Steffen Emmert, Hanoch Slor, David B. Busch, Sima Batko, Roberta B

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Relationship of Neurologic Degeneration to Genotype in Three Xeroderma Pigmentosum Group G Patients1 Steffen Emmert, Hanoch Slor, David B. Busch, Sima Batko, Roberta B. Albert, Donna Coleman, Sikandar G. Khan, Bassam Abu-Libdeh, John J. DiGiovanna, Bari B. Cunningham, Myung-Moo Lee, Jill Crollick, Hiroki Inui, Takahiro Ueda, Mohammad Hedayati, Lawrence Grossman, Tala Shahlavi, James E. Cleaver, Kenneth H. Kraemer Journal of Investigative Dermatology Volume 118, Issue 6, Pages 972-982 (June 2002) DOI: 10.1046/j.1523-1747.2002.01782.x Copyright © 2002 The Society for Investigative Dermatology, Inc Terms and Conditions

Figure 1 Pedigrees of XP families. (A) Pedigree of family of XP96 TA. Six generations of this consanguineous family are shown. Patient XP96TA (arrow) and her affected brother (solid symbols) died before 2 y of age. The parents are obligate heterozygotes (half solid symbols). (B) Pedigree of family XP65BE. Four generations of this family are shown. Patient XP65BE (arrow) has an unaffected sister (open circle). The parents are obligate heterozygotes (half solid symbols). Four relatives have cancer (diagonal shading): MM, cutaneous melanoma; Breast Ca, breast cancer; Throat Ca, throat cancer. Diagonal line indicates death. Journal of Investigative Dermatology 2002 118, 972-982DOI: (10.1046/j.1523-1747.2002.01782.x) Copyright © 2002 The Society for Investigative Dermatology, Inc Terms and Conditions

Figure 2 XP-G patients XP82DC and XP65BE.Upper left: Patient XP82DC at 3 y of age has deep-set eyes characteristic of CS and irregular lentiginous pigmentation on her face characteristic of XP indicating the XP/CS complex. Lower left: Patient XP82DC at 3 y has characteristic XP pigmented lesions present on her forearms and dorsa of hands along with thin, translucent skin with readily visible veins. The small size of her hands is apparent in comparison to the hands of her mother. Middle column, top: Patient XP65BE at age 6 mo experienced severe sunburn of her face on minimal sun exposure. Erythema and swelling is seen on the skin of forehead, cheeks, and periorbital area. Middle column, middle: Patient XP65BE at age 9 mo shows erythema and peeling of skin of the malar area of the face following sun exposure. Middle column, bottom: Patient XP65BE at age 4.5 y shows pigmentary changes on her nose, malar area, and other portions of the face. Upper right: Patient XP65BE at age 4.5 y shows blistering sunburn on upper thigh. Note spared area above the knee where sunscreen was applied. Lower right: Patient XP65BE at age 14 y shows minimal pigmentary changes on face and sparing of neck and hand. She used measures to protect her skin from sun exposure. Journal of Investigative Dermatology 2002 118, 972-982DOI: (10.1046/j.1523-1747.2002.01782.x) Copyright © 2002 The Society for Investigative Dermatology, Inc Terms and Conditions

Figure 3 Characteristics of XP fibroblasts studied. (A) Post-UV cell survival – growth inhibition assay. (B) Post-UV cell survival – colony-forming ability assay. (C) Post-UV DNA repair assays. NER activity was assessed in cultured fibroblasts by measuring UV-induced incorporation of tritiated thymidine in autoradiograms (XP96 TA, XP82DC, and XP20BE) and by detecting DNA strand breaks in alkaline sucrose gradients (XP65BE). DNA repair levels are expressed as percentage compared to normal cells. (D) Post-UV RNA synthesis recovery. RNA synthesis was assessed in cultured fibroblasts by measuring UV-induced incorporation of tritiated uridine in autoradiograms 24 h after UV exposure. (E) Northern blot analysis of XPG mRNA expression. 25 µg of total RNA isolated from GM00637 cells (normal, lane 1), XP65BE cells (lane 2), XP96TA cells (lane 3), and XP20BE cells (XP-G/CS control, lane 4) were loaded per lane, separated by electrophoresis, transferred to a nylon membrane, and probed with a radiolabeled 3.8 kb XPG cDNA fragment. The relative amount of RNA transferred was monitored by probing with β-actin cDNA, which was used to normalize the XPG mRNA levels. Journal of Investigative Dermatology 2002 118, 972-982DOI: (10.1046/j.1523-1747.2002.01782.x) Copyright © 2002 The Society for Investigative Dermatology, Inc Terms and Conditions

Figure 4 HCR and assignment to XP-G. A 1000 J per m2 UVC-treated reporter gene plasmid (pRSVcat or pCMVLuc) was either transfected alone (open triangle) or cotransfected with an XP cDNA containing plasmid [pXPA (open circle), pXPB (triangle), pXPC (diamond), pXPD (inverted triangle), pXPF (cross), pPXG (closed circle)] into triplicate cultures of primary patient fibroblasts. Each symbol represents the relative reporter gene activity in an independent transfection experiment 48 h after transfection compared with the corresponding unirradiated control reporter gene plasmid. Top: XP96TA host cells. Middle: XP82DC host cells. Bottom: XP65BE host cells. Journal of Investigative Dermatology 2002 118, 972-982DOI: (10.1046/j.1523-1747.2002.01782.x) Copyright © 2002 The Society for Investigative Dermatology, Inc Terms and Conditions

Figure 5 Mutational analysis of XPG in XP65BE, XP96TA, and XP82DC cells. The structural map of the XPG gene visualizes the location of the mutations found (top). The 15 exons and 14 introns are numbered and their size in base pairs is indicated below. Each mutation in the two XPG alleles found in each of these XP-G patients is listed (middle) and graphically visualized (bottom). The graphic inserts represent sequencing results from genomic DNA (mix of maternal and paternal alleles). Two inserts show reverse sequences. Results were also verified by sequencing of cDNA obtained from reverse-transcribed mRNA. Journal of Investigative Dermatology 2002 118, 972-982DOI: (10.1046/j.1523-1747.2002.01782.x) Copyright © 2002 The Society for Investigative Dermatology, Inc Terms and Conditions

Figure 6 RFLP detection and functional properties of the XPG-G2817A single amino acid missense mutation found in XP65BE. (A) DNA extracted from cultured cells from XP65 BE, her parents, and normal fibroblasts (AG06239) was used in a PCR employing primers that flank the exon 12 region in the XPG gene. The product was subjected to electrophoresis on a 2% agarose gel with (+) or without (–) digestion with Aci I. (B) The undigested product is 247 bp whereas Aci I digestion converts the product with G at nucleotide 2817 to two fragments of 86 and 161 bp. The product containing A at 2817 is resistant to Aci I digestion. Thus donors of genotype G/G have two bands (at 86 and 161 bp), and G/A heterozygotes have three bands (86, 161, and 247 bp). Cells from XP65BE and her mother were heterozygous for the G2817A mutation. (C) UV-irradiated pCMVLuc plasmid was transfected together with empty vector pcDNA3.1 (diamond) or with a plasmid containing wild-type XPG cDNA (circle) or mutated XPG-G2817A cDNA (triangle) into triplicate cultures of XP-G cells (XP20BE). The XPG-G2817A cDNA retained partial functional activity. (D) UV-irradiated pCMVLuc plasmid was transfected either alone (inverted triangle) or together with a plasmid containing wild-type XPG cDNA (circle) or mutated XPG-G2817A cDNA (triangle) into triplicate cultures of normal repair-proficient cells (GM00637). Overexpression of the XPG mRNAs did not positively or negatively influence the cells' ability to repair UV-damaged plasmid DNA. Each symbol represents the relative luciferase activity in an independent transfection experiment 48 h after transfection compared with the corresponding unirradiated control pCMVLuc plasmid. Journal of Investigative Dermatology 2002 118, 972-982DOI: (10.1046/j.1523-1747.2002.01782.x) Copyright © 2002 The Society for Investigative Dermatology, Inc Terms and Conditions