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Lack of Telomerase Activity in Lung Carcinoids Is Dependent on Human Telomerase Reverse Transcriptase Transcription and Alternative Splicing and Is Associated with Long Telomeres

Authors' Affiliations: Departments of ¹ Experimental Oncology, ² Surgery, and ³ Pathology, Istituto Nazionale per lo Studio e la Cura dei Tumori and ⁴ Department of Thoracic Surgery, Istituto Clinico Humanitas, Milan, Italy

Requests for reprints: Nadia Zaffaroni, Department of Experimental Oncology, Istituto Nazionale per lo Studio e la Cura dei Tumori, Unit 10, Via Venezian 1, 20133 Milan, Italy. Phone: 39-2-23903260; Fax: 39-2-23903052; E-mail: nadia.zaffaroni{at}istitutotumori.mi.it.

Purpose: Preliminary evidence indicates that telomerase activity is significantly less expressed in typical carcinoids than in large cell neuroendocrine carcinomas or in small cell lung cancers. Knowledge of the mechanisms by which telomerase is differentially regulated in neuroendocrine lung tumors is important for a better understanding of the pathogenesis of these malignancies.

Experimental Design: We investigated telomerase activity in 86 neuroendocrine lung tumors and correlated the enzyme activity with the expression of the enzyme subunits [human RNA component (hTR), human telomerase reverse transcriptase (hTERT), and alternatively spliced hTERT variants], with the telomere-associated protein human protection of telomere-1, and with the telomere length pattern.

Results: A significantly (P = 0.0001) lower frequency of telomerase-positive cases was found in typical carcinoids (14%) than in large cell neuroendocrine carcinomas (87%) and small cell lung cancers (92%). hTR was constitutively expressed in all carcinoids. Telomerase-negative carcinoids were characterized by the absence of any hTERT transcript, only displayed the ß^– alternatively spliced variant, or concomitantly expressed the ⁺ß⁺ full-length message with different combinations of alternatively spliced variants. However, in these tumors, a more abundant level of alternatively spliced transcripts than that of the ⁺ß⁺ full-length transcript was generally found. No significant difference was observed in human protection of telomere-1 expression between telomerase-negative and telomerase-positive carcinoids. Telomeres were significantly (P < 0.05) longer in telomerase-negative carcinoids than in telomerase-positive carcinoids (median value, 9.15 versus 4.47 kb). However, alternative lengthening of telomeres, as shown by associated promyelocytic leukemia bodies, was not observed in these tumors.

Conclusions: Our results indicate that telomerase is repressed in most lung carcinoids and that hTERT transcription and alternative splicing play a role in such a negative regulation. Moreover, the absence of any telomerase maintenance mechanism may contribute to the favorable prognosis of this malignancy.

Key Words: human telomerase reverse transcriptase • alternatively spliced variants • ALT mechanisms • neuroendocrine lung cancers

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