Repair of DNA double-strand breaks after low radiation doses in childhood cancer survivors and matched cancer-free individuals

DNA double-strand breaks (DSBs) which arise in G1- or G0-phase normal human cells are repaired by non-homologous end-joining (NHEJ), a pathway which is important for cell survival but can cause mutations at the break sites. DSB repair by NHEJ is very efficient at high damage levels of 1 or more DSBs per cell, much less efficient at lower damage levels and almost absent if only [~]0.05 DSBs per cell are induced. Repair at this low DSB level can be induced if cells are pre-treated prior to DSB induction with low concentrations of hydrogen peroxide, suggesting that the intracellular radical level modulates the efficiency of DSB repair at low damage levels. Here, we have investigated if the inefficiency of repair at low DSB levels contributes to the carcinogenic potential of DSBs or, counterintuitively, may serve as a mechanism to limit cancer development. We have analyzed the repair of high and low levels of radiation-induced DSBs in primary fibroblasts from 136 childhood cancer survivors, half of whom developed a second independent tumor later in life, and compared it to the response of primary fibroblasts from 68 individually matched cancer-free individuals. Although childhood cancer survivors and cancer-free individuals repaired DSBs at high damage levels equally efficiently, their response to low DSB levels differed drastically. While repair in cancer-free individuals was nearly absent at a level of [~]0.05 DSBs per cell, childhood cancer survivors repaired DSBs at this low damage level as efficiently as after high damage levels. These results suggest that most of the cancer survivors analyzed here carry a genetic predisposition that affects their response to low levels of DSBs. They also support the idea that the absence of repair observed in cancer-free individuals represents a mechanism limiting cancer formation.