Molecular Genetics of Hereditary Non-Polyposis Colorectal Cancer (HNPCC)

Public health perspectives on testing for colorectal cancer susceptibility genes

CONTEXT

About 131,600 new cases of colorectal cancer will be diagnosed in the United States in 1998. About 27,900 men and 28,600 women will die from colorectal cancer in 1998. Mutations to the hMSH2 gene on chromosome 2p and to the hMLH1 gene on chromosome 3p have been identified as causes of colorectal cancer. These mismatch repair genes, which have recently been cloned, account for most cases of hereditary nonpolyposis colorectal cancer (HNPCC), one of the most common cancer susceptibility syndromes known. The carrier frequency of hMSH2 and hMLH1 gene mutations in the U.S. population is unknown. An adenomatous polyposis coli (APC) gene variant (I1307K allele), which was recently reported in 1 in 17 Ashkenazi Jewish persons, may double the risk for colorectal cancer in that population.

CONCLUSIONS

The use of genetic tests for susceptibility to cancer of the colon and other sites needs careful scrutiny. Several issues must be addressed before such tests can be recommended for population-based prevention programs. For example, the screening of population subgroups raises concern about potential discrimination and stigmatization. Before genetic tests for colorectal cancer are incorporated into future programs, the safety, effectiveness, and quality of these tests must be evaluated.

Hereditary non-polyposis colorectal cancer syndrome

Hereditary non-polyposis colorectal cancer (HNPCC) syndrome may account for up to 4% of the total colorectal cancer burden in our community. It is assuming an increasingly important role, both as a clinical management issue and as a model for the application of laboratory and clinical genetic services in cancer detection and prevention. Recent developments in the understanding of the molecular biology of the condition have underpinned recommendations for consideration of genetic testing for DNA mismatch repair gene mutation, recommendations that may have far-reaching implications in terms of the numbers of patients offered genetic testing and for associated costs (both financial and psychological). The aim of this review is to highlight the clinical, pathologic and molecular biologic features of HNPCC that underlie the clinical management of affected index patients and their at-risk family members.

Prediction-based threading of the hMSH2 DNA mismatch repair protein

Mutations in the genes whose products participate in DNA mismatch repair underlie the increased risk of cancer in families with hereditary nonpolyposis colon carcinoma. Mutations in hMSH2 account for approximately 50% of the mutations found in these families. We sought to predict the 3-dimensional structure of hMSH2 by identifying structural homologues using prediction-based threading and by computer modeling using information from these putative structurally related proteins. Prediction-based threading identified three candidate structural homologues: glycogen phosphorylase (gpb), a 70 kDa soluble lytic transglycosylase, and ribonucleotide reductase protein R1. An independent approach utilizing a potential-based threading program also identified gpb as a structural homologue. The models based on the structures of these proteins suggest that the ATP binding domain and helix-turn-helix domain are exposed on the outside of the protein. All known bacterial MutS and hMSH2 mutations appear to be clustered in similar vicinities in the theoretical models of hMSH2; the major site is within the ATP binding domain and near the carboxyl-terminal end, whereas a smaller number map to the region coding for exon 5 and the amino-terminal domain. All point mutations also appear to affect amino acids that are exposed on the outside surface of the protein.