinio reguliavimo - metilinimo aspektus pakopiniame skrandžio onkogenezės procese. Šio mokslinio tyrimo metu pirmą kartą buvo nustatytas skirtingas hMLH1 geno metilinimo dažnis atskirose skrandžio anatominėse dalyse atrofiniu pangastritu sergančiųjų audinyje. Įvertinta, kad hMLH1 geno metilinimas sergančiųjų skrandžio vėžiu aplinkiniame nenavikiniame audinyje sietinas su pacientų amžiumi. Išgyvenamumo analizės rezultatai parodė, kad MGMT geno metilinimas agresyvios skrandžio vėžio histologinės formos atveju yra geresnės prognozės rodiklis. Tyrimo metu nustatėme mokslinėje periodikoje neaprašytų tirtųjų genų metilinimo derinių sąsajų su klinikiniais, morfologiniais ir prognoziniais onkologinės ligos ypatumais. / DNA repair and apoptosis are two main pathways supporting the integrity of human genome. After the disturbance of these processes the cell survives, despite the accumulation of DNA lesions, and in this way a basis for a subsequent transformation is formed. In our research we evaluated the epigenetic regulation - methylation - aspects of genes participating in DNA repair function (hMLH1 and MGMT) and also of apoptosis-related genes (DAPK-1, CASP8) in relation to a stepwise gastric oncogenesis process. During this investigation a different hMLH1 gene methylation observation frequency in tissues obtained from separate anatomical parts of the stomach in atrophic pangastritis patients was determined for the first time. It was estimated, that hMLH1 gene methylation in tumor-surrounding non-cancerous tissue in gastric cancer patients could be associated with patient age. Results of survival analysis indicated that MGMT gene methylation is an indicator of better prognosis in case of diffuse form of gastric cancer. During the study we determined some additional associations (not described in previous publications) between methylation combinations of analyzed genes and clinical, morphological and prognostic features of oncological illness.

Defects in mismatch repair genes, particularly the hMLH1 and hMSH2 genes, are associated with pathogenesis and prognosis of some cancers. The lack of correlation between replication error phenotype and mutations in hMLH1 in sporadic human cancers suggested that inactivation of the hMLH1 gene may be associated with promoter hypermethylation. This study was to investigate the association of hMLH1 promoter hypermethylation and hMLH1 protein expression in oral cancer. Our results indicated that all 75 cases (100%) were without any methylation of hMLH1 promoter by use of methylation-specific PCR (MSP). Nineteen of 99 cases (19.2%) were partial methylation by HpaII-based PCR. In addition, 24 (26.1%) of 92 cases of OSCC had reduced levels of hMLH1 protein. The concordance analysis showed that the expression level of hMLH1 protein was not correlated with methylation of hMLH1 promoter. Furthermore, the prognosis significance of hMLH1 or hMSH2 proteins on OSCC was also investigated. We analyzed the association of hMLH1 and hMSH2 protein expression with clinicopathological data of 92 cases of OSCC at KSVGH. We found that 24 (26.1%) of 92 cases of OSCC had reduced levels of hMLH1 protein, however only 10 cases (10.9%) had reduced hMSH2 by use of IHC. In addition, the reduced expression of hMLH1 correlated with the tumor differentiation and N classification. However, none of these clinical and pathological characteristics of the OSCC patients were associated with the extent of hMSH2 expression. Finally, previous studies reports that the hMLH1 and Aurora-A are directly involved in the prognosis of several cancers. The expression levels of hMLH1 and Aurora-A protein were investigated in the 138 tumor samples for consecutive patients with pathological confirmed primary buccal carcinoma (BC). Then the association of the protein expression with clinicopathological data and survival were also evaluated. The loss of hMLH1 protein was found in 15 (10.9%) of 138 tumor sections by IHC. In addition, loss of hMLH1 protein expression was not any correlated with clinical features and patients¡¦ prognosis. The up-regulation of Aurora-A protein was found in 118 (85.5%) of 138 tumor sections by IHC. In addition, the up-regulation of Aurora-A protein expression was correlated with the pathological stage and T classification, but Aurora-A protein up-regulation was not correlated with prognosis. In conclusion, promoter methylation of hMLH1 might not play a potent role in the gene expression in oral cancer. Defective expression of hMLH1 but not hMSH2 was associated with the development of OSCC. In addition, the Aurora-A protein expression but not hMLH1 may affect the malignant behavior of BC. However, the hMLH1 and Aurora-A protein expression might be not the prognostic factors for BC patients.

A queilite actínica (QA) é o resultado da exposição crônica dos lábios à radiação ultravioleta do sol. É considerada uma lesão cancerizável e calcula -se que cerca de 10% a 20% evoluirão para carcinoma epidermóide. Já foi sugerido que virtualmente todos os carcinomas epidermóides de lábio (CEL) iniciem como QA. Sabe-se que as radiações solares têm a capacidade de alterar o DNA e que, nesse contexto, os genes de reparo de DNA têm papel fundamental em reparar essas alterações e limitar os danos causados. Porém, estes genes também podem ser vítimas das radiações ultravioletas do sol. O objetivo deste trabalho foi estudar a participação dos genes de reparo de mau pareamento (RMP) do DNA em QA de diferentes graus de atipia e comparar os achados ao carcinoma de lábio relacionado à QA. Para tanto, foram analisadas nestas lesões a expressão e distribuição das proteínas codificadas por dois destes genes, hMLH1 e hMSH6, através da imunoistoquímica. Foi observado que a expressão das duas proteínas diminuía de acordo com o agravamento da indiferenciação celular das lesões. A partir disto, pode-se concluir que a diminuição na expressão de hMLH1 e hMSH6 parece estar relacionada com a progressão do grau de atipia nas QA, e, conseqüentemente, com a tumorigênese do CEL. Além disso, a proteína hMSH6 não pareceu ter um papel importante no reparo do DNA do epitélio labial normal. / Actinic cheilitis (AC) results from chronic and excessive exposure of the lips to the ultraviolet radiation in sunlight. AC is recognized as a potentially malignant condition and it is estimated that 10% to 20% will become lip squamous cell carcinoma (LSCC). It has been suggested that virtually every LSCC was initially AC. It is well known that solar radiation causes DNA damage and, in this context, the DNA repair systems play an extremely important role in restoring the injuries. The purpose of this study was to evaluate the participation of the mismatch repair (MMR) system in AC with all grades of dysplasia, as well as, LSCC related to AC. The protein expression and distribution of two of these genes, hMLH1 and hMSH6 were analyzed by means of immunohistochemistry. The results have shown an association between decreased expression of hMLH1 and hMSH6 proteins and the progression of the dysplasia in AC and, therefore, LSCC carcinogenesis. In addition, the hMSH6 protein does not seem to have a primary role in DNA repair of the normal lip epithelium.

A queilite actínica (QA) é o resultado da exposição crônica dos lábios à radiação ultravioleta do sol. É considerada uma lesão cancerizável e calcula -se que cerca de 10% a 20% evoluirão para carcinoma epidermóide. Já foi sugerido que virtualmente todos os carcinomas epidermóides de lábio (CEL) iniciem como QA. Sabe-se que as radiações solares têm a capacidade de alterar o DNA e que, nesse contexto, os genes de reparo de DNA têm papel fundamental em reparar essas alterações e limitar os danos causados. Porém, estes genes também podem ser vítimas das radiações ultravioletas do sol. O objetivo deste trabalho foi estudar a participação dos genes de reparo de mau pareamento (RMP) do DNA em QA de diferentes graus de atipia e comparar os achados ao carcinoma de lábio relacionado à QA. Para tanto, foram analisadas nestas lesões a expressão e distribuição das proteínas codificadas por dois destes genes, hMLH1 e hMSH6, através da imunoistoquímica. Foi observado que a expressão das duas proteínas diminuía de acordo com o agravamento da indiferenciação celular das lesões. A partir disto, pode-se concluir que a diminuição na expressão de hMLH1 e hMSH6 parece estar relacionada com a progressão do grau de atipia nas QA, e, conseqüentemente, com a tumorigênese do CEL. Além disso, a proteína hMSH6 não pareceu ter um papel importante no reparo do DNA do epitélio labial normal. / Actinic cheilitis (AC) results from chronic and excessive exposure of the lips to the ultraviolet radiation in sunlight. AC is recognized as a potentially malignant condition and it is estimated that 10% to 20% will become lip squamous cell carcinoma (LSCC). It has been suggested that virtually every LSCC was initially AC. It is well known that solar radiation causes DNA damage and, in this context, the DNA repair systems play an extremely important role in restoring the injuries. The purpose of this study was to evaluate the participation of the mismatch repair (MMR) system in AC with all grades of dysplasia, as well as, LSCC related to AC. The protein expression and distribution of two of these genes, hMLH1 and hMSH6 were analyzed by means of immunohistochemistry. The results have shown an association between decreased expression of hMLH1 and hMSH6 proteins and the progression of the dysplasia in AC and, therefore, LSCC carcinogenesis. In addition, the hMSH6 protein does not seem to have a primary role in DNA repair of the normal lip epithelium.