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Alternative lengthening of telomeres (ALT). ALT is a telomerase-independent mechanism that occurs via homologous recombination to maintain telomere length. The inactivation of α-thalassemia/mental retardation syndrome X-linked protein (ATRX) and death domain-associated protein (DAXX) upregulates telomeric repeat containing RNA (TERRA), which activates telomeric recombination and initiation of ALT. Adapted from [97].
