Go to JCI Insight
  • About
  • Editors
  • Consulting Editors
  • For authors
  • Publication ethics
  • Publication alerts by email
  • Advertising
  • Job board
  • Contact
  • Clinical Research and Public Health
  • Current issue
  • Past issues
  • By specialty
    • COVID-19
    • Cardiology
    • Gastroenterology
    • Immunology
    • Metabolism
    • Nephrology
    • Neuroscience
    • Oncology
    • Pulmonology
    • Vascular biology
    • All ...
  • Videos
    • ASCI Milestone Awards
    • Video Abstracts
    • Conversations with Giants in Medicine
  • Reviews
    • View all reviews ...
    • The cGAS-STING pathway: DNA sensing in health and disease (Jun 2026)
    • Neurodegeneration (Mar 2026)
    • Clinical innovation and scientific progress in GLP-1 medicine (Nov 2025)
    • Pancreatic Cancer (Jul 2025)
    • Complement Biology and Therapeutics (May 2025)
    • Evolving insights into MASLD and MASH pathogenesis and treatment (Apr 2025)
    • Microbiome in Health and Disease (Feb 2025)
    • View all review series ...
  • Viewpoint
  • Collections
    • In-Press Preview
    • Clinical Research and Public Health
    • Research Letters
    • Letters to the Editor
    • Editorials
    • Commentaries
    • Editor's notes
    • Reviews
    • Viewpoints
    • 100th anniversary
    • Top read articles

  • Current issue
  • Past issues
  • Specialties
  • Reviews
  • Review series
  • ASCI Milestone Awards
  • Video Abstracts
  • Conversations with Giants in Medicine
  • In-Press Preview
  • Clinical Research and Public Health
  • Research Letters
  • Letters to the Editor
  • Editorials
  • Commentaries
  • Editor's notes
  • Reviews
  • Viewpoints
  • 100th anniversary
  • Top read articles
  • About
  • Editors
  • Consulting Editors
  • For authors
  • Publication ethics
  • Publication alerts by email
  • Advertising
  • Job board
  • Contact
Targeted degradation of MDM2 overcomes feedback regulation of p53 signaling in Merkel cell carcinoma models
Varsha Ananthapadmanabhan, Simone Bruno, Leonard Vonk, Yu-Chen Cheng, Abeba Teshager, Benjamin K. Eschle, Charles L. Howarth, Joana S. Rodrigues, Julia Schnabel, Ananya Kodali, Prafulla C. Gokhale, Rujuta Kshirsagar, Susanne B. Breitkopf, Kirti Sharma, Joao A. Paulo, Yvonne Li, Andrew D. Cherniack, Franziska Michor, Yogesh Chutake, Joyoti Dey, James A. DeCaprio
Varsha Ananthapadmanabhan, Simone Bruno, Leonard Vonk, Yu-Chen Cheng, Abeba Teshager, Benjamin K. Eschle, Charles L. Howarth, Joana S. Rodrigues, Julia Schnabel, Ananya Kodali, Prafulla C. Gokhale, Rujuta Kshirsagar, Susanne B. Breitkopf, Kirti Sharma, Joao A. Paulo, Yvonne Li, Andrew D. Cherniack, Franziska Michor, Yogesh Chutake, Joyoti Dey, James A. DeCaprio
View: Text | PDF
Research Article Cell biology Oncology

Targeted degradation of MDM2 overcomes feedback regulation of p53 signaling in Merkel cell carcinoma models

  • Text
  • PDF
Abstract

MDM2 is transcriptionally activated by the ST-MYCL-Tip60 complex in virus-positive Merkel cell carcinoma (MCC). MDM2 suppresses p53 and is a rational therapeutic target. MDM2 inhibitors face an intrinsic limitation: p53 activation induces MDM2 transcription, creating a feedback loop that blunts inhibitor efficacy. We demonstrate that MDM2 degraders KTX-049 and KT-253 overcome this limitation by collapsing the p53/MDM2 negative feedback loop. KTX-049 was >100-fold more potent than the MDM2 inhibitor DS-3032 across WT p53 MCC cell lines, and this superior potency was quantitatively supported by mechanistic mathematical modeling. In vivo, KT-253 produced deep and durable tumor regressions, including complete responses in patient-derived xenograft models. Acquired resistance was strongly associated with acquisition of TP53 mutations, confirming on-target pathway pressure. These findings establish feedback architecture as a critical determinant of therapeutic response and position MDM2 degradation as a qualitatively distinct strategy that produces more durable pathway engagement than MDM2 inhibition, providing a preclinical rationale for prioritizing MDM2 degraders in WT TP53 MCC.

Authors

Varsha Ananthapadmanabhan, Simone Bruno, Leonard Vonk, Yu-Chen Cheng, Abeba Teshager, Benjamin K. Eschle, Charles L. Howarth, Joana S. Rodrigues, Julia Schnabel, Ananya Kodali, Prafulla C. Gokhale, Rujuta Kshirsagar, Susanne B. Breitkopf, Kirti Sharma, Joao A. Paulo, Yvonne Li, Andrew D. Cherniack, Franziska Michor, Yogesh Chutake, Joyoti Dey, James A. DeCaprio

×

Figure 5

Global proteomics reveals that KTX-049 and KT-253 induce increased levels of direct p53 targets.

Options: View larger image (or click on image) Download as PowerPoint
Global proteomics reveals that KTX-049 and KT-253 induce increased level...
(A) Scheme (left) showing WaGa and MKL-1 cells were treated with DMSO, KTX-049, or DS-3032 followed by TMT profiling. Heatmaps showing the log2(fold change) from MKL-1 and WaGa cells treated with KTX-049 or DS-3032 highlight the most significantly regulated proteins with Gene Ontology Biological Process (GOBP) cell cycle process annotation (middle) or with the KEGG p53 signaling annotation (right). The cell cycle process heatmap was filtered to include only proteins with log2(fold change) > 1 or < –1, while the p53 signaling heatmap was filtered to include only proteins with log2(fold change) > 0.5 or < –0.5. NOTCH1 is not a KEGG p53 signaling pathway protein but is a direct p53 target (38) and was also included in the heatmap. A pathway analysis was performed for WaGa and MKL-1 cells, and the enrichment factors for identified GOBP and KEGG terms common to both cell lines were plotted as a scatterplot (right). (B) Mice implanted with PDX 48396 were treated with vehicle or KT-253 for 24 h before tumor harvesting, processing, and analysis by DIA-based global proteomics (left). The corresponding heatmaps highlight the most regulated proteins with the GOBP cell cycle process annotation (middle) or KEGG p53 signaling annotation (right), with log2(fold change) filtering criteria as described above. Both heatmaps show the direct comparison of log2(fold change) between WaGa cells and PDX 48396 (referred to as MCC PDX) treated with KT-253. As above, a pathway analysis was performed to determine significantly enriched GOBP and KEGG annotation terms, and the enrichment factors for terms identified for WaGa and the PDX 48396 model were plotted as a scatterplot (B, below). Terms associated with mitosis or cell cycle are in blue, those associated with p53 signaling are in red, and all others are purple.

Copyright © 2026 American Society for Clinical Investigation
ISSN: 0021-9738 (print), 1558-8238 (online)

Sign up for email alerts