IntroductionAdenosine deaminase (ADA) catalyzes the irreversible deamination of adenosine and deoxyadenosine to inosine and deoxyinosine, respectively. Mutations in the ADA gene that result in loss of enzyme activity cause severe combined immunodeficiency (1). Biochemical aberrations due to ADA deficiency have been delineated over the past 30 years, but it is still unclear why loss of this enzyme activity exhibits such profound effects on the immune system (reviewed in ref. 2). Adenosine and deoxyadenosine, the substrates of ADA, are generated in the microenvironment of emerging thymocytes through normal mechanisms of lymphocyte selection. Thymocytes failing developmental checkpoints die and are degraded by thymic macrophages (3) generating adenosine and deoxyadenosine (4, 5). In a normal thymus, ADA catabolizes these metabolites, but in ADA deficiency they accumulate (6, 7) and exert lymphotoxic effects either directly (2) or after conversion to phosphorylated derivatives such as AMP and dATP (2,(8)(9)(10)(11). In an environment where up to 95% of the cells undergo programmed cell death, it is easy to visualize the potential of a cell to accumulate toxic levels of purine metabolites.ADA-deficient murine fetal thymic organ culture (FTOC) is an excellent model of the human disease (12) because it exhibits many biochemical features of ADA-deficient patients, including ADA substrate and dATP accumulation as well as S-adenosylhomocysteine (SAH) hydrolase inhibition. Furthermore, the yield of thymocytes from ADA-deficient cultures is 85-95% less than in control cultures, with thymocyte development becoming progressively more impaired Thymocyte development past the CD4 -CD8 -stage is markedly inhibited in adenosine deaminase-deficient (ADA-deficient) murine fetal thymic organ cultures (FTOCs) due to the accumulation of ADA substrates derived from thymocytes failing developmental checkpoints. Such cultures can be rescued by overexpression of Bcl-2, suggesting that apoptosis is an important component of the mechanism by which ADA deficiency impairs thymocyte development. Consistent with this conclusion, ADA-deficient FTOCs were partially rescued by a rearranged T cell receptor β transgene that permits virtually all thymocytes to pass the β-selection checkpoint. ADA-deficient cultures were also rescued by the adenosine kinase inhibitor 5′-amino-5′-deoxyadenosine (5′A5′dAdo), indicating that the metabolite responsible for the inhibition of thymocyte development is not adenosine or deoxyadenosine, but a phosphorylated derivative of an ADA substrate. Correction of ADA-deficient FTOCs by 5′A5′dAdo correlated with reduced accumulation of dATP, implicating this compound as the toxic metabolite. In ADA-inhibited FTOCs rescued with a Bcl-2 transgene, however, dATP levels were superelevated, suggesting that cells failing positive and negative selection continued to contribute to the accumulation of ADA substrates. Our data are consistent with dATP-induced mitochondrial cytochrome c release followed by apoptosis as the mechanism b...