m6A modification of TERRA RNA is required for telomere maintenance and is a therapeutic target for ALT positive Neuroblastoma

Telomerase-negative tumors can maintain telomere length by alternative lengthening of telomeres (ALT) but the mechanism behind ALT is poorly understood. Aggressive Neuroblastoma (NB), in particular, relapsed tumors are positive for ALT (ALT+) which suggests that better dissection of the ALT mechanism could provide novel therapeutic opportunities. TERRA long non-coding RNA (lncRNA) which is derived from the telomere ends is localized to telomeres in R-loop dependent manner and is essential for telomere maintenance. In the present study, we provide evidence that RNA modification at the N6 position of internal adenosine (m6A) in TERRA RNA by methyltransferase METTL3 is essential for telomere maintenance in ALT+ cells and that loss of TERRA m6A/METTL3 leads to telomere damage. We observed that R-loop enriched TERRA is abundantly m6A modified and m6A mediated recruitment of hnRNPA2B1 to TERRA RNA is essential for R-loop formation. Our data suggest that m6A drives telomere targeting of TERRA via R-loop and this m6A mediated R-loop formation could be a widespread mechanism utilized by other chromatin-interacting lncRNAs. Furthermore, treating ALT+ NB cells with METTL3 inhibitor leads to compromised telomere targeting of TERRA and accumulation of DNA damage over telomere, suggesting METTL3 inhibition could be a therapeutic opportunity for ALT+ NB.