Mdm4 loss in mice expressing a p53 hypomorph alters tumor spectrum without improving survival

The p53 pathway is inactivated in most human cancers, and its reactivation in tumors appears as a promising therapeutic strategy. Overexpression of Mdm4, a p53 negative regulator, occurs in a significant fraction of human cancers. Mouse models were used to evaluate the therapeutic potential of strategies against Mdm4, and encouraging results were obtained for tumor cells in which Mdm4 overexpression prevents wild-type p53 to exert its tumor suppressive functions. However, missense mutations in the p53 gene occur in about half of human cancers, and 15% of such mutations lead to the expression of a mutant protein that retains partial activity. In this report, we used mouse models to address the therapeutic potential of strategies against Mdm4 in tumors expressing an hypomorphic p53 mutant. We found that, in an Rb(+/-) background promoting pituitary and thyroid tumors, decreased Mdm4 levels improved the survival of mice expressing wild-type p53, but not that of mice expressing p53(ΔP), a p53 hypomorph lacking the proline-rich domain. Importantly, however, most Rb(+/-) p53(ΔP/ΔP) mice developped pituitary adenomas, but these tumors were rare in Rb(+/-) p53(ΔP/ΔP) Mdm4(-/-) animals, because Mdm4 loss led to increased p21 levels, a suppressor of pituitary tumor growth. On the contrary, Rb(+/-) p53(ΔP/ΔP) and Rb(+/-) p53(ΔP/ΔP) Mdm4(-/-) mice developped anaplastic thyroid carcinomas at equal frequencies. Importantly, wild-type p53 represses the Plk1 gene, which encodes a promising therapeutic target in anaplastic thyroid carcinomas, and this repression is improved when Mdm4 levels are decreased. On the opposite, p53(ΔP) is a mediocre transcriptional repressor that is not improved by Mdm4 loss. In sum, depending on the tumor type, strategies against Mdm4 that work in cells expressing wild-type p53 may not work in cells expressing an hypomorphic p53. Furthermore, p53-mediated transcriptional repression should be considered when evaluating strategies to reactivate p53 in tumors.