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Zhou Y, Chen X, Chen J, Kendrick CD, Ramanathan RK, Graham RP, Kossick KF, Boardman LA, Barrett MT. Genomic landscape of diploid and aneuploid microsatellite stable early onset colorectal cancer. Sci Rep 2024; 14:9368. [PMID: 38654044 DOI: 10.1038/s41598-024-59398-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 04/10/2024] [Indexed: 04/25/2024] Open
Abstract
Although colorectal cancer (CRC) remains the second leading cause of cancer-related death in the United States, the overall incidence and mortality from the disease have declined in recent decades. In contrast, there has been a steady increase in the incidence of CRC in individuals under 50 years of age. Hereditary syndromes contribute disproportionately to early onset CRC (EOCRC). These include microsatellite instability high (MSI+) tumors arising in patients with Lynch Syndrome. However, most EOCRCs are not associated with familial syndromes or MSI+ genotypes. Comprehensive genomic profiling has provided the basis of improved more personalized treatments for older CRC patients. However, less is known about the basis of sporadic EOCRC. To define the genomic landscape of EOCRC we used DNA content flow sorting to isolate diploid and aneuploid tumor fractions from 21 non-hereditary cases. We then generated whole exome mutational profiles for each case and whole genome copy number, telomere length, and EGFR immunohistochemistry (IHC) analyses on subsets of samples. These results discriminate the molecular features of diploid and aneuploid EOCRC and provide a basis for larger population-based studies and the development of effective strategies to monitor and treat this emerging disease.
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Affiliation(s)
- Yumei Zhou
- Department of Research, Mayo Clinic in Arizona, Scottsdale, AZ, USA
| | - Xianfeng Chen
- Division of Computational Biology, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, 55905, USA
| | - Jun Chen
- Division of Computational Biology, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, 55905, USA
| | - Conner D Kendrick
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Ramesh K Ramanathan
- Mayo Clinic Cancer Center, Phoenix, AZ, 85054, USA
- Ironwood Cancer and Research Center, Scottsdale, AZ, 85260, USA
| | | | - Kimberlee F Kossick
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Lisa A Boardman
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Michael T Barrett
- Department of Research, Mayo Clinic in Arizona, Scottsdale, AZ, USA.
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic in Arizona, Scottsdale, AZ, USA.
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Pauleck S, Sinnott JA, Zheng YL, Gadalla SM, Viskochil R, Haaland B, Cawthon RM, Hoffmeister A, Hardikar S. Association of Telomere Length with Colorectal Cancer Risk and Prognosis: A Systematic Review and Meta-Analysis. Cancers (Basel) 2023; 15:1159. [PMID: 36831502 PMCID: PMC9954736 DOI: 10.3390/cancers15041159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 02/04/2023] [Accepted: 02/08/2023] [Indexed: 02/15/2023] Open
Abstract
(1) Background: Colorectal cancer risk and survival have previously been associated with telomere length in peripheral blood leukocytes and tumor tissue. A systematic review and meta-analysis of the literature was conducted. The PubMed, Embase, and Web of Science databases were searched through March 2022. (2) Methods: Relevant studies were identified through database searching following PRISMA guidelines. Risk estimates were extracted from identified studies; meta-analyses were conducted using random effects models. (3) Results: Fourteen studies were identified (eight on risk; six on survival) through systematic review. While no association was observed between circulating leukocyte telomere length and the risk of colorectal cancer [overall OR (95% CI) = 1.01 (0.82-1.24)], a worse survival for those with shorter telomeres in leukocytes and longer telomeres in tumor tissues was observed [Quartile1/Quartile2-4 overall HR (95% CI) = 1.41 (0.26-7.59) and 0.82 (0.69-0.98), respectively]. (4) Conclusions: Although there was no association with colorectal cancer risk, a poorer survival was observed among those with shorter leukocyte telomere length. Future larger studies evaluating a potentially non-linear relationship between telomeres and colorectal cancer are needed.
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Affiliation(s)
- Svenja Pauleck
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, USA
- Medical Department II, Division of Gastroenterology, University of Leipzig Medical Center, 04103 Leipzig, Germany
| | - Jennifer A. Sinnott
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, USA
- Department of Pediatrics, University of Utah, Salt Lake City, UT 84108, USA
- Department of Statistics, The Ohio State University, Columbus, OH 43210, USA
| | - Yun-Ling Zheng
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC 20057, USA
| | - Shahinaz M. Gadalla
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD 20892, USA
| | - Richard Viskochil
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, USA
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT 84108, USA
| | - Benjamin Haaland
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, USA
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT 84108, USA
| | - Richard M. Cawthon
- Department of Human Genetics, University of Utah, Salt Lake City, UT 84108, USA
| | - Albrecht Hoffmeister
- Medical Department II, Division of Gastroenterology, University of Leipzig Medical Center, 04103 Leipzig, Germany
| | - Sheetal Hardikar
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, USA
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT 84108, USA
- Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA
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Telomere Length as a New Risk Marker of Early-Onset Colorectal Cancer. Int J Mol Sci 2023; 24:ijms24043526. [PMID: 36834938 PMCID: PMC9965248 DOI: 10.3390/ijms24043526] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 02/02/2023] [Accepted: 02/07/2023] [Indexed: 02/12/2023] Open
Abstract
Early-onset colorectal cancer (EOCRC; age younger than 50 years) incidence has been steadily increasing in recent decades worldwide. The need for new biomarkers for EOCRC prevention strategies is undeniable. In this study, we aimed to explore whether an aging factor, such as telomere length (TL), could be a useful tool in EOCRC screening. The absolute leukocyte TL from 87 microsatellite stable EOCRC patients and 109 healthy controls (HC) with the same range of age, was quantified by Real Time Quantitative PCR (RT-qPCR). Then, leukocyte whole-exome sequencing (WES) was performed to study the status of the genes involved in TL maintenance (hTERT, TERC, DKC1, TERF1, TERF2, TERF2IP, TINF2, ACD, and POT1) in 70 sporadic EOCRC cases from the original cohort. We observed that TL was significantly shorter in EOCRC patients than in healthy individuals (EOCRC mean: 122 kb vs. HC mean: 296 kb; p < 0.001), suggesting that telomeric shortening could be associated with EOCRC susceptibility. In addition, we found a significant association between several SNPs of hTERT (rs79662648), POT1 (rs76436625, rs10263573, rs3815221, rs7794637, rs7784168, rs4383910, and rs7782354), TERF2 (rs251796 and rs344152214), and TERF2IP (rs7205764) genes and the risk of developing EOCRC. We consider that the measurement of germline TL and the status analysis of telomere maintenance related genes polymorphisms at early ages could be non-invasive methods that could facilitate the early identification of individuals at risk of developing EOCRC.
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Pauleck S, Gigic B, Cawthon RM, Ose J, Peoples AR, Warby CA, Sinnott JA, Lin T, Boehm J, Schrotz-King P, Li CI, Shibata D, Siegel EM, Figueiredo JC, Toriola AT, Schneider M, Ulrich AB, Hoffmeister A, Ulrich CM, Hardikar S. Association of circulating leukocyte telomere length with survival in patients with colorectal cancer. J Geriatr Oncol 2022; 13:480-485. [PMID: 34998722 PMCID: PMC9197691 DOI: 10.1016/j.jgo.2021.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 10/31/2021] [Accepted: 12/07/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Telomere shortening, as seen with aging, can cause chromosomal instability and promote cancer progression. We investigated the association between circulating telomere length and overall and disease-free survival in a sub-cohort of patients with colorectal cancer. METHODS Baseline genomic DNA from blood leukocytes was extracted from N = 92 newly diagnosed stage I-IV patients with colorectal cancer enrolled at the ColoCare Study site in Heidelberg, Germany. Detailed information on clinicodemographic (including age) and lifestyle risk factors, and clinical outcomes (including recurrence and survival) was collected. Telomere length was measured in DNA using multiplex quantitative polymerase chain reaction. Kaplan Meier survival curves were generated comparing shorter to longer telomere lengths with log-rank testing. RESULTS The mean T/S ratio for study patients was 0.5 (range: 0.3-0.9). Shorter telomeres were associated with older age at baseline. Patients with shorter telomeres experienced a worse overall and disease-free survival, although this association did not reach statistical significance. Kaplan-Meier survival curves for those with circulating telomere length below vs. above the median showed poorer overall (log-rank p = 0.31) and disease-free survival (long-rank p = 0.23). CONCLUSIONS Our results suggest that individuals with shorter telomeres, as seen with aging, may experience a worse overall and disease-free survival after colorectal cancer diagnosis. Larger sample sizes with longer follow-up are needed to further evaluate telomere length as a prognostic biomarker in colorectal cancer progression.
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Affiliation(s)
- Svenja Pauleck
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA; University of Leipzig Medical Center, Medical Faculty, Leipzig, Germany
| | - Biljana Gigic
- Heidelberg University Hospital, Heidelberg, Germany; National Center for Tumor Diseases (NCT) and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Richard M Cawthon
- Department of Human Genetics, University of Utah, Salt Lake City, UT, USA
| | - Jennifer Ose
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA; Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA
| | - Anita R Peoples
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA; Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA
| | - Christy A Warby
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA; Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA
| | - Jennifer A Sinnott
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA; Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA; Department of Pediatrics, University of Utah, Salt Lake City, UT, USA; Department of Statistics, The Ohio State University, Columbus, OH, USA
| | - Tengda Lin
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA; Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA
| | - Juergen Boehm
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Petra Schrotz-King
- National Center for Tumor Diseases (NCT) and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - David Shibata
- University of Tennessee Health Science Center, Memphis, TN, USA
| | - Erin M Siegel
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | | | - Adetunji T Toriola
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, St. Louis, MO, USA
| | - Martin Schneider
- Heidelberg University Hospital, Heidelberg, Germany; National Center for Tumor Diseases (NCT) and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Alexis B Ulrich
- Heidelberg University Hospital, Heidelberg, Germany; National Center for Tumor Diseases (NCT) and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Albrecht Hoffmeister
- Medical Department II, Division of Gastroenterology, University of Leipzig Medical Center, Leipzig, Germany
| | - Cornelia M Ulrich
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA; Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA
| | - Sheetal Hardikar
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA; Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA; Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
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Xiong F, Frasch WD. ΩqPCR measures telomere length from single-cells in base pair units. Nucleic Acids Res 2021; 49:e120. [PMID: 34534325 PMCID: PMC8599887 DOI: 10.1093/nar/gkab753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 08/13/2021] [Accepted: 09/07/2021] [Indexed: 12/25/2022] Open
Abstract
ΩqPCR determines absolute telomere length in kb units from single cells. Accuracy and precision of ΩqPCR were assessed using 800 bp and 1600 bp synthetic telomeres inserted into plasmids, which were measured to be 819 ± 19.6 and 1590 ± 42.3 bp, respectively. This is the first telomere length measuring method verified in this way. The approach uses Ω-probes, a DNA strand containing sequence information that enables: (i) hybridization with the telomere via the 3' and 5' ends that become opposed; (ii) ligation of the hybridized probes to circularize the Ω-probes and (iii) circularized-dependent qPCR due to sequence information for a forward primer, and for a reverse primer binding site, and qPCR hydrolysis probe binding. Read through of the polymerase during qPCR occurs only in circularized Ω-probes, which quantifies their number that is directly proportional to telomere length. When used in concert with information about the cell cycle stage from a single-copy gene, and ploidy, the MTL of single cells measured by ΩqPCR was consistent with that obtained from large sample sizes by TRF.
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Affiliation(s)
- Fusheng Xiong
- School of Life Sciences, Arizona State University, PO Box 874501, Tempe, AZ 85287-4501, USA
| | - Wayne D Frasch
- School of Life Sciences, Arizona State University, PO Box 874501, Tempe, AZ 85287-4501, USA
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Familial Melanoma and Susceptibility Genes: A Review of the Most Common Clinical and Dermoscopic Phenotypic Aspect, Associated Malignancies and Practical Tips for Management. J Clin Med 2021; 10:jcm10163760. [PMID: 34442055 PMCID: PMC8397216 DOI: 10.3390/jcm10163760] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 08/13/2021] [Accepted: 08/18/2021] [Indexed: 12/11/2022] Open
Abstract
A family history of melanoma greatly increases the risk of developing cutaneous melanoma, a highly aggressive skin cancer whose incidence has been steadily increasing worldwide. Familial melanomas account for about 10% of all malignant melanomas and display an inheritance pattern consistent with the presence of pathogenic germline mutations, among which those involving CDKN2A are the best characterized. In recent years, a growing number of genes, such as MC1R, MITF, CDK4, POT1, TERT, ACD, TERF2IP, and BAP1, have been implicated in familial melanoma. The fact that individuals harboring these germline mutations along with their close blood relatives have a higher risk of developing multiple primary melanomas as well as other internal organ malignancies, especially pancreatic cancer, makes cascade genetic testing and surveillance of these families of the utmost importance. Unfortunately, due to a polygenic inheritance mechanism involving multiple low-risk alleles, genetic modifiers, and environmental factors, it is still very difficult to predict the presence of these mutations. It is, however, known that germline mutation carriers can sometimes develop specific clinical traits, such as high atypical nevus counts and specific dermoscopic features, which could theoretically help clinicians predict the presence of these mutations in prone families. In this review, we provide a comprehensive overview of the high- and intermediate-penetrance genes primarily linked to familial melanoma, highlighting their most frequently associated non-cutaneous malignancies and clinical/dermoscopic phenotypes.
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Association Between Leukocyte Telomere Length and Colorectal Cancer Risk in the Singapore Chinese Health Study. Clin Transl Gastroenterol 2020; 10:1-9. [PMID: 31117113 PMCID: PMC6602767 DOI: 10.14309/ctg.0000000000000043] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Telomeres and telomerase play important roles in maintaining chromosome integrity and genomic stability. To address a lack of consensus about the association between leukocyte telomere length and colorectal cancer, we investigated this association in the Singapore Chinese Health Study.
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Jebaraj BMC, Tausch E, Landau DA, Bahlo J, Robrecht S, Taylor-Weiner AN, Bloehdorn J, Scheffold A, Mertens D, Böttcher S, Kneba M, Jäger U, Zenz T, Wenger MK, Fingerle-Rowson G, Wendtner C, Fink AM, Wu CJ, Eichhorst B, Fischer K, Hallek M, Döhner H, Stilgenbauer S. Short telomeres are associated with inferior outcome, genomic complexity, and clonal evolution in chronic lymphocytic leukemia. Leukemia 2019; 33:2183-2194. [PMID: 30911113 PMCID: PMC6737251 DOI: 10.1038/s41375-019-0446-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Revised: 01/19/2019] [Accepted: 02/11/2019] [Indexed: 11/08/2022]
Abstract
Telomere length in chronic lymphocytic leukemia (CLL) has been shown to be of prognostic importance, but the analyses have largely been executed on heterogeneous patient cohorts outside of clinical trials. In the present study, we performed a comprehensive analysis of telomere length associations in the well characterized CLL8 trial (n = 620) of the German CLL study group, with validation in a representative cohort of the CLL4 trial (n = 293). Absolute telomere length was analyzed using quantitative-PCR. Apart from identifying associations of short telomere length with adverse prognostic factors and survival, the study identified cases with 17p- and 11q- associated with TP53 and ATM loss, respectively, to have the shortest telomeres, even when these aberrations were present in small subclones. Thus, telomere shortening may precede acquisition of the high-risk aberrations, contributing to disease evolution. In line with this, telomere shortening was associated with an increase in genomic complexity as well as clonal evolution, highlighting its importance as a biomarker especially in monitoring disease progression in non-high-risk CLL.
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Affiliation(s)
| | - Eugen Tausch
- Department of Internal Medicine III, Ulm University, Ulm, Germany
| | - Dan A Landau
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
- Department of Physiology and Biophysics, Weill Cornell Medicine, New York, USA
- New York Genome Center, New York, NY, USA
| | - Jasmin Bahlo
- Department I for Internal Medicine and Centre for Integrated Oncology, University of Cologne, Cologne, Germany
| | - Sandra Robrecht
- Department I for Internal Medicine and Centre for Integrated Oncology, University of Cologne, Cologne, Germany
| | | | | | - Annika Scheffold
- Department of Internal Medicine III, Ulm University, Ulm, Germany
| | - Daniel Mertens
- Department of Internal Medicine III, Ulm University, Ulm, Germany
- Mechanisms of Leukemogenesis, DKFZ, Heidelberg, Germany
| | - Sebastian Böttcher
- Department II of Internal Medicine, University Hospital of Schleswig-Holstein, Kiel, Germany
- Division of Internal Medicine, Medical Clinic III, Rostock University Medical Center, Rostock, Germany
| | - Michael Kneba
- Department II of Internal Medicine, University Hospital of Schleswig-Holstein, Kiel, Germany
| | - Ulrich Jäger
- Department of Medicine I, Division of Hematology and Hemostaeology, Medical University of Vienna, Vienna, Austria
| | - Thorsten Zenz
- Department of Internal Medicine III, Ulm University, Ulm, Germany
- Division of Hematology, University Hospital Zürich, Zürich, Switzerland
| | | | | | - Clemens Wendtner
- Klinikum Schwabing, Academic Teaching Hospital of University of Munich, Munich, Germany
| | - Anna-Maria Fink
- Department I for Internal Medicine and Centre for Integrated Oncology, University of Cologne, Cologne, Germany
| | | | - Barbara Eichhorst
- Department I for Internal Medicine and Centre for Integrated Oncology, University of Cologne, Cologne, Germany
| | - Kirsten Fischer
- Department I for Internal Medicine and Centre for Integrated Oncology, University of Cologne, Cologne, Germany
| | - Michael Hallek
- Department I for Internal Medicine and Centre for Integrated Oncology, University of Cologne, Cologne, Germany
| | - Hartmut Döhner
- Department of Internal Medicine III, Ulm University, Ulm, Germany
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Peacock SD, Massey TE, Vanner SJ, King WD. Telomere length in the colon is related to colorectal adenoma prevalence. PLoS One 2018; 13:e0205697. [PMID: 30332457 PMCID: PMC6192597 DOI: 10.1371/journal.pone.0205697] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 09/28/2018] [Indexed: 12/19/2022] Open
Abstract
Telomere length has been associated with risk of several cancers. However, studies of the relationship between telomere length and colorectal cancer risk have been inconsistent. This study examined the relationship between telomere length in normal colon tissue and the prevalence of colorectal adenoma, a precursor to colorectal cancer. This nested case-control study consisted of 85 patients aged 40 to 65 undergoing a screening colonoscopy: 40 cases with adenoma(s) detected at colonoscopy and 45 controls with normal colonoscopy. During the colonoscopy, two pinch biopsies of healthy, normal appearing mucosa were obtained from the descending colon. Relative telomere length (rTL) was quantified in DNA extracted from colon mucosa using quantitative real-time PCR. Logistic regression was used to assess the relationship between telomere length and adenoma prevalence and estimate odds ratios and 95% confidence intervals. rTL was significantly longer in colon tissue of individuals with adenomas compared to healthy individuals (p = 0.008). When rTL was categorized into quartiles according to the distribution of rTL among controls, individuals with the longest telomeres had increased odds of adenoma when compared to individuals with shortest telomeres (OR = 4.58, 95% CI: 1.19, 17.7). This study suggests that long telomeres in normal colon tissue are associated with increased colorectal cancer risk.
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Affiliation(s)
- Sarah D. Peacock
- Department of Public Health Sciences, Queen’s University, Kingston, Ontario, Canada
- * E-mail:
| | - Thomas E. Massey
- Department of Biomedical and Molecular Sciences, Queen’s University, Kingston, Ontario, Canada
| | - Stephen J. Vanner
- Gastrointestinal Disease Research Unit, Queen’s University, Kingston, Ontario, Canada
| | - Will D. King
- Department of Public Health Sciences, Queen’s University, Kingston, Ontario, Canada
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Gielen M, Hageman GJ, Antoniou EE, Nordfjall K, Mangino M, Balasubramanyam M, de Meyer T, Hendricks AE, Giltay EJ, Hunt SC, Nettleton JA, Salpea KD, Diaz VA, Farzaneh-Far R, Atzmon G, Harris SE, Hou L, Gilley D, Hovatta I, Kark JD, Nassar H, Kurz DJ, Mather KA, Willeit P, Zheng YL, Pavanello S, Demerath EW, Rode L, Bunout D, Steptoe A, Boardman L, Marti A, Needham B, Zheng W, Ramsey-Goldman R, Pellatt AJ, Kaprio J, Hofmann JN, Gieger C, Paolisso G, Hjelmborg JBH, Mirabello L, Seeman T, Wong J, van der Harst P, Broer L, Kronenberg F, Kollerits B, Strandberg T, Eisenberg DTA, Duggan C, Verhoeven JE, Schaakxs R, Zannolli R, dos Reis RMR, Charchar FJ, Tomaszewski M, Mons U, Demuth I, Iglesias Molli AE, Cheng G, Krasnienkov D, D'Antono B, Kasielski M, McDonnell BJ, Ebstein RP, Sundquist K, Pare G, Chong M, Zeegers MP. Body mass index is negatively associated with telomere length: a collaborative cross-sectional meta-analysis of 87 observational studies. Am J Clin Nutr 2018; 108:453-475. [PMID: 30535086 PMCID: PMC6454526 DOI: 10.1093/ajcn/nqy107] [Citation(s) in RCA: 95] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 04/27/2018] [Indexed: 12/12/2022] Open
Abstract
Background Even before the onset of age-related diseases, obesity might be a contributing factor to the cumulative burden of oxidative stress and chronic inflammation throughout the life course. Obesity may therefore contribute to accelerated shortening of telomeres. Consequently, obese persons are more likely to have shorter telomeres, but the association between body mass index (BMI) and leukocyte telomere length (TL) might differ across the life span and between ethnicities and sexes. Objective A collaborative cross-sectional meta-analysis of observational studies was conducted to investigate the associations between BMI and TL across the life span. Design Eighty-seven distinct study samples were included in the meta-analysis capturing data from 146,114 individuals. Study-specific age- and sex-adjusted regression coefficients were combined by using a random-effects model in which absolute [base pairs (bp)] and relative telomere to single-copy gene ratio (T/S ratio) TLs were regressed against BMI. Stratified analysis was performed by 3 age categories ("young": 18-60 y; "middle": 61-75 y; and "old": >75 y), sex, and ethnicity. Results Each unit increase in BMI corresponded to a -3.99 bp (95% CI: -5.17, -2.81 bp) difference in TL in the total pooled sample; among young adults, each unit increase in BMI corresponded to a -7.67 bp (95% CI: -10.03, -5.31 bp) difference. Each unit increase in BMI corresponded to a -1.58 × 10(-3) unit T/S ratio (0.16% decrease; 95% CI: -2.14 × 10(-3), -1.01 × 10(-3)) difference in age- and sex-adjusted relative TL in the total pooled sample; among young adults, each unit increase in BMI corresponded to a -2.58 × 10(-3) unit T/S ratio (0.26% decrease; 95% CI: -3.92 × 10(-3), -1.25 × 10(-3)). The associations were predominantly for the white pooled population. No sex differences were observed. Conclusions A higher BMI is associated with shorter telomeres, especially in younger individuals. The presently observed difference is not negligible. Meta-analyses of longitudinal studies evaluating change in body weight alongside change in TL are warranted.
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Affiliation(s)
- Marij Gielen
- Departments of Complex Genetics,Address correspondence to MG (e-mail: )
| | - Geja J Hageman
- Toxicology, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht University, Netherlands
| | - Evangelia E Antoniou
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Netherlands
| | | | - Massimo Mangino
- Twin Research and Genetic Epidemiology, King's College London, London, United Kingdom,NIHR Biomedical Research Center at Guy's and St. Thomas’ Foundation Trust, London, United Kingdom
| | | | - Tim de Meyer
- Department of Mathematical Modeling, Statistics, and Bioinformatics, Ghent University, Ghent, Belgium
| | - Audrey E Hendricks
- Population Sciences Branch of the National Heart, Lung, and Blood Institute (NHLBI), NIH, NHLBI's Framingham Heart Study, Framingham, MA,Department of Mathematical and Statistical Sciences, University of Colorado–Denver, Denver, CO
| | - Erik J Giltay
- Department of Psychiatry, Leiden University Medical Center, Leiden, Netherlands
| | - Steven C Hunt
- Cardiovascular Genetics Division, Department of Medicine, University of Utah, Salt Lake City, UT
| | - Jennifer A Nettleton
- Division of Epidemiology, Human Genetics, and Environmental Sciences, University of Texas Health Science Center, Houston, TX
| | - Klelia D Salpea
- Department of Molecular Biology and Genetics, BSRC “Alexander Fleming,” Athens, Greece
| | - Vanessa A Diaz
- Department of Family Medicine, Medical University of South Carolina, Charleston, SC
| | - Ramin Farzaneh-Far
- Division of Cardiology, San Francisco General Hospital, San Francisco, CA
| | - Gil Atzmon
- Department of Medicine and Genetics, Albert Einstein College of Medicine, Bronx, NY, and Department of Biology, Faculty of Natural Science, University of Haifa, Haifa, Israel
| | - Sarah E Harris
- Center for Cognitive Aging and Cognitive Epidemiology and Medical Genetics Section and Center for Genomics and Experimental Medicine and MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom
| | - Lifang Hou
- Department of Preventive Medicine and Robert H Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - David Gilley
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN
| | - Iiris Hovatta
- Department of Biosciences, University of Helsinki, Helsinki, Finland,Department of Health, National Institute for Health and Welfare, Helsinki, Finland
| | - Jeremy D Kark
- Epidemiology Unit, Hebrew University–Hadassah School of Public Health and Community Medicine, Jerusalem, Israel
| | - Hisham Nassar
- Department of Cardiology, Hadassah University Medical Center, Jerusalem, Israel
| | - David J Kurz
- Department of Cardiology, Triemli Hospital, Zurich, Switzerland
| | - Karen A Mather
- Centre for Healthy Brain Ageing, Psychiatry, UNSW Australia, Sydney, Australia
| | - Peter Willeit
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria, and Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Yun-Ling Zheng
- Department of Oncology, Georgetown University Medical Center, Georgetown University, Washington, DC
| | - Sofia Pavanello
- Department of Cardiac, Thoracic, and Vascular Sciences, Unit of Occupational Medicine, University of Padova, Padova, Italy
| | - Ellen W Demerath
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN
| | - Line Rode
- The Copenhagen General Population Study, Department of Clinical Biochemistry, Copenhagen University Hospital, Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - Daniel Bunout
- Institute of Nutrition and Food Technology University of Chile, Santiago, Chile
| | - Andrew Steptoe
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Lisa Boardman
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN
| | - Amelia Marti
- Department of Nutrition, Food Science, and Physiology, University of Navarra, Pamplona, Spain,Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain,CIBER Fisiopatología de la Obesidad y Nutrición, (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain
| | - Belinda Needham
- Department of Epidemiology, University of Michigan, Ann Arbor, MI
| | - Wei Zheng
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN
| | | | | | - Jaakko Kaprio
- Department of Public Health,Institute for Molecular Medicine, University of Helsinki, Helsinki, Finland
| | - Jonathan N Hofmann
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, MD
| | - Christian Gieger
- Research Unit of Molecular Epidemiology and Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Giuseppe Paolisso
- Department of Medical, Surgical, Neurological, Metabolic, and Geriatric Sciences, Second University of Naples, Naples, Italy
| | - Jacob B H Hjelmborg
- Department of Epidemiology, Biostatistics, and Biodemography, Institute of Public Health, University of Southern Denmark, Odense C, Denmark
| | - Lisa Mirabello
- Department of Medical, Surgical, Neurological, Metabolic, and Geriatric Sciences, Second University of Naples, Naples, Italy
| | - Teresa Seeman
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Jason Wong
- Stanford University School of Medicine, Stanford, CA
| | - Pim van der Harst
- Department of Cardiology, University Medical Center Groningen, Groningen, Netherlands
| | - Linda Broer
- Department of Internal Medicine, Erasmus MC, Rotterdam, Netherlands
| | - Florian Kronenberg
- Division of Genetic Epidemiology, Department of Medical Genetics, Molecular, and Clinical Pharmacology, Medical University of Innsbruck, Innsbruck, Austria
| | - Barbara Kollerits
- Division of Genetic Epidemiology, Department of Medical Genetics, Molecular, and Clinical Pharmacology, Medical University of Innsbruck, Innsbruck, Austria
| | - Timo Strandberg
- University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland; Center for Life Course Epidemiology, University of Oulu, Oulu, Finland
| | - Dan T A Eisenberg
- Department of Anthropology and Center for Studies in Demography and Ecology, University of Washington, Seattle, WA
| | | | - Josine E Verhoeven
- Department of Psychiatry, VU University Medical Center, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Roxanne Schaakxs
- Department of Psychiatry, VU University Medical Center, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Raffaela Zannolli
- Pediatrics Unit, Azienda Ospedaliera Universitaria, Senese/University of Siena, Policlinico Le Scotte, Siena, Italy
| | - Rosana M R dos Reis
- Department of Gynecology and Obstetrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Fadi J Charchar
- School of Science and Technology, Federation University Australia, Department of Physiology, University of Melbourne, Melbourne, Australia, and Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
| | - Maciej Tomaszewski
- Division of Cardiovascular Sciences, Faculty of Medicine, Biology, and Health, University of Manchester, Manchester, United Kingdom,Division of Medicine, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Ute Mons
- Division of Clinical Epidemiology and Aging Research,Cancer Prevention Unit, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Ilja Demuth
- Charité–Universitätsmedizin Berlin (corporate member of Freie Universität Berlin), Humboldt-Universität zu Berlin, and Berlin Institute of Health, Lipid Clinic at the Interdisciplinary Metabolism Center, Berlin, Germany
| | - Andrea Elena Iglesias Molli
- CONICET-Universidad de Buenos Aires. Instituto de Inmunología, Genética y Metabolismo (INIGEM). Laboratorio de Diabetes y Metabolismo, Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina
| | - Guo Cheng
- Department of Nutrition, Food Safety, and Toxicology, West China School of Public Health, Sichuan University, Chengdu, China
| | - Dmytro Krasnienkov
- Department of Epigenetics, DF Chebotarev State Institute of Gerontology NAMS of Ukraine, Kyiv, Ukraine
| | - Bianca D'Antono
- Research Center, Montreal Heart Institute, and Psychology Department, University of Montreal, Montreal, Quebec, Canada
| | - Marek Kasielski
- Bases of Clinical Medicine Teaching Center, Medical University of Lodz, Lodz, Poland
| | - Barry J McDonnell
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, United Kingdom
| | | | - Kristina Sundquist
- Center for Primary Health Care Research, Lund University, Region Skåne, Lund, Sweden
| | - Guillaume Pare
- Population Health Research Institute and McMaster University, Hamilton, Canada
| | - Michael Chong
- Population Health Research Institute and McMaster University, Hamilton, Canada
| | - Maurice P Zeegers
- Departments of Complex Genetics,CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, Netherlands
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11
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Zöchmeister C, Brezina S, Hofer P, Baierl A, Bergmann MM, Bachleitner-Hofmann T, Karner-Hanusch J, Stift A, Gerger A, Leeb G, Mach K, Rachakonda S, Kumar R, Gsur A. Leukocyte telomere length throughout the continuum of colorectal carcinogenesis. Oncotarget 2018; 9:13582-13592. [PMID: 29568379 PMCID: PMC5862600 DOI: 10.18632/oncotarget.24431] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 01/31/2018] [Indexed: 12/21/2022] Open
Abstract
Considering the high prevalence of colorectal cancer (CRC) and relatively high mortality there is strong interest in identification of clinically relevant biomarkers. Telomere shortening is supposed to contribute to genomic instability and crucially involved in process of carcinogenesis. Peripheral blood leukocyte (PBL) telomere length was previously investigated in several studies as potential biomarker for CRC but with controversial results. This prompted us to investigate relative PBL telomere length in association with different histological findings throughout the continuum of colorectal carcinogenesis in order to reflect the whole spectrum of putative CRC development in a large study involving 2011 individuals. The study based on the Colorectal Cancer Study of Austria (CORSA), including 384 CRC cases as well as age- and gender-matched 544 high-risk adenomas, 537 low-risk adenoma patients and 546 colonoscopy-negative controls. Relative expression of telomeric repeats and the single copy reference gene, albumin (T/S ratio) was determined using monochrome multiplex quantitative PCR (MMQPCR). Telomeres were found to be significantly longer in CRC patients compared to control subjects (P = 3.61x10-6). Yet, no significant differences in telomere length could be detected for high-risk (P = 0.05956) and low-risk colorectal adenoma patients (P = 0.05224). In addition, results presented in this manuscript highlight the impact of various epidemiological factors on PBL telomere length and its involvement in CRC. However, further large studies also including colorectal adenomas are necessary to confirm these results.
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Affiliation(s)
- Cornelia Zöchmeister
- Medical University Vienna, Department of Medicine I, Institute of Cancer Research, Vienna, Austria
| | - Stefanie Brezina
- Medical University Vienna, Department of Medicine I, Institute of Cancer Research, Vienna, Austria
| | - Philipp Hofer
- Medical University Vienna, Department of Medicine I, Institute of Cancer Research, Vienna, Austria
| | - Andreas Baierl
- University of Vienna, Department of Statistics and Operations Research, Vienna, Austria
| | | | | | | | - Anton Stift
- Medical University Vienna, Department of Surgery, Vienna, Austria
| | - Armin Gerger
- Medical University of Graz, Division of Oncology, Department of Internal Medicine, Graz, Austria
| | - Gernot Leeb
- Hospital Oberpullendorf, Burgenland, Austria
| | - Karl Mach
- Hospital Oberpullendorf, Burgenland, Austria
| | | | - Rajiv Kumar
- German Cancer Research Center, Division of Molecular Genetic Epidemiology, Heidelberg, Germany
| | - Andrea Gsur
- Medical University Vienna, Department of Medicine I, Institute of Cancer Research, Vienna, Austria
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12
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Li P, Xiao ZT, Braciak TA, Ou QJ, Chen G, Oduncu FS. Impact of age and mismatch repair status on survival in colorectal cancer. Cancer Med 2017; 6:975-981. [PMID: 28345223 PMCID: PMC5430087 DOI: 10.1002/cam4.1007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 12/05/2016] [Accepted: 12/14/2016] [Indexed: 01/01/2023] Open
Abstract
Previous studies have suggested that deficiencies in mismatch repair genes (dMMR) often occur in patients with colorectal cancer (CRC) and contribute to disease etiology. Here, we looked for a correlation of MMR status to disease outcomes from a large number of Chinese CRC patients stratified by the age of onset of disease. A total of 2233 CRC patients were analyzed and tissue biopsies of surgically removed tumors scored for MMR gene status. The patient distribution after classification consisted of 188 younger aged patients (20-39 years of age), 1024 middle aged patients (40-59 years of age), and 1020 older aged patients (60-85 years of age). In this analysis, the expression of four MMR genes was assessed by immunohistochemistry (IHC). We found that the young group of CRC patients with dMMR had higher overall survival (OS) than the young group of patients with proficient MMR (pMMR) (77% vs. 56%, P = 0.03). Middle-aged patients with dMMR also had higher OS than middle-aged group patients with pMMR (78% vs. 68%, P = 0.012). However, we found no statistical difference in OS between dMMR and pMMR status in the older group of patients (75% vs. 71%, P = 0.224). Finally, the middle- and older-aged group set of patients had higher OS than the young group of patients (69% vs. 71% vs. 59%, P = 0.008). These data demonstrated that the age of disease onset can be an important factor to help evaluate the prognosis of CRC when combined with the analysis of MMR status within tumor biopsied tissue.
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Affiliation(s)
- Pan Li
- Department of hematology and oncology, Medizinische Klinik und Poliklinik IV, Ludwig Maximilians University, Munich, Germany
| | - Zhi-Tao Xiao
- Department of Colorectal Surgery, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Todd A Braciak
- Department of hematology and oncology, Medizinische Klinik und Poliklinik IV, Ludwig Maximilians University, Munich, Germany
| | - Qing-Jian Ou
- Department of Colorectal Surgery, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Gong Chen
- Department of Colorectal Surgery, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Fuat S Oduncu
- Department of hematology and oncology, Medizinische Klinik und Poliklinik IV, Ludwig Maximilians University, Munich, Germany
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13
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Naing C, Aung K, Lai PK, Mak JW. Association between telomere length and the risk of colorectal cancer: a meta-analysis of observational studies. BMC Cancer 2017; 17:24. [PMID: 28056862 PMCID: PMC5216529 DOI: 10.1186/s12885-016-2997-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Accepted: 12/13/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Human chromosomes are capped and stabilized by telomeres. Telomere length regulates a 'cellular mitotic clock' that defines the number of cell divisions and hence, cellular life span. This study aimed to synthesize the evidence on the association between peripheral blood leucocytes (PBL) telomere length and the risk of colorectal cancer (CRC). METHODS We searched relevant studies in electronic databases. When two or more observational studies reported the same outcome measures, we performed pooled analysis. All the analyses were performed on PBL using PCR. The odds ratio (OR) and its 95% confidence interval (CI) were used to assess the strength of association. RESULTS Seven studies (with 8 datasets) were included in this meta-analysis; 3 prospective studies, 3 retrospective studies and 1 study with a separate prospective and retrospective designs. The pooled analysis of 4 prospective studies (summary OR 1.01, 95% CI: 0.77-1.34, I 2:30%) and 4 retrospective studies (summary OR 1.65, 95% CI: 0.96-2.83, I 2:96%) showed no relationship between PBL telomere length and the CRC risk. A subgroup analysis of 2 prospective studies exclusively on females also showed no association between PBL telomere length and the CRC risk (summary OR, 1.17, 95% CI:0.72-1.91, I 2:57%). CONCLUSION The current analysis is insufficient to provide evidence on the relationship between PBL telomere length and the risk of CRC. Findings suggest that there may be a complex relationship between PBL telomere length and the CRC risk or discrepancy between genetics, age of patients and clinical studies. Future well powered, large prospective studies on the relationship between telomere length and the risk of CRC, and the investigations of the biologic mechanisms are recommended.
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Affiliation(s)
- Cho Naing
- School of Postgraduate Studies, International Medical University (IMU), Kuala Lumpur, 57000, Malaysia.
| | - Kyan Aung
- School of Medicine, International Medical University (IMU), Kuala Lumpur, Malaysia
| | - Pei Kuan Lai
- School of Postgraduate Studies, International Medical University (IMU), Kuala Lumpur, 57000, Malaysia
| | - Joon Wah Mak
- School of Postgraduate Studies, International Medical University (IMU), Kuala Lumpur, 57000, Malaysia
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14
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Borresen EC, Brown DG, Harbison G, Taylor L, Fairbanks A, O'Malia J, Bazan M, Rao S, Bailey SM, Wdowik M, Weir TL, Brown RJ, Ryan EP. A Randomized Controlled Trial to Increase Navy Bean or Rice Bran Consumption in Colorectal Cancer Survivors. Nutr Cancer 2016; 68:1269-1280. [PMID: 27689688 DOI: 10.1080/01635581.2016.1224370] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Consumption of navy beans (NB) and rice bran (RB) have been shown to inhibit colon carcinogenesis. Given the overall poor diet quality in colorectal cancer (CRC) survivors and low reported intake of whole grains and legumes, practical strategies to increase consumption merit attention. This study determined feasibility of increasing NB or RB intake in CRC survivors to increase dietary fiber and examined serum inflammatory biomarkers and telomere lengths. Twenty-nine subjects completed a randomized controlled trial with foods that included cooked NB powder (35 g/day), heat-stabilized RB (30 g/day), or no additional ingredient. Fasting blood, food logs, and gastrointestinal health questionnaires were collected. The amount of NB or RB consumed equated to 4-9% of subjects' daily caloric intake and no major gastrointestinal issues were reported with increased consumption. Dietary fiber amounts increased in NB and RB groups at Weeks 2 and 4 compared to baseline and to control (P ≤ 0.01). Telomere length correlated with age and HDL cholesterol at baseline, and with improved serum amyloid A (SAA) levels at Week 4 (P ≤ 0.05). This study concludes feasibility of increased dietary NB and RB consumption to levels associated with CRC chemoprevention and warrants longer-term investigations with both foods in high-risk populations that include cancer prevention and control outcomes.
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Affiliation(s)
- Erica C Borresen
- a Department of Environmental and Radiological Health Sciences , Colorado State University , Fort Collins , Colorado , USA
| | - Dustin G Brown
- a Department of Environmental and Radiological Health Sciences , Colorado State University , Fort Collins , Colorado , USA
| | - Greg Harbison
- a Department of Environmental and Radiological Health Sciences , Colorado State University , Fort Collins , Colorado , USA
| | - Lynn Taylor
- a Department of Environmental and Radiological Health Sciences , Colorado State University , Fort Collins , Colorado , USA
| | - Amanda Fairbanks
- a Department of Environmental and Radiological Health Sciences , Colorado State University , Fort Collins , Colorado , USA
| | - Joanne O'Malia
- b University of Colorado Health-North Cancer Clinical Research , Fort Collins , Colorado , USA
| | - Marlon Bazan
- b University of Colorado Health-North Cancer Clinical Research , Fort Collins , Colorado , USA
| | - Sangeeta Rao
- c Department of Clinical Sciences , Colorado State University , Fort Collins , Colorado , USA
| | - Susan M Bailey
- a Department of Environmental and Radiological Health Sciences , Colorado State University , Fort Collins , Colorado , USA
| | - Melissa Wdowik
- d Department of Food Science and Human Nutrition , Colorado State University , Fort Collins , Colorado , USA.,e Kendall Reagan Nutrition Center , Colorado State University , Fort Collins , Colorado , USA
| | - Tiffany L Weir
- d Department of Food Science and Human Nutrition , Colorado State University , Fort Collins , Colorado , USA
| | - Regina J Brown
- f University of Colorado School of Medicine , Aurora , Colorado , USA
| | - Elizabeth P Ryan
- a Department of Environmental and Radiological Health Sciences , Colorado State University , Fort Collins , Colorado , USA.,e Kendall Reagan Nutrition Center , Colorado State University , Fort Collins , Colorado , USA.,g University of Colorado Cancer Center , Aurora , Colorado , USA
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15
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Slattery ML, Herrick JS, Pellatt AJ, Wolff RK, Mullany LE. Telomere Length, TERT, and miRNA Expression. PLoS One 2016; 11:e0162077. [PMID: 27627813 PMCID: PMC5023115 DOI: 10.1371/journal.pone.0162077] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 08/17/2016] [Indexed: 11/19/2022] Open
Abstract
It has been proposed that miRNAs are involved in the control of telomeres. We test that hypothesis by examining the association between miRNAs and telomere length (TL). Additionally, we evaluate if genetic variation in telomerase reverse transcriptase (TERT) is associated with miRNA expression levels. We use data from a population-based study of colorectal cancer (CRC), where we have previously shown associations between TL and TERT and CRC, to test associations between TL and miRNA expression and TERT and miRNA expression. To gain insight into functions of miRNAs associated with TERT we tested linear associations between miRNAs and their targeted gene mRNAs. An Agilent platform that contained information on over 2000 miRNAs was used. TL was measured using a multiplexed quantitative PCR (qPCR). RNAseq was used to assess gene expression. Our sample consisted of 1152 individuals with SNP data and miRNA expression data; 363 individuals with both TL and miRNA; and 148 individuals with miRNA and mRNA data. Thirty-three miRNAs were directly associated with TL after adjusting for age and sex (false discovery rate (FDR) of 0.05). TERT rs2736118 was associated with differences in miRNA expression between carcinoma and normal colonic mucosa for 75 miRNAs (FDR <0.05). Genes regulated by these miRNAs, as indicated by mRNA/miRNA associations, were associated with major signaling pathways beyond their TL-related functions, including PTEN, and PI3K/AKT signaling. Our data support a direct association between miRNAs and TL; differences in miRNA expression levels by TERT genotype were observed. Based on miRNA and targeted mRNA associations our data suggest that TERT is involved in non-TL-related functions by acting through altered miRNA expression.
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Affiliation(s)
- Martha L. Slattery
- Department of Medicine, University of Utah, 383 Colorow, Salt Lake City, Utah 84108, United States of America
- * E-mail:
| | - Jennifer S. Herrick
- Department of Medicine, University of Utah, 383 Colorow, Salt Lake City, Utah 84108, United States of America
| | - Andrew J. Pellatt
- Department of Medicine, University of Utah, 383 Colorow, Salt Lake City, Utah 84108, United States of America
| | - Roger K. Wolff
- Department of Medicine, University of Utah, 383 Colorow, Salt Lake City, Utah 84108, United States of America
| | - Lila E. Mullany
- Department of Medicine, University of Utah, 383 Colorow, Salt Lake City, Utah 84108, United States of America
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16
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Druliner BR, Ruan X, Johnson R, Grill D, O'Brien D, Lai TP, Rashtak S, Felmlee-Devine D, Washechek-Aletto J, Malykh A, Smyrk T, Oberg A, Liu H, Shay JW, Ahlquist DA, Boardman LA. Time Lapse to Colorectal Cancer: Telomere Dynamics Define the Malignant Potential of Polyps. Clin Transl Gastroenterol 2016; 7:e188. [PMID: 27584834 PMCID: PMC5288594 DOI: 10.1038/ctg.2016.48] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 07/26/2016] [Indexed: 02/07/2023] Open
Abstract
Objective: Whereas few adenomas become cancer, most colorectal cancers arise from adenomas. Telomere length is a recognized biomarker in multiple cancers, and telomere maintenance mechanisms (TMM) are exploited by malignant cells. We sought to determine whether telomere length and TMM distinguish cancer-associated adenomas from those that are cancer-free. Methods: Tissues were identified as cancer-adjacent polyp (CAP)—residual adenoma contiguous with cancer—and cancer-free polyp (CFP)—adenomas without malignancy. Telomere length, TMM, and expression were measured in 102 tissues including peripheral blood leukocytes (PBLs), normal colon epithelium, adenoma, and cancer (in CAP cases) from 31 patients. Telomere length was measured in a separate cohort of 342 PBL from CAP and CFP patients. Results: The mean differences in telomere length between normal and adenoma were greater in CAP than in CFP cases, P=0.001; telomere length in PBL was 91.7 bp greater in CAP than in CFP, P=0.007. Each 100 bp telomere increase was associated with a 1.14 (1.04–1.26) increased odds of being a CAP, P=0.0063. The polyp tissue from CAP patients had shorter telomeres and higher Telomerase reverse transcriptase (hTERT) expression compared with polyps from CFP patients, P=0.05. There was a greater degree of alternative lengthening of telomere (ALT) level difference in CFP polyps than in CAP polyps. The polyp telomere lengths of aggressive CAPs were significantly different from the polyps of non-aggressive CAPs, P=0.01. Conclusions: Adenomas that progress to cancer exhibit distinct telomere length and TMM profiles. We report for the first time that PBL telomeres differ in patients with polyps that become malignant, and therefore may have clinical value in adenoma risk assessment and management.
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Affiliation(s)
- Brooke R Druliner
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Xiaoyang Ruan
- Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Ruth Johnson
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Diane Grill
- Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniel O'Brien
- Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Tsung-Po Lai
- Department of Cell Biology UT Southwestern Medical Center, Dallas, Texas, USA
| | - Shahrooz Rashtak
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Donna Felmlee-Devine
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Jill Washechek-Aletto
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Andrei Malykh
- Capital Biosciences Inc., Gaithersburg, Maryland, USA
| | - Thomas Smyrk
- Anatomic Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Ann Oberg
- Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Hongfang Liu
- Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Jerry W Shay
- Department of Cell Biology UT Southwestern Medical Center, Dallas, Texas, USA
| | - David A Ahlquist
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Lisa A Boardman
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
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17
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Mitro SD, Birnbaum LS, Needham BL, Zota AR. Cross-sectional Associations between Exposure to Persistent Organic Pollutants and Leukocyte Telomere Length among U.S. Adults in NHANES, 2001-2002. ENVIRONMENTAL HEALTH PERSPECTIVES 2016; 124:651-8. [PMID: 26452299 PMCID: PMC4858394 DOI: 10.1289/ehp.1510187] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 10/05/2015] [Indexed: 05/19/2023]
Abstract
BACKGROUND Exposure to persistent organic pollutants (POPs) such as dioxins, furans, and polychlorinated biphenyls (PCBs) may influence leukocyte telomere length (LTL), a biomarker associated with chronic disease. In vitro research suggests dioxins may bind to the aryl hydrocarbon receptor (AhR) and induce telomerase activity, which elongates LTL. However, few epidemiologic studies have investigated associations between POPs and LTL. OBJECTIVES We examined the association between 18 PCBs, 7 dioxins, and 9 furans and LTL among 1,330 U.S. adults from NHANES 2001-2002. METHODS We created three summed POP metrics based on toxic equivalency factor (TEF), a potency measure including affinity for the AhR: a) non-dioxin-like PCBs (composed of 10 non-dioxin-like PCBs; no AhR affinity and no TEF); b) non-ortho PCBs (composed of 2 non-ortho-substituted PCBs with high TEFs); and c) toxic equivalency (TEQ) (composed of 7 dioxins, 9 furans, 2 non-ortho-substituted PCBs, and 6 mono-ortho-substituted PCBs; weighted by TEF). We tested the association between each metric and LTL using linear regression, adjusting for demographics, blood cell count and distribution, and another metric with a different TEF (i.e., non-ortho PCBs and TEQ adjusted for non-dioxin-like PCBs; non-dioxin-like PCBs adjusted for non-ortho PCBs). RESULTS In adjusted models, each doubling of serum concentrations of non-ortho PCBs and TEQ was associated with 3.74% (95% CI: 2.10, 5.40) and 5.29% (95% CI: 1.66, 9.05) longer LTLs, respectively. Compared with the lowest quartile, the highest quartile of exposure was associated with 9.16% (95% CI: 2.96, 15.73) and 7.84% (95% CI: -0.53, 16.92) longer LTLs, respectively. Non-dioxin-like PCBs were not associated with LTL. CONCLUSIONS POPs with high TEFs and AhR affinity were associated with longer LTL. Because many dioxin-associated cancers are also associated with longer LTL, these results may provide insight into the mechanisms underlying PCB- and dioxin-related carcinogenesis. CITATION Mitro SD, Birnbaum LS, Needham BL, Zota AR. 2016. Cross-sectional associations between exposure to persistent organic pollutants and leukocyte telomere length among U.S. adults in NHANES, 2001-2002. Environ Health Perspect 124:651-658; http://dx.doi.org/10.1289/ehp.1510187.
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Affiliation(s)
- Susanna D. Mitro
- Department of Environmental and Occupational Health, Milken Institute School of Public Health, George Washington University, Washington DC, USA
| | - Linda S. Birnbaum
- National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, North Carolina, USA
| | - Belinda L. Needham
- Department of Epidemiology, School of Public Health, University of Michigan Ann Arbor, Ann Arbor, Michigan, USA
| | - Ami R. Zota
- Department of Environmental and Occupational Health, Milken Institute School of Public Health, George Washington University, Washington DC, USA
- Address correspondence to A.R. Zota, Milken Institute School of Public Health, Department of Environmental and Occupational Health, 950 New Hampshire Ave. NW, Suite 414, Washington, DC 20052 USA. Telephone: (202) 994-9289. E-mail:
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Svenson U, Öberg Å, Stenling R, Palmqvist R, Roos G. Telomere length in peripheral leukocytes is associated with immune cell tumor infiltration and prognosis in colorectal cancer patients. Tumour Biol 2016; 37:10877-82. [PMID: 26883253 DOI: 10.1007/s13277-016-4987-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 02/10/2016] [Indexed: 12/27/2022] Open
Abstract
Telomeres are protective structures at the end of chromosomes, essential for chromosomal integrity. A large number of studies have investigated leukocyte telomere length as a possible risk marker for various cancers, colorectal cancer (CRC) included. In contrast, studies investigating leukocyte telomere length in relation to CRC survival are lacking. We previously reported that relative telomere length (RTL) of leukocytes collected at diagnosis predicted survival in patients with breast and kidney cancer. We suggested that these findings might reflect various immunological mechanisms, affected by the presence of a tumor. In the present study, leukocyte RTL was examined in relation to immune cell tumor infiltration and prognosis in 130 patients with CRC diagnosis. RTL was measured with a well-established qPCR method. We found that patients with the highest degree of lymphocyte tumor infiltration had shorter leukocyte RTL. Consistent with our previous findings, short RTL was a favorable prognostic marker in univariate survival analysis. In the current study, RTL did not remain as an independent predictor in multivariate survival analysis, when including metastatic status in the model. However, a non-significant trend towards a similar telomere-associated survival pattern was observed in patients with limited disease. In contrast, for patients who died of other causes than CRC, short RTL was associated with significantly shorter survival time. To our knowledge, this is the first study to investigate an association between leukocyte RTL, immune cell tumor infiltration, and cancer-specific survival in CRC patients. Larger studies are warranted to verify these findings.
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Affiliation(s)
- Ulrika Svenson
- Department of Medical Biosciences, Umeå University, Umeå, Sweden.
| | - Åke Öberg
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Roger Stenling
- Department of Medical Biosciences, Umeå University, Umeå, Sweden
| | | | - Göran Roos
- Department of Medical Biosciences, Umeå University, Umeå, Sweden
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Giunco S, Rampazzo E, Celeghin A, Petrara MR, De Rossi A. Telomere and Telomerase in Carcinogenesis: Their Role as Prognostic Biomarkers. CURRENT PATHOBIOLOGY REPORTS 2015. [DOI: 10.1007/s40139-015-0087-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Telomere length and the risk of cutaneous melanoma and non-melanoma skin cancer: a review of the literature and meta-analysis. J Dermatol Sci 2015; 80:168-74. [PMID: 26341697 DOI: 10.1016/j.jdermsci.2015.08.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 08/18/2015] [Accepted: 08/19/2015] [Indexed: 12/23/2022]
Abstract
There is much evidence supporting the role of telomeres in cancer pathogenesis, however the studies that investigated the association between telomere length and skin cancer risk provided inconsistent results. To help clarify this issue, we performed a systematic review and meta-analysis of published papers on the association between peripheral leukocytes telomere length (PLTL) and the risk of cutaneous melanoma and non-melanoma skin cancer (NMSC). We calculated summary relative risks (SRR) and 95% confidence intervals (95% CI) using random effect models with maximum likelihood estimates, and explored causes of between-studies heterogeneity of risk estimates. We included 1629 cutaneous melanoma and 1439 NMSC from eight independent studies published until March 2015. The SRR of cutaneous melanoma for those in the lowest (vs. highest) category of PLTL distribution was 0.25 (95% CI 0.09-0.67). The results were less clear for NMSC, with two studies reporting no association and one study showing an increase in risk for those in the lowest (vs. highest) category of PLTL distribution. For both cutaneous melanoma and NMSC, the between-studies heterogeneity was large, mainly due to inclusion of hospital-based case-control studies. Our meta-analysis shows evidence of an association between short PLTL and reduced risk for cutaneous melanoma.
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Udomsinprasert W, Poovorawan Y, Chongsrisawat V, Vejchapipat P, Zhan D, Honsawek S. Telomere Length in Peripheral Blood Leukocytes Is Associated with Severity of Biliary Atresia. PLoS One 2015; 10:e0134689. [PMID: 26230851 PMCID: PMC4521951 DOI: 10.1371/journal.pone.0134689] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Accepted: 07/13/2015] [Indexed: 01/29/2023] Open
Abstract
Objective The purpose of this study was to investigate the association of telomere length in peripheral blood leukocytes with the severity of biliary atresia (BA). Methods One hundred and fourteen BA patients and 114 age-matched healthy controls were enrolled. Relative telomere length (RTL) was assessed using a quantitative real-time polymerase chain reaction. Multivariate regression analysis was used to estimate RTL as an independent risk factor of BA. Receiver operating characteristic curve analysis was used to calculate the accuracy of biomarkers in the prediction of liver cirrhosis. Results BA patients had significantly shorter telomeres than healthy controls (p < 0.0001). The RTL in BA patients with jaundice was considerably lower than that of patients without jaundice (p = 0.005). Moreover, RTL was markedly shorter in patients with cirrhosis (F4), as compared to patients with mild fibrosis (F2) and non-fibrosis (F0-F1, p < 0.0001). Logistic regression analysis indicated that short RTL was associated with a higher risk of liver cirrhosis in BA. Tertile analysis showed a dose-response effect for this association (p trend < 0.0001). Additionally, RTL in BA children revealed a negative correlation with age (r = -0.50, p < 0.001). We noted an association between reduction of RTL and liver stiffness scores, adjusted for age and gender (b = -0.01, p < 0.0001). Short RTL can be employed to distinguish cirrhosis patients from non-cirrhosis patients (AUC = 0.78). Further analysis showed a linear correlation between leukocyte RTL and liver RTL in BA patients (r = 0.83, p < 0.001). Conclusion The findings of this study provide evidence that telomere shortening is associated with an elevated risk of liver cirrhosis in BA.
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Affiliation(s)
- Wanvisa Udomsinprasert
- Department of Biochemistry, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand
| | - Yong Poovorawan
- Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand
| | - Voranush Chongsrisawat
- Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand
| | - Paisarn Vejchapipat
- Department of Surgery, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand
| | - Dong Zhan
- Department of Biochemistry, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand
| | - Sittisak Honsawek
- Department of Biochemistry, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand
- * E-mail:
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Robles-Espinoza CD, Velasco-Herrera MDC, Hayward NK, Adams DJ. Telomere-regulating genes and the telomere interactome in familial cancers. Mol Cancer Res 2015; 13:211-22. [PMID: 25244922 PMCID: PMC4278843 DOI: 10.1158/1541-7786.mcr-14-0305] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Telomeres are repetitive sequence structures at the ends of linear chromosomes that consist of double-stranded DNA repeats followed by a short single-stranded DNA protrusion. Telomeres need to be replicated in each cell cycle and protected from DNA-processing enzymes, tasks that cells execute using specialized protein complexes such as telomerase (that includes TERT), which aids in telomere maintenance and replication, and the shelterin complex, which protects chromosome ends. These complexes are also able to interact with a variety of other proteins, referred to as the telomere interactome, to fulfill their biological functions and control signaling cascades originating from telomeres. Given their essential role in genomic maintenance and cell-cycle control, germline mutations in telomere-regulating proteins and their interacting partners have been found to underlie a variety of diseases and cancer-predisposition syndromes. These syndromes can be characterized by progressively shortening telomeres, in which carriers can present with organ failure due to stem cell senescence among other characteristics, or can also present with long or unprotected telomeres, providing an alternative route for cancer formation. This review summarizes the critical roles that telomere-regulating proteins play in cell-cycle control and cell fate and explores the current knowledge on different cancer-predisposing conditions that have been linked to germline defects in these proteins and their interacting partners.
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Affiliation(s)
| | | | - Nicholas K Hayward
- Oncogenomics Laboratory, QIMR Berghofer Medical Research Institute, Herston, Brisbane, Queensland, Australia
| | - David J Adams
- Experimental Cancer Genetics, Wellcome Trust Sanger Institute, Hinxton, United Kingdom
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Baichoo E, Boardman LA. Toward a molecular classification of colorectal cancer: the role of telomere length. Front Oncol 2014; 4:158. [PMID: 24995160 PMCID: PMC4061573 DOI: 10.3389/fonc.2014.00158] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 06/05/2014] [Indexed: 11/19/2022] Open
Abstract
Telomere biology is central to the maintenance of genomic stability and telomeric dysfunction is thought to be an early stage in carcinogenesis. Reports of telomere lengths and their ascribed colorectal cancer (CRC) risks have been discordant, with both very short and very long telomeres implicated. Nevertheless, telomeres appear to play a very central role in cancer initiation. Telomere length changes also appear to impact disease burden, progression, and overall survival. This review covers contemporary views on telomere biology and CRC risk, with a brief overview of analytical methods employed in telomere measurement. We conclude with arguments in favor of including telomere assessment in the molecular profiling of CRCs.
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Affiliation(s)
- Esha Baichoo
- Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic , Rochester, MN , USA
| | - Lisa A Boardman
- Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic , Rochester, MN , USA
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