Main Category: Colorectal Cancer
Also Included In: Genetics
Article Date: 03 Apr 2011 – 3:00 PDT

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Cells control which genes they express by multiple mechanisms, one of which is the direct modification of DNA with small molecules. Methylation of genes effectively silences them, and excess DNA methylation, particularly of genes that control the cell cycle, is known to promote cancer formation. However, it is unclear whether the enzymes that modify DNA in this way target specific genes or whether random modifications select cells for enhanced tumorigenic capactiy.

In new research, Rudolf Jaenisch and colleagues, at the Whitehead Institute in Cambridge, Massachusetts, investigated DNA methylation in a mouse model of colon cancer. They found that a DNA methylating enzyme, Dnmt3b, targeted specific genes for silencing, and that these genes were similar to those silenced in human tumors. In addition, the researchers believe that their results show that aberrant DNA methylation may be one of the initiating events in the development of cancer.

Source:
Kathryn Claiborn

Journal of Clinical Investigation

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Editor’s Choice
Main Category: Colorectal Cancer
Also Included In: Stem Cell Research;  Transplants / Organ Donations;  Crohn’s / IBD
Article Date: 31 Mar 2011 – 0:00 PDT

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Stem cells in the intestine, which when they mutate can lead to bowel cancers, might also be grown into transplant tissues to combat the effects of those same cancers, the UK National Stem Cell Network (UKNSCN) annual science meeting heard.

Professor Nick Barker of the Institute of Medical Biology in Singapore will explain how he and his team identified that the stem cells which are crucial to maintaining a healthy intestine are also the site at which bowel cancers first begin, and how he also hopes to use healthy stem cells to regenerate tissues to help patients with Crohn’s disease and some cancers.

Having discovered a gene that is only turned on in these particular stem cells Professor Barker and his team have been able to isolate the cells in mice and grow small pieces of intestine in the lab. The researchers hope that if they are able to grow larger pieces, they will be able to produce transplant tissues to replace damaged intestines.

Professor Barker explains: “Processing our dinner every day is a tough job so the lining of our intestines quickly get worn out. To keep the intestine working stem cells in little pockets along the surface replace the lining, cell by cell, about once a week.

“We already knew these stem cells existed for a while we didn’t know much about them because it was difficult to distinguish them from all of the other types of cells in our intestines. Our team was able to single them out and study them because we discovered a gene that is only turned on in these particular stem cells.”

Once the researchers had found this gene they were able to track where the stem cells occur throughout the body finding that, as well as the intestine, the stomach lining and in hair follicles, the cells were also present in bowel tumours.

Professor Barker continues: “We hope that studying these stem cells will be doubly useful: One day we hope to grow large enough pieces in the lab to form replacement tissues for transplant; and by studying the cells we will be able to find new ways to prevent them from mutating and hence leading to cancer.

“Bowel cancer is the third most common type of cancer in England and an estimated 38,000 new cases are diagnosed each year. We know these stem cells are both implicated in causing the cancer but that they also could be useful for treating disease so we hope that studying them will help us to understand how to attack the disease on two fronts.

Source:
Biotechnology and Biological Sciences Research Council

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Main Category: Colorectal Cancer
Also Included In: Preventive Medicine
Article Date: 30 Mar 2011 – 3:00 PDT

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The simple practice of letters and a telephone call to patients who are due for a colonoscopy significantly improves adherence to endoscopic follow-up recommendations, according to a new study in Gastroenterology, the official journal of the American Gastroenterological Association (AGA) Institute. This work provides justification for the creation of reminder systems to improve colorectal cancer screening rates.

“Our automated, patient-dependent colonoscopy follow-up reminder system significantly improved adherence with recommended surveillance colonoscopy and patient satisfaction,” said Daniel A. Leffler, MD, MS, of Harvard Medical School. “Although this study focused only on colonoscopy, it is expected that this approach would be widely applicable across different procedures and medical specialties.”

In this study, patients were assigned to groups that received the standard of care or a newly developed follow-up system that included a letter to the primary care provider, two letters to the patient and a telephone call to patients who had not yet scheduled an examination by the procedure due date. Doctors created and tested an electronic medical record-based system that reminds patients and providers when follow-up examinations – in this case, colonoscopies – are due and provides documentation in the medical record of this communication.

The low-cost intervention almost doubled the rate of recommended exams during the time period of the study. Also, the intervention was well received by patients and even more effective in minority populations who typically receive lower quality care. This could lead to improvements in disparities in care for those needing repeat colonoscopies.

Although evidence-based guidelines for colon cancer screening and surveillance exist, there are significant issues with patient adherence to recommendations regarding colonoscopy. In fact, colonoscopy presents particular difficulty for both patients and providers because of variability in the recommended follow-up interval and long length of time between examinations. After an initial colonoscopy is performed, appropriate follow-up testing often is neglected with potentially serious consequences. Few institutions or practices, however, have implemented systems to monitor and improve compliance with suggested follow-up tests.

“Regardless of whether information is transmitted on paper, in e-mails, texts or other media, we anticipate that the need for integrated systems to assist in prompting patients to obtain recommended care will increase,” added Dr. Leffler. “As electronic medical record systems are adopted and refined, protocols for notifying and documenting communication regarding recommended follow-up screening and diagnostic procedures should be strongly considered.”

Although there are some upfront costs associated with the adoption of a follow-up system, once running, well-designed systems can function with little additional burden to the physician or administrative staff. This finding suggests that use of similar solutions can reduce the disparities seen in medical care across the U.S. medical system.

Source:
Alissa J. Cruz
American Gastroenterological Association

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