The onset of p53 loss of heterozygosity is differentially induced in various stem cell types and may involve the loss of either allele

p53 loss of heterozygosity (p53LOH) is frequently observed in Li-Fraumeni syndrome (LFS) patients who carry a mutant (Mut) p53 germ-line mutation. Here, we focused on elucidating the link between p53LOH and tumor development in stem cells (SCs). Although adult mesenchymal stem cells (MSCs) robustly underwent p53LOH, p53LOH in induced embryonic pluripotent stem cells (iPSCs) was significantly attenuated. Only SCs that underwent p53LOH induced malignant tumors in mice. These results may explain why LFS patients develop normally, yet acquire tumors in adulthood. Surprisingly, an analysis of single-cell sub-clones of iPSCs, MSCs and ex vivo bone marrow (BM) progenitors revealed that p53LOH is a bi-directional process, which may result in either the loss of wild-type (WT) or Mut p53 allele. Interestingly, most BM progenitors underwent Mutp53LOH. Our results suggest that the bi-directional p53LOH process may function as a cell-fate checkpoint. The loss of Mutp53 may be regarded as a DNA repair event leading to genome stability. Indeed, gene expression analysis of the p53LOH process revealed upregulation of a specific chromatin remodeler and a burst of DNA repair genes. However, in the case of loss of WTp53, cells are endowed with uncontrolled growth that promotes cancer.Heterozygosity, caused by a mutation in a single allele of a tumor suppressor gene (TSG), is one of the first steps in malignant transformation.¹ Often, TSGs undergo loss of the wild-type (WT) allele, designated as loss of heterozygosity (LOH).^{2, 3, 4} Patients with the rare cancer predisposition Li-Fraumeni syndrome (LFS), carrying germ-line heterozygous p53 mutations,⁵ apparently exhibit normal development yet later in adult life develop a wide spectrum of tumors; predominantly sarcomas,^{6, 7, 8} where 40–60% of tumors exhibit WT p53 loss of heterozygosity (p53LOH).⁸Giving that cancer development could be associated with stemness deregulation challenges, the notion that the occurrence of p53LOH in stem cells (SCs) may contribute to the emergence of cancer SCs. Genomic fidelity is a hallmark of SCs.⁹ The genome of embryonic stem cells (ESCs) is extremely stable, whereas adult stem cells (ASCs) exhibit a less stable genome.¹⁰ Genetic deregulation in ASCs was shown to be associated with tumor development.^{11, 12, 13} Mesenchymal stem cells (MSCs) that acquire mutations in oncogenes/TSGs such as p53 may function as tumor-initiating cells leading to de-novo sarcomagensis.^{14, 15, 16, 17} Furthermore, MSCs isolated from young mice, aged in culture acquired clinically relevant p53 mutations.¹⁸ In all, these findings suggest a link between p53 inactivation in SCs and tumorigenesis.Although induced pluripotent stem cells (iPSCs) seemed to represent ESCs,^{19, 20} several studies questioned the assumption that iPSCs are as genomically stable as ESCs.^{21, 22, 23, 24} p53 was found to have a major role in the generation of iPSCs both in attenuating reprogramming and controlling the quality of the reprogrammed cells.^{25, 26} An additional role of p53 during reprogramming may be an indirect effect on cell proliferation²⁷ and on the restriction of mesenchymal–epithelial transition during the early phases of reprogramming.²⁸ Importantly, Mutp53 cells exhibiting a fully reprogrammed iPSC phenotype in vitro, form malignant tumors in vivo, instead of the benign teratomas induced by the WTp53-iPSCs.²⁵ As p53 is the guardian of the genome, it is important to investigate how p53LOH would affect genome stability and tumorigenicity of iPSCs.The availability of in vitro SC p53LOH models (iPSCs, MSCs) can help decipher the role of p53LOH in cancer initiation. Indeed, the incidence of p53LOH was found to be extremely different between these SCs. Surprisingly, we found that reprograming of heterozygous p53 (HZp53) fibroblasts, which frequently undergo p53LOH, gave rise to iPSC clones, most of which retained their HZp53 status and exhibited features of normal WTp53-iPSCs. However, p53LOH process is robust in MSCs. Interestingly, single-cell sub-cloning of iPSCs, MSCs and ex vivo bone marrow (BM) progenitors revealed that, in addition to the loss of the WTp53, loss of the Mutp53 allele also takes place. Of note, this bi-directional p53LOH occurred in an age-dependent manner linking LOH to aging and tumorigenesis. Surprisingly, most of the p53LOH events in BM progenitors preferred the loss of the Mutp53 allele. Taken together, our results of a bi-directional p53LOH process, accompanied by a burst of DNA repair pathways, may suggest that p53LOH can be regarded as a DNA repair event. In the case of a DNA repair-orientated productive LOH process, where the Mutp53 allele is lost, cells are rescued of tumorigenesis. However, when the WTp53 allele is lost, cells become prone to tumor initiation.