Haploinsufficient tumor suppressor genes.

Haploinsufficiency of tumor suppressor genes (TSGs) indicates that the reduced levels of proteins in cells that lack one allele of the genomic locus results in the inability of the cell to execute normal cellular functions contributing to tumor development. Representative cases of haploinsufficient TSGs are p27^Kip1, p53, DMP1, NF1, and PTEN. Tumor development is significantly accelerated in both mice with homozygous and heterozygous gene deletion, with expression of the wild type allele in the latter. Newly characterized TSGs such as AML1, EGR1, TGFβR1/2, and SMAD4 have also shown haploid insufficiency for tumor suppression. This phenotype has typically been demonstrated in gene knockout mouse models, but analyses of human samples have been conducted in some cases. Recent studies suggest collaboration of multiple haploinsufficient TSGs in 5q-, 7q-, and 8q- syndromes, which is called compound haploinsufficiency. Although ARF is a classical TSG, it also belongs to this category since Arf^+/- accelerates tumor development when both alleles for Ink4a are inactivated. Haploid insufficiency of Arf was also reported in myeloid leukemogenesis in the presence of inv(16). In case of p53, p53^+/- cells achieve only ~25% of p53 mRNA and protein levels as compared to those in wild type, which could explain the mechanism. TGFβR1^+/- collaborates with Apc^Min+/- in colorectal cancer development; TGFβR2^+/- and Smad4^+/- collaborates with K-Ras mutation in pancreatic ductal adenocarcinomagenesis, demonstrating the synergism of haploinsufficient TSGs and other oncogenic events. These TSGs can be targets for activation therapy in cancer since they retain a functional allele even in tumor cells.