Detection of TP53 dysfunction in chronic lymphocytic leukemia by an in vitro functional assay based on TP53 activation by the non-genotoxic drug Nutlin-3: A proposal for clinical application

Federico Pozzo, Nadia Peragine, Riccardo Bomben, Antonella Zucchetto, Francesca Maria Rossi, Massimo Degan, Davide Rossi, Annalisa Chiarenza, Alberto Grossi, Francesco Di Raimondo, Francesco Zaja, Gabriele Pozzato, Paola Secchiero, Gianluca Gaidano, Giovanni Del Poeta, Giorgio Zauli, Robin Foà, Anna Guarini, Valter Gattei, Michele Dal Bo

Research output: Contribution to journalArticlepeer-review


Background: TP53 defects, i.e. 17p13 deletion and/or nucleotide mutations, associate with short survival and chemorefractoriness in chronic lymphocytic leukemia (CLL). In this context, since direct sequencing of the TP53 gene does not evaluate TP53 functionality, a functional assessment of TP53 pathway may be of interest to identify high risk CLL. By taking advantage of a training cohort of 100 CLL and a validation cohort of 40 CLL with different patterns of TP53 mutation/deletion by FISH and sequencing, we propose an in-vitro assay in which the modulation of TP53 protein and CDKN1A mRNA were investigated upon 24-hour exposure of CLL cells to Nutlin-3. Methods. The functional assay was set-up on cell lines recapitulating all TP53 genotypes (EHEB, TP53 wt/wt; RAJI, TP53 mut/wt; MEC-1 and MAVER1, TP53 mut/del; HL-60, TP53 del/del) and evaluated in two multi-institutional cohorts, purposely enriched in CLL bearing TP53 disruption: a training cohort of 100 cases and a validation cohort of 40 cases, both characterized by FISH and TP53 direct sequencing. Cells were exposed to 10 μM Nutlin-3 for 24 hours; TP53 accumulation was evaluated by Western blotting; TP53 transcriptional activity was determined by quantitative realtime PCR (qRT-PCR) of the TP53 target gene CDKN1A. Results: According to TP53 protein modulation, in the training cohort we identified: i) 63 cases (51 TP53 wt/wt, 12 TP53 del/wt) with absence of basal TP53 and induction after treatment (normal pattern); ii) 18 cases (3 TP53 mut/wt, 15 TP53 mut/del) with high basal TP53 without increase after treatment (mutant pattern); iii) 19 cases (5 TP53 mut/wt; 3 TP53 mut/del; 11 TP53 wt/wt) with basal TP53 that increases upon treatment (intermediate pattern). Evaluation of CDKN1A mRNA levels upon Nutlin-3 exposure showed that the 26 TP53 mutated (TP53 mut/del or TP53 mut/wt) cases had lower induction levels than the majority (57/63) of cases with normal pattern, and 10/12 cases with intermediate pattern without evidence of TP53 derangement by FISH and sequencing. These results were confirmed in the independent validation cohort of 40 cases (13 TP53 wt/wt, 3 TP53 del/wt, 12 TP53 mut/del, 12 TP53 mut/wt). Conclusions: The proposed functional assay may integrate the conventional analyses for the identification of TP53 dysregulated CLL.

Original languageEnglish
Article number83
JournalJournal of Hematology and Oncology
Issue number1
Publication statusPublished - 2013


  • CLL
  • Prognosis
  • TP53

ASJC Scopus subject areas

  • Hematology
  • Oncology
  • Cancer Research
  • Molecular Biology


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