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by biotechbio 599 days ago
There's a decent amount of cynicism in the comments, which I understand. I think this is a really cool and novel study, though.

Historically, cancer was treated with therapies that are toxic to all cells, relying on the fact that cancer cells divide quickly and are unable to handle stress as well as normal cells (chemotherapy, radiation).

The last couple of decades we've seen many targeted cancer therapies. These drugs generally inhibit the activity of a specific protein that lets the cancer cells grow (e.g. EGFR inhibitors) or prevents the immune system from killing the cancer cells (e.g. PDL1 inhibitors).

This mechanism is way more interesting. The gene BCL6 is usually turned on in immune cells when they are mutating to recognize foreign invaders. This process involves lots of DNA damage and stress, but BCL6 stops the cells from dying and is therefore important for normal immune function. Unfortunately, this makes BCL6 a gene that is often co-opted in cancer cells to help them survive.

The method cleverly exploits the oncogenic function of BCL6 not by inhibiting it, but by turning it into a guide, enabling the delivery of activating machinery to the targets of BCL6 and reversing the inhibitory effects on cell death.

The whole field of targeted degraders, molecular glues, and heterobifunctional molecules is a growing area of interest in cancer research.

3 comments

This comment hits the nail on the head. Another big consideration with the technology in this paper that hasn't been mentioned in this thread is that it opens up a huge range of possibilities for targeting "undruggable" protein targets. Most drugs are small molecules that bind to sites an (relatively much larger) proteins, thereby getting in the way of their function. Unfortunately the vast majority of proteins do not have a site that can be bound by a molecule in a way that 1) has high affinity, 2) has high specificity (doesn't bind to other proteins) and 3) actually abolishes the protein's activity.

With "induced proximity" approaches like the one in this study, all you need is a molecule that binds the target protein somewhere. This idea has been validated extensively in the field of "targeted protein degradation", where a target protein and an E3 ubiquitin ligase, a protein that recruits the cell's native proteolysis machinery, are recruited to each other. The target protein doesn't have to be inactivated by the therapeutic molecule because the proteolysis machinery destroys it, so requirement #3 from above is effectively removed.

The molecule in this study does something similar to targeted protein degradation, but this time using a protein that effects gene expression instead of one that recruits proteolysis machinery. The article focuses on the fact that cancers are addicted to BCL6. This is an important innovation in the study and an active area of research (another example at [1]), but leaves out the fact that these induced proximity platforms are much more generalizable than traditional small molecules because it's the proteins that they recruit that do all the work rather than the molecules themselves. This study goes a long way to validate this principle, pioneered by targeted protein degradation and PROTACs, and shows that it can be applied broadly.

[1] https://www.biorxiv.org/content/10.1101/2024.07.27.605429v1

I haven’t read the paper yet but the news article seemed a bit, meeh.

BCL-2 inhibitors, mainly Venetoclax, is used in cancer therapies quite often which also triggers cell apoptosis and it’s very effective. It was also designed to target B-cell related cancers, but it found to be so effective that FDA approved it to be used in primary cases of Acute Myeloid Leukemia. So, killing cancer with triggerring apoptosis is very well known. I think the novel part might be the two protein, so it is probably more targeted for metabolic activities… but yeah didn’t read the paper yet.

Anyways, for the side effects a major one could be Tumor Lysis Syndrome (TLS). Basically, if you apoptose the cancer cells super fast, the molecules from those cells spread everywhere and it becomes toxic for the patient. This is at least the case for Venetoclax.

How much cancerous cells are similar to let us know how to target them and deliver a payload?

I guess some payload delivering mechanisms expect very 'standard' features from cancer cells?

Cancerous cells are fairly diverse across individuals, or even within a single individual, and many biological treatments require precise sequencing of the tumor DNA of that individual patient to adjust and work. In some cancers, there is a nasty "Russian roulette" effect in play, where a certain treatment may be extremely efficient (in practice a cure, even though oncologists avoid that word) in people with a certain mutation and totally useless in others, even though from the macroscopic point of view, their tumors look the same.
Then, basically, each cancer, cancer cells should be sequenced, then based on the type of cell and DNA sequencing, we have a list of "tools" to deliver payload to those very cells (without delivering such payload to sane cells, ofc)?
That would be the ideal scenario, yes.

In practice, we can only make use of some known mutations. Not just for delivering chemicals, but also for "teaching" the immune system to attack such cells, which, once it is able to recognize them, it will do vigorously.

Let's hope that this catalogue will grow until it covers at least all the typical cases.

What would be the kinds of expected side effects of such approaches?
My understanding is that even though immunotherapy's mechanism may seem more natural than chemotherapy and radiation, and in some instances may be a magic bullet, up-regulating the immune system can have serious consequences. I remember reading about a clinical trial showing similar progression free survival but increased grade 4-5 toxicities (requiring hospitalization or being fatal). My assumption was that these are autoimmune conditions that are aggravated in some of the patient population.
oop talked about mechanism, so we can't know side effects here. someone will publish a new drug that relies on this mechanism, and then they will check the side effects of the specific drug on cells, rats, or other experimental species.