Kossick, Kim

Abstract Background: Aberrations in telomere length have important implications in cancer development and progression. This study aimed to determine whether leukocyte telomere length (LTL) in patients with colorectal cancer (CRC) is associated with survival outcomes. We also investigated whether genetic variants in telomere maintenance genes are associated with survival in these patients. Methods: Blood specimens were collected from 1,007 patients prior to receiving chemotherapy or radiation. Genomic DNA was extracted using the Promega Maxwell RSC instrument. LTL was measured in triplicate using monochrome multiplex PCR, where the average amplification value of telomeric repeats was termed T. Similarly, PCR amplification of a single-copy reference gene was performed, and its average amplification value was termed S. The telomere length for each sample was expressed as the T/S ratio. Genotyping of single-nucleotide polymorphisms (SNPs) in TERC, TERT, and OBFC1 genes was conducted at the institutional Genome Analysis Core facility. Kaplan-Meier survival curves were generated to evaluate patient survival outcomes. Results: Younger individuals (∼25 years) exhibited nearly a twofold longer LTL compared with older individuals (∼75 years). No significant difference in LTL was observed between stage II and stage III CRC patients. A strong inverse correlation was observed between patient age and LTL (Spearman’s r = -0.48; p = 1.13 × 10-58). Females had significantly longer LTL than males (p = 3.97 × 10-5). The TERC SNP rs1317082 was significantly associated with both overall survival (OS) and disease-free survival (DFS) in the combined stage II and stage III patient cohort (p = 0.017 and p = 0.023, respectively). Similarly, the OBFC1 SNP rs9419958 was significantly associated with OS (p = 0.016). Importantly, LTL itself was significantly associated with both OS and DFS (p = 0.008 and p = 0.044, respectively) among the combined stage II and stage III patients. Kaplan-Meier survival analyses demonstrated that age- and sex-adjusted LTL was predictive of long-term survival outcomes. Conclusions: Survival among patients with stage II and III colorectal cancer is significantly influenced by LTL. Additionally, specific allelic variants of telomere maintenance genes, including TERC and OBFC1, are independently associated with improved survival, irrespective of LTL. These findings suggest that peripheral blood LTL measurement, along with telomere-related genotyping, may serve as a valuable prognostic marker for colorectal cancer outcomes. Funding: Individualizing colorectal cancer patient care using the host and tumor telomere phenotype (RO1 CA204013), Curtiss Fund (92541775), C-SiG Core(s): Epigenomics & Spatial Biology Core, and Clinical Core of the Mayo Clinic Center for Cell Signaling in Gastroenterology (P30DK084567) Citation Format: Estela M. Cruz Garcia, Gobinda Sarkar, Jun Chen, Shubham Sood, Kim Kossick, Daniel Schupack, Rondell Graham, Brooke Druliner, Zahra Heydari, Lauren Helgeson, Richard G. Cawthon, Lisa A. Boardman. Longer leukocyte telomeres and specific alleles of telomere maintenance genes are independently associated with improved survival of colon cancer patients [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2026; Part 1 (Regular Abstracts); 2026 Apr 17-22; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2026;86(7 Suppl):Abstract nr 1919.

Background and aims: Aberrations in telomere length can have important implications in cancer. Using a cohort of 1007 patients, we investigated whether leukocyte telomere length (LTL) in patients with colorectal cancer (CRC) is associated with survival. We also investigated whether some telomere maintenance genes are associated with survival in these patients. Methods: The Biobank for Gastrointestinal Health Research (BGHR), an ongoing project involving collection of biospecimens at the Mayo Clinic, was utilized to obtain data from patients diagnosed with stage II or III CRC. Blood samples were collected prior to chemotherapy/radiation and DNA was extracted for measuring median LTL. The main outcome measures were overall survival (OS) and disease-free survival (DFS) by disease stage. Results: A significant inverse relationship was observed with patient age and LTL (spearman correlation coefficient (r) = −0.48, 95%; p = 1.13 × 10−58). Females had significantly longer LTL than males (p = 3.97 × 10−5). The rs1317082 SNP in the TERC gene was significantly associated with both OS and DFS in combined stage II and stage III patients (p = 0.017 and p = 0.023, respectively). A statistically significant association of the OBFC1 SNP (rs9419958) was observed for OS for the combined stage II and stage III patients (p = 0.016). Importantly, LTL was significantly associated with both OS and DFS (p = 0.008 and 0.044 respectively) in combined stage II and stage III patients. Conclusions: Our results show that LTL is predictive of OS and DFS for stage II and III CRC patients, particularly over a longer follow-up, extending beyond five years after a diagnosis of CRC, and certain SNPs in genes involved in telomere maintenance are significantly associated with patient outcomes, independent of telomere length.

Abstract Colon polyps are the most common neoplastic finding at colonoscopy and have the potential to transform to cancer. Understanding the mechanisms involved in the transformation from normal colon to polyp is central to the identification of interventions to prevent or stop a polyp from forming or, in the worst case, from transforming. Therefore, the clinical conundrum is to predict which polyps will progress. It is crucial to understand if there are molecular features that define premalignant lesions and that may contribute to the final steps of transformation, which could potentially be targets for early detection or more individualized clinical management. Cellular transformation is driven by the interplay of genetic and epigenetic changes, and a large body of research has identified modifications of chromatin and the role of those modifications in regulating genes. Telomeres, telomere maintenance mechanisms, and chromatin remodelers maintain genetic stability, and their disruption is associated with the development of many diseases, including cancer. Organoids are multicellular structures grown from the stem cells of an organ to recapitulate the diverse cell types of the parent organ. This renewable resource of an individual’s tissue provides the opportunity to study colon carcinogenesis in combination with advanced genomic tools such as gene editing. The overall objective of this study is to determine the role of telomere and chromatin remodeler alterations in neoplastic transformation. The functional interaction between hTERT and specific chromatin remodelers will be resolved in two steps: 1) activating telomerase in normal colon and polyp organoids from patients and measuring chromatin remodeler expression, and 2) incorporating mutations in the chromatin remodelers using genome editing and then measuring the expression of hTERT in the normal colon and polyp organoids from patients with cancer-adjacent and cancer-free polyps. Gene editing experiments were performed utilizing transposon-based vectors (PiggyBac), short homology arm-based knockin (GeneWeld), or CRISPR/Cas9, coupled with electroporation for cargo delivery. To assess neoplastic transformation as a result of the gene edits, we used histology and cellular morphology of the organoid specimen by hematoxylin and eosin staining and pathologist review, and the markers by immunofluorescence. These models of neoplastic transformation in organoids from patient tissues provide an accessible tool to visualize the functional changes that correspond to alterations in telomerase and chromatin remodelers and how alterations in these targets affect growth, proliferation, differentiation, and cell turnover. Identification of epigenomic molecular alterations linked with progression of polyps to cancer could lead to modifiable targets for preventive interventions and provide candidate molecular markers in order to better tailor polyp patient screening recommendations. Note: This abstract was not presented at the conference. Citation Format: Brooke R. Druliner, Brandon Simone, Miguel Munoz-Gomez, Kim Kossick, Daniel O'Brien, Alexej Abyzov, Stephen Ekker, Lisa A. Boardman. Characterizing telomere and chromatin dynamics in colorectal cell transformation [abstract]. In: Proceedings of the AACR Special Conference on the Evolving Landscape of Cancer Modeling; 2020 Mar 2-5; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2020;80(11 Suppl):Abstract nr A33.