BACKGROUND: Constitutional mismatch repair deficiency (CMMRD) syndrome is a rare and aggressive cancer predisposition syndrome. Because a scarcity of data on this condition contributes to management challenges and poor outcomes, we aimed to describe the clinical spectrum, cancer biology, and impact of genetics on patient survival in CMMRD. METHODS: In this cohort study, we collected cross-sectional and longitudinal data on all patients with CMMRD, with no age limits, registered with the International Replication Repair Deficiency Consortium (IRRDC) across more than 50 countries. Clinical data were extracted from the IRRDC database, medical records, and physician-completed case record forms. The primary objective was to describe the clinical features, cancer spectrum, and biology of the condition. Secondary objectives included estimations of cancer incidence and of the impact of the specific mismatch-repair gene and genotype on cancer onset and survival, including after cancer surveillance and immunotherapy interventions. FINDINGS: We analysed data from 201 patients (103 males, 98 females) enrolled between June 5, 2007 and Sept 9, 2022. Median age at diagnosis of CMMRD or a related cancer was 8·9 years (IQR 5·9-12·6), and median follow-up from diagnosis was 7·2 years (3·6-14·8). Endogamy among minorities and closed communities contributed to high homozygosity within countries with low consanguinity. Frequent dermatological manifestations (117 [93%] of 126 patients with complete data) led to a clinical overlap with neurofibromatosis type 1 (35 [28%] of 126). 339 cancers were reported in 194 (97%) of 201 patients. The cumulative cancer incidence by age 18 years was 90% (95% CI 80-99). Median time between cancer diagnoses for patients with more than one cancer was 1·9 years (IQR 0·8-3·9). Neoplasms developed in 15 organs and included early-onset adult cancers. CNS tumours were the most frequent (173 [51%] cancers), followed by gastrointestinal (75 [22%]), haematological (61 [18%]), and other cancer types (30 [9%]). Patients with CNS tumours had the poorest overall survival rates (39% [95% CI 30-52] at 10 years from diagnosis; log-rank p<0·0001 across four cancer types), followed by those with haematological cancers (67% [55-82]), gastrointestinal cancers (89% [81-97]), and other solid tumours (96% [88-100]). All cancers showed high mutation and microsatellite indel burdens, and pathognomonic mutational signatures. MLH1 or MSH2 variants caused earlier cancer onset than PMS2 or MSH6 variants, and inferior survival (overall survival at age 15 years 63% [95% CI 55-73] for PMS2, 49% [35-68] for MSH6, 19% [6-66] for MLH1, and 0% for MSH2; p<0·0001). Frameshift or truncating variants within the same gene caused earlier cancers and inferior outcomes compared with missense variants (p<0·0001). The greater deleterious effects of MLH1 and MSH2 variants as compared with PMS2 and MSH6 variants persisted despite overall improvements in survival after surveillance or immune checkpoint inhibitor interventions. INTERPRETATION: The very high cancer burden and unique genomic landscape of CMMRD highlight the benefit of comprehensive assays in timely diagnosis and precision approaches toward surveillance and immunotherapy. These data will guide the clinical management of children and patients who survive into adulthood with CMMRD. FUNDING: The Canadian Institutes for Health Research, Stand Up to Cancer, Children's Oncology Group National Cancer Institute Community Oncology Research Program, Canadian Cancer Society, Brain Canada, The V Foundation for Cancer Research, BioCanRx, Harry and Agnieszka Hall, Meagan's Walk, BRAINchild Canada, The LivWise Foundation, St Baldrick Foundation, Hold'em for Life, and Garron Family Cancer Center.
- MeSH
- dědičné nádorové syndromy * genetika terapie MeSH
- dítě MeSH
- DNA vazebné proteiny * MeSH
- dospělí MeSH
- homolog 2 proteinu MutS genetika MeSH
- incidence MeSH
- kolorektální nádory genetika patologie mortalita MeSH
- lidé MeSH
- longitudinální studie MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mutace MeSH
- MutL homolog 1 genetika MeSH
- nádory mozku genetika terapie mortalita patologie epidemiologie MeSH
- oprava chybného párování bází DNA MeSH
- předškolní dítě MeSH
- průřezové studie MeSH
- Check Tag
- dítě MeSH
- dospělí MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- předškolní dítě MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- práce podpořená grantem MeSH
ABSTRACT: Sebaceous neoplasms occur sporadically or in the setting of Muir-Torre syndrome. The data regarding the correlation of pathologic features and DNA mismatch repair (MMR) staining pattern in sebaceous tumors of the skin are very scanty and based on relatively small series of patients. The goal of this study was to correlate MMR staining pattern with selected morphological features in a series of 145 sebaceous neoplasms (sebaceous adenoma, sebaceoma, and extraocular sebaceous carcinoma) from 136 patients. Cystic change, intratumoral mucin deposits, squamous metaplasia in the absence of keratoacanthoma-like changes, ulceration, intratumoral and peritumoral lymphocytes (in cases without epidermal ulceration), and intertumoral heterogeneity proved to be significantly associated with MMR deficiency. Identification of any of these changes, alone or in combination, should prompt further investigation of the patient to exclude Muir-Torre Syndrome. Our study also confirms the previously published observation that the diagnosis and tumor location are significantly associated with MMR deficiency.
- MeSH
- adenom metabolismus patologie MeSH
- DNA vazebné proteiny metabolismus MeSH
- dospělí MeSH
- homolog 2 proteinu MutS metabolismus MeSH
- imunohistochemie MeSH
- karcinom metabolismus patologie MeSH
- končetiny MeSH
- lidé středního věku MeSH
- lidé MeSH
- mismatch repair endonukleáza PMS2 metabolismus MeSH
- mladiství MeSH
- mladý dospělý MeSH
- MutL homolog 1 metabolismus MeSH
- nádory hlavy a krku metabolismus patologie MeSH
- nádory mazových žláz metabolismus patologie MeSH
- obličej MeSH
- oprava chybného párování bází DNA MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- skalp MeSH
- trup MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
BACKGROUND: Vaginal brachytherapy is currently recommended as adjuvant treatment in patients with high-intermediate risk endometrial cancer to maximize local control and has only mild side effects and no or limited impact on quality of life. However, there is still considerable overtreatment and also some undertreatment, which may be reduced by tailoring adjuvant treatment to the patients' risk of recurrence based on molecular tumor characteristics. PRIMARY OBJECTIVES: To compare the rates of vaginal recurrence in women with high-intermediate risk endometrial cancer, treated after surgery with molecular-integrated risk profile-based recommendations for either observation, vaginal brachytherapy or external pelvic beam radiotherapy or with standard adjuvant vaginal brachytherapy STUDY HYPOTHESIS: Adjuvant treatment based on a molecular-integrated risk profile provides similar local control and recurrence-free survival as current standard adjuvant brachytherapy in patients with high-intermediate risk endometrial cancer, while sparing many patients the morbidity of adjuvant treatment and reducing healthcare costs. TRIAL DESIGN: A multicenter, international phase III randomized trial (2:1) of molecular-integrated risk profile-based adjuvant treatment (experimental arm) or adjuvant vaginal brachytherapy (standard arm). MAJOR INCLUSION/EXCLUSION CRITERIA: Women aged 18 years and over with a histological diagnosis of high-intermediate risk endometrioid endometrial cancer after total abdominal or laparoscopic hysterectomy and bilateral salpingo-oophorectomy. High-intermediate risk factors are defined as: (i) International Federation of Gynecology and Obstetrics stage IA (with invasion) and grade 3; (ii) stage IB grade 1 or 2 with age ≥60 and/or lymph-vascular space invasion; (iii) stage IB, grade 3 without lymph-vascular space invasion; or (iv) stage II (microscopic and grade 1). ENDPOINTS: The primary endpoint is vaginal recurrence. Secondary endpoints are recurrence-free and overall survival; pelvic and distant recurrence; 5-year vaginal control (including treatment for relapse); adverse events and patient-reported symptoms and quality of life; and endometrial cancer-related healthcare costs. SAMPLE SIZE: 500 eligible and evaluable patients. ESTIMATED DATES FOR COMPLETING ACCRUAL AND PRESENTING RESULTS: Estimated date for completing accrual will be late 2021. Estimated date for presentation of (first) results is expected in 2023. TRIAL REGISTRATION: The trial is registered at clinicaltrials.gov (NCT03469674) and ISRCTN (11659025).
- MeSH
- adjuvantní radioterapie MeSH
- brachyterapie MeSH
- DNA vazebné proteiny genetika metabolismus MeSH
- endometroidní karcinom genetika radioterapie terapie MeSH
- homolog 2 proteinu MutS genetika metabolismus MeSH
- klinické zkoušky, fáze III jako téma MeSH
- lidé MeSH
- mismatch repair endonukleáza PMS2 genetika metabolismus MeSH
- multicentrické studie jako téma MeSH
- MutL homolog 1 genetika metabolismus MeSH
- nádory endometria genetika radioterapie terapie MeSH
- randomizované kontrolované studie jako téma MeSH
- Check Tag
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- protokol klinické studie MeSH
The phenotypic effects of single nucleotide polymorphisms (SNPs) in the development of sporadic solid cancers are still scarce. The aim of this review was to summarise and analyse published data on the associations between SNPs in mismatch repair genes and various cancers. The mismatch repair system plays a unique role in the control of the genetic integrity and it is often inactivated (germline and somatic mutations and hypermethylation) in cancer patients. Here, we focused on germline variants in mismatch repair genes and found the outcomes rather controversial: some SNPs are sometimes ascribed as protective, while other studies reported their pathological effects. Regarding the complexity of cancer as one disease, we attempted to ascertain if particular polymorphisms exert the effect in the same direction in the development and treatment of different malignancies, although it is still not straightforward to conclude whether polymorphisms always play a clear positive role or a negative one. Most recent and robust genome-wide studies suggest that risk of cancer is modulated by variants in mismatch repair genes, for example in colorectal cancer. Our study shows that rs1800734 in MLH1 or rs2303428 in MSH2 may influence the development of different malignancies. The lack of functional studies on many DNA mismatch repair SNPs as well as their interactions are not explored yet. Notably, the concerted action of more variants in one individual may be protective or harmful. Further, complex interactions of DNA mismatch repair variations with both the environment and microenvironment in the cancer pathogenesis will deserve further attention.
- MeSH
- homolog 2 proteinu MutS genetika MeSH
- jednonukleotidový polymorfismus genetika MeSH
- lidé MeSH
- metylace DNA genetika MeSH
- MutL homolog 1 genetika MeSH
- nádory genetika patologie MeSH
- oprava chybného párování bází DNA genetika MeSH
- progrese nemoci MeSH
- zárodečné mutace genetika MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
PURPOSE: Constitutional mismatch repair deficiency (CMMRD) is a highly penetrant cancer predisposition syndrome caused by biallelic mutations in mismatch repair (MMR) genes. As several cancer syndromes are clinically similar, accurate diagnosis is critical to cancer screening and treatment. As genetic diagnosis is confounded by 15 or more pseudogenes and variants of uncertain significance, a robust diagnostic assay is urgently needed. We sought to determine whether an assay that directly measures MMR activity could accurately diagnose CMMRD. PATIENTS AND METHODS: In vitro MMR activity was quantified using a 3'-nicked G-T mismatched DNA substrate, which requires MSH2-MSH6 and MLH1-PMS2 for repair. We quantified MMR activity from 20 Epstein-Barr virus-transformed lymphoblastoid cell lines from patients with confirmed CMMRD. We also tested 20 lymphoblastoid cell lines from patients who were suspected for CMMRD. We also characterized MMR activity from patients with neurofibromatosis type 1, Li-Fraumeni syndrome, polymerase proofreading-associated cancer syndrome, and Lynch syndrome. RESULTS: All CMMRD cell lines had low MMR activity (n = 20; mean, 4.14 ± 1.56%) relative to controls (n = 6; mean, 44.00 ± 8.65%; P < .001). Repair was restored by complementation with the missing protein, which confirmed MMR deficiency. All cases of patients with suspected CMMRD were accurately diagnosed. Individuals with Lynch syndrome (n = 28), neurofibromatosis type 1 (n = 5), Li-Fraumeni syndrome (n = 5), and polymerase proofreading-associated cancer syndrome (n = 3) had MMR activity that was comparable to controls. To accelerate testing, we measured MMR activity directly from fresh lymphocytes, which yielded results in 8 days. CONCLUSION: On the basis of the current data set, the in vitro G-T repair assay was able to diagnose CMMRD with 100% specificity and sensitivity. Rapid diagnosis before surgery in non-neoplastic tissues could speed proper therapeutic management.
- MeSH
- dědičné nádorové syndromy diagnóza genetika metabolismus MeSH
- DNA vazebné proteiny genetika metabolismus MeSH
- enzymy opravy DNA genetika metabolismus MeSH
- fenotyp MeSH
- genetická predispozice k nemoci MeSH
- genetické testování * MeSH
- homolog 2 proteinu MutS genetika metabolismus MeSH
- kolorektální nádory diagnóza genetika metabolismus MeSH
- lidé MeSH
- mismatch repair endonukleáza PMS2 genetika metabolismus MeSH
- mutace * MeSH
- MutL homolog 1 genetika metabolismus MeSH
- nádorové biomarkery genetika metabolismus MeSH
- nádorové buněčné linie MeSH
- nádory mozku diagnóza genetika metabolismus MeSH
- oprava chybného párování bází DNA * MeSH
- prediktivní hodnota testů MeSH
- studie případů a kontrol MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- MeSH
- chybné párování bází * genetika MeSH
- dědičné nepolypózní kolorektální nádory genetika MeSH
- DNA vazebné proteiny MeSH
- dospělí MeSH
- homolog 2 proteinu MutS MeSH
- imunohistochemie MeSH
- kohortové studie MeSH
- kolorektální nádory * genetika MeSH
- lidé středního věku MeSH
- lidé MeSH
- mikrosatelitní nestabilita * MeSH
- mismatch repair endonukleáza PMS2 MeSH
- MutL homolog 1 MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- práce podpořená grantem MeSH
Lynchův syndrom (dříve nazývaný hereditární nepolypózní kolorektální karcinom) je nejčastější genetickou příčinou familiárního výskytu kolorektálního karcinomu. Způsobuje jej zárodečná mutace některého z genů, které jsou zodpovědné za opravy chyb ve struktuře DNA vznikající při její replikaci. V důsledku toho dochází k dysfunkci opravného komplexu způsobující rozvoj nestability mikrosatelitů (MSI), která je asociována se zvýšením rizika vzniku nádorů, zejména kolorektálního karcinomu. V současné době se odhaduje, že až 5 % kolorektálních karcinomů vzniká v souvislosti s Lynchovým syndromem. Vzhledem k této poměrně vysoké četnosti, absenci premorbidního fenotypu, familiárnímu výskytu a prezentaci maligních nádorů v produktivním věku je včasná diagnostika Lynchova syndromu důležitá nejen z etického, ale i ekonomického hlediska. Klinická kritéria představovaná zejména revidovanými Bethesda guidelines, která byla navržena pro detekci pacientů vhodných ke genetickému vyšetření možnosti Lynchova syndromu, nejsou však dostatečně senzitivní. Vyšší senzitivity lze dosáhnout aplikací metod moderní patologie. Tato diagnostika je založena na přímém nebo nepřímém průkazu MSI. Mezi metody nepřímého průkazu MSI patří jednak detekce morfologických znaků asociovaných s MSI při histologickém vyšetření vzorků kolorektálních karcinomů, jednak imunohistochemické vyšetření exprese MMR proteinů, které navíc umožní i identifikaci dysfunkčního proteinu. K vyloučení sporadických MSI-H karcinomů způsobených somatickou epigenetickou inaktivací MMR genu z dalšího testování slouží hlavně vyšetření genu BRAF a analýza metylace promotoru genu MLH1. Podezření na Lynchův syndrom vyplývající z výsledků těchto vyšetření by mělo být nakonec potvrzeno detekcí zárodečné mutace některého z MMR genů v periferní krvi pacienta.
Lynch syndrome (formerly known as hereditary non-polyposis colorectal cancer) is the most common hereditary colorectal cancer syndrome. The syndrome is caused by a germline mutation of one of the mismatch repair (MMR) genes responsible for DNA replication error repair. Impaired function of the proteins encoded by these genes leads to microsatellite instability (MSI), which is associated with increased incidence of neoplasms: mainly colorectal cancer. According to recent estimates, up to 5% of all colorectal cancers are associated with Lynch syndrome. Due to this relatively high frequency, familial occurence, absence of premorbid phenotype, and development of malignant tumors at a reproductive age, a correct diagnosis is important not only from an ethical but also from an economical point of view. Unfortunately, clinical means of diagnosis, namely, the revised Bethesda guidelines designed to detect patients suitable for genetic testing for Lynch syndrome, lack sufficient sensitivity. The methods associated with modern pathology are more sensitive than the clinical criteria used to detect patients suspected of having Lynch syndrome. Pathological diagnostics are based on direct or indirect detection of MSI. Indirect methods include analysis of morphological signs associated with MSI in histological samples from colorectal carcinoma patients and immunohistochemical investigation of MMR protein expression. To rule out sporadic cases caused by epigenetic inactivation of an MMR gene, molecular genetic investigation of the BRAF gene and methylation analysis of the MLH1 promoter are performed during diagnostic workup. A suspicion of Lynch syndrome based on the results of the methods mentioned above should be proven by detection of a germline mutation in an MMR gene in peripheral blood leukocytes.
- MeSH
- adaptorové proteiny signální transdukční * genetika MeSH
- algoritmy MeSH
- chybné párování bází MeSH
- dědičné nepolypózní kolorektální nádory * diagnóza genetika klasifikace patologie MeSH
- homolog 2 proteinu MutS * genetika MeSH
- imunohistochemie MeSH
- lidé MeSH
- mikrosatelitní nestabilita MeSH
- mutace genetika MeSH
- mutační analýza DNA MeSH
- oprava chybného párování bází DNA MeSH
- Torrého-Muirův syndrom MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- práce podpořená grantem MeSH
- přehledy MeSH
This article reports an unusual case of aggressive extraocular sebaceous carcinoma located on the scalp with subsequent usurpation of the bone and penetrating through the bone and meninges to the brain in a 56-year-old man affected by Muir-Torre syndrome. Microscopically, the sebaceous neoplasm was located in the middle to deep dermis without any connection to the epidermis and showed a multinodular growth with neoplastic nodules with a central comedo-type necrosis separated from each other by fibrovascular stroma. The nodules were composed of varying proportions of mature sebaceous cells and atypical basaloid cells with high degree of atypia, including high nuclear/cytoplasmic ratio, nuclear pleomorphism, macronucleoli, atypical mitoses, and necrosis. The neoplasm was totally removed. Histopathological examinations of the recurrent lesion showed identical morphological features and, in addition, signs of the tumors growing through the periosteum were noted. In the final excision specimen, both the dura mater and the brain tissue were infiltrated by the sebaceous carcinoma. The diagnosis of Muir-Torre syndrome was confirmed by molecular genetic investigation that revealed an identical germline mutation in MSH2 gene in several family members, some of whom had colorectal tumors.
- MeSH
- biopsie MeSH
- dospělí MeSH
- fatální výsledek MeSH
- fenotyp MeSH
- genetická predispozice k nemoci MeSH
- homolog 2 proteinu MutS genetika MeSH
- imunohistochemie MeSH
- invazivní růst nádoru MeSH
- karcinom genetika patologie chirurgie MeSH
- lidé středního věku MeSH
- lidé MeSH
- magnetická rezonanční tomografie MeSH
- mozek patologie MeSH
- mutační analýza DNA MeSH
- nádory hlavy a krku genetika patologie chirurgie MeSH
- nádory mazových žláz genetika patologie chirurgie MeSH
- počítačová rentgenová tomografie MeSH
- progrese nemoci MeSH
- rodokmen MeSH
- skalp patologie chirurgie MeSH
- Torrého-Muirův syndrom genetika patologie chirurgie MeSH
- zárodečné mutace MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
Ataxia telangiectasia-mutated and Rad3-related (ATR) protein kinase, a master regulator of DNA-damage response, is activated by RPA-coated single-stranded DNA (ssDNA) generated at stalled replication forks or DNA double-strand breaks (DSBs). Here, we identify the mismatch-binding protein MutSβ, a heterodimer of MSH2 and MSH3, as a key player in this process. MSH2 and MSH3 form a complex with ATR and its regulatory partner ATRIP, and their depletion compromises the formation of ATRIP foci and phosphorylation of ATR substrates in cells responding to replication-associated DSBs. Purified MutSβ binds to hairpin loop structures that persist in RPA-ssDNA complexes and promotes ATRIP recruitment. Mutations in the mismatch-binding domain of MSH3 abolish the binding of MutSβ to DNA hairpin loops and its ability to promote ATR activation by ssDNA. These results suggest that hairpin loops might form in ssDNA generated at sites of DNA damage and trigger ATR activation in a process mediated by MutSβ.
- MeSH
- aktivace enzymů MeSH
- ATM protein metabolismus MeSH
- DNA vazebné proteiny chemie metabolismus fyziologie MeSH
- dvouřetězcové zlomy DNA * MeSH
- fosforylace MeSH
- HEK293 buňky MeSH
- homolog 2 proteinu MutS chemie fyziologie MeSH
- homologní rekombinace MeSH
- jednovláknová DNA chemie MeSH
- lidé MeSH
- oprava DNA MeSH
- posttranslační úpravy proteinů MeSH
- transport proteinů MeSH
- vazba proteinů MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
Mismatch repair genes (MMR) play an essential role in DNA repair. MMR mutations predominantly in MLH1, MSH2, MSH6, PMS2, and rarely in PMS1, may cause the production of abnormally short or inactivated proteins. The antiapoptotic protein survivin functions in the inhibition of apoptosis, regulation of cell division and also enhances angiogenesis. Both MMRP and survivin are considered to be powerful prognostic parameters. This study was designed to determine the relationship between MMRP and survivin in colon lesions. The study included 113 cases of colon carcinoma and 51 cases of colon polyps. Survivin expression and MMRP status were assessed by immunohistochemistry. In each section, expression, intensity of immunostaining and percentage of labeled cells were analyzed. In carcinomas, immunoreaction was detected in 100/113 cases for MLH1 (88.5%), 112/113 cases for MSH2 (99.1%), 110/113 cases for MSH6 (97.3%), and 103/113 cases for PMS2 (91.2%). Survivin was shown in 47/113 cases (41.6%). The statistical analysis confirmed a significant correlation between the expression of MMRP and survivin in the assessed parameters. All 51 polyp samples were positive for MLH1, MSH2, MSH6 and PMS2. Only 8 of those (15.7%) were positive for survivin. Statistically significant differences were observed between the expression of MMRP and survivin. In conclusion, this study revealed that MMRP may suppress the antiapoptotic function of survivin through p53 inactivation of its promoter in grade 1 and grade 2 colon carcinomas.
- MeSH
- adaptorové proteiny signální transdukční metabolismus MeSH
- adenokarcinom enzymologie MeSH
- adenosintrifosfatasy metabolismus MeSH
- DNA vazebné proteiny metabolismus MeSH
- enzymy opravy DNA metabolismus MeSH
- homolog 2 proteinu MutS metabolismus MeSH
- inhibitory apoptózy metabolismus MeSH
- jaderné proteiny metabolismus MeSH
- lidé středního věku MeSH
- lidé MeSH
- nádorové proteiny metabolismus MeSH
- nádory tračníku enzymologie MeSH
- oprava chybného párování bází DNA MeSH
- polypy tlustého střeva enzymologie MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH