Gut 1999;45:822-828 ( December )

Article

Rectal epithelial apoptosis in familial adenomatous polyposis patients treated with sulindac J J Keller^d, G J A Offerhaus^c, M Polak^d, S N Goodman^b, M L Zahurak^b, L M Hylind^a, S R Hamilton^c, F M Giardiello^a

^a Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA, ^b Oncology Centre, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA, ^c Department of Pathology, The John Hopkins University School of Medicine, Baltimore, Maryland, USA, ^d Department of Pathology, Academic Medical Centre, The Netherlands

Correspondence to: Dr F M Giardiello, The Johns Hopkins University, Room 431, 1830 East Monument Street, Baltimore, Maryland 21205, USA.

Accepted for publication 11 May 1999

BACKGROUNDSulindac regresses colorectal adenomas in patients with familial adenomatous polyposis (FAP), although the mechanism of polyp regression is unclear.
AIMSTo determine whether differences occur in alteration of rectal epithelial apoptotic index and expression of apoptosis related proteins in FAP patients treated with sulindac compared with placebo.
PATIENTSTwenty one FAP patients; 12 had not undergone colectomy.
METHODSPatients with FAP were treated with sulindac 150 mg orally twice a day for three months (n=10) or placebo (n=11). Colorectal polyp number was determined and biopsies of the normal rectal mucosa were performed before and after three months of treatment. Response to treatment and alteration of the apoptotic ratio (index in base of crypt divided by index in surface epithelium) were evaluated. Bcl-2, bax, p21/WAF-1, and p53 proteins were assessed semiquantitatively by immunohistochemistry.
RESULTSSignificant decreases in polyp number and in the apoptotic ratio were seen in patients treated with sulindac compared with controls. The mean percentage change in polyp number from baseline was 46% in the sulindac group and +13% in the placebo group (p=0.005). Mean percentage change in the apoptotic ratio was 8% and +25% in the sulindac and placebo treated patients, respectively (p=0.004). No differences in expression or compartmentalisation of apoptosis related proteins were noted between treatment groups.
CONCLUSIONSSulindac regression of colorectal adenomas is accompanied by alteration of the rectal epithelial apoptotic ratio with relative increase in apoptosis in surface cells compared with the deeper crypt. The utility of the apoptotic ratio as an intermediate biomarker for colorectal tumorigenesis deserves further study.


Keywords: apoptosis; familial adenomatous polyposis; sulindac; intermediate biomarker; tumorigenesis

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