Current Molecular Medicine - Volume 5, Issue 2, 2005

Chromosome end protection is essential for all organisms with linear genomes. Specialized structures, called telomeres, accomplish this protection by forming DNA-protein complexes that hide the natural chromosome ends from the DNA damage machinery. In mammalian cells protection takes place on several levels. Telomeric DNA forms large duplex loops with the help of telomeric proteins, consequently hiding the very tip of the telomere. Telomeric proteins play additional roles in protecting the end from degradation, regulating telomere length, and suppressing the DNA damage response machinery. Here we summarize the current knowledge about telomere structure, and discuss the future directions of the field.

The telomere-based model of cell aging has proven to among been among the most enduring hypotheses in cell biology. This model, suggesting that the gradual loss of telomere sequences during the proliferation of cultured human somatic cells imposes a barrier on cellular replicative potential, has been strongly supported by recent genetic and biochemical studies. In addition, evidence implicating telomere dynamics in organismal ageing and cancer progression in vivo suggest that such a process is likely to have considerable physiological relevance in homeostasis and disease. What is the sensing mechanism for shortened telomeres and what is the molecular basis for the ensuing checkpoint response? Moreover, what is the outcome when such failsafe mechanisms are lost? Here we will review the signaling pathways that are induced by alterations in telomere length and integrity and illustrate how these processes provoke downstream effects on cell proliferation and survival. In addition, we discuss how the telomere-induced pathways intersect with the DNA damage response and document how the failure in either process results in unrestrained chromosomal instability.

Understanding the molecular basis of the aging process is a daunting problem, given the complex genetic and physiological changes that underlie human aging and the lack of genetically amenable primate model systems. However, analysis of mouse models exhibiting aging phenotypes reminiscent of those observed in elderly humans has enhanced our understanding of the biological mechanisms underlying mammalian aging. In particular, these mouse models have brought to light the importance of the DNA damage pathway during the aging process. Increased genomic instability is associated with accelerated cellular decline and manifestation of premature aging phenotypes in mice. Here I discuss how one form of genomic instability, initiated by critically short telomeres in the telomerase knockout mouse, perturb normal mammalian aging. Insights into the molecular pathways of the aging process may offer unprecedented opportunities to delay the deleterious effects of the aging process.

Dyskeratosis congenita (DC) is a rare inherited bone marrow failure syndrome associated with abnormalities of the skin, fingernails, and tongue. Other clinical manifestations may include epiphora, lung fibrosis, liver cirrhosis, osteoporosis, and a predisposition to develop a variety of malignancies. The clinical picture often resembles that of a premature aging syndrome and tissues affected are those with a high cell turnover. DC has been linked to mutations in at least four distinct genes, three of which have been identified. The product of these genes, dyskerin, the telomerase RNA (TERC), and the catalytic unit of telomerase (TERT) are part of a ribonucleoprotein complex, the telomerase enzyme, that is essential for the elongation and maintenance of chromosome ends or telomeres. All patients with DC have excessively short telomeres, indicating that the underlying defect in these individuals is an inability to maintain the telomeres. The purpose of the current review is to highlight recent insights into the molecular pathogenesis of DC. We discuss the impact these findings have on our current understanding of telomere function and maintenance, and on the diagnosis, management, and treatment of patients with conditions caused by dysfunctional telomeres.

Skin is a complex tissue composed of two very different compartments - the continuously renewing epidermis made up mostly by keratinocytes and the underlying matrix-rich dermis with the resting fibroblasts as its major cellular components. Both compartments are tightly interconnected and a paracrine mutual interaction is essential for epidermal growth, differentiation, and tissue homeostasis. Skin aging is commonly viewed as wrinkle formation, hair greying, and impaired wound healing. Nevertheless, the epidermis as the outermost shield needs to remain intact in order to guarantee an inside-out and outside-in barrier function throughout life time of a human being. Furthermore, the epidermis is one of the few regenerative tissues that express telomerase, the ribonucleoprotein complex that can counteract telomere erosion, one of the presently mostly favoured potential mechanisms causing cellular aging. This raises the question whether in the epidermis telomerase is able to counteract telomere erosion and thereby to prevents a telomere-dependent aging process and consequently which part of the skin is responsible for the most obvious changes associated with skin aging.

The hematopoietic system has an outstanding regenerative capacity which depends on a relatively small population of hematopoietic stem cells (HSC). In contrast to normal human cells, blood-forming stem cells, like most of their counterparts from other adult tissues, exhibit telomerase activity to a certain level. Nevertheless, this telomerase activity does not prevent telomere shortening in HSC, suggesting a restriction of their proliferative capacity. Here, we review recent studies on telomere dynamics in HSC of humans and mice. Furthermore, we discuss the impact of telomere manipulation in HSC for possible clinical applications and speculate on functions of telomerase beyond telomere lengthening.

The use of chemotherapy provides an essential arm in the treatment of a number of cancers. The biological feature common to all cancerous cells that sensitizes them to chemotherapeutic agents is their elevated division rate. Rapidly dividing cells, such as tumor cells, are more sensitive to chemotherapeutic agents that act to initiate pathways leading to cell death, a process enhanced in cells with compromised DNA damage responses. The toxicity accompanying chemotherapy is due to side-effects induced in normal regenerative tissues which also have relatively high replication rates, such as hair follicles, the hematopoietic system, the gastrointestinal system, the germline and skin cells. While the side-effects of chemotherapy may be tolerated by the patient, the long term impact of the cytotoxic effects of chemotherapy on healthy tissues is only now becoming apparent. Chemotherapy-induced cytotoxicity in regenerative tissues requires multiple cell divisions in order to reconstitute the affected tissues. At least in part as a consequence of these extra divisions, telomeres in individuals treated with chemotherapy are shorter than age-matched control individuals who have never been exposed to these drugs. Given the essential role of telomeres in regulating cellular aging and chromosomal stability, it is possible that the prematurely shortened telomeres that arise following chemotherapy may impact the long-term replicative potential of these tissues. This review is focused on how telomeres may be modulated, directly or indirectly, by anticancer drugs and the potential long-term consequences of accelerated telomere shortening in healthy tissue as a result of current cancer treatment protocols.

Telomeres in telomerase-negative cells shorten during DNA replication in vitro due to numerous causes including the inability of DNA polymerases to fully copy the lagging strand, DNA end processing and random damage, often caused by oxidative stress. Short telomeres activate replicative senescence, an irreversible cell cycle arrest. Thus, telomere length is an indicator of replicative history, of the probability of cell senescence, and of the cumulative history of oxidative stress. Telomeres in most human cells shorten during ageing in vivo as well, suggesting that telomere length could be a biomarker of ageing and age-related morbidity. There are two distinct possibilities: First, in a tissue-specific fashion, short telomeres might indicate senescence of (stem) cells, and this might contribute to age-related functional attenuation in this tissue. Second, short telomeres in one tissue might cause systemic effects or might simply indicate a history of high stress and damage in the individual and could thus act as risk markers for age-related disease residing in a completely different tissue. In recent years, data have been published to support both approaches, and we will review these. While they together paint a fairly promising picture, it needs to be pointed out that until now most of the evidence is correlative, that much of it comes from underpowered studies, and that causal evidence for essential pathways, for instance for the impact of cell senescence on tissue ageing in vivo, is still very weak.

Telomerase is active in early embryonic and fetal development but is down-regulated in all human somatic tissues before birth. Since telomerase is virtually absent or only transiently active in normal somatic cells throughout postnatal life, telomere length gradually decreases as a function of age in most human tissues. Although telomerase repression likely evolved as a tumor suppressor mechanism, a growing body of evidence from epidemiology and genetic studies point to a role of telomerase repression and short telomeres in a broad spectrum of diseases: (a) Humans with shorter than average telomere length are at increased risk of dying from heart disease, stroke, or infection; (b) Patients with Dyskeratosis congenita are born with shortened telomeres due to mutations in telomerase components, suffer from a variety of proliferative tissue disorders, and typically die early of bone marrow failure; and (c) Individuals with long-term chronic stress or infections have accelerated telomere shortening compared to age-matched counterparts. Telomerase activation may prove useful in the treatment of diseases associated with telomere loss. While human cells dividing in culture lose telomeric DNA and undergo changes that mirror certain age- or disease-associated changes in vivo, telomerase transduced cells have extended replicative capacities, increased resistance to stress, improved functional activities in vitro and in vivo, and no loss of differentiation capacity or growth control. In addition, telomerase transduction in vivo can prevent telomere dysfunction and cirrhotic changes in liver of telomerase knockout mice. Thus, pharmacological activation of telomerase has significant potential for the treatment of a broad spectrum of chronic or degenerative diseases.

Eukaryotic chromosomes terminate in specialized nucleic acid-protein complexes known as telomeres. Disruption of telomere structure by erosion of telomeric DNA or loss of telomere binding protein function activates a signal transduction program that closely resembles the cellular responses generated upon DNA damage. Telomere dysfunction in turn induces a permanent proliferation arrest known as senescence. Senescence is postulated to perform a tumor suppressor function by limiting cellular proliferative capacity, thus imposing a barrier to cellular immortalization. Genetic or epigenetic silencing of components of the DNA damage pathway, allows cells to proliferate beyond senescence limits. However, these cells eventually reach a stage of extreme telomere dysfunction known as crisis that is characterized by cell death and the concomitant appearance of cytogenetic abnormalities. Telomeric crisis produces significant chromosomal instability, a hallmark of human cancer, and may thus be relevant to carcinogenesis by increasing the occurrence of genetic alterations that would favor neoplastic transformation. The following review examines the relationship of telomere function during crisis in accelerating chromosomal instability and cancer.

Human cancer arises in a stepwise process by the accumulation of genetic alterations in oncogenes, tumor suppressor genes and other genes involved in the regulation of cell growth and proliferation. Many genes, important for the pathogenesis of various cancers and the pathways through which they act, have been characterized over the past decades. Nevertheless, recent successes in experimental models of immortalization and malignant transformation of human cells indicate that the disruption of a limited number of cellular pathways is sufficient to induce a cancerous phenotype in a wide variety of normal cells. In this context, immortalization is an essential prerequisite for the formation of a tumor cell. Besides classical cancer related pathways as the pRB and p53 tumor suppressor pathway or the ras signaling pathway, the maintenance of telomeres plays an essential role in both of these processes. Alterations in telomere biology both suppress and facilitate malignant transformation by regulating genomic stability and cellular life span. This review will summarize recent advances in the understanding of the molecular mechanisms of malignant transformation in human cells and the role of telomere maintenance in these processes. This ultimately leads to the development of cellular models of human cancer that phenocopy the corresponding disease. Furthermore, in the future these models could provide an ideal basis for the testing of novel chemopreventive or therapeutic approaches in the treatment of different types of human cancer.

Accumulating evidence now implicates telomeres and telomerase as critical regulators genomic stability and replicative lifespan in mammalian cells. Disruption of telomere maintenance and/or telomerase expression contributes to the etiology of some degenerative diseases and may participate in the process of aging. Although telomere dysfunction and aberrant telomerase expression clearly play important roles in cancer development, the contribution of telomere biology to cancer is complex and involves both positive and negative influences on tumor development. Indeed, recent work from several laboratories suggests additional roles for telomeres and telomerase in both normal and malignant physiology. Understanding the complexity of telomere biology will provide further insights into chromosome biology in both normal and malignant cells.

Telomerase reverse transcriptase (TERT), a catalytic subunit of telomerase, has been demonstrated to exert a reverse transcriptase function when combined with telomerase RNA component (TERC), the complex of which ensures the maintenance of telomere length in all eukaryotes. Telomerase also prevents cell death, and promotes survival in many types of cells, from various tissues or organs including neurons, muscle, and immune cells, as well as a variety of tumor cells. Recently, a new aspect of telomerase activity, independent of telomere lengthening, has emerged to explain its protective effects on cell survival. Consistent with this, TERT was found to enhance tumorigenesis, and to regulate the expression of genes that control cell growth, which cannot be explained by telomere stabilization per se. Furthermore, the observation that TERT resides not only in the nucleus, but also in the cytosol, reinforces the notion of possible telomere-independent functions. In this review, recent studies regarding the extratelomeric functions of TERT have been comprehensively summarized, and their implications discussed.

Adenovirus-mediated gene therapy approaches have evolved as promising means for cancer treatment during the last decade. Utilizing a broad spectrum of tumor-specific promoters, numerous oncotropic vectors have been created with exceptional properties regarding tumor-restricted specificity. The discovery of telomerase, its high prevalence in tumor tissues and the discovery of its transcriptional regulation via the hTERT promoter have extended the applicability of adenoviral gene therapy vectors to approximately 90% of all tumors. First generation adenoviral vectors expressing transgenes under the control of the hTERT promoter confirmed the therapeutic potential but were restricted to initially transduced cancer cells. Recently, telomerase-dependent conditionally replicative adenoviral vectors (CRADs) have been developed that combine the specificity of hTERT promoter based expression systems with the lytic efficacy of replicative viruses. To evaluate the potential for clinical applications, various efforts have been made to establish combinative strategies including systemic chemotherapy, radiotherapy and antiangiogenesis. This review highlights the rapid advances of telomerase-based gene therapy and gives insight into future prospects and future development of oncotropic vectors.

The acquisition of cellular immortality is a critical step in human tumorigenesis. While the vast majority of human tumors activate the catalytic component of telomerase (hTERT) to stabilize their telomeres and attain immortality, a significant portion (7-10%) utilize a poorly defined alternative form of telomere maintenance referred to as ALT. Interestingly, telomerase activation is often favored in tumors arising from the epithelial compartment whereas ALT occurs in a more significant portion of tumors that arise from tissues of mesenchymal origin. This observation raises the possibility that cell type specific mechanisms favor the activation of telomerase versus ALT in human tumorigenesis. Because cellular immortality is critical to tumorigenesis it may represent an important anti-neoplastic target. Indeed, several approaches have successfully eliminated telomerase activity in human tumor models and some of these approaches are now moving into clinical trials. While these results are encouraging, it is clear that these approaches will have no impact on cells that utilize the ALT mechanism for telomere maintenance. Furthermore, the existence of ALT raises the possibility that telomerase-positive tumors undergoing anti-telomerase therapies may escape by activating the ALT pathway. For these reasons a detailed understanding of the ALT pathway is critical to the future design of anti-neoplastic therapies.