Hereditary mutations in
polynucleotide kinase-
phosphatase (PNKP) result in a spectrum of neurological pathologies ranging from neurodevelopmental dysfunction in
microcephaly with early onset
seizures (MCSZ) to neurodegeneration in
ataxia oculomotor apraxia-4 (AOA4) and
Charcot-Marie-Tooth disease (
CMT2B2). Consistent with this, PNKP is implicated in the repair of both
DNA single-strand breaks (SSBs) and
DNA double-strand breaks (DSBs); lesions that can trigger neurodegeneration and neurodevelopmental dysfunction, respectively. Surprisingly, however, we did not detect a significant defect in
DSB repair (DSBR) in primary fibroblasts from PNKP patients spanning the spectrum of PNKP-mutated pathologies. In contrast, the rate of SSB repair (SSBR) is markedly reduced. Moreover, we show that the restoration of SSBR in patient fibroblasts collectively requires both the
DNA kinase and
DNA phosphatase activities of PNKP, and the fork-head associated (FHA) domain that interacts with the SSBR
protein, XRCC1. Notably, however, the two enzymatic activities of PNKP appear to affect different aspects of disease pathology, with reduced
DNA phosphatase activity correlating with neurodevelopmental dysfunction and reduced
DNA kinase activity correlating with neurodegeneration. In summary, these data implicate reduced rates of SSBR, not DSBR, as the source of both neurodevelopmental and neurodegenerative pathology in PNKP-mutated disease, and the extent and nature of this reduction as the primary determinant of disease severity.