Cited by 84Protein Degradation and InhibitorsMultiple Myeloma Research and TreatmentsUbiquitin and proteasome pathways

Cereblon and its downstream substrates as molecular targets of immunomodulatory drugs

Open access
Ito, Takumi, Handa, Hiroshi·2016·International Journal of Hematology

Abstract

Thalidomide was first developed as a sedative around 60 years ago, but exhibited teratogenicity, leading to serious defects such as limb deformities. Nevertheless, thalidomide is now recognized as a therapeutic drug for the treatment of Hansen's disease and myeloma. Immunomodulatory drugs (IMiDs), a new class of anti-cancer drug derived from thalidomide, have also been developed and exert potent anti-cancer effects. Although the molecular mechanism of thalidomide and IMiDs remained unclear for a long time, cereblon, a substrate receptor of the CRL4 E3 ubiquitin ligase was identified as a primary direct target by a new affinity technique. A growing body of evidence suggests that the effect of IMiDs on myeloma and other cancer cells is mediated by CRBN. Each IMiD binds to CRBN and alters the substrate specificity of the CRBN E3 ubiquitin ligase complex, resulting in breakdown of intrinsic downstream proteins such as Ikaros and Aiolos. Here we give an overview of the current understanding of mechanism of action of IMiDs via CRBN and prospects for the development of new drugs that degrade protein of interest.

AI snapshot

Written from the paper’s full text.

TL;DR

This review summarizes how thalidomide and immunomodulatory drugs (IMiDs) act through cereblon (CRBN), a substrate receptor of the CRL4 E3 ubiquitin ligase, rather than through multiple direct targets. Binding of IMiDs to CRBN alters substrate specificity, leading to degradation of neo-substrates such as Ikaros, Aiolos, and, for lenalidomide specifically, Ck1α.

Key findings

  • CRBN was identified as a primary direct thalidomide-binding protein using Handa bead affinity purification; only DDB1 and CRBN specifically bound thalidomide, with CRBN binding directly and DDB1 indirectly via complex formation.
  • CRBN is a 442-amino-acid protein; thalidomide binds its C-terminal region (339–442), DDB1 binds the intermediate region (187–260), and the glutarimide moiety alone is sufficient for CRBN binding. The S enantiomer of thalidomide binds CRBN more strongly than the R enantiomer.
  • IMiDs require CRBN for anti-myeloma effects; lenalidomide and pomalidomide bind CRBN more strongly than thalidomide, and IMiD-induced changes in c-myc, IRF4, and p21 are CRBN-mediated.
  • IMiD binding induces degradation of Ikaros (IKZF1) and Aiolos (IKZF3); lenalidomide specifically induces ubiquitination and degradation of Ck1α, explaining its efficacy in del(5q) myelodysplastic syndrome. Human/mouse CRBN homology is 94%, but four amino acids near the thalidomide-binding region differ, and mouse I391 versus human V388 prevents Ck1α degradation in mice.

Methods

  • Narrative review of thalidomide/IMiD mechanisms, integrating the authors’ prior biochemical, structural, zebrafish, and chick studies with cited literature.
  • Data/sample: no new primary dataset; the review discusses affinity purification with Handa beads, mass spectrometry, recombinant proteins, cell lysates, zebrafish and chick embryos, X-ray crystallography, and published clinical/experimental reports.
  • Main analysis: thematic synthesis of findings on CRBN as the direct target, IMiD-induced substrate specificity changes, structural determinants, and species specificity.

Limitations

  • The paper states unresolved issues: the CRBN substrate responsible for thalidomide teratogenicity is unknown, as is CRBN’s role in thalidomide’s sedative effects; many questions remain about how IMiD binding induces specific substrates.
  • The paper notes concerns for CRBN-based degradation drugs, including off-target protein degradation and interference by internal ligands.
  • Evident from the text: this is a narrative review without systematic search criteria, quantitative synthesis, or new experimental data.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1007/s12185-016-2073-4

Cites

Statistics

Nothing to recompute.

Claims the paper makes

0 of 23 cited sources checked · 0 supported · 0 flagged

  • Findingcitation

    Because the equivalent of V388 of humans is I391 in mice, Ck1α is not degraded in mice.

    “it was demonstrated that because the equivalent of V388 of humans is I391 in mice, Ck1α is not degraded in mice [31].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [31] Jaras M, Miller PG, Chu LP, et al. Csnk1a1 inhibition has p53-dependent therapeutic efficacy in acute myeloid leukemia. J Exp Med. 2014;211:605–12. source

      Not checked in the free run.

  • Findingown data

    CRBN binds to BPA and BPC of DDB1.

    “CRBN binds to BPA and BPC.”
    Quote in the paperNot a substantial claim
  • Findingcitation

    When lenalidomide binds to CRBN, casein kinase 1a (Ck1α) is specifically ubiquitinated and degraded.

    “Ebert and colleagues who previously identified Ikaros and Aiolos reported that when lenalidomide binds to CRBN, casein kinase 1a (Ck1α) is specifically ubiquitinated and degraded [30].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [30] Kronke J, Fink EC, Hollenbach PW, et al. Lenalidomide induces ubiquitination and degradation of Ck1αlpha in del(5q) MDS. Nature. 2015;523:183–8. source

      Not checked in the free run.

  • Findingown data

    Cereblon (CRBN) was identified as a primary direct target of thalidomide by a new affinity technique.

    “cereblon, a substrate receptor of the CRL4 E3 ubiquitin ligase was identified as a primary direct target by a new affinity technique.”
    • Also stated in: § Cereblon, a direct target of thalidomide · plain
      “We concluded that CRBN is a direct target of thalidomide.”
    Quote in the paperSubstantial claim
  • Findingcitation

    Upon binding of IMiDs to CRBN, original substrates (e.g. MEIS2) of CRBN are spared from ubiquitination and degradation, and accumulate.

    “It was also found that upon the binding of IMiDs to CRBN, original substrates (e.g.MEIS2) of CRBN are spared from ubiquitination and degradation, and accumulate [32].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [32] Jadersten M, Saft L, Smith A, et al. TP53 mutations in low-risk myelodysplastic syndromes with del(5q) predict disease progression. J Clin Oncol. 2011;29:1971–9. source

      Not checked in the free run.

  • May combine two claims. 7
  • Classified as probably not a substantial claim. 1
  • May combine two claims.

    Findingcitation

    DDB1 binds to the intermediate region (187-260) of CRBN, whereas thalidomide binds to the C-terminus region (339-442).

    “DDB1 was found to bind to the intermediate region (187-260) of CRBN, whereas thalidomide was found to bind to the C-terminus region (339-442) [19].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [19] Ito T, Ando H, Suzuki T, et al. Identification of a primary target of thalidomide teratogenicity. Science. 2010;327:1345–50. source

      Not checked in the free run.

  • May combine two claims.

    Findingreasoning

    Ikaros and Aiolos are ubiquitinated and degraded by thalidomide, lenalidomide, and pomalidomide, whereas Ck1α is only ubiquitinated and degraded by lenalidomide.

    “Regarding neo-substrates, Ikaros and Aiolos are ubiquitinated and degraded by thalidomide, lenalidomide, and pomalidomide, whereas Ck1α is only ubiquitinated and degraded by lenalidomide, suggesting that there may be unidentified substrates of IMiDs.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Even when thalidomide is bound to CRBN, the ubiquitination and degradation of Ikaros and Aiolos are weakly induced.
    • Rests on an assumption: The ubiquitination and degradation of Ck1α by CRBN is specific to lenalidomide, and thalidomide and pomalidomide do not exhibit this activity.
  • May combine two claims.

    Findingcitation

    Four amino acids in CRBN around its thalidomide-binding region differ between humans and rodents, and this is responsible for the observed species specificity.

    “it was found that four amino acids in CRBN around its thalidomide-binding region differ between humans and rodents, and that this is responsible for the observed species specificity [34].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [34] Chamberlain PP, Lopez-Girona A, Miller K, et al. Structure of the human Cereblon-DDB1-lenalidomide complex reveals basis for responsiveness to thalidomide analogs. Nat Struct Mol Biol. 2014;21:803–9. source

      Not checked in the free run.

    • Rests on an assumption: The homology between human and mouse CRBN is 94%.
    • Rests on an assumption: Thalidomide lacks teratogenicity in rodents.
    • Rests on an assumption: The therapeutic effects of IMiDs are hardly detectable in rodents.
  • May combine two claims.

    Findingown data

    CRBN binds directly to thalidomide, whereas DDB1 forms a complex with CRBN and hence binds indirectly to thalidomide.

    “Binding analyses using affinity beads and DDB1 and CRBN recombinant proteins demonstrated that CRBN binds directly to thalidomide, whereas DDB1 forms a complex with CRBN, and hence binds indirectly to thalidomide.”
    Quote in the paperSubstantial claim
  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    Glutamine induces acetylation-dependent breakdown of glutamine synthetase via CRBN.

    “More recently, it was reported that glutamine induces acetylation-dependent breakdown of glutamine synthetase via CRBN.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [42] Nguyen TV, Lee JE, Sweredoski MJ, et al. Glutamine triggers acetylation-dependent degradation of glutamine synthetase via the thalidomide receptor cereblon. Mol Cell. 2016;61:809–20. source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    IMiDs are effective against diffuse large B-cell lymphoma (DLBCL) and mantle cell lymphoma, and these effects depend on CRBN.

    “IMiDs are now known to be effective against not only multiple myeloma and 5q-syndrome, but also diffuse large B-cell lymphoma (DLBCL), a type of non-Hodgkin lymphoma, as well as mantle cell lymphoma, and these effects are known to also depend on CRBN [37,38].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [37] Yang Y, Shaffer AL, 3rd, Emre NC et al. Exploiting synthetic lethality for the therapy of ABC diffuse large B cell lymphoma. Cancer Cell. 2012;21:723–37. source

      Not checked in the free run.

    • cites [38] Zhang LH, Kosek J, Wang M, Heise C, Schafer PH, Chopra R. Lenalidomide efficacy in activated B-cell-like subtype diffuse large B-cell lymphoma is dependent upon IRF4 and cereblon expression. Br J Haematol. 2013;160:487–502. source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    IMiDs bind a single target (CRBN), and by modulating the substrate specificity of CRBN in numerous ways, IMiDs exert diverse effects.

    “these agents appear to bind a single target (CRBN), and by modulating the substrate specificity of CRBN in numerous ways, IMiDs are thought to exert diverse effects (Fig. 4).”
    Quote in the paperSubstantial claim
  • May combine two claims.

    Interpretationcitation

    CRBN controls glutamine metabolism and acetylation is needed for degradation of some substrates of CRBN.

    “That study indicated that CRBN controls glutamine metabolism and acetylation is needed for degradation of some substrates of CRBN [42].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [42] Nguyen TV, Lee JE, Sweredoski MJ, et al. Glutamine triggers acetylation-dependent degradation of glutamine synthetase via the thalidomide receptor cereblon. Mol Cell. 2016;61:809–20. source

      Not checked in the free run.

8 of 8
  • The paper relies on this without support.

    The homology between human and mouse CRBN is 94%.

    “The homology between human and mouse CRBN is 94 %, and because they both bind to thalidomide, it was expected that solving this mystery would be difficult.”
  • The paper relies on this without support.

    In 5q-syndrome, the genetic locus coding for Ck1α is located within the deleted region on chromosome 5.

    “In 5q-syndrome, there is a deletion in the long arm of one of the two chromosome 5, resulting in haploinsufficiency; the genetic locus coding for Ck1α is located right within this deleted region.”
  • The paper relies on this without support.

    In 5q-cells, the expression level of Ck1α is half of that of wild-type cells.

    “In 5q-cells, the expression level of Ck1α is thus half of that of wild-type cells.”
  • The paper relies on this without support.

    Thalidomide lacks teratogenicity in rodents.

    “One long-standing mystery of thalidomide has been its lack of teratogenicity in rodents.”
  • The paper relies on this without support.

    The therapeutic effects of IMiDs are hardly detectable in rodents.

    “Even more mysterious was that the therapeutic effects of IMiDs could hardly be detected in rodents.”
  • The paper relies on this without support.

    Even when thalidomide is bound to CRBN, the ubiquitination and degradation of Ikaros and Aiolos are weakly induced.

    “Subsequently it was found that even when thalidomide is bound to CRBN, the ubiquitination and degradation of Ikaros and Aiolos are weakly induced, resulting in a new issue.”
  • The paper relies on this without support.

    The ubiquitination and degradation of Ck1α by CRBN is specific to lenalidomide, and thalidomide and pomalidomide do not exhibit this activity.

    “It was also found that the ubiquitination and degradation of Ck1α by CRBN is specific to lenalidomide, and that thalidomide and pomalidomide do not exhibit this activity.”
7 of 7

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References 45 · Cited by 84

Authors
Ito, T., & Handa, H.
Affiliations
Tokyo Medical University (JP)
Corresponding author
Handa, Hiroshi
Venue
International Journal of Hematology
Published
2016-07-26
Volume
104
Issue
3
Pages
293-299
ISSN
  • 0925-5710 (ISSN-L)
  • 1865-3774
OpenAlex
W2479018367
Cited by
84
References
45
Citations by year
2026: 2 · 2025: 4 · 2024: 6 · 2023: 7 · 2022: 10 · 2021: 16 · 2020: 8 · 2019: 10 · 2018: 10 · 2017: 10 · 2016: 1
FWCI
0.93
Type
journal article
Language
en
Open access
Locations
  • International Journal of Hematology (publishedVersion)
  • PubMed (publishedVersion)
Funders
Japan Society for the Promotion of Science (26750374)
Topics
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Protein Degradation and Inhibitors
  • Health Sciences › Medicine › Hematology › Multiple Myeloma Research and Treatments
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Ubiquitin and proteasome pathways
Keywords
cereblon, immunomodulators, thalidomide, CRL4 E3 ubiquitin ligase, Ikaros, Aiolos, multiple myeloma, drug repurposing, protein degradation, mechanism of action, drug target identification
MeSH terms
Antineoplastic Agents, Humans, Immunologic Factors, Peptide Hydrolases, Substrate Specificity, Ubiquitin-Protein Ligases, Adaptor Proteins, Signal Transducing, Molecular Targeted Therapy

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