Development of an MSI-positive colon tumor with aberrant DNA methylation in a PPAP patient

J Hum Genet. 2019 Aug;64(8):729-740. doi: 10.1038/s10038-019-0611-7. Epub 2019 May 14.

Abstract

Polymerase proofreading-associated polyposis (PPAP) is a disease caused by germline variations in the POLE and POLD1 genes that encode catalytic subunits of DNA polymerases. Studies of cancer genomes have identified somatic mutations in these genes, suggesting the importance of polymerase proofreading of DNA replication in suppressing tumorigenesis. Here, we identified a germline frameshift variation in the POLE gene (c.4191_4192delCT, p.Tyr1398*) in a case with multiple adenomatous polyps and three synchronous colon cancers. Interestingly, one of the colon cancers showed microsatellite instability-high (MSI-H) and another microsatellite stable. Immunohistochemical staining revealed that the MSI-H tumor cells lost the expression of MLH1 protein. Whole genome sequencing of the MSI-H tumor did not find pathogenic somatic mutations in mismatch repair genes but found frameshift mutations in the TET genes that catalyze 5-methylcytosine hydroxylation. Bisulfite sequencing of the tumor corroborated an increase in the number of hypermethylated regions including the MLH1 promoter. These data indicate that PPAP patients might develop MSI-positive tumors through epigenetic silencing of MLH1. These findings will contribute to comprehensive understanding of the molecular basis of tumors that involve deficiency of proofreading activity of DNA polymerases.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Alleles
  • Colonic Neoplasms / diagnosis
  • Colonic Neoplasms / genetics*
  • Colorectal Neoplasms, Hereditary Nonpolyposis / diagnosis
  • Colorectal Neoplasms, Hereditary Nonpolyposis / genetics*
  • DNA Methylation*
  • DNA Mutational Analysis
  • DNA Polymerase II / genetics
  • DNA Polymerase II / metabolism
  • Female
  • Frameshift Mutation
  • Gene Expression Profiling
  • Gene Expression Regulation, Neoplastic
  • Genetic Association Studies*
  • Genetic Predisposition to Disease*
  • Genotype
  • Germ-Line Mutation
  • Humans
  • Immunohistochemistry
  • Male
  • Microsatellite Instability*
  • Neoplasm Staging
  • Pedigree
  • Phenotype
  • Poly-ADP-Ribose Binding Proteins / genetics
  • Poly-ADP-Ribose Binding Proteins / metabolism
  • Repressor Proteins / genetics
  • Whole Genome Sequencing

Substances

  • Poly-ADP-Ribose Binding Proteins
  • Repressor Proteins
  • tetracycline resistance-encoding transposon repressor protein
  • DNA Polymerase II
  • POLE protein, human