FAN1 nuclease processes and pauses on disease-associated slipped-DNA repeats: Mechanism against repeat expansions

FAN1 nuclease is a modifier of repeat expansion diseases, including Huntingtons disease (HD), fragile X syndrome, and autism. The age of HD onset correlates with ongoing inchworm-like repeat expansions (1-3 CAG units/event) in HD brains, and is regulated by three modifiers: The first two, repeat tract length and purity exert their effects by enhancing and slowing CAG expansions, respectively, by affecting the formation of slipped-DNAs -- mutagenic intermediates of instability; which are processed to expansions by the third modifiers, DNA repair proteins. FAN1 protects against hyper-expansions of repeats, by unknown mechanisms. We show FAN1, through iterative cycles bound, dimerized and cleaved slipped-DNAs, yielding striking patterns of distinct exo-nuclease pauses along slip-outs; 5'-C{downarrow}A{downarrow}GC{downarrow}A{downarrow}G-3' and 5'-C{downarrow}T{downarrow}G{downarrow}C{downarrow}T{downarrow}G-3'. The transcriptionally-displaced CAG strand was excised slower than its complementary CTG strand, required A*A and T*T mismatches, as fully-paired hairpins arrested excision progression, while disease-delaying CAA interruptions further slowed FAN1 excision. In contrast, endo-nucleolytic cleavage was insensitive to slip-outs. Rare FAN1 variants were found in autism individuals with CGG/CCG repeat expansions. Excision of CGG/CCG slip-outs were similarly excised, with CGG being slower than CCG. The slip-out specific ligand, Naphthyridine-Azaquinolone, shown to induce contractions of expanded repeats in cells, required FAN1 for its effect, and protected slip-outs from FAN1s exo- but not endo-nucleolytic digestion. FAN1s inchworm pausing of slip-out excision is suited to minimize incremental expansions and modulating disease onset.