Abstract Cell cycle/tumor repressors can be pharmacologically activated to repress uncontrollable proliferation of cancer cells. However, targeting cell cycle regulators of G2/M and mitotic checkpoints to achieve maximum therapeutic benefit remains a challenge due to a limited therapeutic index. Here, we identified highly potent and selective oral bioavailable clinical candidate inhibitors to the first-in-class oncology target Microtubule Associated Serine/Threonine Kinase-Like (MASTL) aimed at expanding therapeutic control of the cell cycle for cancer therapy. Breath of efficacy screening in multiple tumor indications in vitro followed by computational analyses identified the regulatory subunit PPP2R2A as a potential patient selection biomarker that strongly correlates to MASTL inhibitor response irrespective of cancer genetic alterations. Functional genetics studies confirmed that sensitivity to MASTL inhibition is defined by PPP2R2A expression. To identify genetic mediators of MASTL inhibitor resistance, a whole genome CRISPR knockout screen with the MASTL inhibitor was performed and further established that the MASTL inhibitor response is dependent on PPP2R2A containing PP2A complexes. Mechanistic studies (proteomics, resistance, functional genetics, and time-lapse microscopy) demonstrated that MASTL inhibition disrupts mitosis by activating the tumor suppressor PP2A, leading to a switch from CDK1 activity to CDK1 inactivity, mitotic defects, and cancer cell death. MASTL inhibition treatment in tumor models in vivo and in patient-derived organoid models results in potent tumor growth inhibition. Our results demonstrate that the first identified highly selective MASTL clinical candidate inhibitors represent a potential new cancer therapeutic strategy to target mitosis and mitotic exit by activating the tumor repressor PP2A to counter CDK1 activity. All procedures performed on animals were in accordance with regulations and established guidelines and were reviewed and approved by an Institutional Animal Care and Use Committee or through an ethical review process. Citation Format: Chad M. Toledo, Koleen J. Eisele, Dong Hyun Kim, Xinmeng Mu, Sonja Brun, Carl Davis, Eric C. Greenwald, Fion Hui, Meilan He, Yanling Yang, Ana Flores-Bojorquez, Yuxin Li, Penney L. Khamphavong, Joseph H. Lee, Jian Li, Dana J. Ramms, Greg Jones, Marin Auth, Cory L. Painter, Andrew Nager, Jon Oyer, Sergei L. Timofeevski, William E. Pierceall, Anwar Murtaza, Jonathan R. Heyen, Rebecca Gallego, Casey Quinlan, Indrawan McAlpine, Todd L. VanArsdale. MASTL small-molecule inhibition to target mitosis for cancer therapy [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 5903.
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