showing cells with abnormal p53 expression (brown) in a brain tumor.
p53 immunostain. If the
TP53 gene is damaged, its ability to suppress tumors is severely compromised. Individuals who inherit only one functional copy of
TP53 are predisposed to developing tumors in early adulthood, a condition known as
Li–Fraumeni syndrome. The
TP53 gene can also be altered by
mutagens—such as
chemicals,
radiation, or certain
viruses—thereby increasing the likelihood of uncontrolled cell division. More than 50 percent of human
tumors harbor a
mutation or
deletion of the
TP53 gene. Loss of p53 function leads to genomic instability, frequently resulting in an
aneuploidy phenotype. Certain pathogens can also disrupt p53 activity. For example,
human papillomavirus (HPV) produces the viral protein
E6, which binds to and inactivates p53. In conjunction with the HPV protein
E7, which inactivates the cell cycle regulator
pRb, this promotes repeated cell division, clinically presenting as
warts. High-risk HPV types, particularly types 16 and 18, can drive the progression from benign warts to low- or high-grade
cervical dysplasia, reversible precancerous lesions. Persistent cervical infection can lead to irreversible changes, including
carcinoma in situ and invasive cervical cancer. These outcomes are primarily driven by viral integration into the host genome and the continued expression of the E6 and E7 oncoproteins.
Mutations Most p53 mutations are detected by DNA sequencing. However, it is known that single missense mutations can have a large spectrum from rather mild to very severe functional effects. (A) Wild-type p53 forms homotetramers that activate gene expression. (B) Dominant-negative mutants form heterotetramers with wild-type p53, impairing transcription in heterozygous states (p53mut/+). (C) Loss-of-function arises from complete inactivation of wild-type alleles and inactivity of the mutant protein. (D) Gain-of-function mutations confer neomorphic activities, such as hijacking other transcription factors, promoting tumorigenesis. Abbreviation: WT, wild type. TP53 mutation also hits energy metabolism and increases glycolysis in breast cancer cells.
Codon 72 variations A common human
polymorphism in
TP53 involves a substitution of
arginine for
proline at codon 72 of exon 4. Numerous studies have explored the relationship between this variation and cancer susceptibility, yielding mixed results. For instance, a 2009 meta-analysis found no association between the codon 72 polymorphism and cervical cancer risk. Other studies have identified possible associations between the codon 72 polymorphism and various cancers. A 2011 study reported that the proline variant significantly increased pancreatic cancer risk in males. Another study found that proline homozygosity was associated with decreased breast cancer risk in Arab women. Additional research suggested that
TP53 codon 72 polymorphisms, in combination with
MDM2 SNP309 and
A2164G, may affect susceptibility and age of onset for non-oropharyngeal cancers in women. A separate 2011 study linked the polymorphism to an increased risk of lung cancer in a Korean population. However, meta-analyses published in 2011 found no significant associations between the codon 72 variant and risks of either colorectal or endometrial cancer. A study of a Brazilian birth cohort found an association between the arginine variant and individuals without a family history of cancer. Meanwhile, another study reported that individuals with the homozygous Pro/Pro genotype had a significantly increased risk of renal cell carcinoma.
Therapeutic reactivation and gene therapy While increasing p53 levels might appear beneficial for treating cancer, sustained p53 activation can cause premature aging. A more promising approach involves restoring normal,
endogenous p53 function. In some tumor types, this leads to regression via apoptosis or normalization of cell growth. The first commercial gene therapy,
Gendicine, was approved in China in 2003 for
head and neck squamous cell carcinoma. It delivers a functional copy of the
TP53 gene using a modified
adenovirus. The small-molecule inhibitor MI-63 can bind to
MDM2, blocking its interaction with p53 and reactivating p53 in cancers where its function is suppressed.
Diagnostic and prognostic significance for p53 can help distinguish a
papillary urothelial neoplasm of low malignant potential (PUNLMP) from a low grade
urothelial carcinoma. Overexpression is seen in 75% of low-grade urothelial carcinomas and only 10% of PUNLMP. == Discovery ==