Mutations in a gene that helps repair damaged chromosome ends may make smokers -- especially female smokers -- more susceptible to emphysema, according to results of a new study led by Johns Hopkins Kimmel Cancer Center researchers.
The mutations are one of a few genetic factors directly linked to chronic obstructive pulmonary disease (COPD), including emphysema, since the 1960s, says Mary Armanios, M.D., associate professor of oncology at the Johns Hopkins University School of Medicine.
Specifically, the alteration occurs in the telomerase reverse transcriptase (TERT) gene, which helps produce an enzyme called telomerase. Telomerase maintains and repairs the "caps" that protect the ends of chromosomes from degradation during cell division. Telomeres gradually shorten with age and act as a sort of cellular clock in cells. Mutations in TERT lead to excessively shortened telomeres.
Using genetic data gathered in COPD studies funded by the National Institutes of Health, Armanios and colleagues found TERT mutations in three of 292 smokers with emphysema. The researchers then looked at a sample of 50 Johns Hopkins patients with syndromes linked to telomere shortening. Among 39 nonsmokers, there were no cases of emphysema. Among smokers, seven of 11 patients, including all six female smokers, had emphysema. Armanios says this suggests that female smokers with telomerase-related mutations may be more susceptible to emphysema.
A report on the research was published Dec. 22 in the Journal of Clinical Investigation. Lung disease is the third leading cause of death in the U.S., and the main risk factors are aging and smoking. However, only about 10 percent of smokers develop COPD, according to Armanios. "Not everyone who smokes gets emphysema, so our study is part of a bigger effort to find out why some people get it and others do not," says Armanios, who notes that other studies have shown that young women who smoke may be more susceptible to emphysema.
The researchers had some clues about telomerase genes from earlier studies, including one in which Armanios and her colleagues identified the impact of shortened telomeres in mice as a risk factor for emphysema after being exposed to cigarette smoke. The scientists previously had noted a link between telomerase mutations and a severe hereditary lung disease called idiopathic pulmonary fibrosis.
Patients with emphysema often suffer from other health problems, including osteoporosis, liver disease and cancer. These disorders are common in people with shortened telomeres as well. The new study, says Armanios, "may now give us an explanation for why people with emphysema have these systemic problems. If we know that they have a telomerase mutation, it may help us take care of them in a more sophisticated way and delay the onset of those diseases."
Armanios and colleagues published a study last year showing that telomerase mutations may lead to more complications during lung transplants for people with idiopathic pulmonary fibrosis.
In the current study, only 1 percent of the smokers with severe emphysema carried the TERT mutation, but Armanios says this is comparable to the percentage who carry another known genetic factor related to COPD -- a mutation in the alpha-1 antitrypsin gene.
The researchers only looked at mutations in two telomerase genes but will now search for mutations in other telomere-regulating genes that might also predispose people to lung disease. "There are many genes that regulate the telomere, so it's likely that more than 1 percent could be impacted by these predisposing factors," says Armanios.
Other scientists who contributed to the study include Susan E. Stanley, Jonathan K. Alder, Nadia N. Hansel, Rasika A. Mathias, Nicholas M. Rafaels, Robert A. Wise and Kathleen C. Barnes of the Johns Hopkins University School of Medicine; Julian J.L. Chen, Joshua D. Podlevsky and Xiaodong Qi of Arizona State University; and Edwin K. Silverman of Brigham and Women's Hospital and Harvard Medical School.
Funding for the study was provided by the National Institutes of Health (R01 GM094450,K99 HL113105, R01 HL089856, U01 HG004738, UC2 HL102923, R01 CA160433, R01 HL119476 and T32GM007309) and grants from the Mary Beryl Patch Turnbull Scholar Program, the Flight Attendant Medical Research Institute and the Commonwealth Foundation.
J Clin Invest. doi:10.1172/JCI78554. http://www.jci.org/articles/view/78554
J. K. Alder, N. Guo, F. Kembou, E. M. Parry, C. J. Anderson, A. I. Gorgy, M. F. Walsh, T. Sussan, S. Biswal, W. Mitzner, R. M. Tuder, M. Armanios. Telomere Length is a Determinant of Emphysema Susceptibility. American Journal of Respiratory and Critical Care Medicine, 2011; DOI: 10.1164/rccm.201103-0520OC
Mary Y. Armanios, M.D., Julian J.-L. Chen, Ph.D., Joy D. Cogan, Ph.D., Jonathan K. Alder, B.A., Roxann G. Ingersoll, B.S., Cheryl Markin, B.S., William E. Lawson, M.D., Mingyi Xie, B.S., Irma Vulto, B.S., John A. Phillips, III, M.D., Peter M. Lansdorp, M.D., Ph.D., Carol W. Greider, Ph.D., and James E. Loyd, M.D. Telomerase Mutations in Families with Idiopathic Pulmonary Fibrosis. N Engl J Med 2007; 356:1317-1326; March 29, 2007; DOI: 10.1056/NEJMoa066157
Silhan LL1, Shah PD1, Chambers DC2, Snyder LD3, Riise GC4, Wagner CL5, Hellström-Lindberg E6, Orens JB1, Mewton JF7, Danoff SK1, Arcasoy MO3, Armanios M8. Lung transplantation in telomerase mutation carriers with pulmonary fibrosis.Eur Respir J. 2014 Jul;44(1):178-87. doi: 10.1183/09031936.00060014. Epub 2014 May 15.
About Johns Hopkins Medicine
Johns Hopkins Medicine (JHM), headquartered in Baltimore, Maryland, is a $7 billion integrated global health enterprise and one of the leading academic health care systems in the United States. JHM unites physicians and scientists of the Johns Hopkins University School of Medicine with the organizations, health professionals and facilities of The Johns Hopkins Hospital and Health System. JHM's vision, "Together, we will deliver the promise of medicine," is supported by its mission to improve the health of the community and the world by setting the standard of excellence in medical education, research and clinical care. Diverse and inclusive, JHM educates medical students, scientists, health care professionals and the public; conducts biomedical research; and provides patient-centered medicine to prevent, diagnose and treat human illness. JHM operates six academic and community hospitals, four suburban health care and surgery centers, and more than 39 Johns Hopkins Community Physicians practices. The Johns Hopkins Hospital, opened in 1889, has been ranked number one in the nation by U.S. News & World Report for 22 years of the survey's 25 year history, most recently in 2013. For more information about Johns Hopkins Medicine, its research, education and clinical programs, and for the latest health, science and research news, visit http://www.hopkinsmedicine.org
Journal of Clinical Investigation