Defective antibody production in double-strand DNA breakage syndromes: insights and implications

Abstract

DNA double-strand breakage (DSB) syndrome are rare monogenic inborn errors of immunity with a vast spectrum of manifestations. In addition to a high predisposition to malignancies, these patients are also at risk of recurrent, severe, or opportunistic infections. Therefore, monitoring of immunoglobulin levels and responses to vaccination, as well as interventions such as immunoglobulin replacement therapy should be considered to improve the patients’ outcomes. As DNA double-strand breakage repair pathways have a great impact on lymphocyte development through involvement in the generation of B and T cell receptors, disruption in one of their components may lead to genomic instability, aberrant B-cell receptor (BCR)/T-cell receptor (TCR) development, impaired B cell lymphocyte development and antibody production. The aim of this review is to describe the most common of DBSs, such as ataxia telangiectasia (AT), AT-like disorder (ATLD), Nijmegen breakage syndrome (NBS), Nijmegen breakage syndrome-like disorder (NBSLD), Bloom syndrome (BS), Fanconi anemia (FA) and some others with a focus on the role of DNA repair proteins in the development of humoral immunity. We also describe the immunoglobulin profile, recommendations for diagnosis, screening, and interventions for the ideal management of affected patients.