Defective antibody production in double-strand DNA breakage syndromes: insights and implications

Publication: LymphoSign Journal
19 March 2024

Abstract

DNA double-strand breakage (DSB) syndrome are rare monogenic inborn errors of immunity with a vast spectrum of manifestations. In addition to a high predisposition to malignancies, these patients are also at risk of recurrent, severe, or opportunistic infections. Therefore, monitoring of immunoglobulin levels and responses to vaccination, as well as interventions such as immunoglobulin replacement therapy should be considered to improve the patients’ outcomes. As DNA double-strand breakage repair pathways have a great impact on lymphocyte development through involvement in the generation of B and T cell receptors, disruption in one of their components may lead to genomic instability, aberrant B-cell receptor (BCR)/T-cell receptor (TCR) development, impaired B cell lymphocyte development and antibody production. The aim of this review is to describe the most common of DBSs, such as ataxia telangiectasia (AT), AT-like disorder (ATLD), Nijmegen breakage syndrome (NBS), Nijmegen breakage syndrome-like disorder (NBSLD), Bloom syndrome (BS), Fanconi anemia (FA) and some others with a focus on the role of DNA repair proteins in the development of humoral immunity. We also describe the immunoglobulin profile, recommendations for diagnosis, screening, and interventions for the ideal management of affected patients.

Get full access to this article

View all available purchase options and get full access to this article.

REFERENCES

Ababou M. 2021. Bloom syndrome and the underlying causes of genetic instability. Mol. Genet. Metab. 133(1): 35–48.
Amirifar P., Mozdarani H., Yazdani R., Kiaei F., Moeini Shad T., Shahkarami S., Abolhassani H., Delavari S., Sohani M., Rezaei A., Hassanpour G., Akrami S.M., and Aghamohammadi A. 2020. Effect of class switch recombination defect on the phenotype of ataxia-telangiectasia patients. Immunol. Invest. 50: 201–215.
Bahjat M. and Guikema J.E.J. 2017. The complex interplay between DNA injury and repair in enzymatically induced mutagenesis and DNA damage in B lymphocytes. Int. J. Mol. Sci. 18(9): 1876.
Bajin I.Y., Ayvaz D.C., Unal S., Ozgur T.T., Cetin M., Gumruk F., Tezcan İ., Villartay J.P., and Sanal Ö. 2013. Atypical combined immunodeficiency due to Artemis defect: A case presenting as hyperimmunoglobulin M syndrome and with LGLL. Mol. Immunol. 56(4): 354–357.
Buck D., Malivert L., de Chasseval R., Barraud A., Fondanèche M.C., Sanal O., Plebani A., Stéphan J.L., Hufnagel M., le Deist F., Fischer A., Durandy A., de Villartay J.P., and Revy P. 2006. Cernunnos, a novel nonhomologous end-joining factor, is mutated in human immunodeficiency with microcephaly. Cell. 124(2): 287–299.
Chang H.H.Y., Pannunzio N.R., Adachi N., and Lieber M.R. 2017. Non-homologous DNA end joining and alternative pathways to double-strand break repair. Nat. Rev. Mol. Cell. Biol. 18(8): 495–506.
Chrzanowska K.H., Gregorek H., Dembowska-Baginska B., Kalina M.A., and Digweed M. 2012. Nijmegen breakage syndrome (NBS). Orphanet. J. Rare Dis. 7: 13.
Cunniff C., Djavid A.R., Carrubba S., Cohen B., Ellis N.A., Levy C.F., Jeong S, Lederman H.M., Vogiatzi M., Walsh M.F., and Zauber A.G. 2018. Health supervision for people with Bloom syndrome. Am. J. Med. Genet. A. 176(9): 1872–1881.
de Miranda N.F., Bjorkman A., and Pan-Hammarstrom Q. 2011. DNA repair: the link between primary immunodeficiency and cancer. Ann. N. Y. Acad. Sci. 1246: 50–63.
Doshi A., Ryu J., Thornburg C.D., Hershey D., Cherry R., Milligan K., Rosenzweig S., and Leonard S. 2016. Ataxia telangiectasia presenting as hyper IgM syndrome without neurologic signs. Ann. Allergy Asthma Immunol. 117(3): 221–226.
Driessen G.J., Ijspeert H., Weemaes C.M., Haraldsson A., Trip M., Warris A., van der Flier M., Wulffraat N., Verhagen M.M., Taylor M.A., van Zelm M.C., van Dongen J.J., van Deuren M., and van der Burg M. 2013. Antibody deficiency in patients with ataxia telangiectasia is caused by disturbed B- and T-cell homeostasis and reduced immune repertoire diversity. J. Allergy Clin. Immunol. 131(5): 1367–1375.
Federighi P., Ramat S., Rosini F., Pretegiani E., Federico A., and Rufa A. 2017. Characteristic eye movements in ataxia-telangiectasia-like disorder: An explanatory hypothesis. Front. Neurol. 8: 596.
Fernet M., Gribaa M., Salih M.A., Seidahmed M.Z., Hall J., and Koenig M. 2005. Identification and functional consequences of a novel MRE11 mutation affecting 10 Saudi Arabian patients with the ataxia telangiectasia-like disorder. Hum. Mol. Genet. 14(2): 307–318.
Fievet A., Bellanger D., Valence S., Mobuchon L., Afenjar A., Giuliano F., Dubois d'Enghien C., Parfait B., Pedespan J.M., Auger N., Rieunier G., Collet A., Burglen L., Stoppa-Lyonnet D., and Stern M.H. 2019. Three new cases of ataxia-telangiectasia-like disorder: No impairment of the ATM pathway, but S-phase checkpoint defect. Hum. Mutat. 40(10): 1690–1699.
Fontes F.L., Pinheiro D.M., Oliveira A.H., Oliveira R.K., Lajus T.B., and Agnez-Lima L.F. 2015. Role of DNA repair in host immune response and inflammation. Mutat. Res. Rev. Mutat. Res. 763: 246–257.
Giri N., Alter B.P., Penrose K., Falk R.T., Pan Y., Savage S.A, Williams M., Kemp T.J., and Pinto L.A. 2015. Immune status of patients with inherited bone marrow failure syndromes. Am. J. Hematol. 90(8): 702–708.
Gregorek H., Chrzanowska K.H., Michalkiewicz J., Syczewska M., and Madalinski K. 2002. Heterogeneity of humoral immune abnormalities in children with Nijmegen breakage syndrome: An 8-year follow-up study in a single centre. Clin. Exp. Immunol. 130(2): 319–324.
Hasbaoui B.E., Elyajouri A., Abilkassem R., and Agadr A. 2020. Nijmegen breakage syndrome: Case report and review of literature. Pan. Afr. Med. J. 35: 85.
Jamee M., Sharifi L., and Ghiasy S. 2019. Anti-peptide antibody responses in patients with ataxia-telangiectasia. Immunol. Genet. J. 2(1): 28–36.
Jiang J., Tang W., An Y., Tang M., Wu J., Qin T., and Zhao X. 2016. Molecular and immunological characterization of DNA ligase IV deficiency. Clin. Immunol. 163: 75–83.
Kaneko H. and Kondo N. 2004. Clinical features of Bloom syndrome and function of the causative gene, BLM helicase. Expert Rev. Mol. Diagn. 4(3): 393–401.
Kaseb, H., Hozayen, S. 2019. Chromosome Instability Syndromes. Treasure Island (FL): StatPearls Publishing LLC.
Keijzers G., Bakula D., and Scheibye-Knudsen M. 2017. Monogenic diseases of DNA repair. N. Engl. J. Med. 377(19): 1868–1876.
Kook H. 2005. Fanconi anemia: current management. Hematology. 10(Suppl 1): 108–110.
Korthof E.T., Svahn J., Peffault de Latour R., Terranova P., Moins-Teisserenc H., Socie G., Soulier J., Kok M., Bredius R.G., van Tol M., Jol-van der Zijde E.C., Pistorio A., Corsolini F., Parodi A., Battaglia F., Pistoia V., Dufour C., and Cappelli E. 2013. Immunological profile of Fanconi anemia: A multicentric retrospective analysis of 61 patients. Am. J. Hematol. 88(6): 472–476.
Lee P.P., Woodbine L., Gilmour K.C., Bibi S., Cale C.M., Amrolia P.J., Veys P.A., Davies E.G., Jeggo P.A., and Jones A. 2013. The many faces of Artemis-deficient combined immunodeficiency - Two patients with DCLRE1C mutations and a systematic literature review of genotype-phenotype correlation. Clin. Immunol. 149(3): 464–474.
Maciejczyk M., Heropolitanska-Pliszka E., Pietrucha B., Sawicka-Powierza J., Bernatowska E., Wolska-Kusnierz B., Pac M, Car H, Zalewska A, and Mikoluc B. 2019. Antioxidant defense, redox homeostasis, and oxidative damage in children with ataxia telangiectasia and Nijmegen breakage syndrome. Front. Immunol. 10: 2322.
Meijers R.W.J., Dzierzanowska-Fangrat K., Zborowska M., Solarska I., Tielemans D., van Turnhout B.A.C., Driessen G., van der Burg M., van Dongen J.J.M., Chrzanowska K.H., and Langerak A.W. 2017. Circulating T cells of patients with Nijmegen breakage syndrome show signs of senescence. J Clin Immunol.37(2): 133–142.
Meyer S., Tischkowitz M., Chandler K., Gillespie A., Birch J.M., and Evans D.G. 2014. Fanconi anemia, BRCA2 mutations and childhood cancer: A developmental perspective from clinical and epidemiological observations with implications for genetic counselling. J. Med. Genet. 51(2): 71–75.
Mohammadinejad P., Abolhassani H., Aghamohammadi A., Pourhamdi S., Ghosh S., Sadeghi B., Nasiri Kalmarzi R., Durandy A., and Borkhardt A. 2015. Class switch recombination process in ataxia telangiectasia patients with elevated serum levels of IgM. J. Immunoassay Immunochem. 36(1): 16–26.
Moshous D., Pannetier C., Chasseval Rd R., Deist Fl F., Cavazzana-Calvo M., Romana S., Macintyre E., Canioni D., Brousse N., Fischer A., Casanova J.L., and Villartay J.P. 2003. Partial T and B lymphocyte immunodeficiency and predisposition to lymphoma in patients with hypomorphic mutations in Artemis. J. Clin. Investig. 111(3): 381–387.
Myers K.C., Bleesing J.J, Davies S.M, Zhang X., Martin L.J., Mueller R., Harris R.E., Filipovich A.H., Kovacic M.B., Wells S.I., and Mehta P.A. 2011. Impaired immune function in children with Fanconi anemia. Br. J. Haematol. 154(2): 234–240.
Nutt S.L., Hodgkin P.D., Tarlinton D.M., and Corcoran L.M. 2015. The generation of antibody-secreting plasma cells. Nat. Rev. Immunol. 15(3): 160–171.
Offer S.M, Pan-Hammarström Q., Hammarström L., and Harris R.S. 2010. Unique DNA repair gene variations and potential associations with the primary antibody deficiency syndromes IgAD and CVID. PLoS One. 5(8): e12260.
Palmeri S., Rufa A., Pucci B., Santarnecchi E., Malandrini A., Stromillo M.L., Mandalà M, Rosini F, De Stefano N, and Federico A. 2013. Clinical course of two Italian siblings with ataxia-telangiectasia-like disorder. Cerebellum. 12(4): 596–599.
Pereira C.T.M., Carvalho B.T.C., Ferreira N.V.S., Brunialti M.K.C., Salomao R., and Silva D.B. 2015. Cytokines production, expression of CD40/CD40L and correlation with immunoglobulins in patients with ataxia-telangiectasia. J. Allergy Clin. Immunol. 135(2):AB274.
Perez E.E., Orange J.S., Bonilla F., Chinen J., Chinn I.K., Dorsey M., El-Gamal Y., Harville T.O., Hossny E., Mazer B., Nelson R., Secord E., Jordan S.C., Stiehm E.R., Vo A.A., and Ballow M. 2017. Update on the use of immunoglobulin in human disease: A review of evidence. J. Allergy Clin. Immunol. 139(3s): S1–S46.
Piatosa B., van der Burg M., Siewiera K., Pac M., van Dongen J.J., Langerak A.W., Chrzanowska K.H., and Bernatowska E. 2012. The defect in humoral immunity in patients with Nijmegen breakage syndrome is explained by defects in peripheral B lymphocyte maturation. Cytometry A. 81(10): 835–842.
Reynolds J.J. and Stewart G.S. 2013. A nervous predisposition to unrepaired DNA double strand breaks. DNA Repair (Amst.). 12(8): 588–599.
Rohr J., Pannicke U., Doring M., Schmitt-Graeff A., Wiech E., Busch A., Speckmann C, Müller I, Lang P, Handgretinger R, Fisch P, Schwarz K, and Ehl S. 2010. Chronic inflammatory bowel disease as key manifestation of atypical ARTEMIS deficiency. J. Clin. Immunol. 30(2): 314–320.
Roxo P. Jr., Arruda L.K., Nagao A.T., Carneiro-Sampaio M.M., and Ferriani V.P. 2001. Allergic and immunologic parameters in patients with Fanconi’s anemia. Int. Arch. Allergy Immunol. 125(4): 349–355.
Sahan A.Z., Hazra T.K., and Das S. 2018. The pivotal role of DNA repair in infection mediated-inflammation and cancer. Front. Microbiol. 9: 663.
Schoenaker M.H.D., Henriet S.S., Zonderland J., van Deuren M., Pan-Hammarstrom Q., Posthumus-van Sluijs S.J., Pico-Knijnenburg I., Weemaes C.M.R., and IJspeert H. 2018. Immunodeficiency in Bloom’s Syndrome. J. Clin. Immunol. 38(1): 35–44.
Sedghi M., Salari M., Moslemi A.-R., Kariminejad A., Davis M., Goullée H., Olsson B, Laing N, and Tajsharghi H. 2018. Ataxia-telangiectasia-like disorder in a family deficient for MRE11A, caused by a MRE11 variant. Neurol. Genet. 4(6): e295.
Syed A. and Tainer J.A. 2018. The MRE11-RAD50-NBS1 complex conducts the orchestration of damage signaling and outcomes to stress in DNA replication and repair. Annu. Rev. Biochem. 87: 263–294.
Szczawinska-Poplonyk A., Tapolska-Jozwiak K., Schwartzmann E., and Pietrucha B. 2022. Infections and immune dysregulation in ataxia-telangiectasia children with hyper-IgM and non-hyper-IgM phenotypes: A single-center experience. Front. Pediatr. 10: 972952.
Taylor A.M., Groom A., and Byrd P.J. 2004. Ataxia-telangiectasia-like disorder (ATLD) - Its clinical presentation and molecular basis. DNA Repair (Amst.). 3(8-9): 1219–1225.
Taylor A.M.R., Rothblum-Oviatt C., Ellis N.A., Hickson I.D., Meyer S., Crawford T.O., Smogorzewska A, Pietrucha B, Weemaes C, and Stewart GS. 2019. Chromosome instability syndromes. Nat. Rev. Dis. Primers. 5(1): 64.
Teive H.A., Moro A., Moscovich M., Arruda W.O., Munhoz R.P., Raskin S., and Ashizawa T. 2015. Ataxia-telangiectasia - A historical review and a proposal for a new designation: ATM syndrome. J. Neurol. Sci. 355(1-2): 3–6.
Tomkinson A.E., Naila T., and Khattri Bhandari S. 2020. Altered DNA ligase activity in human disease. Mutagenesis. 35(1): 51–60.
van der Burg M., Ijspeert H., Verkaik N.S., Turul T., Wiegant W.W., Morotomi-Yano K., Mari P.O., Tezcan I., Chen D.J., Zdzienicka M.Z., van Dongen J.J., and van Gent D.C. 2009. A DNA-PKcs mutation in a radiosensitive T-B- SCID patient inhibits Artemis activation and nonhomologous end-joining. J. Clin. Investig. 119(1): 91–98.
van Engelen B.G., Hiel J.A., Gabreels F.J., van den Heuvel L.P., van Gent D.C., and Weemaes C.M. 2001. Decreased immunoglobulin class switching in Nijmegen Breakage syndrome due to the DNA repair defect. Hum. Immunol. 62(12): 1324–1327.
van Os N.J.H., Jansen A.F.M., van Deuren M., Haraldsson A., van Driel N.T.M., Etzioni A., van der Flier M., Haaxma C.A., Morio T., Rawat A., Schoenaker M.H.D., Soresina A., Taylor A.M.R., van de Warrenburg B.P.C., Weemaes C.M.R., Roeleveld N., and Willemsen M.A.A.P. 2017. Ataxia-telangiectasia: Immunodeficiency and survival. Clin. Immunol. 178: 45–55.
Volk T., Pannicke U., Reisli I., Bulashevska A., Ritter J., Bjorkman A., Schäffer AA, Fliegauf M, Sayar EH, Salzer U, Fisch P, Pfeifer D, Di Virgilio M, Cao H, Yang F, Zimmermann K, Keles S, Caliskaner Z, Güner SÜ, Schindler D, Hammarström L, Rizzi M, Hummel M, Pan-Hammarström Q, Schwarz K, and Grimbacher B. 2015. DCLRE1C (ARTEMIS) mutations causing phenotypes ranging from atypical severe combined immunodeficiency to mere antibody deficiency. Hum. Mol. Genet. 24(25): 7361–7372.
Walsh M.F., Chang V.Y., Kohlmann W.K., Scott H.S., Cunniff C., Bourdeaut F., Molenaar JJ, Porter CC, Sandlund JT, Plon SE, Wang LL, and Savage SA. 2017. Recommendations for childhood cancer screening and surveillance in DNA repair disorders. Clin. Cancer Res. 23(11): e23–e31.
Waltes R., Kalb R., Gatei M., Kijas A.W., Stumm M., Sobeck A., Wieland B., Varon R., Lerenthal Y., Lavin M.F., Schindler D., and Dörk T. 2009. Human RAD50 deficiency in a Nijmegen breakage syndrome-like disorder. Am. J. Hum. Genet. 84(5): 605–616.
Weemaes C.M., Bakkeren J.A., ter Haar B.G., Hustinx T.W., and van Munster P.J. 1979. Immune responses in four patients with Bloom syndrome. Clin. Immunol. Immunopathol. 12(1): 12–19.
Weitering T.J., Melsen J.E., van Ostaijen-Ten Dam M.M., Weemaes C.M.R., Schilham M.W., and van der Burg M. 2021. Normal numbers of stem cell memory T cells despite strongly reduced naive T cells support intact memory T cell compartment in ataxia telangiectasia. Front Immunol. 12: 686333.
Wolska-Kusnierz B., Gregorek H., Chrzanowska K., Piatosa B., Pietrucha B., Heropolitanska-Pliszka E., Pac M., Klaudel-Dreszler M., Kostyuchenko L., Pasic S., Marodi L., Belohradsky B.H., Čižnár P., Shcherbina A., Kilic S.S., Baumann U., Seidel M.G., Gennery A.R., Syczewska M., Mikołuć B., Kałwak K., Styczyński J., Pieczonka A., Drabko K., Wakulińska A., Gathmann B., Albert M.H., Skarżyńska U., and Bernatowska E.; Inborn Errors Working Party of the Society for European Blood and Marrow Transplantation and the European Society for Immune Deficiencies. 2015. Nijmegen breakage syndrome: clinical and immunological features, long-term outcome and treatment options - A retrospective analysis. J. Clin. Immunol. 35(6): 538–549.
Yabuki M., Fujii M.M., and Maizels N. 2005. The MRE11-RAD50-NBS1 complex accelerates somatic hypermutation and gene conversion of immunoglobulin variable regions. Nat. Immunol. 6(7): 730–736.
Zaki-Dizaji M., Akrami S.M., Abolhassani H., Rezaei N., and Aghamohammadi A. 2017. Ataxia telangiectasia syndrome: Moonlighting ATM. Expert. Rev. Clin. Immunol. 13(12): 1155–1172.
Zanotti K.J. and Gearhart P.J. 2016. Antibody diversification caused by disrupted mismatch repair and promiscuous DNA polymerases. DNA Repair (Amst.). 38: 110–116.
Zielen S., Duecker R.P., Woelke S., Donath H., Bakhtiar S., Buecker A., Kreyenberg H., Huenecke S., Bader P., Mahlaoui N., Ehl S., El-Helou S.M., Pietrucha B., Plebani A., van der Flier M., van Aerde K., Kilic S.S., Reda S.M., Kostyuchenko L., McDermott E., Galal N., Pignata C., Pérez J.L.S., Laws H.J., Niehues T., Kutukculer N., Seidel M.G., Marques L., Ciznar P., Edgar J.D.M., Soler-Palacín P., von Bernuth H., Krueger R., Meyts I., Baumann U., Kanariou M., Grimbacher B., Hauck F., Graf D., Granado L.I.G., Prader S., Reisli I., Slatter M., Rodríguez-Gallego C., Arkwright P.D., Bethune C., Deripapa E., Sharapova S.O., Lehmberg K., Davies E.G., Schuetz C., Kindle G., and Schubert R. 2021. Simple measurement of IgA predicts immunity and mortality in ataxia-telangiectasia. J. Clin. Immunol. 41(8): 1878–1892.

Information & Authors

Information

Published In

cover image LymphoSign Journal
LymphoSign Journal
Volume 11Number 1March 2024
Pages: 1 - 11

History

Received: 23 November 2023
Accepted: 24 January 2024
Accepted manuscript online: 21 February 2024
Version of record online: 19 March 2024

Authors

Affiliations

Mohammadreza Shafiei
Student Research Committee, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
Mahnaz Jamee [email protected]
Student Research Committee, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran

Metrics & Citations

Metrics

Other Metrics

Citations

Cite As

Export Citations

If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Simply select your manager software from the list below and click Download.

There are no citations for this item

View Options

Get Access

View options

PDF

View PDF

Full Text

View Full Text

Media

Media

Other

Tables

Share Options

Share

Share the article link

Share on social media