Telomere length in atherosclerosis and diabetes

The Nobel Prize in Medicine in 2009 was awarded to Elizabeth Blackburn, Carol Greider and Jack Szostak for discovering the molecular structure of the far ends of chromosomes, called telomeres (Fig. 1), and how these protect chromosomes from degradation. Their discoveries shed light on a basic biological mechanism which stimulated research in a new exciting field aiming to explore the role of telomeres in normal ageing, cancer and age-related disease pathology. Elizabeth Blackburn first announced the identification of the repeated sequence of DNA in telomeres at a conference in 1980 and together with Jack Szostak in 1982 revealed that telomeres constitute a fundamental mechanism offering protection to chromosomes from degradation throughout different species [[1]Szostak J.W. Blackburn E.H. Cloning yeast telomeres on linear plasmid vectors.Cell. 1982; 29: 245-255Abstract Full Text PDF PubMed Scopus (414) Google Scholar]. In 1984 Carol Greider working with Elizabeth Blackburn discovered the enzyme which forms telomeric sequences [2Greider C.W. Blackburn E.H. Identification of a specific telomere(definition) terminal transferase activity in Tetrahymena extracts.Cell. 1985; 43: 405-413Abstract Full Text PDF PubMed Scopus (2707) Google Scholar, 3Greider C.W. Blackburn E.H. A telomeric sequence in the RNA of Tetrahymena telomerase required for telomere repeat synthesis.Nature. 1989; 337: 331-337Crossref PubMed Scopus (1363) Google Scholar]. This enzyme prevents telomere shortening with cell division, which otherwise takes place due to the incapability of DNA polymerase to fully copy the very end sequences of chromosomes during DNA replication, the so-called end-replication problem [[4]Olovnikov A.M. Principle of marginotomy in template synthesis of polynucleotides.Doklady Akademii nauk SSSR. 1971; 201: 1496-1499PubMed Google Scholar]. The impact of Blackburn's, Greider's and Szostak's work during the early 1980s is indicated by the increasing rate of publications in the field of telomeres thereafter (Fig. 2). We now know that telomeres’ biological function goes beyond the protection of chromosome ends from degradation or fusion, playing an important role in the cell's ageing process [[5]Blackburn E.H. Greider C.W. Szostak J.W. Telomeres and telomerase: the path from maize, Tetrahymena and yeast to human cancer and aging.Nature Medicine. 2006; 12: 1133-1138Crossref PubMed Scopus (717) Google Scholar]. The length of telomeres serves as a mechanism of normal cell senescence(definition) [[6]Allsopp R.C. Harley C.B. Evidence for a critical telomere length in senescent human fibroblasts.Experimental Cell Research. 1995; 219: 130-136Crossref PubMed Scopus (354) Google Scholar]. In somatic cells, where the enzyme telomerase is not expressed, telomeres become shorter with each cell division, due to the end-replication problem. Once the length reduces below a critical value replicative senescence, also called the Hayflick limit, is induced [[7]Sozou P.D. Kirkwood T.B. A stochastic model of cell replicative senescence based on telomere shortening, oxidative stress, and somatic mutations in nuclear and mitochondrial DNA.Journal of Theoretical Biology. 2001; 213: 573-586Crossref PubMed Scopus (85) Google Scholar]. The rate of telomere shortening in telomerase negative cells is not only dependent on the number of cell divisions, but also on DNA damage. The ends of telomeres constitute 3′ single-strand overhangs which are prone to single-strand breaks, particularly those caused by oxidative damage, due to their G-rich content. The accumulation of such breaks along the telomeres leads to additional loss during replication [8Petersen S Saretzki G. von Zglinicki T. Preferential accumulation of single-stranded regions in telomeres of human fibroblasts.Experimental Cell Research. 1998; 239: 152-160Crossref PubMed Scopus (354) Google Scholar, 9Serra V. Grune T. Sitte N. Saretzki G. von Zglinicki T. Telomere length as a marker of oxidative stress in primary human fibroblast cultures.Annals of the New York Academy of Sciences. 2000; 908: 327-330Crossref PubMed Scopus (81) Google Scholar]. Therefore, the length of telomeres indicates the replicative capacity and cumulative genomic damage of somatic cells, reflecting in this way the tissue's “biological age”. In recent years, the role of telomere length in the pathology of cardiovascular disease (CVD) and diabetes, where tissue ageing and senescence play major roles, has attracted a continuously growing research interest, and in the last two years alone six articles on telomere length have been published in Atherosclerosis. An article by Adaikalakoteswari et al. in the November 2007 issue associated shorter leukocyte telomere length (LTL) with impaired glucose tolerance, type 2 diabetes (T2D) and atherosclerotic plaques in T2D patients [[10]Adaikalakoteswari A. Balasubramanyam M. Ravikumar R. Deepa R. Mohan V. Association of telomere shortening with impaired glucose tolerance and diabetic macroangiopathy.Atherosclerosis. 2007; 195: 83-89Abstract Full Text Full Text PDF PubMed Scopus (131) Google Scholar]. In June 2008, Satoh et al. showed that telomere length was shorter and telomerase activity lower in endothelial progenitor cells from patients with coronary heart disease (CHD) and even more reduced in CHD patients with metabolic syndrome. At the same time, oxidative DNA damage in these subjects displayed the opposite trend [[11]Satoh M. Ishikawa Y. Takahashi Y. Itoh T. Minami Y. Nakamura M. Association between oxidative DNA damage and telomere shortening in circulating endothelial progenitor cells obtained from metabolic syndrome patients with coronary artery disease.Atherosclerosis. 2008; 198: 347-353Abstract Full Text Full Text PDF PubMed Scopus (117) Google Scholar]. Following this, LTL was shown to negatively correlate with homocysteine levels by Richards et al. [[12]Richards J.B. Valdes A.M. Gardner J.P. et al.Homocysteine levels and leukocyte telomere length.Atherosclerosis. 2008; 200