KLF4 Mutation Shapes Pathologic Characteristics of Foveolar-Type Gastric Adenoma in Helicobacter pylori-Naive Patients

Along with a recent remarkable decrease in Helicobacter pylori -infected individuals, reports of gastric neoplasms such as sporadic foveolar-type gastric adenoma (FGA) in H. pylori -naive patients have been increasing. This tumor, with its raspberry-like appearance, is common in H. pylori -naive gastric mucosa. The current study investigated the genomic features of sporadic FGA. Fresh-frozen sporadic FGA tissue samples from H. pylori -naive patients were subjected to whole genome analysis using a next-generation sequencer. Proliferation ability and apoptotic profiles of human gastric epithelial cells, along with plasmid transfection of candidate variants, were examined. A mean of 6.65 x 108 total reads were obtained for each sample. Common genetic abnormalities in well-known proliferation driver genes of conventional gastric dysplasia/cancer were not found. However, a com-mon single-nucleotide variation (SNV) was noted within the DNA-binding domain of the tumor sup-pressor gene KLF4. This novel SNV was located in the zinc finger 2 region. Additional experiments showed that it significantly suppressed proliferation of gastric epithelial cells compared with wild-type KLF4 plasmid-transfected cells, although suppression was reduced in early apoptotic phase -related genes. A novel SNV in the KLF4 zinc finger 2 region was commonly found in sporadic FGA tissue samples, which may explain the slow-growing properties of this neoplasm. (Am J Pathol 2022, 192: 1250-1258; https://doi.org/10.1016/j.ajpath.2022.06.005)

Automated summary

With the decrease in Helicobacter pylori-infected individuals, the occurrence of gastric neoplasms in H. pylori-naive patients, such as sporadic foveolar-type gastric adenoma (FGA), has been increasing. This study investigated the genomic features of sporadic FGA and identified a novel single-nucleotide variation (SNV) in the KLF4 gene that may contribute to the slow-growing properties of this neoplasm.