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Loss of ATRX, Genome Instability, and an Altered DNA Damage Response Are Hallmarks of the Alternative Lengthening of Telomeres Pathway
Open accessAbstract
The Alternative Lengthening of Telomeres (ALT) pathway is a telomerase-independent pathway for telomere maintenance that is active in a significant subset of human cancers and in vitro immortalized cell lines. ALT is thought to involve templated extension of telomeres through homologous recombination, but the genetic or epigenetic changes that unleash ALT are not known. Recently, mutations in the ATRX/DAXX chromatin remodeling complex and histone H3.3 were found to correlate with features of ALT in pancreatic neuroendocrine cancers, pediatric glioblastomas, and other tumors of the central nervous system, suggesting that these mutations might contribute to the activation of the ALT pathway in these cancers. We have taken a comprehensive approach to deciphering ALT by applying genomic, molecular biological, and cell biological approaches to a panel of 22 ALT cell lines, including cell lines derived in vitro. Here we show that loss of ATRX protein and mutations in the ATRX gene are hallmarks of ALT-immortalized cell lines. In addition, ALT is associated with extensive genome rearrangements, marked micronucleation, defects in the G2/M checkpoint, and altered double-strand break (DSB) repair. These attributes will facilitate the diagnosis and treatment of ALT positive human cancers.
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“ALT is associated with mutations in the chromatin remodeller α-thalassaemia/mental retardation syndrome X-linked (AT R X ) both in vitro and in several human cancers, including glioblastomas162–165.”
From Telomeres in cancer: tumour suppression and genome instability (2017) · cites this paper as [162]
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Kovatcheva, M., Liu, D. D., Dickson, M. A., Klein, M. E., O’Connor, R., Wilder, F. O., Socci, N. D., Tap, W. D., Schwartz, G. K., Singer, S., et al. (2015) · Oncotarget · doi:10.18632/oncotarget.3364 · Cited by 142
“We measured ALT by both telomere-FISH and telomere restriction fragment assays [43, 44](Supplementary Figure 7).”
BackgroundMethodBallew, B. J., Vijai, J., De, S., Sarek, G., Vannier, J., Stracker, T. H., Schrader, K. A., Small, T. N., O'Reilly, R., Manschreck, C., et al. (2013) · PLoS Genetics · doi:10.1371/journal.pgen.1003695 · Cited by 150
“The frequency of chromatid ends lacking telomeric FISH signal in MSK-41 cells was approximately 10%, approaching that seen in SaOS2, a cell line with the alternative lengthening of telomeres (ALT) phenotype [13].”
BackgroundMethodSelf-citationGarcía-Expósito, L., Bournique, E., Bergoglio, V., Bose, A., González, J. B., Zhang, S., Roncaioli, J. L., Lee, M., Wallace, C. T., Watkins, S. C., et al. (2016) · Cell Reports · doi:10.1016/j.celrep.2016.10.048 · Cited by 150
“To date, no deficiency in shelterin function has been linked with ALT activation or the elevated replicative stress and DNA damage observed at ALT telomeres (Lovejoy et al., 2012).”
Exome Sequencing of Uterine Leiomyosarcomas Identifies Frequent Mutations in TP53, ATRX, and MED12
Mäkinen, N., Aavikko, M., Heikkinen, T., Taipale, M., Taipale, J., Koivisto-Korander, R., Bützow, R. C., & Vahteristo, P. (2016) · PLoS Genetics · doi:10.1371/journal.pgen.1005850 · Cited by 140
“Loss of ATRX expression has been associated with ALT [13,24], which prompted us to analyze the telomeres with telomere-specific FISH.”
BackgroundMechanisms and Consequences of Cancer Genome Instability: Lessons from Genome Sequencing Studies
Lee, J. J.-K., Choi, Y., Kwon, M., & Park, P. J. (2016) · Annual Review of Pathology Mechanisms of Disease · doi:10.1146/annurev-pathol-012615-044446 · Cited by 135
The chromatin remodelling factor ATRX suppresses R‐loops in transcribed telomeric repeats
Nguyen, D. T. T., Voon, H. P. J., Xella, B., Scott, C., Clynes, D., Babbs, C., Ayyub, H., Kerry, J., Sharpe, J. A., Sloane‐Stanley, J., et al. (2017) · EMBO Reports · doi:10.15252/embr.201643078 · Cited by 147
“Acquired mutations in ATRX have been identified in almost all tumours which maintain their telomere length via the alternative lengthening of telomeres (ALT) pathway [17-19].”
Job, S., Drašković, I., Burnichon, N., Buffet, A., Cros, J. F., Lépine, C., Vénisse, A., Robidel, E., Verkarre, V., Méatchi, T., et al. (2018) · Clinical Cancer Research · doi:10.1158/1078-0432.ccr-18-0139 · Cited by 141
“On the other hand, the genetic basis of ALT tumors remains poorly defined, although mutations in ATRX have been reported to be associated with this phenotype (18).”
BackgroundThe Role of Double-Strand Break Repair Pathways at Functional and Dysfunctional TelomeresPreprint
Doksani, Y., & de Lange, T. (2014) · Cold Spring Harbor Perspectives in Biology · doi:10.1101/cshperspect.a016576 · Cited by 143
“The only consistent genetic defect so far identified in ALT is the loss of ATRX (Heaphy et al. 2011a,b; Lovejoy et al. 2012).”
BackgroundInfluentialGenomic footprints of activated telomere maintenance mechanisms in cancer
Sieverling, L., Hong, C., Koser, S. D., Ginsbach, P., Kleinheinz, K., Hutter, B., Braun, D. M., Cortés‐Ciriano, I., Xi, R., Kabbe, R., et al. (2020) · Nature Communications · doi:10.1038/s41467-019-13824-9 · Cited by 141
“In 16 samples, evidence for TERRA expression at telomere insertion sites was found.”
InfluentialTelomere Maintenance Mechanisms in Cancer
Gaspar, T. B., Sá, A., Lopes, J. M., Sobrinho-Simões, M. A., Soares, P., & Vinagre, J. (2018) · Genes · doi:10.3390/genes9050241 · Cited by 144
“Still, no clear correlation between ATRX and global TERRA expression levels is apparent [475,479,480].”
BackgroundAtrx deficiency induces telomere dysfunction, endocrine defects, and reduced life span
Watson, L. A., Solomon, L. A., Li, J. R., Jiang, Y. Y., Edwards, M., Shin‐ya, K., Beier, F., & Bérubé, N. G. (2013) · Journal of Clinical Investigation · doi:10.1172/jci65634 · Cited by 133
“Tumors with ATRX mutations often harbor long telomeres, which are characteristic of the telomere maintenance mechanism known as alternative lengthening of telomeres (ALT) (6, 7, 11, 13, 14).”
NuRD–ZNF827 recruitment to telomeres creates a molecular scaffold for homologous recombination
Conomos, D., Reddel, R. R., & Pickett, H. A. (2014) · Nature Structural & Molecular Biology · doi:10.1038/nsmb.2877 · Cited by 129
Self-citationLi, F., Deng, Z., Zhang, L., Wu, C., Jin, Y., Hwang, I., Vladimirova, O. V., Xu, L., Yang, L., Lu, B., et al. (2019) · The EMBO Journal · doi:10.15252/embj.201796659 · Cited by 135
“In addition, ALT is also associated with massive genome rearrangement, defective G2/M checkpoint control, and altered DNA damage repair (Lovejoy et al , 2012).”
InfluentialBreak induced replication in eukaryotes: mechanisms, functions, and consequences
Sakofsky, C. J., & Malkova, A. (2017) · Critical Reviews in Biochemistry and Molecular Biology · doi:10.1080/10409238.2017.1314444 · Cited by 142
“In addition, recent studies suggested that ALT is also promoted by a replication collapse at positions of R-loops formed by annealing of long noncoding TERRA RNA that is transcribed from the telomeres, which remains attached to the template (Arora et al., 2014; Azzalin et al., 2007; Episkopou et al., 2014; Flynn et al…”
Integrity of the human centromere DNA repeats is protected by CENP-A, CENP-C, and CENP-T
Giunta, S., & Funabiki, H. (2017) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.1615133114 · Cited by 123
DAXX in cancer: phenomena, processes, mechanisms and regulation
Mahmud, I., & Liao, D. (2019) · Nucleic Acids Research · doi:10.1093/nar/gkz634 · Cited by 122
“Abnormal telomeres due to alternative lengthening of telomeres (ALT) independent of telomerase activity in PanNETs were observed frequently and can be attributed to the loss-of-function mutations of DAXX and/or ATRX (23,24,80).”
BackgroundThe chromatin remodeller ATRX: a repeat offender in human disease
Clynes, D., Higgs, D. R., & Gibbons, R. J. (2013) · Trends in Biochemical Sciences · doi:10.1016/j.tibs.2013.06.011 · Cited by 132
TERRA and the state of the telomere
Rippe, K., & Luke, B. (2015) · Nature Structural & Molecular Biology · doi:10.1038/nsmb.3078 · Cited by 122
METTL3-mediated m6A modification stabilizes TERRA and maintains telomere stability
Chen, L., Zhang, C., Ma, W., Huang, J., Zhao, Y. B., & Liu, H. (2022) · Nucleic Acids Research · doi:10.1093/nar/gkac1027 · Cited by 124
“There are lots of special characteristics in ALT cancer cells such as the C-circle, ALT-associated PML bodies (APBs), heterogeneous telomere length, absence of ATRX, telomere recombination and a high telomeric repeat-containing RNA (TERRA) level (7–11).”
Hoelper, D., Huang, H., Jain, A. Y., Patel, D. J., & Lewis, P. W. (2017) · Nature Communications · doi:10.1038/s41467-017-01206-y · Cited by 127
Leung, J. W. C., Ghosal, G., Wang, W., Shen, X. H., Wang, J., Li, L., & Chen, J. (2013) · Journal of Biological Chemistry · doi:10.1074/jbc.m112.411603 · Cited by 124
“As a matter of fact, SWI/SNF family proteins are implicated in cancers and other human syndromes with mental retardation (MR) and genomic instability, including alpha thalassemia/mental retardation syndrome X-linked (ATRX) (10, 11).”
Aguilera, P., & Lopez-Contreras, A. J. (2023) · Trends in Genetics · doi:10.1016/j.tig.2023.02.009 · Cited by 122
ATRX Dysfunction Induces Replication Defects in Primary Mouse Cells
Clynes, D., Jelinska, C., Xella, B., Ayyub, H., Taylor, S., Mitson, M., Bachrati, C. Z., Higgs, D. R., & Gibbons, R. J. (2014) · PLoS ONE · doi:10.1371/journal.pone.0092915 · Cited by 120
“Interestingly, a role for ATRX in facilitating replication through potential G-quadruplex forming sequences may shed light on its recently ascribed role as a tumor suppressor in a specific subset of malignancies that depend on a telomerase-independent pathway of telomere maintenance called the ‘alternative lengthening…”
BackgroundAlternative lengthening of telomeres in childhood neuroblastoma from genome to proteome
Hartlieb, S., Sieverling, L., Nadler-Holly, M., Ziehm, M., Toprak, U. H., Herrmann, C., Ishaque, N., Okonechnikov, K., Gartlgruber, M., Park, Y.-G., et al. (2021) · Nature Communications · doi:10.1038/s41467-021-21247-8 · Cited by 115
Doxorubicin Enhances Nucleosome Turnover around Promoters
Yang, F., Kemp, C. J., & Henikoff, S. (2013) · Current Biology · doi:10.1016/j.cub.2013.03.043 · Cited by 120
“3/DAXX/ATRX nucleosome assembly pathway [33].”
Nuclear PARPs and genome integrityPreprint
Azarm, K., & Smith, S. H. (2020) · Genes & Development · doi:10.1101/gad.334730.119 · Cited by 116
“Along with its roles in chromatin remodeling and histone deposition, ATRX sequesters the soluble pool of macroH2A (Ratnakumar et al. 2012), a histone variant comprised of an N-terminal H2A-like domain and a C-terminal PAR-binding macrodomain (Gamble and Kraus 2010; Cantariño et al. 2013).”
BackgroundInfluentialExtensive Proliferation of Human Cancer Cells with Ever-Shorter Telomeres
Dagg, R. A., Pickett, H. A., Neumann, A. A., Napier, C. E., Henson, J. D., Teber, E., Arthur, J. W., Reynolds, C. P., Murray, J. E., Haber, M., et al. (2017) · Cell Reports · doi:10.1016/j.celrep.2017.05.087 · Cited by 110
Self-citationTERRA and RAD51AP1 promote alternative lengthening of telomeres through an R- to D-loop switch
Yadav, T., Zhang, J., Ouyang, J., Leung, W., Simoneau, A., & Zou, L. (2022) · Molecular Cell · doi:10.1016/j.molcel.2022.09.026 · Cited by 111
R Loops and Their Composite Cancer Connections
Wells, J. P., White, J., & Stirling, P. C. (2019) · Trends in cancer · doi:10.1016/j.trecan.2019.08.006 · Cited by 111
Telomere Maintenance Mechanisms Define Clinical Outcome in High-Risk Neuroblastoma
Koneru, B., López, G., Farooqi, A. S., Conkrite, K. L., Nguyen, T. H., Macha, S. J., Modi, A., Rokita, J. L., Urias, E., Hindle, A., et al. (2020) · Cancer Research · doi:10.1158/0008-5472.can-19-3068 · Cited by 112
Histone variant H3.3 provides the heterochromatic H3 lysine 9 tri-methylation mark at telomeres
Udugama, M., Chang, F. T. M., Chan, F. L., Tang, M. C., Pickett, H. A., McGhie, J. D. R., Mayne, L., Collas, P., Mann, J. R., & Wong, L. H. (2015) · Nucleic Acids Research · doi:10.1093/nar/gkv847 · Cited by 109
“eric DNA, resulting in persistent replication stalling and in turn leading to DNA damage, ALT and genome instability (23).”
BackgroundNew players in heterochromatin silencing: histone variant H3.3 and the ATRX/DAXX chaperone
Voon, H. P. J., & Wong, L. H. (2016) · Nucleic Acids Research · doi:10.1093/nar/gkw012 · Cited by 118
“This is particularly pertinent to ALT cancers where ATRX mutations have been strongly linked to increased recombination at telomeres (32,33).”
BackgroundSETDB1-dependent heterochromatin stimulates alternative lengthening of telomeres
Gauchier, M., Kan, S., Barral, A., Sauzet, S., Agirre, E., Bonnell, E., Saksouk, N., Barth, T. K., Ide, S., Urbach, S., et al. (2019) · Science Advances · doi:10.1126/sciadv.aav3673 · Cited by 115
“Besides mutations in the ATRX pathway, no other mutation has been linked to ALT in human cancer (6).”
BackgroundAksenova, A. Y., & Mirkin, S. M. (2019) · Genes · doi:10.3390/genes10020118 · Cited by 114
IDH inhibition in gliomas: from preclinical models to clinical trials
Rudà, R., Horbinski, C., van den Bent, M. J., Preusser, M., & Soffietti, R. (2024) · Nature Reviews Neurology · doi:10.1038/s41582-024-00967-7 · Cited by 105
“ATRX inactivation is associated with alternative lengthening of telomeres (ALT) — a telomere maintenance mechanism involving homologous recombination that is characteristic of IDH -mutant astrocytomas with ATRX loss 66–69 .”
Influential
Metadata
- Authors
- Lovejoy, C. A., Li, W., Reisenweber, S., Thongthip, S., Bruno, J., de Lange, T., De, S., Petrini, J. H. J., Sung, P. A., Jasin, M., Rosenbluh, J., Zwang, Y., Weir, B. A., Hatton, C., Ivanova, E., Macconaill, L., Hanna, M., Hahn, W. C., Lue, N. F., Reddel, R. R., Jiao, Y., Kinzler, K., Vogelstein, B., Papadopoulos, N., Meeker, A. K., & for the ALT Starr Cancer Consortium
- Affiliations
- Rockefeller University (US)
- Memorial Sloan Kettering Cancer Center (US)
- Broad Institute (US)
- Dana-Farber Cancer Institute (US)
- Cornell University (US)
- The University of Sydney (AU)
- Johns Hopkins University (US)
- ORCID
- Lovejoy, Courtney A.
- Thongthip, Supawat
- Bruno, Joanne
- De, Saurav
- Petrini, John H. J.
- Sung, Patricia A.
- Jasin, Maria
- Rosenbluh, Joseph
- Zwang, Yaara
- Hatton, Charlie
- Ivanova, Elena
- Macconaill, Laura
- Hahn, William C.
- Lue, Neal F.
- Reddel, Roger R.
- Jiao, Yuchen
- Kinzler, Kenneth
- Vogelstein, Bert
- Papadopoulos, Nickolas
- Meeker, Alan K.
- Venue
- PLoS Genetics
- Publisher
- Public Library of Science (PLoS)
- Published
- 2012-07-19
- Volume
- 8
- Issue
- 7
- Pages
- e1002772
- ISSN
- 1553-7390 (ISSN-L)
- 1553-7404
- PMC
- PMC3400581
- OpenAlex
- W1999626396
- Cited by
- 629
- References
- 60
- Citations by year
- 2026: 34 · 2025: 41 · 2024: 33 · 2023: 44 · 2022: 51 · 2021: 52 · 2020: 49 · 2019: 54 · 2018: 53 · 2017: 44 · 2016: 41 · 2015: 49 · 2014: 44 · 2013: 33 · 2012: 6
- FWCI
- 28.08
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- PLoS Genetics (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Figshare (submittedVersion, cc-by)
- Funders
- U.S. Department of Defense
- National Institutes of Health
- Cancer Council NSW
- National Institute on Aging (R01AG023145)
- National Cancer Institute (CA076027, R01CA076027, R37CA043460, R13CA162528)
- National Institute of General Medical Sciences (R37GM059413, R37GM049046, R01GM049046, F32GM090437, GM049046, R01GM056888)
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Cell Biology › Telomeres, Telomerase, and Senescence
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › DNA Repair Mechanisms
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › DNA and Nucleic Acid Chemistry
- Keywords
- alternative lengthening of telomeres, ATRX, histone H3.3, genomic instability, DNA damage response, DNA double-strand break repair, G2/M checkpoint, micronucleation, genome rearrangement, telomere maintenance
- MeSH terms
- X-linked Nuclear Protein, DNA Damage, DNA Repair, DNA Helicases, HeLa Cells, Histones, Humans, Nuclear Proteins, Signal Transduction, Telomere, Molecular Chaperones, Telomerase, Chromatin Assembly and Disassembly, Genomic Instability, Adaptor Proteins, Signal Transducing, DNA Breaks, Double-Stranded, Co-Repressor Proteins, Telomere Homeostasis, G2 Phase Cell Cycle Checkpoints, Homologous Recombination
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