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p15INK4b expression is lost in a striking 80% of all patients suffering from acute myeloid leukemia (AML). Specific inactivation of the gene by aberrant promoter hypermethylation is also detected in about 50% of patients diagnosed with myelodysplastic syndromes (MDS) and almost 60% of patients with myeloproliferative disorders (MPD). More importantly, a strong correlation between the methylation levels of p15INK4b and poor prognosis is now well established in these patients. Hypermethylation levels also provide a marker for subsequent transformation and progression of the disease to a more aggressive phenotype. These clinical observations establish the repression of p15INK4b expression by promoter hypermethylation as the most prevalent genetic abnormality in myeloid leukemia. The p15INK4b gene (also referred to as CDKN2B and MTS2) encodes a 15kDa cyclin dependent kinase inhibitor (CDKI). Specific and preferential epigenetic targeting of p15INK4b for silencing over other CDKIs such as p16INK4a and p21WAF/CIP in AML, MDS and MPD patients strongly supports a role for this protein as a tumor suppressor in hematological malignancies of the myeloid lineage. This chapter provides a review of the literature outlining the high prevalence of p15INK4b loss of expression in human myeloid malignancies, as well as the latest research carried out in mice which supports a role for p15Ink4b as a tumor suppressor. It also focuses on the well established function of p15INK4b in the control of the cell cycle, as well as its role during early and late myeloid cells development. Finally, this chapter discusses the multiple mechanisms by which p15INK4b is silenced and presents a few examples of clinical studies of drugs that target p15INK4b for re-expression. These include treatments for reversing aberrant DNA methylation, and are currently being tested and used for the therapy of MDS and AML.

p15INK4b, a Tumor Suppressor in Acute Myeloid Leukemia