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Mutation and Cancer: The Antecedents to Our Studies of Adaptive Mutation
John Cairnsaa Clinical Trial Service Unit, Radcliffe Infirmary, Oxford OX2 6HE, United Kingdom
Corresponding author: John Cairns, Clinical Trial Service Unit, Harkness Building, The Radcliffe Infirmary, Oxford OX2 6HE, UK, j.cairns{at}ctsu.ox.ac.uk (E-mail).
It is clear that the experimental evidence supporting many currently popular hypotheses concerning mutational processes is quite inadequate.
(DRAKE 1970 )
LITTLE excuse is needed for still being interested in mutation. We are here thanks to the germline mutations experienced by our ancestors, and, at least in the developed nations of the world, more of us die from somatic mutations than from any other single cause. For the evolutionary biologist, the process of mutation presents no problems. For anyone attempting an overview of cancer research, however, the process has become increasingly obscure. It was this obscurity that prompted my laboratory in the 1980s to look again at the interplay between mutation and selection.
| Germline mutation |
|---|
To some extent, the particular mutational changes that generated the evolutionary tree can be deduced from comparisons of the differences in sequence that distinguish the different branches of the tree. It is not easy, however, to investigate what were the causes of those changes. Perhaps for that reason, it is customary to think of mutation as being driven by chance events attributable to the natural instability of nucleic acids and the inherent imprecision of polymerases, and these may not in a sense have any identifiable external cause.
What does have a clearly identifiable causal chain, however, is the extent to which each organism is protected against changes in sequence. As ![]()
Because the germline is physically isolated from the environment, the obvious thought is that in large multicellular organisms, mutation rate may be optimized for the germline, whereas the cost: benefit ratio is optimized in somatic cells, for if the germline is not in contact with the environment, its mutation rate must be largely in the hands of intrinsic determinants. This view is usually attributed to WEISMANN, even though he himself claimed that "The primary causes of variation is always the effect of external influences. Were it possible for growth to take place under absolutely constant external influences, variation would not occur" (![]()
The first suggestion that mutation rates could be raised artificially came as a casual aside in a speech by ![]()
For practical purposes, however, evolutionary mutation rates were regarded as being constant under normal conditions. If you are considering what kind of selection would have resulted in some particular observed combination of traits coming to the fore, you have to simplify, and the first step is to assume a constant rate of mutation.
| Cancer and somatic mutation |
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The history of ideas about somatic mutation is very different because the subject is of immediate, practical importance. It is the process that underlies (or soon will underlie) roughly half of all human deaths. It is responsible for most forms of cancer and is probably responsible for a large proportion of all deaths from cardiovascular disease. Unlike classical (germline) geneticists, who are more interested in genetic mechanisms and natural selection than in mutagenesis, somatic geneticists tend to be concerned with mutagenesis rather than the selective processes that may operate in somatic tissues.
The early microscopists saw that each cancer appears to be made up of a family of cells that have inherited the same appearance and invasive characteristics. Indeed, the presence of chromosome abnormalities in cancer cells was part of the earliest evidence that genetic traits are carried by chromosomes. So it was a natural thought that cancers were the result of "somatic mutation" (![]()
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Cancer research has always been quick to apply discoveries in the basic sciences and sometimes has even been in the lead. In the 1930s, much effort had gone into establishing which chemicals were carcinogenic and which were not, and in the early 1940s, two classes of chemical carcinogens were shown to be mutagenicthe nitrogen mustards by AUERBACH in England and the nitrosamines by RAPAPORT in Russia. As soon as DNA was established as the genetic material, these and other chemical carcinogens were quickly tested for their interaction with DNA (![]()
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It was therefore natural to suppose that most human cancer was caused by either radiation or certain reactive chemicals in our environment. Once ways for assaying mutagenicity using bacteria or yeasts had been developed, a search began for the major mutagens to which we are exposed. This proved to be a popular enterprise because it was initially coupled with the belief that most cancer is the product of modern industry and that it can be prevented by stopping industrialists from contaminating our diet and environment.
There was a branch of cancer research that was giving us direct information about the causes of cancerthe science of epidemiology. However, because it is a somber discipline that is somewhat remote from the day-to-day hurly-burly of clinical medicine and the laboratory sciences, it has not been accorded the respect it deserves. Yet it is a source of precise information about the fate of millions of the very animal in whom we are most interested, and this sets limits on the kind of factors that must be important in determining the incidence of the various kinds of cancer (![]()
First and foremost, it is clear that most types of cancer do have external causes. When populations migrate from one country to another, they leave behind the cancers that are typical of their birthplace and then take on the cancers that are typical of their new home. Next, it is clear that modern industry cannot be held responsible for more than a small fraction of all cancers because the spectrum of cancers found in each of the developed nations of the world is not related to the kinds of industries they support; for example, the types of cancers that arise in the United States are not markedly different from those in essentially agrarian countries such as Iceland and New Zealand. Last in this short list of important facts is the observation that carcinogenesis represents an accumulated response to prolonged exposure to causative factors; for example, the risk of lung cancer for old smokers is determined by both the number of cigarettes they currently smoke and the amount they smoked half a century earlier. The same is true for experimental carcinogenesis: a single exposure to a carcinogen given to a young mouse will permanently alter its susceptibility to subsequent exposures.
The list of factors that have been identified by epidemiologists as contributing to the incidence of one or more types of cancer is far more peculiar than most people imagine and not at all what might have been supposed from the work on experimental carcinogenesis. For the industrialized world at the end of the 20th century, the list is headed by tobacco smoke (which is a highly toxic irritant but is not carcinogenic for most experimental animals), various viruses such as hepatitis B and certain papilloma viruses (which are not thought to be mutagenic), infection of the stomach with Helicobacter (which is not likely to be mutagenic), various hormonal factors, too many calories in your diet, and ultraviolet light. Of these, only the last is a conventional mutagen.
It is highly significant, therefore, that skin cancer is the only common cancer that is increased in frequency in people who inherit a defect in nucleotide excision repair (![]()
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If this argument against the importance of chemical mutagens seems too heretical, consider the following. We can identify members of the population who are awash with chemical mutagens by looking for people who have a high concentration of mutagens in their urine. Three groups stand out: smokers, users of certain semipermanent hair dyes, and patients undergoing cytotoxic chemotherapy. Smokers show only marginally raised rates of nonrespiratory cancers, and no increase in cancer rates has been detected in those who use hair dyes. Also, even though cytotoxic chemotherapy certainly does increase the incidence of other normally rare cancers, this could be because the primary, intended effect of these drugs is to kill cells rather than to cause mutations, so they are strong stimulators of cell proliferation. Most of these points were laid out in great detail 20 years ago (![]()
We certainly cannot, however, discard the idea that cancer is a result of somatic mutation. Thanks to the techniques of modern molecular biology, it has become possible to prepare at least partial inventories of the sequence changes found in cancer cells. And, as has been expected, the cells of each cancer prove to contain sequence changes in several members of that multitudinous cast of genes now known to be involved in the control of cell multiplication and cell-cell interactions. Furthermore, those few varieties of cancers that have been linked to a mutagen (e.g., skin cancers caused by ultraviolet light and liver cancers caused by aflatoxin) show the kind of mutations that are characteristic of the mutagen (![]()
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But what about the vast majority of cancers? They are apparently the result of a stimulation of cell proliferation rather than the result of any obvious exposure to mutagens. What is the relation between excessive cell multiplication and the accumulation of sequence changes in the genes affecting cell behavior?
We know virtually nothing about the rules that govern the growth and turnover of cells in multicellular organisms. More than 90% of all human cancers arise in our epithelia, where the only cells that survive throughout our lifetime (and therefore can accumulate damage) are the stem cells at the base of the epithelium (![]()
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The evidence from epidemiology, experimental carcinogenesis, and molecular biology suggests that a rather large number of genes have to be mutated to convert a normal cell into a fully invasive cancer cell. The human body probably contains ~1010 stem cells. If each of these divides once every other day (the value for mice is once a day), a human lifetime will contain roughly 1014 stem cell divisions. So it is hard to see how any one of these cells can acquire enough mutations to become cancerous, unless some process is raising the mutation rate far above its usual value of ~10-7 mutations per gene per cell division. The problem is made much worse if, as seems likely, the major variables that determine cancer rates are not mutagens. So perhaps we should be looking for some other driving force that can be linked to (or triggered by) cell proliferation.
Two rather similar hypotheses have been proposed. If a single mutation is enough to disrupt the rules of cell replacement so that an expanding group of stem cells is created, this one step would increase the target for the further mutations that are needed to make the cells fully cancerous; this model was originally developed by epidemiologists as one of the ways of explaining the sharp rise in cancer rates that occurs with advancing age (![]()
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The mutator hypothesis is thought to have gained further support with the discovery that roughly half of all human cancers bear mutations in p53 and that the P53 protein ("the guardian of the genome") is one of the crucial elements that link the checkpoints in the cell cycle to the state of the genome. Against this must be set the awkward fact that although the cells in most cancers contain many point mutations they do not show a raised rate of point mutations when cultivated in vitro (![]()
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One other factor, which I think may be the most important, has to be brought into the analysis of carcinogenesis (![]()
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In summary, one of the problems for cancer research now is to find some way of relating the molecular biology to the epidemiology. On the one hand, cancer cells contain point mutations in genes that are known to regulate cell behavior. On the other hand, cancer cells usually do not show a raised rate of point mutations when growing in vitro ; the known causes of the cancers in developed nations are not mutagens; and certain major kinds of inherited defects in DNA repair have little or no effect on the rate of most types of cancer. None of these findings might be considered sufficient on its own to disturb the conventional view of carcinogenesis. Taken together, however, they strongly suggest that something is missing.
| Spontaneous mutation in Escherichia coli |
|---|
Because the conventional wisdom about the causes of human cancer seemed so uncertain and incomplete (![]()
Since that initial stage in the history of bacterial genetics, the picture has become more complicated. ![]()
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A second complication was introduced by RYAN, who showed that populations of bacteria would steadily accumulate selectable mutations, even when the cells were not able to divide (![]()
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During the next 25 years, the mechanisms underlying spontaneous mutation ceased to attract much attention. The reason, I think, was largely the triumphant development of molecular biology, which inevitably diverted everyone's attention away from what might be called the natural history of bacteria. It was, however, partly the opportunities for rewarding study of artificial mutagenesis and partly the discovery of DNA repair that gave a totally new insight into how DNA is protected against mutagenesis.
Our worries about the cause of the mutations underlying cancer eventually prompted us in 1981 to consider what factors determine spontaneous mutation rates in bacteria. Because most forms of cancer do not appear to be dependent on exposure to conventional mutagens and are not made more common by defects in the repair of bulky adducts, I had concluded that major rearrangements of DNA had to be the crucial, rate-limiting mutations (![]()
At that point, chance intervened. STEPHAN MILLER was measuring reversion rates of a lacZam mutation by conventional fluctuation tests and observed that in one genetic background, the number of revertants formed the classical Luria-Delbrück distribution, but in another background, it formed a Poisson distribution. This suggested that the pathways leading to mutations during growth in a nonselective medium and to mutations during stationary phase on selective plates were not exactly the same. A similar conclusion could have been drawn from the results of a much earlier study (![]()
Meanwhile, various unusual forms of spontaneous mutation had been reported. One of these was the excision of an integrated fragment of µ bacteriophage that placed lacZ next to the araB promoter (![]()
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Our first experiments looked at these various strange classes of spontaneous mutation and the more orthodox reversion of a lacZam mutation. They showed that mutation before selection and mutation during selection are affected differently by changes in medium and by differences of genetic background. Because there were so many experiments waiting to be done and we had only meager resources for doing them, I wrote to HALL in 1986 and suggested that he, too, should look at some of these issues. That led to two papers on "adaptive mutation" (![]()
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| Adaptive mutation |
|---|
In the nine years since those two papers were published, a growing number of people have been investigating the interaction between selection and mutation in the life of microorganisms. It would be foolish of me to attempt a general review of the literature because I no longer have it at my fingertips, but I feel that I can safely mention some of the main developments.
The issue that attracted the attention of the neo-Darwinists was, of course, the notion that some types of mutation occur only when they confer an advantage, that is, when they are being selected. The clearest example seemed to be the µ excision that allows transcription of lacZ from a neighboring araB promoter (![]()
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Point mutations in the normally cryptic ebgA gene of E.coli have been reported to behave rather like the aralac fusion because the exact form of the selection appears to determine which sequence is retained (![]()
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In an effort to dissect the pathway(s) for stationary phase mutation, we chose the example of reversion of a frameshift in an episomal lacZ (![]()
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For want of suitable markers, it has been difficult to determine the rate at which unselected mutations accumulate in stationary phase. This has now seemingly been settled, however, at least for the time being. Certain classes of unselected mutations can be shown to accumulate linearly during the linear accumulation of selected mutations (![]()
Just in the last year, the analysis of mutation in stationary phase has acquired a further, fascinating complication. Some time ago, two instances had been recorded where mutants that arose on selective plates appeared to have a raised frequency of mutations in other genes (![]()
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Cells in stationary phase that have acquired a selected mutation are ~50 times more likely to bear an unselected mutation than the cells that make up the rest of the population. A little simple algebra (see APPENDIX) shows that to achieve this, the hypermutating minority must comprise less than 2% of the population and must have a mutation rate that is at least 200 times higher than the rate for the rest of the population. This raises the interesting possibility that the bulk of the population may not be undergoing any mutations at all.
Although some of the mutating minority will be stable hypermutators as the result of a mutator mutation (![]()
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We should, however, consider a possible minor addition to NINIO'S hypothesis. Many of the proteins involved in the maintenance of the correct base sequence are normally present in fairly high numbers; although a defective protein may make (or fail to repair) a changed base, its nondefective counterparts can then undo the damage. It may be only when growth becomes impossible and the concentration of these proteins decreases that individual defective proteins are able to cause changes in sequence. We may find that transient mutators are confined to the terminal stages of growth and to stationary phase. If so, the concentration of polymerases and other repair proteins in starved cells may have been influenced by the evolutionary opportunities that arise when nongrowing populations contain an unstable minority. When growth ceases, there is presumably no way for a cell to determine whether or not it requires a mutation to start growing again. What more natural than to hedge your bets? If the environment has undergone a major change and mutation is required for the resumption of growth, the mutants will be there. If two mutations are needed (as is the case for the activation of certain cryptic genes), the frequency of such double events will be much higher than would be expected for strictly independent events. If, however, growth has stopped because it is autumn and the environmental change is simply the usual temporary retreat from mellow fruitfulness, the majority of the population will wake up in spring, unburdened by needless mutations.
In summary, a significant proportion of the mutations that arise "spontaneously" in bacteria are apparently the result of changes in DNA that accumulate in stationary phase. One of the first steps when growth resumes is presumably the repair of these accumulated changes, which makes unusually large demands on the systems for repair, so this is the moment when mistakes are most likely to occur. Because a small minority of the cells in stationary phase are transient mutators, the frequency of multiple mutations in the cells that come out of stationary phase is much higher when resumption of growth has required a mutation. In other words, populations of cells that have just undergone selection for some novel trait show a much higher frequency of unselected mutations than populations that have not been subject to such selection, even though their subsequent mutation rate may be perfectly normal.
| Carcinogenesis |
|---|
These recent discoveries show that the response of bacteria to selection is more complicated than anyone could have guessed 50 years ago. Many classes of mutation seem to be less a matter of exposure to mutagens and errors made during replication, and more a matter of failure to rectify damage accumulated during prolonged periods when metabolism and repair have to be held to a minimum.
This fits nicely with what is known about the epidemiology of human cancer. Stem cells in G-zero can be compared to a population of nongrowing bacteria. When undisturbed, their multiplication is strictly controlled; there is no competition between neighboring stem cells and no selection pressure, and, therefore, they will only slowly accumulate mutations. On the other hand, if growth is stimulated so that the stem cell population has to increase temporarily, this will provide the opportunity for selection (and perhaps allow less time to be set aside for correcting the accumulated changes in their DNA) and could, therefore, cause a sharp increase in the frequency of cells with multiple mutations. Indeed, the importance of mutational events in nongrowing cells has been reinforced by the recent demonstration that certain tumor cell lines, which are deficient in mismatch repair, have normal mutation rates during growth but raised rates when they are not growing (![]()
Taken collectively, these results may explain why the accumulation of cancer cells bearing multiple sequence changes seems to be driven more by agents that stimulate cell proliferation than by the rather low levels of mutagens found in our environment. It was with thoughts such as these that we began our study of spontaneous mutation almost 20 years ago.
| ACKNOWLEDGMENTS |
|---|
First and foremost I want to acknowledge PAT FOSTER'S continuing contributions to the study of adaptive mutation. In my enforced absence, she has delineated the subject by means of an exemplary combination of careful experiments and impartial analysis. I would like to thank DAVID DRESSLER, MONICA HOLLSTEIN, FRANK STAHL, and an anonymous reviewer for help with this manuscript. Last but not least, I am also pleased to have this opportunity to thank JAN DRAKE, who has come to my aid in one way or another on many occasions during the past 40 years.
| APPENDIX |
|---|
THE ARITHMETIC OF MUTATOR MINORITIES
For the sake of simplicity, I shall assume that the population contains a small proportion (p) of high mutators, all of which have a mutation rate that is M-fold higher than the rate for the majority of the population (the low mutators).
Two mutations (or classes of mutations) are measured: A-mutations and B -mutations. In the low mutators, they occur at frequencies a and b ; in the high mutators, they occur at frequencies of aM and bM.
The overall frequency of A-mutations is
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(1) |
The proportion of As that are in high mutators is
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(2) |
The proportion of As that are in low mutators is
Therefore, the overall frequency of B mutations among the A mutants will equal
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(3) |
The absolute rate of mutation, even in the high mutators, is much less than unity. Therefore, the population that has not acquired the A mutation will not be significantly depleted of high mutators; like the starting population, it will contain p high mutators and (1 - p) low mutators.
Therefore, the frequency of B mutations among the non-As is
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(4) |
The ratio (frequency of Bs among the As)/(frequency of Bs among the non-As) is
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(5) |
If all mutations are caused by the high mutators,
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(6) |
Three measurements have been made: the frequency of A mutations, the frequency of B mutations among the A mutants, and the frequency of B mutations in the rest of the population. There are, however, four independent variables (a, b, p, and M ), so it is not possible from these three measurements to determine the absolute values of the four variables.
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Interestingly, ![]()
1/p. So if NINIO'S estimate of p is correct, M would have to be
1999. From Equation 5, it follows that R should be
500. In fact, the values of R observed by ![]()
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This leads to an interesting thought. It is easily conceivable that NINIO'S estimate of p is too low by a factor of 10. If so, the real value of 1/p could be equal to the observed value of R. As Equation 6 shows, this is the case when all mutations are caused by the high mutator minority and most of the population are not accumulating any mutations. Under these special conditions, any third class of mutation will, of course, be no more common in double mutants than in single mutants, and that is a testable prediction.
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