Unraveling the link between the Mdm2-p53 axis and aging

The transcription factor p53 is an important master regulator of the cellular response to stress. Mdm2 is an E3 ubiquitin ligase that is the primary negative regulator of p53. Mdm2 downregulates p53 activity through three mechanisms: proteasome-mediated degradation, exportation from the nucleus, and direct inhibition through binding. Though the roles of the Mdm2-p53 axis in cancer have been well characterized, the relationship between p53 and other diseases remain elusive. Recently, three novel Mdm2 mutations were identified in patients with premature aging. One mutation leads to the abolishment of the Mdm2 stop codon, thereby extending the Mdm2 C-terminus by five additional amino acids. The other mutation leads to alternative splicing of Mdm2, resulting in two isoforms: a full length Mdm2 protein with a point mutation in the p53 binding domain and a truncated Mdm2 protein that has a 25 amino acid deletion in the p53 binding domain. Our results indicate that the causative Mdm2 variants are hyper-stable and lead to increased p53 protein stabilization. The anti-terminating mutant Mdm2 is defective as an E3 ligase, but retains its ability to bind and dampen p53 activity. However, p53 can be hyper-activated upon induction. Analysis of patient fibroblasts, patient lymphoblastoid cell lines, and genome-edited cells that express mutant Mdm2 confirmed the aberrant regulation of p53. MdmX may also potentially play a compensatory role in this axis. Altogether, our results demonstrate that defective Mdm2 can lead to constitutive dysfunctional regulation of p53 and contribute to accelerated aging phenotypes.