Cited by 314Cytokine Signaling Pathways and InteractionsNF-κB Signaling PathwaysProtein Tyrosine Phosphatases

The DOI matches its Crossref record; 609 of the 623 references it cites were found in a registry or an index; 200 of the 405 sources its claims cite were checked for support.

Targeting Janus Kinases and Signal Transducer and Activator of Transcription 3 To Treat Inflammation, Fibrosis, and Cancer: Rationale, Progress, and Caution

Open access

Abstract

Before it was molecularly cloned in 1994, acute-phase response factor or signal transducer and activator of transcription (STAT)3 was the focus of intense research into understanding the mammalian response to injury, particularly the acute-phase response. Although known to be essential for liver production of acute-phase reactant proteins, many of which augment innate immune responses, molecular cloning of acute-phase response factor or STAT3 and the research this enabled helped establish the central function of Janus kinase (JAK) family members in cytokine signaling and identified a multitude of cytokines and peptide hormones, beyond interleukin-6 and its family members, that activate JAKs and STAT3, as well as numerous new programs that their activation drives. Many, like the acute-phase response, are adaptive, whereas several are maladaptive and lead to chronic inflammation and adverse consequences, such as cachexia, fibrosis, organ dysfunction, and cancer. Molecular cloning of STAT3 also enabled the identification of other noncanonical roles for STAT3 in normal physiology, including its contribution to the function of the electron transport chain and oxidative phosphorylation, its basal and stress-related adaptive functions in mitochondria, its function as a scaffold in inflammation-enhanced platelet activation, and its contributions to endothelial permeability and calcium efflux from endoplasmic reticulum. In this review, we will summarize the molecular and cellular biology of JAK/STAT3 signaling and its functions under basal and stress conditions, which are adaptive, and then review maladaptive JAK/STAT3 signaling in animals and humans that lead to disease, as well as recent attempts to modulate them to treat these diseases. In addition, we will discuss how consideration of the noncanonical and stress-related functions of STAT3 cannot be ignored in efforts to target the canonical functions of STAT3, if the goal is to develop drugs that are not only effective but safe. SIGNIFICANCE STATEMENT: Key biological functions of Janus kinase (JAK)/signal transducer and activator of transcription (STAT)3 signaling can be delineated into two broad categories: those essential for normal cell and organ development and those activated in response to stress that are adaptive. Persistent or dysregulated JAK/STAT3 signaling, however, is maladaptive and contributes to many diseases, including diseases characterized by chronic inflammation and fibrosis, and cancer. A comprehensive understanding of JAK/STAT3 signaling in normal development, and in adaptive and maladaptive responses to stress, is essential for the continued development of safe and effective therapies that target this signaling pathway.

Overview

AI snapshot

Written from the paper’s full text.

TL;DR

This review summarizes canonical and noncanonical JAK/STAT3 biology and argues that persistent or dysregulated JAK/STAT3 signaling drives inflammation, fibrosis, metabolic disease, cachexia, and cancer. It also cautions that STAT3-targeting therapies must avoid noncanonical/mitochondrial STAT3 functions to reduce toxicity.

Key findings

  • JAK/STAT3 signaling is essential in development and stress responses: global STAT3 deletion is embryonic lethal at day 6.5, and JAK1/JAK2 deficiency is embryonically lethal due to neurologic defects and deficient erythropoiesis, respectively.
  • Persistent JAK/STAT3 activation is maladaptive in many diseases; JAK2 V617F is present in ∼95% of polycythemia vera, 50%–60% of essential thrombocythemia, and ∼50% of primary myelofibrosis patients.
  • STAT3 inhibitors in clinical testing show mixed results: in a Phase IB danvatirsen trial, 30 patients were enrolled, with 2 of 27 diffuse large B cell lymphoma patients achieving complete responses and 2 partial responses; in a Phase I OPB-111077 trial of 145 patients, objective responses occurred in only two patients with diffuse large B-cell lymphoma.
  • TTI-101 (C188-9) inhibited STAT3 with Ki = 12.4 nM; in a Phase I study, 5 of 10 patients had clinical benefit, with one partial response (40% tumor reduction) lasting 12 months, and TTI-101 did not affect mitochondrial ATP generation or oxygen consumption in tested cells.

Methods

  • Design: narrative review of molecular, cellular, preclinical, and clinical literature on JAK/STAT3 signaling and its therapeutic targeting.
  • Data/sample: published studies, animal models, patient syndromes such as autosomal-dominant hyper-IgE syndrome (AD-HIES/Job’s syndrome), and clinical trials of Jakinibs and STAT3 inhibitors.
  • Main analysis: synthesis of canonical and noncanonical STAT3 functions, disease associations, and drug-development progress, with a cautionary framework for targeting STAT3 safely.

Limitations

  • The paper states that STAT3 inhibitors must achieve sufficient target engagement, especially in cancer, while avoiding toxicity in noncancer indications; it specifically warns that targeting mitochondrial STAT3 caused toxicities in OPB-31121/OPB-51602 trials.
  • The paper advises monitoring patients for AD-HIES-like symptoms (e.g., eczema, bacterial pneumonia, skin abscesses, mucocutaneous candidiasis) and avoiding STAT3 inhibitors around surgery or traumatic injury until wound healing is complete.
  • Evident from the text: this is a narrative review without a described systematic search or meta-analysis, and many cited therapeutic findings are preclinical or from early-phase, small, and sometimes unselected clinical trials.

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

Integrity signals

Registry

Crossref · 10.1124/pr.119.018440

Cites

609 of 609 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Verification

Claims the paper makes

200 of 405 cited sources checked · 72 supported · 3 flagged · accuracy not yet measured

Show all 184 claims

  • It may state two separate claims as one. 106
  • Probably not a substantial claim. 19
  • The quote only partly states this claim. 2
119 of 119
  • The paper relies on this without support.

    The adaptive versus maladaptive categorization of JAK/STAT3 signaling is sufficient to guide safe therapeutic targeting.

    “Key biological functions of Janus kinase (JAK)/signal transducer and activator of transcription (STAT)3 signaling can be delineated into two broad categories: those essential for normal cell and organ development and those activated in response to stress that are adaptive.”
  • The paper relies on this without support.

    The cited animal and human studies are predictive of human disease mechanisms and therapeutic outcomes.

    “In this review, we will summarize the molecular and cellular biology of JAK/STAT3 signaling and its functions under basal and stress conditions, which are adaptive, and then review maladaptive JAK/STAT3 signaling in animals and humans that lead to disease, as well as recent attempts to modulate them to treat these diseases.”
  • The paper relies on this without support.

    Findings from mouse models of STAT3 deletion or mutation can be extrapolated to human STAT3 biology and disease.

    “STAT3 dysfunction in any direction could cause pathophysiological alterations in mice and humans”
  • The paper relies on this without support.

    Findings from mouse models and cell lines about JAK/STAT3 function translate to human disease.

    “The data summarized above suggest that targeting JAK and STAT3 with small-molecule inhibitors may provide a superior anti-asthma treatment approach compared with standard therapies as, they would target both Th2- and Th17-associated asthmas (Choy et al., 2015).”
  • The paper relies on this without support.

    The therapeutic effects of STAT3 inhibitors are primarily due to on-target inhibition of STAT3 rather than off-target effects.

    “It should, however, be noted that not all the molecules identified as STAT3 inhibitors are competitive inhibitors. Some, such as Stattic and some members of the S3I-201 family of compounds, inhibit STAT3 by covalently reacting with residues (largely cysteines) at key locations within STAT3, as well as other off-target proteins (Heidelberger et al., 2013; Ball et al., 2016).”
  • The paper relies on this without support.

    Mouse models of cachexia predict human cachexia.

    “The link between IL-6/STAT3 signaling and muscle and adipose tissue wasting is well established in mouse models of cachexia (White et al., 2011; Silva et al., 2015) and has been reinforced preliminarily in clinical studies.”
  • The paper relies on this without support.

    Mouse models of fibrosis predict human fibrosis.

    “Genetic and pharmacological inhibition of STAT3 signaling has been shown to suppress fibrosis in many animal models, including models of lung fibrosis, in which haploinsufficiency of STAT3 eliminated the increase in lung collagen (hydroxproline) content in bleomycin-treated mice”
  • The paper relies on this without support.

    Findings in preclinical cancer models translate to human cancer.

    “Inhibition of STAT3 activation in many preclinical cancer models results in increased apoptosis and decreased proliferation.”
  • The paper relies on this without support.

    The only curative treatment for PMF is allogenic hematopoietic cell transplantation, and long-term survival is hampered by relapse and/or graft-versus-host disease, leaving an unmet need for targeted therapies.

    “Currently, the only curative treatment option for PMF is allogenic hematopoietic cell transplantation, but long-term survival is usually hampered by disease relapse and/or graft-versus-host disease, leaving the unmet need to develop targeted therapies for PMF, e.g., JAK/STAT pathway inhibition.”
  • The paper relies on this without support.

    Lactic acidosis is a clinical laboratory marker of mitochondrial dysfunction.

    “Of note, lactic acidosis is a clinical laboratory marker of mitochondrial dysfunction.”
  • The paper relies on this without support.

    In Phase I/II trials of CDDO-Me in patients with moderate to severe chronic kidney disease, data demonstrated a significant increase from baseline in estimated glomerular filtration rate.

    “Data from these studies demonstrated a significant increase from baseline in estimated glomerular filtration rate, a measure of improved kidney function, which suggested that CDDO-Me may be beneficial in these patients.”
  • The paper relies on this without support.

    No new adverse events or pharmacokinetic interactions occur when napabucasin is combined with paclitaxel.

    “Notably, no new AE or pharmacokinetic interactions were observed when napabucasin was combined with paclitaxel.”
  • The paper relies on this without support.

    Most forms of post-translationally modified STAT3 proteins are modified after their phosphorylation at key tyrosine sites.

    “Most forms of post-translational modified STAT3 proteins, including those that that are phosphorylated on serine, methylated, acetylated, ubiquitinated, ISGylated, and SUMOylated, are modified after their phosphorylation at key tyrosine sites.”
  • The paper relies on this without support.

    The scaffold function of STAT3 in platelet activation is mediated by homodimers of pY-STAT3.

    “Similarly, because the scaffold function of STAT3 in platelet activation is mediated by homodimers of pY-STAT3, STAT3 inhibitors that reduce pY-STAT3 could potentially reduce platelet function in inflamed tissue, such as a ruptured atherosclerotic plaque.”
  • The paper relies on this without support.

    The activity of STAT3 in the ER does not require STAT3 to be phosphorylated at Y705.

    “Similarly, because the activity of STAT3 in the ER does not require STAT3 to be phosphorylated at Y705, the impact of reduced pY-STAT3 on the ER function of STAT3 is expected to be minimal.”
  • The paper relies on this without support.

    STAT3 has a critical role in wound healing.

    “In addition, based on the critical role of STAT3 in wound healing, it would be advisable to avoid the use of STAT3 inhibitors in the period immediately prior to surgery or following traumatic injury until wound healing is complete.”
16 of 16

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Ghrelin is said to reduce feeding despite opposing leptin

    Minor

    The paper says ghrelin opposes leptin to downregulate feeding behavior, but elsewhere says leptin activation decreases food intake. Opposing that effect would increase, not decrease, feeding.

  • Chemotherapy-induced senescence is described as both autocrine and paracrine

    Minor

    Table 2 calls the IL-6/STAT3 effect autocrine, whereas the discussion describes the same chemotherapy-induced senescence and residual tumor burden as paracrine.

2 of 2

Citations

Cites

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14 of the 623 references couldn’t be matched to a known paper.

Research works printed but not linked: 1

  1. Simeone-Penney, 2008, STAT3: A Novel Regulator of Airway Inflammation and Remodeling in Asthma in Sackler School of Graduate Biomedical Sciences, Tuft University (MA), ProQuest Dissertations Publishing, 2008

Cited by

Sorted by citations

Items 101–200 of 314

Metadata

Authors
Bharadwaj, U., Kasembeli, M. M., Robinson, P., & Tweardy, D. J.
Affiliations
The University of Texas MD Anderson Cancer Center (US)
Venue
Pharmacological Reviews
Publisher
Elsevier BV
Published
2020-04
Volume
72
Issue
2
Pages
486-526
ISSN
0031-6997 (ISSN-L)
OpenAlex
W3011547660
Cited by
314
References
623
Citations by year
2026: 38 · 2025: 56 · 2024: 56 · 2023: 55 · 2022: 50 · 2021: 46 · 2020: 13
FWCI
13.16
Type
journal article
Language
en
Update notices
erratum (2020-07-01)
Open access
Locations
  • Pharmacological Reviews (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • PubMed Central (submittedVersion, cc-by-nc)
Funders
  • National Institutes of Health (1p50ca221707-01a1)
  • National Cancer Institute (P50CA221707)
Topics
  • Life Sciences › Immunology and Microbiology › Immunology › Cytokine Signaling Pathways and Interactions
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Cancer Research › NF-κB Signaling Pathways
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Protein Tyrosine Phosphatases
Keywords
Janus kinase, STAT3, JAK/STAT signaling, cytokine signaling, acute phase response, chronic inflammation, fibrosis, cancer, mitochondrial function, platelet activation, endothelial permeability, drug safety, therapeutic targeting, cachexia, oxidative phosphorylation, innate immunity
MeSH terms
Animals, Anti-Inflammatory Agents, Antineoplastic Agents, Fibrosis, Humans, Inflammation, Neoplasms, Phosphorylation, Clinical Trials, Phase II as Topic, Protein Kinase Inhibitors, STAT3 Transcription Factor, Janus Kinases, Molecular Targeted Therapy

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