Gut doi:10.1136/gutjnl-2011-300622
  • Colorectal cancer
  • Original article

Aberrant intestinal stem cell lineage dynamics in Peutz–Jeghers syndrome and familial adenomatous polyposis consistent with protracted clonal evolution in the crypt

  1. Wendy W J de Leng1
  1. 1Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
  2. 2Department of Pathology, Academic Medical Center, Amsterdam, The Netherlands
  3. 3Division of Gastroenterology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  1. Correspondence to Wendy W J de Leng, Department of Pathology, University Medical Center Utrecht, H 04.312, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands; w.w.j.deleng{at}
  1. Contributors DL, MJ, GJAO and WWJdL drafted the concept and design of the study; DL, DVdB, MvS and FHM were involved in the acquisition of data; DL, MJ, GJAO and WWJdL contributed to the analysis and interpretation of data; DL, MJ, GJAO and WWJdL were involved in the drafting of the manuscript; LAAB and FMG contributed to the critical revision of the manuscript for important intellectual content; GJAO and WWJdL were involved in obtaining funding.

  • Accepted 17 August 2011
  • Published Online First 22 September 2011


Objective Genetic predisposition to cancer in Peutz–Jeghers syndrome (PJS) and the role of germline serine–threonine kinase (LKB1) mutations are poorly understood. The authors studied the effect of germline LKB1 mutations on intestinal stem cell dynamics in unaffected flat PJS mucosa. Recent research has documented that the intestinal crypt houses multiple equipotent stem cell lineages. Lineages continuously compete through random drifts, while somatically inherited methylation patterns record clonal diversity.

Design To study the effect of germline LKB1 mutations on clonal expansion, the authors performed quantitative analyses of cardiac-specific homeobox methylation pattern diversity in crypts isolated from unaffected colonic mucosa obtained from archival PJS patient material. The authors compared methylation density and methylation pattern diversity in patients with PJS to those in patients with familial adenomatous polyposis and age-matched controls.

Results The percentage of total methylation is comparable between groups, but the number of unique methylation patterns is significantly increased for patients with familial adenomatous polyposis and patients with PJS compared to control subjects.

Conclusions Monoallelic LKB1 loss is not silent and provokes a protracted clonal evolution in the crypt. The increased methylation pattern diversity observed in unaffected PJS mucosa predicts that premalignant lesions will arise at an accelerated pace compared to the general population.


  • Funding This work was supported by The Netherlands Digestive Disease Foundation (WS07-05), Stichting Vanderes and the National Institutes of Health (grant P50 CA62924-17).

  • Competing interests None.

  • Patient consent Study materials are archival tissues of anonymised patients from different institutions that were used with patient consent and according to the medical ethical guidelines of the institutions.

  • Ethics approval The ethics committee of the University Medical Center Utrecht and Academic Medical Center Amsterdam granted approval to the study.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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