Telomere shortening in renal cell carcinoma.

The ends of human chromosomes consist of a specialized structure, the telomere, composed of repeats of TTAGGG making up a total of 5-15 kilobase pairs, depending on age and proliferative activity of the tissue. The major function of telomeres is to provide stability to chromosomes and protect underlying unique coding sequences from degradation. There is a loss of telomeric sequences following every cell division estimated to be between 50 and 65 basepairs/cell division in human fibroblasts and embryonic kidney cells in vitro. This loss is due to the fact that DNA replication is incomplete for one strand at each telomere end. In lower eukaryotes there is a compensation mechanism provided by the enzyme telomerase, which is inactive in human somatic cells. Telomerase activation has also been detected in vitro immortalized human cells. In this study we analyzed renal cell carcinoma for the occurrence of telomere shortening using the probe (TTAGGG)4. Southern blots of HinfI-digested DNA revealed a shortening of mean telomere restriction fragment (TRF) length of 0.4 to 2.5 kilobase pairs in 2 or 3 intratumoral samples in all 10 tumors analyzed. No obvious intratumoral heterogeneity was found in mean TRF length values. However, heterogeneity was shown by the occurrence of at least two separate peak TRF values in 7 of 10 tumors, indicating the presence of different tumor cell clones. A conflicting observation was made when we evaluated the intensity of the hybridization signals, where three of the tumors showed an increase in hybridization signals despite concomitant TRF reduction. We found no correlation between tumor size and calculated tumor cell divisions undergone. In two tumors, the calculated cell division cycles were unrealistically low compared to the tumor size. These data suggest that telomerase activation might occur in human renal cell carcinoma.

Telomerase activity in vivo in human malignant hematopoietic cells.

In somatic cells, each DNA replication round gives a shortening of the telomere ends as a consequence of incomplete lagging strand synthesis. Telomeres are essential for chromosomal integrity and extensive telomere length reduction is associated with increased instability of the genome. In germ line cells and in established cell lines, telomerase activity maintains the length of the telomeres by de novo synthesis of telomeric repeats, in humans (T2AG3)n. Recently, it was for the first time shown the existence of telomerase activity in human ovarian carcinomas. In the present study we show that telomerase activation can also occur in human hematopoietic tumor cells in vivo. Cell extracts from 19 cases with leukemia, lymphoma and myeloma were tested for telomerase activity using an in vitro assay with (T2AG3)3 or permutations of this sequence as primers. Eight cases demonstrated an RNAse A sensitive ability to add new nucleotides to the human telomere sequence. Nine acute leukemias were tested telomerase negative. Our data demonstrate that telomerase activation in vivo seems to be a common event in B cell neoplasias with a mature immunophenotype like non-Hodgkin's lymphoma and myeloma, in contrast to acute leukemias of B, T or myeloid cell origin. Telomere length evaluation indicated no marked differences between samples with or without telomerase activity which could argue for a telomere length independent mechanism for telomerase activation in at least some cases.

Telomerase activity in human renal cell carcinoma.

Telomeres have a vital role in maintaining chromosome stability and are essential for long term viability. Since the very ends of linear chromosomes cannot replicate, telomeres shorten in normal somatic cells eventually resulting in growth inhibition. However, most immortal cell lines maintain stable telomeres indicating that mechanisms exist to compensate for the end replication problem. Telomerase activity, leading to synthesis of telomeric DNA repeats, has been proposed to be an important step in the immortalization process of tumor cells. In the present study, 56 renal cell carcinomas were tested for telomerase activity using the sensitive TRAP (telomeric repeat amplification protocol). Forty of the analysed tumors (71%) were positive for telomerase activity, whereas none of the 56 corresponding normal kidney samples showed telomerase activity. All telomerase negative tumors had a reduction in mean telomere restriction fragment (TRF) length and a decrease in total telomere repeat hybridization signal, though cases were observed with an increase in peak TRF lengths. No obvious association between the presence of telomerase activity and clinicopathological parameters (histopathologic grade, DNA-ploidy, stage and clinical outcome) was found. The high frequency of detection of telomerase activity in the renal cell carcinomas indicates that this enzyme is likely to be an important factor involved in the evolution of this tumor type.

Loss of heterozygosity at chromosome 3p correlates with telomerase activity in renal cell carcinoma.

Acquired loss of the entire or parts of the short arm of chromosome 3 is a frequent aberration in renal cell carcinoma as well as in other tumour types, indicating the presence of at least one tumour suppressor gene on 3p. Previous studies have defined the distal and proximal ends of one critical region to reside between 3p21 and 3p11, and one gene involved in von Hippel-Lindau disease has been identified at 3p25. Experimental in vitro data has suggested a negative regulator of telomerase activity on chromosome 3. In the present study we investigated the relationship between telomerase activity and loss of heterozygosity (LOH) on 3p in a series of renal cell carcinomas. Telomerase activity was evaluated using the telomeric repeat amplification protocol assay and LOH, by analysis of 17 polymorphic microsatellite markers. Twenty-nine out of 45 tumours (64%) demonstrated telomerase activity and 37 tumours (82%) showed allelic loss of single or multiple areas of chromosome 3p. A significant correlation between LOH of at least one of three markers localised within 4 cM in the region of 3p21.2-3p14.2 and telomerase activity was demonstrated (p=0.0031), as well as for three distal markers within 3 cM at 3p24.3-3p24.1 (p=0.0287). These data suggest the presence of at least two genes with regulatory function on the expression of telomerase. These genes can encode proteins of importance for senescence and/or immortalisation or have a more direct effect on activation of telomerase.

Clinical significance of nm23 expression in renal cell carcinoma.

In many tumors an expression of nm23 gene products is associated with a lower metastatic potential. The aim was to evaluate whether nm23 gene expression in renal cell carcinoma was associated with clinicopathological findings and survival. In 41 patients, the expression of nm23 protein was analyzed in tumor and corresponding kidney cortex tissue by immunohistochemical analysis using a monoclonal nm23-H1 antibody. In all kidney cortex samples intense nm23 staining was found. Of 41 tumors, 15 had high, 12 intermediate, 5 low nm23 expression whereas 9 tumors showed none. There were no differences in nm23 staining between different stages, grades or size of tumor. No correlation between survival and nm23 expression was observed. However, diploid tumors had significantly less nm23 staining compared with aneuploid tumors, indicating that nm23 gene inactivation might be a favorable sign. The expression of nm23 gene products seems not to be correlated to tumor progression and metastatic ability in renal cell carcinoma.

DNA fingerprinting of renal cell carcinoma with special reference to tumor heterogeneity.

Genomic alterations in renal cell carcinoma were investigated by DNA fingerprinting using the simple repetitive oligonucleotide probe (CAC)s. Nine of ten tumors showed somatic changes in the fingerprint pattern compared with constitutional DNA. The most consistent changes were deletions and/or decrease in intensity of a band. When using two or three samples from different parts within the tumor, up to three different cell clones could be detected. These results indicate that DNA fingerprinting analysis can be a useful technique for the study of genomic alterations and tumor heterogeneity in renal cell carcinoma.

p53 mutations, protein expression and cell proliferation in squamous cell carcinomas of the head and neck.

Thirty-three patients with squamous cell carcinoma of the head and neck region were studied concerning p53 protein expression and mutations in exons 4-9 of the p53 gene using immunohistochemistry, polymerase chain reaction (PCR)-single strand conformation polymorphism analysis and DNA sequencing. Immunoreactivity was found in 64% and p53 gene mutations in 39% of the tumours. Thirty-three per cent of the immunopositive and 50% of the immunonegative tumours were mutated within exons 5-8. In one immunopositive tumour three variants of deletions were observed. Sequencing of the p53 mutated, immunonegative tumours revealed four cases with deletions, one case with a transversion resulting in a stop codon and one case with a splice site mutation which could result in omission of the following exon at splicing. All mutations in the immunonegative tumours resulted in a truncated p53 protein. No association between p53 gene status and expression of proliferating cell nuclear antigen (PCNA) or cell proliferation as judged by in vivo incorporation of the thymidine analogue iododeoxyuridine (IdUrd) was found.

Heterogeneity in renal cell carcinoma and its impact no prognosis--a flow cytometric study.

In the process of tumour progression genetic instability is the basis for the evolution of tumour cell clones with various genotypic and phenotypic characteristics causing heterogeneity. Renal cell carcinoma has a long prediagnostic growth period, which increases the probability of clonal evolution. We have studied 200 consecutive renal cell carcinomas, addressing the interrelationship between intratumour heterogeneity and clinicopathological factors. DNA ploidy patterns were analysed in multiple samples from each tumour using flow cytometry and compared with clinical stage, tumour invasion, metastatic rate and survival. Eighty-five of 192 evaluable tumours (44%) were homogeneous concerning DNA ploidy (62% diploid, 38% aneuploid). Among 107 heterogeneous tumours a majority (79%) contained aneuploid as well as diploid cell clones. Homogeneously diploid tumours had a lower incidence of local tumour spread compared with tumours with aneuploid cell clones (P < or = 0.001), but the frequency of distant metastasis at time of diagnosis was similar. The presence of aneuploidy in at least one sample from a tumour was a significant adverse prognostic factor (P < 0.001), whereas the degree of heterogeneity had no influence on survival. The frequent heterogeneity demonstrated indicates that multiple samples must be investigated to evaluate properly the malignant character of renal cell carcinoma.

Telomere length and telomerase activity in malignant lymphomas at diagnosis and relapse.

Telomere length maintenance, in the vast majority of cases executed by telomerase, is a prerequisite for long-term proliferation. Most malignant tumours, including lymphomas, are telomerase-positive and this activity is a potential target for future therapeutic interventions since inhibition of telomerase has been shown to result in telomere shortening and cell death in vitro. One prerequisite for the suitability of anti-telomerase drugs in treating cancer is that tumours exhibit shortened telomeres compared to telomerase-positive stem cells. A scenario is envisioned where the tumour burden is reduced using conventional therapy whereafter remaining tumour cells are treated with telomerase inhibitors. In evaluating the realism of such an approach it is essential to know the effects on telomere status by traditional therapeutic regimens. We have studied the telomere lengths in 47 diagnostic lymphomas and a significant telomere shortening was observed compared to benign lymphoid tissues. In addition, telomere length and telomerase activity were studied in consecutive samples from patients with relapsing non-Hodgkin's lymphomas. Shortened, unchanged and elongated telomere lengths were observed in the relapse samples. The telomere length alterations found in the relapsing lymphomas appeared to be independent of telomerase and rather represented clonal selection random at the telomere length level. These data indicate that anti-telomerase therapy would be suitable in only a fraction of malignant lymphomas.

A non-random deletion in the p53 gene in oral squamous cell carcinoma.

In a retrospective study of the mutational spectrum of the p53 gene in oral squamous cell carcinoma, 80 primary tumours diagnosed in 1980-90 were included. Using polymerase chain reaction/single strand conformation polymorphism (PCR/SSCP) analysis 47 mutations were found distributed in 39 of the tumours (49%). Unexpectedly, the majority of the mutations (29/47; 62%) were found in exon 8, and at sequencing 17 of them showed a 14 bp deletion in codons 287-292, causing formation of a stop codon and accordingly a truncated protein lacking the C-terminal. The majority of the patients with the 14 bp deletion were women (13/17), and it seemed as though certain potential risk factors for carcinoma of the head and neck were less common in this group.