中国人家族性腺瘤性患肉病患者结肠腺瘤性患肉病基因的胚系突变

目的 探讨中国人家族性腺瘤性息肉病(familial adenomatous polyposis,FAr)患者的结肠腺瘤性息肉病(adenomatous polyposis coli,APC)基因的胚系突变类型.方法 对9个FAP家系18名成员进行多重连接依赖性探针扩增(multiplex ligation-dependent probe amplification,MLPA)检测APC基因有无大片段缺失.再应用PCR扩增APC基因的15个外显子区域,经变性高效液相色谱(denaturing high performance liquid chromatography,DHPLC)对每个扩增片段进行筛查,流出峰异常的片段,经DNA测序验证小片段的改变.结果 9个家系中有3个家系发现有APC基因的胚系突变:家系2为c.3184-3187 del CAhA,家系4为c.5432C＞T,家系9为c.3925-3929 del AAAAG.3种突变中c.5432C＞T在数据库中未见报道.结论 中国人不同的APC基因的胚系突变可引起FAP;无APC胚系突变的FAP患者的发病可能存在其他的机制.     

家族性腺瘤性息肉病一家系调查及APC基因胚系突变分析

目的 探讨家族性腺瘤性息肉病(familial adenomatous polyposis,FAP)家系调查及高危亲属基因筛查的意义,报道云南省一FAP家系发病相关基因APC基因的胚系突变结果.方法 查阅对2001年昆明医学院第一附属医院1例FAP患者病例,电话联系及登门随访进行其家系调查,绘制家系图谱.抽取该家系成员外周静脉血提取DNA,利用PCR方法扩增APC基因,应用DNA自动测序仪进行测序.结果 该家系三代共计9人,成员Ⅰ1、Ⅱ1、Ⅱ2、Ⅱ3、Ⅱ4、Ⅲ2、Ⅲ3、Ⅲ48人检出APC基因胚系突变c.3587C>A(S1196X),其中Ⅱ2、Ⅱ2、Ⅱ4、Ⅲ2、Ⅲ3经肠镜检查证实有结直肠多发息肉,Ⅲ4未检出息肉,为基因突变携带者.结论 通过家系调查对高危亲属进行基因筛查可以发现早期患者,尤其是无临床表现的FAP基因突变携带者,以早期进行医学干预及预防性手术治疗,降低FAP的癌变率、病死率;APC基因c.3587C>A(S1196X)胚系突变是引起该家系FAP患者发病的原因.     

家族性腺瘤性息肉病与高脂血症的关系

家族性腺瘤性息肉病（familial adenomatous polyposis,FAP）是由APC（adenomatous polyposis coli）基因突变引起的常染色体显性遗传病。高脂血症作为FAP的肠外伴随症状逐渐被关注,同时在FAP的经典模型Apc基因突变的Min小鼠上也出现了高血脂症状。本文从高脂血症、FAP以及APC基因突变的角度,阐述三者的相互联系,期望对病人的预防与治疗提供有价值的参考。     

家族性腺瘤样息肉病中APC基因的胚系突变分析

目的 探索有效的突变检测技术，系统分析家族性腺瘤样息肉病(familial adenomatous polyposis，FAP)相关基因结肠腺瘤病(adenomatous polyposis coli，APC)基因的胚系突变，及其与疾病表型的关系。方法 从22例临床确诊的FAP患者，外周静脉血中提取基因组DNA。变性高效液相色谱、蛋白截短检测、测序技术结合应用进行全基因分析。根据患者临床资料，进行基因型-表型分析。结果 22例FAP患者中13例检出APC基因胚系突变，均为无义或移码突变。基因型-表型关系的初步分析表明，在基因5′端或3′端发生突变的患者临床症状较轻，在基因中段发生突变的患者临床症状典型或严重。结论 本研究中所采用的技术体系可敏感、高效地检出APC基因突变，APC基因的突变型与FAP患者的临床表型存在关联，所采用的技术体系适用于FAP症状出现前的基因诊断。     

家族性腺瘤性息肉病家系中一种新的APC基因的胚系突变

目的研究1个家族性腺瘤性息肉病家系的腺瘤样息肉病基因（adenomatous polyposis coli，APC）的胚系突变。方法经结肠镜、组织病理学检查和家族史的调查，确定了1例家族性腺瘤性息肉病（familial adenomatous polyposis，FAP）患者。应用多重连接依赖性探针扩增（multiplex ligation-dependent probe amplification，MLPA）、变性高效液相色谱（denaturing high-performance liquid chromatography，DHPLC）测序等技术对这一家系的成员进行系统的APC全基因筛查。结果在此家系中发现一个新的APC基因的胚系突变c。1999 C〉T（Q667X），这一突变造成了APC基因终止密码子的形成，从而形成有功能障碍的截短蛋白。临床上，此突变可引起严重的FAP症状，早发结直肠腺瘤和腺癌。结论Q667X胚系突变是引起该家系临床表型的原因，受累成员可考虑大肠预防性切除手术。     

应用变性高效液相色谱检测31例家族性腺瘤性息肉病家系结肠腺瘤性息肉病基因突变

目的 应用变性高效液相色谱(denaturing high performance liquid chromatography,DHPLC)技术检测我国家族性腺瘤性息肉病(familial adenomatons polyposis,FAP)家系的结肠腺瘤性息肉病(adenoinatous pelyposis coli,APC)基因变异特征,研究其病因机制.方法 采集31个家系的先证者、患者和家系成员的外周血淋巴细胞,抽提DNA并以降落式PCR扩增APC基因各外显子和启动子.基因突变检测先由DHPLC进行筛选,发现异常峰者进行测序鉴定并TA克隆鉴定,结果与网络数据进行比对.结果 31个家系中共有15个家系检出了12种不同的突变类型,FAP家系APC基因的突变检出率为48.39%.发现了4种新的突变及3例不同的内含子突变.4个新的突变分别位于255、677、1192、1403密码子,均为移码突变.证明了DHPLC能检出APC基因的突变.在APC基因的突变中,移码突变占86.67%,无义突变占13.33%,说明移码突变是中国人APC基因突变的主要方式.在突变位点上,第15外显子突变最常见,约占86.67%.结论 FAP家系APC基因的突变检出率为48.39%,发现了4种新的导致蛋白编码改变的突变.证实中国人FAP家系中APC基因突变位点以第15外显子最常见,类型以移码突变为主.     

中国人家族性腺瘤性息肉病的基因型与临床表型的关系分析

目的 分析中国人家族性腺瘤性息肉病(FAP)的基因型与表现型的相关关系。 方法 14个经过了APC基因胚系突变检测的FAP家系患者,将所发现的APC基因胚系突变类型与临床特征进行综合分析。结果 位于密码子443、779、1062、1068、1309、1308、1394、c.657+1和c.532-2 微小突变的患者均表现为密集型息肉病,2例大片段缺失的患者表现为中间型息肉病,3例APC基因突变阴性的患者中2例表现为中间型息肉,1例表现为衰减型息肉病, 结论 中国人密集型息肉病APC基因突变范围较西方报道的位于密码子1250~1464之间广。     

腹腔镜全结肠切除治疗家族性腺瘤性息肉病9例报道

目的探讨腹腔镜在全结肠切除治疗家族性腺瘤性息肉病（FAP）的应用价值。方法9例家族性腺瘤性息肉病患者应用腹腔镜实施全结肠切除术,对手术及术后恢复情况进行总结分析。结果9例FAP患者手术均获成功,无中转开腹手术病例,手术时间230～310min,术中失血量80～210mL,肛门排气时间为术后2～3d,住院时间为12～14d,随访6～36个月,术后恢复良好。结论腹腔镜全结肠切除治疗家族性腺瘤性息肉病,手术创伤小,术中出血少,切口小美观,术后恢复快,效果良好。     

一个家族性腺瘤性息肉病家系同时出现的和基因突变CSCD

目的探讨一个家族性腺瘤性息肉病(familial adenomatous polyposis, FAP)家系APC和MLH1基因的突变情况。方法通过临床表现、家族史及组织病理学等诊断1例FAP女性患者。患者两年后出现子宫内膜上皮内瘤变(endometrial intraepithelial neoplasia, EIN),而后者是Ⅱ型Lynch综合征的病变之一。提取患者及其家系成员的外周血DNA,采用Sanger测序的方法筛查APC和MLH1基因突变。结果该家系同时存在APC基因第7外显子的杂合性突变c.637C>T(p.R213X)和MLH1基因第12外显子的杂合性突变c.1153C>T(p.R385C)。两种突变同时出现的情况既往未见报道。前者突变造成终止密码子提前出现,后者突变了造成氨基酸的改变。结论同时出现的APC基因c.637C>T(p.R213X)和MLH1基因c.1153C>T(p.R385C)突变是该家系的致病性突变,其出现临床表现的年龄较晚,且严重程度存在差异。对于FAP患者,应询问其家族史并对APC基因进行突变筛查,同时关注其是否存在肠外病变。对于出现子宫内膜病变的患者,可进行MMR基因的筛查,以确定是否同时存在Lynch综合征。     

APC基因甲基化定量检测芯片的建立

目的 建立抑癌基因APC（adenomatous polyposis coli，APC）启动子1A的甲基化定量芯片检测方法。方法选取一段420bp的APC基因启动子1A CpG密集序列作为靶序列，针对M0、M1、M2、M3、M4 5个CpG靶位点，设计一套检测甲基化与非甲基化的探针。采用脐带血DNA克隆体作为阴性、阳性质控品。结果甲基化阳性、阴性质控的芯片结果与测序吻合。每组探针中荧光强度由强至弱依次为，阳性质控（甲基化）：探针1〉2、3〉4；阴性质控（非甲基化）：探针3〉4、1〉2。5个位点的5条荧光强度标准曲线，尺。范围是0．93～0．99。M0、M1、M2、M3、M4 5个位点甲基化杂合型的检测范围分别为50．0％±3．6％、50．0％±6．9％、50．0％±3．5％、50．0％±8．5％、50．0％±7．3％。结论建立了APC基因启动子5个COG位点的甲基化定量检测芯片。     

Promoter hypermethylation and loss of heterozygosity of the APC gene in patients with familial adenomatous polyposis

OBJECTIVE: To investigate the status of hypermetne in 3 familial adenomatous polyposis (FAP) pedigrees and to screen large fragment deletions in the APC gene. METHODS: DNA from tumor tissues and corresponding normal tissues of 5 FAP patients was modified by sodium bisulfite. Then the methylation status of the APC gene was analyzed by methylation specific-PCR (MSP) and DNA sequencing. Multiplex ligation-dependent probeamplification (MLPA) was used to screen aberrations involving large fragments from all the 15 exons and promoter region of APC gene. RESULTS: No methylation was present in normal tissues. Hypermethylation was found in tumor tissues of one proband and her son. Loss of heterozygosity was observed in another patient from the same FAP family. CONCLUSION: Aberrantmethylation of the APC promoter region provides an important mechanism for impairing APC function and may occur early during colon neoplasia progression. Loss of heterozygosity may play a role in patients with classical polyposis.     

Germline mutations in APC and MUTYH are responsible for the majority of families with attenuated familial adenomatous polyposis

A small fraction of families with familial adenomatous polyposis (FAP) display an attenuated form of FAP (AFAP). We aimed to assess the presence of germline mutations in the MUTYH and adenomatous polyposis coli (APC) genes in AFAP families and to compare the clinical features between the two causative genes. Families with clinical AFAP were selected from the Dutch Polyposis Registry according to the following criteria: (a) at least two patients with 10-99 adenomas diagnosed at age >30 years or (b) one patient with 10-99 adenomas at age >30 years and a first-degree relative with colorectal cancer (CRC) with a few adenomas, and, applying for both criteria, no family members with more than 100 polyps before the age of 30 years. All probands were screened for germline mutations in the APC and MUTYH genes. Twenty-five of 315 Dutch families with FAP (8%) met our criteria for AFAP. These families included 146 patients with adenomas and/or CRC. Germline APC mutations were identified in nine families and biallelic MUTYH mutations in another nine families. CRC was identified at a mean age of 54 years (range 24-83 years) in families with APC and at 50 years (range 39-70 years) in families with MUTYH (p = 0.29). APC and biallelic MUTYH mutations are responsible for the majority of AFAP families. Based on our results and those reported in the literature, we recommend colonoscopy once every 2 years in AFAP families, starting surveillance from the late teens in APC mutation carriers and from age 20-25 years in biallelic MUTYH mutation carriers.     

Novel germline mutations in the APC gene of Cypriot patients with familial and sporadic adenomatous polyposis

Familial adenomatous polyposis (FAP) is one of the two commonest familial syndromes that predispose to colorectal cancer. FAP is caused by mutations in the adenomatous polyposis coli (APC) tumour suppressor gene that has a high penetrance. The disease is characterized by the occurrence of hundreds to thousands of colorectal polyps, which if left untreated give rise to colorectal cancer. In Cyprus, there are no molecular data available as yet on families with FAP. This work presents the results of APC analysis in our population for the first time. The APC gene was analyzed in 33 DNA samples from 20 individuals belonging to four FAP families and 13 patients with sporadic polyposis. We identified three truncating mutations, four missense mutations and 11 polymorphisms. It is of interest that two of the three truncating mutations, 2307delA and Q1242X, are novel, which supports the existence of a unique genetic pool in the Cypriot population. This ethnic molecular study in addition to highlighting population heterogeneity also contributes to phenotype-genotype associations that are essential for the clinical management of FAP families in Cyprus.     

Non-allelic heterogeneity of familial adenomatous polyposis

Linkage studies on familial adenomatous polyposis (FAP) reported so far suggest that FAP is a genetically homogeneous disease. Recently, we found that the putative gene for Turcot syndrome, an apparently autosomal recessive clinical variant of FAP, is not allelic to FAP. Here we describe another family, segregating for an autosomal dominant disease clinically indistinguishable from FAP but genetically not linked to the APC locus, adding further evidence for the occurrence of non-allelic heterogeneity of FA. These observations have implications to the linkage-based genetic counselling of persons at risk for FAP especially when they are drawn from small families giving insufficient information. © 1993 Wiley-Liss, Inc.     

Strategies and outcomes of PGD of familial adenomatous polyposis

Owing to adult onset of hereditary cancer, prenatal diagnosis (PND) raises numerous ethical issues on the acceptability to terminate an affected pregnancy (TOP). PND for these disorders is often considered as unacceptable by couples as well as geneticists and legal or ethical authorities, but preimplantation genetic diagnosis (PGD), even if subject to controversy, seems to be a more acceptable option. Therefore, many couples, who do not want to transmit their cancer to their children, consider PGD as their only reproductive option. This article describes our experience of PGD for familial adenomatous polyposis (FAP). Twelve couples were referred between 2000 and 2005. We developed PGD tests to detect the mutation alone, but we rapidly set up multiplex PCR combining mutation detection and indirect diagnosis. Finally, we set up duplex and triplex indirect diagnoses to be able to offer a PGD, whatever mutation was involved in familial cases. PGD strategies were based on (i) a new double allele-specific PCR approach (D-ARMS) allowing the detection of the wild-type and mutated allele; (ii) PCR fragments sizing and (iii) restriction length polymorphisms. For the 12 referrals, we developed eight tests, and 11 cycles have been performed for four couples, resulting in eight embryo transfers and five pregnancies, with the birth of one healthy boy and two ongoing pregnancies. We are now able to propose PGD to most couples at risk of transmitting FAP to their offspring, whether the mutation is familial or occurred de novo.     

APC gene hypermethylation and prostate cancer: a systematic review and meta-analysis

Prostate cancer (PCa) is a worldwide disease that affects a large number of males. Although prostate-specific antigen (PSA) screening is used, the specificity is limited. This study analyzes the sensitivity and specificity of adenomatous polyposis coli (APC) methylation for PCa detection in body fluids and tissues. Combining search results from PubMed and Embase, 19 studies were included, 5 involving body fluids and 14 involving prostate tissue, with 2344 subjects. In body fluid subgroups, the pooled sensitivity and specificity was 0.53 (95% confidence interval (CI): 0.28–0.78) and 0.92 (95% CI: 0.86–0.95), respectively. From tissue studies, the results presented as 0.84 (95% CI: 0.70–0.92) and 0.91 (95% CI: 0.77–0.97). To confirm the results, we conducted a further analysis by removing studies which introduced high heterogeneity due to the type of cases and controls. The same degree of sensitivity and specificity was presented in two subgroups (urine: sensitivity 0.46, 95% CI: 0.39–0.53; specificity 0.87, 95% CI: 0.64–0.96; tissue: sensitivity 0.87, 95% CI: 0.72–0.94; specificity 0.89, 95% CI: 0.68–0.97). In addition, analysis of the interaction between APC methylation and PCa showed strong association in the whole data set (odds ratio (OR)=24.91, 95% CI: 12.86–48.24, I²=72.5%). Pooling the same two main subgroups (tissue/fluid) gave a pooled OR of 33.54 (95% CI: 14.88–75.59; I²=70.7%) and 8.20 (95% CI: 2.84–23.74, I²=64.2%), respectively. From this study, the results suggest that APC promoter methylation may be the potential testing for PCa diagnosis and provide a new viewpoint in the treatment of PCa.     

APC germline mutations identified in Czech patients with familial adenomatous polyposis

Familial adenomatous polyposis (FAP) is an autosomal dominantly inherited predisposition to colorectal cancer, which is caused by germline mutations in the adenomatous polyposis coli (APC) gene. The APC mutations have been investigated in 46 Czech unrelated FAP families and 9 suspected FAP families using DGGE analysis and direct DNA sequencing. We found 25 germline APC mutations and identified 11 which were not previously reported. Of the identified mutations, 10 were 1 to 5 bp deletions, four were 1 bp insertions and six were nonsense, all leading to the formation of premature stop codon. In addition, we detected two mutations in the splice-donor region of APC intron 11, one missense and two samesense mutations. Phenotypes of patients with known and novel types of mutations are presented and discussed.