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Testing new ways to identify untapped opportunities for glioblastoma therapies remains highly significant. Amplification and overexpression of MDM2 gene is frequent in glioblastoma and disrupting the MDM2−p53 interaction is a promising strategy to treat the cancer. RG7112 is the first-in class inhibitor and recently discovered AMG232 is the most potent MDM2 inhibitor known to date. Here, we compared the effects of these two clinical MDM2 inhibitors in six glioblastoma cell lines and ten patient-derived glioblastoma stem cells. Targeted sequencing of the  TP53 ,  MDM2  genes and whole transcriptome analysis were conducted to verify genetic status associated with sensitivity and resistance to the drugs. Although  TP53  wild-type glioblastoma cell lines are similarly sensitive to AMG232 and RG7112, we found that four  TP53  wild-type out of ten patient-derived glioblastoma cells are much more sensitive to AMG232 than RG7112 (average IC 50  of 76 nM vs. 720 nM). Among these, 464T stem cells containing  MDM2  gene amplification were most sensitive to AMG232 with IC 50  of 5.3 nM. Moreover, AMG232 exhibited higher selectivity against p53 wild-type cells over p53 mutant stem cells compared to RG7112 (average selectivity of 512-fold vs. 16.5-fold). Importantly, we also found that AMG232 is highly efficacious in three-dimensional (3D) tumor spheroids growth and effectively inhibits the stemness-related factors, Nestin and ZEB1. Our data provide new evidence that glioblastoma stem cells have high susceptibility to AMG232 suggesting the potential clinical implications of MDM2 inhibition for glioblastoma treatment. These will facilitate additional preclinical and clinical studies evaluating MDM2 inhibitors in glioblastoma and direct further efforts towards developing better MDM2-targeted therapeutics.

Potent effect of the MDM2 inhibitor AMG232 on suppression of glioblastoma stem cells