Anaplastic lymphoma kinase 1 (ALK-1) is a member of the insulin receptor tyrosine kinase family. member of the insulin receptor tyrosine kinase family (RTK) . Members of this family include and type PDGF receptors, EGF receptor, HER2/neu, insulin and IGF-1 receptors which regulate cellular growth and may trigger neoplastic transformation when mutated, translocated, or expressed aberrantly [1-3]. ALK-1 first was found to be associated with the (2; 5)(p23; q35) chromosome translocation in Ki-1 lymphoma or anaplastic large cell lymphoma (ALCL) . The same translocation has also been associated 300832-84-2 manufacture with Hodgkin lymphoma . Multiple mutations involving the ALK gene have since been identified in ALCL. ALK mutations have also been implicated in the pathogenesis of rhabdomyosarcoma , inflammatory myofibroblastic pseudo tumor , neuroblastoma  and non-small cell lung Cancer . In this article, we discussed common ALK mutations and provided a 300832-84-2 manufacture review of ALK-1 Inhibitors that are currently in clinical use or under clinical development. ALK-1 mutations and oncogenesis Multiple mutations involving the ALK gene located on 2p23 have been described. The first and prototype of these mutations has been the NPM-ALK mutation caused by translocation (2; 5)(p23; q35) [4,9,10]. This mutation fuses the nucleophosmin (NPM) gene with the ALK gene and was first described in Ki-1 Lymphoma. Ki-1 Lymphoma is a distinct subset of large cell lymphomas that are characterized by CD-30 (Ki-1 antigen) positivity. CD30 is a transmembrane protein which belongs to the nuclear growth factor superfamily and is thought to be involved in ligand binding . NPM encodes for the nucleophosmin protein that is localized to the nucleolus and involved in ribosomal assembly. It is postulated that it provides positive feedback to cell growth [11,12]. The NPM-ALK fusion gene encodes a chimeric receptor tyrosine kinase (RTK) that is de-regulated and constitutionally activated. This leads to activation of phospholipase C- (PLC-) . Activation of PLC- leads to growth factor independent proliferation of lymphocytes. Another mechanism that 300832-84-2 manufacture has been elucidated is the hyperphosphorlyation of p80. Fusion of ALK with NPM leads to hyperphosphorylation of p80 and its constitutional activation. This constitutionally active p80 is localized to the cytoplasm and catalyzes the phosphorylation of SH2 domain-containing transforming protein (SHC), an adaptor protein, and insulin receptor substrate 1 (IRS-1) with downstream effects on RAS and epidermal growth factor receptor (EGFR) pathways . Other mechanisms that have been unearthed mainly occur through the Jun set IFNB1 of proteins [13,14]. Jun (cJun, JunB and JunD) are members of the activated protein 1 (AP-1) transcription factor complex. cJun is regulated by the NPM-ALK tyrosine kinase via pathologic phosphorylation and subsequent activation of cJun N-terminal kinase (JNK), the protein kinase capable of phosphorylating serine residues in the N-terminal of cJun and effecting its subsequent activation . JNK is only physiologically phosphorylated by the mitogen activated protein kinase (MAPK) kinases MKK4 and MKK7. However, in the ALCL cells, JNK is phosphorylated by NPM-ALK which in turn phosphorylates and activates cJun. Activated cJun causes the transcriptional activation of cell cycle proteins (Cyclin D1, Cyclin D3, Cyclin A and Cyclin E) and the inhibition of tumor suppressors such as p53, p21Cip1 and p16Ink4. This is mediated through the recruitment of cAMP response element binding (CREB) protein (CBP) activator . JunB, another member of the Jun subset of APC1 complex, is also a positive regulator of cell cycle progression . 300832-84-2 manufacture NPM-ALK also increases JunB expression through the mTOR pathway. mTOR is activated by the phosphoinositol 3- kinase/Akt pathways [14,15]. NPM-ALK has also been shown to act through the signal transducer and activator 300832-84-2 manufacture of transcription (STAT), principally STAT3 and STAT5 [16-19]. STAT3, for example, is constitutionally activated by NPM-ALK phosphorylation and is actively involved in the malignant transformation of NPM-ALK expressing lymphocytes . Activated STAT3 enhances the positive autocrine loop involving IL-6 and the IL-6 receptor (IL6R), which in turn up-regulates the expression of Bcl-xL and survivin, two anti-apoptotic factors . STAT5 activation also is thought to protect cells from apoptosis, likely from activation of anti-apoptotic factors such as A1 (or its human homologue, Bfl-1), Bcl-xL, pim-1 and oncostatin M . Another mechanism for NPM-ALK oncogenesis has been elucidated as occurring through the phosphorylation of p60c-src. p60c-src is a src kinase which plays specific roles in downstream effects of the T-cell receptor and causes hematopoietic growth factor.