Cockayne syndrome type II in a Druze isolate in Northern Israel in association with an insertion mutation in ERCC6.

Cockayne syndrome (CS) (OMIM #133540) is a rare autosomal recessive disease characterized by severe growth and developmental retardation, progressive neurological dysfunction and symptoms of premature aging. The underlying cause of the disease is a defect in transcription-coupled DNA repair, specifically the nucleotide excision repair (NER) pathway. To date, about half of the reported CS cases have an altered cellular response to UV resulting from mutations in either the CSA or the CSB genes. We have identified a large, highly consanguineous, Druze kindred descended from a single ancestor, with six CS cases. All six of them presented with the congenital severe phenotype that includes severe failure to thrive, severe mental retardation, congenital cataracts, loss of adipose tissue, joint contractures, distinctive face with small, deep-set eyes and prominent nasal bridge, and kyphosis. They had no language skills, could not sit or walk independently, and died by the age of 5 years. Cellular studies of the fibroblasts from three patients showed a significant defect in transcription-coupled DNA repair (TCR) and a marked correction of the abnormal cellular phenotype with a plasmid containing the cDNA of the ERCC6 gene. Molecular studies led to identification of a novel insertion mutation, c.1034-1035insT in exon 5 of the ERCC6 gene (p.Lys345Asnfs*24). This mutation was identified in 1:15 healthy individuals from the same village, indicating an extremely high carrier frequency. Identification of the causative mutation enables comprehensive genetic counseling among the population at risk from this village.

[Clinical, biochemical and molecular characterization of rare genetic disorders, related to nucleotide excision repair (NER) system].

All living organisms are equipped with DNA repair systems that can cope with a wide variety of DNA lesions. Among these repair pathways, nucleotide excision repair (NER) is quite versatile, involved in the removal of a variety of bulky DNA lesions induced by ultraviolet light and chemical carcinogens and mutagens. The importance of NER for human health is illustrated mainly by the occurrence of rare life-threatening disorders such as Xeroderma Pigmentosum (XP), Cockayne Syndrome (CS) and Trichthiodystrophy (TTD). XP, CS and most TTD patients exhibit increased sensitivity to UV light and premature aging. XP is associated with a high incidence of skin tumors, CS is primarily a developmental disorder associated with failure to thrive, and psychomotor retardation. The authors report the clinical, biochemical and molecular aspects of the NER pathway in individuals suspected to have a DNA repair, NER type-related disease. These diseases are rare worldwide, but are frequent in Israel, probably due to the high rate of consanguinity among certain Arab, Druze and Jewish populations. Our laboratory is the only one in Israel, and one of very few labs world-wide that is performing DNA repair evaluation as a diagnostic test for DNA repair-deficient inherited diseases. Identification of the causative genes and proteins in suspected families will facilitate accurate diagnosis, genetic counseling, identification of couples at risk and prenatal diagnosis.