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J Invest Dermatol. Author manuscript; available in PMC 2012 Aug 1.
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PMCID: PMC3258346

Meta-analysis combining new and existing data sets confirms that the TERT-CLPTM1L locus influences melanoma risk


A number of GWAS have observed association between SNPs located in 5p15.33 with increased risk for a range of cancers, including some non-melanoma skin cancers (Baird, 2010). Contrary to the increased risk observed for other cancers the peak variant, rs401681 C allele, has been associated with a decreased risk for melanoma (OR=0.86, 95% CI 0.81–0.91 p=5.0×10−8) (Stacey et al., 2009). There have been two attempts at independent replication. Nan et al., (2011) observed a similar direction of effect in a small sample (OR=0.73, 95% CI 0.59–0.91). However an additional replication study observed no evidence for association between rs401681 C allele and melanoma (OR=1.01, 95% CI 0.87–1.19) (Pooley et al., 2010). As replication has been inconsistent, we present here unpublished Australian data and rationalize the findings.

The 5p15.33 SNPs are located within or adjacent to two genes in strong LD, encoding Telomerase Reverse Transcriptase (TERT, MIM: 187270) and CLPTM1-like protein (CRR9p; CLPTM1L, MIM: 612585). CLPTM1L was identified as up-regulated in cisplatin resistant cancer cells (Yamamoto et al., 2001) and while a role for CLPTM1L should not be excluded little is known about its function. TERT is a striking candidate as it encodes the catalytic subunit of telomerase. Incomplete replacement of telomere repeat sequences by telomerase following their loss during S phase is a likely cause of cell senescence (Shawi et al., 2008). While TERT expression is generally absent in adult tissues it is enhanced in most, but not all, cancerous cells (Engelhardt et al., 1997; Kolquist et al., 1998). Nevi (moles) result from melanocyte proliferation and nevus count is positively associated with melanoma risk. Longer telomeres have been associated with increased nevus count and size as well as a non-significant increase in melanoma risk (OR 1.85, 95% CI 0.99–3.44) (Han et al., 2009). Nan et al, (2011) reported a marginal association between the rs401681 C allele and shorter telomere length, an intriguing result given their earlier observation of decreased nevus count in those with shorter telomere length (Han et al., 2009). Specifically, rs401681 C may associate with reduced melanoma incidence via shortened telomere mediated inhibition of nevi growth. However a far larger study observed no association between rs401681 and telomere length (Pooley et al., 2010).

We recently performed a large melanoma GWAS in a Caucasian population by combining 2,168 cases from the Q-MEGA (Baxter et al., 2008) and AMFS studies (Cust et al., 2009) and 4,387 controls combined from 3 studies (Baxter et al., 2008; Cust et al., 2009; Painter et al., 2011). This population gave sufficient power to detect effect sizes in line with other cancer GWAS (1.2<OR<1.5). Samples were genotyped on Illumina SNP arrays (Cases: Omni1-Quad or HumanHap610; Controls: Omni1-Quad or HumanHap610 or HumanHap670). Cases and controls were combined into a single data set for quality control, outlier removal and imputation. Imputation via MACH2 (Li et al., 2010) based on the 1000 Genomes Project data, June 2010 release (Durbin et al., 2010), allowed association testing for 5,480,804 well imputed SNPs (r̂2 >0.5). Locuszoom (Pruim et al., 2010) was used to plot SNP significance values across the region spanning TERT and CLPTM1L, which confirms there is indeed an association peak between TERT and CLPTM1, albeit below genome wide significance (Figure 1). Although imputation is able to fill in the missing data in cases where SNPs were not present on all arrays used, there remain regions where SNPs could not be well imputed, which in our case is a 30kb block within TERT. However those SNPs directly genotyped in this region were not meaningfully associated with melanoma (boxed squares, Figure 1) indicating the association signal between TERT and CLPTM1L does not extend into this region. Key SNP rs401681 is not on Omni1-Quad arrays. It was hence genotyped separately using the Sequenom platform (Brown et al., 2008).

Figure 1
Genome wide association results for the TERT-CLPTM1L locus. Solid triangles represent genotyped SNPs, and hollow triangles fully imputed SNPs. The top imputed SNP rs13356727 is displayed as a purple diamond and the degree of LD (r2) with all other plotted ...

In the combined Australian dataset the rs401681 allele C was clearly inversely associated with melanoma as previously observed, but did not reach genome-wide significance (p=0.00107, Table 1). Meta-analysis of rs401681 C allele across all four studies supports the association with reduced melanoma rates (Stacey et al., 2009; Pooley et al., 2010; Nan et al., 2011). As the I2 was high at 48.98 the random effect model is most appropriate (random effect p=3.00×10−4, OR=0.873 95% CI 0.812–0.939; fixed effect p=9×10−10, OR=0.871 95% CI 0.833–0.910). A forest plot is available in the supplementary data (Sup. Figure 1).rs401681 was not our highest association signal in this region. The strongest association for the TERT-CLPTM1L was observed at rs4975616 (Table 1), which has previously been associated with lung cancer (Broderick et al., 2009), and higher again at the fully imputed rs13356727 (Table 1). rs13356727 lies less than 10 kb from rs401681 and is also between TERT and CLPTM1L (Figure 1). All 3 SNPs exhibit strong LD (r2>0.8) with one another (Supplementary Figure 3), and all fall within the same LD block that spans the TERT promotor and the 3’ end of the CLPTM1L gene (Supplementary Figure 2). The signal at rs13356727 remained significant following covariation by rs401681 (Table 1). Similarly, covarying for rs13356727 abolished all signal at rs401681 (C allele p=0.512, OR=1.071, 95% CI 0.873–1.312). When each SNP was covaried by the other two only rs13356727 remains significant (p=0.046, OR=0.804, 95% CI 0.649–0.996). This suggests that rs13356727 represents a better proxy for the potential causal variant in this region leading to a reduced risk for melanoma. As nevi count is also associated with melanoma we hypothesized that the inverse association of rs13356727 with melanoma may result from an interaction with mole count. Self reported mole count (“None”, ”Few”, ”Some” and “Many”) was available for 1398 controls and 1592 cases with melanoma. Co varying for mole count did not meaningfully change the association between rs13356727 and melanoma (subset melanoma association p=4.88×10−5 OR 0.800 95% CI 0.718–0.891; subset co-varied by mole count p=3.01×10−4, OR 0.816 95% CI 0.731–0.911). The protective rs13356727 A allele was also associated with a reduction in mole count (regression of self reported mole count on rs13356727 100,000 permutations p=0.00042). rs401681 C and rs4975616 A alleles were also associated with reduced mole count to a lesser extent (pperm=0.00407 and pperm 0.00069 respectively).

Table 1
Association results at the TERT- CLPTM1L locus

In conclusion we examined the role of TERT-CLPTM1L variants in determining melanoma risk by presenting new data on a large Australian case-control sample. Combining these data with inconclusive existing data clarifies that TERT-CLPTM1L variants do influence risk, albeit with a relatively small effect size. In our data there was an association with mole count and it is intriguing to speculate that the inverse association (relative to other cancers) may be due to an interaction with nevus propensity. However, the observed melanoma association was unchanged by correction with mole count and further work is required to dissect the specific role variation at TERT-CLPTM1L plays in mole count and melanoma. When considered in the light of studies by Nan et al (2011) and Han et al (2009), it may be that the apparently independent association we observed between this loci and melanoma or mole count was due to a functional variant influencing telomere length, which in turn altered melanoma and nevus development in a complex manner.

Supplementary Material

Replacement Sup file


This work was supported by the Melanoma Research Alliance, the National Institutes of Health/National Cancer Institute (CA88363, CA83115, CA122838, CA87969, CA055075, CA100264, CA133996 and CA49449), the National Health and Medical Research Council of Australia (NHMRC) (107359, 200071, 241944, 339462, 380385, 389927,389875, 389891, 389892,389938, 402761, 443036, 442915, 442981, 496610, 496675, 496739, 552485, 552498), the Cancer Councils NSW, Victoria and Queensland, the Cancer Institute New South Wales, the Cooperative Research Centre for Discovery of Genes for Common Human Diseases (CRC), Cerylid Biosciences (Melbourne), the Australian Cancer Research Foundation, The Wellcome Trust (WT084766/Z/08/Z) and donations from Neville and Shirley Hawkins. NKH and GWM are supported by the NHMRC Fellowships scheme. SM is the recipient of a Career Development Award from the NHMRC (496674, 613705). KMB is supported by the National Institutes of Health/National Cancer Institute. The AMFS, QMEGA, QIMR and endometriosis studies gratefully acknowledge its participants and the hard work of all its research interviewers, research assistants, technicians, project managers, data as well as sample managers and examiners. We thank Endometriosis Associations for supporting study recruitment and Sullivan Nicolaides and Queensland Medical Laboratory for pro bono collection and delivery of blood samples and other pathology services for assistance with blood collection.

Abbreviations used

TERTTelomerase Reverse Transcriptase
CLPTM1LCLPTM1-like proteinl
Q-MEGAQueensland study of Melanoma: Environment and Genetic Associations
AMSFAustralian Melanoma Family Study


Conflicts of Interest

All authors have no conflict of interest or financial interest in this work.


  • Baird DM. Variation at the TERT locus and predisposition for cancer. Expert Rev Mol Med. 2010;12:e16. [PubMed]
  • Baxter AJ, Hughes MC, Kvaskoff M, et al. The Queensland Study of Melanoma: environmental and genetic associations (Q-MEGA); study design, baseline characteristics, and repeatability of phenotype and sun exposure measures. Twin Res Hum Genet. 2008;11:183–96. [PMC free article] [PubMed]
  • Broderick P, Wang Y, Vijayakrishnan J, et al. Deciphering the impact of common genetic variation on lung cancer risk: a genome-wide association study. Cancer Res. 2009;69:6633–41. [PMC free article] [PubMed]
  • Brown KM, Macgregor S, Montgomery GW, et al. Common sequence variants on 20q11.22 confer melanoma susceptibility. Nat Genet. 2008;40:838–40. [PMC free article] [PubMed]
  • Cust AE, Schmid H, Maskiell JA, et al. Population-based, case-control-family design to investigate genetic and environmental influences on melanoma risk: Australian Melanoma Family Study. Am J Epidemiol. 2009;170:1541–54. [PMC free article] [PubMed]
  • Durbin RM, Abecasis GR, Altshuler DL, et al. A map of human genome variation from population-scale sequencing. Nature. 2010;467:1061–73. [PMC free article] [PubMed]
  • Engelhardt M, Albanell J, Drullinsky P, et al. Relative contribution of normal and neoplastic cells determines telomerase activity and telomere length in primary cancers of the prostate, colon, and sarcoma. Clin Cancer Res. 1997;3:1849–57. [PubMed]
  • Han J, Qureshi AA, Prescott J, et al. A prospective study of telomere length and the risk of skin cancer. J Invest Dermatol. 2009;129:415–21. [PMC free article] [PubMed]
  • Kolquist KA, Ellisen LW, Counter CM, et al. Expression of TERT in early premalignant lesions and a subset of cells in normal tissues. Nat Genet. 1998;19:182–6. [PubMed]
  • Li Y, Willer CJ, Ding J, et al. MaCH: using sequence and genotype data to estimate haplotypes and unobserved genotypes. Genet Epidemiol. 2010;34:816–34. [PMC free article] [PubMed]
  • Nan H, Qureshi AA, Prescott J, et al. Genetic variants in telomere-maintaining genes and skin cancer risk. Hum Genet. 2011;129:247–53. [PMC free article] [PubMed]
  • Painter JN, Anderson CA, Nyholt DR, et al. Genome-wide association study identifies a locus at 7p15.2 associated with endometriosis. Nat Genet. 2011;43:51–4. [PMC free article] [PubMed]
  • Pooley KA, Tyrer J, Shah M, et al. No association between TERT-CLPTM1L single nucleotide polymorphism rs401681 and mean telomere length or cancer risk. Cancer Epidemiol Biomarkers Prev. 2010;19:1862–5. [PMC free article] [PubMed]
  • Pruim RJ, Welch RP, Sanna S, et al. LocusZoom: regional visualization of genome-wide association scan results. Bioinformatics. 2010;26:2336–7. [PMC free article] [PubMed]
  • Shawi M, Autexier C. Telomerase, senescence and ageing. Mech Ageing Dev. 2008;129:3–10. [PubMed]
  • Stacey SN, Sulem P, Masson G, et al. New common variants affecting susceptibility to basal cell carcinoma. Nat Genet. 2009;41:909–14. [PMC free article] [PubMed]
  • Yamamoto K, Okamoto A, Isonishi S, et al. A Novel Gene, CRR9, Which Was Up-Regulated in CDDP-Resistant Ovarian Tumor Cell Line, Was Associated with Apoptosis. Biochemical and biophysical research communications. 2001;280:1148–54. [PubMed]
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