We found that
Blm deficiency reduced the survival of
Ptch1+/− mice, largely via significantly enhanced RMS tumor formation, with reduced tumor latency and increasing tumor number. Blm deficiency also significantly enhanced the development of microscopic BCC-like tumors, albeit not of visible BCCs. Similar to our findings of mutant
Blm alleles enhancing tumorigenesis in
Ptch1+/− mice, mutant
Blm alleles have been reported to enhance by 2- to 3-fold intestinal tumor formation in
Apc +/min mice but, as in our study, did not alter the histology of the tumors (
19,
20). Similarly,
Blmtm3Brd/tm3Brd mice develop far more hematologic malignancies than do
Blm wild-type mice, an increase similar to that induced by ionizing radiation, and the incidence is enhanced in a multiplicative fashion by the two (
26). Thus, genetically engineered mice with mutated
Blm alleles develop cancers of the same types as occur in
Blm+/+ mice. Similarly, human Bloom syndrome patients have an abnormally high incidence of cancers, and of 100 such cancers in 168 persons, the range of tumor types was not significantly different from that in sporadic cases (
27). One Bloom syndrome patient with many BCCs has been reported (
28), but no data on
BLM sequences in BCCs have been published. Patients heterozygous for a mutant
BLM allele have been reported to have an increased incidence of cancers of various types (
29,
30). Hence,
Blm appears to act as a ‘caretaker’ with respect to many types of cancers as opposed to a ‘gatekeeper’ whose loss enhances the incidence of a more limited range of cancers.
Age and hair cycle phase at irradiation time point can affect murine
Ptch1+/− BCC carcinogenesis, with increased BCCs if ionizing radiation is given specifically during anagen (
31). In our study, we did not control specifically for follicular phase.
Bloom syndrome cells have an increased frequency of somatic mutations (
32,
33), micronucleus formation (
34) and homologous recombination (
35). Chromosome instability in this syndrome is characterized by a striking tendency for spontaneous exchanges between DNA strands. These exchanges occur either within chromosomes, termed sister-chromatid exchanges or between chromosomes at homologous sites (
36). Sister-chromatid exchanges, the genetic hallmark of Bloom syndrome, cause chromosomal rearrangements such as duplications, deletions and translocations if they occur either unequally using identical sequences or between non-identical repeat sequences (
37). The somatic recombination leads to homozygosity, hemizygosity or partial loss of the expression, e.g. of tumor suppressor genes in Bloom Syndrome cells (
33). Mitotic recombination in Bloom Syndrome cells that are heterozygous for tumor suppressor genes may result in daughter cells homozygous or hemizygous for a mutant allele (
38,
39), and this increased tendency for loss of wild-type alleles may explain at least part of the cancer predisposition in Bloom syndrome patients (
40).
Blm appears to function primarily in DNA repair, especially in reducing error-prone homologous recombination, e.g. following double-strand DNA breaks. Blm protein localizes to foci at double-strand DNA breaks with p-ATM, p-CHK1 and 53BP1 and is capable of binding directly to 53BP1 and CHK1(
41). Cells lacking Blm protein appear to have increased activation of their endogenous DNA damage response with increased numbers of the latter such foci (
42), and this finding suggests that Blm protein normally participates in repair of DNA damage and that its absence delays such resolution.
Like the
Blm gene, hypomorphic alleles of the gene encoding another enzyme particularly active in double-strand DNA breakage repair, the Nijmegen breakage syndrome gene (
Nbs1ΔB), also induced relatively little qualitative change in intestinal tumorigenesis in
Apcmin/+min mice. Although they did not test for chromosomal instability, the authors of that study hypothesized that reduction in
Nbs1 activity may not lead to genetic instability in epithelial cells of the intestine. (
43). Indeed, knockdown of Blm protein expression in human colorectal carcinoma cell lines did not cause chromosomal aberrations (
35,
44). These observations are consistent with our findings of a lack of extensive DNA copy number aberrations in either BCC or RMS tumors in our
Ptch1+/− mice with mutant
Blm alleles (); however, CGH does not detect all types of genome instability.
The BCC and RMS tumors differed markedly in their spectra of copy number alterations, including loss of chromosomes 4 and 13 in all BCCs and gain of chromosome 10 in 80% of RMS tumors. In addition, losses of chromosomes 10 and 11, including the
Gli1 and
Trp53 loci, respectively, were observed in 50% of BCCs (). Since
Gli1 is one of the transcriptional effectors of hedgehog signaling, selection for its loss in BCCs would not be expected. Indeed, in only one of the three cases was the entire chromosome lost, in the other two
Gli1 was excluded from the large minimal region of deletion defined by the extent of the copy number loss. The marked difference we found in loss of chromosome 13, the site of the murine
Ptch1 gene, between BCC and RMS tumors is consistent with past findings of frequent, albeit not uniform, retention of the wild-type gene in RMS tumors. Some evidence suggests that in such RMS tumors with both wild-type and mutant alleles, most of the expressed Ptch1 messenger RNA is encoded by the mutant allele, perhaps reflecting epigenetic silencing of the wild-type allele (
45,
46).
A role for Blm protein in maintaining genomic integrity is certain, but the mechanism by which
Blm loss enhances BCC and RMS tumorigenesis in
Ptch1+/− mice and the connection between genomic stability and tumor behavior remain open to conjecture (
47,
48).