When a fork meets a lesion that has not been repaired, the replicative polymerase stalls. Translesion synthesis (TLS) calls in a specialised polymerase with a roomier active site and no proofreading — Pol for pyrimidine dimers, Pol , , and Rev1 for other lesions — which inserts a few nucleotides opposite the lesion and steps aside. Pol puts two adenines opposite a thymine dimer, which is usually right; the others are often wrong. TLS trades accuracy for the survival of the fork, and is the source of most ultraviolet-induced mutations. The variant form of xeroderma pigmentosum (XP-V) has intact excision repair and lacks Pol : the dimers that escape excision are bypassed by the more error-prone polymerases, and the cancers follow.
Examples
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.