20The immunomodulatory drugs (IMiDs) thalidomide, lenalidomide, and pomalidomide as well as 21 the novel cereblon modulating agents (CMs) including CC-122, CC-220 and cereblon-based 22 proteolysis-targeting chimaeras (PROTACs) repurpose the Cul4-RBX1-DDB1-CRBN 23 (CRL4 CRBN ) E3 ubiquitin ligase complex to induce the degradation of specific neomorphic 24 substrates via polyubiquitination in conjunction with an E1 ubiquitin-activating enzyme and E2 25 ubiquitin-conjugating enzymes, which have until now remained elusive. Here we show that the 26 ubiquitin-conjugating enzymes UBE2G1 and UBE2D3 cooperatively promote the 27 polyubiquitination of CRL4 CRBN neomorphic substrates in a cereblon-and CM-dependent 28 manner via a sequential ubiquitination mechanism: UBE2D3 transforms the neomorphic 29 substrates into mono-ubiquitinated forms, upon which UBE2G1 catalyzes K48-linked 30 polyubiquitin chain extension. Blockade of UBE2G1 diminishes the ubiquitination and 31 degradation of neomorphic substrates, and consequent antitumor activities elicited by all tested 32CMs. For example, UBE2G1 inactivation significantly attenuated the degradation of myeloma 33 survival factors IKZF1 and IKZF3 induced by lenalidomide and pomalidomide, hence conferring 34 drug resistance. UBE2G1-deficient myeloma cells, however, remained sensitive to a more potent 35 IKZF1/3 degrader CC-220. Collectively, these findings suggest that loss of UBE2G1 activity 36 might be a resistance mechanism to drugs that hijack the CRL4 CRBN to eliminate disease-driving 37 proteins, and that this resistance mechanism can be overcome by next-generation CMs that 38 destroy the same targeted protein more effectively. 39 40 41 42The ubiquitin-proteasome system (UPS) is a highly regulated component of the protein 43 homeostasis network that dictates multiple cellular processes in eukaryotes (Hershko and 44 Ciechanover, 1998). Through the orchestrated actions of ubiquitin-activating enzymes (E1), 45 ubiquitin-conjugating enzymes (E2) and ubiquitin-ligating enzymes (E3), the ε-amine of a lysine 46 residue in a target protein is covalently conjugated with K48-or K11-linked poly-ubiquitin 47 chains, thereby marking the target protein for proteasomal degradation (Jin et al., 2008; 48 Komander and Rape, 2012; Pickart, 2001). Recently, repurposing the Cullin-Ring E3 ligase 49 complexes CRL4 CRBN (Cul4-RBX1-DDB1-CRBN) and CRL2 VHL (Cul2-RBX1-EloB/C-VHL) 50 with small-molecule degraders to remove disease-driving proteins otherwise considered 51 'undruggable' has emerged as a novel therapeutic modality that has the potential to transform 52 drug discovery and development (Bondeson and Crews, 2017; Huang and Dixit, 2016; Lebraud 53 and Heightman, 2017).
54There are two types of small-molecule degraders that have been exploited used to date. The first 55 is represented by thalidomide (THAL), lenalidomide (LEN) and pomalidome (POM), as well as 56 other cereblon modulating agents This class of molecule docks 57 into a tri-tryptophan pocket in the thalidomide...