The Role of ATRX and TERT Expressions in Determining Aggressiveness of Neuroblastoma

Objective: Neuroblastoma (NB) is a common childhood tumour, affecting telomerase enzyme activity.Expression of telomerase reverse transcriptase (TERT) protein is crucial for the functioning of telomerase activity, but its association with risk stratification and prognosis is unclear.The adenosine triphosphatedependent helicase alpha-thalassemia/mental retardation x-linked (ATRX) protein, a chromatin remodeling protein, accumulates H3.3 histone variants.The study aimed to assess the correlation between expression levels of ATRX and TERT with the NB risk group and its prognosis.Method: Immunohistochemical expressions of TERT and ATRX proteins in tumour tissue samples of 54 NB cases at different stages and risk groups were evaluated.Results: Immunohistochemical expression rates of TERT and ATRX proteins in tissues were 55.8% and 61.2%, respectively, with ATRX positively expressed at a rate of 50%, and 69% in early and in advanced stages of NB, and rates of 67.7%, and 50% in high and low-risk groups, respectively.TERT expression varies in early and advanced stages of NB, with higher levels in high-risk groups.ATRX expression is significantly higher in NB patients with Neuroblastoma myc (NMYC) gene amplification. Conclusion:High expression of ATRX in NB patients with NMYC gene amplification suggests that ATRX may be used as a potential immunohistochemical prognostic marker in NB patients.