Douglas Hanahan, Robert A. Weinberg. Hallmarks of cancer: the next generation. Cell, Volume 144, Issue 5, p646–674, 4 March 2011
By 2000, it was widely accepted that cancer cells require unlimited replicative potential in order to generate macroscopic tumors. This capability stands in marked contrast to the behavior of the cells in most normal cell lineages in the body, which are able to pass through only a limited number of successive cell growth-and-division cycles. This limitation has been associated with two distinct barriers to proliferation: senescence, a typically irreversible entrance into a nonproliferative but viable state, and crisis, which involves cell death. Accordingly, when cells are propagated in culture, repeated cycles of cell division lead first to induction of senescence and then, for those cells that succeed in circumventing this barrier, to a crisis phase, in which the great majority of cells in the population die. On rare occasion, cells emerge from a population in crisis and exhibit unlimited replicative potential. This transition has been termed immortalization, a trait that most established cell lines possess by virtue of their ability to proliferate in culture without evidence of either senescence or crisis.
Multiple lines of evidence indicate that telomeres protecting the ends of chromosomes are centrally involved in the capability for unlimited proliferation. The telomeres, composed of multiple tandem hexanucleotide repeats, shorten progressively in nonimmortalized cells propagated in culture, eventually losing the ability to protect the ends of chromosomal DNAs from end-to-end fusions; such fusions generate unstable dicentric chromosomes whose resolution results in a scrambling of karyotype that threatens cell viability. Accordingly, the length of telomeric DNA in a cell dictates how many successive cell generations its progeny can pass through before telomeres are largely eroded and have consequently lost their protective functions, triggering entrance into crisis.
Telomerase, the specialized DNA polymerase that adds telomere repeat segments to the ends of telomeric DNA, is almost absent in nonimmortalized cells but expressed at functionally significant levels in the vast majority (∼90%) of spontaneously immortalized cells, including human cancer cells. By extending telomeric DNA, telomerase is able to counter the progressive telomere erosion that would otherwise occur in its absence. The presence of telomerase activity, either in spontaneously immortalized cells or in the context of cells engineered to express the enzyme, is correlated with a resistance to induction of both senescence and crisis/apoptosis; conversely, suppression of telomerase activity leads to telomere shortening and to activation of one or the other of these proliferative barriers.
The two barriers to proliferation—senescence and crisis/apoptosis—have been rationalized as crucial anticancer defenses that are hard-wired into our cells, being deployed to impede the outgrowth of clones of preneoplastic and frankly neoplastic cells. According to this thinking, most incipient neoplasias exhaust their endowment of replicative doublings and are stopped in their tracks by one or the other of these barriers. The eventual immortalization of rare variant cells that proceed to form tumors has been attributed to their ability to maintain telomeric DNA at lengths sufficient to avoid triggering senescence or apoptosis, achieved most commonly by upregulating expression of telomerase or, less frequently, via an alternative recombination-based telomere maintenance mechanism. Hence, telomere shortening has come to be viewed as a clocking device that determines the limited replicative potential of normal cells and thus one that must be overcome by cancer cells.
Пересмотр репликационного старения
Whereas telomere maintenance has been increasingly substantiated as a condition critical to the neoplastic state, the concept of replication-induced senescence as a general barrier requires refinement and reformulation. (Differences in telomere structure and function in mouse versus human cells have also complicated investigation of the roles of telomeres and telomerase in replicative senescence.) Recent experiments have revealed that the induction of senescence in certain cultured cells can be delayed and possibly eliminated by the use of improved cell culture conditions, suggesting that recently explanted primary cells may be able to proliferate unimpeded in culture up the point of crisis and the associated induction of apoptosis triggered by critically shortened telomeres. In contrast, experiments in mice engineered to lack telomerase indicate that the consequently shortened telomeres can shunt premalignant cells into a senescent state that contributes (along with apoptosis) to attenuated tumorigenesis in mice genetically destined to develop particular forms of cancer. Such telomerase null mice with highly eroded telomeres exhibit multiorgan dysfunction and abnormalities that include evidence for both senescence and apoptosis, perhaps analogous to the senescence and apoptosis observed in cell culture.
Of note, and as discussed earlier, a morphologically similar form of cell senescence induced by excessive or unbalanced oncogene signaling is now well documented as a protective mechanism against neoplasia; the possible interconnections of this form of senescence with telomerase and telomeres remain to be ascertained. Thus, cell senescence is emerging conceptually as a protective barrier to neoplastic expansion that can be triggered by various proliferation-associated abnormalities, including high levels of oncogenic signaling and, apparently, subcritical shortening of telomeres.
Отсроченная активация теломеразы и ограничивает, и поддерживает прогрессирование неоплазм
There is now evidence that clones of incipient cancer cells often experience telomere loss-induced crisis relatively early during the course of multistep tumor progression due to their inability to express significant levels of telomerase. Thus, extensively eroded telomeres have been documented in premalignant growths through the use of fluorescence in situ hybridization (FISH), which has also revealed the end-to-end chromosomal fusions that signal telomere failure and crisis. These results also suggest that such cells have passed through a substantial number of successive telomere-shortening cell divisions during their evolution from fully normal cells-of-origin. Accordingly, the development of some human neoplasias may be aborted by telomere-induced crisis long before they succeed in becoming macroscopic, frankly neoplastic growths.
In contrast, the absence of TP53-mediated surveillance of genomic integrity may permit other incipient neoplasias to survive initial telomere erosion and attendant chromosomal breakage-fusion-bridge (BFB) cycles. The genomic alterations resulting from these BFB cycles, including deletions and amplifications of chromosomal segments, evidently serve to increase the mutability of the genome, thereby accelerating the acquisition of mutant oncogenes and tumor suppressor genes. The realization that impaired telomere function can actually foster tumor progression has come from the study of mutant mice that lack both p53 and telomerase function. The proposition that these two defects can cooperatively enhance human tumorigenesis has not yet been directly documented.
Circumstantial support for the importance of transient telomere deficiency in facilitating malignant progression has come, in addition, from comparative analyses of premalignant and malignant lesions in the human breast. The premalignant lesions did not express significant levels of telomerase and were marked by telomere shortening and nonclonal chromosomal aberrations. In contrast, overt carcinomas exhibited telomerase expression concordantly with the reconstruction of longer telomeres and the fixation (via clonal outgrowth) of the aberrant karyotypes that would seem to have been acquired after telomere failure but before the acquisition of telomerase activity. When portrayed in this way, the delayed acquisition of telomerase function serves to generate tumor-promoting mutations, whereas its subsequent activation stabilizes the mutant genome and confers the unlimited replicative capacity that cancer cells require in order to generate clinically apparent tumors.
Новые функции теломеразы
Telomerase was discovered because of its ability to elongate and maintain telomeric DNA, and almost all telomerase research has been posited on the notion that its functions are confined to this crucial function. However, in recent years it has become apparent that telomerase exerts functions that are relevant to cell proliferation but unrelated to telomere maintenance. The noncanonical roles of telomerase, and in particular its protein subunit TERT, have been revealed by functional studies in mice and cultured cells; in some cases novel functions have been demonstrated in conditions where the telomerase enzymatic activity has been eliminated. Among the growing list of telomere-independent functions of TERT/telomerase is the ability of TERT to amplify signaling by the Wnt pathway, by serving as a cofactor of the β-catenin/LEF transcription factor complex. Other ascribed telomere-independent effects include demonstrable enhancement of cell proliferation and/or resistance to apoptosis, involvement in DNA-damage repair, and RNA-dependent RNA polymerase function. Consistent with these broader roles, TERT can be found associated with chromatin at multiple sites along the chromosomes, not just at the telomeres. Hence, telomere maintenance is proving to be the most prominent of a diverse series of functions to which TERT contributes. The contributions of these additional functions of telomerase to tumorigenesis remain to be fully elucidated.