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“Biallelic POLA2 Variants Linked to Autosomal Recessive Telomere Biology Disorder in Two Families”

**Biallelic POLA2 Variants Linked to Autosomal Recessive Telomere Biology Disorder in Two Families**

Telomeres, the protective caps at the ends of chromosomes, play a critical role in maintaining genomic stability and cellular lifespan. Dysfunction in telomere biology has been implicated in a range of disorders, collectively referred to as telomere biology disorders (TBDs). These conditions are characterized by premature cellular senescence, genomic instability, and a spectrum of clinical manifestations, including bone marrow failure, pulmonary fibrosis, and developmental abnormalities. Recent research has identified biallelic variants in the *POLA2* gene as a novel cause of autosomal recessive TBD in two unrelated families, shedding light on the critical role of *POLA2* in telomere maintenance and DNA replication.

### **The Role of POLA2 in DNA Replication and Telomere Maintenance**

The *POLA2* gene encodes the B subunit of DNA polymerase alpha-primase, a key enzyme complex involved in the initiation of DNA replication. DNA polymerase alpha-primase synthesizes short RNA-DNA primers that are essential for the elongation of both leading and lagging DNA strands during replication. Importantly, this complex also plays a pivotal role in the replication of telomeric DNA, ensuring the proper maintenance of telomere length and structure.

Telomeres are particularly vulnerable to replication stress due to their repetitive sequences and the end-replication problem, which results in the progressive shortening of telomeres with each cell division. Dysfunction in components of the DNA replication machinery, including *POLA2*, can exacerbate telomere attrition and lead to telomere-related pathologies.

### **Discovery of Biallelic POLA2 Variants in Two Families**

In a groundbreaking study, researchers identified biallelic variants in *POLA2* as the underlying cause of a novel autosomal recessive TBD in two unrelated families. Whole-exome sequencing (WES) was performed on affected individuals presenting with clinical features consistent with TBD, including growth retardation, bone marrow failure, and developmental delays. The analysis revealed rare, homozygous or compound heterozygous variants in *POLA2* that segregated with the disease phenotype in both families.

Functional studies demonstrated that these *POLA2* variants resulted in reduced protein stability and impaired interaction with other subunits of the DNA polymerase alpha-primase complex. This disruption led to defects in DNA replication and telomere maintenance, as evidenced by increased telomere shortening, elevated DNA damage at telomeric regions, and heightened cellular sensitivity to replication stress.

### **Clinical and Molecular Features of POLA2-Related TBD**

The affected individuals in the study exhibited a range of clinical features, including:

1. **Growth Retardation**: Delayed growth and short stature were prominent features, likely reflecting the impact of telomere dysfunction on