Hematopoietic p53 loss cell-extrinsically defines an immune infiltrated microenvironment in leukemia and pre-leukemia

Abstract

TP53 is the most frequently mutated gene in human cancers. In Acute Myeloid Leukemia (AML) and Clonal Hematopoiesis of Indeterminate Potential (CHIP), it is one of several recurrent genetic alterations. Despite multiple recent therapeutic advances for AML, TP53 mutated AML is associated with resistance to currently approved therapies and thus, a very poor prognosis. Emerging evidence suggests that mutations in TP53 may be a predictor of positive response to immunotherapy. To model cell - extrinsic consequences of hematopoietic p53 loss, we generated bone marrow chimeric mice bearing p53-/- and congenic wild type cells. Following reconstitution, we observed increased levels of wild type CD8+ and CD4+ T cells in mice transplanted with p53-/- hematopoietic cells compared to controls. In addition, we observed a change in the frequency of T cell subsets in p53-/- chimeras including an increase in Tregs. To determine if these alterations were mirrored in the leukemic setting, we next generated p53-/-;nRasG12D leukemia. While the bone marrow of p53-/-;nRasG12D leukemia showed the presence of both T and B lymphocytes, MLL-AF9 showed a near complete absence of lymphocytes, akin to immune-infiltrated and immune-desert phenotypes seen in solid tumors. These data clearly demonstrate a causal cell-extrinsic effect of hematopoietic p53 loss on the immune system, both in the context of leukemia and preleukemic states. Modeling AML genetics in murine models serves as a powerful tool to define the association between genetic drivers and immune subtypes of AML towards precise patient stratification critical for the application of emerging targeted and immune therapies. Statement of SignificanceTP53 mutations are frequent in both AML and CHIP, and are associated with both resistance to therapy as well as very poor prognosis. We provide evidence to investigate the immunotherapy as a treatment option for this subgroup of AML.