The
advent of multi-specific targeted protein degradation (TPD)
therapies has made it possible to drug targets that have long been
considered to be inaccessible. For this reason, the foremost TPD modalities
- molecular glues and proteolysis targeting chimeras (PROTACs) -have
been widely adopted and developed in therapeutic programs across the
pharmaceutical and biotechnology industries. While there are many
clear advantages to these two approaches, there are also blind spots.
Specifically, PROTACs and molecular glues are inherently mechanistically
analogous in that targets of both are degraded via the 26s proteasome;
however, not all disease-relevant targets are suitable for ubiquitin
proteasome system (UPS)-mediated degradation. The alternative mammalian
protein degradation pathway, the autophagy–lysosome system
(or ALS), is capable of degrading targets that elude the UPS such
as long-lived proteins, insoluble protein aggregates, and even abnormal
organelles. Emerging TPD strategies- such as ATTEC, AUTAC, and LYTAC-
take advantage of the substrate diversity of the ALS to greatly expand
the clinical utility of TPD. In this Perspective, we will discuss
the array of current TPD modalities, with a focus on critical evaluation
of these novel ALS-mediated degradation techniques.