Cell Proliferation in Normal, Preneoplastic and Neoplastic Gastrointestinal Cells

APC in the regulation of intestinal crypt fission

The functional effects of APC (adenomatous polyposis coli gene) germ-line mutations on crypt fission and cell proliferation were investigated in the normal intestine of human familial adenomatous polyposis (FAP) and multiple intestinal neoplasia (MIN) mice. Compared with controls, there was a 19-fold increase in the proportion of crypts in fission in FAP colon [95 per cent confidence interval (CI): 11-32, P < 0.0001], and a 75 and 61 per cent increase in MIN colon (95 per cent CI: 1.08-2.82, P < 0.02) and small bowel, respectively (95 per cent CI: 1.31-1.99, P < 0.001). In marked contrast, no significant differences in intra-cryptal epithelial cell proliferation or mitotic distribution were seen. Furthermore, 10.9 per cent of crypts in FAP were in asymmetrical fission as opposed to only 1 per cent in controls (P = 0.001). The largest relative increases in MIN crypt fission were in the colon (proximal and distal colon:190 per cent, P = 0.02 and 83 per cent, P = 0.01), suggesting that Apc mutations exert their maximal influence site-specifically. However, sites with the highest relative increases were also those with the largest eventual tumour sizes, but not the highest polyp counts. Three-dimensional serial section reconstruction analysis corroborated that FAP adenomas enlarge by crypt fission, which was frequently both asymmetrical and atypical. It is proposed that the absence of an increase in intestinal cell division infers that APC regulates intestinal crypt differentiation, specifically through the crypt cycle. This role appears analogous to the control of axis re-duplication in embryonic development, when downstream targets of APC are over-expressed. It is concluded that in vivo, the major defect in pre-neoplastic intestine harbouring APC mutations is elevated rates of crypt fission, and that this is also the mode by which micro-adenomas enlarge.

Growth kinetics and chemoprevention of aberrant crypts in the rat colon

Single and multiple colonic crypts exhibiting dysplasia that are detectable in situ by staining of rat colon with methylene blue are called aberrant crypts (AC) and may serve as an intermediate marker for colon cancer. In a characterization study, we have established the kinetics of AC growth and development over a period of 20 d following injection of rats with the carcinogen azoxymethane (AOM). AC are not present at 5 d post-injection, but are a constant feature at 10 d and thereafter. Multiple AC, presumably clonal, begin to evolve at 10 d and are consistent by 20 d, forming incipient microadenomata. We have examined 20 candidate chemopreventive agents for inhibition of AC. All agents were given in AIN-76 diet, at two dose levels, with injections of AOM. AC were measured after 5 weeks of growth. Among the most active AC-inhibiting agents were BHA, DFMO, quercetin, diallyl sulfide, 18 beta-glycyrrhetinic acid, and ascorbyl palmitate. In a post-initiation study, the differentiating agent sodium butyrate was ineffective, but piroxicam was highly effective in modulating AC growth. Further, piroxicam inhibited AC development at all stages of growth from single to polycryptal clusters of AC. The AC assay shows marked sensitivity and specificity for screening agents for chemoprevention of colon cancer.

Calcium and colon cancer

Calcium has been hypothesized as being a regulator of cell proliferation in the colon. Epidemiologic studies suggest that ingestion of higher levels of dietary calcium are related to a decreased risk for colon cancer. Short term studies in vitro and in vivo of the proliferative behavior of human and animal colon mucosa verify that calcium does modulate proliferative response. Preliminary clinical studies suggest that the hyperproliferative mucosa of patients at high risk for colon cancer, based on proliferation analysis of biopsied mucosa, became decidedly less proliferative when the subjects were given oral calcium. Our studies address the molecular mechanisms by which calcium controls mucosal proliferation and the ways in which tumor cells circumvent this regulation.

Nuclear binding of tritiated actinomycin in surface epithelial cells from normal stomach and atrophic gastritis

Triated actinomycin binding to DNA is closely linked to the degree of repression in chromatin. 3H-AM binding to DNA is the most pronounced in nuclei of cells committed into cycle. Inversely, in cells in the last steps of their differentiation or (and) in the resting state (non-dividing cells), 3H-AM binding for DNA is diminished down to a baseline since it is limited by the deoxynucleoproteins. Epithelial cells of stomach mucosa and duodenum demonstrate an increased cell uptake of tritiated actinomycin from the surface to the bottom of the pits. In severe gastritis and in intestinalysed metaplasia this was abolished: with a uniform enhancement of 3H-AM binding. These findings seem to indicate that these cells are derepressed.

Ultrastructure of the "transitional" mucosa adjacent to large bowel carcinoma

The transitional mucosa immediately adjacent to large bowel carcinoma was examined in 13 patients by scanning electron microscopy (SEM), and this was correlated with transmission electron microscopy (TEM) and light microscopy (LM). Marked abnormalities were present in this mucosa in 9/13 patients with distortion and loss of the normal architecture. Examination of adenomas showed abnormalities also to be present adjacent to the neoplastic mucosa. In all patients, the transitional mucosa was compared with two pieces of normal mucosa; in one patient, typical changes of transitional mucosa were found in this region. In the remaining patients, normal mucosa by SEM was found to consist to large deep furrows (primary crypts) as well as the crypts of Lieberkuhn (secondary crypts). The secondary crypts structure showed marked individual variation between patients but one type was present in nine patients. It is uncertain whether this is a pattern with a high incidence in the general population, or whether patients with this type of mucosa are particularly predisposed to large bowel carcinoma. SEM may, therefore, play a part in identifying patients particularly likely to develop large bowel carcinoma.