Specific Variants in the MLH1 Gene Region May Drive DNA Methylation, Loss of Protein Expression, and MSI-H Colorectal Cancer

<div><h3>Background</h3><p>We previously identified an association between a mismatch repair gene, <em>MLH1</em>, promoter SNP (rs1800734) and microsatellite unstable (MSI-H) colorectal cancers (CRCs) in two samples. The current study expanded on this finding as we explored the genetic basis of DNA methylation in this region of chromosome 3. We hypothesized that specific polymorphisms in the <em>MLH1</em> gene region predispose it to DNA methylation, resulting in the loss of <em>MLH1</em> gene expression, mismatch-repair function, and consequently to genome-wide microsatellite instability.</p><h3>Methodology/Principal Findings</h3><p>We first tested our hypothesis in one sample from Ontario (901 cases, 1,097 controls) and replicated major findings in two additional samples from Newfoundland and Labrador (479 cases, 336 controls) and from Seattle (591 cases, 629 controls). Logistic regression was used to test for association between SNPs in the region of <em>MLH1</em> and CRC, MSI-H CRC, <em>MLH1</em> gene expression in CRC, and DNA methylation in CRC. The association between rs1800734 and MSI-H CRCs, previously reported in Ontario and Newfoundland, was replicated in the Seattle sample. Two additional SNPs, in strong linkage disequilibrium with rs1800734, showed strong associations with <em>MLH1</em> promoter methylation, loss of MLH1 protein, and MSI-H CRC in all three samples. The logistic regression model of MSI-H CRC that included <em>MLH1</em>-promoter-methylation status and MLH1 immunohisotchemistry status fit most parsimoniously in all three samples combined. When rs1800734 was added to this model, its effect was not statistically significant (<em>P</em>-value = 0.72 vs. 2.3×10⁻⁴ when the SNP was examined alone).</p><h3>Conclusions/Significance</h3><p>The observed association of rs1800734 with MSI-H CRC occurs through its effect on the <em>MLH1</em> promoter methylation, MLH1 IHC deficiency, or both.</p>