Abstract Mutational signatures are imprints of pathophysiological processes arising through tumorigenesis. Here, we generate isogenic CRISPR-Cas9 knockouts (Δ) of 43 genes in human induced pluripotent stem cells, culture them in the absence of added DNA damage, and perform wholegenome sequencing of 173 daughter subclones. Δ OGG1 , Δ UNG , Δ EXO1 , Δ RNF168 , Δ MLH1 , Δ MSH2 , Δ MSH6 , Δ PMS1 , and Δ PMS2 produce marked mutational signatures indicative of being critical mitigators of endogenous DNA changes. Detailed analyses reveal that 8-oxo-dG removal by different repair proteins is sequence-context-specific while uracil clearance is sequencecontext-independent. Signatures of mismatch repair (MMR) deficiency show components of C&gt;A transversions due to oxidative damage, T&gt;C and C&gt;T transitions due to differential misincorporation by replicative polymerases, and T&gt;A transversions for which we propose a ‘reverse template slippage’ model. Δ MLH1 , Δ MSH6 , and Δ MSH2 signatures are similar to each other but distinct from Δ PMS2 . We validate these gene-specificities in cells from patients with Constitutive Mismatch Repair Deficiency Syndrome. Based on these experimental insights, we develop a classifier, MMRDetect, for improved clinical detection of MMR-deficient tumors.

Dissecting mutational mechanisms underpinning signatures caused by replication errors and endogenous DNA damage