Abstract 1198: Presence of non-canonical tumorigenesis pathways in early-onset sporadic rectal cancer

Chromosomal instability (CIN) caused by β-Catenin dependent aberrant activation of canonical Wnt signaling or Microsatellite instability (MSI) triggered by inactivation of mismatch repair (MMR) pathway, are the two major genetic instability pathways that drive classical age-related sporadic colorectal cancer (CRC). Activation of canonical Wnt signaling and MSI are primary tumor initiating events in about 80% and 15% of late-onset CRC cases, respectively. Canonical Wnt signaling is also reported as a secondary event in tumors primarily driven by MSI. These inferences are based on seminal studies that included a disproportionately greater number of colon tumors (as compared to rectal tumors). Recent genome-wide studies have suggested colon and rectal cancer to be a single entity, though several other studies appear to indicate otherwise. Exclusive studies on rectal cancer (RC), especially the early-onset sporadic subtype, have been fewer. Despite a recent trend of increased worldwide incidence, early-onset sporadic rectal cancer (EOSRC) is not well understood. We profiled canonical Wnt, KRAS and p53 (components of the classical colorectal carcinoma progression model) and MSI status in a panel of 298 colorectal cancer samples. 41% of EOSRC samples did not harbor Wnt or MSI pathways; the high proportion of a ‘double negative’ entity was neither identified in late-onset RC samples nor in colon cancer samples. KRAS mutation frequency was also significantly lower in EOSRC (24%). Since CIN is a hallmark of canonical Wnt activation driven CRC, we profiled genome-wide DNA copy number alterations (CNAs) in microsatellite stable EOSRC samples and surprisingly identified extensive chromosomal aberrations in both Wnt active and Wnt inactive subtypes suggesting the interesting possibility of presence of CIN in the absence of canonical Wnt activation. Several CNAs were detected exclusively in Wnt inactive samples (being absent in Wnt active samples) and were validated by quantitative PCR. As expected, a few CNAs, such as an amplification detected at 17q12 (ERBB2/GRB7), were present in both subtypes. Genome-wide transcript profiling performed in parallel revealed the elevated expression of genes located within the amplifications, validated by quantitative reverse transcription PCR (Q-RT-PCR). More importantly, aberrant activation of non-canonical signaling pathways was identified in a subset of the ‘double negative’ EOSRC samples, based on unsupervised (hierarchical clustering) and supervised (significance analysis of microarrays and gene set enrichment analysis) analyses of the transcriptome data. Elevation of non-canonical pathway gene transcripts was confirmed by Q-RT-PCR. Our study has therefore revealed presence of unique tumorigenesis pathways in EOSRC samples distinct from canonical pathways that drive late-onset CRC.

Citation Format: Ratheesh Raman, Viswakalyan Kotapalli, Raju SR Adduri, Vasantha Kumar Bhaskara, Swarnalata Gowrishankar, Leena Bashyam, Ajay Chaudhary, Mohana Vamsy Chigurupati, Sujith Patnaik, Mukta Srinivasulu, Regulagadda Sastry, Subramanyeshwar Rao, Anjayneyulu Vasala, NarasimhaRaju Kalidindi, Jonathan Pollack, Sudha Murthy, Murali D. Bashyam. Presence of non-canonical tumorigenesis pathways in early-onset sporadic rectal cancer. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 1198. doi:10.1158/1538-7445.AM2013-1198

Abstract 1216: Analysis of genetic aberrations in squamous cell carcinoma of the oral tongue

Squamous cell carcinoma of the oral tongue (SCCOT) is a common form of head and neck squamous cell carcinoma (HNSCC). In the last few decades, a steady increase in incidence rates of SCCOT has been reported across the world including India. SCCOT is known to be an age related disease and tobacco consumption is implicated as the main etiological agent, like other HNSCC subtypes. Recent reports have indicated an increase in incidence of SCCOT in the young and in nonsmokers. Among HNSCC, SCCOT appears to be more aggressive with respect to its clinical and biological behavior. Molecular genetic studies on SCCOT are scarce and most studies have been conducted on a small cohort of patients and/or restricted to a single/few molecular marker(s). We have conducted a multipronged molecular genetic study of SCCOT and analyzed the status of known tumorigenesis pathways including TP53, epidermal growth factor receptor (EGFR), microsatellite instability (MSI), CDKN2A, FHIT and human papilloma virus (HPV) infection in surgically resected primary tumor samples and correlated with clinocopathological variables. 67% (67/100) of SCCOT samples exhibited p53 nuclear stabilization whereas a greater proportion (87/100; 87%) exhibited elevated EGFR expression, in accordance with existing literature. Interestingly, p53 nuclear stabilization was found to be more common in young (31/39; 79.5%) than in older (35/59; 59.3%) patients (p = 0.0481). As expected, patients with p53 nuclear stabilization exhibited poorer survival. Further, PCR based mutation screening of exons 5-8 of TP53 (encoding the DNA binding domain) revealed mutations in 50% of samples exhibiting nuclear stabilization. HPV infection was observed in 11/82 (13.4%) tumors while the frequencies of MSI (12/86; 14%) and loss of heterozygosity (LoH) in CDKN2A (32.6%) and FHIT (28.4%) loci were significantly higher than previous studies. In addition, LoH at FHIT locus was significantly associated with p53 nuclear stabilization (p=0.047). Analysis of genome-wide DNA copy number alterations (CNA) using array based comparative genomic hybridization revealed unique copy number alterations validated by quantitative PCR. Exome sequencing and transcriptome profiling are currently underway to understand the pathways/genes deregulated in SCCOT, especially in samples not exhibiting p53 nuclear stabilization.

Citation Format: Raju Sr Adduri, Viswakalyan Kotapalli, Neha Ak Gupta, Swarnalata Gowrishankar, Mukta Srinivasulu, Subramanyeshwar Rao, Shantveer G. Uppin, Umanath Karopadi Nayak, Mohana Vamsy Chigurupati, Sujith Chayu Patnaik, NarasimhaRaju Kalidindi, Murali D. Bashyam. Analysis of genetic aberrations in squamous cell carcinoma of the oral tongue. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 1216. doi:10.1158/1538-7445.AM2013-1216

Evidence for possible non-canonical pathway(s) driven early-onset colorectal cancer in India

Two genetic instability pathways viz. chromosomal instability, driven primarily by APC mutation induced deregulated Wnt signaling, and microsatellite instability (MSI) caused by mismatch repair (MMR) inactivation, together account for >90% of late-onset colorectal cancer (CRC). Our understanding of early-onset sporadic CRC is however comparatively limited. In addition, most seminal studies have been performed in the western population and analyses of tumorigenesis pathway(s) causing CRC in developing nations have been rare. We performed a comparative analysis of early and late-onset CRC from India with respect to common genetic aberrations including Wnt, KRAS, and p53 (constituting the classical CRC progression sequence) in addition to MSI. Our results revealed the absence of Wnt and MSI in a significant proportion of early-onset as against late-onset CRC in India. In addition, KRAS mutation frequency was significantly lower in early-onset CRC indicating that a significant proportion of CRC in India may follow tumorigenesis pathways distinct from the classical CRC progression sequence. Our study has therefore revealed the possible existence of non-canonical tumorigenesis pathways in early-onset CRC in India.