The Discovery of Small Molecule Inhibitors of cFLIP that Sensitise Tumour Cells to TRAIL

The TNF-related apoptosis-inducing ligand (TRAIL) has potential as a therapeutic agent as it has previously been shown to induce apoptosis in triple-negative breast cancer. Recombinant human TRAIL has shown promise in pre-clinical studies of breast cancer. TRAIL exhibits specificity for triple-negative and treatment-resistant disease subsets. However, several studies have demonstrated that patient tumours exhibit resistance to TRAIL and TRAIL-receptor agonists. We have previously demonstrated that suppression of the TRAIL-receptor inhibitor cFLIP can sensitise breast cancer stem cells to apoptosis inducers, but development of pharmacological inhibitors of cFLIP have been impeded by concerns over structural similarities between cFLIP and the pro-apoptotic procaspase-8. We used molecular dynamics to model the interactions between cFLIP, procaspase-8 and the TRAIL-receptor Death Inducing Signalling Complex (TRAIL-DISC), followed by virtual pharmacophore screening and in-cell viability assays to identify a small-molecule (OH14, 3) that selectively inhibited cFLIP binding to the DISC and promoted TRAIL-mediated apoptosis in breast cancer cell lines. When used in combination with TRAIL, OH14 significantly impaired breast cancer cell viability in primary derived and established cell culture. Given the relatively low (micromolar) potency of the initial hit compound inhibitor OH14 (3), limiting its utility as a preclinical development candidate, we carried out structure-activity relationship studies to find a cFLIP inhibitor with more potent cellular activity. Our findings confirm the proof-of-principle that selective pharmacological inhibition of cFLIP can be used to target a vulnerability in breast cancer cells. ### Competing Interest Statement The authors have declared no competing interest.