Breaking the CREB-CBP alliance: Progress, challenges, and therapeutic promise of small-molecule and peptide disruptors of the pKID-KIX interaction

Abstract

The kinase-inducible domain (pKID) of the transcription factor CREB engages the KIX domain of the co-activator CBP/p300 to drive signal-dependent gene expression that underpins cell proliferation, metabolism and survival. Aberrant CREB-CBP signaling is now implicated in numerous cancers and metabolic disorders, yet until recently the shallow, dynamic pKID-KIX interface was viewed as chemically intractable. This review integrates two decades of progress that overturns that paradigm. We first dissect the structural and allosteric features of KIX that enable coupled folding-and-binding of pKID and reveal hidden ligandable pockets. We then survey the expanding inhibitor repertoire-from early micromolar naphthols (KG-501) through nanomolar naphthamides (666-15) and orally tractable pro-drugs, to high-affinity stapled and D-peptide mimetics-highlighting the assays, structure-activity relationships and pharmacokinetic optimization that have driven each advance. Biophysical and computational insights, including ¹⁹F NMR ligandability maps and millisecond-scale molecular-dynamics trajectories, are shown to guide next-generation design and machine-learning pipelines. Pre-clinical data demonstrate that disrupting CREB-CBP selectively suppresses tumor growth with favorable tolerability, and we outline opportunities for combination therapies, degrader strategies and indication expansion into metabolic and neurocognitive disease. Collectively, these findings position the CREB-CBP interaction as a tractable, multi-modal drug target poised for first-in-human exploration.

Keywords: CREB–CBP interaction; KIX domain; Protein-protein interaction inhibitors; Small-molecule disruptors; Transcriptional oncology.