Germline POT1 variants are associated with long telomeres and an unexpected broad spectrum of malignancies.
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Abu Shtaya Aasem, Aloni Shahar, Eskin-Schwartz Marina, Asher Nethanel, Azulay Noy, Basel-Salmon Lina, Bazak Lily, Bernstein Molho Rinat, Douiev Liza, Barhom Sarit Farage, Friedman Eitan, Isakov Ofer, Mahamid Ahmad, Michaeli Orli, Kedar Inbal, Levi Zohar, Liberman Sari, Mordechai Shikma, Reiter Ofer, Levi Gili Reznick, Shkedi Rafid Shiri, Sarsor Zinab, Uziel Orit, Simchoni Sharon, Walsh Tom, Wolach Ofir, Segol Ori, Yablonski-Peretz Tamar, Zick Aviad, Gluck Avinoam, Tzfati Yehuda, Goldberg Yael
Аннотация
METHODS: We conducted a retrospective analysis of 44 individuals carrying pathogenic or likely pathogenic POT1 variants identified between 2018 and 2025. Clinical, pathologic, and demographic data were extracted from medical records. Telomere length was assessed using in-gel hybridization of telomeric restriction fragments.
RESULTS: Of 44 heterozygotes, 31 had the c.233T>C; p.(Ile78Thr) variant, 8 had c.1672dup; p.(Tyr558Leufs∗6), and 5 had other frameshifting, likely loss-of-function variants. Cancer was diagnosed in 27 heterozygotes (61%), totaling 84 primary malignancies (range: 0-8 per person), with most cases (79%) occurring after the age of 50 years. Melanoma (34%) and breast cancer in females (45%) were the most common. Additional tumors included papillary thyroid carcinoma, desmoid tumors, and diverse malignant and benign neoplasms. Colonic polyps were frequent. POT1 heterozygotes with the p.(Ile78Thr) variant exhibited significantly longer telomeres than control participants, with a 62-year-old woman showing comparable or even longer telomeres than her children.
CONCLUSION: POT1 pathogenic variants confer susceptibility to a wide tumor spectrum, notably melanoma and, unexpectedly, breast cancer. At least some of these variants are linked to ultralong telomeres, consistent with findings from this study and others. These findings support incorporating POT1 into multigene panels and suggest telomere length as a potential biomarker for diagnosis.