458: Somatic or inherited? Reading TP53 risk from shared DNA

MacGregor et al., The American Journal of Human Genetics - Pathogenic TP53 variants found in blood have long been read as inherited Li-Fraumeni alleles, but many turn out to be somatic clones that grew with age. Using whole-exome data from 469,391 UK Biobank participants, this study combines variant allele fraction with haplotype sharing to tell the two origins apart, and finds that in cancer-free middle-aged adults the risk is mostly somatic and mostly hematological. Key terms: TP53, clonal hematopoiesis, Li-Fraumeni syndrome, UK Biobank, variant classification.

Study Highlights:
Rare coding TP53 variants were called in 469,391 UK Biobank participants aged 40 to 70, and 1,753 nonsynonymous variants were sorted by variant allele fraction combined with haplotype sharing across individuals carrying the same allele. Of 55 unique pathogenic TP53 variants detected, only six were classified as germline, and most of those sit at positions linked to partial rather than complete loss of p53 function. Classic Li-Fraumeni alleles behaved like somatic clonal expansions: their prevalence rose with age at an odds ratio of 2.3 per decade, while likely germline variants showed no age trend. Incident cancer risk separated sharply by origin, with the signal for somatic and inconclusive variants driven almost entirely by blood cancers rather than solid tumors, reaching a hazard ratio of 16.5 for the high-allele-fraction inconclusive class. The prevalence of somatic expansion tracked missense pathogenicity, suggesting that clonal growth in blood is itself an in vivo readout of how much a variant damages p53.

Conclusion:
In a population cohort of healthy middle-aged adults, most apparently pathogenic TP53 variants detected in blood reflect somatic clonal expansion rather than inherited predisposition, and the cancer risk they carry is predominantly hematological. Distinguishing the two origins with allele fraction and shared haplotypes gives a scalable way to interpret TP53 variants outside the clinic, where classic Li-Fraumeni assumptions do not hold.

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Article title:
Shared inheritance reveals landscape of somatic and germline cancer risk in TP53

First author:
MacGregor

Journal:
The American Journal of Human Genetics

DOI:
10.1016/j.ajhg.2026.07.011

Reference:
MacGregor, H.A.J., Blundell, J.R., and Easton, D.F. (2026). Shared inheritance reveals landscape of somatic and germline cancer risk in TP53. The American Journal of Human Genetics 113, 1916-1928. https://doi.org/10.1016/j.ajhg.2026.07.011

License:
This episode is based on an open-access article published under the Creative Commons Attribution 4.0 International License (CC BY 4.0) – https://creativecommons.org/licenses/by/4.0/

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QC:
This episode was checked against the original article PDF and publication metadata for the episode release published on 2026-09-10.

QC Scope:
- article metadata and core scientific claims from the narration
- excludes analogies, intro/outro, and music
- transcript coverage: Audited the scientific body from the TP53 and Li-Fraumeni background through clonal hematopoiesis, the allele-f...