Respirable antisense oligonucleotide (RASON) therapy for allergic asthma

A new technology for treating respiratory disease, respirable antisense oligonucleotides (RASONs), has recently been developed by our group. RASONs are short, single-stranded nucleic acids, generally modified to reduce degradation. They differ from traditional drugs, which usually antagonise preformed proteins already functioning in a disease process. Instead, RASONs can attenuate the expression of disease-associated genes by targeting the messenger RNA (mRNA). Delivered directly to the target tissue, the lung, they avoid the problems of ineffective delivery encountered by other routes of administration. When an adenosine A(1) antisense oligonucleotide was delivered to the lungs of allergic rabbits with up-regulated A(1) adenosine receptors, desensitisation to the bronchoconstrictor effects of adenosine, histamine and a common aeroallergen (dust mite) occurred. The effect on A(1) receptors persisted on average for nearly 7 days. RASON (the phosphorothioate antisense oligonucleotide EPI-2010) administered in low dosage was evenly distributed throughout the lung (with no detectable systemic active metabolites), and was excreted primarily in urine. These results demonstrate that RASONs can be efficiently and effectively delivered to the peripheral lung. They potently and selectively attenuate the expression of disease-associated genes, an approach to therapy which is now being extended to other potentially important mediators of bronchial asthma.

Respirable antisense oligonucleotides as novel therapeutic agents for asthma and other pulmonary diseases

Respirable antisense oligonucleotides (rAsONs) targeting discordantly expressed mediators of inflammation and/or bronchoconstriction and delivered to the lung via inhalation represent a new class of epigenetic-based therapeutics for asthma and other pulmonary diseases. The properties of these agents (solubility, chemical stability, rapid design based on primary DNA sequence information) combine synergistically with characteristics of the lung (non-invasive route of administration directly to the target organ, presence of uptake-modifying surfactant) to enhance the therapeutic potential of these oligonucleotide-based drugs. Their potential is further increased by the possibility of engineering antisense oligonucleotides whose effects are limited to the lung, reducing or avoiding the possibility of systemic toxicity.

RASONs: a novel antisense oligonucleotide therapeutic approach for asthma

Inhalation based approaches enable the local delivery of antisense oligonucleotides (ASONs) to the respiratory tract and thus facilitate the ability of ASONs to target and modulate the activity of discordantly expressed respiratory disease genes. Studies involving EPI-2010, a respirable antisense oligonucleotide (RASON), targeting the adenosine A(1) receptor, a G-protein-coupled-receptor (GPCR) that plays an important role in the aetiology of asthma, demonstrate that ASON therapeutics can be delivered directly to the lung as an aerosol. EPI-2010 has been shown to inhibit adenosine A(1) receptor expression and significantly improve allergen-induced airway obstruction and bronchial hyper-responsiveness in animal models of human asthma. Absorption, tissue distribution, metabolism and excretion (ADME) and safety studies of aerosolised EPI-2010 suggest that phosphorothioate RASONs can be delivered to target respiratory tissues in low, safe, efficacious and long-acting doses. This supports the concept that RASONs offer the potential to address a variety of respiratory targets including those for which approaches employing systemic distribution and systemic bioavailability of the therapeutic agent may be undesirable. In addition, our studies with EPI-2010 indicate that the RASON approach may represent a technology that is uniquely positioned to address the challenges of the post-genome era in respiratory drug discovery, since it enables simultaneous in vivo target validation and antisense therapeutic discovery in an accelerated timeframe.

Absorption, distribution, metabolism, and excretion of a respirable antisense oligonucleotide for asthma

EPI-2010 is a respirable antisense oligonucleotide (RASON), which selectively attenuates discordantly overexpressed adenosine A(1) receptors in allergic lung (Nature 1997;385:721). In the present study, aerosolized [(35)S]-labeled EPI-2010 (5 mg exposure; specific activity 0.055 Ci/mmol) was administered to normal rabbits by endotracheal tube to assess biodistribution, route of elimination, and potential cardiovascular toxicity. The animals were killed at 0, 6, 24, 48, and 72 h after inhalation of EPI-2010. Duplicate aliquots from different tissues and samples were solubilized and assessed for radioactivity. Approximately 1.4% of the total aerosolized EPI-2010 was deposited into the lung. The concentration of the drug in the lung at 0, 6, 24, 48, and 72 h was 64.0 +/- 1.5, 67.0 +/- 4.4, 32.0 +/- 3.7, 23.4 +/- 1.4, and 2.1 +/- 0.5 microg equivalents, respectively. Only a small amount of the radioactivity was detected in extrapulmonary tissues. By 72 h, 67.5% of the administered dose was excreted in the urine, which represented the major pathway of elimination. In postlabeling studies, intact full-length EPI-2010 could only be detected in the lung. Autoradiographic analysis after inhalation of [(35)S]-labeled EPI-2010 showed a relatively uniform deposition of drug throughout the lung. The aerosolized EPI-2010 did not have any significant systemic effects on the cardiovascular system as determined by Cardiomax-II analysis. This pattern of distribution and the lack of effect on cardiovascular function support the concept that RASONs offer the potential to safely address respiratory targets for which systemic distribution and systemic bioavailability may be contraindicated.

Autoradiographic evidence that intrastriatal administration of adenosine A(1) receptor antisense oligodeoxynucleotide decreases adenosine A(1) receptors in the rat striatum and cortex

In this study, the effect of a phosphorothioated A(1) adenosine receptor antisense oligodeoxynucleotide on A(1) receptor density and mRNA in the striatum and cortex of rats was determined. Receptor autoradiography and in situ hybridization revealed a reduction in striatal and cortical A(1) receptor density and cortical A(1) receptor mRNA, respectively, in antisense-treated brains but not in those treated with a mismatch oligonucleotide. There was no change in A(2) receptor binding. These data imply that the corticostriatal pathway synthesizes A(1) receptors and transports them to its terminals.

Oligonucleotide therapy of allergic asthma

The recent increase in the prevalence of and mortality from asthma has inspired several new molecular techniques to improve treatment. Because asthma is a disease of gene polymorphism, gene therapy is unlikely to be effective. Alternative methods use oligonucleotides (ODNs) in the form of (1) DNA vaccination expressing CpG motifs that mimic bacterial DNA or (2) antisense ODNs inhaled and locally deposited into pulmonary airways to specifically modulate receptors for inflammatory mediators. DNA vaccination, a form of "molecular immune surveillance," attenuates a TH2 predominance. Antisense directed against the adenosine A(1 ) receptor abrogates A(1 ) sensitivity, improves allergen-induced immediate airway obstruction, and inhibits the expected increase in histamine responsiveness in allergic rabbits. Adenosine receptor inhibition lasts for an average of 7 days and the majority of the antisense remains in the lung. ODN therapy for asthma seem unlimited, but confirmation awaits the extension from animal models to human studies.

Insight into adenosine receptor function using antisense and gene-knockout approaches

The extensive role of adenosine in discriminating input from the extracellular environment is effected through a series of cell membrane-spanning proteins--the adenosine A1, A2A, A2B and A3 receptors. New genetic and epigenetic tools have emerged that facilitate the elucidation of the function of these receptors with greater specificity than is generally possible with traditional antagonist drugs. These tools include antisense oligonucleotides (epigenetic) and gene 'knockin' and 'knockout' mice (genetic) and are discussed in this article by Jonathan Nyce.

Intrastriatal adenosine A1 receptor antisense oligodeoxynucleotide blocks ethanol-induced motor incoordination

Intrastriatal administration of a 21-mer phosphorothioate antisense oligodeoxynucleotide targeting the adenosine A1 receptor blocked ethanol-induced motor incoordination in the rat and reduced striatal adenosine A1 receptor content, as judged by specific binding of the A1-specific ligand 8-cyclopentyl-1,3-dipropylxanthine (Bmax = 0.350 +/- 0.07, Kd = 1.87 +/- 0.50 nM). No effect upon striatal adenosine A2 receptor content was observed (Bmax = 0.415 +/- 0.04, Kd = 13.13 +/- 1.25 nM) with the A2-specific ligand 2-p-(2-carboxyethyl)phenethylamino-5'-N-ethylcarboxamidoadenosine. A mismatched control oligodeoxynucleotide of identical G-C base composition and general sequence structure was without effect on adenosine A1 receptor (Bmax = 0.666 +/- 0.11, Kd = 1.32 +/- 0.27 nM) or adenosine A2 receptor content (Bmax = 0.501 +/- 0.08; Kd = 14.65 +/- 1.82 nM) or ethanol-induced motor incoordination. These results confirm an important role of the striatal adenosine A1 receptor in mediating certain motor-related physiological effects of ethanol.

Effects of ubiquinone and mevalonic acid on hepatic peroxisomal enzymes induced by dehydroepiandrosterone

The adrenal steroid, dehydroepiandrosterone (DHEA) has been identified as a peroxisome proliferator. We examined the effects of the cellular antioxidant ubiquinone and its precursor mevalonic acid on the induction of enzymes associated with DHEA-mediated peroxisome proliferation in male F-344 rats. Upon treatment with DHEA (300 mg/kg orally for 14 days), there was a significant increase in hepatic activities of peroxisomal beta-oxidation (3 fold), 3-ketoacyl-CoA thiolase (4 fold) and catalase (1.8 fold). Co-administration of either mevalonic acid (100 mg/kg intraperitoneally) or ubiquinone (50 mg/kg orally) with DHEA significantly attenuated the DHEA-mediated induction of these enzymes. However, neither ubiquinone nor mevalonic acid alone significantly altered peroxisomal enzyme activities in rat liver. These data suggest that exogenous administration of ubiquinone or mevalonic acid can modulate the induction of the enzymes involved in peroxisome proliferation.

DNA antisense therapy for asthma in an animal model

Asthma is an inflammatory disease characterized by bronchial hyper-responsiveness that can proceed to life-threatening airway obstruction. It is one of the most common diseases in industrialized countries, and in the United States accounts for about 1% of all healthcare costs. Asthma prevalence and mortality have increased dramatically over the past decade, and occupational asthma is predicted to be the pre-eminent occupational lung disease in the next decade. Increasing evidence suggests that adenosine, an endogenous purine that is involved in normal physiological processes, may be an important mediator of bronchial asthma. In contrast to normal individuals, asthmatic individuals respond to adenosine challenge with marked airway obstruction, and concentrations of adenosine are elevated in the bronchoalveolar lavage fluid of asthma patients. We performed a randomized crossover study using the dust mite-conditioned allergic rabbit model of human asthma. Administration of an aerosolized phosphorothioate antisense oligodeoxynucleotide targeting the adenosine A1 receptor desensitized the animals to subsequent challenge with either adenosine or dust-mite allergen.

Induction of peroxisomal enzymes in rat liver by dehydroepiandrosterone sulfate

Male F-344 rats, when treated with either 150 mg/kg or 300 mg/kg body weight of DHEAS for 14 days, produced a dose-dependent increase in liver weight and peroxisomal beta-oxidation activity, characteristic of peroxisomal proliferation. Contrary to previous observations in vitro, we also found a significant increase in catalase activity in rat liver with the higher dose of the steroid. Furthermore, the in vivo induction of peroxisomal beta-oxidation by DHEAS observed in our study was significantly less than reported in vitro, and also unlike previously reported in vitro results, was approximately equivalent to DHEA administered in vivo.

NPY-Y1 receptor antisense injected centrally in rats causes hyperthermia and feeding

The central actions of neuropeptide Y antisense oligodeoxynucleotide (aNPY) and NPY-Y1 receptor antisense (aNPY-Y1) on body temperature (Tb), feeding and body weight of unrestrained rats were determined by the repeated intracerebroventricular (i.c.v.) injection of 0.5 microgram doses. aNPY-Y1 caused intense phasic rises in Tb, lowered body weight and caused transient feeding. aNPY increased food intake paradoxically, accompanied by a gain in body weight but did not affect Tb. Circadian activity was unaffected by either antisense oligodeoxynucleotide, and the mismatched NPY (mNPY) was without effect. These results show that NPY-Y1 receptors underlie the central thermolytic action of NPY, since aNPY-Y1 induces hyperthermic responses. Overall, the functional reduction in NPY activity by aNPY might cause a compensatory de novo synthesis of NPY in structures remote from the ventricles to augment feeding behavior.

Antisense to NPY-Y1 demonstrates that Y1 receptors in the hypothalamus underlie NPY hypothermia and feeding in rats

Neuropeptide Y (NPY) is a highly potent endogenous peptide which when injected into the medial hypothalamus causes spontaneous eating behaviour and an intense fall in body temperature (Tb). This study used antisense oligodeoxynucleotides (ODNs) to determine whether the Y1 subtype of NPY receptor could underlie these remarkable physiological responses. In the unrestrained rat, the ventromedial hypothalamus (VMH) which is highly reactive to NPY was injected with antisense for NPY (aNPY), Y1 receptors (aNPY-Y1) and mismatched controls (mNPY; mNPY-Y1). After cannulae were implanted bilaterally in the brain of 19 rats, 0.4 or 0.8 microgram per 0.8 microliter of the phosphorothioate synthesised ODNs were delivered to the VMH of the rats at 12 h intervals over 2 d. Only the lower dose of aNPY-Y1, but not aNPY, evoked an intense phasic rise in the Tb following each micro-injection. Simultaneously, 0.4 microgram per 0.8 microliter of aNPY-Y1, but not aNPY, suppressed feeding behaviour after a sequence of micro-injections and on the following day. Body weights and locomotor activity of the rats likewise declined concomitantly with the hyperthermia and hypophagia caused by the Y1 receptor antisense. Neither of the control ODNs for NPY or Y1 receptors injected similarly in the VMH of the rats exerted any effects on these measures. These results clearly provide convincing evidence that in the VMH the Y1 subtype of NPY receptor mediates, in part, the neuronal mechanisms responsible for spontaneous feeding and hypothermia produced by native NPY when applied directly to this structure. The concurrent decline in body weight and activity caused by aNPY-Y1 could be caused by the episodes of hyperthermia.

Anorexic action of a new potential neuropeptide Y antagonist [D-Tyr27,36, D-Thr32]-NPY (27-36) infused into the hypothalamus of the rat

Neuropeptide Y (NPY) produces a vigorous feeding response in several species when it is injected into hypothalamic structures involved in eating behavior. The purpose of this study was to determine whether a unique carboxy terminal fragment of NPY would alter the pattern of eating induced in the rat either by NPY injected into the hypothalamus or by a 24-h period of food deprivation. In this case, two L-tyrosine residues and one L-threonine residue of the NPY27-36 fragment were transformed to their D-conformation to produce [D-Tyr27,36,D-Thr32]-NPY (27-36), i.e., D-NPY27-36. Guide cannulae for microinjection were implanted stereotaxically just dorsal to the paraventricular nucleus (PVN) or ventromedial hypothalamus (VMH) of 24 adult male Sprague-Dawley rats. Following postoperative recovery, a microinjection of artificial CSF or 1.1 microgram or 3.3 micrograms of a peptide was made directly into the PVN or VMH as follows: native NPY; D-NPY27-36; or [L-Tyr27,36, L-Thr32]-NPY (27-36), i.e., L-NPY27-36. Food intakes were measured at intervals of 0.25, 0.5, 1.1, 2.0, 4.0, and 24 h. When D-NPY27-36 was microinjected at NPY reactive sites in the PVN or VMH of the rat 15 min before a similar microinjection of NPY, the intense eating response induced by the peptide was reduced significantly. Not only was the effect dose dependent, but D-NPY27-36 also augmented the latency to feed. A mixture of the two doses of NPY and D-NPY27-36 injected at the same hypothalamic loci did not attenuate the intake of food but tended to enhance the feeding response in the rats.(ABSTRACT TRUNCATED AT 250 WORDS)

Hypotensive effects of [D-Tyr27,36, D-Thr32]Neuropeptide Y (27-36)

An analogue of the 10 C-terminal amino acids of neuropeptide Y (NPY) containing three D-isomeric substitutions (27-36-D) has been synthesized and its cardiovascular activity studied in Sprague-Dawley (SD) and spontaneously hypertensive (SHR) rats. Intravenous administration of 1000 nmol/kg 27-36-D decreases MAP in SHR (-59.9 +/- 5.0 mmHg) and SD rats (-44.4 +/- 4.7 mmHg). The hypotension produced by 1000 nmol/kg 27-36-D diminished by 71.2% following pretreatment with the histamine receptor antagonist diphenhydramine, although histamine depletion with compound 48/80 does not significantly alter this hypotension. These data suggest that NPY (27-36)-D produces a profound and sustained hypotension in two strains of rat which is partially attributable to activity at histamine receptors.

Inhibition of protein farnesyltransferase: a possible mechanism of tumor prevention by dehydroepiandrosterone sulfate

Dehydroepiandrosterone sulfate (DHEAS) is the most abundant adrenal steroid with apparent anticarcinogenic properties. Given our recent observation of the dehydro-epiandrosterone-mediated inhibition of protein isoprenylation and the fact that 99% of the circulating dehydro-epiandrosterone is sulfated, with less than 1% representing the free steroid, we investigated the effects of DHEAS on post-translational isoprenylation of proteins. We here report that exposure of HT-29 SF human colonic adenocarcinoma cells to DHEAS inhibited the incorporation of [3H]mevalonate into cellular proteins in a dose-dependent manner when endogenous mevalonate synthesis was blocked by lovastatin. Interestingly, significant inhibition was observed at concentrations of DHEAS which are comparable to peak serum levels of this steroid occurring in the second decade of life. Immunoprecipitation revealed that isoprenylation of p21ras was also suppressed in DHEAS-treated HT-29 SF cells. In a cell-free system, DHEAS inhibited the farnesylation of a biotinylated decapeptide corresponding to the C-terminus of K-ras by 50% at a concentration of 100 microM. This suggests that DHEAS inhibits isoprenylation of cellular proteins, including p21ras, at a point in the mevalonate pathway distal to 3-hydroxy-3-methylglutaryl-CoA reductase and that the DHEAS-mediated suppression of protein farnesylation may largely be due to inhibition at the level of protein farnesyltransferase. Thus, these findings may provide a plausible explanation for the antitumor activity of DHEAS.

Quantitation of 5-methylcytosine by one-dimensional high-performance thin-layer chromatography

A method for the quantitative analysis of DNA 5-methylcytosine by one-dimensional high-performance thin-layer chromatography using alkylamino modified silica (HPTLC-NH2) plates is described. The preparative method is simple, involving enzymatic digestion of DNA with micrococcal nuclease and phosphodiesterase II to 3'-monophosphate nucleosides, conversion by T4 polynucleotide kinase to 32P-labeled 3',5'-bisphosphate nucleosides, and chromatographic separation of nuclease P1-cleaved 5'-monophosphate nucleosides. The weak, basic anion exchanger property of the HPTLC-NH2 plate enables separation of multiple samples in one dimension, whereas traditional polyethyleneimine cellulose plates require development of individual samples in two dimensions for analysis of 5'-methylcytosine.

Chemotherapy of murine colorectal carcinoma with cisplatin and cisplatin plus 3'-deoxy-3'-azidothymidine

In light of the discouraging results obtained with conventional chemotherapy of human colon cancer using 5-fluorouracil, we examined the effects of cis-diamminedichloroplatinum (cisplatin) alone and combined with 3'-deoxy-3'-azidothymidine (AZT) on chemotherapy of colorectal adenocarcinomas induced by dimethyldrazine in CD-1 mice. Thirteen weeks after a 20 week tumor induction period (15 mg/kg dimethylhydrazine weekly) groups of 19 mice were given either no therapy, or weekly cisplatin (6 mg/kg for 4 wks), AZT (400 mg/kg, wks 3 and 4), or cisplatin and AZT. Animals were autospied at death or after euthanasia on day 99 post initiation of therapy, their colons excised, fixed in buffered formalin and the number and volume of tumors measured. Cisplatin alone or with AZT decreased tumor size by 47-52%, and enhanced survival, leaving 55% of the mice alive at day 99 compared to 18% in controls. These therapeutic effects were amplified when animals were given chemotherapy during recovery from the effects of short-term dietary provision of the anti-carcinogenic steroid, dehydroepiandrosterone (DHEA). Our results suggest cisplatin is an effective chemotherapeutic agent against colon cancer in this murine model, and warrant further studies of its interaction with AZT and DHEA in enhancing this effect.

Mechanisms of cell growth inhibition and cell cycle arrest in human colonic adenocarcinoma cells by dehydroepiandrosterone: role of isoprenoid biosynthesis

We have previously demonstrated that the chemopreventive agent dehydroepiandrosterone (DHEA) inhibits the isoprenylation of cellular proteins by depletion of endogenous mevalonate. We now report that treatment of HT-29 SF human colonic adenocarcinoma cells with DHEA at concentrations ranging from 12.5 to 200 microM for up to 72 h inhibited growth and arrested cells in the G1 phase of the cell cycle in a time- and dose-dependent manner. Exposure to 25 or 50 microM DHEA also transiently delayed cells in G2M phase after 48 h. Addition of mevalonic acid partially overcame both the growth and cell cycle effects of 25 microM DHEA in the initial 48 h. During prolonged exposure (72 h), the addition of mevalonic acid as well as cholesterol was required to reconstitute cell cycle progression. This suggests that the depletion of endogenous mevalonate and other isoprenoids is involved in DHEA-mediated growth inhibition and cell cycle arrest.

Inhibition of protein isoprenylation and p21ras membrane association by dehydroepiandrosterone in human colonic adenocarcinoma cells in vitro

Treatment of mice and rats with the adrenal steroid, dehydroepiandrosterone (DHEA), protects against spontaneous and chemically induced tumors. The mechanism of the chemopreventive action of DHEA, however, remains uncertain. DHEA has been reported to inhibit cholesterol biosynthesis. Mevalonic acid constitutes the basic precursor not only for cholesterol but also for a variety of nonsterol isoprenoids involved in cell growth. Certain of these nonsterol isoprenoids are utilized for posttranslational modification of proteins including p21ras. We therefore investigated the effects of DHEA upon protein isoprenylation. Twenty-four-h exposure of HT-29 SF human colonic adenocarcinoma cells to 50 microM DHEA was associated with significant incorporation of products of [3H]mevalonate metabolism into several size classes of cellular proteins. The pattern of incorporation was similar to that obtained after treatment with 25 microM lovastatin, a specific 3-hydroxy-3-methyl-glutaryl-CoA reductase inhibitor. Very little incorporation of label from [3H]mevalonate was observed in untreated cells. This suggests that [3H]mevalonate gains entrance to isoprenylation sites after treatment with DHEA or lovastatin because of depletion of endogenous mevalonate and subsequent inhibition of protein isoprenylation. Isoprenylation plays a critical role in promoting the association of p21ras with the cell membrane. Posttranslational processing and membrane association of p21ras were both found to be inhibited by DHEA. Thus, it is possible that the inhibition of isoprenylation of p21ras and other cellular proteins by DHEA may contribute to its anti-cancer effects.

Differential feeding responses evoked in the rat by NPY and NPY1-27 injected intracerebroventricularly

Neuropeptide Y (NPY) given by the intracerebroventricular (ICV) route in the rat evokes hyperphagic-like feeding. To examine the molecular nature of action of NPY, comparisons were made between the central effects of this peptide and a newly synthesized amino-terminus fragment, NPY1-27. A single guide tube was implanted stereotaxically to rest just above a lateral cerebral ventricle so that ICV injections in a volume of 10 microliters of either CSF control vehicle or peptide could be given in the unrestrained rat. Native NPY or NPY1-27 was given in doses of 5.0 or 10.0 micrograms, whereas nondeprotected NPY was infused in a dose of 10.0 micrograms. The intakes of either regular commercial rat diet or specially prepared chocolate-flavored biscuits as well as water were recorded intermittently for 4.0 h following each ICV infusion. Although a clear-cut dose response with a latency of similar magnitude emerged for both molecules, NPY was found to be nearly twice as potent as NPY1-27 in inducing spontaneous feeding. A corresponding infusion in the same volume of either nondeprotected NPY or CSF control vehicle was without effect. When chocolate-flavored biscuits were provided to the rat, an ICV infusion of a 10.0 micrograms dose of NPY enhanced significantly both rate of eating and total cumulative intake of flavored food in comparison to that after a similar infusion of NPY1-27 or either control solution. These results suggest that native NPY acting centrally affects gustatory and/or olfactory systems to a much greater degree than does NPY1-27.(ABSTRACT TRUNCATED AT 250 WORDS)

Inhibition of 1,2-dimethylhydrazine-induced colon tumorigenesis in Balb/c mice by dehydroepiandrosterone

Long-term administration of dehydroepiandrosterone (DHEA) to Balb/c mice significantly inhibits the rate of appearance of 1,2-dimethylhydrazine (DMH)-induced macroscopic colon and anal tumors and microscopic precursor and malignant lesions. The steroid, which has previously been shown to inhibit spontaneous breast cancer and chemically induced lung tumors in mice, may find application as a chemopreventive in individuals at high risk for developing colon cancer.