Csbm/m mice exhibit several CS features (e.g., attenuated growth, blindness, neurological dysfunction), but their phenotype is overall milder than the human syndrome [
16] despite the fact that the truncation in the N-terminal part (mimicking a mutant allele of CS-B patient CS1AN) completely inactivates the protein and TC-NER [
16]. Although the severity of clinical features in humans does not seem to correlate with the severity of the molecular defect [
33], the absence of the complete spectrum of CS features in the
Csbm/m mouse model is likely to originate from human-mouse differences (i.e., adaptation to stress, tolerance to DNA damage/genome instability), rather than from the nature of the
Csbm/m mutation. This idea is supported by our observations that
XpdTTD and
XpdXPCS mice (all carrying causative point mutations) also fail to show the severe CS features associated with XPCS and TTD [
9,
34].
Yet, the present study reveals that inactivation of GG-NER or complete abrogation of NER (through inactivation of
Xpc or
Xpa, respectively) in TCR-deficient
Csbm/m mice dramatically aggravates the
Csbm/m mouse phenotype. Because animals were not exposed to exogenous genotoxic agents, we attribute this effect to enhanced levels of unrepaired endogenous (oxidative) DNA damage. In further support of this, we have shown that
Csbm/m/Xpc−/− and
Csbm/m/Xpa−/− MEFs, as well as
Csbm/m/Xpa−/− retinal photoreceptor cells, are more sensitive to environmental genotoxic insults (i.e., UV light and ionizing radiation) than their single mutant counterparts. A comparable phenotypic deterioration has been noticed when
Xpa was inactivated in
XpdTTD [
9],
XpdXPCS [
34], compound heterozygous
XpdTTD/XPCS animals (carrying causative mutations for TTD and combined XP/CS) [
35] or
XpgdeltaEx15 mice [
36].
Importantly,
Csbm/m/Xpa−/− mice appeared normal at birth, indicating a normal intra-uterine development and ruling out that this condition is in fact an embryonic developmental disorder. Instead, after birth, the
Csbm/m/Xpa−/− pups displayed progressive kyphosis, cachexia, photoreceptor loss, and motor dysfunction, all common postnatal manifestations of CS [
13], as well as of natural mammalian ageing [
37–
39]. Also similar to human CS patients (average age 12.5 y),
Csbm/m/Xpa−/− pups fail to grow into adulthood and die before weaning. The relation between (residual) repair capacity, time, and severity of a particular phenotype is well illustrated by the retinal photoreceptor loss in the
Csbm/m mouse models. Whereas ageing C57Bl/6J mice lose about 5%–10% of their rods and cones in 30 months, TCR-deficient
Csbm/m mice have already lost about 50% of their photoreceptor cells by the age of 16 months. This spontaneous retinal degeneration in
Csbm/m mice originates from enhanced apoptotic sensitivity of photoreceptor cells (T. Gorgels, I. van der Pluijm, R. Brandt, G. Garinis, H. van Steeg, et al, unpublished data), evolving in the first 1 or 2 months after weaning. Interestingly, further crippling of NER in
Csbm/m animals by inactivation of
Xpa accelerates the onset of photoreceptor loss, which becomes visible as early as postnatal day 15, and progressively increases thereafter. The strong correlation between the severity of the repair deficiency and the onset of photoreceptor loss, as well as the enhanced ionizing radiation hypersensitivity of photoreceptor cells of
Csbm/m/Xpa−/− mice (as compared to age-matched
Csbm/m animals), well support the hypothesis that (oxidative) DNA damage likely underlies the retinal degeneration.
Full genome transcriptome analysis of the
Csbm/m/Xpa−/− mouse liver, aiming at unraveling the etiology of the severe double-mutant phenotype, led us to identify significant genome-wide parallels between the 2-wk-old
Csbm/m/Xpa−/− and 130-wk, but not 16-wk-old, wt animals at the fundamental level of gene expression. This resemblance was largely attributable to the substantial down-regulation of genes associated with processes implicated in oxidative energy and growth metabolism that were previously revealed by others to represent a conserved transcriptional response in ageing [
28].
The down-regulation of genes associated with the GH/IGF1 growth axis in the liver, the systemic reduction in
GH receptor mRNA levels, and the impaired
Igf1 gene expression in liver and other tissues (resulting in low serum IGF1 levels) likely underlie the postnatal growth defect in
Csbm/m/Xpa−/− pups. These changes were not due to reduced GH serum levels or pituitary abnormalities. A steady decline in the GH/IGF1 somatotroph axis was also observed in rodents and humans during natural ageing [
40]. Furthermore
, Csbm/m/Xpa−/− pups failed to up-regulate metabolism; instead, they displayed a sharp systemic reduction in the expression levels of genes involved in glycolysis, tricarboxylic acid cycle (including decreased citrate synthase activity), and oxidative respiration, which coincided with the onset of weight loss (cachexia). In addition,
Csbm/m/Xpa−/− pups up-regulated genes associated with glycogen and fatty acid synthesis, leading to increased hepatic glycogen storage and fat accumulation (steatosis) and pronounced hypoglycemia. Simultaneously, subcutaneous fat tissue was virtually absent. Given that in mammals, the GH/IGF1 signaling pathway is one of the major regulators of energy homeostasis to integrate metabolism with growth [
30,
41,
42], it is tempting to speculate that reduced IGF1 signaling is responsible for the postnatal metabolic shift and growth defect seen in
Csbm/m/Xpa−/− mice. Interestingly, several CS patients have been previously reported with hypoglycemia and low IGF1 serum levels [
43,
44], low metabolic rate [
45], and abnormal fat deposition [
46].
Paradoxically, however, the systemic suppression of the somatotrophic axis and energy metabolism, along with the up-regulation of antioxidant defenses, low IGF1 serum levels, and low blood glucose levels observed in the
Csbm/m/Xpa−/− mouse, are all associated with increased longevity rather than with the short lifespan of this mouse model. In lower paradigms for lifespan extension
(C. elegans, D. melanogaster), genetic interference in the insulin-signaling pathway can prolong life multi-fold [
47,
48]. In mammals, IGF1-deficient, Ames and Snell dwarf mice (characterized by defects in the development of the anterior pituitary due to mutations in the
Prop-1 and
Pit1 loci and diminished levels of GH, thyroid stimulating hormone, and prolactin hormone) combine hypoglycemia, low body temperature, and increased storage of carbohydrates and lipids [
40,
42] with up-regulation of antioxidant defense capacity and extended lifespan [
49,
50]. Conversely, GH-overexpressing transgenic mice display reduced lifespan and antioxidant responses [
51]. These findings have also been recently confirmed by our identification of genome-wide parallels between the extremely short-lived DNA repair mutants (
Csbm/m/Xpa−/− and
Ercc1−/−) and the extremely long-lived Ames and Snell dwarfs and growth hormone receptor knockout
(Ghr−/−) mice (Garinis
et al. manuscript in preparation). Last but not least, IGF1 plasma levels decline with age in humans and rodents [
52–
54]. Along with this hormonal shift, ageing cells surmount an intricate antioxidant defense response [
55,
56] that is thought to prevent the detrimental consequences of oxidative stress. Interestingly, the progressive, age-related decrease in the somatotroph axis has been suggested to confer a selective advantage by postponing the onset of age-related disease and prolonging lifespan through the reduction of toxic free radicals [
40].
How would repair-deficient mice benefit from such a response? During development, the mitogenic action of GH and IGF1 fuels cellular metabolism, thereby promoting tissue growth and function [
40,
57,
58]. A high metabolic activity, however, leads to higher oxygen consumption [
40] and may also increase the ROS burden through the parallel increase of mitochondrial electron transport, peroxisomal fatty acid metabolism, and/or microsomal cytochrome
P-450 enzymes [
59]. Despite antioxidant defense and DNA repair, oxidative DNA damage will still accumulate, leading to transcriptional stress, impaired replication, cellular senescence, malfunction or death and eventually to progressive loss of tissue homeostasis and organismal decline (, model). We hypothesize that complete abrogation of NER (by inactivation of
Xpa) renders TCR-deficient
Csbm/m mice unable to adequately cope with the increased burden of DNA damage in the transcribed strand of active genes. This triggers an adaptive response; i.e., reduction of metabolic activity through down-regulation of the GH/IGF1 axis to relieve the pressure on their genome. We interpret this as an attempt to limit the deleterious effects of arrested transcription, such as cellular senescence and death causing accelerated ageing. As a consequence, the initially normal growth becomes arrested soon after birth, leading to severe growth retardation. This scenario provides a plausible explanation for the growth defect in CS patients. However, this response is unable to fully compensate for the repair defect, and thus damage still accumulates to critical levels and triggers apoptosis and/or senescence, thereby leading to ageing-associated pathology such as neurodegeneration (as illustrated by the photoreceptor cells in
Csbm/m/Xpa−/− mice).
The conceptual link between DNA damage and the systemic adaptive response is supported by our observation that chronic exposure of wt mice to a sub-toxic dose of DEHP (a pro-oxidant that enhances the DNA damage load; [
60]) triggers a response similar to that observed in (untreated)
Csbm/m/Xpa−/− mice. Although DEHP at much higher concentrations has been previously documented to affect the endocrine function of the pituitary, proteome analysis revealed that synthesis of prolactin and growth hormone appears unaffected in DEHP-treated rats [
61]. This suggests that the observed suppression of genes associated with the somatotroph axis and oxidative metabolism in the liver of DEHP-exposed mice is triggered by DNA damage in the liver, rather than by a pituitary defect or hypothalamic defect.
As one would predict, other short-lived NER mouse models (e.g.,
Xpg and
Xpf mice [
62,
63]) or NER mutant mice with a milder progeroid phenotype could also show accelerated attenuation of the somatotrophic axis in response to their DNA repair defect. Indeed,
Ercc1−/− animals, carrying a combined NER/crosslink DNA repair defect and a lifespan of only a few weeks, demonstrate a remarkable genome-wide similarity in liver gene expression profiles with
Csbm/m/Xpa−/− mice (L. Niedernhofer, G. Garinis, A. Raams, A. Lalai, A. Rasile Robinson, et al., unpublished data), whereas
XpdXPCS/Xpa−/− and compound heterozygous
XpdTTD/XPCS/Xpa−/− mice contain lower serum IGF1 levels [
35]. Furthermore,
XpdTTD mice, which manifest accelerated ageing in many (but not all) organs and tissues, have recently been shown to display features related to a caloric restricted–like phenotype and suppression of the GH/IGF1 axis in a limited set of organs and tissues, stressing the segmental nature that is characteristic of all progeroid syndromes and the systemic nature of the response [
64]. Finally, proper glucose homeostasis and normal IGF1 levels were recently shown to require activity of Sirt6, a chromatin deacetylase that may promote DNA repair [
65]. Because ROS-mediated DNA damage appears to be the underlying cause of the
Csbm/m/Xpa−/− progeria, it is tempting to speculate that one can attenuate the premature onset of age-related features by directly counteracting the harmful byproducts of metabolism (ROS) and, consequently, DNA damage. An antioxidant-based nutraceutical intervention pilot study with
Csbm/m/Xpa−/− mice, aiming at extending lifespan and delaying onset of pathology, yielded promising results (I. van der Pluijm, R. Brandt, J. Hoeijmakers, G. van der Horst, unpublished data).