Osteosarcomas often suffer mutations of the RB (retinoblastoma) gene , with resultant inactivation of the pRb protein. pRb is one component in a cell-cycle control pathway that includes the p16 (encoded by the CDKN2A gene) and cyclin-dependent kinase 4 (cdk4 , encoded by the CDK4 gene) proteins. We therefore sought to determine whether the CDKN2A and CDK4 genes were altered in those osteosarcomas that lacked RB inactivation. Twenty-one osteosarcomas (2 low-grade and 19 high-grade) were evaluated for homozygous deletion of the CDKN2A gene , CDK4 amplification , and allelic loss of the RB gene , as well as for expression of p16 and pRb proteins. Five highgrade osteosarcomas showed loss of p16 expression; four of these had homozygous CDKN2A deletions, and the fifth had a probable deletion obscured by numerous nonneoplastic , p16-immunopositive multinucleated giant cells. Thus , p16 immunohistochemistry may provide a sensitive means for assessing CDKN2A status. Twelve tumors (including the two low-grade osteosarcomas) were immunopositive for pRb , and nine tumors were immunonegative for pRb. Of the five cases with CDKN2A/p16 alterations , none had allelic loss of the RB gene and all expressed pRb, suggesting that each of these tumors had an intact RB gene. None of the tumors showed CDK4 amplification. No alterations were detected in the two lowgrade osteosarcomas. This study suggests that CDKN2A is a tumor suppressor inactivated in osteosarcomas that lack RB mutations and that the p16-pRb cell-cycle control pathway is deregulated in a large number of high-grade osteosarcomas. (Am J Pathol 1998, 153:159 -163)Genetic changes underlying the initiation and progression of osteosarcomas are poorly understood. Except for ring chromosomes in parosteal osteosarcomas, 1 karyotypic changes in osteosarcomas are often complex and include a variety of structural and numerical abnormalities with frequent losses of chromosomes 13q, 17p, 18q, and 3q.2-9 Of the known tumor suppressor genes at these loci, the RB gene on chromosome 13q has been most clearly implicated in osteosarcoma tumorigenesis. RB mutations occur in a large number of sporadic osteosarcomas and patients with germline RB mutations have an increased incidence of osteosarcomas.
-15The pRb protein encoded by the RB gene functions as part of a cell cycle regulatory pathway that also involves the p16 protein (encoded by the CDKN2A gene on chromosome 9p21) and cyclin-dependent kinase 4 (cdk4, encoded by the CDK4 gene on chromosome 12q13). p16 appears to inhibit the function of cdk4-cyclin D1 complexes, which regulate pRb through phosphorylation. Phosphorylation inactivates RB, thereby allowing entry of the cell into S phase with resultant cellular proliferation. Thus, either inactivation of p16 or overexpression of cdk4 could promote tumorigenesis in a manner similar to that of pRb inactivation. Accordingly, the various components of this pathway are deregulated in a large number of human cancers. 16 -23 Although RB mutations are a well-recognized oncogenic event in ost...