Telomerase is an enzyme that adds specific DNA sequence repeats ("TTAGGG" in all vertebrates) to the 3' ("three prime") end of DNA strands in the telomere regions at the ends of chromosomes. These telomeres contain condensed DNA material during replication. The enzyme is a reverse transcriptase that carries its own RNA template; this RNA is used as a template for eukaryotic DNA replication.
TERT is a reverse transcriptase, which is a class of enzymes that creates single stranded DNA using single stranded RNA as a template. Enzymes of this class (but not TERT specifically) are utilized by scientists in the molecular biological process of Reverse Transcriptase PCR (RT-PCR), which allows the creation of several DNA copies of a target sequence using RNA as a template. TERT carries its own template around, TERC.
By using TERC, TERT can add a six nucleotide repeating sequence, 5'-TTAGGG (in humans and all vertebrates...the sequence differs in other organisms) to the 3' strand of chromosomes. These TTAGGG repeats, with their various protein binding partners are called telomeres. The template region of TERC is 3'-CAAUCCCAAUC-5'. This way, telomerase can bind the first few nucleotides of the template to the last telomere sequence on the chromosome, add a new telomere repeat (5'-GGTTAG-3') sequence, let go, realign the new 3'-end of telomere to the template, and repeat the process
Immortal cancer cells. With the activation of telomerase, some types of cells and their offspring become immortal. Cancer cells are considered 'immortal' because telomerase activity allows them to divide forever, which is why they can form a tumor. A good example of cancer cells' immortality is HeLa cells. HeLa cells were originally removed from the cervical cancer of Henrietta Lacks in 1951 and are still used in laboratories as a model cell line. They are indeed immortal - daily production of HeLa cells is estimated at several tons - all from the few cells taken from Ms. Lacks' tumor.
While this method of modeling human cancer in cell culture is effective and has been used for many years by scientists, it is also very imprecise. The exact changes which allow for the formation of the tumorigenic clones in the above experiment are not clear. Scientists have subsequently been able to address this question by the serial introducation of several mutations present in a variety of human cancers. This has led to the elucidation of several combinations of mutations which are sufficient for the formation of tumorigenic cells, in a variety of cell types. While the combination varies depending on the cell type, a common theme is that the following alterations are required: activation of TERT, loss of p53 pathway function, loss of pRb pathway function, activation of the Ras or myc proto-oncogenes, and aberration of the PP2A protein phosphatase.
This model of cancer in cell culture accurately describes the role of telomerase in actual human tumors. Telomerase activation has been observed in ~90% of all human tumors, suggesting that the immortality conferred by telomerase is required for cancer development. Of the tumors which have not activated TERT, most have found a separate pathway to maintain telomere length termed ALT (Alternative Lengthening of Telomeres). The exact mechanism behind telomere maintenance in the ALT pathway has not been elucidated, but likely involves multiple recombination events at the telomere.
Cri du chat Syndrome (CdCS). Loss of one copy of TERT has been suggested as a cause or contributing factor of CdCS *.
Dyskeratosis congenita (DC) is a disease of the bone marrow which can be caused by a mutation in the telomerase RNA subunit, TERC. Mutation of TERC only accounts for 5% of all cases, and when DC occurs by this mutation, it is inherited as an autosomal dominant disorder. Mutations in the gene Dyskerin (DKC1) account for about 35% of DC cases, and in this case the inheritance pattern is X-linked recessive.
Patients with DC have severe bone marrow failure manifesting as abnormal skin pigmentation, leucoplakia (a white thickening of the oral mucosa), and nail dystophy, as well as a variety of other symtoms. Individuals with either TERC or DKC1 mutations have shorter telomeres and defective telomerase activity in vitro than other individuals of the same age *.
There has also been one family in which autosomal dominant DC has been linked to a heterozygous mutation in TERT *. These patients also exhibited an increased rate of telomere shortening, and gentic anticipation (i.e. the DC phenotype worsened with each generation).
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