Nuclear-Receptor-Mediated Telomere Insertion Leads to Genome Instability in ALT Cancers

The breakage-fusion-bridge cycle is a classical mechanism of telomere-driven genome instability in which dysfunctional telomeres are fused to other chromosomal extremities, creating dicentric chromosomes that eventually break at mitosis. Here, we uncover a distinct pathway of telomere-driven genome instability, specifically occurring in cells that maintain telomeres with the alternative lengthening of telomeres mechanism. We show that, in these cells, telomeric DNA is added to multiple discrete sites throughout the genome, corresponding to regions regulated by NR2C/F transcription factors. These proteins drive local telomere DNA addition by recruiting telomeric chromatin. This mechanism, which we name targeted telomere insertion (TTI), generates potential common fragile sites that destabilize the genome. We propose that TTI driven by NR2C/F proteins contributes to the formation of complex karyotypes in ALT tumors. [Display omitted] •NR2C/F orphan nuclear receptors bind to ALT telomeres at GGGTCA direct repeats•NR2C/F factors bridge their target loci, clustering and relocalizing ALT telomeres•Telomeric sequences are inserted in ALT genomes in an NR2C/F-dependent manner•Telomere insertion destabilizes ALT genomes and contributes to complex rearrangements GGGTCA variant repeats accumulate on ALT telomeres and lead to the aberrant recruitment of NR2C/F nuclear receptors. These receptors can then bridge to their native binding sites within chromatin and drive the inclusion of telomeric sequences within the genome, creating sites prone to breakage and translocations.