Loss of Cdx2 Expression in Primary Tumors and Lymph Node Metastases is Specific for Mismatch Repair-Deficiency in Colorectal Cancer

Background: Approximately 20% of all colorectal cancers are hypothesized to arise from the "serrated pathway" characterized by mutation in BRAF, high-level CpG Island Methylator Phenotype, and microsatellite instability/mismatch repair (MMR)-deficiency. MMR-deficient cancers show frequent losses of Cdx2, a homeodomain transcription factor. Here, we determine the predictive value of Cdx2 expression for MMR-deficiency and investigate changes in expression between primary cancers and matched lymph node metastases. Methods: Immunohistochemistry for Cdx2, Mlh1, Msh2, Msh6, and Pms2 was performed on whole tissue sections from 201 patients with primary colorectal cancer and 59 cases of matched lymph node metastases. Receiver operating characteristic curve analysis and Area under the Curve (AUC) were investigated; association of Cdx2 with clinicopathological features and patient survival was carried out. Results: Loss of Cdx2 expression was associated with higher tumor grade (p = 0.0002), advanced pT (p = 0.0166), and perineural invasion (p = 0.0228). Cdx2 loss was an unfavorable prognostic factor in univariate (p = 0.0145) and multivariate [p = 0.0427; HR (95% CI): 0.58 (0.34-0.98)] analysis. The accuracy (AUC) for discriminating MMR-proficient and - deficient cancers was 87% [OR (95% CI): 0.96 (0.95-0.98); p < 0.0001]. Specificity and negative predictive value for MMR-deficiency was 99.1 and 96.3%. One hundred and seventy-four patients had MMR-proficient cancers, of which 60 (34.5%) showed Cdx2 loss. Cdx2 loss in metastases was related to MMR-deficiency (p < 0.0001). There was no difference in expression between primary tumors and matched metastases. Conclusion: Loss of Cdx2 is a sensitive and specific predictor of MMR-deficiency, but is not limited to these tumors, suggesting that events "upstream" of the development of microsatellite instability may impact Cdx2 expression.

Possible role of Cdx2 in the serrated pathway of colorectal cancer characterized by BRAF mutation, high-level CpG Island methylator phenotype and mismatch repair-deficiency

Colorectal cancer is a heterogeneous disease at the histomorphological, clinical and molecular level. Approximately 20% of cases may progress through the "serrated" pathway characterized by BRAF mutation and high-level CpG Island Methylator Phenotype (CIMP). A large subgroup are additionally microsatellite instable (MSI) and demonstrate significant loss of tumor suppressor Cdx2. The aim of this study is to determine the specificity of Cdx2 protein expression and CpG promoter hypermethylation for BRAF(V600E) and high-level CIMP in colorectal cancer. Cdx2, Mlh1, Msh2, Msh6, and Pms2 were analyzed by immunohistochemistry using a multi-punch tissue microarray (TMA; n = 220 patients). KRAS and BRAF(V600E) mutation analysis, CDX2 methylation and CIMP were investigated. Loss of Cdx2 was correlated with larger tumor size (P = 0.0154), right-sided location (P = 0.0014), higher tumor grade (P < 0.0001), more advanced pT (P = 0.0234) and lymphatic invasion (P = 0.0351). Specificity was 100% for mismatch repair (MMR)-deficiency (P < 0.0001), 92.2% (P < 0.0001) for BRAF(V600E) and 91.8% for CIMP-high. Combined analysis of BRAF(V600E) /CIMP identified Cdx2 loss as sensitive (80%) and specific (91.5%) for mutation/high status. These results were validated on eight well-established colorectal cancer cell lines. CDX2 methylation correlated with BRAF(V600E) (P = 0.0184) and with Cdx2 protein loss (P = 0.0028). These results seem to indicate that Cdx2 may play a role in the serrated pathway to colorectal cancer as underlined by strong relationships with BRAF(V600E) , CIMP-high and MMR-deficiency. Whether this protein can only be used as a "surrogate" marker, or is functionally involved in the progression of these tumors remains to be elucidated.

Regulation of the expression of {\it mutS, mutL}, and {\it mutH\/} mismatch repair genes in {\it Escherichia coli\/} K-12

Post-replication DNA mismatch repair plays crucial roles in mutation avoidance and maintenance of chromosome stability in both prokaryotes and eukaryotes. In humans, deficiency in this repair system leads to a predisposition for certain cancers. The biochemistry of this repair system has been best studied in a model bacterium Escherichia coli. In this thesis, regulation of expression of mutS, mutL and mutH genes, whose products mediate methyl-directed mismatch (MDM) repair in E. coli, is investigated. One-step affinity purification schemes were developed to purify E. coli MutS, MutL and MutH proteins fused to a His-6-affinity tag. His-6-MutS exhibited the same mismatch binding activity and specificity as the native MutS protein. Purified His-6-MutS, -MutL and -MutH proteins were used to develop quantitative Western blotting assays for amounts of MutS, MuL and MutH proteins under various conditions. It was found that the three proteins were present in relatively low amounts in exponentially growing cells and MutS and MutH were diminished in stationary-phase cells. Further studies indicated that the drop in the amounts of MutS and MutH proteins in stationary-phase cells was mediated through RpoS, a key global regulator of stationary-phase transition. In both exponential- and stationary-phase cells, MutS amount was also negatively regulated by the Hfq (HF-I) global regulator, which is required for RpoS translation, through an RpoS-independent mechanism. $\beta$-galactosidase assays of mutS-lacZ operon and gene fusions suggested that hfq regulates mutS posttranscriptionally, and RNase T2 protection assays revealed that Hfq destabilizes mutS transcripts in exponentially growing cells. To study the relation between regulation of MDM repair and mutagenesis, amounts of MutS, MutL and MutH were measured in starved cells undergoing adaptive mutagenesis. It was found that MutS amount dropped drastically, MutH amount dropped slightly, whereas MutL amount remained essentially constant in starved cells. Overexpression of MutL did not reverse the drop in the amounts of MutS or MutH protein. These results ruled out several explanations for a phenomenon in which overexpression of MutL, but not MutS, reversed adaptive mutagenesis. The findings further suggested that functional MutL is limiting during adaptive mutagenesis. The implications of regulation of the MDM repair are discussed in the context of mutagenesis, pathogenesis and tumorigenesis. ^

Statistical Learning, Syllable Processing, and Speech Production in Healthy Hearing and Hearing-Impaired Preschool Children: A Mismatch Negativity Study

OBJECTIVES The objectives of the present study were to investigate temporal/spectral sound-feature processing in preschool children (4 to 7 years old) with peripheral hearing loss compared with age-matched controls. The results verified the presence of statistical learning, which was diminished in children with hearing impairments (HIs), and elucidated possible perceptual mediators of speech production. DESIGN Perception and production of the syllables /ba/, /da/, /ta/, and /na/ were recorded in 13 children with normal hearing and 13 children with HI. Perception was assessed physiologically through event-related potentials (ERPs) recorded by EEG in a multifeature mismatch negativity paradigm and behaviorally through a discrimination task. Temporal and spectral features of the ERPs during speech perception were analyzed, and speech production was quantitatively evaluated using speech motor maximum performance tasks. RESULTS Proximal to stimulus onset, children with HI displayed a difference in map topography, indicating diminished statistical learning. In later ERP components, children with HI exhibited reduced amplitudes in the N2 and early parts of the late disciminative negativity components specifically, which are associated with temporal and spectral control mechanisms. Abnormalities of speech perception were only subtly reflected in speech production, as the lone difference found in speech production studies was a mild delay in regulating speech intensity. CONCLUSIONS In addition to previously reported deficits of sound-feature discriminations, the present study results reflect diminished statistical learning in children with HI, which plays an early and important, but so far neglected, role in phonological processing. Furthermore, the lack of corresponding behavioral abnormalities in speech production implies that impaired perceptual capacities do not necessarily translate into productive deficits.

Roles of mismatch repair proteins in the recognition and processing of DNA interstrand crosslinks in human cells

DNA interstrand crosslinks (ICLs) are among the most toxic type of damage to a cell. Many ICL-inducing agents are widely used as therapeutic agents, e.g. cisplatin, psoralen. A bettor understanding of the cellular mechanism that eliminates ICLs is important for the improvement of human health. However, ICL repair is still poorly understood in mammals. Using a triplex-directed site-specific ICL model, we studied the roles of mismatch repair (MMR) proteins in ICL repair in human cells. We are also interested in using psoralen-conjugated triplex-forming oligonucleotides (TFOs) to direct ICLs to a specific site in targeted DNA and in the mammalian genomes. ^ MSH2 protein is the common subunit of two MMR recognition complexes, and MutSα and MutSβ. We showed that MSH2 deficiency renders human cell hypersensitive to psoralen ICLs. MMR recognition complexes bind specifically to triplex-directed psoralen ICLs in vitro. Together with the fact that psoralen ICL-induced repair synthesis is dramatically decreased in MSH2 deficient cell extracts, we demonstrated that MSH2 function is critical for the recognition and processing of psoralen ICLs in human cells. Interestingly, lack of MSH2 does not reduce the level of psoralen ICL-induced mutagenesis in human cells, suggesting that MSH2 does not contribute to error-generating repair of psoralen ICLs, and therefore, may represent a novel error-free mechanism for repairing ICLs. We also studied the role of MLH1, anther key protein in MMR, in the processing of psoralen ICLs. MLH1-deficient human cells are more resistant to psoralen plus UVA treatment. Importantly, MLH1 function is not required for the mutagenic repair of psoralen ICLs, suggesting that it is not involved in the error-generating repair of this type of DNA damage in human cells. ^ These are the first data indicating mismatch repair proteins may participate in a relatively error-free mechanism for processing psoralen ICL in human cells. Enhancement of MMR protein function relative to nucleotide excision repair proteins may reduce the mutagenesis caused by DNA ICLs in humans. ^ In order to specifically target ICLs to mammalian genes, we identified novel TFO target sequences in mouse and human genomes. Using this information, many critical mammalian genes can now be targeted by TFOs.^

Mismatch Repair Deficient Tumors Lacking Known Sporadic Causes: Are They All Due to Lynch Syndrome?

BACKGROUND: Mismatch repair deficient (MMRD) colorectal (CRC) or endometrial (EC) cancers in the absence of MLH1 promoter hypermethylation and BRAF mutations are suggestive of Lynch syndrome (LS). Positive germline genetic test results confirm LS. It is unclear if individuals with MMRD tumors but no identified germline mutation or sporadic cause (MMRD+/germline-) have LS. HYPOTHESIS: Since LS is hereditary, individuals with LS should have a stronger family history of LS-related cancers than individuals with sporadic tumors. We hypothesized that MMRD+/germline- CRC and/or EC patients would have less suggestive family histories than LS CRC and/or EC patients. METHODS: 253 individuals with an MMRD CRC or EC who underwent genetic counseling at one institution were included in analysis in 1 of 4 groups: LS, MMRD+/germline-, MMRD+/VUS, sporadic MSI-H (MMRD tumor with MLH1 promoter hypermethylation or BRAF mutation). Family histories were analyzed utilizing MMRpro and PREMM1,2,6. Kruskal-Wallis tests were used to compare family history scores. Logistic regression was used to determine what factors were predictive of LS. RESULTS: MMRD+/germline- individuals had significantly lower median family history scores (PREMM1,2,6=7.3, MMRpro=8.1) than LS individuals (PREMM1,2,6=26.1, MMRpro=89.8, p CONCLUSION: MMRD+/germline- individuals have less suggestive family histories of LS than individuals with LS, but more suggestive family histories than sporadic MSI-H individuals. CRC and/or EC patients with abnormal tumor studies are more likely to have a germline LS mutation if they have a family history suggestive of hereditary cancer. These results imply that the MMRD+/germline- group may not all have LS. This finding highlights the need to determine other somatic, epigenetic or germline causes of MMRD tumors so that these patients and their families can be accurately counseled regarding screening and management.

Modeling sub-threshold slope and DIBL mismatch of sub-22nm FinFet

A great challenge for future information technologies is building reliable systems on top of unreliable components. Parameters of modern and future technology devices are affected by severe levels of process variability and devices will degrade and even fail during the normal lifeDme of the chip due to aging mechanisms. These extreme levels of variability are caused by the high device miniaturizaDon and the random placement of individual atoms. Variability is considered a "red brick" by the InternaDonal Technology Roadmap for Semiconductors. The session is devoted to this topic presenDng research experiences from the Spanish Network on Variability called VARIABLES. In this session a talk entlited "Modeling sub-threshold slope and DIBL mismatch of sub-22nm FinFet" was presented.

Design and Simulation of Deep Nanometer SRAM Cells under Energy, Mismatch, and Radiation Constraints

La fiabilidad está pasando a ser el principal problema de los circuitos integrados según la tecnología desciende por debajo de los 22nm. Pequeñas imperfecciones en la fabricación de los dispositivos dan lugar ahora a importantes diferencias aleatorias en sus características eléctricas, que han de ser tenidas en cuenta durante la fase de diseño. Los nuevos procesos y materiales requeridos para la fabricación de dispositivos de dimensiones tan reducidas están dando lugar a diferentes efectos que resultan finalmente en un incremento del consumo estático, o una mayor vulnerabilidad frente a radiación. Las memorias SRAM son ya la parte más vulnerable de un sistema electrónico, no solo por representar más de la mitad del área de los SoCs y microprocesadores actuales, sino también porque las variaciones de proceso les afectan de forma crítica, donde el fallo de una única célula afecta a la memoria entera. Esta tesis aborda los diferentes retos que presenta el diseño de memorias SRAM en las tecnologías más pequeñas. En un escenario de aumento de la variabilidad, se consideran problemas como el consumo de energía, el diseño teniendo en cuenta efectos de la tecnología a bajo nivel o el endurecimiento frente a radiación. En primer lugar, dado el aumento de la variabilidad de los dispositivos pertenecientes a los nodos tecnológicos más pequeños, así como a la aparición de nuevas fuentes de variabilidad por la inclusión de nuevos dispositivos y la reducción de sus dimensiones, la precisión del modelado de dicha variabilidad es crucial. Se propone en la tesis extender el método de inyectores, que modela la variabilidad a nivel de circuito, abstrayendo sus causas físicas, añadiendo dos nuevas fuentes para modelar la pendiente sub-umbral y el DIBL, de creciente importancia en la tecnología FinFET. Los dos nuevos inyectores propuestos incrementan la exactitud de figuras de mérito a diferentes niveles de abstracción del diseño electrónico: a nivel de transistor, de puerta y de circuito. El error cuadrático medio al simular métricas de estabilidad y prestaciones de células SRAM se reduce un mínimo de 1,5 veces y hasta un máximo de 7,5 a la vez que la estimación de la probabilidad de fallo se mejora en varios ordenes de magnitud. El diseño para bajo consumo es una de las principales aplicaciones actuales dada la creciente importancia de los dispositivos móviles dependientes de baterías. Es igualmente necesario debido a las importantes densidades de potencia en los sistemas actuales, con el fin de reducir su disipación térmica y sus consecuencias en cuanto al envejecimiento. El método tradicional de reducir la tensión de alimentación para reducir el consumo es problemático en el caso de las memorias SRAM dado el creciente impacto de la variabilidad a bajas tensiones. Se propone el diseño de una célula que usa valores negativos en la bit-line para reducir los fallos de escritura según se reduce la tensión de alimentación principal. A pesar de usar una segunda fuente de alimentación para la tensión negativa en la bit-line, el diseño propuesto consigue reducir el consumo hasta en un 20 % comparado con una célula convencional. Una nueva métrica, el hold trip point se ha propuesto para prevenir nuevos tipos de fallo debidos al uso de tensiones negativas, así como un método alternativo para estimar la velocidad de lectura, reduciendo el número de simulaciones necesarias. Según continúa la reducción del tamaño de los dispositivos electrónicos, se incluyen nuevos mecanismos que permiten facilitar el proceso de fabricación, o alcanzar las prestaciones requeridas para cada nueva generación tecnológica. Se puede citar como ejemplo el estrés compresivo o extensivo aplicado a los fins en tecnologías FinFET, que altera la movilidad de los transistores fabricados a partir de dichos fins. Los efectos de estos mecanismos dependen mucho del layout, la posición de unos transistores afecta a los transistores colindantes y pudiendo ser el efecto diferente en diferentes tipos de transistores. Se propone el uso de una célula SRAM complementaria que utiliza dispositivos pMOS en los transistores de paso, así reduciendo la longitud de los fins de los transistores nMOS y alargando los de los pMOS, extendiéndolos a las células vecinas y hasta los límites de la matriz de células. Considerando los efectos del STI y estresores de SiGe, el diseño propuesto mejora los dos tipos de transistores, mejorando las prestaciones de la célula SRAM complementaria en más de un 10% para una misma probabilidad de fallo y un mismo consumo estático, sin que se requiera aumentar el área. Finalmente, la radiación ha sido un problema recurrente en la electrónica para aplicaciones espaciales, pero la reducción de las corrientes y tensiones de los dispositivos actuales los está volviendo vulnerables al ruido generado por radiación, incluso a nivel de suelo. Pese a que tecnologías como SOI o FinFET reducen la cantidad de energía colectada por el circuito durante el impacto de una partícula, las importantes variaciones de proceso en los nodos más pequeños va a afectar su inmunidad frente a la radiación. Se demuestra que los errores inducidos por radiación pueden aumentar hasta en un 40 % en el nodo de 7nm cuando se consideran las variaciones de proceso, comparado con el caso nominal. Este incremento es de una magnitud mayor que la mejora obtenida mediante el diseño de células de memoria específicamente endurecidas frente a radiación, sugiriendo que la reducción de la variabilidad representaría una mayor mejora. ABSTRACT Reliability is becoming the main concern on integrated circuit as the technology goes beyond 22nm. Small imperfections in the device manufacturing result now in important random differences of the devices at electrical level which must be dealt with during the design. New processes and materials, required to allow the fabrication of the extremely short devices, are making new effects appear resulting ultimately on increased static power consumption, or higher vulnerability to radiation SRAMs have become the most vulnerable part of electronic systems, not only they account for more than half of the chip area of nowadays SoCs and microprocessors, but they are critical as soon as different variation sources are regarded, with failures in a single cell making the whole memory fail. This thesis addresses the different challenges that SRAM design has in the smallest technologies. In a common scenario of increasing variability, issues like energy consumption, design aware of the technology and radiation hardening are considered. First, given the increasing magnitude of device variability in the smallest nodes, as well as new sources of variability appearing as a consequence of new devices and shortened lengths, an accurate modeling of the variability is crucial. We propose to extend the injectors method that models variability at circuit level, abstracting its physical sources, to better model sub-threshold slope and drain induced barrier lowering that are gaining importance in FinFET technology. The two new proposed injectors bring an increased accuracy of figures of merit at different abstraction levels of electronic design, at transistor, gate and circuit levels. The mean square error estimating performance and stability metrics of SRAM cells is reduced by at least 1.5 and up to 7.5 while the yield estimation is improved by orders of magnitude. Low power design is a major constraint given the high-growing market of mobile devices that run on battery. It is also relevant because of the increased power densities of nowadays systems, in order to reduce the thermal dissipation and its impact on aging. The traditional approach of reducing the voltage to lower the energy consumption if challenging in the case of SRAMs given the increased impact of process variations at low voltage supplies. We propose a cell design that makes use of negative bit-line write-assist to overcome write failures as the main supply voltage is lowered. Despite using a second power source for the negative bit-line, the design achieves an energy reduction up to 20% compared to a conventional cell. A new metric, the hold trip point has been introduced to deal with new sources of failures to cells using a negative bit-line voltage, as well as an alternative method to estimate cell speed, requiring less simulations. With the continuous reduction of device sizes, new mechanisms need to be included to ease the fabrication process and to meet the performance targets of the successive nodes. As example we can consider the compressive or tensile strains included in FinFET technology, that alter the mobility of the transistors made out of the concerned fins. The effects of these mechanisms are very dependent on the layout, with transistor being affected by their neighbors, and different types of transistors being affected in a different way. We propose to use complementary SRAM cells with pMOS pass-gates in order to reduce the fin length of nMOS devices and achieve long uncut fins for the pMOS devices when the cell is included in its corresponding array. Once Shallow Trench isolation and SiGe stressors are considered the proposed design improves both kinds of transistor, boosting the performance of complementary SRAM cells by more than 10% for a same failure probability and static power consumption, with no area overhead. While radiation has been a traditional concern in space electronics, the small currents and voltages used in the latest nodes are making them more vulnerable to radiation-induced transient noise, even at ground level. Even if SOI or FinFET technologies reduce the amount of energy transferred from the striking particle to the circuit, the important process variation that the smallest nodes will present will affect their radiation hardening capabilities. We demonstrate that process variations can increase the radiation-induced error rate by up to 40% in the 7nm node compared to the nominal case. This increase is higher than the improvement achieved by radiation-hardened cells suggesting that the reduction of process variations would bring a higher improvement.