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Supplemental Figure 1 SSA/Ps Syndromic SSA/Ps Sporadic 63 284 9 342 236 600 124 HPs Sporadic Genes differentially expressed ≥ 2-fold in syndromic and sporadic SSA/Ps and hyperplastic polyps by RNA sequencing. Differentially expressed genes with ≥ 2fold change and FDR < 0.05 in syndromic SSA/Ps (n=12), sporadic SSA/Ps (n=9) and HPs (n=10) compared to control colon. Syndromic and sporadic SSA/Ps were compared to control right colon (n=10) and HPs were compared to control left colon (n=10). 1350, 698 and 711 genes were differentially expressed in syndromic and sporadic SSA/Ps and HPs, respectively. 1422 genes total were differentially expressed in syndromic and/or sporadic SSA/Ps. SporadicRight_2 SyndromicRight_5 SyndromicRight_1 SyndromicRight_2 SporadicRight_1 SporadicLeft_2 SyndromicRight_3 SyndromicRight_4 ControlRight_6 SporadicLeft_1 SyndromicLeft_1 ControlRight_10 ControlRight_4 ControlRight_9 ControlRight_8 ControlRight_1 ControlRight_3 ControlRight_5 ControlRight_7 ControlRight_2 Supplemental Figure 2 Log2 Ratio Color Bar Comparison of gene expression in uninvolved colon from patients with SSA/Ps with control colon from patients without polyps. Relative expression of 1922 genes found differentially expressed (Fold ≥ 2 and FDR < 0.01) between uninvolved (n=10, 7 right and 3 left) and control right colon (n=10). Uninvolved colon includes six uninvolved colon from syndromic patients with SSA/Ps and four uninvolved colon from sporadic patients with SSA/Ps. Log2 ratios comparing each individual sample to the mean of 10 right control colon samples was used for hierarchical clustering. Supplemental Figure 3 Log2 Ratio Color Bar Evaluation of an SSA/P gene signature using previously published microarray data of SSA/Ps, MVHPs and control colon. Quantile normalized expression data for each signature gene was downloaded from the Gene Expression Omnibus (GEO) under accession number GSE43841. Expression data from six SSA/Ps, six MVHPs and six control colon FFPE samples (three right and three left) was evaluated for expression of our gene markers. Hierarchical clustering of log2 ratio values comparing each individual colon sample (SSA/P – sessile serrated adenoma/polyp, MVHP – microvesicular hyperplastic polyp, CTRL – control colon) to the mean of all 18 colon samples is shown. Red and green denote overexpression and underexpression, respectively. Clustering was performed using a correlation metric and complete linkage. Supplemental Figure 4 mRNA expression of four SSA/P signature genes (FSCN1, MUC6, SEMG1 and ZIC5) in SSA/Ps, HPs, uninvolved colon and control colon by quantitative RT-PCR (qPCR). mRNA expression for each gene was determined using commercially available TaqMan gene expression assays (Invitrogen) and a Applied Biosystems 7900HT real-time PCR instrument. 10ul qPCR reactions were performed with forward and reverse primers, internal probe, master mix and 10-15 ng cDNA. cDNA was made from total RNA using the High Capacity RNA to cDNA kit (Invitrogen). A total of 73 samples were analyzed, 21 SSA/Ps, 12 HPs, 17 uninvolved and 23 control colon. Beta-actin was used a reference and control colon as the baseline for determining fold change using the ΔΔCT method. Statistical significance was determined by the non-parametric Mann Whitney U test.