Small-Molecule Targeting of Oncogenic FTO Demethylase in Acute Myeloid Leukemia

FTO, an mRNA N6-methyladenosine (m6A) demethylase, was reported to promote leukemogenesis. Using structure-based rational design, we have developed two promising FTO inhibitors, namely FB23 and FB23-2, which directly bind to FTO and selectively inhibit FTO's m6A demethylase activity. Mimicking FTO depletion, FB23-2 dramatically suppresses proliferation and promotes the differentiation/apoptosis of human acute myeloid leukemia (AML) cell line cells and primary blast AML cells in vitro. Moreover, FB23-2 significantly inhibits the progression of human AML cell lines and primary cells in xeno-transplanted mice. Collectively, our data suggest that FTO is a druggable target and that targeting FTO by small-molecule inhibitors holds potential to treat AML. [Display omitted] •Structure-guided design and optimization yield potent FTO inhibitors•mRNA m6A acts as the major effector of the inhibitor/FTO axis in AML cells•FTO inhibitor FB23-2 displays therapeutic effects in PDX AML models•Targeting epitranscriptomic RNA methylation holds potential to treat AML Huang et al. use structure-based rational design to develop FB23-2, an inhibitor of the mRNA m6A demethylase FTO. FB23-2 suppresses proliferation and promotes the differentiation of acute myeloid leukemia (AML) cells and prolongs survival of patient-derived AML mouse models.