Alternative paths to telomere elongation

Overcoming cellular senescence that is induced by telomere shortening is critical in tumorigenesis. A majority of cancers achieve telomere maintenance through telomerase expression. However, a subset of cancers takes an alternate route for elongating telomeres: recombination-based alternative lengthening of telomeres (ALT). Current evidence suggests that break-induced replication (BIR), independent of RAD51, underlies ALT telomere synthesis. However, RAD51-dependent homologous recombination is required for homology search and interchromosomal telomere recombination in human ALT cancer cell maintenance. Accumulating evidence suggests that the breakdown of stalled replication forks, the replication stress, induces BIR at telomeres. Nevertheless, ALT research is still in its early stage and a comprehensive view is still unclear. Here, we review the current findings regarding the genesis of ALT, how this recombinant pathway is chosen, the epigenetic regulation of telomeres in ALT, and perspectives for clinical applications with the hope that this overview will generate new questions.

Automated summary

Overcoming cellular senescence induced by telomere shortening is crucial in tumorigenesis, with most cancers maintaining telomeres through telomerase expression, while a subset use ALT for telomere elongation. The BIR mechanism, independent of RAD51, underlies ALT telomere synthesis, while homologous recombination dependent on RAD51 is necessary for ALT cancer cell maintenance. Despite evidence suggesting replication stress induces BIR at telomeres, ALT research is still in its early stages with much still unknown.