A lesion is any chemical alteration of DNA away from the four normal bases correctly paired on an intact backbone. Spontaneous lesions arise from the chemistry of water and oxygen: depurination, hydrolysis of the bond between a purine and its sugar, leaving an abasic site (about per cell per day); deamination, which turns cytosine into uracil, 5-methylcytosine into thymine, and adenine into hypoxanthine (a few hundred per day); oxidation by reactive oxygen species, chiefly to 8-oxoguanine, which pairs with adenine as readily as with cytosine; and replication errors, a misincorporated or slipped base. Environmental lesions include the cyclobutane pyrimidine dimer and the 6-4 photoproduct made by ultraviolet light between two adjacent pyrimidines; alkylated bases from alkylating agents (O-methyl- guanine pairs with thymine); bulky adducts from aromatic hydrocarbons and aflatoxin; interstrand cross-links from cisplatin and nitrogen mustards; and the single- and double-strand breaks made by ionising radiation, about single-strand and double-strand breaks per cell per gray.
Examples
Example 3.3 (Lesions against mutations)
A human cell of base pairs dividing once a day accumulates on the order of – lesions a day and about new mutations per division: fewer than one lesion in ten thousand survives to become a permanent change. The rest are repaired before replication reads them, and the rate of survival to mutation — not the rate of damage — is what selection has minimised. The same arithmetic shows why the number of mutations in a tumour or in the sperm of an older father counts divisions: the mutations a cell carries are, to first order, the divisions it has undergone times the error per division.
Example 3.9 (Why xeroderma is a disease of the fork)
A dose of sun leaves pyrimidine dimers in a keratinocyte. With a nucleotide excision half-life of () and a fork arriving after , dimers are still there to be copied; with the near-absent repair of an XP cell (), are. Each dimer met by the fork is bypassed by translesion synthesis (below), which is error-prone: the patient’s mutation load per division is fifteen times the normal one, and the skin cancers follow in childhood. The cure that works is to keep small — total avoidance of ultraviolet light.
Example 3.13 (Synthetic lethality: BRCA and PARP)
Women who inherit one defective copy of BRCA1 or BRCA2 have a lifetime risk of breast cancer of ; the tumours arise in cells that have lost the second copy and can no longer do homologous recombination. Such cells repair their double-strand breaks by end joining alone and accumulate rearrangements. They also acquire a specific weakness. Single-strand breaks, some a day, are repaired by a route that needs the enzyme PARP; when PARP is inhibited by a drug, single-strand breaks persist to S phase, where a fork converts each into a double-strand break with only one end — repairable only by recombination. A normal cell, with one good BRCA allele, copes; the tumour cell dies. Two defects, each harmless alone, are lethal together: the drug kills by synthetic lethality, and spares the patient’s other cells.