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. 2021 Feb 24;12:1269. doi: 10.1038/s41467-021-21247-8

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© The Author(s) 2021

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

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Fig. 8 — Graphical abstract illustrating the hypothesis of neo-telomere formation in ALT-positive neuroblastomas. a The majority of telomeric repeat loci are one-sided. We hypothesize that ALT-positive cells are able to add telomeric sequences to open chromosomal breaks to protect them from degradation. I Microhomology to TTAGGG favors the formation of a neo-telomere at the open chromosomal break. Loss of some chromosomal regions might present a selection advantage for the cell and cells with a neo-telomere at the chromosomal breakpoint are selected. II Without microhomology, structural rearrangements involving other chromosomal arms (light gray) can represent an alternative route of protecting open chromosomal breaks. b Rare two-sided events can result from insertion of telomeric sequences I or from the formation of neo-telomeres on both sides of the breakpoint II. Small circles represent C-Circles. Chromosomes are shown in gray and telomeric sequences in blue.