title: The influence of DNA repair on neurological degeneration, cachexia, skin cancer and internal neoplasms: autopsy report of four xeroderma pigmentosum patients (XP-A, XP-C and XP-D).
abstract: BACKGROUND
  To investigate the association of DNA nucleotide excision repair (NER) defects with neurological degeneration, cachexia and cancer, we performed autopsies on 4 adult xeroderma pigmentosum (XP) patients with different clinical features and defects in NER complementation groups XP-A, XP-C or XP-D.
  
  
  RESULTS
  The XP-A (XP12BE) and XP-D (XP18BE) patients exhibited progressive neurological deterioration with sensorineural hearing loss. The clinical spectrum encompassed severe cachexia in the XP-A (XP12BE) patient, numerous skin cancers in the XP-A and two XP-C (XP24BE and XP1BE) patients and only few skin cancers in the XP-D patient. Two XP-C patients developed internal neoplasms including glioblastoma in XP24BE and uterine adenocarcinoma in XP1BE. At autopsy, the brains of the 44 yr XP-A and the 45 yr XP-D patients were profoundly atrophic and characterized microscopically by diffuse neuronal loss, myelin pallor and gliosis. Unlike the XP-A patient, the XP-D patient had a thickened calvarium, and the brain showed vacuolization of the neuropil in the cerebrum, cerebellum and brainstem, and patchy Purkinje cell loss. Axonal neuropathy and chronic denervation atrophy of the skeletal muscles were observed in the XP-A patient, but not in the XP-D patient.
  
  
  CONCLUSIONS
  These clinical manifestations and autopsy findings indicate advanced involvement of the central and peripheral nervous system. Despite similar defects in DNA repair, different clinicopathological phenotypes are seen in the four cases, and therefore distinct patterns of neurodegeneration characterize XP-D, XP-A and XP-C patients.
authors.affiliation: DNA Repair Section, Dermatology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, 20892, USA. kraemerk@nih.gov.
authors.forename: Jin-Ping
authors.initials: JP
authors.lastname: Lai
authors.forename: Yen-Chun
authors.initials: YC
authors.lastname: Liu
authors.forename: Meghna
authors.initials: M
authors.lastname: Alimchandani
authors.forename: Qingyan
authors.initials: Q
authors.lastname: Liu
authors.forename: Phyu Phyu
authors.initials: PP
authors.lastname: Aung
authors.forename: Kant
authors.initials: K
authors.lastname: Matsuda
authors.forename: Chyi-Chia R
authors.initials: CC
authors.lastname: Lee
authors.forename: Maria
authors.initials: M
authors.lastname: Tsokos
authors.forename: Stephen
authors.initials: S
authors.lastname: Hewitt
authors.forename: Elisabeth J
authors.initials: EJ
authors.lastname: Rushing
authors.forename: Deborah
authors.initials: D
authors.lastname: Tamura
authors.forename: David L
authors.initials: DL
authors.lastname: Levens
authors.forename: John J
authors.initials: JJ
authors.lastname: Digiovanna
authors.forename: Howard A
authors.initials: HA
authors.lastname: Fine
authors.forename: Nicholas
authors.initials: N
authors.lastname: Patronas
authors.forename: Sikandar G
authors.initials: SG
authors.lastname: Khan
authors.forename: David E
authors.initials: DE
authors.lastname: Kleiner
authors.forename: J Carl
authors.initials: JC
authors.lastname: Oberholtzer
authors.forename: Martha M
authors.initials: MM
authors.lastname: Quezado
authors.forename: Kenneth H
authors.initials: KH
authors.lastname: Kraemer
mesh_terms: D000328:Adult; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology; D002100:Cachexia / Q000235:genetics / Q000473:pathology / Q000503:physiopathology*; D004260:DNA Repair; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009410:Nerve Degeneration / Q000235:genetics / Q000473:pathology / Q000503:physiopathology*; D012878:Skin Neoplasms / Q000235:genetics / Q000473:pathology / Q000503:physiopathology*; D014057:Tomography, X-Ray Computed; D014983:Xeroderma Pigmentosum / Q000235:genetics / Q000473:pathology / Q000503:physiopathology*