Genetic predispositions to colorectal cancer.

Genetic predispositions to colorectal cancer can schematically be divided in two categories depending on the presence or absence of a diffuse polyposis i.e.: a large number of adenomatous polyps in the colon and rectum of affected patients. These syndromes are referred as familial adenomatous polyposis coli and hereditary non polyposis colon cancer (HNPCC) respectively. The gene which when altered causes familial adenomatous polyposis coli is called APC and has been identified in 1991 but the function of its product remained elusive. Recent experimental data indicate that the APC protein can interact with catenins and tubulins, two groups of proteins known to be components of adherens junctions and cytoskeleton. Thus the APC protein may play a role in cell adhesion and in transduction of signal regulating the cell cycle. Of more immediate clinical interest is the observation that specific APC mutations appear to participate in the severity of the disease and determine the development of hypertrophy of the retinal pigment epithelium, a diagnostically important manifestation of the APC disease found in 70% of the patients. HNPCC syndromes have been recognized as being frequently associated with a defect in the DNA mismatch repair pathway. Furthermore, human genes, demonstrating homology with the bacterial DNA repair genes MutS and MutL, have been identified and shown to be altered in several HNPCC families. There are now indications that genotyping of tumor DNA at particular loci, termed microsatellite, may contribute in the identification of patients genetically predisposed to tumor development.(ABSTRACT TRUNCATED AT 250 WORDS)