Cited by 1,279Cancer-related Molecular PathwaysHeat shock proteins researchPI3K/AKT/mTOR signaling in cancer

The DOI matches its Crossref record; 174 of the 174 references it cites were found in a registry or an index; none of the 131 sources its claims cite is checked for support yet.

MDM2, MDMX and p53 in oncogenesis and cancer therapy

Open access
Wade, Mark, Li, Yao-Cheng, Wahl, Geoffrey M.·2013·Nature Reviews Cancer

Abstract

The MDM2 and MDMX (also known as HDMX and MDM4) proteins are deregulated in many human cancers and exert their oncogenic activity predominantly by inhibiting the p53 tumour suppressor. However, the MDM proteins modulate and respond to many other signalling networks in which they are embedded. Recent mechanistic studies and animal models have demonstrated how functional interactions in these networks are crucial for maintaining normal tissue homeostasis, and for determining responses to oncogenic and therapeutic challenges. This Review highlights the progress made and pitfalls encountered as the field continues to search for MDM-targeted antitumour agents.

Overview

AI snapshot

Written from the paper’s full text.

TL;DR

This review argues that MDM2 and MDMX are major negative regulators of p53 whose deregulation contributes to many cancers, but their full oncogenic potential generally requires cooperating lesions. It surveys mechanisms, mouse models, and drug development, concluding that p53 reactivation via MDM2/MDMX antagonists is promising but context-dependent and still limited by lack of selective MDMX inhibitors and clinical challenges.

Key findings

  • MDM2 and MDMX inhibit p53 transactivation by binding its N-terminal domain; MDM2 homo-oligomers have E3 ubiquitin ligase activity via an intact C-terminal RING domain, whereas MDMX lacks intrinsic ligase activity but hetero-oligomerizes with MDM2, and this hetero-oligomerization is crucial for p53 suppression during embryonic development.
  • In vivo evidence shows context dependence: MDM2 overexpression can induce carcinoma and lymphomas or sarcomas, and an MDM2 SNP knock-in accelerates tumorigenesis at a rate similar to Trp53-hemizygous animals; MDMX overexpression alone has yielded conflicting tumorigenicity results, while MDMX3SA mice are radioresistant and more prone to Myc-induced tumors, and MDM2-Ser394Ala mice show increased spontaneous tumors.
  • In a Phase I proof-of-mechanism study of RG7112 in 20 patients with MDM2-amplified liposarcoma, the drug reached its target and increased MIC1/GDF15, but increases in p53 and p21 and decreased proliferation did not reach significance; at least one adverse event occurred in each patient, most frequently haematological toxicities.
  • Nutlin 3a is 500-fold less potent against MDMX than MDM2; the dual inhibitor RO-5963 had better in vitro MDM2 binding affinity than nutlin 3a (IC50 17.3 nM versus 18.7 nM) but poorer pharmacological properties, and the stapled peptide SAH-p53-8 had tenfold better MDM2 IC50 than nutlin 3a and also disrupts p53–MDMX interactions.

Methods

  • Design: narrative review of MDM2, MDMX, and p53 biology, oncogenesis, and therapeutic targeting.
  • Data: published mechanistic studies, cell-based assays, mouse genetic models, and clinical trial data; no new primary data are reported.
  • Analysis: qualitative synthesis of the core pathway, transcriptional/post-transcriptional regulation, oncogenic evidence, and small-molecule/peptidic inhibitor strategies.

Limitations

  • The paper states that much remains unknown about MDM2 and MDMX transcriptional regulation, that in vivo mutation of p53 response elements in Mdm2 and Mdmx promoters is needed, that the biological importance of the p53–miRNA network remains to be clarified, and that the identity of the relevant E2 ubiquitin-conjugating enzymes is unknown.
  • The paper states that no selective MDMX small-molecule inhibitor currently exists, that the RG7112 trial was preliminary with only 20 patients and heterogeneous tumour tissue, and that relying on MDM gene amplification alone for patient selection is inadequate.
  • Evident from the text: as a narrative review, it does not perform a systematic search or quantitative meta-analysis, and it reports conflicting mouse-model results for MDMX overexpression, so conclusions depend on context and cited study designs.

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

Integrity signals

Registry

Crossref · 10.1038/nrc3430

Cites

174 of 174 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Verification

Claims the paper makes

0 of 131 cited sources checked · 0 supported · 0 flagged

Show all 76 claims

  • It may state two separate claims as one. 42
  • Probably not a substantial claim. 3
45 of 45
  • The paper relies on this without support.

    p53 is mutated or functionally inactivated in most human cancers.

    “Thirty years of research have shown that the tumour suppressor p53 has a crucial role in many physiological processes, and that it is mutated or functionally inactivated in most human cancers.”
  • The paper relies on this without support.

    In a substantial proportion of cancers, TP53 is wild type but the p53 protein is inactivated.

    “In a substantial proportion of cancers TP53 (which encodes p53) is wild type but the protein is inactivated; this offers an attractive strategy for cancer therapy based on p53 reactivation.”
  • The paper relies on this without support.

    Single-agent cancer therapy makes resistance more likely.

    “Conventional single-agent cancer therapy increases the likelihood of resistance.”
  • The paper relies on this without support.

    The PI3K–AKT pathway generally promotes cancer cell survival by opposing apoptosis.

    “The PI3K–AKT pathway usually has an anti-apoptotic role to promote cancer cell survival.”
  • The paper relies on this without support.

    Resistance to MDM2 antagonists can result from several mechanisms, such as p53 mutation, dominant survival pathways, or blocked death pathways.

    “Insensitivity to MDM2 antagonists can arise from a variety of mechanisms, including p53 mutation, the presence of dominant survival pathways or the inhibition of death-inducing pathways.”
  • The paper relies on this without support.

    ATM kinase activates p53 after DNA damage.

    “ATM kinase activates p53 in response to DNA damage.”
  • The paper relies on this without support.

    The intracellular E2 enzymes needed for p53 ubiquitylation in vivo remain unidentified.

    “the intracellular E2s that are required for p53 ubiquitylation have not been identified.”
7 of 7

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Metadata

Authors
Wade, M., Li, Y.-C., & Wahl, G. M.
Affiliations
  • Center for Genomic Science (IT)
  • Salk Institute for Biological Studies (US)
Corresponding author
Wahl, Geoffrey M.
Venue
Nature Reviews Cancer
Published
2013-01-10
Volume
13
Issue
2
Pages
83-96
ISSN
  • 1474-175X (ISSN-L)
  • 1474-1768
OpenAlex
W1976295398
Cited by
1,279
References
174
Citations by year
2026: 76 · 2025: 81 · 2024: 73 · 2023: 83 · 2022: 92 · 2021: 104 · 2020: 109 · 2019: 117 · 2018: 89 · 2017: 98 · 2016: 100 · 2015: 90 · 2014: 118 · 2013: 49
FWCI
12.77
Type
journal article
Language
en
Open access
Locations
  • Nature reviews. Cancer (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • Sanofi
  • National Institutes of Health
  • National Institute of Mental Health (R03MH089489, R03‑MH089489‑01)
  • National Cancer Institute (CA014195, R01CA061449, R01‑CA61449, P30CA014195)
Topics
  • Health Sciences › Medicine › Oncology › Cancer-related Molecular Pathways
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Heat shock proteins research
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › PI3K/AKT/mTOR signaling in cancer
Keywords
MDM2, MDMX, p53, p53 reactivation, MDM2 inhibitors, HDMX, MDM4, carcinogenesis, cancer therapy, signaling networks, tissue homeostasis, anticancer agents
MeSH terms
Animals, Cell Transformation, Neoplastic, Humans, Neoplasms, Tumor Suppressor Protein p53, Proto-Oncogene Proteins c-mdm2

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