Briefly, our findings indicate that an increased level of the EMSY N-terminal domain only partially mimics BRCA2 deficiency. Similar to BRCA2-deficient CAPAN-1 cells (Abaji et al. 2005), EMSY-overexpressing MCF-7 cells also exhibit an increased rate of SCRS and a deficit in HR repair of I-SceI-induced DSBs. However, unlike CAPAN-1 cells that present an increased rate of spontaneous HR and heightened efficiency of DSB repair by SSA (Abaji et al. 2005), EMSY-overexpressing MCF-7 cells rather display a decreased rate of the former and normal efficiency of the latter.
The differential effect of short EMSY on these processes, together with the lack of influence on expression of the reporter genes Hyg and Puro at three distinct loci and endogenous RAD51, BRCA2 and EMSY, seems to argue against EMSY as a general chromatin-assembly factor/transcription repressor. The lack of effect on gene expression could not be attributed to the slight elevation of EMSY level in MCF-7 cell lines, as a higher level of a similar truncated form of EMSY in a telomerase-immortalized human breast epithelial cell line also does not affect BRCA2, BRCA1, p53 or p21 expression (Raouf et al. 2005). In addition, it also does not much affect the stability of BRCA2 protein or its ability to interact and/or co-localize with RAD51, since this would confer hyper-recombination as BRCA2 deficiency does (Abaji et al. 2005). Rather, short EMSY bestows hypo-recombination by decreasing the rate of spontaneous HR, presumably by enhancing the repressive effect of BRCA2 on RAD51 (Abaji et al. 2005).
Both the promotion of RAD51 activity by BRCA2 in response to I-SceI-induced DSBs and its repression in the absence of such lethal damage were thought to be orchestrated by BRCA1, ATR and ATM (Abaji et al. 2005; Cousineau et al. 2005). Consistent with this view are the findings that, in undamaged human cells, the BRCA2 C-terminal RAD51-binding motif ser3291 encoded by exon27 (BRCA2ex27) is phosphorylated by CDK1, a post-translational modification that blocks its interaction with RAD51 (Thorslund and West 2007). However, after the induction of DSBs that inactivate CDK1, BRCA2ex27 becomes de-phosphorylated, and its ability to both bind RAD51 and carry out HR repair of such lethal damage is restored (Thorslund and West 2007). RAD51 is functional as oligomers (1 oligomer contains 6 or 7 RAD51 monomers) that coat 3′-ssDNA and form a nucleoprotein filament that undertakes the DNA strand-exchange reaction by invading an intact homologous DNA (dsDNA) to prime new DNA synthesis and thus repair the damage (Thorslund and West 2007). Whereas the eight BRC repeats encoded by exon 11 (BRCA2ex11) can bind both RAD51 monomers and oligomers, BRCA2ex27, which is unrelated to BRC repeats, exclusively binds RAD51 oligomers or RAD51 filament (Thorslund and West 2007). Since BRCA2 can bind only 20% of the cellular RAD51 pool (Marmorstein et al. 1998; Yu et al. 2003), one way by which short EMSY could repress both spontaneous HR and HR repair of DSBs is to both disrupt RAD51 oligomers into monomers and maintain BRCA2ex27 phosphorylation.
EMSY-overexpressing MCF-7 cells exhibit approximately a fourfold decrease in the efficiency of HR repair of I-SceI-induced DSBs similar to BRCA1- or BRCA2-deficient tumor cells (Abaji et al. 2005; Cousineau et al. 2005), or hypoxic human cells, since hypoxia also decreases the synthesis of HR proteins to offset chemo- and radio-resistances (Chan et al. 2008). Consistently, a similar decrease has also been reported with cells repressed or disrupted in BARD1 (Westermark et al. 2003); MRN (Yang et al. 2006); BRIP1 (BRCA1-interacting protein, also known as the helicase BACH1) (Litman et al. 2005); CtIP that links BRCA1 to MRN (Chen et al. 2008); ATM (Golding et al. 2004); ATR (Wang et al. 2004); CHK2 (Zhang et al. 2004); CHK1 (Sorensen et al. 2005); PALB2 (Xia et al. 2006); RPA (Sleeth et al. 2007); or RAD51 (Daboussi et al. 2002). Since short EMSY neither represses the expression of HR reporter genes nor affects SSA efficiency, the fourfold decrease in HR repair of I-SceI-induced DSBs cannot be ascribed to chromatin assembly diminishing DNA accessibility to transcription factors and restriction enzymes (Villemure et al. 2001). Rather, it could be due to either reduced efficiency of RAD51-mediated DNA strand-exchange/invasion or I-SceI-induced cell death (apoptosis) or permanent cell-cycle arrest (senescence), in which case the essential role of HR in cell survival would be at least checkpoint rather than DSB repair per se. Consistent with this view, (a) all these HR mutant cells are hypersensitive to DSB-inducing agents that activate p53-dependent or independent apoptosis/senescence; (b) after p53 disruption or repression, the efficiency of HR repair of I-SceI-induced DSBs increases by up to 20-fold, whereas the rate of spontaneous HR remains unchanged in the absence of such lethal damage (Akyuz et al. 2002; Lemelin et al. 2005); and (c) similar to BRCA1, both BRCA2 and RAD51 bind p53, and BRCA2/RAD51 complex represses the expression of p53-responsive genes in transient assays (Marmorstein et al. 1998). In such assays, DNA transfection per se can activate DDR, specifically the ATR/ATM pathway (Igoucheva et al. 2006), and DDR activation can repress both p53-dependent and independent gene expression (Zhou et al. 2007), and p53 can repress not only cellular genes but also all viral promoters that drive the expression of HR/transcription-reporter genes (Lemelin et al. 2005). Thus, since the I-SceI assay system does not discriminate between checkpoint/repair and apoptosis/senescence, short EMSY may affect all DDR aspects.
However, short EMSY does not seem to interfere with the localization of activated ATM, the processing of DSB ends into ssDNA by BRCA1/MRN or the stability of ssDNA ends. If it were to negatively affect any of these processes, one would have expected a similar decrease in the efficiency of DSB repair by SSA, which also requires all these HR proteins, except BRCA2/RAD51 complex that would shift DSB repair from SSA to gene conversion (Abaji et al. 2005; Gudmundsdottir and Ashworth 2006; Moynahan and Jasin 2010). Rather, short EMSY shifted DSB repair from gene conversion to SSA without affecting the efficiency of the latter. Thus, it seems that short EMSY interferes with free RAD51 molecules and the loading of RAD51 oligomers by BRCA2ex27 at least at DSBs (Thorslund and West 2007), without affecting the ability of BRCA2/RAD51 to bind/stabilize ssDNA and promote SSA.
The SSA-promoting activity of BRCA2 has been appreciated with human full-length BRCA2 in CAPAN-1 cells (Abaji et al. 2005), and with its mini-homologs Brh2 in the smut, yeast-like fungus Ustilago maydis and CeBRC2 in C. elegans (Petalcorin et al. 2006; Mazloum et al. 2007). However, evidence indicates that in mammals, the SSA-promoting activity of BRCA2 may be overshadowed in the context of at least RPA/BRCA2/RAD51 complex and may become apparent only after the loss of either component of this complex. (a) In RAD51-disrupted cells that exhibit increased efficiency of SSA at I-SceI-induced DSBs (Daboussi et al. 2002), RPA/BRCA2 could still bind/stabilize ssDNA ends and promote SSA, given that similar to RPA and RAD51, BRCA2 also binds ssDNA, its C-terminal domain contains both ssDNA and dsDNA-binding motifs (Thorslund and West 2007). (b) Likewise, in BRCA2-disrupted cells that also display heightened efficiency of SSA at I-SceI-induced DSBs (Abaji et al. 2005; Gudmundsdottir and Ashworth 2006), RPA/RAD51 could still bind ssDNA ends and promote SSA. However, in this case, the ability of RAD51 alone to bind and displace RPA from ssDNA and form RAD51 filament to carry out DNA strand-exchange/invasion, as it does in vitro (Stauffer and Chazin 2004) and in CAPAN-1 cells causing hyper-recombination (Abaji et al. 2005), is crippled by I-SceI-induced DSBs (Abaji et al. 2005). In response to DSBs, ATM and its BRCA1-interacting tyrosine kinase c-ABL, another downstream target of DNA-PK, as well as ATR proximal kinase CHK1, each phosphorylates RAD51 (Daboussi et al. 2002; Shiloh 2003; Sorensen et al. 2005).
It has been shown that RAD51 phosphorylation cripples the ability of RAD51 to both bind ssDNA and undertake DNA strand-exchange/invasion in vitro and HR repair of I-SceI-induced chromosomal DSBs, presumably by disrupting RAD51 oligomers into monomers and preventing RAD51 oligomerization (Yuan et al. 1998; Daboussi et al. 2002; Conilleau et al. 2004). Thus, in response to DSBs, RAD51 phosphorylation would affect not only its function but also that of BRCA2, since de-phosphorylated BRCA2ex27 exclusively binds RAD51 oligomer but not RAD51 monomers (Thorslund and West 2007), raising the question: how does BRCA2/RAD51 complex conduct HR repair of DSBs? Since none of the models proposed for HR in general or for BRCA1/2 function in particular considers such a conundrum, we propose that BRCA2 may have the ability to protect its RAD51 monomers bound by the BRC repeats (exon 11) against phosphorylation (Abaji et al. 2005) (Fig. 4a).
(c) In the absence of RPA, BRCA2/RAD51 could still bind/stabilize ssDNA and promote SSA. Consistently, in in vitro assays, the BRCA2 C-terminal domain, Brh2 or CeBRC2 can displace RPA from ssDNA, load RAD51 oligomer onto the dsDNA–ssDNA junction that mimics one processed DSB end, and promote SSA between RAD51 filament and its complementary ssDNA, provided as linear, circular or embedded in synthetic D-loops (Petalcorin et al. 2006; Mazloum et al. 2007; Thorslund and West 2007; Fig. 4b).
Since short EMSY does not seem to negatively affect the SSA-promoting activity of BRCA2/RAD51, it must have then interfered at least with the loading of RAD51 oligomer by BRCA2 (Thorslund and West 2007). However, the loading of RAD51 oligomer by BRCA2 at DSBs cannot occur before recruitment/activation of ATR, since BRCA2ex27 would be still phosphorylated by CDK1. Then, the supply of RAD51 oligomers for RAD51 filament formation could originate afterwards from the BRC repeats of RPA/BRCA2/RAD51, EMSY/BRCA2/RAD51 and PALB2/BRCA2/RAD51, with each complex providing eight non-phosphorylated RAD51 monomers and, thus, a total of three to four RAD51 oligomers. This may be sufficient for HR repair, given previous demonstrations that only one DSB end can invade the undamaged template and prime new DNA synthesis, whereas the other DSB end can capture the displaced, newly synthesized DNA strand through SSA (Fig. 4b) or NHEJ under certain circumstances, culminating in deletion, insertion, or amplification events (Belmaaza and Chartrand 1994; Villemure et al. 1997, 2003). Thus, by overriding at least RPA, short EMSY could block the recruitment/activation of ATR, not only at stalled forks—increasing the likelihood of their collapse into DSBs (Raouf et al. 2005) as BRCA2 deficiency does (Lomonosov et al. 2003)—but also at such DSBs without affecting the localization of ATM or the processing of DSBs into ssDNA ends by BRCA1/MRN. This would decrease SCC/alignment, induce RAD51 phosphorylation, and maintain BRCA2ex27 phosphorylation, thereby increasing SCRS and repressing both spontaneous HR and HR repair of DSBs without affecting SSA, as found to be the case.
That EMSY/BRCA2, RPA/BRCA2 and PALB2/BRCA2 complexes have independently been fractionated from undamaged human cells indicates that, similar to PALB2, EMSY and RPA are also partners and stabilizers of BRCA2 (Hughes-Davies et al. 2003; Wong et al. 2003; Xia et al. 2006). However, regardless of their proportions in cells, increased EMSY level would be expected to shift protein concentration equilibrium towards EMSY/BRCA2, overriding PALB2 and RPA by quenching BRCA2 without affecting its overall stability. As it still interacts with HP1β and BS69, short EMSY might also override full-length EMSY. However, notwithstanding the exact role of full-length EMSY, the effects of short EMSY reported here provide evidence that, in addition to chromatin and transcription regulation, BRCA2ex3 may also be directly involved in the development of DDR in at least replication/checkpoint and recombination/repair.
Such a heretofore unappreciated function of BRCA2 can be best examined in phenotypes of BRCA2 knockout (KO) mice. Whereas BRCA2 null, BRCA2
Δex1−5 and BRCA2
Δex11 KO mice all die at an early embryonic stage in a manner similar to RPA and RAD51 KO mice, BRCA2
Δex27 KO mice are viable and develop normally (Donoho et al. 2003; Evers and Jonkers 2006; Friedberg and Meira 2006), indicating that whereas the function of at least BRCA2ex3 and BRCA2ex11 in replication/checkpoint is essential, that of BRCA2ex27 in RAD51-mediated HR repair of DSBs and resistance to DSB-induced lethality (Thorslund and West 2007; Moynahan and Jasin 2010) is dispensable for cell survival, proliferation and differentiation. The embryonic lethality of BRCA2 KO mice has been associated with chromosomal breakage and activation of p53, suggesting that: (a) such lethal damage does not arise accidentally in BRCA2
Δex27 KO mice or normal proliferating/differentiating cells; and (b) the essential role of BRCA2 in replication/checkpoint is at least to prevent fork collapse into fatal injury rather than promote RAD51-mediated HR repair of collapsed forks.
Consistently, in response to fork stalling, bacteria, budding or fission yeast do not undergo fork collapse; only replication/checkpoint mutants do, through the activities of HR enzymes (Branzei and Foiani 2005). Such organisms do not possess BRCA homologs and yet they carry out DSB repair almost exclusively by HR. In contrast, in organisms that possess BRCA homologs, NHEJ is the predominant DSB repair pathway, whether at collapsed forks or IR/enzyme-induced DSBs. Therefore, in such evolved organisms, one would expect NHEJ and SSA to rescue HR mutants from DSB-induced lethality. In contrast, KO of HR genes, such as RPA, RAD51, BRCA1, BARD1, MRE11, RAD50, NBS1, ATR, CHK1, RAD51B, RAD51D, XRCC2, TOPII, and BLM, in mice makes them all undergo chromosomal breakage and succumb to death in a manner similar to BRCA2 KO mice (Friedberg and Meira 2006). Thus, in addition to their well-established role in HR repair of DSBs, RAD51 and its paralogs RAD51B, RAD51D and XRCCs are also essential for checkpoint/fork stability. Consistent with this aspect, not all RAD proteins required for HR repair of DSBs are essential for survival; RAD52, RAD54 and RAD51C KO mice were all found to be viable (Friedberg and Meira 2006).
In addition, ATM, master of the response to DSBs including their repair by HR, NHEJ and SSA, is also dispensable for survival; KO mice remain viable, except that they exhibit hyper-sensitivity to IR, gonadotrophy, infertility, immunodeficiency and thymic lymphoma, since in germ-line cells and lymphocytes, DSBs rather arise in a programmed manner to initiate meiotic HR, ensuring “gene shuffling” and the orderly segregation of homologous chromosomes and thus the formation of healthy gametes, and V(D)J recombination (NHEJ) for immune system development, protecting against infectious diseases and cancer (Friedberg and Meira 2006). In the absence of ATM, such ‘heavenly’ breaks could trigger apoptosis/senescence and act as anti-cancer barriers in ‘specialized’ tissues at the expense of their atrophy. Consistently, ATM/RAG1 and ATM/RAG2 double KO (DKO) mice that no longer undergo programmed DSBs and V(D)J recombination also develop CIN and lymphoma (Petiniot et al. 2002). Moreover, other ATM downstream targets that play a role in HR repair of DSBs are also dispensable for survival; CHK2 and H2AX KO mice are as viable as ATM/CHK2 and ATM/H2AX DKO mice (Friedberg and Meira 2006). Furthermore, NHEJ key components, including DNA-PK, another master of DSBs, Ku70, Ku80, Ku86 and Artemis, except ligase IV, are also dispensable for survival; KO mice remain viable (Friedberg and Meira 2006); and last but not least, genes of mutation-avoidance systems, such as base-excision repair/single-strand break repair (BER/SSBR) of oxidative damage (XRCC1, APEX, LIG1, POLβ, FEN, PARP1/PARP2), nucleotide-excision repair (NER) and transcription-coupled NER of DNA adducts (XPD, XAB), or translesion DNA synthesis (TLS) (REV3), which are not necessary for DSB repair, all appear to be essential for survival (Friedberg and Meira 2006). Collectively, these findings indicate that (a) checkpoint/fork stability requires the participation of components of all DNA-damage repair mechanisms—HR, SSA, NHEJ, BER/SSBR, NER and TLS—rather than DNA damage/repair per se; (b) the same machinery that responds to programmed DSBs also acts to suppress accidental breakage in both specialized and normal tissues; and (c) DSB has been conceived as a fundamental requirement of life, evolution and death, acting as a ‘longevity clock’ and ‘quality control’, eliminating aberrant proliferating/differentiating cells (cancer) and embryos (abortion).
In such replication/checkpoint mutants, the collapse of stalled forks into lethal DSBs has been associated with cleavage of HR intermediates (HJs) resembling a chicken-foot structure that forms as a consequence of “replication-fork reversal” (RFR) or “run-off” of specialized SC junctions resembling hemicatenanes (pseudo-double HJs) (Branzei and Foiani 2005; Fig. 5). In yeast, pseudo-double HJs have been shown to form during the early S phase, after origin firing, and to migrate, chasing the forks and presumably assisting SCC/alignment until anaphase whereas in human cells, such SC bridges have been reported to form at fragile sites, after replication stress, and at anaphase before their resolution by BLM/TOPIIIα and TOPII and SC segregation as two intact chromosomes (Branzei and Foiani 2005, 2007; Chan et al. 2007, 2009). In yeast, pseudo-double HJs are thought to form at stalled forks by strand invasion and D-loop formation (template switch) as an error-free DNA-damage bypass mechanism compared to TLS polymerases, which often replicate across lesions in an error-prone manner (Branzei and Foiani 2007). Since BRCA2Δex27 cannot carry out RAD51-mediated strand invasion (Thorslund and West 2007), ‘hemicatenation’ (HR) in mammals may result instead from BRCA2/RAD51-mediated strand switching: twisting/melting dsDNA into ssDNA and, thus, displacement of both lagging and leading strands and their subsequent annealing into one harmless DSB end, flipping out the chicken foot, recruiting/activating ATR, ATM and DNA-PK to terminate HR within an intact chromosome (Fig. 5).
In support of this, (a) its mini-homologs Brh2 and CeBRC2 that each contains only one RAD51-binding BRC motif and one ssDNA-binding domain possess the ability to twist dsDNA into both D-loops and ssDNA and carry out SSA (Petalcorin et al. 2006; Mazloum et al. 2007; Fig. 4b). BRCA2Δex27 would be expected to conduct such reactions with higher efficiency, as it still possesses eight dsDNA- and ssDNA-binding motifs through its interaction with RAD51, given that RAD51 binds to ssDNA (5′ or 3′) and dsDNA with comparable affinities (Forget and Kowalczykowski 2010). In addition, the binding of RAD51 oligomers to the homologous dsDNA partner inhibits DNA strand-exchange/invasion in vitro and can be modulated by BRC repeats (Forget and Kowalczykowski 2010). In this case, BRCA2/RAD51 complexes together with free RAD51 oligomers may also stabilize replication forks by holding SCs aligned, acting as bridges until activation of replication/checkpoint that would disrupt RAD51 oligomers into monomers and recruit bona fide cohesins (Fig. 5). (b) Mouse embryonic stem (ES) cells expressing BRCA2Δex27 exhibit heightened efficiency of SSA at I-SceI-induced DSBs and hyper-sensitivity to IR, but maintain both G1/S and G2/M checkpoints and resistance to UV radiation as wt ES cells (Morimatsu et al. 1998; Jasin 2002; Gudmundsdottir and Ashworth 2006), indicating that BRCA2Δex27 is still efficient in recruiting/activating at least ATR and DNA-damage repair by error-free TLS, NER, BER/SSBR, or mismatch repair (MMR) (Branzei and Foiani 2008). MMR key proteins are also components of BASC (Wang et al. 2000), and although dispensable for survival (Friedberg and Meira 2006), they have also been implicated in DDR and the processing of HR intermediates containing HJs or branched DNA in collaboration with NER proteins (Villemure et al. 2003). (c) NER, transcription-coupled NER and PCNA-dependent pathways of BER/SSBR also require BRCA1, BRCA2, RPA, RAD51 and ATR (Le Page et al. 2000; Bogliolo et al. 2000; Daboussi et al. 2002; Aboussekhra and Al-Sharif 2005; Auclair et al. 2008). (d) As the localization of activated ATM and BRCA2/RAD51 complexes by BRCA1/MRN is needed for ATR activation in response to DSBs, that of ATR also seems to be required for ATM and DNA-PK activation in response to stalled forks (Stiff et al. 2006; Yajima et al. 2006). (e) BRCA1 and ATR have been shown to enforce TOPII-mediated decatenation G2 checkpoint (Deming et al. 2001). In normal proliferating cells, all replication forks would stall at termination of the S phase by catenanes, positive DNA supercoils that develop under torsional stress between advancing/colliding forks, acting as topological barriers, activating TOPII-mediated decatenation of SCs to allow completion of the S phase, chromosome condensation and segregation during the G2 and M phases (Deming et al. 2001; Branzei and Foiani 2008). Thus, with its HAT on doing the twist and changing partners at DNA, BRCA2Δex27 still has the ability to provide a finger to any stalled fork, and thereby act upstream and downstream of PIKKs, orchestrating at least S/G2/M-transition checkpoints and mutation-avoidance systems as full-length BRCA2, ensuring the accuracy rather than efficiency of such DNA transactions that can be carried out in vitro and by organisms that do not possess BRCA homologs.
In addition, unlike humans, BRCA2
Δex27 KO mice or mice heterozygous for BRCA2-truncating mutations are not spontaneously more cancer-prone than wt animals (Donoho et al. 2003; Evers and Jonkers 2006). Moreover, unlike BRCA2-deficient human cells (Abaji et al. 2005), mouse cells expressing BRCA2Δex27 have not been reported to undergo hyper-recombination or SCRS (Gudmundsdottir and Ashworth 2006; Moynahan and Jasin 2010). These two ‘mutator’ phenotypes and cancer predisposition highlight the importance of both replication/checkpoint in chromosomal stability and the difference between human and mouse BRCA2. Whereas human BRCA2 contains one nuclear localization signal (NLS) at the C-terminal domain, mouse BRCA2 possesses an additional NLS at the N-terminal domain (Jasin 2002). The majority of inherited, cancer-eliciting BRCA2 mutations encode truncated proteins as in CAPAN-1 cells, where BRCA2 is truncated at exon 11, weakly expressed, and exclusively localized in the cytoplasm, allowing both hyper-recombination and SCRS to take place (Abaji et al. 2005). Conversely, truncated mouse BRCA2Δex27 is expressed normally and localizes exclusively in the nucleus (Jasin 2002).
Hyper-recombination and its hallmarks are characteristic features of not only BRCA-deficient and BRCA-haploinsufficient tumor cells, but also normal breast epithelial cells and lymphocytes from healthy carriers of BRCA mutations, indicating that a ‘single hit’ in a chromosomal stability gene is sufficient to deregulate HR and induce CIN and the emergence of pre-cancerous lesions (Cousineau and Belmaaza 2007). Although somatic BRCA mutations are scarce in sporadic breast cancer, representing less than 1%, the remaining cases are either BRCA1- or BRCA2-haploinsufficient due to loss (deletion/aneuploidy) or epigenetic silencing of wt BRCA alleles (Welcsh and King 2001), and all exhibit amplification of oncogenes most notably EMSY, MYC, E2F-1, CyclinD1, or AKT, or loss of tumor-suppressor genes, such as PTEN, p53, or RB (Kenemans et al. 2004). Similar to EMSY, amplification/overexpression of other oncogenes, such as MYC or E2F-1, has also been shown to induce fork stalling and CIN as well as fork collapse into DSBs, activating ATM and not ATR, triggering apoptosis/senescence, acting as an anti-cancer barrier (Hong et al. 2006; Halazonetis et al. 2008). Thus, oncogenes can behave as tumor suppressors. Similarly, aneuploidy also acts both oncogenically and as a tumor suppressor (Weaver et al. 2007).
Hyper-recombination and its hallmarks are also characteristic features of PARP1- and ATM-deficient cells or KO mice (Claybon et al. 2010) and cells disrupted in DNA-PK (Allen et al. 2002) or MMR proteins (Villemure et al. 2003), or cells expressing p53 mutant proteins (Daboussi et al. 2002; Akyuz et al. 2002; Lemelin et al. 2005) or derived from patients with CIN syndromes, such as ataxia telangiectasia, Bloom’s syndrome, Werner’s syndrome, and Fanconi’s anemia, associated with mutations in ATM, BLM, WRN, and several FANC genes, respectively (Meyn 1997). Consistently, the most notable of FANC genes include FANC-D1 (BRCA2), FANC-D2, FANC-J (BRIP1, BACH1), and FANC-N (PALB2) (Walsh and King 2007). In addition, similar to BRCA1 and BRCA2, the inheritance of a mutated copy of ATM, PALB2, BRIP1, p53 or CHK2 (mutated in Li-Fraumeni syndrome), MRE11 (mutated in ataxia telangiectasia-like disease), NBS1 (mutated in Nijmegen breakage syndrome), or PTEN (mutated in Cowden disease) also confers a high lifetime risk of developing breast cancer (Walsh and King 2007). Cancer predisposition aside, patients with these syndromes also suffer from several other illnesses, such as neurological and cardiovascular diseases, diabetes, immunodeficiency, anemia, infertility, or premature aging as patients with Xeroderma pigmentosum, Cockyane syndrome, Trichothiodystrophy and Rothmund-Thompson syndrome, associated with mutations in components of NER, transcription-coupled NER, and RecQ-like DNA helicases such as BLM and WRN (Shiloh 2003; Vogelstein and Kinzler 2004; Branzei and Foiani 2008).
In conclusion, we briefly wielded the ‘triple-edged’ sword of HR: life, death and human diseases. That BRCA1 and BRCA2 act upstream of PIKKs as the masters of chromosomal stability may also explain: (a) why among all the inherited, breast cancer-eliciting gene mutations identified to date, BRCA1 and BRCA2 represent the majority of cases, whereas ATM, CHK2, p53, MRE11, RAD50, PALB2, BRIP1 (BACH1) and PTEN each accounts for approximately 1% of the remaining cases (Walsh and King 2007); (b) why in sporadic breast cancer, the majority if not all cases are either BRCA1- or BRCA2-haploinsufficient (Welcsh and King 2001); and (c) why breast cancer exhibits decreased or increased levels of almost exclusively those proteins that interact with BRCA1 and BRCA2. This indicates that (a) cancer may be a gene-dosage disease, in which tumor-suppressor genes and oncogenes are two facets of the same process with dosage amount acting both as a cancer promoter and an anti-cancer barrier through fork stalling and collapse, respectively; and (b) tissue specificity of the tumor-suppressive or -promoting property of all these housekeeping chromosomal stability genes may be determined by tissue-specific DNA-damaging agents, such as estrogens, anti-estrogens and phytoestrogens in breast cancer. The anti-cancer facet of such compounds could be enhanced if employed as tissue-specific carriers of potent DSB-inducing drugs.