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Birinapant is a synthetic small molecule and peptidomimetic of the second mitochondrial-derived activator of caspases (SMAC), classified as a SMAC mimetic. It functions as an antagonist of inhibitor of apoptosis proteins (IAPs), particularly targeting cellular IAP1 (cIAP1) and cIAP2, with higher potency for cIAP1. By binding to these proteins, birinapant induces their autoubiquitination and subsequent proteasomal degradation, thereby promoting apoptosis in cancer cells that overexpress IAPs. This mechanism can restore apoptotic signaling pathways suppressed in many cancers and may also inhibit the nuclear factor-kappa B (NF-kB)-mediated survival pathway. Birinapant has been investigated primarily for hematologic malignancies such as myelodysplastic syndromes (MDS) and chronic myelomonocytic leukemia (CMML), as well as solid tumors including ovarian cancer, colorectal cancer, pancreatic cancer, and others[1][2][3][4][5].
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