Structural and biochemical insights on the mechanism of action of the clinical USP1 inhibitor, KSQ-4279

Abstract DNA damage triggers cell signalling cascades that mediate repair. This signalling is frequently dysregulated in cancers. The proteins that mediate this signalling are potential targets for therapeutic intervention. Ubiquitin-specific protease 1 (USP1) is one such target, with small molecule inhibitors already in clinical trials. Here we use biochemical assays and cryo-electron microscopy (cryo-EM) to study the clinical USP1 inhibitor, KSQ-4279 (RO7623066), and compare this to the well-established, tool compound, ML323. We find that KSQ-4279 binds to the same cryptic site of USP1 as ML323 but disrupts the protein structure in subtly different ways. Inhibitor binding drives a substantial increase in thermal stability of USP1, which may be mediated through the inhibitors filling a hydrophobic tunnel in USP1. Our results contribute to the understanding of the mechanism of action of USP1 inhibitors at the molecular level.