LIG4 syndrome or ligase IV syndrome is an extremely rare condition caused by mutations in the DNA ligase IV (LIG4) gene. Some mutations in this gene are associated with a resistance against multiple myeloma and severe combined immunodeficiency. Severity of symptoms depends on the degree of reduced enzymatic activity of Ligase IV or gene expression. Ligase IV is a critical component of the non-homologous end joining (NHEJ) mechanism that repairs DNA double-strand breaks. It is employed in repairing DNA double-strand breaks caused by reactive oxygen species produced by normal metabolism, or by DNA damaging agents such as ionizing radiation. NHEJ is also used to repair the DNA double-strand break intermediates that occur in the production of T and B lymphocyte receptors.