Introduction
The capacity of cells to survive and to evade cancer development depends on their ability to maintain genomic integrity. This can be seriously jeopardized when nucleic acid phosphodiester bonds are disrupted, whether during normal genetic metabolism or through the action of DNA damaging agents such as ionizing radiation. This disruption can take the form of single-stranded breaks (SSBs), such as naturally occurs between Okazaki fragments, or double-stranded breaks (DSBs) such as those generated during meiosis. Extensive molecular mechanisms exist to detect and correct these breaks, which are ultimately resolved in humans by a trio of DNA ligases [
1].
Of the three, LIG1 is the most critical ligase for DNA replication, connecting over 50 million Okazaki fragments during every replication cycle [
2]. It is also involved in SSB DNA repair in the base excision repair pathway and may also play a poorly-understood role in DSB repair through the alternative end-joining route [
3,
4]. Through its C-terminus it fully envelops nicked DNA [
5,
6], in a multi-step process that ultimately seals the phosphodiester backbone after consumption of ATP.
Excessive production of this protein is often detected in cancer cells, suggesting that it is required for their survival, and in vitro studies have shown that greater levels of LIG1 expression are associated with enhanced cell proliferation [
7]. Serum starvation and cellular differentiation, on the other hand, are associated with decreased expression [
8].
In 1992 the first case of hereditary LIG1 impairment was identified in humans. The patient was born underweight and anemic and had growth retardation, developmental delays, and photosensitivity. Recurring ear and chest infections were also present along with hypogammaglobulinemia, indicative of immunodeficiency. The patient died from pneumonia at the age of 19 [
9,
10]. The heterozygous mutations identified in this patient included E566K, which rendered the protein's ATP-binding site inactive, and R771W, situated next to a DNA-binding motif which severely hampered protein function [
9,
11].
Since then, additional patients with hereditary LIG1 impairment have been reported. Their clinical manifestations include hypogammaglobulinemia, decreased B and T cell counts, and lymphopenia, suggesting that rapidly dividing adaptive immune cells are more sensitive to LIG1 perturbations [
12]. DNA substrate experiments demonstrated that these mutant residues either were affected by non-canonical base pairing architecture, such as failure to ligate nicked DNA containing 3’end 8-oxoGuanine (oxoG), or inactive [
13]. Recently a severe combined immunodeficiency (SCID) patient was described with Omenn-like features, bearing compound heterozygosity in LIG1 for a missense mutation and a splice site (truncating) mutation [
14]. Intriguingly, all reported LIG1 patients have at least one hypomorphic allele that preserves some residual function, suggesting that full loss of function may be incompatible with life.
In this report we describe the genetic, functional and immunological characteristics of a patient with a hitherto-unreported homozygous LIG1 mutation which was identified through next generation sequencing. She presented with recurrent infections and was found to have anemia, leukopenia, neutropenia, lymphopenia and pan-hypogammaglobulinemia. Molecular analysis of the mutant protein indicated not only diminished ligase activity but also heightened fidelity, providing a detailed mechanistic view of how this LIG1 defect contributes to the onset of SCID.
Discussion
LIG1 deficiency represents an extremely rare form of inborn error of immunity characterized by diverse clinical manifestations. Including this study, only eight cases have been documented since its initial description 32 years ago [
10,
12,
14], as summarized in Table
1. Clinical onset typically occurs from birth to two years of age. Affected patients may present with SCID, Omenn-like syndrome, or other combined immunodeficiency phenotypes. Severe viral respiratory and gastrointestinal infections are common, along with severe macrocytic anemia which is likely related to impaired DNA synthesis in hematopoietic stem cells. Immunologically, patients often exhibit severe T and B cell lymphopenias, expansion of γδ-T cells, and panhypogammaglobulinemia.
Management strategies include immunoglobulin therapy, prophylactic antibiotics, and HSCT. To date four patients have undergone HSCT, with three receiving reduced-intensity conditioning due to concerns about chemotherapy-induced toxicity in DNA repair defects [
14,
20]. One of these patients achieved 100% donor lymphoid and myeloid engraftment, curing both the immune defect and anemia. The other two cases showed mixed donor cell engraftment, resulting in improved T- but poor B-cell function, and continued to require blood transfusions. Our case is the first reported instance of HSCT without conditioning, achieving 87% lymphoid and 4% myeloid cell engraftment. The patient showed improved T cell function but exhibited poor B cell engraftment and mild macrocytic anemia, yet did not require blood transfusions. Further data are urgently needed to establish the optimal conditioning protocol for LIG1 deficiency, ensuring high donor cell engraftment to fully correct the disease phenotype.
Here we describe the genetic and molecular findings associated with a novel mutation in the
LIG1 gene, which leads to an A624T residue change that affects the protein’s interaction with the catalytic Mg
2+ ion. Cognate substrate ligation experiments indicated reduced catalytic activity in the mutant, which may result in increased unligated nicks throughout the genome and concomitant genomic instability. Most likely this reduced efficiency is affecting ligation during the maturation of Okazaki fragments, where LIG1 must also compete with other proteins for successful ligation [
5,
21], thus amplifying its deleterious effect. Mechanistically, we show that the mutant’s reduced ligation yield is directly due to its lower Mg
2+ affinity. Conversely, our data also show a near-complete inability of the mutant to process oxoG, indicating a > 50-fold increased fidelity against this lesion.
This higher fidelity against 3’ end oxoG, also observed in LIG1 mutants R641L and R771W [
13], might at first glance appear to be a gain of function rather than a defect, since oxoG should be excluded from the final mature genome due to its connection to mutagenesis and carcinogenesis. 8-oxoG is naturally generated by radical oxygen species and represents the most abundant and prevalent DNA lesion [
22,
23]. 8oxoG/C pairs are corrected by the specific glycosylase OGG1 during or post-DNA replication. On the other hand, 8oxoG/A pairs are primarily removed post-replication by the base excision repair (BER) pathway [
23]. Therefore, achieving timely DNA replication may necessitate temporarily accepting the incorporation of 8-oxoG into the ligated genome, only to repair it later through BER, rather than leaving behind numerous nicks through abortive ligation. In this context, the higher fidelity of A624T would produce increased genomic fragmentation, especially in the presence of high oxidative stress.
Our MD and RINS analysis revealed that doubling of the side chain volume, and the polar effect introduced by the A624T hydroxyl group, reorganizes the molecular packing in the core of the adenylation domain. Such an event may provoke an uncoupling of the stabilization residues that ensure the atomic coordination of glutamic acid 592 and the 335–344 protein loop that plays a decisive role in stabilizing the high-fidelity magnesium.
While our study corroborates earlier findings that show enhanced fidelity as a mechanism underlying LIG1 dysfunction, it also highlights the lack of a clear genotype–phenotype correlation, though this is partially confounded by the limited number of patients reported to date. However, the literature does show certain compound heterozygous patients who had one allele coding for a truncated product, and the other coding for a protein with defective oxoG processing, who had a relatively mild clinical course. These individuals experienced an age of onset at 2 years, had defects in antibody production and a CVID-like picture, and were managed via immunoglobulin treatment. On the other hand there are patients homozygous for alleles encoding defective oxoG processing, wherein the age of onset is in the 2–4 month range and the clinical management generally necessitates HSCT transplantation [
12,
13]. Our patient, with a more SCID-like presentation, falls towards the severe end of the phenotypic spectrum. This phenotypic disparity highlights the central role of each patient’s genetic background in determining clinical severity and indicates that the exact molecular nature of the LIG1 defect is not sufficient to predict the expected clinical course for the patient.
The earliest reported LIG1-deficient fibroblast cell line, derived from the initial LIG1 patient, revealed an increased sensitivity to ionizing radiation in line with our patient findings [
24]. These SV40-transformed cells (46BR.1G1) demonstrated 3–5% normal LIG1 activity and delayed maturation of replication intermediates [
9,
25], resulting in the buildup of both SSBs and DSBs [
26]. The latter likely stemmed from the cells’ attempt to handle SSBs that are a by-product of this defective maturation. Unrepaired SSBs cause complex DSBs [
27], as seen by our patient cells’ elevated baseline gamma-H2AX levels.
In 46BR.1G1, gamma-H2AX foci form in the S phase and persist through metaphase and telophase, indicating that DNA damage does not prevent cell division [
26]. The number of foci then diminishes in G1, possibly due to compensatory repair by LIG3 and LIG4. This damage does not appear to impede the cell cycle, since the proportion of cells in each cell cycle phase remains almost constant following complementation with a WT LIG1 vector [
26]. In contrast, cell cycle analysis of our patient fibroblasts (without treatment) shows a significantly higher percentage of G1 cells than in controls or 46BR.1G1 data. This discrepancy between the two LIG1-deficient fibroblast cell lines may be due to the use of primary cells versus a simian virus-transformed cell line.
Two main checkpoints assess DNA integrity throughout the cell cycle. ATM/Chk2 is located prior to S phase entry, and searches for the presence of DSBs [
28]. The general G1 block in our untreated patient cells suggests that this checkpoint is active. The fact that so few cells are in G2 implies that ATR/Chk1, the checkpoint that blocks entrance into mitosis in the presence of SSBs, is not monitoring the damage caused by faulty replication. However, exposure to ionizing radiation causes a significant and prolonged G2 block. Ionizing radiation produces roughly 50-fold more SSBs than DSBs [
29]. This implies that the ATR/Chk1 checkpoint is discriminating between SSBs caused by radiation damage and those caused by replication defects.
Taken together, our results show that the LIG1 A624T defect stems from a combination of reduced ligation efficiency on cognate substrates, and excessive abortive ligation on non-cognate substrates which contain lesions that should be tolerated, at least temporarily, until other pathways can intervene to correct them. The acuteness of our patient’s clinical presentation highlights the presence of these two mechanistic factors, both impacting LIG1 function in disparate ways and stemming from a single mutation.
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