DNA adducts and p53 mutations in a patient with aristolochic acid-associated nephropathy

Background: Aristolochic acid-associated nephropathy (AAN) Is a specific type of renal disease that predisposes patients to a high risk of urothelial carcinoma. The authors have analyzed DNA from a patient who had urothelial malignancy 6 years after presenting with AAN and later had a breast carcinoma that metastasized to the liver. Methods and Results: DNA was Isolated from the primary breast tumor, the liver tumor, and the original urothelial malignancy and assayed for aristolochic acid (AA)-DNA adducts and mutations In the p53 gone. The adduct detected was the adenosine adduct of aristolochic acid I 7-(deoxyadenosin-N-6-yl)aristolactam I (dA-AAI). In DNA from the breast and liver tumors the authors showed the same missense mutation in codon 245 (GGC-->GAC; Gly-->Asp) of exon 7 of p53. In contrast, DNA extracted from the urothelial tumor showed an AAG to TAG mutation in codon 139 (Lys-->Stop) of exon 5. Conclusion: A to T transversions, as observed here, are the typical mutations observed in the H-ras gene of tumors Induced when rodents are treated with AA and correspond with DNA adduct formation at adenosine residues. These data Indicate the probable molecular mechanism whereby AA causes urothelial malignancy.