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CREB-binding protein

CREB-binding protein (CBP), also known as KAT3A, encoded by the CREBBP gene on chromosome 16p13.3 in humans, is a ubiquitously expressed protein that functions as a transcriptional coactivator and lysine acetyltransferase, essential for regulating through and interactions with transcription factors. CBP is closely related to its paralog p300 (KAT3B), with which it shares significant and functional similarities. Weighing approximately 265 and comprising 2442 , CBP was first identified for its binding to the phosphorylated cAMP response element-binding protein (CREB), but it interacts with a broad array of signaling molecules to integrate diverse cellular pathways. Structurally, CBP features multiple functional domains, including the interaction domain, KIX domain for CREB binding, cysteine-histidine-rich (CH) domains, a for acetylated recognition, a catalytic (lysine acetyltransferase) domain spanning 380 residues, and the NCBD/IBiD domain for protein-protein interactions. These domains enable CBP to serve as a molecular scaffold, recruiting components of the basal transcription machinery, such as , and facilitating the assembly of multiprotein complexes at gene promoters and enhancers. Its acetyltransferase activity targets both —promoting an open conformation for transcription—and non-histone proteins like and , thereby modulating their stability and activity. CBP plays pivotal roles in cellular processes, including embryonic development, , , and , by coupling to transcriptional responses. In hematopoiesis, it regulates formation through coactivation and , while in the , it influences stress responses and via CREB-mediated pathways. Dysregulation of CBP is implicated in several diseases; heterozygous mutations cause Rubinstein-Taybi syndrome, a characterized by and distinctive physical features, and chromosomal translocations involving CREBBP contribute to . Additionally, CBP's involvement in super-enhancers at oncogenes makes it a target for cancer therapies, with inhibitors such as CCS1477 and inobrodib in clinical trials as of 2025 for hematologic and other malignancies.

Overview

Definition and discovery

The CREB-binding protein (CBP), also known as CREBBP, is a multifunctional transcriptional coactivator that specifically interacts with the phosphorylated form of the response element-binding protein (CREB) to facilitate . As a (HAT), CBP catalyzes the of residues on , which promotes relaxation and enhances transcriptional , while also acetylating non-histone proteins such as transcription factors to modulate their activity. This dual role positions CBP as a critical integrator in pathways that regulate cellular processes like , , and . CBP was first discovered in 1993 through a yeast two-hybrid screening approach designed to identify nuclear proteins that bind to CREB phosphorylated by (PKA), a key mediator of signaling. In this seminal study by Chrivia et al., CBP was characterized as a 265 kDa nuclear protein that specifically associates with the kinase-inducible domain () of phosphorylated CREB, thereby linking -responsive signals to transcriptional machinery. This interaction was shown to be essential for CREB's ability to activate transcription from promoters containing response elements (). The human CREBBP gene, which encodes CBP, is located on the short arm of at position 16p13.3 and spans approximately 159 kb with 31 exons. It produces a protein consisting of 2442 , resulting in a molecular weight of about 265 kDa, consistent with its identification as a large multifunctional regulator. Early investigations following its discovery established CBP's pivotal role in CRE-mediated transcription, demonstrating that its recruitment by phosphorylated CREB is required for efficient of cAMP-inducible genes, such as those involved in metabolic and neuronal signaling. These foundational studies highlighted CBP's selectivity for phosphorylated CREB over its unphosphorylated form, underscoring its function as a signal-dependent coactivator in the cAMP pathway.

Nomenclature and relation to p300

The CREB-binding protein (CBP), encoded by the CREBBP , derives its name from its specific interaction with the phosphorylated form of the cAMP response element-binding protein (CREB), a activated by . This binding was first demonstrated in 1993, when CBP was isolated as a 265-kDa nuclear protein that associates with the kinase-inducible domain () of CREB to facilitate transcriptional activation. In 1994, p300 was identified as a distinct 300-kDa protein that interacts with the adenoviral E1A oncoprotein, serving as a transcriptional adaptor. Shortly thereafter, revealed that p300 and CBP share approximately 63% amino acid identity across their entire lengths, establishing them as highly homologous paralogs arising from an ancient event estimated to have occurred over 450 million years ago. Due to this homology and their overlapping roles as transcriptional coactivators, p300 and CBP are frequently referred to collectively as p300/CBP in the literature.90127-9) While both proteins exhibit broad expression, subtle tissue-specific differences exist: CBP shows higher levels in neuronal tissues, whereas p300 is more ubiquitously distributed across cell types. These patterns contribute to context-dependent functions, though early studies often used the terms interchangeably owing to their redundant activities in many signaling pathways, leading to historical ambiguities in attributing specific effects to either protein.

Structure

Zinc finger and cysteine-histidine rich domains

The transitional adapter (Taz) domains of CREB-binding protein (CBP), namely Taz1 and Taz2, are specialized C2HC-type s that mediate protein-protein interactions essential for transcriptional adapter functions. These domains, located in the N-terminal and central regions of CBP, respectively, facilitate the recruitment of transcription factors by providing structured surfaces that stabilize disordered domains. Taz1 and Taz2 each coordinate multiple ions through and residues, forming compact helical bundles that act as versatile scaffolds for complex assembly. Taz1, encompassing residues approximately 340–439, exhibits a triangular with four stabilized by three zinc-binding sites, each featuring an HCCC motif involving one and three cysteines. This interacts with transcription factors such as HIF-1α, inducing folding of the partner’s C-terminal activation (CTAD) through extensive hydrophobic contacts and serving as a scaffold for hypoxic . In contrast, Taz2, spanning residues approximately 1764–1855, adopts a similar four- bundle but with a rotated fourth helix, enabling to the kinase-inducible (KID) of CREB and the (TAD) of ; these interactions are enhanced by phosphorylation-induced conformational changes in the transcription factors, promoting signal-responsive recruitment. The cysteine-histidine rich regions (CH1, , CH3) of CBP represent multi-domain motifs with inherent zinc-binding capacity, functioning as integrated scaffolds for the assembly of transcriptional complexes. CH1 corresponds to the Taz1 domain, while CH3 encompasses Taz2 along with adjacent ZZ-type zinc-binding elements; both exhibit robust Zn²⁺ coordination essential for structural integrity and partner engagement. , positioned centrally between CH1 and CH3, comprises and subdomains that also bind zinc ions, contributing to adapter versatility by linking upstream signaling inputs to downstream coactivator recruitment without direct recognition. These regions collectively enable CBP's role in by undergoing dynamic conformational shifts that accommodate phosphorylated ligands, thereby facilitating ordered assembly of multiprotein complexes at promoters.

Kinase-inducible and bromodomains

The kinase-inducible domain (KIX) of CREB-binding protein (CBP), spanning approximately residues 586 to 672 in the human protein, functions as an amphipathic helix-binding that selectively interacts with phosphorylated kinase-inducible domains (KIDs) of various transcription factors, including CREB. This , a compact three-helix bundle of about 90 , serves as a critical docking site for signal-dependent transcriptional activation. Upon stimulation by cAMP-dependent (), phosphorylation of CREB at serine 133 within its KID triggers a conformational change, enabling the KID to form an α-helical structure that binds to a hydrophobic groove on the KIX surface. The binding interface involves key hydrophobic residues from both KIX and the phosphorylated KID, stabilizing the complex and recruiting CBP to promoter regions to enhance transcription. Structural studies using (NMR) have elucidated the binding mechanism, revealing that the phosphorylated serine 133 forms hydrogen bonds with conserved residues (e.g., Tyr658) in KIX, while the amphipathic helix of nestles into the groove formed by helices II and III of KIX. This interaction is highly specific to the phosphorylated state, as unphosphorylated exhibits low affinity, ensuring that CBP recruitment is tightly regulated by signaling pathways like /PKA. The KIX domain's plasticity allows it to accommodate similar motifs from other activators, such as c-Myb, underscoring its role in integrating diverse signals for . The of CBP, comprising approximately residues 1085 to 1165 and consisting of about 110 , acts as a specialized module for recognizing acetylated residues on tails, thereby facilitating epigenetic readout during transcription. This domain adopts a conserved left-handed four-helix bundle fold (αZ, αA, αB, αC), with variable ZA and BC loops that form a shallow for binding acetyl-s, such as H4K8ac and H3K14ac, through hydrophobic and interactions. Crystal and NMR structures demonstrate that the is anchored by a conserved residue (Asn1168) in the BC loop, which donates a to the carbonyl oxygen, while surrounding hydrophobic pockets accommodate the lysine side chain. These interactions promote CBP's association with acetylated , aiding in the recruitment of coactivators to active promoters.

Acetyltransferase and coactivator binding domains

The lysine acetyltransferase (KAT) domain of CREB-binding protein (CBP), spanning approximately residues 1342–1648 and also referred to as the (HAT) domain, catalyzes the transfer of acetyl groups from to the ε-amino groups of residues on s and transcription factors, thereby modulating structure and transcriptional activity. This intrinsic enzymatic function was first identified in 1996 through assays demonstrating CBP's ability to acetylate all four core s (H2A, H2B, , and H4). The domain's catalytic core includes motifs, such as motif A (containing the YGNKG pentapeptide) and the B-loop, which are critical for binding, substrate recognition, and nucleophilic attack by the substrate , ensuring efficient acetyl transfer. These motifs contribute to CBP's substrate specificity, with a preference for acetylating at lysines 14 and 18 (H3K14, H3K18) and histone H4 at lysines 5, 8, 12, and 16 (H4K5, H4K8, H4K12, H4K16), as determined by steady-state kinetic analyses using synthetic histone peptides and nucleosomes. The coactivator binding domain (NCBD) of CBP, encompassing approximately residues 2059–2117, functions as an intrinsically disordered region that transiently forms α-helical structures to recruit coactivators bearing LXXLL motifs, such as steroid receptor coactivator-1 (SRC-1), thereby facilitating multiprotein assembly at promoters. In its unbound state, NCBD exhibits characteristics of a molten globule, with secondary , compact conformation, and high flexibility due to a dynamic hydrophobic core lacking stable packing. and NMR structures of NCBD in with ligands like the SRC-1 domain (ACTR) reveal an induced-fit mechanism, where binding stabilizes three amphipathic helices in NCBD, reorganizing its interface to accommodate diverse partners through hydrophobic and electrostatic interactions. This plasticity enables NCBD's role in coactivator recruitment while maintaining low-affinity, transient interactions in the absence of ligands.

Molecular interactions

Binding to transcription factors

The CREB-binding protein (CBP) primarily interacts with the CREB through its KIX domain, which recognizes the kinase-inducible domain () of CREB following at serine 133 by () in response to cAMP signaling. This phosphorylation-dependent binding enables CBP recruitment to CRE-dependent gene promoters, such as that of c-fos, facilitating transcriptional activation. The interaction involves a coupled folding and binding mechanism where the intrinsically disordered folds into two α-helices upon binding to the globular KIX domain, with binding affinities for the phosphorylated typically in the range of 0.5–3 μM, though multi-site interactions and cellular context can enhance specificity and effective affinity to the low nanomolar range. Seminal structural studies have elucidated this interface, highlighting hydrophobic contacts between KID residues (e.g., Leu144, Leu147) and KIX helices as critical for high-affinity . CBP also binds to components of the AP-1 complex, including c-Jun and c-Fos, primarily through its C-terminal region and KIX domain, integrating (MAPK) signaling with transcriptional responses. This interaction potentiates AP-1 activity at promoters involved in and stress responses, with CBP acting as a bridge for coactivator assembly. In interferon-γ (IFN-γ) signaling, CBP interacts with via two distinct contact regions: the N-terminal domain of STAT1 binds the KIX domain of CBP, while the C-terminal associates with the E1A-binding domain, promoting IFN-γ-responsive . Similarly, CBP engages the p65 () subunit of through bivalent interactions involving the Rel homology domain and , enhancing NF-κB-driven transcription in inflammatory contexts; phosphorylation of p65 by further strengthens this association. Under hypoxic conditions, CBP is recruited by HIF-1α via its C-terminal (CAD), which binds the CH1 domain of CBP, stabilizing the HIF-1α/ARNT heterodimer at hypoxia-response elements. Beyond these, CBP is recruited to during , where it interacts with the basic helix-loop-helix domain of to support myogenic . In the DNA damage response, CBP binds the N-terminal of , particularly following at serine 15, which increases affinity and promotes p53-dependent and arrest.

Interactions with chromatin modifiers

The CREB-binding protein (CBP) often functions cooperatively with its paralog p300, facilitating cooperative regulation of chromatin accessibility through their homologous acetyltransferase domains. This cooperation enhances the overall (HAT) activity at target loci, allowing for more efficient acetylation of histones and non-histone proteins. Structural studies indicate that the CH1 and CH3 regions of CBP and p300 contribute to stable complex formation by serving as docking sites for shared binding partners, thereby amplifying enzymatic output in multi-subunit assemblies. CBP also associates with the chromatin remodeling complex, particularly through the BRG1 subunit, to promote mobilization and repositioning at enhancers and promoters. This binding enables SWI/SNF to facilitate the exposure of DNA for subsequent modifications, with CBP providing acetyltransferase activity that stabilizes open states. Similarly, CBP interacts with complex, a multi-subunit coactivator that bridges transcription factors and , coordinating remodeling with transcriptional initiation. These associations ensure synergistic effects on dynamics, where SWI/SNF and work in concert with CBP to mobilize and sustain gene activation. In addition to p300, CBP forms complexes with other HATs such as PCAF and GCN5, contributing to the assembly of enhanceosomes—multi-protein hubs at regulatory elements that integrate diverse signals for precise transcriptional control. These interactions allow CBP to collaborate with PCAF/GCN5 in sequential events, where CBP often initiates broad modifications followed by substrate-specific actions from GCN5/PCAF. CBP further recruits deacetylases (HDACs), including and HDAC2, to establish dynamic acetylation cycles that toggle between active and poised states, preventing sustained hyperacetylation and enabling rapid responses to cellular cues. This recruitment balances HAT and deacetylase activities, supporting cyclical modifications essential for processes like progression. Notable multi-protein assemblies involving CBP include ternary complexes with p300 and additional factors, such as in p53-mediated , where CBP-p300 heterodimers integrate with ligases to fine-tune and stability at damage sites. In contexts, CBP interacts with the TIP60 complex, enhancing of repair proteins like and promoting efficient double-strand break resolution through coordinated relaxation. These specific complexes underscore CBP's role as a central scaffold in epigenetic networks, linking to broader remodeling efforts.

Functions

Transcriptional coactivation mechanisms

The CREB-binding protein (CBP) functions as a transcriptional coactivator by bridging sequence-specific transcription factors to the basal transcription machinery, thereby stabilizing the pre-initiation complex (PIC) at target promoters. This bridging occurs through direct interactions with components such as TBP and TFIIB, as well as recruitment of the Mediator complex, which integrates signals from enhancers to RNA polymerase II (Pol II). In this capacity, CBP enhances the assembly and stability of the PIC, promoting efficient transcription initiation without directly contacting Pol II. A key aspect of CBP's coactivation involves of non-histone targets, particularly transcription factors. For instance, following of CREB at Ser133 by (), CBP binds to phospho-CREB via its KIX domain and subsequently CREB at residues 91, 94, and 136 within the activation domain. This enhances CREB's potential, increasing CREB-dependent transcription by approximately 4-fold in cellular assays, independent of effects on DNA binding affinity. Similar acetylation events on other factors, such as p53 and STAT3, amplify their transcriptional output by modulating protein stability and cofactor recruitment. CBP's multidomain architecture and large molecular weight (approximately 265 kDa) enable it to act as a scaffold for looping, facilitating physical proximity between distal enhancers and promoters over distances of tens to hundreds of kilobases. By simultaneously binding enhancer-associated transcription factors and promoter-proximal elements, CBP stabilizes these loops, often in coordination with , to boost enhancer-promoter communication. This structural role contributes to quantitative enhancements in transcription, with CBP overexpression driving 80- to 90-fold increases in activity in mammalian cells. Additionally, CBP promotes the release of promoter-proximal paused Pol II into productive elongation by acetylating histones near the transcription start site and interacting with pausing factors like TFIIB, preventing Pol II backlog and accelerating elongation rates; inhibition of CBP reduces paused Pol II occupancy by up to 80% within an hour.

Role in chromatin modification and cell cycle

The CREB-binding protein (CBP) plays a pivotal role in modification through its intrinsic (HAT) activity, primarily targeting core histones H3 and H4. of these histones by CBP neutralizes their positive charge, thereby reducing the affinity between histones and negatively charged DNA, which loosens structure and facilitates an open conformation conducive to transcriptional . This modification is essential for establishing euchromatic regions that allow access for transcription factors and other regulatory proteins. Additionally, CBP undergoes autoacetylation, a self-modification process that significantly enhances its own HAT activity, thereby amplifying its capacity to acetylate histones and maintain dynamic states. In the context of cell cycle regulation, CBP contributes to key transitions by acetylating critical regulators. Specifically, CBP acetylates the tumor suppressor at lysine 382 (K382), a modification that stabilizes , enhances its DNA-binding affinity, and promotes transcriptional activation of genes such as p21, leading to G1/ arrest in response to cellular stress. Conversely, CBP interacts with transcription factors, serving as a coactivator that facilitates their recruitment to promoters of genes, thereby promoting entry into the during normal . This dual role is exemplified in the activation of the cyclin E promoter, where CBP, through its HAT activity, acetylates histones to enable -dependent transcription and progression through the G1/S checkpoint. CBP also contributes to epigenetic memory by depositing histone H3 lysine 27 acetylation (H3K27ac) marks at active enhancers, which sustain patterns during . These H3K27ac modifications, catalyzed by CBP's domain, distinguish active from poised enhancers and propagate transcriptional competence across cell generations, ensuring stable epigenetic landscapes in differentiating tissues. Dysregulation of CBP's chromatin-modifying functions disrupts these balanced controls, often resulting in aberrant due to unchecked progression through phases.

Distinction from p300

The CREB-binding protein (CBP) and p300, also known as , are paralogous transcriptional coactivators that share approximately 63% amino acid sequence identity and conserved functional domains, including the (HAT) domain, , and motifs, enabling partial redundancy in acetylation activities. However, they exhibit notable structural differences outside these core regions, with CBP possessing unique extensions in its C-terminal glutamine-rich domains that facilitate distinct protein-protein interactions. In terms of expression patterns, CBP is preferentially enriched in neuronal and hematopoietic tissues, reflecting its specialized roles in these systems, whereas p300 displays broader ubiquitous expression, particularly in epithelial and cardiac tissues. This divergence influences their tissue-specific contributions to development and . Functionally, CBP plays a more prominent role in CREB-mediated processes, such as neuronal and formation, where its activity is essential for activity-dependent gene expression in the . In contrast, p300 is predominantly involved in interactions with viral oncoproteins, including adenovirus E1A and human papillomavirus E7, which hijack p300 to disrupt cellular regulation and promote transformation. These non-overlapping functions underscore their non-redundant contributions despite shared coactivation capabilities. Genetic studies further highlight their distinctions: homozygous CBP knockout in mice is embryonic lethal and associated with Rubinstein-Taybi syndrome phenotypes in heterozygotes, characterized by growth retardation and skeletal defects, whereas p300 null mice exhibit broader developmental defects, including cardiac malformations and increased accumulation without proper . Despite these differences, evidence from conditional s and double-null lines indicates partial redundancy, as each can partially compensate for the loss of the other in histone acetylation and certain transcriptional responses.

Role in diseases

Rubinstein–Taybi syndrome

(RTS) is a rare autosomal dominant primarily caused by heterozygous pathogenic variants in the CREBBP , which encodes the CREB-binding protein (CBP), accounting for approximately 50-60% of cases. The remaining cases are attributed to variants in the homologous , but CREBBP mutations predominate in RTS type 1. These mutations typically include nonsense, frameshift, splice site, and missense variants, often leading to through premature truncation or loss of functional protein domains. Deletions encompassing CREBBP or contiguous gene syndromes at 16p13.3 also contribute, spanning from small intragenic changes to larger genomic rearrangements up to 6.5 Mb. The prevalence of RTS is estimated at 1 in 100,000 to 125,000 live births. Clinically, RTS is characterized by moderate to severe (IQ typically 35-50), distinctive craniofacial dysmorphology including downslanting palpebral fissures, a low-hanging , and a , as well as broad and angulated thumbs and halluces. Additional features encompass , growth retardation, congenital heart defects in about one-third of individuals, recurrent infections, and an increased risk of certain tumors. These manifestations arise during embryonic development, reflecting CBP's critical role in regulating essential for neuronal and skeletal . At the pathophysiological level, CREBBP mutations result in reduced CBP acetyltransferase (HAT) activity, disrupting histone acetylation and chromatin remodeling processes that are vital for transcriptional coactivation of developmental genes. This haploinsufficiency impairs the expression of target genes involved in neuronal signaling pathways and limb bud formation, leading to the syndrome's core phenotypes. Mutations within the HAT domain of CREBBP are particularly overrepresented and associated with more pronounced disruptions in these epigenetic mechanisms. Diagnosis of RTS relies on clinical evaluation followed by molecular genetic testing, such as targeted sequencing of CREBBP and or multigene panels, with deletion/duplication analysis for unresolved cases. Recent studies from the have explored genotype-phenotype correlations, revealing that while overall severity does not strongly correlate with type across large cohorts, variants in domain or early truncating mutations may contribute to more severe and dysmorphic features in some patients. For instance, screening of over 200 individuals identified novel variants emphasizing domain's role, and specific mutations in 5 have been linked to atypical milder outcomes potentially due to alternative isoform expression.

Cancer involvement

The CREB-binding protein (CBP), encoded by the CREBBP gene, exhibits a in cancer pathogenesis, functioning as both an and a tumor suppressor depending on the cellular context and cancer type. Overexpression of CBP is observed in numerous malignancies, where it promotes tumor , survival, and progression by acetylating key oncoproteins such as and β-catenin, thereby enhancing their stability and transcriptional activity. Conversely, loss-of-function mutations or deletions in CREBBP, often involving the 16p13.3 chromosomal locus, impair CBP's acetyltransferase function and act as a tumor suppressor mechanism in other cancers, leading to reduced acetylation and disrupted essential for tumor suppression. Mechanistically, CBP drives oncogenesis by enhancing Wnt/β-catenin signaling through direct of β-catenin at 49, which stabilizes the protein and amplifies its ability to activate downstream target genes involved in and invasion. In , CBP serves as a critical coactivator for the (), acetylating AR to prevent its ubiquitin-mediated and sustain AR-dependent transcription that fuels tumor growth and resistance to therapy. These interactions underscore CBP's role in deregulating proliferative pathways across solid tumors. Genomic alterations in CREBBP are prevalent in specific cancers, with inactivating occurring in approximately 9% of colorectal cancers based on large-scale sequencing , often contributing to epigenetic silencing of tumor suppressor genes. In , CREBBP amplification is frequently detected in estrogen receptor-positive subtypes (luminal A and B) as well as , correlating with aggressive disease features and poorer prognosis. Recent studies have highlighted CBP's involvement in the , where it coactivates hypoxia-inducible factor 1α (HIF-1α) to promote and metabolic adaptation under hypoxic conditions, further supporting tumor progression. Chromosomal translocations involving CREBBP, particularly t(8;16)(p11;p13) resulting in KAT6A-CREBBP fusion, are associated with a subtype of (AML) characterized by monocytic or myelomonocytic differentiation (FAB M4/M5) and often . This acts as an aberrant transcriptional coactivator, promoting leukemogenesis through disrupted epigenetic regulation, and is linked to poor .

Metabolic and neurological disorders

The CREB-binding protein (CBP) plays a critical role in metabolic homeostasis by acetylating sterol regulatory element-binding proteins (SREBPs), which stabilizes these transcription factors and promotes their transcriptional activity in lipid metabolism regulation. Dysregulation of CBP in the hypothalamus contributes to obesity and diabetes by altering glucose and lipid metabolism profiles. In hepatic contexts, p300 (a homolog of CBP) suppresses gluconeogenesis through acetylation of PEPCK, which promotes its ubiquitination and degradation, and impairments in this process exacerbate hyperglycemia in diabetic models, as evidenced by metformin-induced CBP phosphorylation that suppresses gluconeogenic gene expression. In neurological disorders, polyglutamine-expanded in sequesters CBP into nuclear inclusions, depleting its availability for transcriptional coactivation and histone acetylation, which leads to reduced and progressive neuronal death. Similarly, in , hyperactive p300/CBP acetylates at specific residues, impairing binding, promoting tau aggregation into neurofibrillary tangles, and enhancing tau secretion and propagation via disrupted autophagy-lysosomal pathways. Prenatal ethanol exposure in fetal alcohol spectrum disorders inhibits CBP recruitment to neuronal promoters, disrupting histone and essential for neural development, resulting in deficits and long-term cognitive impairments. Recent studies from 2023 to 2025 highlight CBP's involvement in , where α-synuclein mutations or overexpression mislocalize cytoplasmic p300/CBP, perturbing metabolism and exacerbating dopaminergic neuron vulnerability through altered epigenetic regulation. Additionally, CBP degradation or dysfunction contributes to disruptions in sleep disorders, as seen in models where amyloid-β induces CBP loss alongside BMAL1, desynchronizing clock expression like PER2 and leading to fragmented sleep-wake cycles. The CBP KIX domain specifically modulates circadian period length, and its impairment links to broader neurological vulnerabilities in rhythm-related pathologies.

Therapeutic targeting

CBP inhibitors and development

Small-molecule inhibitors targeting the CREB-binding protein (CBP) have been developed primarily against its histone acetyltransferase (HAT, also known as KAT3B) domain and bromodomain, aiming to disrupt its coactivator function in transcription and chromatin remodeling. These inhibitors typically act by competing with substrates or mimicking regulatory motifs, leading to reduced histone acetylation at key sites such as H3K27ac, which diminishes enhancer activity and gene expression in disease contexts. Early efforts focused on the HAT domain, while more recent advances target the bromodomain for greater selectivity. A prominent HAT inhibitor is C646, a pyrazolone-based compound that competitively binds the HAT domain of CBP (and the related p300), blocking substrate access with an of approximately 5 μM. Developed as one of the first selective probes for CBP/p300, C646 has been widely used in preclinical studies to validate HAT inhibition as a therapeutic strategy. Another potent HAT inhibitor, A-485, exhibits nanomolar potency ( ~0.06 μM for p300 HAT and similar for CBP), acting through allosteric modulation of the catalytic site to prevent acetylation without directly competing with . For bromodomain targeting, CCS1477 (also known as inobrodib) serves as a selective that mimics acetyl- to occupy the bromodomain binding pocket, disrupting CBP recruitment to acetylated histones with high specificity over other bromodomains. By 2025, CCS1477 has advanced to phase I/II clinical trials for hematological malignancies, including (AML) and , evaluating safety and preliminary efficacy in combination regimens. As of September 2025, enrollment has been completed for phase II dose optimization cohorts in relapsed/refractory . In preclinical models, CBP inhibitors demonstrate antitumor activity, particularly in AML, where HAT blockade by A-485 or C646 suppresses leukemic and induces in patient-derived xenografts and mouse models. Bromodomain inhibition with CCS1477 similarly reduces AML burden in orthotopic mouse models by downregulating oncogenes like . Notably, CBP inhibitors synergize with bromodomain and extra-terminal (, such as , enhancing and overcoming resistance in AML cells through complementary disruption of super-enhancer networks. Despite promising efficacy, challenges in CBP inhibitor development include off-target effects on the paralog p300, which shares high structural similarity and can lead to unintended inhibition of normal cellular processes. Additionally, dose-limiting toxicity in non-cancerous cells, such as hematopoietic progenitors, arises from broad disruption of acetylation-dependent gene regulation, necessitating optimized dosing or combinations to improve therapeutic windows.

Emerging therapeutic strategies

Emerging therapeutic strategies for modulating CREB-binding protein (CBP) activity extend beyond inhibition to include , targeted degradation, and genetic interventions, aiming to address CBP's roles in neurodevelopmental and oncogenic disorders. One promising approach involves small-molecule activators that enhance CBP's () activity and its interaction with CREB to restore transcriptional function. For instance, CSP-TTK21, a conjugate of the CBP/p300 activator TTK21 with glucose-derived carbon nanospheres, improves blood-brain barrier penetration and ameliorates amyloid-β-induced impairments in and in mouse models by boosting CREB-CBP-mediated . This strategy highlights CBP's potential in countering epigenetic deficits in neurodegenerative conditions, with preclinical data showing enhanced and . Targeted protein degradation using proteolysis-targeting chimeras (PROTACs) represents another innovative avenue, particularly for cancer where CBP drives oncogenic enhancer activity. The PROTAC dCBP-1, which recruits the E3 ubiquitin ligase (CRBN) to CBP/p300, selectively induces ubiquitination and proteasomal degradation of these proteins, potently killing cells by abolishing MYC-driving enhancers without affecting normal cells at therapeutic doses. This approach offers superior efficacy over small-molecule inhibitors by achieving complete loss of CBP function, with ongoing development focusing on broader hematologic malignancies. Gene therapy strategies are advancing in preclinical stages to correct CBP deficiencies, such as those in (RTS). Recent developments emphasize combination therapies pairing CBP activators with (HDAC) inhibitors show synergistic rescue of memory deficits in Alzheimer's models by amplifying global histone acetylation and CREB-CBP signaling, with preclinical evidence of enhanced synaptic and cognitive performance. These multimodal strategies underscore CBP's therapeutic versatility across contexts.

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