Which one of the following is a genetic disorder that causes severe intellectual disability when a destructive chemical accumulates?

Viruses survive by injecting their genetic material into living cells with the consequence that the biochemical machinery of the host cell is subverted from serving its own needs to serving the needs of the virus. During this process the viral genome often integrates itself into the genome of the host cell. This integration, or insertion, can occur either in the intergenic regions that make up the vast majority of human genomes, or it can occur in the middle of an important regulatory sequence or even in the region coding for a protein—i.e., a gene. In either of the latter two scenarios, the regulation or function of the interrupted gene is lost. If that gene encodes a protein that normally regulates cell division, the result may be unregulated cell growth and division. Alternatively, some viruses carry dominant oncogenes in their genomes, which can transform an infected cell and start it on the path toward cancer. Furthermore, viruses can cause mutations leading to cancer by the killing of the infected cell. Indeed, one of the body’s defenses against viral infection involves recognizing and killing infected cells. The death of cells necessitates their replacement by the division of uninfected cells, and the more cell division that occurs, the greater the likelihood of a mutation arising from the small but finite infidelity in DNA replication. Among the viruses that can cause cancer are Epstein-Barr virus, papilloma viruses, hepatitis B and C viruses, retroviruses (e.g., human immunodeficiency virus), and herpes virus.

During the ongoing struggle for survival, organisms have evolved toxic compounds as protection against predators or simply to gain competitive advantage. At the same time, these organisms have evolved mechanisms that make themselves immune to the effects of the toxins that they produce. Plants in particular utilize this strategy since they are rooted in place and cannot escape from predators. One-third of the dry weight of some plants can be accounted for by the toxic compounds that are collectively referred to as alkaloids. Aspergillus flavus, a fungus that grows on stored grain and peanuts, produces a powerful carcinogen called aflatoxin that can cause liver cancer. Bacteria produce many proteins that are toxic to the infected host, such as diphtheria toxin. They also produce proteins called bacteriocins that are toxic to other bacteria. Toxins can cause mutations indirectly by causing cell death, which necessitates replacement by cell division, thus enhancing the opportunity for mutation. Cyanobacteria that grow in illuminated surface water produce several carcinogens, such as microcystin, saxitoxin, and cylindrospermopsin, that can also cause liver cancer.

Tens of thousands of different chemicals are routinely used in the production of plastics, fuels, food additives, and even medicines. Many of these chemicals are mutagens, and some have been found to be carcinogenic (cancer-producing) in rats or mice. A relatively easy and inexpensive test for mutagenicity, the Ames test, utilizes mutant strains of the bacterium Salmonella typhimurium and can be completed in a few days. Testing for carcinogenesis, on the other hand, is very time-consuming and expensive because the test substance must be administered to large numbers of laboratory animals, usually mice, for months before the tissues can be examined for cancers. For this reason, the number of known mutagens far exceeds the number of known carcinogens. Furthermore, animal tests for carcinogenesis are not completely predictive of the effects of the test chemical on humans for several reasons. First, the abilities of laboratory animals and humans to metabolize and excrete specific chemicals can differ greatly. In addition, in order to avoid the need to test each chemical at a range of doses, each chemical is usually administered at the maximum tolerated dose. At such high doses, toxicity and cell death occur, necessitating cell replacement by growth and cell division; cell division, in turn, increases the opportunity for mutation and hence for cancer. Alternatively, unusually high doses of a chemical may actually mask the carcinogenic potential of a compound because damaged cells may die rather than survive in mutated form.

The burning of fossil fuels quite literally powers modern industrial societies. If the combustion of such fuels were complete, the products would be carbon dioxide and water. However, combustion is rarely complete, as is evidenced by the visible smoke issuing from chimneys and from the exhausts of diesel engines. Moreover, in addition to the particulates that we can see, incomplete combustion produces a witch’s brew of volatile compounds that we do not see; and some of these, such as the dibenzodioxins, are intensely mutagenic and have been demonstrated to cause cancer in laboratory rodents. Epidemiological data indicate that dioxins are associated with increased risk of a variety of human cancers. The health consequences of combustion are further increased by impurities in fossil fuels and in the oxygen that supports their burning. For example, coal contains sulfur, mercury, lead, and other elements in addition to carbon. During combustion, sulfur becomes sulfur dioxide and that, in turn, gives rise to sulfurous and sulfuric acids. The mercury in the fuel is emitted as a vapour that is very toxic. Atmospheric nitrogen is oxidized at the high temperature of combustion.

The smoke from a cigarette, drawn directly into the lungs, imparts a large number of particulates, as well as a host of volatile compounds, directly into the airways and alveoli. Some of the volatile compounds are toxic in their own right and others, such as hydroquinones, slowly oxidize, producing genotoxic free radicals. As macrophages in the lungs attempt to engulf and eliminate particulates, they cause the production of mutagenic substances. A large fraction of lung cancers are attributable to cigarette smoking, which is also a risk factor for atherosclerosis, hypertension (high blood pressure), heart attack, and stroke.

Moderate consumption of alcohol (ethanol) is well-tolerated and may even increase life span. However, alcohol is a potentially toxic substance and one of its metabolites, acetaldehyde, is a mild mutagen. Hence, it is not surprising that the chronic consumption of alcohol leads to liver cirrhosis and other untoward effects. Consumption of alcohol during pregnancy can cause fetal alcohol syndrome, which is characterized by low birth weight, intellectual disability, and congenital heart disease.