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1 Functional analysis of the p53 pathway in neuroblastoma cells using the small-molecule MDM2 antagonist nutlin-3 Tom Van Maerken, 1,2 Ali Rihani, 1 Daniel Dreidax, 3 Sarah De Clercq, 4 Nurten Yigit, 1 Jean- Christophe Marine, 4 Frank Westermann, 3 Anne De Paepe, 1 Jo Vandesompele, 1 Frank Speleman 1 1 Center for Medical Genetics, Ghent University Hospital, Ghent, Belgium 2 Department of Clinical Chemistry, Microbiology and Immunology, Ghent University Hospital, Ghent, Belgium 3 Department of Tumor Genetics, German Cancer Research Center, Heidelberg, Germany 4 Laboratory for Molecular Cancer Biology, VIB-UGent, Ghent, Belgium Running title: Analysis of the p53 pathway in neuroblastoma Keywords: neuroblastoma, p53, nutlin-3, p14 ARF Abbreviations: CI, confidence interval; qPCR, quantitative real-time PCR; qRT-PCR, quantitative real-time reverse transcription PCR Grants: Research Foundation – Flanders (FWO), Concerted Research Actions – UGent (GOA), Interuniversity Attraction Poles – Belgium (IUAP), and Emmanuel van der Schueren Foundation. T. Van Maerken has conducted the study as Ph.D. fellow of the FWO. Correspondence: Tom Van Maerken, Center for Medical Genetics, Ghent University Hospital, De Pintelaan 185, B-9000 Ghent, Belgium. Phone: 32-9-332-0352; Fax: 32-9-332- 6549. E-mail: [email protected] Conflict-of-interest disclosure: None. on July 9, 2021. © 2011 American Association for Cancer Research. mct.aacrjournals.org Downloaded from Author manuscripts have been peer reviewed and accepted for publication but have not yet been edited. Author Manuscript Published OnlineFirst on April 1, 2011; DOI: 10.1158/1535-7163.MCT-10-1090
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  • 1

    Functional analysis of the p53 pathway in neuroblastoma cells using the

    small-molecule MDM2 antagonist nutlin-3∗

    Tom Van Maerken,1,2 Ali Rihani,1 Daniel Dreidax,3 Sarah De Clercq,4 Nurten Yigit,1 Jean-

    Christophe Marine,4 Frank Westermann,3 Anne De Paepe,1 Jo Vandesompele,1 Frank

    Speleman1

    1Center for Medical Genetics, Ghent University Hospital, Ghent, Belgium

    2Department of Clinical Chemistry, Microbiology and Immunology, Ghent University

    Hospital, Ghent, Belgium

    3Department of Tumor Genetics, German Cancer Research Center, Heidelberg, Germany

    4Laboratory for Molecular Cancer Biology, VIB-UGent, Ghent, Belgium

    Running title: Analysis of the p53 pathway in neuroblastoma

    Keywords: neuroblastoma, p53, nutlin-3, p14ARF

    Abbreviations: CI, confidence interval; qPCR, quantitative real-time PCR; qRT-PCR,

    quantitative real-time reverse transcription PCR

    ∗Grants: Research Foundation – Flanders (FWO), Concerted Research Actions – UGent (GOA), Interuniversity Attraction Poles – Belgium (IUAP), and Emmanuel van der Schueren Foundation. T. Van Maerken has conducted the study as Ph.D. fellow of the FWO. Correspondence: Tom Van Maerken, Center for Medical Genetics, Ghent University Hospital, De Pintelaan 185, B-9000 Ghent, Belgium. Phone: 32-9-332-0352; Fax: 32-9-332-6549. E-mail: [email protected] Conflict-of-interest disclosure: None.

    on July 9, 2021. © 2011 American Association for Cancer Research. mct.aacrjournals.org Downloaded from

    Author manuscripts have been peer reviewed and accepted for publication but have not yet been edited. Author Manuscript Published OnlineFirst on April 1, 2011; DOI: 10.1158/1535-7163.MCT-10-1090

    http://mct.aacrjournals.org/

  • 2

    Abstract

    Suppression of p53 activity is essential for proliferation and survival of tumor cells. A direct

    p53-activating compound, nutlin-3, was used in this study, together with p53 mutation

    analysis, to characterize p53 pathway defects in a set of 34 human neuroblastoma cell lines.

    We identified 9 cell lines (26%) with a p53 loss-of-function mutation, including 6 missense

    mutations, 1 nonsense mutation, 1 in-frame deletion, and 1 homozygous deletion of the 3′ end

    of the p53 gene. Sensitivity to nutlin-3 was highly predictive of absence of p53 mutation.

    Signaling pathways downstream of p53 were functionally intact in 23 out of 25 cell lines with

    wild-type p53. Knockdown and overexpression experiments revealed a potentiating effect of

    p14ARF expression on the response of neuroblastoma cells to nutlin-3. Our findings shed light

    on the spectrum of p53 pathway lesions in neuroblastoma cells, indicate that defects in

    effector molecules downstream of p53 are remarkably rare in neuroblastoma, and identify

    p14ARF as a determinant of the outcome of the response to MDM2 inhibition. These insights

    may prove useful for the clinical translation of evolving strategies aimed at p53 reactivation

    and for the development of new therapeutic approaches.

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    Author manuscripts have been peer reviewed and accepted for publication but have not yet been edited. Author Manuscript Published OnlineFirst on April 1, 2011; DOI: 10.1158/1535-7163.MCT-10-1090

    http://mct.aacrjournals.org/

  • 3

    Introduction

    The p53 transcription factor plays a critical role in the cellular defense against malignant

    transformation by promoting cell cycle arrest, DNA damage repair, apoptosis, and senescence

    in response to stress signals (1). Tumor cells therefore invariably acquire aberrations that

    permit them to escape from p53-mediated growth control. It is estimated that approximately

    50% of all human cancers harbor inactivating mutations in the TP53 (p53) gene, whereas

    defects in upstream or downstream components of the p53 pathway are believed to account

    for loss of p53 activity in the other half of malignancies. Dissection of the p53 pathway

    defects in individual tumor types is important, since improved understanding of the

    mechanisms behind p53 inactivation may guide the development of targeted therapeutic

    strategies.

    Neuroblastoma is an aggressive childhood tumor of neural crest origin, that has a lethal

    outcome in the majority of high-risk patients (2). A remarkable feature is that p53 is rarely

    mutated at diagnosis and only in a minority of neuroblastoma tumors at relapse, as

    demonstrated by a recent study that found mutation rates of 2% and 15%, respectively (3).

    Conflicting data exist regarding p53 pathway signaling in neuroblastoma cells. The DNA

    damage-induced G1 checkpoint function and apoptotic activity of p53 have been reported to

    be impaired by cytoplasmic p53 sequestration (4-6), which may be caused by p53

    hyperubiquitination (7). Furthermore, wild-type p53 in neuroblastoma cells may be in a

    conformation refractory to integration into transcriptional complexes, resulting in reduced

    transcriptional activity (8). In contrast, others have demonstrated a normal DNA-binding and

    transactivation capacity of the p53 protein and an intact p53 signal transduction pathway in

    neuroblastoma cells with wild-type p53 (9-11). No study has yet systematically investigated

    the functional integrity of the p53 pathway in neuroblastoma cells on a larger scale, as the

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    Author manuscripts have been peer reviewed and accepted for publication but have not yet been edited. Author Manuscript Published OnlineFirst on April 1, 2011; DOI: 10.1158/1535-7163.MCT-10-1090

    http://mct.aacrjournals.org/

  • 4

    reports mentioned above relied on the use of only one to five neuroblastoma cell lines to

    judge on p53 functionality.

    We have previously reported that a small-molecule MDM2 antagonist, nutlin-3, is capable of

    inducing potent antitumor effects against neuroblastoma cells and xenografts with wild-type

    p53, which may provide a new opportunity for targeted therapeutic intervention (12, 13).

    Nutlin-3 is designed to compete with p53 for binding into a hydrophobic pocket on the

    surface of MDM2 (14). The resulting disruption of the interaction between both proteins

    releases p53 from negative control by MDM2, which functions as an E3 ubiquitin ligase to

    promote p53 proteasomal degradation and as an inhibitor of p53 transcriptional activity.

    Treatment with nutlin-3 thus leads to stabilization and activation of p53 and, if downstream

    effectors are functionally intact, to a robust p53 response.

    The availability of a direct and selective p53 activator makes it possible to systematically

    search for defects in p53 and its downstream signaling components. Here, we set out to

    examine the nature of p53 pathway defects in a large panel of neuroblastoma cell lines using

    nutlin-3 as a tool for interrogating the functionality of the p53 pathway.

    on July 9, 2021. © 2011 American Association for Cancer Research. mct.aacrjournals.org Downloaded from

    Author manuscripts have been peer reviewed and accepted for publication but have not yet been edited. Author Manuscript Published OnlineFirst on April 1, 2011; DOI: 10.1158/1535-7163.MCT-10-1090

    http://mct.aacrjournals.org/

  • 5

    Materials and Methods

    Cell culture and nutlin-3 treatment

    Human neuroblastoma cell lines were obtained between 1993 and 2010 from Peter Ambros

    (STA-NB-1.2, STA-NB-3, STA-NB-8, STA-NB-9, STA-NB-10), Garrett Brodeur (NGP,

    NLF, NMB), Susan Cohn (NBL-S, SHEP), Valérie Combaret (CLB-GA), Thomas Look

    (SJNB-1, SJNB-8, SJNB-10), John Lunec [SK-N-BE(1n), SK-N-BE(2c)], Sven Påhlman

    (SH-SY5Y), Patrick Reynolds (CHP-134, CHP-901, CHP-902R, SMS-KAN, SMS-KCNR),

    and Rogier Versteeg (GICIN-1, IMR-32, LA-N-1, LA-N-2, LA-N-5, LA-N-6, N-206, SK-N-

    AS, SK-N-FI, SK-N-SH, TR-14), or established in our laboratory (UHG-NP). The

    authenticity of the cell lines was verified during this study by array comparative genomic

    hybridization and short tandem repeat genotyping. Cell culturing and treatment with nutlin-3

    (Cayman Chemical, Ann Arbor, MI) were performed as previously described (12).

    p53 mutation analysis

    Sequencing of the p53 coding region was performed as previously described (12).

    Cell viability analysis

    Cells were seeded in duplicate or triplicate wells of a 96-well plate (104 cells per well) and

    incubated for 6 h before treatment was initiated. Treatment typically consisted of exposure to

    0, 2, 4, 8, 16, and 32 µM nutlin-3 for 24, 48, and 72 h, except for experiments with inducible

    model systems, in which the inducing agent or a negative control was applied for 16 h prior to

    incubation with nutlin-3. Cell viability was measured using a luminescent ATP-based assay

    (CellTiter-Glo, Promega, Madison, WI).

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    http://mct.aacrjournals.org/

  • 6

    Analysis of caspase-3 and caspase-7 activity

    Cells were plated in duplicate or triplicate wells of a 96-well plate (104 cells per well) and

    incubated for 6 h prior to treatment, which was performed in a similar way as described for

    the cell viability experiments. The combined activity of caspase-3 and caspase-7 was

    determined using the Caspase-Glo 3/7 assay (Promega).

    Cell cycle and hypodiploidy analysis

    Measurements of cell cycle phase distribution and hypodiploid (sub-G1) DNA content were

    performed as previously described (13).

    Quantitative real-time reverse transcription PCR (qRT-PCR)

    Cells were treated with 0 or 8 µM nutlin-3 for 24 h (or, in the case of an inducible model

    system, with the inducing agent or a negative control for 16 h and then with 0 or 8 µM nutlin-

    3 for an additional 24 h). Total RNA extraction, DNase treatment, cDNA synthesis, and

    SYBR Green I qRT-PCR were performed as previously described (13). Primer sequences are

    available in the RTPrimerDB database (15): BAX (RTPrimerDB ID #814), BBC3 (PUMA;

    #3500), CDKN1A (p21WAF1/CIP1; #631), GAPDH (#3), SDHA (#7), and UBC (#8). Expression

    levels of the p53 target genes BAX, PUMA, and p21WAF1/CIP1 were calculated using qbasePLUS

    software version 1.5 (Biogazelle, Ghent, Belgium) (16). Levels of GAPDH, SDHA, and UBC

    were used for normalization.

    Western blot analysis

    Western blotting was performed as previously described (12) using primary antibodies against

    p53 (mouse clone DO-1; Calbiochem, San Diego, CA), p21WAF1/CIP1 (mouse clone SX118;

    BD Biosciences, San Jose, CA), and BAX (rabbit monoclonal antibody; Upstate,

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    http://mct.aacrjournals.org/

  • 7

    Charlottesville, VA). An anti-β-actin antibody (mouse clone AC-74; Sigma, St. Louis, MO)

    was used to confirm equal loading.

    Knockdown and overexpression of CDKN2A (p16INK4a/p14ARF)

    See Supplementary Data.

    Statistical analysis

    See Supplementary Data.

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    http://mct.aacrjournals.org/

  • 8

    Results

    p53 mutation analysis

    The 34 human neuroblastoma cell lines used in this study were first characterized for

    mutations in the p53 gene. Sequencing of the entire coding region in two overlapping

    fragments demonstrated wild-type p53 in 25 cell lines (74%) and various genetic defects in

    the other 9 cell lines (26%) (Table 1). The most frequent aberrations were missense

    mutations, which were located in exon 5 [N-206, SK-N-BE(2c)], exon 6 (NLF), exon 7

    (NMB, SK-N-FI), and exon 10 (LA-N-2) of p53. One cell line, LA-N-1, was characterized by

    a nonsense mutation, resulting in a stop codon at amino acid residue 182. SJNB-8 cells were

    found to possess an in-frame deletion that removes the coding sequence for amino acids 105-

    125. The PCR step prior to the sequencing did not produce an amplicon for the second part of

    the p53 coding region in SK-N-AS cells. It could be shown by quantitative real-time PCR

    (qPCR) that this was due to a homozygous deletion of the 3′ end of p53 (Supplementary Fig.

    S1), in line with previously published findings (17, 18).

    Sensitivity to nutlin-3

    We next used the selective MDM2 antagonist nutlin-3 to test whether the p53 pathway was

    functional in our series of neuroblastoma cell lines. As illustrated in Fig. 1A, determination of

    the nutlin-3 concentration that causes 50% reduction in cell viability (IC50 value) provides a

    quantitative measure of the functional integrity of the p53 pathway. IC50 values were

    established at 24, 48, and 72 h of nutlin-3 treatment and correlated with the mutation status of

    p53 (Fig. 1B). Cell lines with wild-type p53 displayed highly significantly lower IC50 values

    than lines harboring mutant p53 (P=0.004 at 24 h, P

  • 9

    aberration effectively impaired the function of the p53 protein. Pronounced reductions in cell

    viability after nutlin-3 treatment and corresponding low IC50 values were observed in 23 out

    of the 25 cell lines with wild-type p53. This suggests that p53 downstream signaling pathways

    are not a major target for p53-inactivating lesions in neuroblastoma and lends support to the

    development of therapeutic strategies aimed at p53 reactivation.

    Two cell lines, LA-N-6 and SHEP, were relatively resistant to nutlin-3 despite the presence of

    wild-type p53 (IC50 values comparable to those observed in neuroblastoma lines with mutant

    p53, i.e., IC50 values >32 µM, >30 µM, and >20 µM nutlin-3 at 24, 48, and 72 h of treatment,

    respectively) (Fig. 1B). Of particular interest were SHEP cells, because their response to

    nutlin-3 was strikingly different from that of two closely related cell lines, SK-N-SH and SH-

    SY5Y. Cell line SK-N-SH was originally derived from bone marrow metastases of a patient

    with stage 4 neuroblastoma, and subcloning of these cells has generated several

    morphologically distinct sublines, including SHEP and SH-SY5Y (19). Fig. 2A demonstrates

    that nutlin-3 profoundly suppressed the viability of SK-N-SH and SH-SY5Y cells, whereas

    only mild effects were noted in SHEP cells. Further experiments were performed to determine

    whether the poor nutlin-3 response of SHEP cells was due to failure to enter apoptosis or to

    defective cell cycle arrest. Analysis of caspase-3 and caspase-7 activity indicated that a 24-h

    exposure to nutlin-3 induced a dose-dependent apoptotic response in SK-N-SH and SH-SY5Y

    cells (Fig. 2B). In contrast, no increase in caspase-3 and caspase-7 activity was observed in

    nutlin-3-treated SHEP cells. This was confirmed by flow cytometric analysis of sub-G1 DNA

    content after treatment with vehicle control or 8 µM nutlin-3 for 24 h, which showed a nutlin-

    3-induced increase in the apoptotic sub-G1 fraction in SK-N-SH and SH-SY5Y cells, but not

    in SHEP cells (Fig. 2C). Flow cytometric cell cycle profiling further demonstrated a reduction

    in the percentage of cells in S phase 24 h after treatment of SK-N-SH, SH-SY5Y, and SHEP

    cells with 8 µM nutlin-3, indicative of cell cycle arrest in all three cell lines (Fig. 2D). The

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    http://mct.aacrjournals.org/

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    phenotypic effects of nutlin-3 on apoptosis and cell cycle progression were paralleled by

    similar changes in expression levels of p53 target genes. As shown in Fig. 2E, a 24-h

    treatment of SK-N-SH and SH-SY5Y cells with 8 µM nutlin-3 induced an increase in the

    mRNA levels of p53 target genes involved in apoptosis (BAX, PUMA) and cell cycle arrest

    (p21WAF1/CIP1). A large increase in p21WAF1/CIP1 expression was also present in SHEP cells

    treated with 8 µM nutlin-3 for 24 h, but expression levels of the proapoptotic target genes

    BAX and PUMA remained considerably lower in nutlin-3-treated SHEP cells than in nutlin-3-

    treated SK-N-SH and SH-SY5Y cells. Similar findings were observed by Western blot

    analysis. Treatment with 8 µM nutlin-3 for 24 h induced p53 accumulation and increased

    expression of p21WAF1/CIP1 in all three cell lines, whereas induction of BAX expression was

    observed only in nutlin-3-treated SK-N-SH and SH-SY5Y cells (Fig. 2F). Taken together,

    these data indicate that SHEP cells have an intact cell cycle checkpoint control mechanism,

    but fail to undergo apoptosis in response to treatment with nutlin-3.

    Interestingly, SHEP cells have previously been reported to contain a homozygous deletion of

    the CDKN2A gene on chromosome 9p21, in contrast to SK-N-SH and SH-SY5Y cells (20).

    We confirmed the copy number status of CDKN2A in these three cell lines by qPCR

    (Supplementary Fig. S2). The CDKN2A gene encodes two structurally distinct growth-

    inhibitory proteins, p16INK4a and p14ARF, that are important regulators of the pRb and p53

    tumor suppressor pathways, respectively (21). This raised the possibility that the homozygous

    CDKN2A deletion may underlie the nutlin-3-resistant phenotype of SHEP cells. Analysis of

    the entire panel of 25 neuroblastoma cell lines with wild-type p53 further revealed that the

    presence of homozygous CDKN2A deletion was strongly associated with a higher IC50 value

    at 48 and 72 h of nutlin-3 treatment (P=0.009 and P0.05) (Supplementary Table S1). MYCN-

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    http://mct.aacrjournals.org/

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    amplified neuroblastoma cell lines with wild-type p53 were characterized by a lower IC50

    value at 72 h of nutlin-3 treatment than wild-type p53 neuroblastoma cell lines without MYCN

    amplification (P=0.023), but this difference was not observed anymore after exclusion of cell

    lines with homozygous CDKN2A deletion (P>0.05) (Supplementary Table S1). No significant

    difference in p53 mutation status nor in MDM2 and CDKN2A copy number status was found

    between MYCN-amplified and MYCN-nonamplified neuroblastoma cell lines (P>0.05)

    (Supplementary Table S2).

    Effect of CDKN2A knockdown on the response to nutlin-3

    A possible involvement of p14ARF and p16INK4a in the nutlin-3 response was first tested by

    transient knockdown of the CDKN2A gene in IMR-32 and NGP cells, two easy-to-transfect

    neuroblastoma cell lines that have a good and previously well-characterized nutlin-3 response

    (12), using a pool of siRNAs directed against sequences common to both p14ARF and p16INK4a

    transcripts. The efficiency of CDKN2A knockdown, measured by qRT-PCR 24 h

    posttransfection, is shown in Fig. 3A. Silencing of CDKN2A resulted in a moderate reduction

    in the sensitivity of IMR-32 and NGP cells to nutlin-3, as demonstrated by cell viability

    assays performed after 24, 48, and 72 h of exposure to nutlin-3 (Fig. 3B and C).

    To unravel whether this potentiating effect of CDKN2A expression on the response to nutlin-3

    was mediated by p14ARF or p16INK4a, NGP cells were infected with lentiviruses encoding a

    p14ARF-specific shRNA, a p16INK4a-specific shRNA, an shRNA directed simultaneously

    against both transcripts, or a negative control shRNA targeting firefly luciferase, and

    subsequently selected with puromycin to eliminate uninfected cells. qRT-PCR analysis of

    p14ARF and p16INK4a expression in the established sublines, termed NGP-LV-p14, NGP-LV-

    p16, NGP-LV-p14/p16, and NGP-LV-luc, respectively, demonstrated successful transcript-

    specific knockdown (Fig. 4A). Treatment of these stable knockdown cell lines with nutlin-3

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    followed by cell viability assays indicated that the influence of CDKN2A expression on the

    nutlin-3 response was primarily attributable to p14ARF (Fig. 4B). These findings were

    confirmed by analysis of caspase-3 and caspase-7 activity, which showed that silencing of

    p14ARF decreased the susceptibility of NGP cells to undergo apoptosis upon nutlin-3 treatment

    (Fig. 4C). Quantification of p53 target gene expression demonstrated that knockdown of

    p14ARF, but not p16INK4a, attenuated the p53 transcriptional response induced by a 24-h

    exposure to 8 µM nutlin-3 (Fig. 4D). This was accompanied by a marked p14ARF shRNA-

    induced decrease in the basal mRNA levels of PUMA and p21WAF1/CIP1 in vehicle-treated cells,

    whereas BAX expression was upregulated to a lesser extent by nutlin-3, rather than basically

    suppressed, when p14ARF was silenced.

    Effect of CDKN2A overexpression on the response to nutlin-3

    We next examined whether overexpression of CDKN2A could enhance the response of

    neuroblastoma cells to nutlin-3. We therefore generated stable transfectants of an IMR-32

    subclone, IMR-5/75, in which transgenic expression of either p14ARF or p16INK4a or, as a

    negative control, lacZ was inducible by addition of tetracycline. Fig. 5A shows the relative

    mRNA expression levels of p14ARF and p16INK4a in these sublines, designated as IMR-Tet-

    p14, IMR-Tet-p16, and IMR-Tet-lacZ, respectively, 24 h after treatment with tetracycline or

    vehicle control. Overexpression of p14ARF resulted in a more pronounced reduction in cell

    viability and stronger caspase-3 and caspase-7 activation following nutlin-3 treatment,

    whereas overexpression of p16INK4a or lacZ had no appreciable effect on the nutlin-3 response

    (Fig. 5B and C). In line with these observations, incubation of IMR-Tet-p14 cells with 8 µM

    nutlin-3 for 24 h induced a more potent p53 transcriptional response when the cells had been

    exposed to tetracycline compared to vehicle control (Fig. 5D). The expression of PUMA and

    p21WAF1/CIP1 in these cells in the absence of nutlin-3 was also considerably increased by the

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    addition of tetracycline. In contrast, switching on transgene expression in IMR-Tet-p16 and

    IMR-Tet-lacZ cells did not affect basal nor nutlin-3-induced expression levels of p53-

    responsive genes.

    Finally, similar CDKN2A overexpression experiments were undertaken in SHEP cells to

    investigate whether this manipulation could restore the sensitivity to nutlin-3. Despite

    successful generation of several sublines with tetracycline-inducible expression of p14ARF and

    p16INK4a, we did not observe a reversal or improvement of the nutlin-3-resistant phenotype of

    SHEP cells (Supplementary Fig. S3).

    Taken together, our data provide evidence for a dosage effect of p14ARF expression on the

    response of neuroblastoma cells to nutlin-3, but they also indicate that the homozygous

    CDKN2A deletion in SHEP cells is not responsible for the poor response of these cells to

    nutlin-3.

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    Discussion

    The p53 tumor suppressor protein is at the crossroads of cellular stress response pathways that

    control decisions between life and death. We used here the selective MDM2 antagonist nutlin-

    3 as a tool to gain insight into the mechanisms by which neuroblastoma cells escape from

    p53-mediated growth control. Mutation analysis demonstrated a p53 gene alteration in 9 out

    of 34 neuroblastoma cell lines, which rendered the p53 pathway nonfunctional in all cases.

    Three mutations were located outside the classic hot-spot region (exons 5-9), indicating that

    p53 mutations are best identified by sequencing the entire coding region. The observed

    mutation frequency in our cell line panel (26%) is considerably higher than the p53 mutation

    rate of approximately 1% that was found in early studies of neuroblastoma tumors (22-27).

    This may reflect the fact that cell lines are frequently derived from progressive or relapsed

    tumors, as p53 mutations can develop during chemotherapy and malignant progression of

    neuroblastoma (28). Additionally, older studies may have underestimated to some extent the

    p53 mutation frequency in neuroblastoma tumors, since analysis was often confined to the

    mutational hot-spot region.

    Treatment with nutlin-3 was capable of inducing potent antiproliferative and cytotoxic effects

    in 23 out of 25 neuroblastoma cell lines with wild-type p53. These findings are particularly

    relevant in the light of an ongoing debate whether p53 is functional in neuroblastoma or not

    (4-11). Discrepancies between previous studies may be in part attributed to different treatment

    regimens (11) and to whether the p53-inducing stimulus directly interferes with potential

    restraints on p53 activity, such as p53 hyperubiquitination (7). Our data provide good

    evidence of almost uniform functionality of the p53 protein and its downstream effectors in

    neuroblastoma cells with wild-type p53 when the interaction between p53 and MDM2 is

    disrupted by nutlin-3. As a consequence, selective MDM2 inhibitors may prove beneficial for

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    treating neuroblastoma patients, provided that wild-type p53 is present. Our findings of

    functional p53 effector pathways also suggest that circumvention of the p53-driven antitumor

    barrier in neuroblastoma cells relies primarily on defects upstream of p53. Cumulating

    evidence indicates that it is precisely an increased activity of MDM2 which serves as the

    predominant mode of p53 inactivation in neuroblastoma (28), but further study is warranted to

    identify the full spectrum of aberrations in regulators of p53 activity.

    The presence of a homozygous CDKN2A deletion in the nutlin-3-refractory SHEP cells but

    not in the nutlin-3-sensitive SK-N-SH and SH-SY5Y cells prompted us to investigate the role

    of p14ARF and p16INK4a in the response to nutlin-3. The nutlin-3-resistant phenotype of SHEP

    cells could not be reversed by reintroduction of p14ARF or p16INK4a, but knockdown and

    overexpression experiments in other neuroblastoma cell lines pointed to a stimulatory effect

    of p14ARF expression on the nutlin-3 response. Our data suggest that a p14ARF-driven increase

    in basal expression levels of p53-responsive genes, such as PUMA and p21WAF1/CIP1,

    contributes to this potentiating effect of p14ARF, although other mechanisms cannot be

    excluded. High levels of the MDM2-inhibitory protein p14ARF may result in a larger fraction

    of the nuclear pool of MDM2 molecules being inhibited after nutlin-3 treatment and thus in

    stronger activation of the p53 pathway. Alternatively, p14ARF may provide a costimulatory

    signal for the p53 response independently of MDM2. For instance, p14ARF may increase p53

    protein synthesis (29), inhibit p53 turnover by repressing other components of the p53

    degradation pathway than MDM2 (30), enhance p53 transcriptional activity (31), or regulate

    pathways that crosstalk with p53 signaling (32). We did not aim to identify the molecular

    basis of the cooperation between p14ARF and nutlin-3 in this study, but rather wish to

    comment on the potential clinical implications. Previous studies using mouse models have

    demonstrated that Cdkn2a mutations induce chemoresistance by disabling p53 (33) and that

    loss of p19ARF, the murine homolog of p14ARF, limits the therapeutic response to the tyrosine

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    kinase inhibitor imatinib (34). Based on our findings, it can be expected that tumor cells may

    also gain resistance to nutlin-3 treatment by suppressing p14ARF. The likelihood of this

    scenario is corroborated by data from a switchable p53 knock-in mouse model of lymphoma

    showing that p53 reactivation strongly selects for the emergence of p53-resistant tumors

    through inactivation of either p53 or p19ARF (35). Several early-phase clinical studies with

    selective MDM2 inhibitors and other p53-reactivating compounds have recently been initiated

    (36). Our data indicate that the occurrence of aberrations in p14ARF should be monitored in

    these studies and provide an incentive for the development of strategies to counter p14ARF

    lesions.

    The lack of improvement in nutlin-3 sensitivity after reintroduction of p14ARF into SHEP cells

    leaves us with the question of how to explain the resistant phenotype of these cells. We

    provided evidence of intact cell cycle arrest but defective apoptosis following nutlin-3

    treatment of SHEP cells. This cell line is also resistant to other apoptosis-inducing stimuli,

    including irradiation (37, 38) and adenoviral gene therapy (39). The poor sensitivity to death-

    inducing triggers might be related to the S-type (substrate-

    adherent/Schwannian/melanoblastic) morphology of SHEP cells, as S-type neuroblastoma

    cells seem to be more resistant to apoptosis than N-type (neuroblastic/neuroendocrine)

    neuroblastoma cells (40). Another notable feature is that SHEP cells have lost the capacity to

    form colonies in soft agar and tumors in nude mice (41). One could therefore wonder whether

    the loss of oncogenic signals – which often have a collateral proapoptotic effect – may result

    in desensitization to apoptosis. For instance, SHEP cells lack expression of the MYCN

    oncoprotein, and artificial induction of MYCN expression in these cells has been shown to

    slightly increase the sensitivity to nutlin-3 (42). Alternatively, SHEP cells may contain high

    levels of antiapoptotic proteins, as has been previously proposed (37). Further study is needed

    to pinpoint the exact mechanism underlying the nutlin-3-resistant phenotype of SHEP cells.

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    In conclusion, this study provides several insights into the spectrum of p53 pathway defects in

    neuroblastoma cells that may prove useful for designing new therapeutic approaches. The

    rarity of signaling defects downstream of p53 indicates that p53-reactivating strategies may

    represent an excellent therapeutic tool for treating neuroblastoma tumors with wild-type p53.

    Resistance to nutlin-3 is mostly attributable to the presence of p53 mutation, which is not

    uncommon in neuroblastoma cell lines. This highlights the need to search for effective p53-

    independent anticancer agents or mutant p53-targeting compounds as a complementary

    therapeutic modality. Finally, the finding that p14ARF expression levels modulate the

    sensitivity of neuroblastoma cells to nutlin-3 raises the possibility that p14ARF may contribute

    to the outcome of p53 activation in patients treated with selective MDM2 inhibitors. It

    remains to be determined whether clinical treatment failure with this new class of anticancer

    drugs may result from loss or suppression of p14ARF.

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    Acknowledgments

    We thank Griet Van Lancker and Xiaoyang Zhang for technical assistance.

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    36. Brown CJ, Lain S, Verma CS, Fersht AR, Lane DP. Awakening guardian angels: drugging the p53 pathway. Nat Rev Cancer 2009;9:862–73. 37. Jasty R, Lu J, Irwin T, Suchard S, Clarke MF, Castle VP. Role of p53 in the regulation of irradiation-induced apoptosis in neuroblastoma cells. Mol Genet Metab 1998;65:155–64. 38. Tweddle DA, Malcolm AJ, Cole M, Pearson AD, Lunec J. p53 cellular localization and function in neuroblastoma: evidence for defective G1 arrest despite WAF1 induction in MYCN-amplified cells. Am J Pathol 2001;158:2067–77. 39. Van Maerken T, Sarkar D, Speleman F, Dent P, Weiss WA, Fisher PB. Adenovirus-mediated hPNPaseold-35 gene transfer as a therapeutic strategy for neuroblastoma. J Cell Physiol 2009;219:707–15. 40. Mergui X, Leteurtre F, Lipinski M, Benard J, Amor-Gueret M. Two distinctly altered cellular responses to DNA double-strand breaks in human neuroblastoma. Biochimie 2008;90:1656–66. 41. Ross RA, Spengler BA. Human neuroblastoma stem cells. Semin Cancer Biol 2007;17:241–7. 42. Barbieri E, Mehta P, Chen Z, Zhang L, Slack A, Berg S, et al. MDM2 inhibition sensitizes neuroblastoma to chemotherapy-induced apoptotic cell death. Mol Cancer Ther 2006;5:2358–65. 43. Davidoff AM, Pence JC, Shorter NA, Iglehart JD, Marks JR. Expression of p53 in human neuroblastoma- and neuroepithelioma-derived cell lines. Oncogene 1992;7:127–33. 44. Teitz T, Wei T, Liu D, Valentine V, Valentine M, Grenet J, et al. Caspase-9 and Apaf-1 are expressed and functionally active in human neuroblastoma tumor cell lines with 1p36 LOH and amplified MYCN. Oncogene 2002;21:1848–58. 45. Tweddle DA, Malcolm AJ, Bown N, Pearson AD, Lunec J. Evidence for the development of p53 mutations after cytotoxic therapy in a neuroblastoma cell line. Cancer Res 2001;61:8–13.

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    Table 1. Neuroblastoma cell lines with p53 mutation

    Cell line p53 mutation* Previous report

    LA-N-1 546C>A (C182X)† Yes (43) LA-N-2 1009C>T (R337C) No N-206 529C>A (P177T) No NLF 607G>A (V203M) No NMB 733G>A (G245S) Yes (9) SJNB-8 313-375delGGCAGCTACGGTTTCC

    GTCTGGGCTTCTTGCATTCTGGGA CAGCCAAGTCTGTGACTTGCACG

    (GSYGFRLGFLHSGTAKSVTCT105-125del)

    Yes (44)

    SK-N-AS Homozygous deletion of exons 10-11‡ Yes (17, 18) SK-N-BE(2c) 404G>T (C135F) Yes (45) SK-N-FI 737T>G (M246R) Yes (12)

    *The other neuroblastoma cell lines in this study were wild-type for p53. †X, termination codon. ‡See Supplementary Fig. S1.

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    Figure legends

    Figure 1. Sensitivity of neuroblastoma cells to nutlin-3. A, principle of p53 pathway probing

    by determination of the IC50 value of nutlin-3. B, distribution of IC50 values of nutlin-3 in 34

    neuroblastoma cell lines according to p53 mutation status. Calculated IC50 values above 32

    µM fall outside the range of tested nutlin-3 concentrations and are denoted by dots at 32 µM.

    Bars, median IC50 value; solid arrow, SHEP cells; dashed arrow, LA-N-6 cells.

    Figure 2. Impairment of the apoptotic response to nutlin-3 in SHEP cells, but not in SK-N-

    SH and SH-SY5Y cells. A, effect of nutlin-3 treatment for 24, 48, and 72 h on cell viability.

    Bars, SD (n=3). B, caspase-3 and caspase-7 activity after a 24-h exposure to nutlin-3, relative

    to a similar amount of viable vehicle-treated cells. Bars, SD (n=3). C, flow cytometric

    analysis of the apoptotic sub-G1 fraction after 0 or 8 µM nutlin-3 for 24 h. Bars, SD (n=3). D,

    flow cytometric analysis of cell cycle phase distribution after 0 or 8 µM nutlin-3 for 24 h.

    Results are derived from the same three experiments as those used for sub-G1 quantification.

    E, qRT-PCR analysis of p53 target gene expression after 0 or 8 µM nutlin-3 for 24 h. Bars,

    SEM of duplicate wells. F, Western blot analysis of p53, p21WAF1/CIP1, and BAX expression

    after 0 or 8 µM nutlin-3 for 24 h. β-actin is shown as loading control.

    Figure 3. Transient silencing of CDKN2A decreases the sensitivity of IMR-32 and NGP cells

    to nutlin-3. A, qRT-PCR assessment of siRNA-mediated CDKN2A knockdown 24 h

    posttransfection, using a primer pair that measures both p14ARF and p16INK4a. Bars, SEM of

    duplicate wells. B and C, effect of CDKN2A knockdown on the nutlin-3 response. Cells were

    transfected with negative control siRNA or CDKN2A siRNA and subsequently treated with

    nutlin-3 for 24, 48, and 72 h, followed by cell viability analysis. Three independent

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  • 24

    experiments were performed. Dose-response curves at 24 h, derived from a representative

    experiment, are shown as an example in B. Bars, SD of duplicate wells. RLU, relative

    luminescence units. IC50 ratios at 24, 48, and 72 h, defined as the fold change in the IC50 value

    of nutlin-3 after CDKN2A knockdown relative to control transfection and derived from the

    three experiments, are shown in C. All IC50 ratios were >1, indicating that CDKN2A silencing

    suppresses the response to nutlin-3. Bars, 95% confidence interval (CI).

    Figure 4. Stable knockdown of p14ARF attenuates the response of NGP cells to nutlin-3. A,

    qRT-PCR analysis of p14ARF and p16INK4a expression in NGP cells transduced with

    lentiviruses carrying a negative control shRNA (NGP-LV-luc), an shRNA targeting

    simultaneously p14ARF and p16INK4a (NGP-LV-p14/p16), a p14ARF-specific shRNA (NGP-LV-

    p14), or a p16INK4a-specific shRNA (NGP-LV-p16). Bars, SEM of duplicate wells. B, IC50

    values as determined by cell viability assays at 24, 48, and 72 h of nutlin-3 treatment. Three

    independent experiments were performed. Bars, 95% CI. C, EC50 values as determined by

    caspase-3 and caspase-7 assays at 24, 48, and 72 h of nutlin-3 treatment. The EC50 value is the

    half-maximal effective concentration of nutlin-3 for caspase activation, as defined in the

    “Statistical analysis” section. Two independent experiments were performed. Bars, 95% CI.

    D, qRT-PCR analysis of p53 target gene expression after 0 or 8 µM nutlin-3 for 24 h. Bars,

    SEM of duplicate wells.

    Figure 5. Overexpression of p14ARF increases the sensitivity of IMR-5/75 cells to nutlin-3. A,

    qRT-PCR measurement of p14ARF and p16INK4a expression in IMR-5/75 cells stably

    transfected with a tetracycline-inducible expression vector for a negative control construct

    (IMR-Tet-lacZ), p14ARF (IMR-Tet-p14), or p16INK4a (IMR-Tet-p16). Cells were treated with 1

    µg/mL tetracycline or vehicle control for 24 h. Bars, SEM of duplicate wells. B, effect of

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    p14ARF and p16INK4a overexpression on the cell viability response to nutlin-3. Cells were

    treated with 1 µg/mL tetracycline or vehicle control and subsequently exposed to nutlin-3 for

    24, 48, and 72 h, followed by cell viability analysis. IC50 ratios were determined as the fold

    change in the IC50 value of nutlin-3 after tetracycline pretreatment compared to vehicle

    control. IC50 ratios in IMR-Tet-p14 cells were 1 at all nutlin-3 concentrations, indicating that

    p14ARF overexpression enhances the apoptotic response to nutlin-3. Three independent

    experiments were performed. Bars, 95% CI. D, qRT-PCR analysis of p53 target gene

    expression after treatment with 1 µg/mL tetracycline or vehicle control and subsequent

    exposure to 0 or 8 µM nutlin-3 for 24 h. Bars, SEM of duplicate wells.

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  • Published OnlineFirst April 1, 2011.Mol Cancer Ther Tom Van Maerken, Ali Rihani, Daniel Dreidax, et al. using the small-molecule MDM2 antagonist nutlin-3Functional analysis of the p53 pathway in neuroblastoma cells

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