S_mmimary Hereditary non-polyposis colorectal cancer (HNPCC) has recently been linked to germline defects of DNA repair genes. Colorectal tumours in HNPCC frequently show DNA microsatellite instability, but it is not certain whether this mutator phenotype occurs throughout the morphologically normal colonic mucosa. We have previously used the mPAS histochemical technique in human colorectal mucosa to identify a polymorphism for O-acetyltransferase activity that shows monogenic inheritance and to show that cryptrestricted loss of O-acetyltransferase activity in heterozygotes is due to somatic mutation. We have now used this histochemical technique to measure the somatic mutation frequency in the uninvolved colon of 12 heterozygous patients with HNPCC, 15 with ileocaecal Crohn's disease and 16 with sporadic colorectal cancer (CRC). HNPCC patients showed a significant increase in mutation frequency with age (Mann-Whitney U. P=0.02). In HNPCC patients aged <49 years the mean stem cell mutation frequency was significantly lower than in the slightly younger group of patients with Crohn's disease (0.8 ± 0.9 x 10-' vs 3.5 ± 3.3 x 10-4, P<0.01), probably reflecting an increased mutation rate relating to chronic mucosal damage in Crohn's disease. Although not statistically significant, the stem cell mutation frequency was slightly less in HNPCC patients >50 years than in sporadic CRC cases (4.9 ± 3.4 x 10-4vs 5.9 ± 3.6 x 10-4, P>0.5 al., 1993).The APC gene is thought to act as a tumour-suppressor gene and, although the function of its product is not established, there is evidence to suggest that it is involved in cell adhesion (Su et al., 1993). The four putative HNPCC genes so far identified, on the other hand, appear to be involved in DNA repair. Colorectal adenomas and carcinomas, and extracolonic carcinomas, of HNPCC patients show a high frequency of DNA microsatellite instability (Aaltonen et al., 1994), and human homologues of the prokaryotic DNA mismatch repair genes mutS and mutL map to the regions of chromosomes 2, 3 and 7 that have been shown by linkage studies to bear the HNPCC loci. Moreover, germline mutations of these repair genes occur in affected patients (Fishel et al., 1993;Leach et al., 1993;Bronner et al., 1994;Nicolaides et al., 1994). HNPCC patients might therefore be expected to show an increased frequency of somatic mutation in a wide range of other genes. Loss of heterozygosity for chromosomes 2 or 3 is not common in HNPCC tumours Lindblom et al., 1993) and it is not certain whether the gene is acting dominantly, conferring increased mutation in the normal colon as well as in tumours, or whether its action is confined to tumours. Evidence suggesting-the latter is derived from the fact that a lymphoblastoid cell line from an HNPCC-affected individual was proficient in mismatch repair and that normal tissue (of unspecified type) from HNPCC patients was not found to show microsatellite instability . However, the possibility that the inherited DNA defect is confined to tissues with an increased inci...