The thymidylate synthase (TS) gene has a polymorphic repeated sequence in its 5′ ′ ′ ′-untranslated region. The repeat length is associated with TS protein expression, which suggests that we may be able to predict the efficacy of 5-fluorouracil (5-FU)-based chemotherapy from a patient's TS Key words: Thymidylate synthase -Loss of heterozygosity -Gene polymorphism -Pharmacogenomics -Cancer chemotherapy Thymidylate synthase (TS) catalyzes the reductive methylation of dUMP by 5,10-methylenetetrahydrofolate to form dTMP and dihydrofolate. TS has been an important target for cancer chemotherapy because of its central, rate-limiting role in the de novo synthesis of dTTP. 1) 5-Fluorouracil (5-FU) inhibits TS by forming a stable ternary complex among 5,10-methylenetetrahydrofolate, TS and fluoro-dUMP, the metabolite of 5-FU. Based on this mechanism, the TS expression level in cancer tissue has been expected to be a predictor of response to 5-FU-based chemotherapy, and indeed, recent studies have shown that the sensitivity of various tumors to 5-FU-based chemotherapy is associated with the intratumoral level of TS.
2-5)The TS gene is known to have a unique tandemly repeated sequence in the 5′-untranslated region (5′-UTR) and is polymorphic in the numbers of this repeat.6) The double (2R) or the triple (3R) repeats are the most common, although higher numbers are also found less frequently. We previously reported that this polymorphism was associated with TS protein expression in human gastrointestinal cancers.7) The cancer tissue with 3R/3R genotype showed significantly higher TS protein expression than did that with 2R/3R genotype. This association between TS genotype and TS expression, together with the role of TS expression in 5-FU-based chemotherapy, suggest that the TS genotype might be a novel predictor of efficacy for 5-FU-based chemotherapy. Some clinical evidence has been reported to support this potential of the TS genotype, [8][9][10][11] although the studies had relatively small numbers of subjects, and validation by a larger-scale clinical study is needed.One of advantages of clinical use of TS genotype would be that the genotype can be determined through a blood test, and so the strategy would be applicable to patients with cancer that is not easily accessible. This expectation is based on the assumption that the genotype in normal tissue, i.e. peripheral blood cells, is identical with that in cancer tissue. However, this assumption has not yet been validated in the case of the TS genotype. Theoretically, the TS genotype in cancer tissue could be changed by genetic alterations, including instability of repeat length and allelic loss. To test this possibility, we analyzed the TS genotype