Application of proteolysis targeting chimeric (PROTAC) technology in protein regulation and drug development

The Proteolysis Targeting Chimera (PROTAC) is one of the targeted protein degradation technologies, leveraging the ubiquitin-proteasome system to selectively degrade target proteins within cells. Unlike conventional therapies that rely on continuous occupancy of the target protein, PROTACs operate through an event-driven mechanism that enables catalytic protein degradation, achieving effects at sub-stoichiometric concentrations. This review compares PROTACs with small-molecule inhibitors and monoclonal antibodies (mAbs), highlighting their ability to degrade "undruggable" intracellular proteins, and potential to eliminate targets with high efficiency at low doses. We provide a detailed analysis of PROTAC-based drugs, covering development progress up to 2024 in six major disease areas, including oncology, autoimmune, cardiovascular, neurodegenerative, viral infections, and rare genetic diseases. However, PROTACs face challenges including E3 ligase limitation, systemic toxicity, and delivery inefficiencies. By exploring the stimulus-responsive PROTACs and Nano-PROTACs, we highlight their potential to improve delivery precision, enhance tissue specificity, reduce systemic toxicity, and overcome membrane permeability issues. Advances in PROTACs are expected to improve target specificity, expand the spectrum of druggable targets, and optimize pharmacokinetics, enabling safer and more efficient clinical therapies.