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J Clin Pathol 63:204-209 doi:10.1136/jcp.2009.070961
  • Review

Pharmacological activation of the p53 pathway in haematological malignancies

  1. Hong Chang1,2,4
  1. 1Division of Cellular and Molecular Biology, Toronto General Hospital Research Institute, University of Toronto, Canada
  2. 2Department of Laboratory Medicine & Pathobiology, University of Toronto, Canada
  3. 3Institute of Hematology and Blood Disease Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
  4. 4Department of Laboratory Hematology, University Health Network, Toronto, Canada
  1. Correspondence to Dr Hong Chang, Department of Laboratory Hematology, Toronto General Hospital, University Health Network, 200 Elizabeth Street, 11E-413, Toronto, Ontario M5G 2C4, Canada; Hong.Chang{at}uhn.on.ca
  • Accepted 9 November 2009
  • Published Online First 2 December 2009

Abstract

p53 gene mutations are rarely detected at diagnosis in common haematological cancers such as multiple myeloma (MM), acute myeloid leukaemia (AML), chronic lymphocytic leukaemia (CLL) and Hodgkin's disease (HD), although their prevalence may increase with progression to more aggressive or advanced stages. Therapeutic induction of p53 might therefore be particularly suitable for the treatment of haematological malignancies. Some of the anti-tumour activity of current chemotherapeutics has been derived from activation of p53. However, until recently it was unknown whether p53 signalling is functional in certain haematological cancers including MM and if p53 activity is sufficient to trigger an apoptotic response. With the recent discovery of nutlins, which represent the first highly selective small molecule inhibitors of the p53–MDM2 interaction, pharmacological tools are now available to induce p53 irrespective of upstream signalling defects, and to functionally analyse the downstream p53 pathway in primary leukaemia and lymphoma cells. Combination therapy is emerging as a key factor, and development of non-genotoxic combinations seems very promising for tackling the problems of toxicity and resistance. This review will highlight recent findings in the research into molecules capable of modulating p53 protein activities and mechanisms that activate the p53 pathway, restoring response to therapy in haematological malignancies.

Footnotes

  • Funding This study was funded in part by Canadian Institute of Health Research (CIHR) and Leukemia & Lymphoma Society of Canada (LLSC).

  • Competing interests None.

  • Provenance and peer review Commissioned; not externally peer reviewed.