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Targeting p53 pathways: mechanisms, structures and advances in therapy

Haolan Wang, Ming Guo, Hudie Wei and 1 more

Signal Transduction and Targeted Therapy · 2023 · Systematic review · CC BY

Abstract

The TP53 tumor suppressor is the most frequently altered gene in human cancers, and has been a major focus of oncology research. The p53 protein is a transcription factor that can activate the expression of multiple target genes and plays critical roles in regulating cell cycle, apoptosis, and genomic stability, and is widely regarded as the “guardian of the genome”. Accumulating evidence has shown that p53 also regulates cell metabolism, ferroptosis, tumor microenvironment, autophagy and so on, all of which contribute to tumor suppression. Mutations in TP53 not only impair its tumor suppressor function, but also confer oncogenic properties to p53 mutants. Since p53 is mutated and inactivated in most malignant tumors, it has been a very attractive target for developing new anti-cancer drugs. However, until recently, p53 was considered an “undruggable” target and little progress has been made with p53-targeted therapies. Here, we provide a systematic review of the diverse molecular mechanisms of the p53 signaling pathway and how TP53 mutations impact tumor progression. We also discuss key structural features of the p53 protein and its inactivation by oncogenic mutations. In addition, we review the efforts that have been made in p53-targeted therapies, and discuss the challenges that have been encountered in clinical development.

Full text

From PubMed Central, U.S. National Library of Medicine, as current on Oct 16, 2026. Paragraph numbers are ours, so an answer can point at one.

Introduction

1The tumor suppressor gene TP53 is the most frequently mutated gene in human tumors., The process of tumor development is strongly related to the dysfunctions caused by TP53 mutations., p53 protein functions primarily as a transcription factor, which regulates a wide variety of pathways, such as cell cycle arrest, DNA repair, cell apoptosis, autophagy, and metabolism,,, and determines whether cells die under stress conditions. Over the years, a growing number of studies have revealed the complexity and connectivity of the p53 pathway and by extension its role in metabolic homeostasis, immune microenvironment, stem cell biology and so on. However, mutant p53 can alter DNA-specific binding, disrupt the spatial conformation of the protein and thermostability of the protein, and result in dysfunction of p53 activity.–

2The high frequency of TP53 mutations in tumors and its intrinsic tumor suppressor function make it a highly promising target for tumor therapy. However, the specificity of the p53 structure,, the smooth surface without an ideal drug-binding pocket, and the difficulty to restore p53 function, have stalled drug research against p53 for decades. Nevertheless, researchers still believe that this difficult-to-drug target can be tackled, and have made some progress in recent years. In this review, we aim to provide a comprehensive summary of the biological function of p53, p53 signaling pathway, the structural features of p53 protein, as well as the advances in p53-targeted therapies.

The discovery history of p53

3The TP53 gene is located on the short arm of chromosome 17 (17p13.1) and encodes a protein with 393 amino acid residues. p53 was initially identified as a host protein that bound to simian virus 40 large T antigen in virally transformed cells, and was named p53 in 1979 because its molecular weight was shown to be approximately 53 kilodalton (kDa) in SDS polyacrylamide gel electrophoresis analysis (Fig. 1). The actual molecular weight of p53 is 43.7 kDa, due to the large number of proline residues in the protein that slowed down its migration on SDS polyacrylamide gel electrophoresis. TP53 was initially thought to be an oncogene, and high levels of p53 conferred significant tumorigenic potential to rat embryonic fibroblasts., Subsequent studies have led to a change in the recognition of TP53. The initial p53 cDNA was synthesized using mRNA from tumor cells as a template, and the p53 cDNA subsequently obtained from normal cells did not transform the cells, but rather inhibited tumor cell growth. In tumor cells the TP53 gene is often mutated or lost due to chromosome 17 deletion, whereas in normal cells the gene is intact., When a missense mutation in TP53 occurs, the obtained p53 protein promotes tumorigenic transformation., TP53 knockout mice have a high probability of developing tumors. Overexpression of the wild-type TP53 gene in cells effectively suppressed the transforming effects exerted on cells by those oncogenes, such as the MYC gene and RAS gene., This series of studies overturned the established paradigm of TP53, which has since become one of the most studied tumor suppressor genes.

The p53 pathway

4p53 is a transcription factor that is distributed in the nucleus and cytoplasm, binds specifically to DNA, and regulates a diversity of genes., Under normal conditions, cellular p53 protein levels are very low owing to strict control by its negative regulators MDM2 and MDMX, which promote p53 degradation through ubiquitination., When cells are exposed to internal and external stresses, including DNA damage, hypoxia, nutrient deprivation, and cancer cell risk, p53 ubiquitination is inhibited, triggering a rapid increase in intracellular p53 protein levels. Accumulated p53 is activated and stabilized by posttranslational modifications, including phosphorylation, acetylation and methylation.– Stabilized p53 forms tetramers in the nucleus, binds to target DNA and regulates gene transcription, leading to alterations in downstream signaling pathways.–

5In response to cellular stress, p53 prevents the differentiation of cells with mutated or damaged DNA and terminates cellular processes by transcriptionally activating various genes involved in apoptosis and cell cycle,, which contributes significantly to its tumor suppressor function and is the most studied.–,– Meanwhile, a series of studies have shown that p53 also controls a number of “non-classical” pathways (Fig. 2), including metabolic homeostasis, ferroptosis, stem cell differentiation, autophagy, senescence, tumor microenvironment and so on.–

The biological function of p53 in cancer

6p53 controls a wide range of signaling networks. There is no simple and clear answer to the question of exactly how, when, and what p53 does. Nevertheless, what is clear is that p53 has a very flexible and versatile response, with an integrated response to environmental perturbations determining cell death or maintaining cellular homeostasis. p53 serves as a linkage point for multiple cellular signaling pathways, harmoniously and delicately regulating various biological functions through transcriptional regulation and protein-protein interactions.

Genomic stability

7p53 is considered as the guardian of the genome. It plays an important role in maintaining genomic stability. When DNA is damaged, p53 protects the genome by coordinating multiple DNA damage response mechanisms. The p53 protein activates the expression of DNA repair proteins DDB2 and XPC. The interaction of these proteins with effector proteins may lead to various cell fates, such as apoptosis, senescence or tumorigenesis.,

8The gene encoding p21 (CDKN1A) is the first transcriptional target identified for p53. p21 is a potent inhibitor of binding to cyclin-dependent kinases (CDKs), which inhibits cell cycle proteins and further inhibits phosphorylation of Rb by the cyclin D1-CDK4, cyclin D2-CDK4 and cyclin E-CDK2 complexes.– Hypophosphorylated Rb forms a complex with the E2F transcription factor, which inhibits the transcriptional activity of E2F and leads to G1 phase block., PTPRV, which encodes a transmembrane tyrosine phosphatase, and the phosphatase of regenerating liver-3 are both genes involved in p53-induced G1 phase block.,

9In addition, p53 represses CDKs and cyclin B, which are required for entry into mitosis and are involved in G2/M phase block., p53 induces transcription of 14-3-3 sigma and represses the cell cycle protein-dependent kinase Cdc2. Gadd45 is a member of the growth arrest and DNA damage gene family. p53 regulates the transcription of Gadd45, disrupts the cyclin B1/Cdc2 complex, and further blocks the G2 phase., Reprimo is also involved in p53-induced cell cycle arrest in the G2 phase. These modulations of p53 reduce the risk of gene mutation and prevent the activation of oncogenes.

10On the other hand, p53 can also induce apoptosis in cells with DNA damage. p53 causes apoptosis through transcriptional activation of the expression of the pro-apoptotic genes, such as Puma, Bax and Noxa.– p53 is also thought to regulate mitochondrial apoptosis through a transcription-independent pathway. p53 binds physically to anti-apoptotic proteins (Bcl-2, Bcl-xL and Mcl-1), thereby indirectly inducing apoptosis. p53 directly activates the pro-apoptotic protein Bak or disrupts the Mcl-1 and Bak complex, releasing Bak and initiating apoptosis., In addition, p53-driven miR34a expression may sensitize cells to apoptotic stimuli by decreasing Bcl-2 levels., In the exogenous apoptotic pathway, p53 induces the expression of the death receptors Fas/Fas ligand and KILLER/DR5 located on the cell membrane, which activates caspase 8 and leads to apoptosis., p53 also drives the expression of various genes that may have pro-survival or pro-apoptotic functions,, which also contribute to the maintenance of genomic stability.

11Retrotransposons are replicated and inserted into new genomic sites by reverse transcription of RNA intermediates, which allows them to increase the copy number or gene mutations in the host genome. Disinhibition of retrotransposons has been reported to be closely associated with human tumorigenesis. p53 binds to the promoter region of the retrotransposon element LINE1 and prevents the expression of transposon sequences. When p53 is absent, cells overexpressing synthetic retrotransposon genes are able to avoid apoptosis. Genomic instability caused by deletion or mutation of p53 may accumulate more oncogenes and promote tumorigenesis, proliferation, metastasis and drug resistance. Functional inactivation of p53 not only contributes to genomic mutation and copy number increase, but also maintains the survival of cells carrying faulty genetic information.

Senescence

12Senescence is a permanent cell cycle arrest. p53-mediated senescence is closely related to its tumor suppressive effects. DNA damage triggers senescence, a process often referred to as stress-induced premature senescence. Various internal or external stressors trigger the DNA damage response pathway, activating the p53 and/or p16INK4A pathways. p16INK4A inactivates Cdk4/6, phosphorylates Rb accumulation and inactivates E2F transcription, leading to cell cycle arrest or senescence. Alternatively, when UV-induced DNA damage occurs, ATM/ATR activates Chk1/Chk2 kinase, which further activates p53 and p21CIP1, leading to G1 arrest or senescence. In addition, p21CIP1 protein levels may lead to inhibition of CDK4/6 activity, resulting in G1 arrest or senescence. In addition, p53 directly induces senescence by stabilizing fibrinogen activator inhibitor-1, a marker of senescent cells. p53 also activates the transcription of genes that encode promyelocytic leukemia protein, leading to cellular senescence.

Metabolic homeostasis

13Tumor cells require large amounts of biological raw materials and energy to achieve their rapid and sustained growth. The Warburg effect, which was first proposed, states that tumor cells metabolize glucose differently than normal cells, as evidenced by enhanced glycolysis and increased lactate production. p53 regulation of the glycolytic pathway helps maintain the homeostasis of cellular metabolism and thus acts as a tumor suppressor. p53 can transcribe target genes required for oxidative phosphorylation, such as SCO2, or genes that inhibit glycolysis, such as TIGAR and Parkin., p53 binds to G6PDH, the rate-limiting enzyme of the pentose phosphate pathway, to further inhibit the activated pentose phosphate pathway in tumor cells., p53 inhibits glucose uptake and glycolysis by suppressing the expression and translocation of glucose transporter proteins such as GLUT1 and GLUT4. Glycolysis and gluconeogenesis can be considered reversible processes to some extent. p53 inhibition of glycolysis promotes the process of gluconeogenesis. Since tumor cells are highly dependent on glycolysis and the Warburg effect for proliferation and invasion, p53 inhibition of glycolysis tends to impede cancer cell growth.,,

14Cancer cells may indeed activate different metabolic pathways under different environmental conditions. Mutant p53 activates the Warburg effect by promoting the translocation of the GLUT1 to the plasma membrane, thereby enhancing tumor metabolism. Mutant 53 binds and activates PGC-1α, a major regulator of oxidative phosphorylation, enhancing mitochondrial function and promoting cancer metastasis., These studies suggest that mutant p53 may confer metabolic plasticity to cancer cells, thereby promote their adaptation to metabolic stress and increase their potential for proliferation and metastasis.

15Since tumor cells need to accumulate or synthesize lipids to promote growth and proliferation, p53 promotes lipolysis leading to tumor suppression. The mevalonate pathway is responsible for the biosynthesis of cholesterol and nonsteroidal isoprenoids, and SREBP2 is a major transcriptional regulator of this pathway. p53 blocks the activation of SREBP2 by transcriptionally inducing the ABCA1 cholesterol transporter gene. p53 downregulates the expression of USP19 and SOAT1 to inhibit cholesterol esterification. p53 also promotes fatty acid oxidation by activating the expression of CPT1C, MCD and PANK1.

16Ammonia is a prevalent product of cellular metabolism. Tumor cells produce large amounts of ammonia during amino acid metabolism, and this ammonia can serve as a nitrogen source for tumor growth., p53 regulates ammonia content in tumor cells through the urea cycle. p53 regulates ammonia content in tumor cells by inhibiting the expression of three key enzyme genes in the urea cycle of tumor cells, CPS1, OTC and ARG1, which ultimately inhibits tumor growth.

17p53 is also involved in regulating the metabolism of tumor cells along with other metabolic signaling pathways. Increased levels of reactive oxygen species in tumor cells have a dual effect, both by promoting the acquisition of a tumor phenotype and by activating ROS-dependent death signals to kill tumor cells., The regulation of ROS by p53 also has a dual function. ROS act as an upstream signal to trigger the activation of p53, and p53 transcribes the expression of multiple antioxidant genes, such as GPX1 and manganese superoxide dismutase, to support tumor cell growth or death.– ROS can also act as a downstream factor of p53 to drive tumor cell death through apoptosis and ferroptosis., p53 plays a dual role in inhibiting and promoting the tricarboxylic acid cycle and oxidative phosphorylation.,, p53 is also involved in regulating cellular redox reactions and mediating cancer cell death.,, In addition, p53 is involved in the regulation of lipid, amino acid and nucleotide metabolism.,,

Ferroptosis

18Ferroptosis is a form of regulated cell death initiated notably by severe lipid peroxidation.– p53 was reported to inhibit cystine uptake and promote ferroptosis by transcriptional repression the expression of SLC7A11 which is a key component of the cystine-glutamate antiporter.,, p53 expression further enhances the ability of GPX4 to antagonize ferroptosis by increasing the biosynthesis of GSH. p53 also regulates SLC7A11 expression in a non-transcriptional manner. p53(3KR) is an acetylation-deficient mutant that fails to induce cell cycle arrest, apoptosis and senescence, but retains the ability to regulate SLC7A11 expression. Another mutant of p53(4KR) lost the ability to regulate SLC7A11 expression. This also suggests the importance of acetylation of p53 for the regulation of ferroptosis. H2Bub1 activates SLC7A11 expression. p53 inhibits the level of H2Bub1 by promoting nuclear translocation of the deubiquitinase USP7, which suppresses the expression of SLC7A11 and induces ferroptosis.

19p53 can also activate the expression of SAT1, a rate-limiting enzyme in polyamine catabolism, thereby inducing lipid peroxidation and ferroptosis upon ROS stress. SAT1-induced ferroptosis is involved in elevated expression levels of the lipoxygenase ALOX15. ALOX12 was also reported to be required for p53-mediated ferroptosis. Moreover, p53 promotes ferroptosis through modulation of GLS2, PTGS2, FDXR and noncoding RNAs. On the other hand, interaction of p53 with DPP4 promotes nuclear accumulation of DPP4 and blocks plasma-membrane-associated DPP4-dependent lipid peroxidation, thus limiting ferroptosis. The p53-p21 axis may contribute to the inhibition of cysteine deprivation-induced ferroptosis, whereas it has also been reported that p21 restricts the progression of ferroptosis in a p53-independent way.

Tumor microenvironment

20The status of p53 in tumor cells has a profound impact on the immune microenvironment. p53 regulates the release of cytokines and stimulates macrophage polarization toward the M1 phenotype to suppress tumorigenesis. Macrophages lacking p53 polarize toward M2 and enhance the proliferation of precancerous cells. p53 activation stimulates cellular anti-tumor responses,, leading to interferon production, and there is a synergistic effect between cancer immunotherapy. Deletion or mutation of p53 in cancer affects the recruitment and activity of T cells, leading to immune evasion of cancer cells., Restoration of p53 expression enhanced the antitumor effect of anti-PD-1 monoclonal antibody on hepatocellular carcinoma cells and effectively induced reprogramming of the tumor microenvironment. TP53 mutations are associated with increased expression of PD-L1, which may be a predictor of response to PD-L1 targeted checkpoint inhibitors. Mutant TP53 contributes to the regulation of tumor cells into an immune microenvironment that is conducive to growth.–

Cancer stem cell self-renewal

21The Rb/p53 signaling pathway regulates the proliferation and self-renewal process of neuroendocrine cells in the early stages of injury. Neuroendocrine cells return to a quiescent state after completing a limited proliferation. However, under conditions of Rb/p53 functional deficiency, neuroendocrine cells can acquire a sustained proliferative function and develop into small cell lung cancer., Activation of p53 in breast, prostate, epidermis, central nervous system and hematopoietic stem cells– hinders stem cell self-renewal, but the exact mechanism remains to be confirmed. p53 has an essential role in regulating normal and malignant stem cell differentiation and self-renewal. Conversely, mutant p53 contributes to the maintenance of cancer stem cells. Mutant p53 enhances the proliferation of cancer stem cells by regulating WASP-interacting proteins. Mutant p53 also enhances the self-renewal of hematopoietic cells by upregulating FOXH1.

22The epithelial-mesenchymal transition is a form of reprogramming of cancer cells. Under pathological conditions, epithelial cells transform into mesenchymal cells, enhancing the invasive metastasis of cancer cells. p53 directly activates miR-200, miR-130 and miR-34 and inhibits the transcription factors Slug, Snail1 and Zeb1, which promote epithelial mesenchymal transformation.– p53 deletion enhances self-renewal of lung cancer stem cells.

Autophagy

23Autophagy degrades intracellular macromolecules through the lysosomal pathway, thereby enabling intracellular energy supply and organelle renewal., p53 can directly activate damage-regulated autophagy regulators and induce autophagy., Autophagy is controlled by autophagy-related genes (Atg). Combined ChIP sequencing and RNA sequencing analysis revealed that p53 binds to many autophagy genes, including Atg2, Atg4, Atg7 and Atg10. This suggests that p53 induces autophagy in a transcription-dependent manner. Cathepsin D is a lysosomal aspartate protease and overexpression of cathepsin D activates autophagy., p53 binds to two DNA sites in the cathepsin D promoter region and regulates Cathepsin D expression., The upregulation of TGM2 expression by p53 enhances autophagy, thereby inhibiting oncogenic transformation and tumor formation in primary human mammary epithelial cells.

24p53 inhibits mTOR and enhances autophagy by activating AMP-responsive protein kinase.– The p53 target genes Sestrin1 and Sestrin2 phosphorylate and activate AMPK and promote autophagy. p53 induces mitophagy by increasing the level of BNIP3. Interaction of beclin1 with Bcl-2 family anti-apoptotic proteins inhibits autophagy., p53 promotes the expression of BH3-only protein, which competitively binds to Bcl-2 family anti-apoptotic proteins, contributing to the restoration of beclin1 activity and promoting autophagy.,

25p53 also functions as an inhibitor of autophagy. When p53 with deletion of nuclear localization sequence accumulates in the cytoplasm, it inhibits autophagy., HMGB1 and p53 regulate autophagy by mutually regulating their distribution in the nucleus and cytoplasm., In addition, autophagy regulates p53 activity. Atg7 inhibits p53 activation and p53 induced apoptosis.

Other cellular processes

26The signaling pathways involved in the regulation of p53 also include immune responses, non-coding RNAs and so on that exert tumor suppressive effects.,,– In the process of tumor development, p53 suppresses tumor transformation, proliferation, metastasis and drug resistance through multifaceted regulation. p53 has an exceptionally flexible biological response that is altered by changes in cell type, cell differentiation status, stress conditions, and different signals in the environment.

Oncogenic effects of wild-type p53

27Studies have confirmed that p53 is essential for suppressing cancer in humans. However, a study in 2019 showed that p53 could promote tumor growth by enhancing the metabolism of hepatocellular carcinoma cells (Fig. 3). p53 transcription activates Puma expression, which further initiates apoptosis. But certain levels of Puma protein interfere with normal mitochondrial function, leading to a shift in mitochondrial energy metabolism from oxidative phosphorylation to glycolysis. Another group knocked out MDM2 in hepatocyte-specific KRAS G12D mutant mice and observed p53 accumulation in mouse hepatocytes. These p53-activated mice exhibited increased inflammatory responses, hepatocyte apoptosis, and senescence-associated secretory phenotype, leading to the facilitation of a carcinogenic microenvironment, (Fig. 3). Hepatic progenitor cells from p53-accumulating mice were injected into experimental mice growing tumors. The development of hepatocellular carcinoma and other related phenotypes no longer occurred after knockdown of TP53, suggesting that p53-accumulated mice do promote the development of hepatocellular carcinoma. Cellular activities regulated by p53 are integrated into tumor suppressive functions, but p53-induced regulation of certain elements may also provide a survival advantage for tumors (Fig. 3).

TP53 mutations in cancer

28The TP53 gene is mutated in most tumor cells. Genome sequencing of different human cancer cells showed that 42% of cases carry TP53 mutations. The major type of mutation in TP53 is a missense mutation, a single amino acid substitution and the DNA binding domain (DBD) is the most common mutated region, (Fig. 4a, b). p53 mutants are usually classified as structural mutants and DNA contact surface mutants. Structural mutants (R175H, R249S, G245S, Y220C) have reduced protein thermostability, resulting in proteins that do not fold properly at physiological temperatures and lose the ability to bind to DNA. Among them, R175H and C176Y affect the binding of protein to zinc ions. DNA contact surface mutants (R273H/C, R248W) are located in the DNA core binding region with mutations that prevent the binding of protein to DNA. R175, G245, R249, R282, R248 and R273 are the most common mutation sites and are therefore referred to as “hot spot” mutations of TP53– (Fig. 4b). These mutants not only bind to wild-type p53 to produce dominant-negative (DN) effects but may also be converted to oncogenic proteins via gain-of-function (GOF).,, Thus, TP53 differs from many “classical” oncogenes, which are usually characterized by nonsense or shift mutations that result in truncated protein inactivation.–

29TP53 mutations are prevalent in tumors, but different tissues and organs have different TP53 mutation spectra (Fig. 4c). TP53 mutations were commonly found in the ovary (47.27%), colon and rectum (44.55%), lung (40.8%), pancreas (38.53%), stomach (36.78%), urethra (35.01%), liver (29.17%), breast (26.44%), prostate (22.52%), bone (16.19%), thyroid (11.13%), hematopoietic and lymphatic (10.13%) and kidney (8.75%) (https://cancer.sanger.ac.uk/cosmic). TP53 was mutated more frequently in esophageal carcinoma (93.77%), small cell lung cancer (79.06%), ovarian carcinoma (80.46%), colorectal carcinoma (74.45%) and gallbladder carcinoma (57.77%), and less frequently in thyroid carcinoma (3.13%), embryonal tumor (2.08%) and peripheral nervous system (1.25%). Different tumor subtypes of the same tissue and organ also have different TP53 mutation spectra. For example, the frequency of TP53 mutations in non-small cell lung cancer was 57.04%, which was lower than that in small cell lung cancer (79.06%) (https://www.cbioportal.org/). In addition, TP53 mutation spectra differed by race. The frequency of TP53 mutations in breast cancer is 42.9% in Asian and 30–35% in Caucasians.

Mechanism of action of mutant p53

30TP53 acts as a tumor suppressor gene and genome guardian, so cancer cell transformation is unlikely to occur in cells that maintain normal p53 function., TP53 mutations provide a permissive environment for tumorigenesis., TP53 mutations are a hallmark of an inherited cancer susceptibility syndrome known as Li-Fraumeni., The high frequency of TP53 mutations found in tumor cells,, may be the result of selection pressures that favor tumor cells to escape surveillance and be spared from death., Many mutant p53 proteins are more stable than wild-type p53 proteins and can accumulate in cells. Some mutant p53 proteins may have completely different functions than wild-type proteins, and this effect may be due to altered target gene profiles, mutant p53 secretome or inappropriate protein-protein interactions (Fig. 5).

31Loss of p53 transcriptional activity of mutant p53, and to some extent the DN effect are major drivers of the tumor phenotype (Fig. 5). The loss-of-function or DN effect of wild-type p53 enhanced the viability of tumor cells, and this effect was independent of missense mutations in TP53. The deletion of TP53 in gastric cells combined with an oncogenic diet confers a selective advantage to cancer cells. Analysis of more than 10,000 patient samples from 32 different cancers in The Cancer Genome Atlas revealed that more than 91% of mutant p53 was accompanied by deletion of TP53 alleles. Mutations in TP53 are associated with enhanced chromosomal instability,, and are accompanied by amplification of oncogenes and deletion of suppressor genes., Significant upregulation of proteins associated with cell cycle progression was also observed in p53 mutant cancers, which may be due to loss of control of cell cycle checkpoints by TP53 deletion.,, Scott W. Lowe’s group used a mutation tracking system to reveal a pattern of TP53 inactivation leading to genomic alterations. Although TP53-deficient cells gain the potential for cancer cell transformation, TP53 deletion alone is not sufficient to cause cancer. TP53-deficient cells gain additional gene amplification in an ordered way that eventually spirals out of control and develops into cancer.– Functional, DNA binding and transcriptional analyses against myeloid malignancy cell lines carrying TP53 missense mutations showed loss of p53 function, indicating that DN is the primary choice for TP53 missense mutations in myeloid malignancies.

32The activity of the p53 mutant GOF has been reported to be associated with cellular physiopathology and poor clinical outcomes in cancer patients– (Fig. 5). Mutant p53 binds directly to TBK1, prevents TBK1 from forming a ternary complex with STING and IRF3, and ultimately inhibits the activation of the cGAS-STING pathway. Mutant p53 helps tumor tissue evade the killing effect of the immune system by inhibiting the anti-tumor immune response.,, However, in contrast, the evidence on the effects of p53 mutant GOF is much weaker compared to DN, and it may act modestly or only in certain specific situations.

33Mutated TP53 not only lost its normal biological function, but also promoted cancer metastasis. Missense mutations in TP53 were associated with lymph node metastasis in prostate cancer patients. TP53 R175H and R273H mutations occurred in more metastatic tumors than in TP53 knockout mice., In mouse models of pancreatic cancer that specifically express oncogenic KRAS and mutant TP53, more than twice as many metastatic lesions were observed as in TP53 knockout mice. Lung adenocarcinoma mice carrying TP53 and KRAS mutations are highly aggressive and metastasize to multiple sites of intrathoracic and extrathoracic in a pattern similar to that of human lung cancer. Similarly, TP53 gene deletion induces an increase in systemic neutrophils, which drive systemic inflammation with breast cancer cell metastasis.

34Mutant p53 can lead to treatment resistance in cancer. Multidrug resistance protein 1 (MDR1, also known as P-glycoprotein), encoded by ATP-binding cassette subfamily B member 1, has been shown to be resistant to cytotoxicity and chemotherapy. In p53 mutant R248Q-expressing Hep3B cells, expression and activity of the multiple drug resistance gene, P-glycoprotein, are elevated mediating doxorubicin resistance. Acetylated mutant p53 interacts with p300 to promote transactivation of ephrin-B2 and enhances ATP-binding cassette subfamily G member 2 levels, thereby promoting chemoresistance. In R273H-expressing human squamous cell carcinoma cells, multidrug resistance to doxorubicin, methotrexate and apoptosis-inducing drugs was shown due to downregulation of procaspase-3 levels. Wild-type p53 inhibits LRPPRC expression via miR-34a, further reducing MDR1 expression. However, when TP53 is mutated, chemotherapy-induced inactivation of this pathway and the accumulation of LRPPRC and MDR1 promote drug resistance. Mutated p53 binds to the miR-223 promoter and reduces its transcriptional activity, and the introduction of exogenous miR-223 makes tumor cells carrying mutated TP53 sensitive to treatment.

The structures of p53

35The comprehensive function of p53 is closely related to its modular structure of typical signaling proteins. Human p53 is a multidomain protein that consists of 393 amino acids. It contains an N-terminal transactivation domain (TAD, residues 1–61), a proline-rich domain (PRD, residues 64–92), a DNA-binding domain (DBD, residues 96–292) linked to a tetramerization domain (TET, residues 324–356), and a C-terminal regulatory domain (CTD, residues 364–393), (Fig. 4b). More than 40% of the regions within p53 are intrinsically disordered, including the TAD, CTD, and the linker between DBD and TET. These disordered regions allow p53 to interact as a modular protein with a wide range of partner proteins. These structured and unstructured domains individually have unique properties and contribute to the overall functional diversity and complexity of p53. Due to the intrinsic flexibility of the intact protein, the high-resolution structure of full-length p53 remains unclear.

N-terminal region

36The N-terminal region of p53 contains a highly acidic, intrinsically disordered TAD and a proline-rich region. TADs, including TAD1 (residues 1–40) and TAD2 (residues 40–61), can bind to transcription machinery components and transcriptional coactivators to promote transcriptional initiation and interact with negative regulators to suppress transcriptional activation. TAD can adopt an amphipathic α-helical conformation upon binding of partner proteins, which seems to be an essential binding mode, as seen in the structures of TAD bound to the negative regulator MDM2/MDMX (Fig. 6a), transcription coactivator CBP,/p300, (Fig. 6b), replication protein A, high-mobility group B1, HMGB1, Tfb1 subunits of yeast TFIIH and metastasis-associated protein S100A4. Notably, phosphorylated TAD2 exhibits an acidic string-like conformation when bound to subunit p62 of human TFIIH (Fig. 6c). Phosphorylation of TAD has been shown to serve as a switch to rapidly turn p53 function on and off but also as a mechanism for a graded p53 response., Overall, the conformational plasticity of the TAD, together with posttranslational modifications, makes p53 a highly efficient transcription factor.

37The proline-rich region linking the TAD to DBD is required for p53 to induce cell cycle arrest and apoptosis., This region plays a role in signal transduction by binding to Src homology 3 domains. The PRD is also involved in interactions with focal adhesion kinase (FAK), peptidase D, ASPP family members, and the corepressor protein mSin3a. The PRD contains five PXXP motifs, some of which may adopt a polyproline helix-like structure. The exact structure and interaction mechanism of PRD are largely unknown.

DNA-binding domain

38The structured DBD adopts a basic scaffold of an immunoglobulin-like β-sandwich, a loop-sheet-helix motif (loops L1, S2, and S2’, parts of the extended S10 and H2), and two large loops (L2 and L3) that are stabilized by a tetrahedrally coordinated zinc ion (Fig. 7a). The DBD is responsible for binding sequence-specific target DNA, which is central to the biological function of p53 as a transcription factor. In addition, the DBD is also capable of interactions with diverse proteins.

DNA recognition

39In response to a wide variety of stress signals, p53 regulates the transcription of many different genes involved in various pathways. p53 also acts as a pioneer transcription factor, binding to specific DNA sequences in the nucleosome to promote transcriptional activation in chromatin.– Most p53 target genes contain a consensus response element (RE) composed of two decametric half-sites of RRRCWWGYYY (R = A, G; W = A, T; Y = C, T) separated by 0–13 base pairs.– Some REs are cluster sites that have more than two half-sites. p53 also binds a set of noncanonical DNAs, such as cruciforms, left-handed DNA (Z-DNA), quadruplex and triplex DNA.,

40Various structural studies have demonstrated the molecular mechanism of DNA recognition by p53 (Fig. 7a). Briefly, the residue Arg248 from the large loop L3 interacts with the minor groove. The loop-sheet-helix motif docks into the major groove and makes hydrogen bond contacts with bases via key residues Lys120, Cys277 and Arg280. Residues Ala276, Ser241 and Arg273 contribute to DNA backbone contacts. p53 binds to a full consensus DNA response element as a tetramer through a highly cooperative self-assembling mechanism (Fig. 7b). Two DBDs bind each decameric half-site as a symmetrical dimer (A-B), and two such dimers (A-B and C-D) constitute a tetramer on a full DNA response element via protein-protein and base stacking interactions.,,–

41Upon DNA binding, the DBD and the DNA helix undergo structural changes. The binding of p53-DBD to the BAX response element causes DNA deformation, which is partially disordered around the spacer region, leading to unwinding and compression of the region to allow protein-protein interactions. In some p53/DNA structures, the central A-T doublet of each half-site shows noncanonical Hoogsteen base-pairing geometry instead of standard Watson-Crick base pairs., Some p53/DNA structures reveal that loop L1 of two p53 subunits adopts a conformational switch from an extended conformation where Lys120 interacts directly with DNA to a recessed conformation where there is no direct DNA contact. The conformational switch is related to the DNA-binding specificity of p53. Acetylation of loop L1 residue Lys120 expands the conformational space of loop L1 in the DNA-bound state and promotes sequence-dependent DNA-binding modes for p53.

DBD-mediated protein-protein interactions

42In addition to DNA recognition, the DBD mediates protein-protein interactions with multiple proteins. Interactions with these proteins influence various activities of p53. An increasing number of structures of the DBD/protein complex have been determined, providing fresh perspectives on the mechanisms of p53-DBD binding and functional diversity.

43By using a yeast two-hybrid system, 53BP1 and 53BP2 (namely, the C-terminal fragment of ASPP2) were initially identified to bind to p53. They interact with p53-DBD through the L3 loop and L2 loop– (Fig. 7c, e). 53BP1 plays multiple roles in DNA damage and repair and has been reported to enhance p53-mediated transcriptional activation of ASPP2. The inhibitory member iASPP belongs to the apoptosis-stimulating p53 protein (ASPP) family, which has opposite functions in regulating the apoptotic function of p53. Unlike ASPP2, iASPP preferentially binds p53-PRD and interacts with the DBD through the L1 loop, helix H2 and N-terminal loop (Fig. 7d). The L1 loop of p53 moves away from other DNA-binding modules upon binding iASPP, which disables Lys120 from making contact with a specific base. The different binding interfaces with the ASPP family provide insight into the opposing regulatory mechanism of p53.

44Cytoplasmic p53 has been reported to regulate the mitochondrial apoptosis pathway by inhibiting antiapoptotic BCL-2 and BCL-xL. In a structural model of BCL-xL/p53 characterized by nuclear magnetic resonance (NMR) spectroscopy and determined using the HADDOCK docking method based on 1:1 stoichiometry, the BCL-xL binding surface of p53-DBD largely overlaps with the DNA-binding surface and encompasses helix H1 and the Zn2+-coordination site (Fig. 7f). However, the recently determined crystal structure of the p53/BCL-xL complex indicates that p53 binds BCL-xL with a 2:1 stoichiometry (Fig. 7g). Two p53-DBD molecules dimerize through the N-terminal loop and β9-β10 loop of one p53-DBD and the Zn2+-coordination site of the other p53-DBD, involving residues Tyr107 and His178, respectively. The resulting p53-DBD dimer forms a groove and interacts with one BCL-xL to form a ternary complex. The DNA-contacting residues Arg248 and Arg273 form direct hydrogen bonds with BCL-xL. The binding mode is distinct from other p53-DBD binding proteins.

45The p53-DBD is also targeted by viral oncoproteins, such as the large T antigen (LTag) of simian virus 40 (SV40) (Fig. 7h) and human papillomavirus (HPV) oncoprotein E6, (Fig. 7i). LTag promotes viral replication and cellular transformation. It occupies the entire DNA-binding surface of p53-DBD and interacts with a region of helix H1 that is involved in p53-DBD dimerization. The p53-binding site of HPV E6 substantially overlaps with the binding surface of iASPP, which has been reported to inhibit HPV E6-induced degradation of p53.

46Some of these proteins bind p53 at a surface overlapping with the DNA-binding site, such as 53BP1, ASPP2, Bcl-xL and LTag. Some partner proteins bind at a surface distal from the DNA-binding site, such as iASPP and HPV E6. Notably, the p53 hotspot mutant alleles at residues Arg248 and Arg273 not only make direct contact with DNA but are also involved in direct contact with ASPP, BCL-xL and LTag. Another hotspot residue, Arg282, is involved in iASPP binding. Thus, these hotspot mutants may have multiple hits on p53 activities.

Tetramerization domain

47Full-length p53 reversibly forms tetramers through the TET. The structural analysis demonstrated that monomeric TET is a V-shaped structure composed of a β-strand and an α-helix linked by hinge residue Gly344– (Fig. 7j). The primary dimer relies on eight backbone hydrogen bonds of the β-sheet and is also stabilized by hydrophobic interactions (Phe328, Leu330, Ile332, Phe338 and Phe341) as well as a salt bridge between Arg337 and Asp352. The dimer-dimer interactions are primarily mediated by hydrophobic contacts (Met340, Phe341, Leu344, Ala347, Leu348 and Leu350). R337C/H/P and L344P affect the formation and transcriptional activity of p53 tetramers and are involved in Li-Fraumeni Syndrome and Li-Fraumeni-Like Syndrome. The G334V mutant contributed to a beta-dominated structural transition leading to amyloid formation at physiological temperature. A highly conserved leucine-rich nuclear export signal (NES) within the TET is necessary for the subcellular localization of p53. Some proteins bind directly to TET, but no complex structure has yet been demonstrated.

The C-terminal regulatory domain

48Similar to the NTD, the CTD is also an intrinsically disordered region. This characteristic endows it with multiple regulatory functions in almost every aspect of p53, including DNA binding, cofactor recruitment, cellular localization, and protein stabilization. The CTD possesses many positively charged residues, which are highly conserved in mammals. Extensive posttranslational modifications of the CTD, including acetylation, methylation and phosphorylation, play an essential and interdependent role in its function and stability (Fig. 7k). The CTD adopts different conformations depending on the binding partners and posttranslational modifications, (Fig. 7l–o).

Full-length p53

49The highly intrinsic unfolded regions within p53 make it difficultt to determine the high-resolution structure of full-length p53. A 4.6 Å resolution structure of RNA polymerase II (Pol II) with full-length p53, has shown that the DBD targets the upstream DNA-binding site within Pol II, and the following TET is exposed on top of the DBD. The TAD distal to the DBD forms helices and binds Pol II’s jaw that contacts downstream DNA (Fig. 7p). This association introduces a conformational change in Pol II, providing insight into the p53-mediated regulation of gene expression.

50How an intact p53 tetramer interacts with DNA and proteins is still largely unclear. A combination of NMR, electron microscopy, small-angle X-ray scattering, and FRET techniques indicates that the free p53 tetramer in solution forms an open cross-shaped structure with a pair of loosely coupled DBD., The oligomers close to form a compact complex upon binding a specific DNA response element. Chemical cross-linking and mass spectrometry methods are also employed to study the structural dynamics of full-length p53. A recent study has reported cryo-electron microscopy of p53-DBD and full-length p53 complexed with a nucleosome, in which the DBD binds as a tetramer to the DNA and peels the DNA from the histone surface. The N-terminal and C-terminal regions were not observed in the cryo-EM maps, but biochemical analysis suggests that the C-terminus of p53 may contain an additional DNA binding domain.

51The artificial intelligence system AlphaFold has accomplished the great challenge of protein amino acid sequence to structure, bringing great advances to the field of biology, especially structural biology.– In 2021, AlphaFold2 released its predicted structure of the full-length p53 protein (https://alphafold.com/) (Fig. 7q). The predicted full-length p53 structure is shown as a monomer with the DBD and TET regions resembling the known structures of individual structural domains. Nevertheless, it does not provide more information on how the disordered regions fold and how p53 assembles into a tetramer. In addition, the most important feature of p53 is missense mutations leading to its altered or lost function. AlphaFold2 is currently unable to correctly predict the structural impact of missense mutations. Furthermore, the p53 protein functions by binding to various ligands such as DNA, small molecules, metal ions or other proteins. We still lack structural information about this interaction to aid in drug development against p53 and recognition of protein complexes.– Following technological revolution, we expect that artificial intelligence will provide more valuable information in the future.

52Regardless, structural studies on full-length p53 in complex with different DNA targets, full-length partner proteins, and even higher-order complexes are needed. This structural biology information will not only help to understand the role of p53 in cellular life activities, but these structures may also help to design drugs that target p53.

Structure-based p53 targeting

53Structural and biochemical analyses have provided insight into the function of p53. However, many important questions regarding the structure‒function and specific regulation of p53 remain to be determined. In recent years, with the development of NMR, protein crystallography and cryo-electron microscopy techniques, much structural information has been obtained about the binding of p53 to ligands. From this critical information, structure-based design strategies can be applied to optimize the structure and thus improve activity and selectivity.

MDM2/MDMX-p53, a central hub for p53 activation

54MDM2/MDMX is the major negative regulator of p53. In the MDM2-p53 negative feedback regulatory loop, wild-type p53 activates the transcription of MDM2, while the N-terminal of MDM2 binds to p53-TAD and represses the transcriptional activity of p53. In addition, the C-terminus of MDM2 has the enzymatic activity of E3 ubiquitin ligase, which promotes the nuclear export and degradation of p53., MDMX (or MDM4), a homolog of MDM2, is structurally similar to MDM2, but it lacks ubiquitin ligase activity and can enhance the ubiquitination activity of MDM2 by forming a dimer with MDM2., Overexpression or activation of MDM2/MDM4 is present in many human tumors, leading to p53 inactivation.,, Many antitumor drugs targeting MDM2/MDMX-p53 interactions have been developed in recent years (Fig. 8, Table 1).

MDM2-p53 inhibitor

55The cocrystal structure of p53-TAD with MDM2 shows that Phe19, Trp23 and Leu26 on the α-helix of p53 penetrate deeply into the hydrophobic cleft of MDM2 (Fig. 8a, b), with Leu22 providing additional van der Waals forces. These structural features of the p53/MDM2 complex provide a basis for finding inhibitors that block the interaction between these two proteins.

RG7112

56Based on the structural features of p53/MDM2, researchers synthesized imidazole-like MDM2 antagonists, among which RG7112 is the first small-molecule inhibitor of MDM2 to enter the clinic. The crystal structure showed that the 4-chlorophenyl ring occupied the Trp23 and Leu26 pockets, while the ethoxy group was prominently located in the Phe19 pocket (Fig. 8d). RG7112 had a Kd = 2.9 nM. It effectively blocks p53-MDM2 binding and promotes cancer cell cycle arrest and apoptosis. However, the ability of RG7112 to induce apoptosis in cancer cells varies widely. The best responses were observed in MDM2 gene-amplified osteosarcoma cell lines and xenografts.,

RG7388

57The MDM2 inhibitor RG7388, which was subsequently designed and synthesized, is a class of pyrrolidine derivatives. RG7388, Kd = 0.15 nM, induces dose-dependent apoptosis in wild-type p53 cancer cells. Structurally, the 4-chlorophenyl ring, 3-chlorophenyl group and neopentyl group mimic p53 occupying the Phe19, Trp23 and Leu26 pockets. In addition, the 3-chlorophenyl group forms a π-π stacking interaction with the His96 residue on MDM2, and the pyrrolidine Cα carbonyl group forms another hydrogen bond with His96 (Fig. 8e). RG7388 activates p53 to inhibit hematological tumors and solid tumors,, but long-term administration may lead to p53 mutations and drug resistance.,

AM232

58AMG32, Kd = 0.045 nM, is a piperidone analog that potently inhibits the MDM2-p53 interaction. Structural analysis revealed that the “cleft” of Gly58 may provide additional assistance for the small molecule to bind MDM2. The crystal structure shows that the isopropyl group, C6 aryl group and C5 aryl group occupy the three major binding pockets of p53, namely, Phe19, Trp23 and Leu26, respectively. Meanwhile, the imidazole group of His96 formed π-π stacking interactions with the C5 aryl group and formed hydrogen bonds with carboxylate. In addition, the isopropyl group extends into the “cleft” of Gly58, forming CH·O-type interactions with Gly58 and enhancing contacts with nearby hydrophobic residues (Fig. 8f). In tumor cells with high MDM2 expression, AMG232 enhances p53 activity and inhibits tumor growth. AMG232, in combination with immune checkpoint drugs, also enhances T-cell-mediated tumor killing. However, high doses of AMG232 may trigger gastrointestinal side effects, neutropenia and leukopenia, which requires further study.

SAR405838

59SAR405838 (MI77301), Ki = 0.88 nM, is an optimized spiro-oxide compound that blocks the MDM2-p53 interaction and prevents p53 degradation. SAR405838 mimics the three key amino acid residues of p53 and forms hydrogen bonds with the His96 residue of MDM2 at different chemical groups, generating π-π stacking, as seen in other MDM2 inhibitors. The structural differences are that SAR405838 mediates the refolding of the MDM2 N-terminus (residues 10–18) and interacts extensively with Val14 and Thr16. Moreover, the hydroxy-cyclohexyl group forms a hydrogen bond with Lys94 (Fig. 8g). These structural features allow SAR405838 to achieve a tight binding and high specificity for MDM2. SAR405838 activates the p53 pathway, increases the expression of PUMA and P21, and induces complete tumor regression in SJSA-1 osteosarcoma xenograft mice. The safety of SAR405838 alone or in combination with MEK inhibitors has been established, but the drug activity is limited, and TP53 mutations may occur with long-term administration.

NVP-CGM097

60NVP-CGM097, Ki = 1.3 nM, is a novel dihydroisoquinoline-like MDM2 inhibitor obtained by virtual screening and structural optimization. The cocrystal structure revealed that in addition to the three key amino acids that mimic the interaction between p53 and MDM2, the isopropyl ether group also forms water-mediated hydrogen bonds with Tyr100, Gln24 and Phe55. NVP-CGM097 induced a conformational change in Phe55; thus, Phe55 formed a π-π stacking interaction with the dihydroisoquinolone core (Fig. 8h). NVP-CGM097 exhibits high selectivity for wild-type p53 and shows potent antiproliferative ability in colorectal cancer and osteosarcoma cells with wild-type p53. NVP-CGM097, combined with MEK inhibitors, activates the MAPK signaling pathway and attenuates acute myelogenous leukemia (AML) cell load. When combined with BET or Cdk4/6 inhibitors, NVP-CGM097 induces cell death in neuroblastoma or ER-positive breast cancer cells.,

MDM2/MDMX-p53 inhibitor

61The main features of the MDM2-p53 interaction are preserved in the MDMX-p53 structure, but the central hydrophobic cleft of p53 peptide binding in MDMX is smaller and differently shaped than that of MDM2 (Fig. 8a–c). Therefore, many small molecule drugs targeting MDM2 do not bind MDMX well.

ALRN-6924

62Currently, there are no inhibitors that act on MDMX alone, but one stapled peptide, ALRN-6924, binds both MDM2 (Kd = 10.9 nM) and MDMX (Kd = 57 nM). In AML cells, ALRN-6924 induces cell cycle arrest and apoptosis and significantly prolongs the survival of AML model mice. ALRN-6924 is well tolerated in phase I clinical trials in patients with solid tumors and lymphomas carrying wild-type p53. However, molecular simulations reveal that ATSP-7041, an analog of ALRN-6924, may bind to the p53 coactivator p300 and isolate free p300, thus reducing the transcriptional activity of p53. This mechanism needs further investigation.

Other MDM2 inhibitors

63Other MDM2 inhibitors currently in clinical trials include HDM201,, MK-8242,– BI-907828, APG-115,– and milademetan (DS-3032b) (Table 1). Although the specific interaction sites are unknown, they all induce cell death in a variety of tumor cells, particularly in patients with MDM2 amplification and intact p53 expression. APG-115 was the first MDM2 inhibitor to enter the clinic in China and was granted Fast Track Designation (FTD) by the U.S. Food and Drug Administration. APG-115 interrupts the p53-MDM2 interaction, increases the abundance of MDM2 in T cells, and plays a critical biological role in maintaining T-cell stability, survival, and antitumor immunity.

64In addition, researchers designed Proteolysis-targeting chimera (PROTAC) degraders based on MDM2 inhibitors. WB156, consisting of a nutlin derivative linked to the CRBN ligand lenalidomide, effectively depleted MDM2 and activated wild-type p53, thereby inducing apoptosis., The rapid degradation of MDM2 by MD-224 resulted in complete tumor regression in leukemia cells carrying wild-type p53.

65Overall, the design and development of drugs targeting MDM2/MDMX-p53 is a hot spot and priority in the field of oncology drug research worldwide. However, the specificity of MDM2/MDMX-p53 protein interactions poses a great difficulty in the development of small molecule inhibitors. Although some MDM2 inhibitors have entered clinical trials, there are currently no marketed drugs, and it is hoped that structure-based guidance will lead to new breakthroughs for MDM2-p53 inhibitors.

Tackling the p53 mutation

66Under normal conditions, wild-type p53 suppresses tumor development through transcriptional regulation and protein-protein interactions. However, in many situations, missense mutant p53 is expressed at high levels in tumor cells, partly due to the inability of mutant p53 to induce gene expression of MDM2, which supports the reactivation of mutant p53 as a therapeutic option. Most TP53 mutations are missense mutations located in the DBD.,,,, p53 mutants mainly affect the thermostability of p53 protein, structural stability (structural mutants such as 175, 220, 245 and 249) or p53-DNA contact (DNA contact mutants such as 248 and 273). Therefore, a number of small molecule compounds, peptide or antibody drugs targeting p53 mutants have been developed to recover the native conformation or normal function of the p53 protein.–

Broad-spectrum mutant p53 rescue compounds

67Employing library screens, structure-based design and other methods, drugs or compounds were discovered to have effects on the thermostability, specific DNA binding capacity or transcriptional activity of p53 mutant proteins. Some of them were initially identified as p53 mutant activators, but as research progressed, it was discovered that they could also exert antitumor activity independent of p53 status (Tables 2–3).

PRIMA-1 and APR-246

68PRIMA-1 and APR-246 are prodrugs that are converted into the bioactive compound methylene quinuclidinone (MQ). PRIMA-1 was obtained by screening a library of compounds. PRIMA-1 restores the wild-type conformation and DNA contact of p53 mutants, and induces transcription of the downstream target genes BAX, P21 and PUMA.– After PRIMA-1 treatment of SKOV-His-175 cells, a 46% increase in folded p53 protein was observed using the p53 conformation-specific monoclonal antibody PAb1620. Further studies revealed that APR-246 (PRIMA-1Met, eprenetapopt), a methylated derivative of PRIMA-1, has stronger antitumor activity and fewer toxic side effects than PRIMA-1, and inhibits the growth of p53 mutant tumors of various origins in combination with other anticancer drugs.– Tumor cell lines carrying TP53, TP53 mutations, or TP53 deletions responded to APR-246 treatment.– However, growing evidence suggests that APR-246 exerts its effects through a multitude of pathways independent of p53,– such as downregulating glutathione concentrations in tumor cells,, regulating oxidation-reduction homeostasis– in tumor cells to trigger ferroptosis,– and inducing endoplasmic reticulum stress or unfolded protein responses.

69Clinical and preclinical data showed that the combination of APR-246 and azacytidine (AZA) showed synergistic activity in patients with myelodysplastic syndromes (MDS), AML and solid tumors carrying TP53 mutations with an acceptable safety and tolerability profile.– Food and Drug Administration and European Medicines Agency have granted APR-246 orphan drug status and FTD for the treatment of MDS carrying the TP53 mutation. Aprea Therapeutics recently announced preliminary data from its Phase III clinical trial. In a cohort of 154 intention-to-treat patients, the complete remission rate for APR-246 in combination with AZA was 33.3%, compared to 22.4% in the AZA alone group. Although the complete remission rate was higher with the combination, it did not reach statistical significance (https://www.aprea.com). Data from another clinical study could explain this phenomenon. Decitabine alone (a hypomethylating agent, similar to AZA) was able to produce a very high response rate (100%) in patients with AML or MDS carrying a TP53 mutation. This suggests that the therapeutic effect of the hypomethylating agent may be dominant in myeloid malignancies carrying TP53 mutations.

70MQ can covalently bind to cysteine to restore the function and conformation of mutant p53. MQ is a very active Michael receptor that preferentially and reversibly binds to the soft nucleophile cysteine thiol of p53. Theoretically, all cysteines exposed on the surface of p53 are potential modification sites of Michael addition reaction, (Fig. 9a). Computational docking indicated that Cys124, located in the center of the L1/S3 pocket of the p53 core region, may be the site of the MQ modification. In 2021, Degtjarik and colleagues investigated the mechanism of MQ reactivation of mutant p53 based on structure. Based on the DNA contact surface mutant R273H/R273C and the structural mutant R282W, six cysteines, Cys124, Cys182, Cys229, Cys273, Cys275 and Cys277, were identified to bind to MQ. Among them, the formation of new hydrogen bonds between MQ-Cys277 and DNA stabilizes the protein‒DNA interface, while MQ-Cys124 and MQ-Cys229 stabilize the local conformation and support the p53 dimer interface (Fig. 9b). MQ-Cys182, MQ-Cys275 and MQ-Cys273 are only observed in the structures absent from DNA, and seem to be incompatible with DNA binding. These conjugates form intramolecular interactions or intermolecular interactions with neighboring p53 molecules, stabilizing a p53 dimer different from that in p53-DNA tetrameric complexes. Therefore, MQ shows great diversity in reacting with p53 cysteines, while it worth considering whether each conjugate is beneficial for p53 rescue. Theoretically, MQ can bind to any exposed cysteine and GSH can also bind covalently to MQ, which may be one of the reasons for the antitumor activity of MQ.

ATO

71Arsenic trioxide (ATO) is a traditional Chinese medicine that leads to complete remission in patients with acute promyelocytic leukemia (APL). The specific fusion protein PML-RARα is present in more than 98% of APL patients. One of the mechanisms by which ATO treats APL is its ability to bind directly to the cysteine in the zinc finger structure of the fusion protein, mediating the ubiquitinated degradation of PML-RARα. Subsequently, a series of reports showed that ATO induced apoptosis in tumor cells carrying TP53 mutations.–

72Lu Min’s team found that ATO could help stabilize the structural mutation of p53 (R175H) and restore the cancer suppressive activity of p53. The crystal structure showed that the DNA-binding domains of Cys124, Cys135, Cys141 and Met133 formed an As-binding pocket, with direct interaction of arsenic with Cys124, Cys135 and Cys141 and van der Waals forces between the side chain of Met133 and the arsenic atom (Fig. 9c). Most structural p53 mutants were rescued to varying degrees by ATO, but mutations in the DNA contact surface (R248Q, R273H) were not observed. ATO increased the thermostability of structural mutant p53 by 0.9–6.5 °C, restored the protein folding state close to wild-type, and increased transcriptional activity by several fold to 44-fold. Studies on hematologic tumors showed that ATO significantly prolonged the median survival time in mice; and studies on solid tumors showed that ATO-treated mice had only 10–20% of the tumor volume of the control group.

Potassium antimony tartrate (PAT)

73Subsequently, the Lu Min’s team screened compounds for temperature-sensitive p53 mutant proteins, using thermostability as a criterion for rescue. Potassium antimony tartrate (PAT) was identified as binding to the p53 V272M mutant (Kd = 9.09 μM) in a non-covalent manner, increasing its thermostability by 3.6 °C and remarkably restoring protein folding and transcriptional activity. PAT is an antiparasitic agent that has been used as a treatment for leishmaniasis,, and has since been found to have antitumor activity., PAT is similar to ATO in that both can induce apoptosis in APL cells., PAT and ATO bind to mutant p53 at similar sites (Fig. 9d), but differ in two aspects, with PAT non-covalently binding mutant p53 and preferentially rescuing temperature-sensitive mutants (a subtype of structural mutants), whereas ATO covalently binding mutant p53 and apparently rescuing more structural p53 mutants. Notably, the ATO and PAT studies comprehensively and experimentally compared the set of representative mutant p53-rescuing compounds. PAT exhibited specific p53 V272M antitumor activity in both cellular and xenograft mouse models. Further testing identified 65 of p53 mutants that could be rescued by PAT, but all were non-hotspot mutations. A clinical trial of antimony for the treatment of MDS/AML with TP53 mutations is currently underway.

ZMC1

74Zn2+ is crucial for DNA recognition by p53. Zn2+ can help stabilize the interaction between p53 and DNA by tetrahedral coordination with the imidazole group of H179 and the thiol groups of Cys238, Cys242 and Cys176 (Fig. 9c, d). Conversely, the lack of Zn2+ affects the correct folding and DNA recognition of the p53-DBD protein. Therefore, helping zinc ions to bind in the correct position may be an effective strategy to target p53.

75R175H is one of the p53 hotspot mutations and is classified as a Zn2+-binding mutation. The binding affinity of DBD-R175H to Zn2+ was significantly reduced compared to that of wild type., On the basis of this hotspot mutation, NSC319726, also known as ZMC1, was identified from 48129 compounds. ZMC1 helped coordinate zinc ions at appropriate sites to restore the structure and function of the R175 mutant and significantly inhibited tumor growth in mice carrying the R175H mutation. ZMCI treatment increased the folded R175 mutant protein by twofold. ZMC1 acts as an ionophore, transferring zinc ions from the extracellular space to the cytoplasm, maintaining the cytoplasmic zinc ion concentration within an appropriate range and thus reactivating the p53 mutant.– In addition, ZMC1 can chelate redox-active copper, increase intracellular reactive oxygen levels and decrease glutathione concentrations to exert antitumor effects.,

76ZMC1 acts as an ionophore, transferring zinc ions from the extracellular space to the cytoplasm, maintaining the cytoplasmic zinc ion concentration within an appropriate range and thus reactivating the p53 mutant.– In addition, ZMC1 can chelate redox-active copper, increase intracellular reactive oxygen levels and decrease glutathione concentrations to exert antitumor effects.,

Other compounds

77Salim et al. identified a thiosemicarbazideb compound COTI-2 that showed inhibitory activity in a variety of tumors by using a computational platform. COTI-2 inhibits tumor growth in a p53-dependent and p53-independent manner, ultimately leading to cell cycle arrest and apoptosis.– COTI-2 was reported to restore DNA-binding properties to the p53-mutant protein,,– whereas it is obscure whether COTI-2 can physically bind p53. COTI-2 is currently in phase I clinical trials for the treatment of gynecologic malignancies or head and neck squamous cell carcinomas.

78There are also small molecule drugs that have not been structurally studied but may interact with the cysteine residues of p53-DBD and restore the wild-type conformational and transcriptional function of p53. CP-31398 was screened from a library of >100,000 compounds originally identified to rescue the mutant p53.– However, subsequent studies have shown that CP-31398 does not interact with p53-DBD or full-length p53, but rather acts as an intercalator and may interact with p53 during biosynthesis. CP-31398 inhibited ubiquitination and degradation of p53 and activated BAX independently of p53 to promote apoptosis of tumor cells. Molecular docking structures revealed that STIMA-1, MIRA-1– stictic acid and UCI-LC0023 could bind in the L1/S3 pocket of p53-DBD, probably to the thiol group of Cys124 in this transiently opened pocket.

79Some of these broad-spectrum mutant p53 rescue compounds have been reported to bind p53-DBD cysteine, helping restore the correct folding and thermostability of mutant p53. Complex structures show that MQ can bind to six of the ten cysteines, while ATO and PAT bind at a pocket formed by Cys124, Cys135, Cys141 and Met133. p53 has ten cysteines in its DBD (Fig. 9a). Theoretically, these cysteines are all potential sites for modification. Amino acids exposed on the surface of p53-DBD, Cys182, Cys229 and Cys277, are the most susceptible sites for modification. Cys182 and Cys229 are located on the p53 dimer contact surface and modification of these two sites may cause non-functional artificial dimers. Cys277 is located on the DNA contact surface and modification of this site may result in spatial site blocking that inhibits p53 binding to DNA. Cys176, Cys238 and Cys242 are relatively unlikely to be modified, as they involve the coordination of a zinc atom. Besides, Cys124, Cys135, Cys141 and Cys275 are located in the p53-DBD core region, which is exposed when the protein is not fully folded or conformationally altered, and may also be the site of modification. Specific targeting of these sites may be more helpful in restoring the structure and function of mutant p53.

Y220C

80The Y220C mutation in p53 is a relatively specific mutation. Y220 is far from the site where p53 binds to DNA, while the tyrosine mutation between S7/S8 becomes cysteine, forming a hydrophobic cavity on the p53 surface., Therefore, targeting the hydrophobic pocket of Y220C becomes an ideal drug target, helping p53 to restore normal folding without interfering with p53 binding to DNA. Several small molecules have been shown to bind to the hydrophobic pocket of Y220C and restore p53 function– (Tables 2–3, Fig. 10a–i).

81C14586 is the first orally bioavailable mutant p53 protein-selective reactivator that selectively binds to the cleft produced by the p53 Y220C mutant protein, thereby restoring wild-type p53 protein structure and tumor suppressor function. Preclinical trials have shown that continuous oral administration leads to complete tumor regression in 80% of mice. An ongoing clinical phase 1/2 study will evaluate the safety, tolerability and antitumor activity of C14586 in adult patients with advanced or metastatic solid tumors with the Y220C mutation.

82The hot spot mutation Y220C is a particularly suitable target site for structure-based drug design. The mutant p53 temperature sensitivity can be repaired by small molecule drugs, and the cavity that appears due to the mutation is also a good target for small molecules. Structure-based drug design and optimization may lead to new strategies for patients with tumors carrying the p53-Y220C mutation.

Targeting p53 aggregation

83p53 is a temperature-sensitive protein. Once mutated, its structural stability is compromised, exposing adhesion sequences encased in the hydrophobic core of p53, which drives the formation of p53 aggregates, thereby depriving p53 of its DNA recognition function and proapoptotic capacity, (Tables 2–3, Fig. 11). Amyloid aggregates caused by TP53 mutations have been found in biopsy specimens from ovarian and breast cancers.,

ReACp53

84The formation of p53 aggregates is considered to be an amyloid lesion, where two β-sheet layers stack in parallel to form a tight complementary spatial zipper, forming amyloid fibrils mainly through hydrogen bonding interactions between the main and side chains of the β-sheet layer., Several research groups have reported similar sequence positions as highly adherent fragments of p53 (251–258, ILTIITLE) (Fig. 11). p53 mutations result in reduced p53 stability and expose the highly adherent fragment that drives p53 aggregation, which is effectively inhibited by the I254R mutation.,, Soragni et al. designed a cell-penetrating peptide (named ReACp53) that inhibits amyloid aggregation of the mutant p53 protein and restores the transcriptional function of p53 and its ability to induce mitochondrial apoptosis. ReACp53 treatment increased the nuclear localization of mutant p53 by 70–100% and approximately doubled the transcriptional activity.

85Molecular dynamics simulations were used to study the binding characteristics of the ReACp53 peptide to the R175H mutant p53-DBD. The results show that ReACp53 has hydrophobic interactions with residues Leu188 and Leu201 and forms salt bridges or hydrogen bonds with residues Asp186, Glu198, Asp204, Glu 221 and Glu 224, which prevent the aggregation-prone region (residues 182–213) from being exposed. In addition, the complex formed by the ReACp53 peptide and the R175H mutant p53-DBD has the same positive net charge as wild-type p53. The aggregation of p53 was inhibited by electrostatic repulsion. ReACp53 also inhibits the growth of various tumors characterized by p53 mutations.,–

86ReACp53 inhibits the aggregation of mutant p53 to rescue p53 function, but it is clear that its non-p53 targets are also present in cancer cells. In p53-silenced cells, the response of ReACp53 was not abolished, and addition of this peptide to p53-silenced two-dimensional cultured cancer cells resulted in rapid apoptosis. Thus, although ReACp53 was designed as a mutant p53 rescue compound, its exact mechanism of action and targeting in tumors and whether it acts primarily by targeting p53 need to be further elucidated.

ADH-6

87ADH-6, Kd = 366 nM, is a cationic tripyridylamide obtained by screening the oligopyridylamide library. Previous studies have reported that these α-helix-like mimics can mimic the secondary structure of proteins and effectively regulate amyloid aggregation, (Fig. 11). Using NMR spectroscopy, ADH-6 was shown to bind not only p53-prone aggregation sites but also multiple regions of p53-DBD, including sheet 1, 3, 4, 6, 7 and helix 2. Subsequently, researchers also found that ADH-6 dissociated p53 mutant aggregates and selectively induced apoptosis in multiple p53 aggregation-prone mutated cancer cells (R248W, R248Q, R175H, R273H, Y220C and R280K). In addition, the unfolded state of mutant p53 was reduced by 24–50% after ADH-6 treatment of cells, and the expression of downstream target genes p21, Noxa and BAX was significantly increased.

LI/LH

88Miller et al. designed two bifunctional ligands (LI/LH) based on other compounds that bind amyloid proteins. LI and LH have the same structural features except for an iodine substituent at the ortho position. The iodine atoms may form halogen bonds that bind to exposed hydrophobic amino acid residues and regulate the aggregation of p53 (Fig. 11). LI and LH acted as metallochaperones binding to zinc ions, which increased the intracellular zinc ion level and improved the binding ability of zinc ions to mutant p53, thus regulating mutant p53 aggregation. LI and LH also increased the expression of Noxa and p21 by 1.5 to 4.3-fold. Meanwhile, transmission electron microscopy observation confirmed that mutant p53 could significantly inhibit the formation of aggregates when cocultured with LI.

HDAC6/Hsp90 inhibitors

89Mutant p53 aggregates not only induced wild-type p53 aggregates but also coaggregated with p63 and p73, (Fig. 11). The p53 aggregates led to upregulation of Hsp70 and Hsp90 (Fig. 11). Hsp70 inhibited MDM2-mediated degradation of mutant p53 ubiquitination and led to transient exposure of p53 adhesion sequences, increasing the formation of p53 aggregates. The interaction between Hsp90 and mutant p53 prevented the ubiquitinated degradation of mutant p53 protein. Thus, disruption of the HDAC6/Hsp90 complex by HDAC inhibitors or Hsp90 inhibitors induces degradation of the p53 mutant.

Peptide and antibody drugs targeting protein interactions

90Peptide drugs and antibody drugs are characterized by high specificity and good safety profiles. With the maturation of biotechnology, an increasing number of peptide and antibody therapeutics are beginning to emerge that can bind to mutated p53 and restore the function of the p53 mutant (Tables 2–3). However, although peptide drugs can enter cells to restore p53 function, it is difficult to maintain stability and function after entering the human body.,

CDB3

91A nine amino acid peptide, CDB3, was designed based on the p53 binding protein 53BP2 region (490–498). The NMR structure showed that CDB3 interacts with multiple sites in the DBD region, concentrated between loop 1, helix 2 and sheet 8, located at the edge of the DNA-binding site and partially overlapping with the DNA-binding site. Further experiments revealed that CDB3 could bind to G245S and R249S structural mutants, restore conformational folding, improve the affinity of the β-sheet I195T mutant to DNA, and restore the transcriptional activation function of p53 (R175H, R237H). Upon binding of CDB3 to mutant p53, the p53 protein is activated, and target genes compete for the position of binding CDB3, which in turn is released back into the cell and continues to target other mutants.,

pCAPs

92A series of p53 conformation-activating peptides, or pCAPs, were identified using phage display technology. Despite the absence of clear structural information, pCAPs were shown to bind to misfolded p53 mutants, forcing p53 conformational recovery and activating transcription of p53 downstream target genes. Significantly reduced mouse tumor size in mouse xenograft models of breast, ovarian and colon cancer.

p28

93The amphipathic penetrating peptide p28 contains twenty-eight amino acids from Pseudomonas aeruginosa.– It preferentially enters cancer cells and inhibits their proliferation by stabilizing the expression of p53. p28 forms a complex with the DBD of p53, and structural simulations show that the main binding sites of p28 are in the nonmutagenic loop L1 (amino acids 112–124) and the mutagenic loop L7/L8 regions (Y220C, P223L). p28 inhibits the interaction between the E3 ligase COP1 and p53, improves the posttranslational stability of p53, and increases p53 protein expression in various p53 wild-type or mutated tumor cell lines., These results provide foundational evidence that p28 performs well in phase 1 clinical trials in patients with various p53 wild-type or mutant tumors.–

Nb3 and Nb139

94Nanobodies containing only a heavy chain variable region (VHH) but still retain antigen specificity and high affinity have proven their value in cancer therapy and diagnosis in recent years.– Two p53-binding nanobodies, Nb3 and Nb139, were obtained by immunization and panning procedures. Nb3 binds to the “structural mutations” R175H and R282W, and Nb139 binds to both wild-type and mutant p53, inhibiting the transcriptional capacity of p53. The cocrystal structure shows that the three complementary determining regions (CDRs) of Nb139 interact with p53-DBD by forming backbone or side chain hydrogen bonds and van der Waals forces (Fig. 12a). Compared with the wild-type p53 structure, the Nb139/p53-DBD complex maintains the structural and DNA-binding properties of p53, which provides an innovative approach to study p53.

H2-scDb

95Mutant p53 is hydrolyzed intracellularly to produce a peptide known as a mutation-associated neoantigen that can be presented on the cell surface after forming a complex (pHLA) with human leukocyte antigen (HLA) proteins., In two patients with metastatic epithelial carcinoma carrying the p53R175H mutation, Malekzadeh et al. identified the neoantigen as the HMTEVVRHC peptide, which can be recognized and formed into a complex by HLA*02:01 (Fig. 12b). To exploit this tumor-specific surface antigen, the researchers screened the antibody fragment library and optimized the design to identify a TCR-mimetic antibody in the form of a single-chain double antibody (scDb) with Kd = 86 nM. The structure revealed that the p53R175H peptide occupies the binding cleft between α1 and α2 of HLA-A*02:01. The His175 amino acid residue in the p53R175H peptide fragment plays a significant role in direct contact with H2-Fab. The imidazole side chain of His175 forms hydrogen bonds with Asp54 (CDR-H2) and Tyr94 (CDR-L3) and forms a π-π stacking interaction with Tyr52 (CDR-H2) (Fig. 12b). Functionally, H2-scDb bound specifically to the p53R175H/HLA complex and efficiently induced T-cell immune responses. In multiple myeloma xenograft mice carrying p53R175H, H2-scDb effectively regressed tumors.

Second-site suppressor mutation

96Mutant p53 usually affects the binding of p53 to DNA or the conformation of p53. Second site suppressor mutations could help correct the conformation of mutant p53, improve the stability of p53-DNA binding, and provide a theoretical basis for the reactivation of mutant p53 (Table 4).–

97Crystal structures show that the second-site suppressor mutations usually cause only small local structural changes, whereas do not alter the overall structure of the p53 protein.,,, These second-site suppressor mutations act through two types of mechanisms: supplying a new DNA-contacting amino acids when rescuing DNA-contacting mutants, or increasing thermostability when rescue structural mutants., These mutants provide the basis for designing drugs that restore the transcriptional inactivation and instability of p53 caused by mutations.

Other therapies

98The TET and CTD have essential roles in the proper folding and functional regulation of p53. There are no drugs that specifically target these two structural domains. A synthetic peptide (361–382) extracted from the p53-CTD region (361–382, peptide 46) can interact with the DBD and CTD regions of p53, and the addition of different concentrations of peptide 46 restores the DNA binding ability of p53 mutants (R273H, R248W, R175H, R249S, V143A). The fusion of the p53 protein with the N-terminal spider silk domain contributes to the stability of the p53 protein. The therapeutic effects and specific mechanisms targeting these two structural domains need further exploration.

99Researchers have also developed innovative therapies that target mRNA for protein degradation. For example, a specific deoxyribozyme (DZ-249A) has been designed to target the mutation site of TP53 to degrade the mRNA of mutant TP53, thereby reducing the expression of the mutant p53 protein., Combination therapy of multiple mechanisms is also a promising strategy; for instance, the combination of MDM2 and BCL-2 inhibitors can effectively induce apoptosis., Moreover, gene therapy and immunotherapy are also new options for targeting p53.

Therapeutic strategy for truncated p53

100Nonsense mutations cause proteins to terminate or end translation earlier than expected, generating truncated proteins. A total of 8.19% of TP53 mutant tumors were detected to carry nonsense mutations and were cleared by the nonsense-mediated mRNA decay (NMD) machinery during transcription, (Fig. 1a). Currently, there are two approaches to rescue truncated p53. One is to restore production of full-length p53 protein by drug-induced read-through of the premature termination codon. For instance, G418 and NB124 can stably promote the expression of full-length p53 protein., The other is the inhibition of NMD., However, NMD is a potent cellular surveillance mechanism and non-specific inhibition of NMD may do more harm than good.

Therapeutic strategy for p53 isoforms

101Fourteen isoforms of p53 have been identified: p53, p53β, p53γ, Δ40p53, Δ40p53β, Δ40p53γ, Δ133p53, Δ133p53β, Δ133p53γ, Δ160p53, Δ160p53β, Δ160p53γ, Δp53, and p53ψ.– It was shown that Δ133p53 activates the anti-apoptotic BCL-2 protein and antagonizes p53-induced apoptosis. p53Ψ cannot bind to DNA or transcriptionally activate p53 target genes. However, it induces the expression of epithelial-mesenchymal transition markers and enhances the viability and invasiveness of cancer cells. Overexpression of Δ133p53α facilitates the long-term propagation of primary epithelial cells in vitro. These evidences suggest that some p53 isoforms are in marked contradiction to the function of wild-type full-length p53, exhibit oncogenic effects, and support cancer cell proliferation and invasion. Therefore, rescue therapy may not be appropriate for these p53 isoforms, and targeted degradation may be a better strategy to remove their oncogenic effects, such as PROTAC, ATTEC, AUTAC, and LYTAC.

Conclusion

102The TP53 gene is the most frequently mutated gene in humans. In the 40 years since the discovery of p53, new insights have been made into the gene regulatory mechanisms and tumor suppression pathways of p53. We have learned about an elaborate and complex tumor suppression network, but have not yet discovered its accurate and complete picture. Based on the relationship between the structure and function of p53 and cancer development, many anticancer drugs targeting p53 have been developed. However, there are no approved drugs to date.

Summary points

103Among the molecules developed to target p53, two main mechanistic approaches have been implemented. One is to target wild-type p53 and inhibit the p53/MDM2 complex to prevent its degradation. To date, eleven MDM2 inhibitors are in clinical trials. However, long-term administration of an MDM2 inhibitor may induce acquired resistance related to TP53 mutations and increased MDMX expression., There is still a lack of MDM2/MDMX dual-target or specific MDMX inhibitors. Moreover, the accumulation of p53 in normal tissues may produce greater toxic effects.

104The second is to target p53 mutants. Many therapeutic approaches aim to rescue the function of mutated p53 through small molecule compounds. The development of p53 mutant-rescuing drugs has been hampered by false trials that have proven not to be reproducible in other labs or to function by p53-unrelated pathways. Some drugs were initially identified as p53 mutant activators, but it remains puzzling whether they actually rely on p53 for their action. For example, CP-31398 was initially thought to maintain the wild-type conformation of the mutant p53, but was shown to be unable to bind p53 in a different lab. Dr. Soragni states on her website that “we don’t really know what the mechanism is for ReACp53 to kill cancer cells” (http://alice.mbi.ucla.edu/reacp53.html). This may be because most experiments to rescue mutant p53 drugs are performed in cells, and the lack of information on the direct interaction of compounds with proteins leads to our incomplete understanding of the mechanism of drug action. Most of the currently reported drugs that activate p53 mutants have p53-independent antitumor effects. It is undeniable that these drugs do act to rescue mutant p53 function, but it may be ambiguous which is more effective, whether it is mutant p53-dependent, mutant p53-independent, or both. The field of targeting mutant p53 remains a shimmering light after the dawn, and we see hope, but there is still a long road of discovery to go.

105The availability of structural data on p53 mutants and their complexes with drugs, combined with data on the functional rescue of the mutants, has helped to understand the rescue mechanism and optimize drug design. For example, a special class of p53 structural mutant, Y220C, leads to a hydrophobic cavity in p53 protein structure. Small molecules are designed to target this cavity to stabilize the protein structure. ATO and PAT bind to an allosteric site exposed within the p53 mutant protein and help stabilize the local structure. They are likely to be effective for structural mutants or temperature-sensitive mutants, but not DNA contact mutants. Those mutations at the DNA contact surface tend to benefit from small molecules that have the ability to restore protein-DNA binding. The structures of MQ with p53 mutants R282W, R273H and R273C show that the binding of MQ with Cys277 supports the p53-DNA interface by complementing additional interactions, while MQ interaction modes exhibit large diversity by binding to some other cystines. In addition, structural analysis illustrates the basis of a TCR-like antibody H2-Fab specifically targeting the p53R175H peptide-HLA interaction. Nevertheless, structural information about p53 mutants and their complexes is still insufficient, so we need more structural insights to help target p53 mutants for rational drug design.

Challenges and perspectives

106There are significant challenges in the development of drugs targeting p53. The lack of an established mechanism for protein reactivation and the lack of pockets (except in the case of Y220C) are the two main reasons. It is relatively easy to inhibit protein function by simply using compounds to occupy their active sites, but elusive as to how compound binding leads to reactivation of protein function. In addition, resistance to TP53 mutations, the off-target effects of the drug, and the possible toxic side effects of p53 accumulation in normal tissues, all make p53 difficult to drug. Currently, the structures of full-length p53 in complex with different DNA targets and full-length partner proteins remain unavailable. Certain p53 mutants cannot be expressed, and their structures are not available, which limits structure-based drug design. In recent years, there have been great advances in cryo-electron microscopy, and artificial intelligence. With these technological advances, we have reason to believe that the structural study of p53 will make more progress in the near future, which will provide a structural basis for the development of p53-targeted drugs.

107For p53-targeted therapy, several other factors also need to be considered. First, TP53 mutations are heterogeneous and not all mutations are equal. Hence a one-drug-fits-all approach may not be feasible for targeting TP53 mutations.,, Therefore, different p53-targeting drugs may be required for different p53 mutants. Second, p53-targeted therapy alone may not be sufficient to treat cancer. Combination therapy, such as simultaneous blockade of the MDM2-p53 pathway and p53-BCL-2 pathway, may have a synthetic lethal mechanism. Third, there are some other new therapeutic directions that may be explored, such as targeting p53 mRNA, targeting disordered structural domains, targeting mutant protein for degradation, and genome editing using CRISPR-Cas9. CRISPR-Cas9 based gene editing technology has been applied to cancer treatment., With the advancement of CRISPR-Cas9 technology, the correction of TP53 mutations using CRISPR-Cas9 may become an effective cancer treatment option in the future.

108For decades, there has been a lack of effective progress in the development of drugs targeting p53, and p53 was once considered to be an undruggable target. As technology advances, many undruggable targets are becoming druggable, such as KRAS., We have reason to believe that drugs targeting p53 will also make progress. Given the prevalence of TP53 mutations in human cancers, drugs targeting p53 may bring a breakthrough in cancer therapy.

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Tarasov V, et al. Differential regulation of microRNAs by p53 revealed by massively parallel sequencing: miR-34a is a p53 target that induces apoptosis and G1-arrest. Cell Cycle. 2007;6:1586-1593.
Not in our library10.4161/cc.6.13.4436
75.
Wu GS, Kim K, el-Deiry WS. KILLER/DR5, a novel DNA-damage inducible death receptor gene, links the p53-tumor suppressor to caspase activation and apoptotic death. Adv. Exp. Med. Biol. 2000;465:143-151.
Not in our library10.1007/0-306-46817-4_13
76.
Maecker HL, Koumenis C, Giaccia AJ. p53 promotes selection for Fas-mediated apoptotic resistance. Cancer Res. 2000;60:4638-4644.
Not in our library
77.
Müller M, et al. p53 activates the CD95 (APO-1/Fas) gene in response to DNA damage by anticancer drugs. J. Exp. Med. 1998;188:2033-2045.
Not in our library10.1084/jem.188.11.2033
78.
Global analysis of p53-regulated transcription identifies its direct targets and unexpected regulatory mechanisms · 2014
No notice
79.
Cordaux R, Batzer MA. The impact of retrotransposons on human genome evolution. Nat. Rev. Genet. 2009;10:691-703.
Not in our library10.1038/nrg2640
80.
Tiwari B, Jones AE, Abrams JM. Transposons, p53 and Genome Security. Trends Genet. 2018;34:846-855.
Not in our library10.1016/j.tig.2018.08.003
81.
Harris CR, et al. p53 responsive elements in human retrotransposons. Oncogene. 2009;28:3857-3865.
Not in our library10.1038/onc.2009.246
82.
Haoudi A, Semmes OJ, Mason JM, Cannon RE. Retrotransposition-Competent Human LINE-1 Induces Apoptosis in Cancer Cells With Intact p53. J. Biomed. Biotechnol. 2004;2004:185-194.
Not in our library10.1155/s1110724304403131
83.
Zuckerman V, et al. Tumour suppression by p53: the importance of apoptosis and cellular senescence. J. Pathol. 2009;219:3-15.
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84.
Schmitt CA, et al. A senescence program controlled by p53 and p16INK4a contributes to the outcome of cancer therapy. Cell. 2002;109:335-346.
Not in our library10.1016/s0092-8674(02)00734-1
85.
Role of p53 in the Regulation of Cellular Senescence · 2020
No notice
86.
DNA damage response revisited: the p53 family and its regulators provide endless cancer therapy opportunities · 2022
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87.
Capuozzo M, et al. p53: from fundamental biology to clinical applications in cancer. Biology. 2022;11:1325.
Not in our library10.3390/biology11091325
88.
Kortlever RM, Higgins PJ, Bernards R. Plasminogen activator inhibitor-1 is a critical downstream target of p53 in the induction of replicative senescence. Nat. Cell Biol. 2006;8:877-884.
Not in our library10.1038/ncb1448
89.
Pearson M, et al. PML regulates p53 acetylation and premature senescence induced by oncogenic Ras. Nature. 2000;406:207-210.
Not in our library10.1038/35018127
90.
Warburg O, Wind F, Negelein E. The metabolism of tumors in the body. J. Gen. Physiol. 1927;8:519-530.
Not in our library10.1085/jgp.8.6.519
91.
Devic S. Warburg effect—a consequence or the cause of carcinogenesis? J. Cancer. 2016;7:817-822.
Not in our library10.7150/jca.14274
92.
Matoba S, et al. p53 regulates mitochondrial respiration. Science. 2006;312:1650-1653.
Not in our library10.1126/science.1126863
93.
Bensaad K, et al. TIGAR, a p53-inducible regulator of glycolysis and apoptosis. Cell. 2006;126:107-120.
Not in our library10.1016/j.cell.2006.05.036
94.
Zhang C, et al. Parkin, a p53 target gene, mediates the role of p53 in glucose metabolism and the Warburg effect. Proc. Natl. Acad. Sci. USA. 2011;108:16259-16264.
Not in our library10.1073/pnas.1113884108
95.
Jiang P, et al. p53 regulates biosynthesis through direct inactivation of glucose-6-phosphate dehydrogenase. Nat. Cell Biol. 2011;13:310-316.
Not in our library10.1038/ncb2172
96.
Rac1 activates non-oxidative pentose phosphate pathway to induce chemoresistance of breast cancer · 2020
No notice
97.
Schwartzenberg-Bar-Yoseph F, Armoni M, Karnieli E. The tumor suppressor p53 down-regulates glucose transporters GLUT1 and GLUT4 gene expression. Cancer Res. 2004;64:2627-2633.
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98.
Boidot R, et al. Regulation of monocarboxylate transporter MCT1 expression by p53 mediates inward and outward lactate fluxes in tumors. Cancer Res. 2012;72:939-948.
Not in our library10.1158/0008-5472.can-11-2474
99.
Ward PS, Thompson CB. Metabolic reprogramming: a cancer hallmark even warburg did not anticipate. Cancer Cell. 2012;21:297-308.
Not in our library10.1016/j.ccr.2012.02.014
100.
Zawacka-Pankau J, et al. Inhibition of glycolytic enzymes mediated by pharmacologically activated p53: targeting Warburg effect to fight cancer. J. Biol. Chem. 2011;286:41600-41615.
Not in our library10.1074/jbc.m111.240812
101.
Zhang C, et al. Tumour-associated mutant p53 drives the Warburg effect. Nat. Commun. 2013;4:2935.
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102.
Basu S, et al. Mutant p53 controls tumor metabolism and metastasis by regulating PGC-1α. Genes Dev. 2018;32:230-243.
Not in our library10.1101/gad.309062.117
103.
Wang P-Y, et al. Increased oxidative metabolism in the Li-Fraumeni syndrome. N. Engl. J. Med. 2013;368:1027-1032.
Not in our library10.1056/nejmoa1214091
104.
Snaebjornsson MT, Janaki-Raman S, Schulze A. Greasing the Wheels of the Cancer Machine: The Role of Lipid Metabolism in Cancer. Cell Metab. 2020;31:62-76.
Not in our library10.1016/j.cmet.2019.11.010
105.
Moon S-H, et al. p53 represses the mevalonate pathway to mediate tumor suppression. Cell. 2019;176:564-580.
Not in our library10.1016/j.cell.2018.11.011
106.
Zhu, Y. et al. P53 deficiency affects cholesterol esterification to exacerbate hepatocarcinogenesis. Hepatology, (2022).
Not in our library10.1002/hep.32518
107.
Kruiswijk F, Labuschagne CF, Vousden KH. p53 in survival, death and metabolic health: a lifeguard with a licence to kill. Nat. Rev. Mol. Cell Biol. 2015;16:393-405.
Not in our library10.1038/nrm4007
108.
Spinelli JB, et al. Metabolic recycling of ammonia via glutamate dehydrogenase supports breast cancer biomass. Science. 2017;358:941-946.
Not in our library10.1126/science.aam9305
109.
Zhang T, et al. Metformin inhibits the urea cycle and reduces putrescine generation in colorectal cancer cell lines. Molecules. 2021;26:1990.
Not in our library10.3390/molecules26071990
110.
Li L, et al. p53 regulation of ammonia metabolism through urea cycle controls polyamine biosynthesis. Nature. 2019;567:253-256.
Not in our library10.1038/s41586-019-0996-7
111.
Cheung EC, Vousden KH. The role of ROS in tumour development and progression. Nat. Rev. Cancer. 2022;22:280-297.
Not in our library10.1038/s41568-021-00435-0
112.
Liu B, Chen Y, St Clair DK. ROS and p53: a versatile partnership. Free Radic. Biol. Med. 2008;44:1529-1535.
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113.
Hussain SP, et al. p53-induced up-regulation of MnSOD and GPx but not catalase increases oxidative stress and apoptosis. Cancer Res. 2004;64:2350-2356.
Not in our library10.1158/0008-5472.can-2287-2
114.
Sablina AA, et al. The antioxidant function of the p53 tumor suppressor. Nat. Med. 2005;11:1306-1313.
Not in our library10.1038/nm1320
115.
Humpton TJ, Vousden KH. Regulation of cellular metabolism and hypoxia by p53. Cold Spring Harb. Perspect. Med. 2016;6:a026146.
Not in our library10.1101/cshperspect.a026146
116.
Liu G, Chen X. The ferredoxin reductase gene is regulated by the p53 family and sensitizes cells to oxidative stress-induced apoptosis. Oncogene. 2002;21:7195-7204.
Not in our library10.1038/sj.onc.1205862
117.
Kim J, et al. Wild-Type p53 Promotes cancer metabolic switch by inducing PUMA-dependent suppression of oxidative phosphorylation. Cancer Cell. 2019;35:191-203.
Not in our library10.1016/j.ccell.2018.12.012
118.
Suzuki S, et al. Phosphate-activated glutaminase (GLS2), a p53-inducible regulator of glutamine metabolism and reactive oxygen species. Proc. Natl. Acad. Sci. USA. 2010;107:7461-7466.
Not in our library10.1073/pnas.1002459107
119.
Gallo O, et al. Down-regulation of nitric oxide synthase-2 and cyclooxygenase-2 pathways by p53 in squamous cell carcinoma. Am. J. Pathol. 2003;163:723-732.
Not in our library10.1016/s0002-9440(10)63699-1
120.
Italiano D, Lena AM, Melino G, Candi E. Identification of NCF2/p67phox as a novel p53 target gene. Cell Cycle. 2012;11:4589-4596.
Not in our library10.4161/cc.22853
121.
Faraonio R, et al. p53 suppresses the Nrf2-dependent transcription of antioxidant response genes. J. Biol. Chem. 2006;281:39776-39784.
Not in our library10.1074/jbc.m605707200
122.
Reddy BA, et al. Nucleotide biosynthetic enzyme GMP synthase is a TRIM21-controlled relay of p53 stabilization. Mol. Cell. 2014;53:458-470.
Not in our library10.1016/j.molcel.2013.12.017
123.
Stockwell BR. Ferroptosis turns 10: Emerging mechanisms, physiological functions, and therapeutic applications. Cell. 2022;185:2401-2421.
Not in our library10.1016/j.cell.2022.06.003
124.
Ferroptosis: mechanisms and links with diseases · 2021
No notice
125.
Dixon SJ, et al. Ferroptosis: an iron-dependent form of nonapoptotic cell death. Cell. 2012;149:1060-1072.
Not in our library10.1016/j.cell.2012.03.042
126.
Wang S-J, et al. Acetylation is crucial for p53-mediated ferroptosis and tumor suppression. Cell Rep. 2016;17:366-373.
Not in our library10.1016/j.celrep.2016.09.022
127.
Liu Y, Gu W. p53 in ferroptosis regulation: the new weapon for the old guardian. Cell Death Differ. 2022;29:895-910.
Not in our library10.1038/s41418-022-00943-y
128.
Li T, et al. Tumor suppression in the absence of p53-mediated cell-cycle arrest, apoptosis, and senescence. Cell. 2012;149:1269-1283.
Not in our library10.1016/j.cell.2012.04.026
129.
Wang Y, et al. Epigenetic regulation of ferroptosis by H2B monoubiquitination and p53. EMBO Rep. 2019;20:e47563.
Not in our library10.15252/embr.201847563
130.
Ou Y, et al. Activation of SAT1 engages polyamine metabolism with p53-mediated ferroptotic responses. Proc. Natl Acad. Sci. USA. 2016;113:E6806-E6812.
Not in our library10.1073/pnas.1607152113
131.
Chu B, et al. ALOX12 is required for p53-mediated tumour suppression through a distinct ferroptosis pathway. Nat. Cell Biol. 2019;21:579-591.
Not in our library10.1038/s41556-019-0305-6
132.
The Regulation of Ferroptosis by Tumor Suppressor p53 and its Pathway · 2020
No notice
133.
Xie Y, et al. The tumor suppressor p53 limits ferroptosis by blocking DPP4 activity. Cell Rep. 2017;20:1692-1704.
Not in our library10.1016/j.celrep.2017.07.055
134.
p53 Suppresses Metabolic Stress-Induced Ferroptosis in Cancer Cells · 2018
Not checked
135.
Venkatesh D, Stockwell BR, Prives C. p21 can be a barrier to ferroptosis independent of p53. Aging. 2020;12:17800-17814.
Not in our library10.18632/aging.103961
136.
Lujambio A, et al. Non-cell-autonomous tumor suppression by p53. Cell. 2013;153:449-460.
Not in our library10.1016/j.cell.2013.03.020
137.
Menendez D, et al. p53-responsive TLR8 SNP enhances human innate immune response to respiratory syncytial virus. J. Clin. Invest. 2019;129:4875-4884.
Not in our library10.1172/jci128626
138.
Guo G, et al. Local activation of p53 in the tumor microenvironment overcomes immune suppression and enhances antitumor immunity. Cancer Res. 2017;77:2292-2305.
Not in our library10.1158/0008-5472.can-16-2832
139.
Zhou X, et al. Pharmacologic activation of p53 triggers viral mimicry response thereby abolishing tumor immune evasion and promoting antitumor immunity. Cancer Disco. 2021;11:3090-3105.
Not in our library10.1158/2159-8290.cd-20-1741
140.
Wang B, Niu D, Lai L, Ren EC. p53 increases MHC class I expression by upregulating the endoplasmic reticulum aminopeptidase ERAP1. Nat. Commun. 2013;4:2359.
Not in our library10.1038/ncomms3359
141.
Combining p53 mRNA nanotherapy with immune checkpoint blockade reprograms the immune microenvironment for effective cancer therapy · 2022
No notice
142.
Dong Z-Y, et al. Potential predictive value of and mutation status for response to PD-1 blockade immunotherapy in lung adenocarcinoma. Clin. Cancer Res. 2017;23:3012-3024.
Not in our library10.1158/1078-0432.ccr-16-2554
143.
Ubertini V, et al. Mutant p53 gains new function in promoting inflammatory signals by repression of the secreted interleukin-1 receptor antagonist. Oncogene. 2015;34:2493-2504.
Not in our library10.1038/onc.2014.191
144.
Mutant p53 cancers reprogram macrophages to tumor supporting macrophages via exosomal miR-1246 · 2018
No notice
145.
Cooks T, et al. Mutant p53 prolongs NF-κB activation and promotes chronic inflammation and inflammation-associated colorectal cancer. Cancer Cell. 2013;23:634-646.
Not in our library10.1016/j.ccr.2013.03.022
146.
Di Minin G, et al. Mutant p53 reprograms TNF signaling in cancer cells through interaction with the tumor suppressor DAB2IP. Mol. Cell. 2014;56:617-629.
Not in our library10.1016/j.molcel.2014.10.013
147.
Song H, et al. Functional characterization of pulmonary neuroendocrine cells in lung development, injury, and tumorigenesis. Proc. Natl Acad. Sci. USA. 2012;109:17531-17536.
Not in our library10.1073/pnas.1207238109
148.
Ouadah Y, et al. Rare pulmonary neuroendocrine cells are stem cells regulated by Rb, p53, and Notch. Cell. 2019;179:403-416.
Not in our library10.1016/j.cell.2019.09.010
149.
George J, et al. Comprehensive genomic profiles of small cell lung cancer. Nature. 2015;524:47-53.
Not in our library10.1038/nature14664
150.
Cicalese A, et al. The tumor suppressor p53 regulates polarity of self-renewing divisions in mammary stem cells. Cell. 2009;138:1083-1095.
Not in our library10.1016/j.cell.2009.06.048
151.
Zhou Z, Flesken-Nikitin A, Nikitin AY. Prostate cancer associated with p53 and Rb deficiency arises from the stem/progenitor cell-enriched proximal region of prostatic ducts. Cancer Res. 2007;67:5683-5690.
Not in our library10.1158/0008-5472.can-07-0768
152.
Flores I, Blasco MA. A p53-dependent response limits epidermal stem cell functionality and organismal size in mice with short telomeres. PLoS One. 2009;4:e4934.
Not in our library10.1371/journal.pone.0004934
153.
Zheng H, et al. p53 and Pten control neural and glioma stem/progenitor cell renewal and differentiation. Nature. 2008;455:1129-1133.
Not in our library10.1038/nature07443
154.
Liu Y, et al. p53 regulates hematopoietic stem cell quiescence. Cell Stem Cell. 2009;4:37-48.
Not in our library10.1016/j.stem.2008.11.006
155.
Cheng T, et al. Hematopoietic stem cell quiescence maintained by p21cip1/waf1. Science. 2000;287:1804-1808.
Not in our library10.1126/science.287.5459.1804
156.
van Os R, et al. A Limited role for p21Cip1/Waf1 in maintaining normal hematopoietic stem cell functioning. Stem Cells. 2007;25:836-843.
Not in our library10.1634/stemcells.2006-0631
157.
Shetzer Y, Molchadsky A, Rotter V. Oncogenic mutant p53 gain of function nourishes the vicious cycle of tumor development and cancer stem-cell formation. Cold Spring Harb. Perspect. Med. 2016;6:a026203.
Not in our library10.1101/cshperspect.a026203
158.
Escoll M, et al. Mutant p53 oncogenic functions in cancer stem cells are regulated by WIP through YAP/TAZ. Oncogene. 2017;36:3515-3527.
Not in our library10.1038/onc.2016.518
159.
Loizou E, et al. A gain-of-function p53-Mutant oncogene promotes cell fate plasticity and myeloid leukemia through the pluripotency factor FOXH1. Cancer Disco. 2019;9:962-979.
Not in our library10.1158/2159-8290.cd-18-1391
160.
Dongre A, Weinberg RA. New insights into the mechanisms of epithelial-mesenchymal transition and implications for cancer. Nat. Rev. Mol. Cell Biol. 2019;20:69-84.
Not in our library10.1038/s41580-018-0080-4
161.
Wang S-P, et al. p53 controls cancer cell invasion by inducing the MDM2-mediated degradation of Slug. Nat. Cell Biol. 2009;11:694-704.
Not in our library10.1038/ncb1875
162.
Kim NH, et al. A p53/miRNA-34 axis regulates Snail1-dependent cancer cell epithelial-mesenchymal transition. J. Cell Biol. 2011;195:417-433.
Not in our library10.1083/jcb.201103097
163.
Dong P, et al. Mutant p53 gain-of-function induces epithelial-mesenchymal transition through modulation of the miR-130b-ZEB1 axis. Oncogene. 2013;32:3286-3295.
Not in our library10.1038/onc.2012.334
164.
Chang C-J, et al. p53 regulates epithelial-mesenchymal transition and stem cell properties through modulating miRNAs. Nat. Cell Biol. 2011;13:317-323.
Not in our library10.1038/ncb2173
165.
Wang J, et al. Autophagy augments the self-renewal of lung cancer stem cells by the degradation of ubiquitinated p53. Cell Death Dis. 2021;12:98.
Not in our library10.1038/s41419-021-03392-6
166.
Autophagy in major human diseases · 2021
No notice
167.
Abida WM, Gu W. p53-Dependent and p53-independent activation of autophagy by ARF. Cancer Res. 2008;68:352-357.
Not in our library10.1158/0008-5472.can-07-2069
168.
Crighton D, et al. DRAM, a p53-induced modulator of autophagy, is critical for apoptosis. Cell. 2006;126:121-134.
Not in our library10.1016/j.cell.2006.05.034
169.
Mrschtik M, Ryan KM. Another DRAM involved in autophagy and cell death. Autophagy. 2016;12:603-605.
Not in our library10.1080/15548627.2015.1137412
170.
Levine B, Kroemer G. Biological functions of autophagy genes: a disease perspective. Cell. 2019;176:11-42.
Not in our library10.1016/j.cell.2018.09.048
171.
Kenzelmann Broz D, et al. Global genomic profiling reveals an extensive p53-regulated autophagy program contributing to key p53 responses. Genes Dev. 2013;27:1016-1031.
Not in our library10.1101/gad.212282.112
172.
Zheng W, et al. Inhibition of Cathepsin D (CTSD) enhances radiosensitivity of glioblastoma cells by attenuating autophagy. Mol. Carcinog. 2020;59:651-660.
Not in our library10.1002/mc.23194
173.
Liu Y-J, et al. The noncanonical role of the protease cathepsin D as a cofilin phosphatase. Cell Res. 2021;31:801-813.
Not in our library10.1038/s41422-020-00454-w
174.
Wu GS, Saftig P, Peters C, El-Deiry WS. Potential role for cathepsin D in p53-dependent tumor suppression and chemosensitivity. Oncogene. 1998;16:2177-2183.
Not in our library10.1038/sj.onc.1201755
175.
Ikeguchi M, et al. Correlation between cathepsin D expression and p53 protein nuclear accumulation in oesophageal squamous cell carcinoma. J. Clin. Pathol. 2002;55:121-126.
Not in our library10.1136/jcp.55.2.121
176.
Yeo SY, et al. Transglutaminase 2 contributes to a TP53-induced autophagy program to prevent oncogenic transformation. Elife. 2016;5:e07101.
Not in our library10.7554/elife.07101
177.
Kim J, Kundu M, Viollet B, Guan K-L. AMPK and mTOR regulate autophagy through direct phosphorylation of Ulk1. Nat. Cell Biol. 2011;13:132-141.
Not in our library10.1038/ncb2152
178.
Budanov AV, Karin M. p53 target genes sestrin1 and sestrin2 connect genotoxic stress and mTOR signaling. Cell. 2008;134:451-460.
Not in our library10.1016/j.cell.2008.06.028
179.
Kon N, et al. mTOR inhibition acts as an unexpected checkpoint in p53-mediated tumor suppression. Genes Dev. 2021;35:59-64.
Not in our library10.1101/gad.340919.120
180.
Chang HW, et al. p53/BNIP3-dependent mitophagy limits glycolytic shift in radioresistant cancer. Oncogene. 2019;38:3729-3742.
Not in our library10.1038/s41388-019-0697-6
181.
Fernández ÁF, et al. Disruption of the beclin 1-BCL2 autophagy regulatory complex promotes longevity in mice. Nature. 2018;558:136-140.
Not in our library10.1038/s41586-018-0162-7
182.
Lee EF, et al. Structural insights into BCL2 pro-survival protein interactions with the key autophagy regulator BECN1 following phosphorylation by STK4/MST1. Autophagy. 2019;15:785-795.
Not in our library10.1080/15548627.2018.1564557
183.
Feng W, Huang S, Wu H, Zhang M. Molecular basis of Bcl-xL’s target recognition versatility revealed by the structure of Bcl-xL in complex with the BH3 domain of Beclin-1. J. Mol. Biol. 2007;372:223-235.
Not in our library10.1016/j.jmb.2007.06.069
184.
Zheng R, et al. The status of p53 in cancer cells affects the role of autophagy in tumor radiosensitisation. J. BUON. 2014;19:336-341.
Not in our library
185.
Maiuri MC, et al. Autophagy regulation by p53. Curr. Opin. Cell Biol. 2010;22:181-185.
Not in our library10.1016/j.ceb.2009.12.001
186.
Livesey KM, et al. p53/HMGB1 complexes regulate autophagy and apoptosis. Cancer Res. 2012;72:1996-2005.
Not in our library10.1158/0008-5472.can-11-2291
187.
Livesey KM, et al. Direct molecular interactions between HMGB1 and TP53 in colorectal cancer. Autophagy. 2012;8:846-848.
Not in our library10.4161/auto.19891
188.
Yang Y, et al. Autophagy promotes mammalian survival by suppressing oxidative stress and p53. Genes Dev. 2020;34:688-p700.
Not in our library10.1101/gad.335570.119
189.
Agupitan AD, et al. P53: a guardian of immunity becomes its saboteur through mutation. Int. J. Mol. Sci. 2020;21:3452.
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190.
Levine A. P53 and the immune response: 40 years of exploration-a plan for the future. Int. J. Mol. Sci. 2020;21:541.
Not in our library10.3390/ijms21020541
191.
Min E-Y, et al. The effects of fucodian on senescence are controlled by the p16INK4a-pRb and p14Arf-p53 pathways in hepatocellular carcinoma and hepatic cell lines. Int. J. Oncol. 2014;45:47-56.
Not in our library10.3892/ijo.2014.2426
192.
Winkler L, et al. Functional elements of the cis-regulatory lincRNA-p21. Cell Rep. 2022;39:110687.
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193.
Giacomelli AO, et al. Mutational processes shape the landscape of TP53 mutations in human cancer. Nat. Genet. 2018;50:1381-1387.
Not in our library10.1038/s41588-018-0204-y
194.
Wellenstein MD, et al. Loss of p53 triggers WNT-dependent systemic inflammation to drive breast cancer metastasis. Nature. 2019;572:538-542.
Not in our library10.1038/s41586-019-1450-6
195.
Yang Y, et al. Targeting the miR-34a/LRPPRC/MDR1 axis collapse the chemoresistance in P53 inactive colorectal cancer. Cell Death Differ. 2022;29:2177-2189.
Not in our library10.1038/s41418-022-01007-x
196.
Makino Y, et al. Constitutive activation of the tumor suppressor p53 in hepatocytes paradoxically promotes non-cell autonomous liver carcinogenesis. Cancer Res. 2022;82:2860-2873.
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197.
Immune modulatory effects of oncogenic KRAS in cancer · 2020
No notice
198.
Kandoth C, et al. Mutational landscape and significance across 12 major cancer types. Nature. 2013;502:333-339.
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199.
de Andrade KC, et al. Cancer incidence, patterns, and genotype-phenotype associations in individuals with pathogenic or likely pathogenic germline TP53 variants: an observational cohort study. Lancet Oncol. 2021;22:1787-1798.
Not in our library10.1016/s1470-2045(21)00580-5
200.
Freed-Pastor WA, Prives C. Mutant p53: one name, many proteins. Genes Dev. 2012;26:1268-1286.
Not in our library10.1101/gad.190678.112
201.
Joerger AC, Fersht AR. The p53 pathway: origins, inactivation in cancer, and emerging therapeutic approaches. Annu. Rev. Biochem. 2016;85:375-404.
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202.
Duffy MJ, Synnott NC, O’Grady S, Crown J. Targeting p53 for the treatment of cancer. Semin. Cancer Biol. 2022;79:58-67.
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203.
Baugh EH, et al. Why are there hotspot mutations in the TP53 gene in human cancers? Cell Death Differ. 2018;25:154-160.
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204.
Bullock AN, Henckel J, Fersht AR. Quantitative analysis of residual folding and DNA binding in mutant p53 core domain: definition of mutant states for rescue in cancer therapy. Oncogene. 2000;19:1245-1256.
Not in our library10.1038/sj.onc.1203434
205.
Mutant p53 as a guardian of the cancer cell · 2018
No notice
206.
Yue X, et al. Mutant p53 in cancer: accumulation, gain-of-function, and therapy. J. Mol. Biol. 2017;429:1595-1606.
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207.
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280.
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Pioneer transcription factors in cell reprogramming · 2014
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Highly accurate protein structure prediction with AlphaFold · 2021
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328.
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329.
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330.
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331.
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The role of ubiquitination in tumorigenesis and targeted drug discovery · 2020
No notice
337.
Linke K, et al. Structure of the MDM2/MDMX RING domain heterodimer reveals dimerization is required for their ubiquitylation in trans. Cell Death Differ. 2008;15:841-848.
Not in our library10.1038/sj.cdd.4402309
338.
Iyappan S, et al. Turning the RING domain protein MdmX into an active ubiquitin-protein ligase. J. Biol. Chem. 2010;285:33065-33072.
Not in our library10.1074/jbc.m110.115113
339.
Wade M, Wang YV, Wahl GM. The p53 orchestra: Mdm2 and Mdmx set the tone. Trends Cell Biol. 2010;20:299-309.
Not in our library10.1016/j.tcb.2010.01.009
340.
Emerging insights into HAUSP (USP7) in physiology, cancer and other diseases · 2018
No notice
341.
Vu B, et al. Discovery of RG7112: a small-molecule MDM2 inhibitor in clinical development. ACS Med. Chem. Lett. 2013;4:466-469.
Not in our library10.1021/ml4000657
342.
Sun D, et al. Discovery of AMG 232, a potent, selective, and orally bioavailable MDM2-p53 inhibitor in clinical development. J. Med. Chem. 2014;57:1454-1472.
Not in our library10.1021/jm401753e
343.
Tovar C, et al. MDM2 small-molecule antagonist RG7112 activates p53 signaling and regresses human tumors in preclinical cancer models. Cancer Res. 2013;73:2587-2597.
Not in our library10.1158/0008-5472.can-12-2807
344.
Ding Q, et al. Discovery of RG7388, a potent and selective p53-MDM2 inhibitor in clinical development. J. Med. Chem. 2013;56:5979-5983.
Not in our library10.1021/jm400487c
345.
Khurana A, Shafer DA. MDM2 antagonists as a novel treatment option for acute myeloid leukemia: perspectives on the therapeutic potential of idasanutlin (RG7388). Onco Targets Ther. 2019;12:2903-2910.
Not in our library10.2147/ott.s172315
346.
Fan X, et al. MDM2 inhibitor RG7388 potently inhibits tumors by activating p53 pathway in nasopharyngeal carcinoma. Cancer Biol. Ther. 2019;20:1328-1336.
Not in our library10.1080/15384047.2019.1638677
347.
Cui Y, Zhou J, Rong F. Combination of metformin and RG7388 enhances inhibition of growth and induction of apoptosis of ovarian cancer cells through the PI3K/AKT/mTOR pathway. Biochem. Biophys. Res. Commun. 2020;533:665-671.
Not in our library10.1016/j.bbrc.2020.09.135
348.
Berberich A, et al. Targeting Resistance against the MDM2 Inhibitor RG7388 in Glioblastoma Cells by the MEK Inhibitor Trametinib. Clin. Cancer Res. 2019;25:253-265.
Not in our library10.1158/1078-0432.ccr-18-1580
349.
Skalniak L, et al. Prolonged idasanutlin (RG7388) treatment leads to the generation of p53-mutated cells. Cancers (Basel). 2018;10:396.
Not in our library10.3390/cancers10110396
350.
Rew Y, Sun D. Discovery of a small molecule MDM2 inhibitor (AMG 232) for treating cancer. J. Med. Chem. 2014;57:6332-6341.
Not in our library10.1021/jm500627s
351.
Her N-G, et al. Potent effect of the MDM2 inhibitor AMG232 on suppression of glioblastoma stem cells. Cell Death Dis. 2018;9:792.
Not in our library10.1038/s41419-018-0825-1
352.
Sahin I, et al. AMG-232 sensitizes high MDM2-expressing tumor cells to T-cell-mediated killing. Cell Death Disco. 2020;6:57.
Not in our library10.1038/s41420-020-0292-1
353.
Erba HP, et al. Phase 1b study of the MDM2 inhibitor AMG 232 with or without trametinib in relapsed/refractory acute myeloid leukemia. Blood Adv. 2019;3:1939-1949.
Not in our library10.1182/bloodadvances.2019030916
354.
Wang S, et al. SAR405838: an optimized inhibitor of MDM2-p53 interaction that induces complete and durable tumor regression. Cancer Res. 2014;74:5855-5865.
Not in our library10.1158/0008-5472.can-14-0799
355.
de Jonge M, et al. A phase I study of SAR405838, a novel human double minute 2 (HDM2) antagonist, in patients with solid tumours. Eur. J. Cancer. 2017;76:144-151.
Not in our library10.1016/j.ejca.2017.02.005
356.
de Weger VA, et al. A phase I study of the HDM2 antagonist SAR405838 combined with the MEK inhibitor pimasertib in patients with advanced solid tumours. Br. J. Cancer. 2019;120:286-293.
Not in our library10.1038/s41416-018-0355-8
357.
Jung J, et al. TP53 mutations emerge with HDM2 inhibitor SAR405838 treatment in de-differentiated liposarcoma. Nat. Commun. 2016;7:12609.
Not in our library10.1038/ncomms12609
358.
Holzer P, et al. Discovery of a dihydroisoquinolinone derivative (NVP-CGM097): a highly potent and selective MDM2 inhibitor undergoing phase 1 clinical trials in p53wt tumors. J. Med. Chem. 2015;58:6348-6358.
Not in our library10.1021/acs.jmedchem.5b00810
359.
Weisberg E, et al. Inhibition of wild-type p53-expressing AML by the novel small molecule HDM2 inhibitor CGM097. Mol. Cancer Ther. 2015;14:2249-2259.
Not in our library10.1158/1535-7163.mct-15-0429
360.
The MDM2 inhibitor CGM097 combined with the BET inhibitor OTX015 induces cell death and inhibits tumor growth in models of neuroblastoma · 2020
Not checked
361.
Portman N, et al. MDM2 inhibition in combination with endocrine therapy and CDK4/6 inhibition for the treatment of ER-positive breast cancer. Breast Cancer Res. 2020;22:87.
Not in our library10.1186/s13058-020-01318-2
362.
Carvajal LA, et al. Dual inhibition of MDMX and MDM2 as a therapeutic strategy in leukemia. Sci. Transl. Med. 2018;10:eaao3003.
Not in our library10.1126/scitranslmed.aao3003
363.
Saleh MN, et al. Phase 1 Trial of ALRN-6924, a Dual Inhibitor of MDMX and MDM2, in Patients with Solid Tumors and Lymphomas Bearing Wild-Type. Clin Cancer Res. 2021;27:5236-5247.
Not in our library10.1158/1078-0432.ccr-21-0715
364.
Kannan S, Partridge AW, Lane DP, Verma CS. The dual interactions of p53 with MDM2 and p300: implications for the design of MDM2 inhibitors. Int. J. Mol. Sci. 2019;20:5996.
Not in our library10.3390/ijms20235996
365.
Stein EM, et al. Results from a first-in-human phase I study of siremadlin (HDM201) in patients with advanced wild-type TP53 solid tumors and acute leukemia. Clin. Cancer Res. 2022;28:870-881.
Not in our library10.1158/1078-0432.ccr-21-1295
366.
Stachyra-Valat T, et al. Abstract 1239: NVP-HDM201: Biochemical and biophysical profile of a novel highly potent and selective PPI inhibitor of p53-Mdm2. Cancer Res. 2016;76:1239-1239.
Not in our library10.1158/1538-7445.am2016-1239
367.
Ravandi F, et al. A phase I trial of the human double minute 2 inhibitor (MK-8242) in patients with refractory/recurrent acute myelogenous leukemia (AML). Leuk. Res. 2016;48:92-100.
Not in our library10.1016/j.leukres.2016.07.004
368.
Wagner AJ, et al. Phase I trial of the human double minute 2 inhibitor MK-8242 in patients with advanced solid tumors. J. Clin. Oncol. 2017;35:1304-1311.
Not in our library10.1200/jco.2016.70.7117
369.
Kang MH, et al. Initial testing (stage 1) of MK-8242-A novel MDM2 inhibitor-by the pediatric preclinical testing program. Pediatr. Blood Cancer. 2016;63:1744-1752.
Not in our library10.1002/pbc.26064
370.
Cornillie J, et al. Anti-tumor activity of the MDM2-TP53 inhibitor BI-907828 in dedifferentiated liposarcoma patient-derived xenograft models harboring MDM2 amplification. Clin. Transl. Oncol. 2020;22:546-554.
Not in our library10.1007/s12094-019-02158-z
371.
Zhou J, et al. The ubiquitin ligase MDM2 sustains STAT5 stability to control T cell-mediated antitumor immunity. Nat. Immunol. 2021;22:460-470.
Not in our library10.1038/s41590-021-00888-3
372.
Aguilar, A. et al. Discovery of 4-((3’R,4’S,5’R)-6″-Chloro-4’-(3-chloro-2-fluorophenyl)-1’-ethyl-2″-oxodispiro[cyclohexane-1,2’-pyrrolidine-3’,3″-indoline]-5’-carboxamido)bicyclo[2.2.2]octane-1-carboxylicAcid (AA-115/APG-115): a potent and orally active murine double minute 2 (MDM2) inhibitor in clinical development. J. Med. Chem. 60, 2819–2839 (2017).
Not in our library10.1021/acs.jmedchem.6b01665
373.
A novel small molecule inhibitor of MDM2-p53 (APG-115) enhances radiosensitivity of gastric adenocarcinoma · 2018
Not checked
374.
Takahashi S, et al. Safety and pharmacokinetics of milademetan, a MDM2 inhibitor, in Japanese patients with solid tumors: A phase I study. Cancer Sci. 2021;112:2361-2370.
Not in our library10.1111/cas.14875
375.
Han X, Wei W, Sun Y. PROTAC degraders with ligands recruiting MDM2 E3 ubiquitin ligase: an updated perspective. Acta Mater. Med. 2022;1:244-259.
Not in our library10.15212/amm-2022-0010
376.
Wang B, et al. Development of selective small molecule MDM2 degraders based on nutlin. Eur. J. Med. Chem. 2019;176:476-491.
Not in our library10.1016/j.ejmech.2019.05.046
377.
Wang B, et al. Development of MDM2 degraders based on ligands derived from Ugi reactions: Lessons and discoveries. Eur. J. Med. Chem. 2021;219:113425.
Not in our library10.1016/j.ejmech.2021.113425
378.
Li Y, et al. Discovery of MD-224 as a first-in-class, highly potent, and efficacious proteolysis targeting chimera murine double minute 2 degrader capable of achieving complete and durable tumor regression. J. Med. Chem. 2019;62:448-466.
Not in our library10.1021/acs.jmedchem.8b00909
379.
Terzian T, et al. The inherent instability of mutant p53 is alleviated by Mdm2 or p16INK4a loss. Genes Dev. 2008;22:1337-1344.
Not in our library10.1101/gad.1662908
380.
de Andrade KC, et al. The TP53 database: transition from the international agency for research on cancer to the US national cancer institute. Cell Death Differ. 2022;29:1071-1073.
Not in our library10.1038/s41418-022-00976-3
381.
Yu X, Narayanan S, Vazquez A, Carpizo DR. Small molecule compounds targeting the p53 pathway: are we finally making progress? Apoptosis. 2014;19:1055-1068.
Not in our library10.1007/s10495-014-0990-3
382.
Miller JJ, Gaiddon C, Storr T. A balancing act: using small molecules for therapeutic intervention of the p53 pathway in cancer. Chem. Soc. Rev. 2020;49:6995-7014.
Not in our library10.1039/d0cs00163e
383.
Lopes EA, Gomes S, Saraiva L, Santos MMM. Small molecules targeting mutant P53: a promising approach for cancer treatment. Curr. Med. Chem. 2019;26:7323-7336.
Not in our library10.2174/0929867325666181116124308
384.
Silva JL, et al. Recent synthetic approaches towards small molecule reactivators of p53. Biomolecules. 2020;10:635.
Not in our library10.3390/biom10040635
385.
Binayke A, et al. Awakening the guardian of genome: reactivation of mutant p53. Cancer Chemother. Pharmacol. 2019;83:1-15.
Not in our library10.1007/s00280-018-3701-x
386.
Bykov VJN, et al. Restoration of the tumor suppressor function to mutant p53 by a low-molecular-weight compound. Nat. Med. 2002;8:282-288.
Not in our library10.1038/nm0302-282
387.
Wang T, Lee K, Rehman A, Daoud SS. PRIMA-1 induces apoptosis by inhibiting JNK signaling but promoting the activation of Bax. Biochem. Biophys. Res. Commun. 2007;352:203-212.
Not in our library10.1016/j.bbrc.2006.11.006
388.
Wiman KG. Pharmacological reactivation of mutant p53: from protein structure to the cancer patient. Oncogene. 2010;29:4245-4252.
Not in our library10.1038/onc.2010.188
389.
Bykov VJN, et al. PRIMA-1(MET) synergizes with cisplatin to induce tumor cell apoptosis. Oncogene. 2005;24:3484-3491.
Not in our library10.1038/sj.onc.1208419
390.
Zandi R, et al. PRIMA-1Met/APR-246 induces apoptosis and tumor growth delay in small cell lung cancer expressing mutant p53. Clin. Cancer Res. 2011;17:2830-2841.
Not in our library10.1158/1078-0432.ccr-10-3168
391.
Saha MN, et al. PRIMA-1Met/APR-246 displays high antitumor activity in multiple myeloma by induction of p73 and Noxa. Mol. Cancer Ther. 2013;12:2331-2341.
Not in our library10.1158/1535-7163.mct-12-1166
392.
Müller M, et al. Combining APR-246 and HDAC-inhibitors: a novel targeted treatment option for neuroblastoma. Cancers (Basel). 2021;13:4476.
Not in our library10.3390/cancers13174476
393.
Liu DSH, et al. APR-246 potently inhibits tumour growth and overcomes chemoresistance in preclinical models of oesophageal adenocarcinoma. Gut. 2015;64:1506-1516.
Not in our library10.1136/gutjnl-2015-309770
394.
APR-246 overcomes resistance to cisplatin and doxorubicin in ovarian cancer cells · 2015
No notice
395.
Kobayashi T, et al. APR-246 induces apoptosis and enhances chemo-sensitivity via activation of ROS and TAp73-Noxa signal in oesophageal squamous cell cancer with TP53 missense mutation. Br. J. Cancer. 2021;125:1523-1532.
Not in our library10.1038/s41416-021-01561-0
396.
Ceder S, et al. Mutant p53-reactivating compound APR-246 synergizes with asparaginase in inducing growth suppression in acute lymphoblastic leukemia cells. Cell Death Dis. 2021;12:709.
Not in our library10.1038/s41419-021-03988-y
397.
Nahi H, et al. Effects of PRIMA-1 on chronic lymphocytic leukaemia cells with and without hemizygous p53 deletion. Br. J. Haematol. 2004;127:285-291.
Not in our library10.1111/j.1365-2141.2004.05210.x
398.
Nahi H, et al. Mutated and non-mutated TP53 as targets in the treatment of leukaemia. Br. J. Haematol. 2008;141:445-453.
Not in our library10.1111/j.1365-2141.2008.07046.x
399.
Chipuk JE, Maurer U, Green DR, Schuler M. Pharmacologic activation of p53 elicits Bax-dependent apoptosis in the absence of transcription. Cancer Cell. 2003;4:371-381.
Not in our library10.1016/s1535-6108(03)00272-1
400.
Lambert JMR, et al. Mutant p53 reactivation by PRIMA-1MET induces multiple signaling pathways converging on apoptosis. Oncogene. 2010;29:1329-1338.
Not in our library10.1038/onc.2009.425
401.
Ali D, et al. APR-246 exhibits anti-leukemic activity and synergism with conventional chemotherapeutic drugs in acute myeloid leukemia cells. Eur. J. Haematol. 2011;86:206-215.
Not in our library10.1111/j.1600-0609.2010.01557.x
402.
Li X-L, et al. PRIMA-1met (APR-246) inhibits growth of colorectal cancer cells with different p53 status through distinct mechanisms. Oncotarget. 2015;6:36689-36699.
Not in our library10.18632/oncotarget.5385
403.
Patyka M, et al. Sensitivity to PRIMA-1MET is associated with decreased MGMT in human glioblastoma cells and glioblastoma stem cells irrespective of p53 status. Oncotarget. 2016;7:60245-60269.
Not in our library10.18632/oncotarget.11197
404.
Menichini, P. et al. Antitumor effects of PRIMA-1 and PRIMA-1 (APR246) in hematological malignancies: still a mutant P53-dependent affair? Cells. 10, (2021).
Not in our library10.3390/cells10010098
405.
Tessoulin B, et al. PRIMA-1Met induces myeloma cell death independent of p53 by impairing the GSH/ROS balance. Blood. 2014;124:1626-1636.
Not in our library10.1182/blood-2014-01-548800
406.
Mlakar V, et al. PRIMA-1-induced neuroblastoma cell death is modulated by p53 and mycn through glutathione level. J. Exp. Clin. Cancer Res. 2019;38:69.
Not in our library10.1186/s13046-019-1066-6
407.
Peng X, et al. APR-246/PRIMA-1MET inhibits thioredoxin reductase 1 and converts the enzyme to a dedicated NADPH oxidase. Cell Death Dis. 2013;4:e881.
Not in our library10.1038/cddis.2013.417
408.
Targeting of Mutant p53 and the Cellular Redox Balance by APR-246 as a Strategy for Efficient Cancer Therapy · 2016
No notice
409.
Haffo L, et al. Inhibition of the glutaredoxin and thioredoxin systems and ribonucleotide reductase by mutant p53-targeting compound APR-246. Sci. Rep. 2018;8:12671.
Not in our library10.1038/s41598-018-31048-7
410.
Birsen R, et al. APR-246 induces early cell death by ferroptosis in acute myeloid leukemia. Haematologica. 2022;107:403-416.
Not in our library10.3324/haematol.2020.259531
411.
Inhibiting the system xC−/glutathione axis selectively targets cancers with mutant-p53 accumulation · 2017
No notice
412.
Fujihara KM, et al. Eprenetapopt triggers ferroptosis, inhibits NFS1 cysteine desulfurase, and synergizes with serine and glycine dietary restriction. Sci. Adv. 2022;8:eabm9427.
Not in our library10.1126/sciadv.abm9427
413.
Teoh PJ, et al. PRIMA-1 targets the vulnerability of multiple myeloma of deregulated protein homeostasis through the perturbation of ER stress via p73 demethylation. Oncotarget. 2016;7:61806-61819.
Not in our library10.18632/oncotarget.11241
414.
Ali D, et al. Anti-leukaemic effects induced by APR-246 are dependent on induction of oxidative stress and the NFE2L2/HMOX1 axis that can be targeted by PI3K and mTOR inhibitors in acute myeloid leukaemia cells. Br. J. Haematol. 2016;174:117-126.
Not in our library10.1111/bjh.14036
415.
Sallman DA, et al. Eprenetapopt (APR-246) and Azacitidine in -Mutant Myelodysplastic Syndromes. J. Clin. Oncol. 2021;39:1584-1594.
Not in our library10.1200/jco.20.02341
416.
Cluzeau T, et al. Eprenetapopt plus azacitidine in -mutated myelodysplastic syndromes and acute myeloid leukemia: a phase II study by the groupe Francophone des Myélodysplasies (GFM). J. Clin. Oncol. 2021;39:1575-1583.
Not in our library10.1200/jco.20.02342
417.
Lehmann S, et al. Targeting p53 in vivo: a first-in-human study with p53-targeting compound APR-246 in refractory hematologic malignancies and prostate cancer. J. Clin. Oncol. 2012;30:3633-3639.
Not in our library10.1200/jco.2011.40.7783
418.
Gourley C, et al. PISARRO: A EUTROC phase Ib study of APR-246 in combination with carboplatin (C) and pegylated liposomal doxorubicin (PLD) in platinum sensitive relapsed high grade serous ovarian cancer (HGSOC). J. Clin. Oncol. 2016;34:5571-5571.
Not in our library10.1200/jco.2016.34.15_suppl.5571
419.
Mishra, A. et al. Eprenetapopt plus azacitidine after allogeneic hematopoietic stem-cell transplantation for -mutant acute myeloid leukemia and myelodysplastic syndromes. J. Clin. Oncol., JCO2200181 (2022).
Not in our library10.1200/jco.22.00181
420.
Maslah N, et al. Synergistic effects of PRIMA-1 (APR-246) and 5-azacitidine in -mutated myelodysplastic syndromes and acute myeloid leukemia. Haematologica. 2020;105:1539-1551.
Not in our library10.3324/haematol.2019.218453
421.
Welch JS, et al. TP53 and decitabine in acute myeloid leukemia and myelodysplastic syndromes. N. Engl. J. Med. 2016;375:2023-2036.
Not in our library10.1056/nejmoa1605949
422.
Lambert JMR, et al. PRIMA-1 reactivates mutant p53 by covalent binding to the core domain. Cancer Cell. 2009;15:376-388.
Not in our library10.1016/j.ccr.2009.03.003
423.
Sun XZ, et al. Formation of disulfide bond in p53 correlates with inhibition of DNA binding and tetramerization. Antioxid. Redox Signal. 2003;5:655-665.
Not in our library10.1089/152308603770310338
424.
Wassman CD, et al. Computational identification of a transiently open L1/S3 pocket for reactivation of mutant p53. Nat. Commun. 2013;4:1407.
Not in our library10.1038/ncomms2361
425.
Degtjarik O, et al. Structural basis of reactivation of oncogenic p53 mutants by a small molecule: methylene quinuclidinone (MQ). Nat. Commun. 2021;12:7057.
Not in our library10.1038/s41467-021-27142-6
426.
Soignet SL, et al. Complete remission after treatment of acute promyelocytic leukemia with arsenic trioxide. N. Engl. J. Med. 1998;339:1341-1348.
Not in our library10.1056/nejm199811053391901
427.
Zhang X-W, et al. Arsenic trioxide controls the fate of the PML-RARalpha oncoprotein by directly binding PML. Science. 2010;328:240-243.
Not in our library10.1126/science.1183424
428.
Liu Q, Hilsenbeck S, Gazitt Y. Arsenic trioxide-induced apoptosis in myeloma cells: p53-dependent G1 or G2/M cell cycle arrest, activation of caspase-8 or caspase-9, and synergy with APO2/TRAIL. Blood. 2003;101:4078-4087.
Not in our library10.1182/blood-2002-10-3231
429.
Zheng T, et al. Nutlin-3 overcomes arsenic trioxide resistance and tumor metastasis mediated by mutant p53 in Hepatocellular Carcinoma. Mol. Cancer. 2014;13:133.
Not in our library10.1186/1476-4598-13-133
430.
Li Y, et al. Arsenic trioxide induces apoptosis and G2/M phase arrest by inducing Cbl to inhibit PI3K/Akt signaling and thereby regulate p53 activation. Cancer Lett. 2009;284:208-215.
Not in our library10.1016/j.canlet.2009.04.035
431.
Chen, S. et al. Arsenic trioxide rescues structural p53 mutations through a cryptic allosteric site. Cancer Cell. 39 (2021).
Not in our library10.1016/j.ccell.2020.11.013
432.
Tang Y, et al. Repurposing antiparasitic antimonials to noncovalently rescue temperature-sensitive p53 mutations. Cell Rep. 2022;39:110622.
Not in our library10.1016/j.celrep.2022.110622
433.
Liarte DB, Murta SMF. Selection and phenotype characterization of potassium antimony tartrate-resistant populations of four New World Leishmania species. Parasitol. Res. 2010;107:205-212.
Not in our library10.1007/s00436-010-1852-8
434.
Dumetz, F. et al. Molecular preadaptation to antimony resistance in leishmania donovani on the indian subcontinent. mSphere. 3 (2018).
Not in our library10.1128/msphere.00548-17
435.
Wang B, et al. The antiparasitic drug, potassium antimony tartrate, inhibits tumor angiogenesis and tumor growth in nonsmall-cell lung cancer. J. Pharmacol. Exp. Ther. 2015;352:129-138.
Not in our library10.1124/jpet.114.218644
436.
Zhang Y-K, et al. Establishment and characterization of arsenic trioxide resistant KB/ATO cells. Acta Pharm. Sin. B. 2017;7:564-570.
Not in our library10.1016/j.apsb.2017.04.001
437.
Lecureur V, Lagadic-Gossmann D, Fardel O. Potassium antimonyl tartrate induces reactive oxygen species-related apoptosis in human myeloid leukemic HL60 cells. Int. J. Oncol. 2002;20:1071-1076.
Not in our library
438.
Lecureur V, et al. Potassium antimonyl tartrate induces caspase- and reactive oxygen species-dependent apoptosis in lymphoid tumoral cells. Br. J. Haematol. 2002;119:608-615.
Not in our library10.1046/j.1365-2141.2002.03863.x
439.
Butler JS, Loh SN. Structure, function, and aggregation of the zinc-free form of the p53 DNA binding domain. Biochemistry. 2003;42:2396-2403.
Not in our library10.1021/bi026635n
440.
Bullock AN, et al. Thermodynamic stability of wild-type and mutant p53 core domain. Proc. Natl Acad. Sci. USA. 1997;94:14338-14342.
Not in our library10.1073/pnas.94.26.14338
441.
Yu X, Vazquez A, Levine AJ, Carpizo DR. Allele-specific p53 mutant reactivation. Cancer Cell. 2012;21:614-625.
Not in our library10.1016/j.ccr.2012.03.042
442.
Yu X, et al. Small molecule restoration of wildtype structure and function of mutant p53 using a novel zinc-metallochaperone based mechanism. Oncotarget. 2014;5:8879-8892.
Not in our library10.18632/oncotarget.2432
443.
Yu X, et al. Thiosemicarbazones functioning as zinc metallochaperones to reactivate mutant p53. Mol. Pharmacol. 2017;91:567-p575.
Not in our library10.1124/mol.116.107409
444.
Blanden AR, et al. Synthetic metallochaperone ZMC1 rescues mutant p53 conformation by transporting zinc into cells as an ionophore. Mol. Pharmacol. 2015;87:825-831.
Not in our library10.1124/mol.114.097550
445.
Na B, et al. BRCA1Therapeutic targeting of and mutant breast cancer through mutant p53 reactivation. NPJ breast cancer. 2019;5:14.
Not in our library10.1038/s41523-019-0110-1
446.
Yu X, et al. Zinc metallochaperones reactivate mutant p53 using an ON/OFF switch mechanism: a new paradigm in cancer therapeutics. Clin. Cancer Res. 2018;24:4505-4517.
Not in our library10.1158/1078-0432.ccr-18-0822
447.
Zaman S, et al. Combinatorial therapy of zinc metallochaperones with mutant p53 reactivation and diminished copper binding. Mol. Cancer Ther. 2019;18:1355-1365.
Not in our library10.1158/1535-7163.mct-18-1080
448.
COTI-2, a novel small molecule that is active against multiple human cancer cell lines in vitro and in vivo · 2016
No notice
449.
Lindemann A, et al. COTI-2, a novel thiosemicarbazone derivative, exhibits antitumor activity in HNSCC through p53-dependent and -independent Mechanisms. Clin. Cancer Res. 2019;25:5650-5662.
Not in our library10.1158/1078-0432.ccr-19-0096
450.
Bormio Nunes J, et al. Cancer cell resistance against the clinically investigated thiosemicarbazone COTI-2 is based on formation of intracellular copper complex glutathione adducts and ABCC1-mediated efflux. J. Med. Chem. 2020;63:13719-13732.
Not in our library10.1021/acs.jmedchem.0c01277
451.
Synnott NC, O’Connell D, Crown J, Duffy MJ. COTI-2 reactivates mutant p53 and inhibits growth of triple-negative breast cancer cells. Breast Cancer Res. Treat. 2020;179:47-56.
Not in our library10.1007/s10549-019-05435-1
452.
Guo Y, Zhu X, Sun X. COTI-2 induces cell apoptosis in pediatric acute lymphoblastic leukemia via upregulation of miR-203. Bioengineered. 2020;11:201-208.
Not in our library10.1080/21655979.2020.1729927
453.
Maleki Vareki S, Salim K, Danter W, Koropatnick J. Novel anti-cancer drug COTI-2 synergizes with therapeutic agents and does not induce resistance or exhibit cross-resistance in human cancer cell lines. PLoS One. 2018;13:e0191766.
Not in our library10.1371/journal.pone.0191766
454.
Foster BA, Coffey HA, Morin MJ, Rastinejad F. Pharmacological rescue of mutant p53 conformation and function. Science. 1999;286:2507-2510.
Not in our library10.1126/science.286.5449.2507
455.
Rippin TM, et al. Characterization of the p53-rescue drug CP-31398 in vitro and in living cells. Oncogene. 2002;21:2119-2129.
Not in our library10.1038/sj.onc.1205362
456.
Wischhusen J, et al. CP-31398, a novel p53-stabilizing agent, induces p53-dependent and p53-independent glioma cell death. Oncogene. 2003;22:8233-8245.
Not in our library10.1038/sj.onc.1207198
457.
Wang W, Takimoto R, Rastinejad F, El-Deiry WS. Stabilization of p53 by CP-31398 inhibits ubiquitination without altering phosphorylation at serine 15 or 20 or MDM2 binding. Mol. Cell. Biol. 2003;23:2171-2181.
Not in our library10.1128/mcb.23.6.2171-2181.2003
458.
Zache N, et al. Mutant p53 targeting by the low molecular weight compound STIMA-1. Mol. Oncol. 2008;2:70-80.
Not in our library10.1016/j.molonc.2008.02.004
459.
Bykov VJN, et al. Reactivation of mutant p53 and induction of apoptosis in human tumor cells by maleimide analogs. J. Biol. Chem. 2005;280:30384-30391.
Not in our library10.1074/jbc.m501664200
460.
Bou-Hanna C, et al. Acute cytotoxicity of MIRA-1/NSC19630, a mutant p53-reactivating small molecule, against human normal and cancer cells via a caspase-9-dependent apoptosis. Cancer Lett. 2015;359:211-217.
Not in our library10.1016/j.canlet.2015.01.014
461.
Saha M, et al. Small molecule MIRA-1 induces in vitro and in vivo anti-myeloma activity and synergizes with current anti-myeloma agents. Br. J. Cancer. 2014;110:2224-2231.
Not in our library10.1038/bjc.2014.164
462.
Durairaj, G. et al. Discovery of compounds that reactivate p53 mutants in vitro and in vivo. Cell Chem Biol. 29 (2022).
Not in our library10.1016/j.chembiol.2022.07.003
463.
Kaar JL, et al. Stabilization of mutant p53 via alkylation of cysteines and effects on DNA binding. Protein Sci. 2010;19:2267-2278.
Not in our library10.1002/pro.507
464.
Bauer MR, et al. Targeting cavity-creating p53 cancer mutations with small-molecule stabilizers: the Y220X paradigm. ACS Chem. Biol. 2020;15:657-668.
Not in our library10.1021/acschembio.9b00748
465.
Basse N, et al. Toward the rational design of p53-stabilizing drugs: probing the surface of the oncogenic Y220C mutant. Chem. Biol. 2010;17:46-56.
Not in our library10.1016/j.chembiol.2009.12.011
466.
Bykov VJN, Wiman KG. Mutant p53 reactivation by small molecules makes its way to the clinic. FEBS Lett. 2014;588:2622-2627.
Not in our library10.1016/j.febslet.2014.04.017
467.
Boeckler FM, et al. Targeted rescue of a destabilized mutant of p53 by an in silico screened drug. Proc. Natl. Acad. Sci. USA. 2008;105:10360-10365.
Not in our library10.1073/pnas.0805326105
468.
Small molecule induced reactivation of mutant p53 in cancer cells · 2013
No notice
469.
Wilcken R, et al. Halogen-enriched fragment libraries as leads for drug rescue of mutant p53. J. Am. Chem. Soc. 2012;134:6810-6818.
Not in our library10.1021/ja301056a
470.
Joerger AC, et al. Exploiting transient protein states for the design of small-molecule stabilizers of mutant p53. Structure. 2015;23:2246-2255.
Not in our library10.1016/j.str.2015.10.016
471.
Bauer MR, et al. Harnessing fluorine-sulfur contacts and multipolar interactions for the design of p53 mutant Y220C rescue drugs. ACS Chem. Biol. 2016;11:2265-2274.
Not in our library10.1021/acschembio.6b00315
472.
Baud MGJ, et al. Aminobenzothiazole derivatives stabilize the thermolabile p53 cancer mutant Y220C and show anticancer activity in p53-Y220C cell lines. Eur. J. Med. Chem. 2018;152:101-114.
Not in our library10.1016/j.ejmech.2018.04.035
473.
Bauer MR, et al. A structure-guided molecular chaperone approach for restoring the transcriptional activity of the p53 cancer mutant Y220C. Future Med. Chem. 2019;11:2491-2504.
Not in our library10.4155/fmc-2019-0181
474.
Raghavan V, Agrahari M, Gowda D. Virtual screening of p53 mutants reveals Y220S as an additional rescue drug target for PhiKan083 with higher binding characteristics. Comput. Biol. Chem. 2019;80:398-408.
Not in our library10.1016/j.compbiolchem.2019.05.005
475.
Miller J, et al. Multifunctional compounds for activation of the p53-Y220C mutant in cancer. Chemistry. 2018;24:17734-17742.
Not in our library10.1002/chem.201802677
476.
Dong T, et al. Hybrid molecular dynamics for elucidating cooperativity between halogen bond and water molecules during the interaction of p53-Y220C and the PhiKan5196 complex. Front. Chem. 2020;8:344.
Not in our library10.3389/fchem.2020.00344
477.
Synnott, N. C. et al. Mutant p53 as a therapeutic target for the treatment of triple-negative breast cancer: Preclinical investigation with the anti-p53 drug, PK11007. Cancer Lett. 414 (2018).
Not in our library10.1016/j.canlet.2017.09.053
478.
Bauer MR, Joerger AC, Fersht AR. 2-Sulfonylpyrimidines: Mild alkylating agents with anticancer activity toward p53-compromised cells. Proc. Natl. Acad. Sci. USA. 2016;113:E5271-E5280.
Not in our library10.1073/pnas.1610421113
479.
Dumble M, et al. Abstract LB006: PC14586: The first orally bioavailable small molecule reactivator of Y220C mutant p53 in clinical development. Cancer Res. 2021;81:LB006-LB006.
Not in our library10.1158/1538-7445.am2021-lb006
480.
Dumbrava EE, et al. First-in-human study of PC14586, a small molecule structural corrector of Y220C mutant p53, in patients with advanced solid tumors harboring a TP53 Y220C mutation. J. Clin. Oncol. 2022;40:3003-3003.
Not in our library10.1200/jco.2022.40.16_suppl.3003
481.
Wang G, Fersht AR. First-order rate-determining aggregation mechanism of p53 and its implications. Proc. Natl. Acad. Sci. USA. 2012;109:13590-13595.
Not in our library10.1073/pnas.1211557109
482.
Stenger JE, et al. p53 oligomerization and DNA looping are linked with transcriptional activation. EMBO J. 1994;13:6011-6020.
Not in our library10.1002/j.1460-2075.1994.tb06947.x
483.
Wang G, Fersht AR. Propagation of aggregated p53: Cross-reaction and coaggregation vs. seeding. Proc. Natl. Acad. Sci. USA. 2015;112:2443-2448.
Not in our library10.1073/pnas.1500262112
484.
Levy CB, et al. Co-localization of mutant p53 and amyloid-like protein aggregates in breast tumors. Int. J. Biochem. Cell Biol. 2011;43:60-64.
Not in our library10.1016/j.biocel.2010.10.017
485.
Xu J, et al. Gain of function of mutant p53 by coaggregation with multiple tumor suppressors. Nat. Chem. Biol. 2011;7:285-295.
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486.
Eisenberg D, Jucker M. The amyloid state of proteins in human diseases. Cell. 2012;148:1188-1203.
Not in our library10.1016/j.cell.2012.02.022
487.
Nelson R, et al. Structure of the cross-beta spine of amyloid-like fibrils. Nature. 2005;435:773-778.
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488.
Ghosh S, et al. Investigating the intrinsic aggregation potential of evolutionarily conserved segments in p53. Biochemistry. 2014;53:5995-6010.
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489.
Lei J, et al. Self-aggregation and coaggregation of the p53 core fragment with its aggregation gatekeeper variant. Phys. Chem. Chem. Phys. 2016;18:8098-8107.
Not in our library10.1039/c5cp06538k
490.
Soragni, A. et al. A designed inhibitor of p53 Aggregation rescues p53 tumor suppression in ovarian carcinomas. Cancer Cell. 29 (2016).
Not in our library10.1016/j.ccell.2015.12.002
491.
Lei J, et al. Molecular dynamics study on the inhibition mechanisms of ReACp53 peptide for p53-R175H mutant aggregation. Phys. Chem. Chem. Phys. 2021;23:23032-23041.
Not in our library10.1039/d1cp03094a
492.
Zhang Y, et al. Therapeutic potential of ReACp53 targeting mutant p53 protein in CRPC. Prostate Cancer Prostatic Dis. 2020;23:160-171.
Not in our library10.1038/s41391-019-0172-z
493.
Neal, A. et al. Combining ReACp53 with carboplatin to target high-grade serous ovarian cancers. Cancers (Basel). 13 (2021).
Not in our library10.3390/cancers13235908
494.
Zhang Y, et al. Proteomic identification of ERP29 as a key chemoresistant factor activated by the aggregating p53 mutant Arg282Trp. Oncogene. 2017;36:5473-5483.
Not in our library10.1038/onc.2017.152
495.
Wang G, Fersht AR. Multisite aggregation of p53 and implications for drug rescue. Proc. Natl. Acad. Sci. USA. 2017;114:E2634-E2643.
Not in our library10.1073/pnas.1700308114
496.
Protein mimetic amyloid inhibitor potently abrogates cancer-associated mutant p53 aggregation and restores tumor suppressor function · 2021
No notice
497.
Kumar S, Hamilton AD. α-helix mimetics as modulators of Aβ self-assembly. J. Am. Chem. Soc. 2017;139:5744-5755.
Not in our library10.1021/jacs.6b09734
498.
Kumar S, et al. Islet amyloid-induced cell death and bilayer integrity loss share a molecular origin targetable with oligopyridylamide-based α-helical mimetics. Chem. Biol. 2015;22:369-378.
Not in our library10.1016/j.chembiol.2015.01.006
499.
Miller JJ, et al. Bifunctional ligand design for modulating mutant p53 aggregation in cancer. Chem. Sci. 2019;10:10802-10814.
Not in our library10.1039/c9sc04151f
500.
Li Y, Prives C. Are interactions with p63 and p73 involved in mutant p53 gain of oncogenic function? Oncogene. 2007;26:2220-2225.
Not in our library10.1038/sj.onc.1210311
501.
Molecular Mechanism of Mutant p53 Stabilization: The Role of HSP70 and MDM2 · 2012
Corrected
502.
Muller P, et al. Chaperone-dependent stabilization and degradation of p53 mutants. Oncogene. 2008;27:3371-3383.
Not in our library10.1038/sj.onc.1211010
503.
Tutuska K, et al. Statin as anti-cancer therapy in autochthonous T-lymphomas expressing stabilized gain-of-function mutant p53 proteins. Cell Death Dis. 2020;11:274.
Not in our library10.1038/s41419-020-2466-4
504.
Alexandrova EM, Xu S, Moll UM. Ganetespib synergizes with cyclophosphamide to improve survival of mice with autochthonous tumors in a mutant p53-dependent manner. Cell Death Dis. 2017;8:e2683.
Not in our library10.1038/cddis.2017.108
505.
Cooper B, et al. Peptides as a platform for targeted therapeutics for cancer: peptide-drug conjugates (PDCs). Chem. Soc. Rev. 2021;50:1480-1494.
Not in our library10.1039/d0cs00556h
506.
Saw P, Xu X, Kim S, Jon S. Biomedical Applications of a Novel Class of High-Affinity Peptides. Acc. Chem. Res. 2021;54:3576-3592.
Not in our library10.1021/acs.accounts.1c00239
507.
Friedler A, et al. A peptide that binds and stabilizes p53 core domain: chaperone strategy for rescue of oncogenic mutants. Proc. Natl. Acad. Sci. USA. 2002;99:937-942.
Not in our library10.1073/pnas.241629998
508.
Friedler A, et al. Structural distortion of p53 by the mutation R249S and its rescue by a designed peptide: implications for “mutant conformation”. J. Mol. Biol. 2004;336:187-196.
Not in our library10.1016/j.jmb.2003.12.005
509.
Friedler A, Veprintsev D, Hansson L, Fersht A. Kinetic instability of p53 core domain mutants: implications for rescue by small molecules. J. Biol. Chem. 2003;278:24108-24112.
Not in our library10.1074/jbc.m302458200
510.
Issaeva N, et al. Rescue of mutants of the tumor suppressor p53 in cancer cells by a designed peptide. Proc. Natl Acad. Sci. USA. 2003;100:13303-13307.
Not in our library10.1073/pnas.1835733100
511.
Tal P, et al. Cancer therapeutic approach based on conformational stabilization of mutant p53 protein by small peptides. Oncotarget. 2016;7:11817-11837.
Not in our library10.18632/oncotarget.7857
512.
Yamada T, et al. A peptide fragment of azurin induces a p53-mediated cell cycle arrest in human breast cancer cells. Mol. Cancer Ther. 2009;8:2947-2958.
Not in our library10.1158/1535-7163.mct-09-0444
513.
Taylor BN, et al. Noncationic peptides obtained from azurin preferentially enter cancer cells. Cancer Res. 2009;69:537-546.
Not in our library10.1158/0008-5472.can-08-2932
514.
Yamada T, et al. Internalization of bacterial redox protein azurin in mammalian cells: entry domain and specificity. Cell. Microbiol. 2005;7:1418-1431.
Not in our library10.1111/j.1462-5822.2005.00567.x
515.
Bizzarri AR, et al. Interaction of an anticancer peptide fragment of azurin with p53 and its isolated domains studied by atomic force spectroscopy. Int J. Nanomed. 2011;6:3011-3019.
Not in our library10.2147/ijn.s26155
516.
Signorelli S, et al. Binding of Amphipathic Cell Penetrating Peptide p28 to Wild Type and Mutated p53 as studied by Raman, Atomic Force and Surface Plasmon Resonance spectroscopies. Biochim Biophys. Acta Gen. Subj. 2017;1861:910-921.
Not in our library10.1016/j.bbagen.2017.01.022
517.
Yamada T, et al. p28, a first in class peptide inhibitor of cop1 binding to p53. Br. J. Cancer. 2013;108:2495-2504.
Not in our library10.1038/bjc.2013.266
518.
Yamada T, Das Gupta TK, Beattie CW. p28, an anionic cell-penetrating peptide, increases the activity of wild type and mutated p53 without altering its conformation. Mol. Pharm. 2013;10:3375-3383.
Not in our library10.1021/mp400221r
519.
Yamada T, Das Gupta T, Beattie C. p28-mediated activation of p53 in G2-M phase of the cell cycle enhances the efficacy of DNA damaging and antimitotic chemotherapy. Cancer Res. 2016;76:2354-2365.
Not in our library10.1158/0008-5472.can-15-2355
520.
Warso MA, et al. A first-in-class, first-in-human, phase I trial of p28, a non-HDM2-mediated peptide inhibitor of p53 ubiquitination in patients with advanced solid tumours. Br. J. Cancer. 2013;108:1061-1070.
Not in our library10.1038/bjc.2013.74
521.
Lulla RR, et al. Phase I trial of p28 (NSC745104), a non-HDM2-mediated peptide inhibitor of p53 ubiquitination in pediatric patients with recurrent or progressive central nervous system tumors: A Pediatric Brain Tumor Consortium Study. Neuro Oncol. 2016;18:1319-1325.
Not in our library10.1093/neuonc/now047
522.
Jia L, et al. Preclinical pharmacokinetics, metabolism, and toxicity of azurin-p28 (NSC745104) a peptide inhibitor of p53 ubiquitination. Cancer Chemother. Pharmacol. 2011;68:513-524.
Not in our library10.1007/s00280-010-1518-3
523.
Hamers-Casterman C, et al. Naturally occurring antibodies devoid of light chains. Nature. 1993;363:446-448.
Not in our library10.1038/363446a0
524.
Hu X, et al. A novel nanobody-heavy chain antibody against Angiopoietin-like protein 3 reduces plasma lipids and relieves nonalcoholic fatty liver disease. J. Nanobiotechnology. 2022;20:237.
Not in our library10.1186/s12951-022-01456-z
525.
Zeng, Z. et al. Activatable cancer sono-immunotherapy using semiconducting polymer nanobodies. Adv Mater. e2203246, (2022).
Not in our library10.1002/adma.202203246
526.
Hong J, et al. Dromedary camel nanobodies broadly neutralize SARS-CoV-2 variants. Proc. Natl. Acad. Sci. USA. 2022;119:e2201433119.
Not in our library10.1073/pnas.2201433119
527.
Bethuyne J, et al. A nanobody modulates the p53 transcriptional program without perturbing its functional architecture. Nucleic Acids Res. 2014;42:12928-12938.
Not in our library10.1093/nar/gku962
528.
Danilova L, et al. The mutation-associated neoantigen functional expansion of specific T cells (MANAFEST) assay: a sensitive platform for monitoring antitumor immunity. Cancer Immunol. Res. 2018;6:888-899.
Not in our library10.1158/2326-6066.cir-18-0129
529.
Hsiue, E. H.-C. et al. Targeting a neoantigen derived from a common mutation. Science. 371 (2021).
Not in our library10.1126/science.abc8697
530.
Malekzadeh P, et al. Neoantigen screening identifies broad TP53 mutant immunogenicity in patients with epithelial cancers. J. Clin. Invest. 2019;129:1109-1114.
Not in our library10.1172/jci123791
531.
Nikolova PV, et al. Mechanism of rescue of common p53 cancer mutations by second-site suppressor mutations. EMBO J. 2000;19:370-378.
Not in our library10.1093/emboj/19.3.370
532.
Suad O, et al. Structural basis of restoring sequence-specific DNA binding and transactivation to mutant p53 by suppressor mutations. J. Mol. Biol. 2009;385:249-265.
Not in our library10.1016/j.jmb.2008.10.063
533.
Otsuka K, et al. The screening of the second-site suppressor mutations of the common p53 mutants. Int. J. Cancer. 2007;121:559-566.
Not in our library10.1002/ijc.22724
534.
Joerger AC, Allen MD, Fersht AR. Crystal structure of a superstable mutant of human p53 core domain. Insights into the mechanism of rescuing oncogenic mutations. J. Biol. Chem. 2004;279:1291-1296.
Not in our library10.1074/jbc.m309732200
535.
Odell AF, et al. A novel p53 mutant found in iatrogenic urothelial cancers is dysfunctional and can be rescued by a second-site global suppressor mutation. J. Biol. Chem. 2013;288:16704-16714.
Not in our library10.1074/jbc.m112.443168
536.
Eldar A, et al. Structural studies of p53 inactivation by DNA-contact mutations and its rescue by suppressor mutations via alternative protein-DNA interactions. Nucleic Acids Res. 2013;41:8748-8759.
Not in our library10.1093/nar/gkt630
537.
Brachmann RK, et al. Genetic selection of intragenic suppressor mutations that reverse the effect of common p53 cancer mutations. EMBO J. 1998;17:1847-1859.
Not in our library10.1093/emboj/17.7.1847
538.
Joerger AC, Fersht AR. Structure-function-rescue: the diverse nature of common p53 cancer mutants. Oncogene. 2007;26:2226-2242.
Not in our library10.1038/sj.onc.1210291
539.
Nikolova PV, Henckel J, Lane DP, Fersht AR. Semirational design of active tumor suppressor p53 DNA binding domain with enhanced stability. Proc. Natl. Acad. Sci. USA. 1998;95:14675-14680.
Not in our library10.1073/pnas.95.25.14675
540.
Demir Ö, et al. Ensemble-based computational approach discriminates functional activity of p53 cancer and rescue mutants. PLoS Comput. Biol. 2011;7:e1002238.
Not in our library10.1371/journal.pcbi.1002238
541.
Merabet A, et al. Mutants of the tumour suppressor p53 L1 loop as second-site suppressors for restoring DNA binding to oncogenic p53 mutations: structural and biochemical insights. Biochem. J. 2010;427:225-236.
Not in our library10.1042/bj20091888
542.
Chattopadhyay G, et al. Mechanistic insights into global suppressors of protein folding defects. PLoS Genet. 2022;18:e1010334.
Not in our library10.1371/journal.pgen.1010334
543.
Kamaraj B, Bogaerts A. Structure and function of p53-DNA complexes with inactivation and rescue mutations: a molecular dynamics simulation study. PLoS One. 2015;10:e0134638.
Not in our library10.1371/journal.pone.0134638
544.
Ramani RG, Jacob SG. Prediction of cancer rescue p53 mutants in silico using Naïve Bayes learning methodology. Protein Pept. Lett. 2013;20:1280-1291.
Not in our library10.2174/09298665113209990046
545.
Wallentine BD, et al. Structures of oncogenic, suppressor and rescued p53 core-domain variants: mechanisms of mutant p53 rescue. Acta Crystallogr. 2013;69:2146-2156.
Not in our library10.1107/s0907444913020830
546.
Joerger AC, et al. Structures of p53 cancer mutants and mechanism of rescue by second-site suppressor mutations. J. Biol. Chem. 2005;280:16030-16037.
Not in our library10.1074/jbc.m500179200
547.
Viadiu H, Fronza G, Inga A. Structural studies on mechanisms to activate mutant p53. Subcell. Biochem. 2014;85:119-132.
Not in our library10.1007/978-94-017-9211-0_7
548.
Selivanova G, et al. Restoration of the growth suppression function of mutant p53 by a synthetic peptide derived from the p53 C-terminal domain. Nat. Med. 1997;3:632-638.
Not in our library10.1038/nm0697-632
549.
Selivanova G, et al. Reactivation of mutant p53 through interaction of a C-terminal peptide with the core domain. Mol. Cell. Biol. 1999;19:3395-3402.
Not in our library10.1128/mcb.19.5.3395
550.
Kaldmäe, M. et al. A “spindle and thread” mechanism unblocks p53 translation by modulating N-terminal disorder. Structure30, (2022).
Not in our library10.1016/j.str.2022.02.013
551.
Wang T-H, Li W-T, Yu S-H, Au L-C. The use of 10-23 DNAzyme to selectively destroy the allele of mRNA with a unique purine-pyrimidine dinucleotide. Oligonucleotides. 2008;18:295-299.
Not in our library10.1089/oli.2008.0138
552.
Iyer SV, et al. Allele-specific silencing of mutant p53 attenuates dominant-negative and gain-of-function activities. Oncotarget. 2016;7:5401-5415.
Not in our library10.18632/oncotarget.6634
553.
Hoffman-Luca CG, et al. Elucidation of Acquired Resistance to Bcl-2 and MDM2 Inhibitors in Acute Leukemia In Vitro and In Vivo. Clin. Cancer Res. 2015;21:2558-2568.
Not in our library10.1158/1078-0432.ccr-14-2506
554.
Decaudin, D. et al. Preclinical evaluation of drug combinations identifies co-inhibition of Bcl-2/XL/W and MDM2 as a potential therapy in uveal melanoma. Eur. J. Cancer. 126 (2020).
Not in our library10.1016/j.ejca.2019.12.012
555.
Han X, et al. Nonsense-mediated mRNA decay: a ‘nonsense’ pathway makes sense in stem cell biology. Nucleic Acids Res. 2018;46:1038-1051.
Not in our library10.1093/nar/gkx1272
556.
Pan Y, et al. RNA dysregulation: an expanding source of cancer immunotherapy targets. Trends Pharmacol. Sci. 2021;42:268-282.
Not in our library10.1016/j.tips.2021.01.006
557.
Hassin, O. & Oren, M. Drugging p53 in cancer: one protein, many targets. Nat. Rev. Drug. Discov. (2022).
Not in our library10.1038/s41573-022-00571-8
558.
Floquet C, Deforges J, Rousset J-P, Bidou L. Rescue of non-sense mutated p53 tumor suppressor gene by aminoglycosides. Nucleic Acids Res. 2011;39:3350-3362.
Not in our library10.1093/nar/gkq1277
559.
Bidou L, et al. Characterization of new-generation aminoglycoside promoting premature termination codon readthrough in cancer cells. RNA Biol. 2017;14:378-388.
Not in our library10.1080/15476286.2017.1285480
560.
Gudikote JP, et al. Inhibition of nonsense-mediated decay rescues p53β/γ isoform expression and activates the p53 pathway in MDM2-overexpressing and select p53-mutant cancers. J. Biol. Chem. 2021;297:101163.
Not in our library10.1016/j.jbc.2021.101163
561.
Lindeboom RGH, Vermeulen M, Lehner B, Supek F. The impact of nonsense-mediated mRNA decay on genetic disease, gene editing and cancer immunotherapy. Nat. Genet. 2019;51:1645-1651.
Not in our library10.1038/s41588-019-0517-5
562.
Khajavi M, Inoue K, Lupski JR. Nonsense-mediated mRNA decay modulates clinical outcome of genetic disease. Eur. J. Hum. Genet. 2006;14:1074-1081.
Not in our library10.1038/sj.ejhg.5201649
563.
Chen J, et al. p53 isoform delta113p53 is a p53 target gene that antagonizes p53 apoptotic activity via BclxL activation in zebrafish. Genes Dev. 2009;23:278-290.
Not in our library10.1101/gad.1761609
564.
Bourdon J-C, et al. p53 isoforms can regulate p53 transcriptional activity. Genes Dev. 2005;19:2122-2137.
Not in our library10.1101/gad.1339905
565.
Senturk S, et al. p53Ψ is a transcriptionally inactive p53 isoform able to reprogram cells toward a metastatic-like state. Proc. Natl Acad. Sci. USA. 2014;111:E3287-E3296.
Not in our library10.1073/pnas.1321640111
566.
Khoury MP, Bourdon J-C. p53 isoforms: an intracellular microprocessor? Genes Cancer. 2011;2:453-465.
Not in our library10.1177/1947601911408893
567.
Bourdon JC. p53 isoforms change p53 paradigm. Mol. Cell Oncol. 2014;1:e969136.
Not in our library10.4161/23723548.2014.969136
568.
Marcel V, et al. Δ160p53 is a novel N-terminal p53 isoform encoded by Δ133p53 transcript. FEBS Lett. 2010;584:4463-4468.
Not in our library10.1016/j.febslet.2010.10.005
569.
Mondal AM, et al. Δ133p53α, a natural p53 isoform, contributes to conditional reprogramming and long-term proliferation of primary epithelial cells. Cell Death Dis. 2018;9:750.
Not in our library10.1038/s41419-018-0767-7
570.
Burslem GM, Crews CM. Proteolysis-targeting chimeras as therapeutics and tools for biological discovery. Cell. 2020;181:102-114.
Not in our library10.1016/j.cell.2019.11.031
571.
Li Z, et al. Allele-selective lowering of mutant HTT protein by HTT-LC3 linker compounds. Nature. 2019;575:203-209.
Not in our library10.1038/s41586-019-1722-1
572.
Takahashi, D. et al. AUTACs: cargo-specific degraders using selective autophagy. Mol. Cell. 76 (2019).
Not in our library10.1016/j.molcel.2019.09.009
573.
Banik SM, et al. Lysosome-targeting chimaeras for degradation of extracellular proteins. Nature. 2020;584:291-297.
Not in our library10.1038/s41586-020-2545-9
574.
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Not in our library10.1073/pnas.1620262114
575.
Wang S, Chen F-E. Small-molecule MDM2 inhibitors in clinical trials for cancer therapy. Eur. J. Med. Chem. 2022;236:114334.
Not in our library10.1016/j.ejmech.2022.114334
576.
Sabapathy K, Lane DP. Therapeutic targeting of p53: all mutants are equal, but some mutants are more equal than others. Nat. Rev. Clin. Oncol. 2018;15:13-30.
Not in our library10.1038/nrclinonc.2017.151
577.
Vlatković N, Crawford K, Rubbi CP, Boyd MT. Tissue-specific therapeutic targeting of p53 in cancer: one size does not fit all. Curr. Pharm. Des. 2011;17:618-630.
Not in our library10.2174/138161211795222568
578.
CCNE1 amplification is synthetic lethal with PKMYT1 kinase inhibition · 2022
No notice
579.
Rosenblum, D. et al. CRISPR-Cas9 genome editing using targeted lipid nanoparticles for cancer therapy. Sci Adv. 6 (2020).
Not in our library10.1126/sciadv.abc9450
580.
Canon J, et al. The clinical KRAS(G12C) inhibitor AMG 510 drives anti-tumour immunity. Nature. 2019;575:217-223.
Not in our library10.1038/s41586-019-1694-1
581.
Awad MM, et al. Acquired resistance to KRAS inhibition in cancer. N. Engl. J. Med. 2021;384:2382-2393.
Not in our library10.1056/nejmoa2105281

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