肺癌微卫星不稳定性与错配修复基因缺陷的相关性研究

 目的　通过对肺癌微卫星不稳定性（MSI）的分析与错配修复基因蛋白表达的检测,探讨肺癌发病的分子机制。方法　从50例肺癌患者的正常肺组织、癌组织中提取DNA;SSCP法检测标本中MSI发生情况;免疫组织化学法检测错配修复基因hMLH1及hMSH2在肺癌中的表达情况。结果　50例肺癌中微卫星高度不稳定（MSI-H）14例,低度不稳定（MSI-I）21 例,稳定（MSS）15例,正常组织中未出现MSI,两者之间差异有统计学意义（P＝0.000）;免疫组化结果显示hMLH1在MSI肺癌组织中常为缺失表达,表达率为74 %（37／50）;hMSH2在MSI肺癌组织中也呈缺失表达,表达率为32 %（16／50）;而在MSS肺癌组织中均显示hMLH1、 hMSH2基因蛋白表达阳性。结论　肺癌的发生可能存在MSI途径,而hMLH1、hMSH2的表达失活则可能导致MSI的发生,因此,MSI可作为肺癌诊断的指标之一。     

肺癌微卫星不稳定性与错配修复基因缺陷的相关性研究

目的 通过对肺癌微卫星不稳定性(MSI)的分析与错配修复基因蛋白表达的检测,探讨肺癌发病的分子机制.方法 从50例肺癌患者的正常肺组织、癌组织中提取DNA;SSCP法检测标本中MSI发生情况;免疫组织化学法检测错配修复基因hMLH1及hMSH2在肺癌中的表达情况.结果 50例肺癌中微卫星高度不稳定(MSI-H)14例,低度不稳定(MSI-I)21例,稳定(MSS)15例,正常组织中未出现MSI,两者之间差异有统计学意义(P=0.000);免疫组化结果显示hMLH1在MSI肺癌组织中常为缺失表达,表达率为74%(37/50);hMSH2在MSI肺癌组织中也呈缺失表达,表达率为32%(16/50);而在MSS肺癌组织中均显示hMLH1、hMSH2基因蛋白表达阳性.结论 肺癌的发生可能存在MSI途径,而hMLH1、hMSH2的表达失活则可能导致MSI的发生,因此,MSI可作为肺癌诊断的指标之一.     

DNA错配修复基因与肿瘤研究新进展

DNA错配修复(mismatch repair,MMR)基因对维持基因组的稳定性有重要作用,MMR基因突变与肿瘤的发生、发展关系密切.近年来,MMR基因在肿瘤组织中的作用成为研究热点,本文就其新进展作一简要综述.     

微卫星不稳定性与肿瘤

微卫星是一类新的、多态信息容量高的分子标志，微卫星不稳定性是由于复制错误而产生的微卫星ＤＮＡ改变，这种改变使微卫星不能正常地发挥调控作用。微卫星不稳定性广泛参与了肿瘤的发生及发展，是肿瘤常见的遗传改变之一，微卫星不稳定性也为阐述肿瘤的发生机制提供了新的证据。     

肺癌组织中错配修复基因mRNA表达

目的 探讨ＤＮＡ错配修复（ＭＭＲ）基因ｍＲＮＡ在肺癌组织中冢其与微卫星６改变关系。方法 用ＲＴ－ＰＣＲ和ＰＣＲ－变性聚丙烯酰胺凝胶电泳－银染法,检测４６原发性肺癌组织中５种ＭＭＲ基因ｍＲＮＡ表达及６种微卫星改变。结果 ５种ＭＭＲ基因ｍＲＮＡ在肺癌组织中表达降你的发生庇为１３．０％～３２．６％,至少一种基因ｍＲＮＡ表达降爸的发生率为５８．７％（２７／４６）。３９．１％（１８／４６）病例有至少２种基因     

修饰型微卫星不稳定性与散发结直肠癌p53基因点突变的相关性

目的 高频度微卫星不稳定性被认定为DNA错配修复缺陷的标志,但既往研究发现一个显著矛盾,即在高频度微卫星不稳定结直肠癌中,p53突变率较一般结直肠癌低.研究旨在确认该矛盾的存在并试图阐明其机制.方法 对180例散发结直肠癌采用高分辨率荧光标记微卫星分析法检测微卫星位点稳定性,PCR扩增直接测序检测p53突变.结果 微卫星不稳定性呈现修饰型和跳跃型两种变化.低频度微卫星不稳定性均呈现修饰型而无跳跃型变化;高频度微卫星不稳定性均检出了跳跃型变化,一部分也并存修饰型变化.微卫星不稳定与肿瘤部位及分化程度明显相关,p53突变与肿瘤分化明显相关.高频度微卫星不稳定肿瘤未检出p53突变,而低频度微卫星不稳定肿瘤p53突变率较高.结论 低频度微卫星不稳定性呈现的修饰型微卫星位点长度变化可能是DNA错配修复缺陷的表型;此表型与提高的碱基置换突变率有关.单纯DNA错配修复缺陷可能不足以导致微卫星不稳定性的跳跃型变化,高频度微卫星不稳定的真正原因仍有待阐明.     

筛查结直肠癌DNA错配修复基因缺失的方法分析

目的:通过对筛查结直肠癌DNA错配修复(mismatch repair,MMR)基因缺失两种最常用的检测方法的分析,寻找更为经济有效的检测策略。方法:分析新疆医科大学第一附属医院2018年9月至2019年9月收治并行手术的结直肠癌患者的肿瘤组织223例,采用免疫组织化学法检测平台检测MLH1、MSH2、PMS2、MSH6的表达缺失情况,PCR-毛细管电泳法检测肿瘤微卫星不稳定(microstatellites instability,MSI)状态。结果:在223例结直肠癌中,27例(12.1%)MMR蛋白表达缺失(MMR deficiency,dMMR),196例(87.9%)MMR蛋白表达完整(MMR proficient,pMMR)。MLH1、MSH2、MSH6和PMS2的缺失率分别为9.0%(20/223)、1.8%(4/223)、2.7%(6/223)和9.4%(21/223)。包含PMS2和MSH6的2种抗体试验筛查dMMR结直肠癌的灵敏度和特异度与4种抗体试验(MLH1、MSH2、PMS2、MSH6)的灵敏度和特异度均相同。微卫星高度不稳定(MSI-high,MSI-H)2...     

乳腺癌与癌前病变的微卫星不稳定性与3p杂合性缺失

目的探讨微卫星不稳定性(MSI)与3号染色体短臂杂合性缺失(LOH)在乳腺癌发生机制中的作用及其临床病理学意义。方法采用PCR-SSLP及银染方法检测41例乳腺癌和13例癌前病变中MSI状态以及3p上11个微卫星位点LOH发生情况;应用免疫组化SP法检测错配修复(MMR)基因hMLH1、hMSH2和3p上相关基因的表达情况。结果(1)乳腺癌MSI发生率为36.6%,低分化乳腺癌MSI发生率明显高于高中分化组;癌前病变的发生率为15.4%;良性增生均表现微卫星稳定。(2)乳腺癌中微卫星异常主要分布于D3S1766、D2S2739和TP53 3个位点,癌前病变和乳腺癌具有相同的高频不稳定位点D3S1766和D2S2739。(3)97.0%乳腺癌患者发生3p LOH,检出率较高的位点分别是D3S1295、D3S1029和D3S1038。癌前病变患者3p LOH发生率为41.7%,缺失率较高的位点是D3S1295和D3S1029。(4)hMLH1和hMSH2蛋白在乳腺癌中阳性表达率分别为45.0%和40.0%,在癌前病变中分别为61.5%和76.9%,均明显低于良性增生组(P<0.05)。乳腺癌中两种蛋白阳性率与组织学分级相关(P<0.05),高分化组明显高于低中分化组。MSI 乳腺癌和癌前病变均表现MMR蛋白表达缺失。结论错配修复基因表达缺陷和MSI是乳腺癌多步骤发展过程的早期事件,在进展阶段MSI与乳腺癌低分化相关;D3S1766和D2S2739可能是检测乳腺癌与癌前病变MSI较敏感的位点。3p最小共同缺失区位于3p14-p25,提示该区域有与乳腺肿瘤发生发展相关并影响其生物学行为的候选抑癌基因。     

微卫星不稳定性和杂合性丢失与宫颈癌相关性的研究

目的 :探讨染色体微卫星不稳定性 (MSI)及杂合性丢失 (lossofheterozygosity ,LOH)在宫颈癌的发生及发展的相关性。方法 :运用p53(D17S786)、9p2 1(D9S171) 2对微卫星标志 ,结合PCR银染技术 ,分别检测 4 8例宫颈癌组织、癌旁组织及周围静脉血DNA的MSI(microsatelliteinstability)和LOH及其与临床分期和病理分级的关系。结果 :4 8例宫颈癌组织的 2个位点进行了微卫星MSI和LOH多态性分析 ,分别为 56%、2 5% ,临床病理分级 (P <0 0 5) ,不同病理分级的统计学分析差异有显著性。结论 :p53(D17S786)、9p2 1(D9S171) 2个不同的位点 17号、9号染色体上存在的抑癌基因的失活以及微卫星不稳定性可能在宫颈癌的发生发展中起重要作用     

原发性肺癌线粒体DNA控制区微卫星不稳定性的研究

[目的]探讨线粒体DNA控制区微卫星不稳定性（mitochondrial microsatellite instability,mtMSI）与肺癌的相关性。[方法]采用PCR-SSCP（PCR single-stranded conformation polymorphism,PCR-SSCP）和序列测定技术对37例肺癌组织及癌旁组织线粒体DNA控制区的3个微卫星位点进行了分析。[结果]37例肺癌样本中共检出mtMSI12例（32.4%）,肺癌mtMSI发生率与患者性别、年龄及肿瘤的病理类型无相关性（P〉0.05）,吸烟组（包括曾经吸烟者）与非吸烟组mtMSI发生率两者有显著差异（P〈0.05）。[结论]线粒体DNA控制区的遗传不稳定性在一些肺癌的发生中可能起一定作用。     

Genetic and clinical determinants of constitutional mismatch repair deficiency syndrome: Report from the constitutional mismatch repair deficiency consortium

BackgroundConstitutional mismatch repair deficiency (CMMRD) is a devastating cancer predisposition syndrome for which data regarding clinical manifestations, molecular screening tools and management are limited.MethodsWe established an international CMMRD consortium and collected comprehensive clinical and genetic data. Molecular diagnosis of tumour and germline biospecimens was performed. A surveillance protocol was developed and implemented.ResultsOverall, 22/23 (96%) of children with CMMRD developed 40 different tumours. While childhood CMMRD related tumours were observed in all families, Lynch related tumours in adults were observed in only 2/14 families (p = 0.0007). All children with CMMRD had café-au-lait spots and 11/14 came from consanguineous families. Brain tumours were the most common cancers reported (48%) followed by gastrointestinal (32%) and haematological malignancies (15%). Importantly, 12 (30%) of these were low grade and resectable cancers. Tumour immunohistochemistry was 100% sensitive and specific in diagnosing mismatch repair (MMR) deficiency of the corresponding gene while microsatellite instability was neither sensitive nor specific as a diagnostic tool (p < 0.0001). Furthermore, screening of normal tissue by immunohistochemistry correlated with genetic confirmation of CMMRD. The surveillance protocol detected 39 lesions which included asymptomatic malignant gliomas and gastrointestinal carcinomas. All tumours were amenable to complete resection and all patients undergoing surveillance are alive.DiscussionCMMRD is a highly penetrant syndrome where family history of cancer may not be contributory. Screening tumours and normal tissues using immunohistochemistry for abnormal expression of MMR gene products may help in diagnosis and early implementation of surveillance for these children.     

Clinical and molecular characterisation of hereditary and sporadic metastatic colorectal cancers harbouring microsatellite instability/DNA mismatch repair deficiency

BackgroundPatients treated with chemotherapy for microsatellite unstable (MSI) and/or mismatch repair deficient (dMMR) cancer metastatic colorectal cancer (mCRC) exhibit poor prognosis. We aimed to evaluate the relevance of distinguishing sporadic from Lynch syndrome (LS)-like mCRCs.Patients and methodsMSI/dMMR mCRC patients were retrospectively identified in six French hospitals. Tumour samples were screened for MSI, dMMR, RAS/RAF mutations and MLH1 methylation. Sporadic cases were molecularly defined as those displaying MLH1/PMS2 loss of expression with BRAFV600E and/or MLH1 hypermethylation and no MMR germline mutation.ResultsAmong 129 MSI/dMMR mCRC patients, 81 (63%) were LS-like and 48 (37%) had sporadic tumours; 22% of MLH1/PMS2-negative mCRCs would have been misclassified using an algorithm based on local medical records (age, Amsterdam II criteria, BRAF and MMR statuses when locally tested), compared to a systematical assessment of MMR, BRAF and MLH1 methylation statuses. In univariate analysis, parameters associated with better overall survival were age (P < 0.0001), metastatic resection (P = 0.001) and LS-like mCRC (P = 0.01), but not BRAFV600E. In multivariate analysis, age (hazard ratio (HR) = 3.19, P = 0.01) and metastatic resection (HR = 4.2, P = 0.001) were associated with overall survival, but not LS. LS-like patients were associated with more frequent liver involvement, metastatic resection and better disease-free survival after metastasectomy (HR = 0.28, P = 0.01). Median progression-free survival of first-line chemotherapy was similar between the two groups (4.2 and 4.2 months; P = 0.44).ConclusionsLS-like and sporadic MSI/dMMR mCRCs display distinct natural histories. MMR, BRAF mutation and MLH1 methylation testing should be mandatory to differentiate LS-like and sporadic MSI/dMMR mCRC, to determine in particular whether immune checkpoint inhibitors efficacy differs in these two populations.     

DNA错配修复蛋白表达与胃腺癌临床病理特征的关系及意义

目的:检测DNA错配修复（mismatch repair,MMR）主要蛋白（MLH1、MSH2、MSH6和PMS2)在人胃腺癌组织中的表达,并分析错配修复缺陷（defective mismatch repair,dMMR）与胃腺癌临床病理因素及预后的关系。方法:采用免疫组织化学染色法检测4种MMR蛋白（MLH1、MSH2、MSH6和PMS2)在120例人胃腺癌组织中的表达,并从癌症基因组图谱（The Cancer Genome Atlas,TCGA）公共数据库下载432例胃腺癌患者的临床病理资料和微卫星不稳定性（microsatellite instability,MSI）的检测结果,分析MSI与胃腺癌临床病理特征的关系,利用TCGA的数据分析高频度微卫星不稳定（MSI-H）与胃腺癌患者预后的关系。结果:免疫组化染色结果显示在120例胃腺癌组织中,MMR蛋白表达正常（pMMR）组106例（88.3%）,MMR蛋白表达缺失（dMMR)组14例（11.7%）,其中MLH1缺失2例（1.7%）、PMS2缺失13例（10.8%）、MLH1和PMS2共同缺失2例（1.7%）、MSH2和MSH6共同缺失1例（0.8%）。统计分析结果显示,dMMR与胃腺癌淋巴结转移相关（P=0.022）,而与其他临床病理因素无关。TCGA数据统计分析结果显示,MSI-H与胃腺癌患者年龄（P=0.001)、性别（P=0.000)、原发肿瘤部位（P=0.000)、Lauren分型（P=0.011）、肿瘤浸润深度T分期（P=0.024)、淋巴结有无转移（P=0.008)有关。Kaplan-Meier生存分析结果显示MSI-H型胃腺癌患者有预后更好的趋势,但差异不具有统计学意义（P=0.070）。结论:120例中国胃腺癌患者中MSI/dMMR型胃腺癌占比为11.7%,且dMMR状态与胃腺癌的淋巴结转移呈负相关;MSI-H型胃腺癌患者具有年龄大、多为女性、肿瘤多位于胃远端、肿瘤浸润深度T分期低、无淋巴结转移的特征,且MSI-H型胃腺癌具有预后更好的趋势,但不具有统计学意义。MSI状态与胃癌预后的关系尚需进一步深入研究和大样本数据的验证。     

Association between DNA mismatch repair gene polymorphisms and platinum-based chemotherapy toxicity in non-small cell lung cancer patients

Background: Chemotherapy toxicity is a serious problem from which non-small cell lung cancer (NSCLC) patientssuffer. The mismatch repair (MMR) system is associated with platinum-based chemotherapy toxicity in NSCLC patients.In this study, we aimed to investigate the relationship between genetic polymorphisms in the MMR pathway andplatinum-based chemotherapy toxicity in NSCLC patients.Methods: A total of 220 Chinese lung cancer patients who received at least two cycles of platinum-based chemotherapywere recruited for this study. Toxicity was evaluated in each patient after two cycles of chemotherapy. A totalof 44 single nucleotide polymorphisms were selected to investigate their associations with platinum-based chemotherapytoxicity.Results: MutS homolog 2 (MSH2) rs6544991 [odds ratio (OR) 2.98, 95% confidence interval (CI) 1.20–7.40, P = 0.019]was associated with gastrointestinal toxicity in the dominant model; MSH3 rs6151627 (OR 2.38, 95% CI 1.23–4.60,P = 0.010), rs6151670 (OR 2.05, 95% CI 1.07–3.93, P = 0.031), and rs7709909 (OR 2.38, 95% CI 1.23–4.64, P = 0.010)were associated with hematologic toxicity in the dominant model. Additionally, MSH5 rs805304 was significantly associatedwith overall toxicity (OR 2.21, 95% CI 1.19–4.09, P = 0.012), and MSH5 rs707939 was significantly associated withboth overall toxicity (OR 0.42, 95% CI 0.23–0.76, P = 0.004) and gastrointestinal toxicity (OR 0.44, 95% CI 0.20–0.96,P = 0.038) in the dominant model.Conclusion: Genetic polymorphisms in the MMR pathway are potential clinical markers for predicting chemotherapytoxicity in NSCLC patients.     

Era of universal testing of microsatellite instability in colorectal cancer

Colorectal cancer (CRC) incidence and mortality are constantly decreasing, but CRC still remains the third most prevalent cancer and the third most common cause of cancer death in both males and females in the United States. Recent rapid declines in CRC incidence rates have largely been attributed to increases in screening that can detect and remove precancerous polyps, and the decrease in death rates for CRC largely reflects improvements in early detection, treatment and the understanding of molecular/genetic basis of CRC. One of the important molecular/genetic findings is the presence of microsatellite instability (MSI) in CRCs. Many studies have shown the importance of MSI testing in diagnosing Lynch syndrome and predicting prognosis and response to chemotherapeutic agents in CRCs. Increased emphasis has been placed on the importance of MSI testing for all newly diagnosed individuals with CRCs. Both immunohistochemical staining (IHC) and polymerase chain reaction (PCR)-based MSI testing show high sensitivity and specificity in detecting MSI. The current clinical guidelines and histopathology features are indicative of, but not reliable in diagnosing Lynch syndrome and CRCs with MSI. Currently, there are evidences that universal testing for MSI starting with either IHC or PCR-based MSI testing is cost effective, sensitive, specific and is getting widely accepted.