Classification and risk assessment of individuals with familial polyposis, Gardner's syndrome, and familial non-polyposis colon cancer from [3H]thymidine labeling patterns in colonic epithelial cells

A probabilistic analysis has been developed to assist the binary classification and risk assessment of members of familial colon cancer kindreds. The analysis is based on the microautoradiographic observation of [3H]thymidine-labeled epithelial cells in colonic mucosa of the kindred members. From biopsies of colonic mucosa which are labeled with [3H]thymidine in vitro, the degree of similarity of each subject's cell-labeling pattern measured over entire crypts was automatically compared to the labeling patterns of high-risk and low-risk reference populations. Each individual was then presumptively classified and assigned to one of the reference populations, and a degree of risk for the classification was provided. In carrying out the analysis, a linear score was calculated for each individual relative to each of the reference populations, and the classification was based on the polarity of the score difference; the degree of risk was then quantitated from the magnitude of the score difference. When the method was applied to kindreds having either familial polyposis or familial non-polyposis colon cancer, it effectively segregated individuals affected with disease from others at low risk, with sensitivity and specificity ranging from 71 to 92%. Further application of the method to asymptomatic family members believed to be at 50% risk on the basis of pedigree evaluation revealed a biomodal distribution to nearly zero or full risk. The accuracy and simplicity of this approach and its capability of revealing early stages of abnormal colonic epithelial cell development indicate potential for preclinical screening of subjects at risk in cancer-prone kindreds and for assisting the analysis of modes of inheritance.

12-O-Tetradecanoylphorbol-13-acetate stimulation of DNA synthesis in cultured preneoplastic familial polyposis colonic epithelial cells but not in normal colonic epithelial cells

We have developed a method for the routine primary culture of human colonic epithelial cells. Cultured cells exhibited characteristic epithelial structures, including a brush border and junctional complexes. Flask-like goblet cells containing mucus were also seen within the epithelial monolayer. [3H]Thymidine labeling indices were used to distinguish between cultured cells from familial polyposis patients, other patients at high risk to develop colon cancer, and low-risk control subjects. 12-O-Tetradecanoylphorbol-13-acetate (TPA) at 10 ng/ml enhanced DNA synthesis an average of 8-fold when assayed by labeling index in colonic epithelial cells from five of six familial polyposis patients. No such stimulation by TPA was seen in cells from 13 high-risk patients without familial polyposis or in cells from five low-risk subjects. Hundreds of benign polyps can be found in the colons of familial polyposis patients. One such benign tubular adenoma exhibited the same enhancement of DNA synthesis by TPA as normal-appearing epithelial cells from a biopsy adjacent to that polyp. Mitogenic response to TPA had been seen earlier in cells from each of four tubular adenomas (Friedman, E. Cancer Res., 41: 4588-4599, 1981). Both familial polyposis epithelial cells and adenoma cells are considered preneoplastic, but they are not identical because their patterns of actin cytoskeletal organization differ. These results imply that familial polyposis epithelial cells are precursors of tubular adenoma cells, and their transition to the more advanced preneoplastic cells of this benign tumor is influenced by endogeneous tumor promoters.

Method of binary classification and risk assessment of individuals with familial polyposis based on [3H]TdR labelling of epithelial cells in colonic crypts

An analysis has been developed to improve the quantitation of abnormal patterns of tritiated thymidine [(3H]TdR) labelling of colonic epithelial cells, in biopsy specimens removed from human subjects at varying degrees of risk for colon cancer. After pulse incubation of specimens of colonic mucosa with [3H]TdR, each subject's microautoradiographic epithelial cell labelling distribution was segregated into eleven compartments over entire colonic crypts. The findings of each subject were then analysed to determine their relative degree of similarity to the findings for two reference populations of interest, i.e. a high-risk and a low-risk population; the individual was then classified as being closer to one or the other of the reference populations. The analysis developed is based upon a comparison of multinomial probabilities for the distributions of the labelled cells within the crypts, and permits the routine categorization of uneven distributions of labelled cells. For each subject, certain linear scores, a prognostic index based on them, and a related presumptive risk, were calculated. The sensitivity with which individuals known to be symptomatic for polyposis, and the specificity with which individuals known to be at lower risk were determined, were 73 and 93% respectively. The results suggest that this method of distinguishing among integer distributions of [3H]TdR- labelled cells in biopsies of colonic mucosa, may provide a useful basis for identifying individuals with familial polyposis, by separating their labelling patterns from those of low-risk subjects.

Screening and genetic counseling for beta-thalassemia trait in a population unselected for interest: comparison of three counseling methods

We have assessed the effects of screening and genetic counseling for beta-thalassemia trait on knowledge, attitudes, and behavior in a prospective, controlled study of randomly selected adult members of a health maintenance organization. We report here that knowledge of manifestations and of inheritance of thalassemia, previously reported to be high immediately after counseling, were well maintained at 2 and 10 months following counseling. There was no detectable impairment of self-concept. Marital adjustment improved, and sexual activity increased significantly. Mood, assessed immediately before and after counseling, showed no undesirable changes. A patient-structured counseling method, designed to minimize negative psychological effects via discussion of feelings, was not superior to conventional and programmed methods, described in our previous reports, in terms of learning or attitude change.

Health-care seeking by men in their spouse's pregnancy

This study compares the health-care seeking by 212 married male members of a health maintenance organization of 36,000 whose wives were pregnant, with a group of 212 " nonexpectant " married men matched for age, number of prior children, and HMO membership. Retrospective, blind chart review was used to examine the number and timing of medical visits and the types of symptoms, diagnoses, testing, and treatments recorded over the 21-month period surrounding and including each wife's pregnancy. Contrary to prior reports, the expectant fathers had a significantly lower group visit rate during the nine months of pregnancy when compared to their visit rates before conception and after delivery (p less than 0.01). The control group had a constant visit rate over the same time intervals. The types of symptoms and diagnoses recorded in the medical record over time were comparable in the two groups. The study suggests that expectant fatherhood, a clearly defined psychosocial event for a male, significantly influences health-care seeking but not the types of symptoms presented or diagnoses made.

The medical interview: a core curriculum for residencies in internal medicine

A core curriculum for teaching medical interviewing is presented that enhances the internist's skills in a broad range of interactions with patients. Learning these skills is now left to chance and is often deficient. Four objectives are developed: patient-centered interviewing and treatment; an integrated (biopsychosocial) approach to clinical reasoning and patient care; personal development of humanistic values; and psychosocial and psychiatric medicine. Teaching options include real and simulated encounters with patients, observation with discussion, and use of groups. A general strategy for implementing the curriculum at the local level requires the intellectual and financial support of the dean and department chairman, and a multidisciplinary faculty committed to developing, implementing, and evaluating the curriculum. At many programs, faculty development will be necessary.

The identification of high risk populations

This presentation is concerned with the early identification of individuals at increased risk for cancer of the large intestine. To facilitate this work we developed a comprehensive register of individuals at high risk for colorectal cancer at Memorial Sloan-Kettering Cancer Center. The high risk groups are characterised by an hereditary predisposition to colorectal cancer, as suggested by familial associations or early ages of onset of neoplasia, or by the presence of a previous disease of the large intestine believed to be associated with premalignancy. Recent information on the biological characteristics of colonic mucosa, and related findings in individuals with increased susceptibility to colorectal cancer, are summarised in this review. Particular reference is made to proliferate abnormalities that develop during early stages of neoplastic cell transformation, and to new methods of measurement which facilitate the identification of early abnormalities.

Fetal antigens in the precursor stages of gastric cancer

Gastric epithelial cells, identified in biopsy specimens from individuals with varying degrees of gastritis and cellular atypia, were classified according to morphology and reactivity with an adult tissue-absorbed rabbit antibody to 2nd trimester human fetal tissue. Sections of stomach from normal individuals and patients with superficial gastritis were generally unreactive with this antibody as determined by immunoperoxidase microscopy. However, a progressive increase in the frequency of antigen-positive gastric epithelial cells was observed during the transition from superficial gastritis to mature metaplasia to dysplasia. Adjunct immunohistologic subclassification of gastric lesions, thus, appears to be possible using a suitably prepared antibody probe. This approach may provide additional parameters necessary for assessment of preneoplastic syndromes and contribute to clinical staging of gastric disease.

Methionine dependence in skin fibroblasts of humans affected with familial colon cancer or Gardner's syndrome

Reduced growth in methionine-deficient, homocysteine-, folic acid-, and vitamin B12-supplemented medium, a characteristic of tumor and transformed cell lines, was investigated in skin fibroblasts of patients affected with hereditary colon neoplasms. The presence or absence of this phenotype was studied in 37 cell lines from either low-risk subjects or members of families with Gardner's syndrome (GS) or familial colon cancer (FCC). Growth constants of skin fibroblasts of the low-risk group were not significantly different in the presence of methionine (Kme) or absence of methionine (Kho) (0.106 +/- 0.011 and 0.098 +/- 0.011, respectively). However, growth constants of skin fibroblasts of both GS and FCC were significantly reduced in the absence of methionine. In GS, Kho = 0.086 +/- 0.006 and Kme = 0.120 +/- 0.006 (P less than .01). In FCC, Kho = 0.048 +/- 0.007 and Kme = 0.084 +/- 0.009 (P less than .01). Thus the growth of skin fibroblasts from both GS and FCC was methionine dependent. This phenotype was expressed in skin fibroblasts of an individual several years before any clinical manifestation of GS. In all populations studied the phenotype was independent of the age or sex of the individuals, aging of the cell lines, low serum concentration, and acute carcinogen treatment. In addition, there is a significant correlation (r = -0.85, P less than .001) between the disorganization of actin cables of the skin fibroblasts and the ratio of the growth constants. These data constitute the first report demonstrating methionine dependence in cell lines that are not derived from transformed cells, tumor cells, or fetal cells but are derived from skin fibroblasts of patients with hereditary colonic neoplasms. Inasmuch as these cells are not target cells related to colon cancer, the phenotype appears to be the expression of an inherited autosomal dominant genotype related to the oncogenic transformation.

Natural antibodies in human sera directed against blood-group-related determinants expressed on colon cancer cells

Sera from 136 normal males and 33 members of families at high risk for colon cancer were tested for reactivity with six colon cancer cell lines by the protein A-mixed hemadsorption assay. Ninety-one sera had antibodies to colon cancer cell line HT-29. In 89 cases the antibodies were absorbed by human A and B erythrocytes or sheep erythrocytes. Antibodies in the remaining two sera, which were from sisters in the high-risk group, were not absorbed by red cells but could be absorbed by tumor cells expressing A or B blood-group determinants. Their reactivity was inhibited by some soluble blood-group glycoproteins. One serum (No. 4) was inhibited by A-active glycoproteins from human saliva and ovarian cyst fluids and from porcine mucosa, as well as by a polysaccharide derived from gastric cancer; it has an anti-A-like specificity. The other serum (No. 6) was inhibited by A and B glycoproteins, by a blood group precursor glycoprotein and by the same gastric cancer polysaccharide; it seems to have a wider specificity directed towards both A- and B-like structures. It is not known what caused production of these antibodies but it may be significant that they occurred in members of a family at high risk for developing colon cancer.

Reduced capacity for DNA repair synthesis in patients with or genetically predisposed to colorectal cancer

Peripheral resting mononuclear leukocytes were compared for their capacities to repair DNA lesions induced by a 1-hour exposure to a standardized 10-microM dose of N-acetoxy-N-2-fluorenylacetamide (N-AcO-2-FAA). Leukocytes from the following 3 groups were studied: 39 control subjects, 40 patients after colonic resection because of colorectal cancer (disease-free at the time of this study), and 28 individuals with a hereditary predisposition to colorectal cancer. Although the level of N-AcO-2-FAA that bound to mononuclear leukocyte DNA was the same for the various population groups, the level of N-AcO-2-FAA-induced unscheduled DNA synthesis (UDS) was significantly reduced in the mononuclear leukocytes of individuals who had had colorectal cancer or a genetic predisposition for the disease. These findings indicate that a deficiency in mononuclear leukocyte DNA repair synthesis is associated with the development of colorectal cancer in these populations. Our observation of this nonspecific UDS deficiency (relating to colorectal cancer) was not explained by experimental variations among the sampled groups with regard to individual differences in lymphocyte heterogeneity, age, sex, smoking habits, or blood pressure.

Expression of gastric-associated antigens by human premalignant and malignant colonic epithelial cells

A rabbit antiserum prepared to 2nd-trimester fetal organ extracts and absorbed with adult tissue (anti-STFa) was used to detect antigens common to 2nd-trimester fetal large bowel, normal adult stomach, several colon carcinoma cells (in primary and established cultures) and epithelial cells cultured from benign colonic polyps. The frequency of anti-STFa-positive cells was highest in cultures derived from benign tumors known to be associated with a greater degree of premalignancy. Thus, the percentage of antigen-positive cells increased from 18 and 43% to 70% of cultures from tubular, villotubular and villous adenomas, respectively. Considerable heterogeneity in the distribution of antigen-containing cells was evident within any given area of a positive culture. Absorption experiments, using a spectrum of fetal and normal adult tissue extracts, indicated that the adenoma-carcinoma specificity resides in fetal, but not adult, large bowel and normal adult stomach.

The couvade syndrome: an epidemiologic study

A tracer condition, to be used for clinical epidemiologic examination of psychosociogenic illness, must be common and clearly identifiable, distinguishable from concomitant physical problems, and found in general care. These criteria are met by couvade syndrome, the seeking of care for pregnancy-related symptoms by the mates of expectant women. Records of the mates of 267 postpartum women, representing a systemic sample of all births in a health maintenance organization of 36,000, were rated for the presence of nausea, vomiting, anorexia, abdominal pain, abdominal bloating, and other symptoms. Each patient was his own control. Sixty men (225 of 1000) sought care for couvade syndrome; they had a twofold increase in visits (p less than 0.001); had four times more symptoms than during control periods (p less than 0.001); and received twice as many prescriptions for medication as the men without this syndrome (p less than 0.05). The health care providers did not tend to recognize the "expectant" status of these patients or note the presence of the syndrome.

Cell proliferation in explant cultures of human colon

Biopsy specimens of human colonic mucosa taken from the rectosigmoid of 12 normal subjects were maintained in explant culture for 4 days. Histological, microautoradiographic and chemical measurements were carried out to evaluate cell replication, the effect of deoxycholic acid, and the incorporation of uridine and leucine into RNA and protein. Active cell replication was shown to be greatest during the first day of organ culture, and the number of cells that synthesized DNA also increased when deoxycholic acid was added to the culture medium. At later times, with morphological evidence of tissue viability, the synthesis of DNA, RNA, and protein within colonic epithelial cells decreased, and the total number of cells in the crypt columns declined. Findings indicate good maintenance of metabolic activities of colonic epithelial cells in short-term explant culture, and the utility of both cell-kinetic and morphological observations in assessing the status of colonic explants at early and late intervals.

Differential response of familial polyposis fibroblasts to two bifunctional alkylating agents

Skin fibroblasts from three subjects with familial polyposis coli, a hereditary disorder predisposing to colon cancer, exhibited an unexpected insensitivity to mitomycin C (MMC). Sister chromatid exchanges (SCEs) were either reduced or unchanged after exposure to MMC, while another bi-functional alkylating agent, diepoxybutane (DEB), induced an increase in SCE level at a low, equitoxic dosage in parallel experiments. Increased sensitivity to MMC as assayed by colony formation was, however, shown by one of the subjects with polyposis. These cells with the familial polyposis genotype may have a deficiency in the DNA repair system handling MMC-induced alkylation damage yet remain capable of repairing damage induced by DEB alkylation. This deficiency may contribute to the increased frequency of neoplastic transformation known to occur in these cells in vivo.

Genetic counseling for beta-thalassemia trait following health screening in a health maintenance organization: comparison of programmed and conventional counseling

Providing adequate counseling of patients identified in genetic screening programs is a major responsibility and expense. Adults in a health maintenance organization, unselected for interest, were screened for beta-thalassemia trait as part of preventive health care. Counseling was provided by either a trained physician (conventional counseling) or by a videotape containing the same information followed by an opportunity to question a trained physician (programmed counseling). Immediately before and after counseling, knowledge of thalassemia, knowledge of genetics, and mood change were assessed by questionnaire. Comparable mood changes and similar learning about thalassemia and genetics occurred with both counseling methods. Thus, as judged by immediate effects on knowledge and mood, videotaped instruction can greatly reduce professional time required for genetic counseling and facilitate the incorporation of genetic screening into primary health care.

Tissue culture of human epithelial cells from benign colonic tumors

Human colonic epithelial cells from three classes of benign tumors have been reproducibly cultured free of fibroblasts for 8 wk using a supplemented Medium 199 (M 199S). The cultured colonic cells were identified as epithelial by the presence of junctional complexes (tight junctions, gap junctions, and desmosomes), a brush border on the apical surface, keratin fibrils, and by both a close-packed columnar or cuboidal morphology and the capability to transport water and ions to form hemicysts. Colony formation was initiated by groups of epithelial cells, not by single cells, and was inhibited by cocultivation with either lethally irradiated 3T3 cells or human diploid fibroblasts. Enhancement of epithelial colony formation was observed following culture on nonadherent, "floating" substrates compared with substrates attached directly to the bottom of the culture dish. Replication of epithelial cells in M 199S from the class of benign colonic tumors least prone to malignancy, the tubular, was significantly enhanced by epidermal growth factor (EGF). In contrast, EGF did not stimulate the growth of cells in M 199S from the other classes of benign tumors, the villotubular and the villous, which exhibit more malignant potential. These data imply that premalignant colonic epithelial cells lose responsiveness to growth modulation by EGF as they progress toward frank carcinoma.

Nondegradation of fecal cholesterol in subjects at high risk for cancer of the large intestine

In previous studies subjects with familial polyposis, the autosomal dominant disease leading to colon cancer, excreted higher levels of fecal cholesterol than normal subjects, with decreased conversion to degradation products. Findings suggested fecal cholesterol degradation as a marker of hereditary predisposition to colon cancer. Current measurements now have shown that affected individuals and asymptomatic progeny in a second population group with inherited predisposition to colon cancer are low converters of fecal cholesterol. The latter group consisted of highly colon cancer prone families without polyposis, in which patterns of inheritance similar to the autosomal dominant pattern of familial polyposis were observed. 24-h stool collections were obtained from 72 subjects who consumed mixed western diets. Mean percent degradation of fecal cholesterol to coprostanol, coprostanone, cholestanol, and cholestanone revealed significant decreases in fecal cholesterol conversion in affected and asymptomatic subjects in colon cancer prone families without polyposis (P < 0.001) compared to controls. This is in addition to those with familial polyposis (P < 0.001), and extends this marker of colon cancer susceptibility to a second population group with hereditary predisposition to colonic neoplasia.

Transplantation of adenomatous polyps, normal colonic mucosa and adenocarcinoma of colon into athymic mice

Fragments of benign colonic adenomatous polyps of man, adenocarcinoma of the colon of man, and normal colonic mucosa of man and rodent were transplanted under the kidney capsule of athymic mice. Benign human adenomatous cells survived for periods of up to 28 days, normal rodent colonic epithelial cells for 45 days and colonic carcinoma cells for 43 days. This was demonstrated by morphologic criteria, and by the incorporation of tritiated thymidine into DNA of the epithelial cells. The transplantation technique can supplement organ culture methods for the maintenance of adenomatous tissue derived from human colonic mucosa, in order to facilitate studies of growth characteristics and transformation of the cells.

Organization of actin-containing cables in cultured skin fibroblasts from individuals at high risk of colon cancer

Actin-containing cables were examined by immunofluorescence in cultured skin fibroblasts from individuals genetically prone to colon cancer. The study confirmed our earlier finding of an altered distribution of actin-containing cables in skin fibroblasts of patients with hereditary adenomatosis of the colon and rectum (ACR) (Kopelovich et al., 1977). Abnormalities were also found in about one-half of the asymptomatic offspring at risk for ACR, while a polyposis-free branch of one ACR family showed a normal pattern of actin-containing cables. Persons from colon cancer-prone (CCP) families without polyposis, and normal controls, showed no disturbance in the actin patterns. The results suggest that this phenotypic marker may be useful in identifying ACR gene carriers and in probing cellular controls of carcinogenesis.

Screening and genetic counseling for beta-thalassemia trait in a population unselected for interest: effects on knowledge and mood

To evaluate the effects of genetic screening and counseling in a population unselected for interest, adults in a health maintenance organization (HMO) were screened for beta-thalassemia trait as part of health care or multiphasic screening. Counseling was provided by either a trained physician or a videotape containing the same information, followed by an opportunity to question a trained physician. Knowledge of thalassemia, knowledge of genetics, and mood were assessed by standardized questionnaires and by interview immediately before and after counseling. Compared to controls, trait subjects demonstrated significant learning about thalassemia (P less than .001) and about genetics (P less than .001) and recorded significant mood changes, namely, surprise (startle) (P less than .05), increased alertness (decreased deactivation) (P less than .05), and decreased skepticism (P less than .01). Screening and genetic counseling for beta-thalassemia trait conducted as part of multiphasic screening of the population of a HMO, essentially and unselected population, can result in significant overall learning with acceptable effects on mood.

The identification of individuals at high risk for large bowel cancer: an overview

Attempts to identify individuals with increased susceptibility to colon cancer before clinical manifestations of disease, have recently been made. Early stages of abnormal growth of colonic epithelial cells, and related factors that may contribute to the development of colonic neoplasia have been shown. Based on the identification of early findings, programs to prevent the evolution of malignancy in individuals at increased risk are under consideration at the present time.

Serum stimulation of human fibroblasts: effect on non-histones of nuclear ribonucleoprotein and chromatin

In quiescent human fibroblasts stimulated to proliferate by fresh medium plus 15% serum, no changes were seen in the incorporation of 3H tryptophan into the protein of nuclear ribonucleoprotein during the first three hours following re-feeding. This was in contrast to non-histone chromosomal proteins where the incorporation increased by 90% within ten minutes. The density of the formaldehyde fixed nuclear ribonucleoprotein in CsCl was 1.43-1.44 g/ml and this also did not change following stimulation. The electrophoretic profile of the proteins of nuclear ribonucleoprotein on SDS gels exhibited a predominant band corresponding to a molecular weight of 44,000 closely trailed by a band at 47,000 and other bands at higher molecular weight. This pattern was not altered by serum stimulation and the same was true for the more complex electrophoretic profile of the chromatin proteins. Following a 10-minute pulse of 3H-tryptophan at ten minutes after stimulation, there was a selective increase in the labeling of non-histone chromosomal protein of molecular weight 59,000; no change was seen in the labeling of any protein of nuclear ribonucleoprotein.

Defective recognitive immunity in family aggregates of colon carcinoma

Cancer-free individuals from family agregates of seemingly hereditary colon carcinoma were studied to determine the nature of their cell-mediated immune capacities in miexed leukocyte culture. Members of families who demonstrated no evidence of a precancerous condition such as polyposis coli did demonstrate substantial cellular immunopathology. Of these, 44% showed a decreased responsiveness of their peripheral mononuclear cells to allogeneic stimuli, and in a number of these individuals this deficiency clearly manifested itself as an inappropriate suppression of potentially normal lymphocyte blastogenic capacities by an adherent population of mononuclear leukocytes. This in vitro defect of recognitive immunity appears to be the same type of defect that has already been described for individuals with established maligancies. The pattern of phenotypic expression of this immunopathology within these families is not inconsistent with an hereditary disorder. Individuals from families with a known hereditary somatic precancerous condition usually did not demonstrate this immunopathology. It is appropriate to speculate that the defect of recognitive immunity in the former families could be contributory to the genesis of the colon carcinoma.

Recent studies on the identification of proliferative abnormalities and of oncogenic potential of cutaneous cells in individuals at increased risk of colon cancer

This recent study describes the growth characteristics of ACR skin fibroblasts in culture and their differential susceptibility to transformation by Kirsten murine sarcoma virus (Ki-MSV). The SF were derived from normal appearing subepidermoid biopsies of ACR individuals, their progeny and ocntrols. Normal SF were contact-inhibited and grew only in 15% FCS. SF of ACR subjects, and some asymptomatic ACR progeny were not contact inhibited, grew in both 1% and 15% FCS and were considerably more susceptible to transformation by Ki-MSV than were control SF. The virally transformed SF showed a loss of anchorage dependency in methylcellulose and formed tumors in athymic mice. The results suggest the presence of early and previously undetected metabolic lesions in SF from clinically asymptomatic subjects. These phenotype markers are currently evaluated for their utility in the clinical diagnosis of individuals with latent ACR and those at increased risk for colon cancer. SF from ACR individuals have been recently shown to contain significant alterations in the intracellular distribution of actin (R. Pollack and L. Kopelovich, in preparation), and elevated levels of plasminogen activator (L. Kopelovich).

Fecal bile acids and neutral sterols in patients with familial polyposis

Fecal neutral steroids and bile acids were measured in patients with familial polyposis, family controls who are immediate relatives of patients, and controls other than relatives. All subjects were consuming a mixed Western diet at the time of collection of stool specimens. Although the total fecal neutral sterol concentrations were not different between the groups, the patients with familial polyposis excreted a high amount of cholesterol and low levels of coprostanol and coprostanone compared with other groups. Patients with familial polyposis excreted levels of total bile acids in their feces comparable to those excreted by controls; lithocholic acid excretion was decreased in patients with familial polyposis. These findings suggest that analysis of stools for cholesterol and its metabolites be useful in screening the siblings of polyposis families for latent disease.

Growth abnormalities of cultured human skin fibroblasts derived from individuals with hereditary adenomatosis of the colon and rectum

A heritable propensity to develop malignant lesions is found in individuals with familial adenomatosis of the colon an rectum (ACR) and the Gardner's syndrome variant, an autosomal dominant trait. In the present study, the growth characteristics of cultured skin fibroblasts (SF) derived from normal-appearing flat skin biopsies of ACR families, representing all phenotypes, and appropriate controls were investigated. SF were obtained from stocks between the second and fifth passages and growth to confluency in Eagle's Minimal Essential Medium (EMEM) supplemented with 15% fetal calf serum (FCS). Following trypsinization, cells were replanted in EMEM supplemented with either 1% or 15% FCS at an initial density of 4 x 10(3) cells/cm2 and counted daily for five days. Normal SF representing several age groups (both sexes) and those obtained from non-afflicted individuals of ACR families grew only in 15% FCS. In contrast, SF from ACR subjects and from embryonal skin grew both in 1% and 15% FCS. SF from several clinically asymptomatic adults, children or ACR patients, grew in 1% FCS as well. Cell cultures from ACR individuals showed regions of criss-crossed arrays and multilayered pattern. These growth properties were not observed in normal cell cultures. The SF from ACR individuals did not grow in methocel, nor did they form tumors in athymic mice. These results suggest the occurrence of previously undetected biochemical alterations in SF taken from ACR genotypes.

Digestion of RNA of chromatin and nuclear ribonucleoprotein by staphylococcal nuclease

Following a 1-h [3H]uridine pulse of cells of a human colon carcinoma line, 15% of the radioactivity in heterogeneous nuclear RNA associated with both chromatin and nuclear ribonucleoprotein was not digested to acid soluble fragments during a 2-h incubation with staphylococcal nuclease (EC 3.1.4.7). These [3H]uridine-labeled oligonucleotides were approximately 26 nucleotides in length. An RNA containing structure which sedimented no faster than 2 S could be isolated from the digests. Major and mino peptide species, of molecular weights 40 000 and 66 000, respectively, were associated with this structure isolated from either chromatin or nuclear ribonucleoprotein. The results demonstrate that some protein of nuclear ribonucleoprotein is complexed with the transcript while it is still associated with chromatin.

Early proliferative changes in intestinal cells

Early lesions in the colonic mucosa of humans and rodents are characterized by similar proliferative changes within their epithelial cell population. Progressive phases of abnormal cell development appear during the evolution of neoplastic transformation in colonic cells of rodents exposed to chemical carcinogens and in humans highly susceptible to gastrointestinal cancer. Identification and classification by phenotype of cells of these individuals at increased risk for colon cancer are leading to new methods to improve the detection and diagnosis of neoplasia in high risk individuals and families. An analytical system of precise numerical definitions is aiding an approach to modify the evolution of advanced stages of neoplasia.