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REVIEW ARTICLE
ER stressand diseases
Hiderou Yoshida
1,2
1 Department of Biophysics, Graduate School of Science, Kyoto University, Japan
2 PRESTO-SORST, Japan Science and Technology Agency, Japan
Keywords
conformational disease; cytoplasmic splicing;
ER stress response; ER-associated protein
degradation (ERAD); Golgi stress response
Correspondence
H. Yoshida, Department of Biophysics,
Graduate School of Science, Kyoto
University, Kitashirakawa-Oiwakecho,
Sakyo-ku, Kyoto 606-8502, Japan
Fax: +81 75 753 3718
Tel: +81 75 753 4201
E-mail: hide@biophysics.mbox.media.
kyoto-u.ac.jp
(Received 11 September 2006, revised
14 November 2006, accepted 8 December
2006)
doi:10.1111/j.1742-4658.2007.05639.x
Proteins synthesized in the endoplasmic reticulum (ER) are properly folded
with the assistance of ER chaperones. Malfolded proteins are disposed of
by ER-associated protein degradation (ERAD). When the amount of
unfolded protein exceeds the folding capacity of the ER, human cells acti-
vate a defense mechanism called the ERstress response, which induces
expression of ER chaperones and ERAD components and transiently
attenuates protein synthesis to decrease the burden on the ER. It has been
revealed that three independent response pathways separately regulate
induction of the expression of chaperones, ERAD components, and trans-
lational attenuation. A malfunction of the ERstress response caused by
aging, genetic mutations, or environmental factors can result in various dis-
eases such as diabetes, inflammation, and neurodegenerative disorders
including Alzheimer’s disease, Parkinson’s disease, and bipolar disorder,
which are collectively known as ‘conformational diseases’. In this review, I
will summarize recent progress in this field. Molecules that regulate the ER
stress response would be potential candidates for drug targets in various
conformational diseases.
Abbreviations
AIGP, axotomy-induced glyco ⁄ Golgi protein; APP, amyloid precursor protein; ASK1, apoptosis signal-regulating kinase 1; ATF, activating
transcription factor; BAK, Bcl-2 homologous antagonist ⁄ killer; BAP, BiP-associated protein; Bap31, B cell receptor-associated protein 31; Bax,
Bcl2-associated X protein; Bcl2, B cell leukemia 2; BI-1, Bax inhibitor 1; Bim, Bcl2-interacting mediator of cell death; BiP, binding protein; bZIP,
basic leucine zipper; c-Abl, Abelson murine leukemia viral oncogene homolog 1; C ⁄ EBP, CCAAT ⁄ enhancer-binding protein; CHOP, C ⁄ EBP-
homologous protein; CREB, cAMP response element-binding protein; CREBH, cAMP response element-binding protein H; CReP, constitutive
repressor of eIF2a phosphorylation; DAP, death-associated protein; Der1, degradation in the endoplasmic reticulum protein 1; Derlin-1, Der1-
like protein 1; Doa10, degradation in the endoplasmic reticulum protein 10; DR5, death receptor 5; EDEM, ER degradation enhancing
a)mannosidase-like protein; eIF2 a, a-subunit of eukaryotic translational initiation factor 2; ER, endoplasmic reticulum; ERAD, ER-associated
degradation; ERdj, ER dnaJ; ERO1, ER oxidoreductin; ERp72, ER protein 72; ERSE, ERstress response element; FKBP13, FK506-binding
protein 13; GADD, growth arrest and DNA damage; gp78, glycoprotein 78; GRP, glucose-regulated protein; HEDJ, human ER-associated dnaJ;
HIAP2, human inhibitor of apoptosis 2; HRD1, HMG-CoA reductase degradation protein 1; HSP, heat shock protein; IAP, inhibitor of apoptosis;
IDDM, insulin-dependent diabetes mellitus; IRE1, inositol requirement 1; JNK, Jun kinase; Keap1, Kelch-like Ech-associated protein 1; LZIP,
basic leucine zipper protein; NIDDM, noninsulin-dependent diabetes mellitus; NOXA, neutrophil NADPH oxidase factor; Npl4, nuclear protein
localization 4; NRF, nuclear respiratory factor; ORP150, oxygen-regulated protein 150; OS9, osteosarcoma 9; p58IPK, 58 kDa-inhibitor of
protein kinase; pATF6(N), the nuclear form of ATF6 protein; PDI, protein disulfide isomerase; PERK, PRKR-like endoplasmic reticulum kinase;
PKR, double stranded RNA-dependent protein kinase; PLP1, proteolipid protein 1; polyQ, polyglutamine; PrP, pion protein; PrP
c
, cellular PrP;
PrP
Sc
, scrapie PrP; PS1, presenillin 1; PUMA, p53 up-regulated modulator of apoptosis; pXBP1(S), the spliced form of XBP1 protein; pXBP1(U),
the unspliced form of XBP1 protein; RIP, regulated intramembrane proteolysis; RseA, regulator of s
E
; S1P, site 1 protease; S2P, site 2
protease; SAPK, stress-activated protein kinase; SEL1, suppressor of lin12-like; SREBP, sterol response element-binding protein; TDAG51,
T cell death-associated gene 51; TNF, tumor necrosis factor; TNFR1, tumor necrosis factor receptor 1; TRAF2, TNF receptor-associated
factor 2; TRB3, Tribbles homolog 3; UBC6, ubiquitin conjugase 6; UBC7, ubiquitin conjugase 7; UBE1, ubiquitin-activating enzyme 1; UBE2G2,
ubiquitin-activating enzyme 2G2; UBX2, UBX domain-containing protein 2; UCH-L1, ubiquitin C-terminal esterase L1; Ufd1, ubiquitin fusion
degradation protein 1; UPRE, unfolded protein response element; VCP, valocin-containing protein; WFS1, Wolfram syndrome 1; XBP1, x-box
binding protein 1; XIAP, inhibitor of apoptosis, x-linked; XTP3B, XTP3-transactivated gene B.
630 FEBS Journal 274 (2007) 630–658 ª 2007 The Author Journal compilation ª 2007 FEBS
Introduction
The endoplasmic reticulum (ER) is an organelle where
secretory or membrane proteins are synthesized. Nas-
cent proteins are folded with the assistance of molecu-
lar chaperones and folding enzymes located in the ER
(collectively called ER chaperones), and only correctly
folded proteins are transported to the Golgi apparatus
(Fig. 1). Unfolded or malfolded proteins are retained
in the ER, retrotranslocated to the cytoplasm by the
machinery of ER-associated degradation (ERAD), and
degraded by the proteasome. ER chaperones and
ERAD components are constitutively expressed in the
ER to deal with nascent proteins. When cells synthes-
ize secretory proteins in amounts that exceed the capa-
city of the folding apparatus and ERAD machinery,
unfolded proteins are accumulated in the ER. Unfol-
ded proteins expose hydrophobic amino-acid residues
that should be located inside the protein and tend to
form protein aggregates. Protein aggregates are so
toxic that they induce apoptotic cell death and cause
‘conformational diseases’ such as neurodegenerative
disorders and diabetes mellitus. To alleviate such a
stressful situation (ER stress), eukaryotic cells activate
a series of self-defense mechanisms referred to collec-
tively as the ERstress response or unfolded pro-
tein response [1–4].
The mammalian ERstress response consists of four
mechanisms. The first is attenuation of protein synthe-
sis, which prevents any further accumulation of un-
folded proteins. The second is the transcriptional
induction of ER chaperone genes to increase folding
capacity, and the third is the transcriptional induction
of ERAD component genes to increase ERAD ability.
The fourth is the induction of apoptosis to safely dis-
pose of cells injured by ERstress to ensure the survival
of the organism.
In this article, I will describe the basics of the mam-
malian ERstress response that are essential to under-
standing conformational diseases. I will review hot
topics such as ERAD, regulated intramembrane pro-
teolysis (RIP) and cytoplasmic splicing, and briefly
summarize the ER stress-related diseases.
ER stress-inducing chemicals
Chemicals such as tunicamycin, thapsigargin, and
dithiothreitol are usually used to evoke ERstress in
cultured cells or animals for experimental purposes. I
will briefly summarize the ER stress-inducing chemicals
below.
The first group of ER stressors comprises glycosyla-
tion inhibitors. Most of the proteins synthesized in
the ER are N-glycosylated, and the N-glycosylation is
cytoplasm
ER
ER chaperone
degraded
ribosome
mRNA
unfolded protein
aggregation
ER stresss
nascent protein
Golgi apparatus
apoptosis folding disease
ERAD
translational attenuation
Fig. 1. Mammalian ERstress response. An accumulation of unfolded proteins in the ER evokes ER stress, and cells induce the ER stress
response to cope. The mammalian ERstress response consists of four mechanisms: (1) translational attenuation; (2) expression of ER chap-
erones; (3) enhanced ERAD; (4) apoptosis.
H. Yoshida ERstressand diseases
FEBS Journal 274 (2007) 630–658 ª 2007 The Author Journal compilation ª 2007 FEBS 631
often essential for protein folding. Thus, chemicals that
disturb N-glycosylation have the potential to induce
ER stress. Tunicamycin is an antibiotic produced by
Streptomyces lysosuperificus that inhibits N-glycosyla-
tion by preventing UDP-GlcNAc–dolichol phosphate
GlcNAc-phosphate transferase activity [5,6]. 2-Deoxy-
d-glucose is also used to inhibit N-glycosylation [7],
but is less efficient than tunicamycin.
Another class of ER stressors is Ca
2+
metabolism
disruptors. As the concentration of Ca
2+
ion in the
ER is kept at a high level andER chaperones such as
BiP require Ca
2+
ions, chemicals that perturb Ca
2+
metabolism in the ER induce ER stress. Ca
2+
ionoph-
ores such as A23187 and the Ca
2+
pump inhibitor,
thapsigargin, are often used to evoke ERstress [5,8].
The third category of ER stressors is reducing
agents. As the lumen of the ER is highly oxidative,
proteins synthesized there can form intermolecular or
intramolecular disulfide bonds between their cysteine
residues. As the formation of disulfide bonds is
important for the folding of secretory proteins, redu-
cing agents that disrupt disulfide bonds evoke ER
stress. Dithiothreitol and 2-mercaptoethanol are often
used to this end [9,10].
Hypoxia is also known to induce ER stress,
although the underlying mechanism is unknown. It is
speculated that a decrease in glucose concentration
induced by hypoxia (because hypoxia induces glyco-
lytic enzymes to sustain ATP production and then cells
consume glucose) inhibits N-glycosylation, leading to
ER stress [11].
ER chaperones
ER chaperones include molecular chaperones and fold-
ing enzymes located in the ER, which are responsible
for the folding of nascent proteins [4,12]. They are also
involved in the unfolding of malfolded proteins in
ERAD. In this section, I will review mammalian ER
chaperones, focusing on recent discoveries.
Binding protein (BiP) ⁄glucose-regulated protein (GRP)78
is a well-known ER chaperone that belongs to the heat
shock protein (HSP)70 family. BiP binds to the hydro-
phobic region of unfolded proteins via a substrate-
binding domain and facilitates folding through
conformational change evoked by the hydrolysis of
ATP by the ATPase domain. Oxygen-regulated pro-
tein (ORP)150 ⁄ GRP170 is an ER chaperone belonging
to the HSP110 family (a HSP70 subfamily), and facili-
tates protein folding via a mechanism similar to
that for BiP. It was originally identified as a pro-
tein expressed in response to hypoxia. ER dnaJ
(ERdj)1, ERdj3 ⁄ human ER-asociated dnaJ (HEDJ),
ERdj4, ERdj5, SEC63, and p58IPK are ER chaper-
ones belonging to the HSP40 family, and modulate the
functions of BiP by regulating its ATPase activity as a
cochaperone. BiP-associated protein (BAP), which is a
member of the GrpE family, also modulates the func-
tions of BiP by enhancing nucleotide exchange.
GRP94 is an ER chaperone belonging to the HSP90
family, and facilitates folding through the hydrolysis
of ATP. FKBP13 is a peptidyl-prolyl isomerase
belonging to the FKBP family. These ER chaperones
are involved in the general folding process of secretory
proteins.
Calnexin and calreticulin are ER chaperones specif-
ically involved in the folding of glycoprotein. High-
mannose type oligosaccharide is attached en bloc to
most proteins synthesized in the ER, and then trimmed
sequentially (Fig. 2). When two glucose residues are
trimmed by glucosidase I or II and the protein con-
tains only one glucose residue, calnexin and calreticulin
bind and fold the client protein. When the last glucose
residue is trimmed by glucosidase II, the client is
released from calnexin and calreticulin, and binds to
UDP-glucose–glycoprotein glucosyltransferase. If the
protein is folded, it is released from the enzyme and
transported to the Golgi apparatus. If it is not folded,
UDP-glucose–glycoprotein glucosyltransferase attaches
one glucose residue and returns it to calnexin and cal-
reticulin. This folding process is called the calnexin
cycle [13]. Calnexin and calreticulin share a similar
molecular structure and function, although they are
transmembrane and luminal proteins, respectively.
Numerous folding enzymes are involved in the forma-
tion of disulfide bonds in the ER, such as protein disul-
fide isomerase (PDI), ERp72, ERp61, GRP58 ⁄ ERp57,
ERp44, ERp29, and PDI-P5. These folding enzymes
oxidize cysteine residues of nascent proteins and help
proteins to form correct disulfide bonds. Reduced fold-
ing enzymes are reoxidized by ER oxidoreductin
(ERO1), which can use molecular oxygen as a terminal
electron acceptor [14].
ERAD
Unfolded or malfolded proteins are trapped by the
ERAD machinery and transported to the cytoplasm
[15–17]. Retrotranslocated proteins are ubiquitinated
and degraded by the proteasome in the cytosol.
Thus, the process of ERAD can be divided into four
steps, recognition, retrotranslocation, ubiquitination,
and degradation (Fig. 3). As ERAD is one of the
hottest topics in the study of ER stress, I will sum-
marize our current understanding of mammalian
ERAD systems.
ER stressanddiseases H. Yoshida
632 FEBS Journal 274 (2007) 630–658 ª 2007 The Author Journal compilation ª 2007 FEBS
Recognition
During the calnexin cycle, the oligosaccharide of nascent
polypeptides contains nine mannose residues. When one
mannose residue is trimmed by a-mannosidase I, nas-
cent polypeptides with eight mannose residues are
released from calnexin or calreticulin and bind to
ER degradation-enhancing a-mannosidase-like pro-
tein (EDEM) (Fig. 2), which discriminates unfolded
proteins from folded proteins [18–22]. There are three
genes for EDEM, and both EDEM1 and EDEM2
are involved in ERAD. EDEM1 is an ER membrane
protein, whereas EDEM2 and EDEM3 are luminal pro-
teins [23–25]. All EDEMs contain the mannosidase-like
Fig. 3. Mammalian ERAD machinery. Unfolded proteins released from the calnexin cycle are captured by a recognition complex containing
EDEM and OS9, moved to the cytosol through retrotranslocation machinery, polyubiquitinated by the E1–E2–E3 system, and degraded by
the proteasome. The precise function of each ERAD component is described in the text.
Glucose
Mannose
GlucNAc
Glc3Man9GlcNAc2-unfolded protein
glucosidase I, II
CNX / CRT
glucosidase II
UDP-GP
Glc1Man9GlcNAc2-unfolded protein
Man9GlcNAc2-unfolded protein
Man9GlcNAc2-folded protein
Man8GlcNAc2-folded protein
Glc1Man8GlcNAc2-unfolded protein Man8GlcNAc2-unfolded protein
ERAD
Golgi apparatus
ER
EDEM
mannosidase I
mannosidase I
Fig. 2. Folding and degradation of glycoprotein. Sugar chains of nascent glycoproteins synthesized in the ER are trimmed by glucosidase I or
II, and polypeptides containing one glucose residue are folded by the calnexin cycle. One mannose residue of polypeptides that is unable to
be folded by the calnexin cycle is removed by mannosidase I, and then the polypeptides are recognized by EDEM and degraded by ERAD.
H. Yoshida ERstressand diseases
FEBS Journal 274 (2007) 630–658 ª 2007 The Author Journal compilation ª 2007 FEBS 633
domain, which may be responsible for recognition of
mannose residues.
Osteosarcoma 9 (OS9) and XTP3-transactivated
gene B (XTP3B) are other ERAD components respon-
sible for the recognition of unfolded proteins [26–28].
OS9 specifically binds to unfolded glycoproteins con-
taining eight (or five) mannose residues. OS9 also
binds to unglycosylated unfolded proteins, suggesting
that it plays a critical role in the recognition of both
glycosylated and unglycosylated proteins. OS9 and
XTP3B [29] contain the mannose-6-phosphate recep-
tor-like domain, which may be critical to the recogni-
tion of mannose residues.
Retrotranslocation
Nascent glycoproteins recognized by EDEM and OS9
as malfolded are destined for the retrotranslocation
machinery [30,31]. Before their retrotranslocation, nas-
cent proteins associate with PDI and BiP to cleave
disulfide bonds and to unfold the partially folded struc-
ture, respectively [32–34]. Although unfolded ER pro-
teins were previously speculated to be retrotranslocated
through the translocon containing Sec61, the molecular
structure of the retrotranslocation machinery remains
elusive. Derlin-1 is a mammalian homolog of yeast
Der1, and thought to be a critical component of the
machinery. Derlin-1 may form a retrotranslocation
channel in the ER membrane and associates with p97
through an adaptor protein, valocin-containing
protein (VCP)-interacting membrane protein 1
(VIMP1) [35]. Derlin-2 and Derlin-3, other Der1 homo-
logs, are also involved in ERAD [35–37], although the
exact underlying mechanism is still unclear.
p97 ⁄ cdc48 ⁄ VCP is a cytosolic AAA-ATPase and
recruits unfolded ER proteins to the cytosol [38,39].
Ubiquitin fusion degradation protein 1 (Ufd1) and
nuclear protein localization 4 (Npl4) bind to p97 as a
cofactor and help p97 to extract unfolded proteins.
The polypeptide portion of unfolded proteins interacts
with p97, whereas the polyubiquitin chains attached to
them are recognized by both p97 and Ufd1 and may
activate the ATPase activity of p97 [40–42].
Ubiquitination
Retrotranslocated (or retrotranslocating) proteins are
ubiquitinated by the E1–E2–E3 ubiquitin system.
Ubiquitin is first conjugated to enzyme E2 by enzyme
E1, and then transferred to ERAD substrates by
enzyme E3. HMG-CoA reductase degradation pro-
tein 1 (HRD1), gp78, and TEB4 ⁄ Doa10 are mem-
brane-anchored E3 ligases involved in ERAD [43–46],
whereas ubiquitin conjugase (UBC)6 and UBE2-
G2 ⁄ UBC7 are E2 conjugase involved in ERAD. UBE1
is an E1 ubiquitin-activating enzyme that is ubiqui-
tously involved in protein degradation by the protea-
some. HRD1 shows a preference for substrates that
contain misfolded luminal domains, whereas Doa10
prefers transmembrane proteins containing misfolded
cytosolic domains (Doa10 also ubiquitinates cytosolic
proteins). These two distinctive ERAD systems are
called ERAD-L (luminal ERAD) and ERAD-C (cyto-
solic ERAD) [47,48]. EDEM and OS9 are thought to
specifically recognize ERAD-L substrates. Actually,
they form distinct ubiquitin–ligase complexes: the
HRD1 complex contains HRD1, OS9, HRD3, Derlin-
1, USA1, UBX2 and p97, whereas the Doa10 complex
consists of Doa10, UBX2 and p97 [49–51]. Substrates
containing misfolded transmembrane domains skip the
interaction to OS9 and HRD3, and directly associate
with the HRD1 complex, which is called the ERAD-M
pathway [49].
However, there are a lot of other E3 ligases involved
in the ERAD, and they preferentially recognize distinct
ERAD substrates. FBX2 (F-box only protein 2) is
another E3 ligase that specifically recognizes N-glycos-
ylated proteins located in the cytosol [52,53]. Parkin is
an E3 involved in Parkinson’s disease (see below). In
the case of cystic fibrosis transmembrane conductance
regulator, its folding status is sequentially monitored
by the two E3 ligase complexes, such as the RMA1
complex and the CHIP (C-terminus of Hsc70-interact-
ing protein) complex [54].
Molecules other than E1–E2–E3 enzymes are also
involved in ubiquitination. UBX2 binds to both p97
and E3 ligases such as HRD1 and Doa10 to recruit
E3 to p97 [55], whereas gp78 directly associates with
p97 [56]. The ubiquitin-domain protein, Herp (homo-
cysteine-induced endoplasmic reticulum protein),
associates with a complex containing HRD1, p97,
Derlin-1, and VCP-interacting membrane pro-
tein [57,58].
Degradation
Retrotranslocated and ubiquitinated proteins are
deglycosylated by peptide–N-glycanase before their
degradation by the proteasome, because bulky glycan
chains may hamper the entrance of substrates into
the proteasome pore. As peptide–N-glycanase is asso-
ciated with Derlin-1, it is possible that deglycosylation
occurs coretrotranslocationally [59]. Deglycosylated
substrates are then delivered to the proteasome. Dsk2
and Rad23 facilitate this delivery of ERAD substrates
[60].
ER stressanddiseases H. Yoshida
634 FEBS Journal 274 (2007) 630–658 ª 2007 The Author Journal compilation ª 2007 FEBS
Response pathways for ER stress
The mammalian ERstress response has four mecha-
nisms: (1) translational attenuation; the enhanced
expression of (2) ER chaperones and (3) ERAD
components; (4) induction of apoptosis. These four
responses are regulated by the regulatory pathways as
described below (Fig. 4).
PERK pathway
PERK is a type I transmembrane protein located in the
ER, which senses the accumulation of unfolded pro-
teins in the ER lumen [61–63]. The luminal portion of
PERK is involved in sensing unfolded proteins,
whereas the cytoplasmic portion contains a kinase
domain. In the absence of ER stress, BiP binds to the
luminal domain of PERK and keeps it from being acti-
vated (Figs 4 and 5A). In response to ER stress, BiP is
released from PERK, and PERK is activated through
oligomerization and trans-phosphorylation [64]. Activa-
ted PERK phosphorylates and inactivates the a-subunit
of eukaryotic translational initiation factor 2 (eIF2a),
leading to translational attenuation. The phosphoryla-
tion of PERK is transient as the protein is dephosphor-
ylated by specific phosphatases such as CReP
(constitutive repressor of eIF2a phosphorylation), pro-
tein phosphatase 2C-GADD34, and p58IPK. CReP is
constitutively expressed, whereas the expression of
GADD34 and p58IPK is induced on ERstress by
PERK and activating transcription factor (ATF)6
pathways, respectively.
Interestingly, translation of the transcription factor
ATF4 is up-regulated by eIF2a-mediated translational
attenuation. There are several small ORFs in the
5¢-UTR of ATF4 mRNA (Fig. 5B). The ribosome first
binds to a 5¢-cap structure, slides on the ATF4
mRNA, and then starts translation at the small ORFs
with unphosphorylated (active) eIF2a. As the ribosome
is released from the ATF4 mRNA upon the termin-
ation of translation at the stop codon of small ORFs,
the ATF4 ORF cannot be translated in the absence of
ER stress. In contrast, as phosphorylated (inactive)
eIF2a cannot start translation, the probability that the
ribosome reaches the ATF4 ORF is increased in the
presence of ER stress. Thus, the translation of ATF4
ER
ER stresss
nucleus
AARE ERSE UPRE
4
SS
66
ER chaperone
ERAD component
CHOP
anti-oxidative stress
translation
6
GA
6 6
6
S2P S1P
ATF6 PERK
pATF6(N)
P
eIF2α
GADD34
p58IPK
CReP
translational
attenuation
?
4 ATF4
IRE1α
S U
DBD
AD
XBP1 pre-mRNA
DBD-AD
mature mRNA
NF-Y
pXBP1(S)
pXBP1(U)
Fig. 4. Mammalian response pathways for ER stress. Three response pathways (PERK, ATF6, and IRE1 pathways) regulate the mammalian
ER stress response. PERK, a transmembrane kinase, phosphorylates eIF2a to attenuate translation, and to up-regulate expression of ATF4,
leading to enhanced transcription of target genes such as CHOP. ATF6, a transmembrane transcription factor, is translocated to the Golgi
apparatus and cleaved by proteases such as S1P and S2P, leading to enhanced transcription of ER chaperone genes. IRE1, a transmem-
brane RNase, splices XBP1 pre-mRNA, and pXBP1(S) translated from mature XBP1 mRNA activates transcription of ERAD component
genes.
H. Yoshida ERstressand diseases
FEBS Journal 274 (2007) 630–658 ª 2007 The Author Journal compilation ª 2007 FEBS 635
is remarkably enhanced in response to ER stress. The
targets of ATF4 include CHOP (C ⁄ EBP homology
protein), a transcription factor involved in the induc-
tion of apoptosis, and proteins involved in amino-acid
metabolism such as asparagine synthetase or those
involved in resistance to oxidative stress [65].
eIF2a is also phosphorylated by other kinases, such
as dsRNA-dependent protein kinase (PKR), GCN2
(general control of amino-acid synthesis 2) and heme-
regulated translational inhibitor. These kinases are
activated by viral infections, amino-acid starvation,
and heme deficiency, respectively, indicating that trans-
lational attenuation and ATF4 induction is induced by
not only ERstress but also these physiological situa-
tions. Thus, the cellular response mediated by the
phosphorylation of eIF2a is called the integrated stress
response and is essential for cell survival [66].
ATF6 pathway
There is another sensor molecule, ATF6, on the ER
membrane [67–70]. ATF6 is a type II transmembrane
protein, the luminal domain of which is responsible for
the sensing of unfolded proteins. The cytoplasmic
portion of ATF6 has a DNA-binding domain con-
taining the basic-leucine zipper motif (bZIP) and a
PERK
IRE1
BiP
BiP
BiP
BiP
phosphorylation oligomerization
A
ER
ATF6
GLS
BiP
GLS
BiP
GLS
translocation to Golgi
B
ATF4 mRNA
ATF4 coding region
small ORFs
CAP
- ER stress
ATF4 mRNA
CAP
eIF2α
small peptide
+ ER stress
ATF4 mRNA
CAP
phosphorylated eIF2α
ATF4 protein
ribosome
eIF2α
Fig. 5. Activation of the PERK pathway. (A)
Activation of PERK, IRE1, and ATF6. In the
absence of ER stress, BiP prevents PERK,
IRE1, and ATF6 from being activated by
binding to these sensors. BiP prevents the
activation of IRE1 and PERK by keeping
them from being oligomerized, whereas BiP
inhibits the translocation of ATF6 by mask-
ing the Golgi-localization signal (GLS). When
BiP is sequestered from sensors by unfol-
ded proteins, these sensor molecules are
activated. (B) Regulation of ATF4 expres-
sion. In the absence of ER stress, most of
the eIF2a is active (not phosphorylated), and
translation starts at the small ORFs, leading
to the release of ribosomes before they
reach the ATF4 ORF. Upon ER stress, most
of the eIF2a becomes inactive (phosphoryl-
ated), and translation rarely starts at the
small ORFs, thus ribosomes can reach the
ATF4 ORF and induce translation of ATF4
protein.
ER stressanddiseases H. Yoshida
636 FEBS Journal 274 (2007) 630–658 ª 2007 The Author Journal compilation ª 2007 FEBS
transcriptional activation domain. In the absence of
ER stress, BiP binds to the luminal domain of ATF6
and hinders the Golgi-localization signal, leading to
inhibition of ATF6 translocation (Fig. 5A) [71–75]. In
response to the accumulation of unfolded proteins, BiP
dissociates from ATF6, and ATF6 is moved to the
Golgi apparatus by vesicular transport (Fig. 4). In the
Golgi apparatus, ATF6 is sequentially cleaved by a
pair of processing proteases called site 1 protease (S1P)
and site 2 protease (S2P), and the resultant cytoplas-
mic portion of ATF6 [pATF6(N)] translocates into the
nucleus. In the nucleus, pATF6(N) binds to a cis-act-
ing element, the ERstress response element (ERSE),
and activates the transcription of ER chaperone genes
such as BiP, GRP94 and calreticulin [68]. The consen-
sus sequence of the ERstress response element is
CCAAT-(N9)-CCACG, and ATF6 binds to the
CCACG portion, whereas a general transcription fac-
tor, NF-Y (nuclear factor Y), binds to the CCAAT
portion.
The cleavage of ATF6 is unique, especially as the
second cleavage by S2P occurs in the transmembrane
region [75]. This process is called regulated intramem-
brane proteolysis (RIP), which is well conserved from
bacteria to mammals (Fig. 6). The most characterized
substrate of RIP is sterol response element-binding
protein (SREBP) [75]. SREBP is a transcription factor
that is located in the ER membrane like ATF6. Upon a
deficiency of sterol, SREBP is transported to the Golgi
apparatus, cleaved by S1P and S2P, and activates the
transcription of genes involved in the biosynthesis of
sterol. Thus, the activation of ATF6 and SREBP is
mainly regulated at the level of vesicular transport. The
regulation of the transport of SREBP has been well
characterized, and regulatory components such as the
sensor-escort protein SCAP (SREBP cleavage-activa-
ting protein) and the anchor protein INSIG (insulin-
induced gene 1) have been identified [76].
There are two genes for ATF6, called ATF6a and
ATF6b, which have a similar function and are ubiqui-
tously expressed [68,77]. Recently, several bZIP tran-
scription factors located in the ERand regulated by
RIP have been reported. cAMP response element-bind-
ing protein H (CREBH) is specifically expressed in
liver, and processed by S1P and S2P in response to
ER stress [78]. CREBH activates the transcription of
acute-phase response genes involved in acute inflam-
matory responses. OASIS (old astrocyte specifically
induced substance) is also cleaved by S1P and S2P in
response to ERstress in astrocytes and activates the
transcription of BiP [79]. A spermatid-specific tran-
scription factor, Tisp40 (transcript induced in spermio-
genesis 40), is also severed by S1p and S2P and
activates the transcription of EDEM [80]. These tissue-
specific ATF6-like molecules may contribute to the ER
stress response.
Fig. 6. Molecules regulated by RIP. RIP is conserved from bacteria to mammals, and is involved in various biological processes. SREBP sen-
ses a sterol deficiency and activates the transcription of genes involved in sterol synthesis. Cleavage of APP by RIP results in the production
of antibody, which is responsible for the onset of Alzheimer’s disease. Notch is a cell surface protein that is cleaved by RIP upon binding
Delta, leading to the activation of target genes involved in differentiation. Bacterial RseA protein anchors a transcription factor, r
E
, to keep it
inactive. In response to accumulation of unfolded proteins in the periplasm, RseA is cleaved by RIP, leading to transcriptional activation of
periplasmic chaperones.
H. Yoshida ERstressand diseases
FEBS Journal 274 (2007) 630–658 ª 2007 The Author Journal compilation ª 2007 FEBS 637
Luman ⁄ LZIP ⁄ CREB3 can be cut by S1P and S2P
and activates the transcription of EDEM through a
cis-acting element, unfolded protein response element
(UPRE), although ERstress cannot induce Luman
RIP [80–82]. CREB4 is transported to the Golgi
apparatus in response to ER stress, is cleaved by S1P
and S2P, and activates the transcription of BiP,
although cleavage is not observed upon ERstress [83].
These ATF6-like molecules, which are insensitive to
ER stress, might be activated in situations other than
ER stressand activate transcription of ER chaperones.
IRE1 pathway
The third sensor molecule in the ER membrane is
IRE1 (inositol requirement 1) [84–86]. The luminal
domain of IRE1 is similar to that of PERK and
involved in the sensing of unfolded proteins, whereas
the cytoplasmic domain contains a kinase domain and
an RNase domain. There are two genes for IRE1,
IRE1a and IRE1b. Upon ER stress, BiP suppression
of IRE1 activation is released, and IRE1 is activated
through dimerization and transphosphorylation (Figs 4
and 5A) [64]. Activated IRE1a converts XBP1 (x-box
binding protein 1) pre-mRNA into mature mRNA by
an unconventional splicing mechanism [69,87]. As the
DNA-binding domain and the activation domain are
encoded in ORFs in XBP1 pre-mRNA, a pro-
tein translated from pre-mRNA [pXBP1(U)] cannot
activate transcription. In contrast, a protein translated
from mature mRNA [pXBP1(S)] activates the tran-
scription of ERAD component genes such as EDEM,
HRD1, Derlin-2, and Derlin-3 through a cis-acting ele-
ment, unfolded protein response element, as these two
ORFs are joined in mature mRNA [37,88,89].
pXBP1(S) also induces the expression of proteins
involved in lipid synthesis andER biogenesis, as well
as the expression of ER chaperones such as BiP,
p58IPK, ERdj4, PDI-P5 and HEDJ [90,91]. Thus,
XBP1 is essential to the function of cells that produce
large amounts of secretory proteins such as pancreatic
b-cells, hepatocytes, and antibody-producing plasma
cells [92–95].
The splicing of XBP1 pre-mRNA by IRE1a is quite
different from conventional mRNA splicing (Fig. 7A)
[69]. Conventional splicing is catalyzed by the spliceo-
some, and the consensus sequence at the exon–intron
border is GU-AG or AU-AC (Chambon’s rule). The
splicing reaction is sequential: the 5¢ site is cleaved first,
then the 3¢ site after a lariat structure is formed. In con-
trast, unconventional splicing of XBP1 pre-mRNA is
catalyzed by IRE1a and RNA ligase, and there is a pair
of stem–loop structures at the exon–intron border
instead of GU-AG or AU-AC. Moreover, the splicing
reaction is not sequential but random.
The most important difference between conventional
and unconventional splicing is where the reaction
occurs (Fig. 7B). Conventional splicing (nuclear spli-
cing) takes place in the nucleus, whereas unconven-
tional splicing (cytoplasmic splicing) occurs in the
cytoplasm. The biological significance of cytoplasmic
splicing is that pre-mRNA used for translation in the
cytoplasm can be spliced when it is necessary to
change the nature of the protein translated from the
mRNA, in response to extracellular or intracellular
signaling. In contrast, as nuclear splicing cannot splice
mRNA exported to the cytoplasm, it is necessary for
pre-mRNA to be transcribed de novo and spliced.
Thus, cytoplasmic splicing would be a very rapid, ver-
satile, and energy-efficient mechanism with minimal
waste as compared with conventional mRNA splicing.
Recently, it was found that pXBP1(U) encoded in
XBP1 pre-mRNA is a negative feedback regulator of
pXBP1(S). Thus, in the case of XBP1, pre-mRNA and
mature mRNA encode negative and positive regula-
tors, respectively, and their expression is switched by
cytoplasmic splicing in response to the situation in the
ER [96].
IRE1b is specifically expressed in epithelial cells
of the gastrointestinal tract, and thought to cleave
rRNA to attenuate translation in response to ER
stress [84]. When IRE1 b– ⁄ – mice were exposed to an
inducer of inflammatory bowel disease, they actually
developed colitis, possibly because of the enhanced
ER stress [97].
Recently, the crystal structure of the luminal domain
of IRE1a was solved [98]. The luminal domain is sim-
ilar in structure to the peptide-binding domain of
major histocompatibility complexes, suggesting the
interesting possibility that it directly senses ER stress
by directly binding unfolded proteins.
Apoptosis-inducing pathways
The accumulation of unfolded proteins in the ER is
toxic to cells. Thus, if the PERK, ATF6, and IRE1
pathways cannot suppress ER stress, an apoptotic
pathway is triggered to ensure survival of the organism
as a last line of defense. A number of pathways have
been reported to be involved in ER stress-induced
apoptosis, and the full induction of apoptosis seems to
require the concomitant activation of several death
pathways, although there remain many arguments over
ER stress-induced apoptosis [99–105]. In this section, I
will briefly summarize the known death pathways,
focusing on recent progress (Fig. 8).
ER stressanddiseases H. Yoshida
638 FEBS Journal 274 (2007) 630–658 ª 2007 The Author Journal compilation ª 2007 FEBS
The most characterized pathway is the CHOP path-
way. CHOP ⁄ GADD153 (growth arrest and DNA
damage 153) is a transcription factor, the expression of
which is induced by the ATF6 and PERK pathways
upon ERstress [70,106,107]. CHOP– ⁄ – cells exhibit
less programmed cell death when faced with ER stress
[108], suggesting that the CHOP pathway is a major
regulator of ER stress-induced apoptosis. As for the
target genes of CHOP, CHOP activates the transcrip-
tion of GADD34, ERO1, DR5 (death receptor 5), and
carbonic anhydrase VI, which seem to be responsible
for apoptosis. GADD34 associated with protein phos-
phatase 2C enhances dephosphorylation of eIF2a and
promotes ER client protein biosynthesis [109], whereas
ERO1, which encodes an ER oxidase, makes the ER a
more hyper-oxidizing environment [110]. DR5, which
encodes a cell surface death receptor, may activate
caspase cascades [111]. Carbonic anhydrase VI may
change the cellular pH, affecting various cellular pro-
cesses [112,113]. However, the exact signaling mechan-
ism from CHOP to apoptosis is still unclear.
The second apoptotic pathway is the IRE1–TRAF2–
ASK1 pathway. The cytoplasmic part of IRE1 binds
to an adaptor protein, TRAF2 (tumor necrosis factor
receptor-associated factor 2), which couples plasma
membrane death receptor to Jun kinase (JNK) and
stress-activated protein kinase (SAPK) [114]. IRE1 and
TRAF2 form a complex with a mitogen-activated
protein kinase kinase kinase, ASK1 (apoptosis signal-
regulating kinase 1), and this IRE1–TRAF2–ASK1
complex is responsible for the phosphorylation and
activation of JNK [115]. Actually, IRE1– ⁄ – cells as
well as ASK1– ⁄ – cells are impaired in the activation
of JNK and apoptosis by ER stress. In contrast,
A
B
Fig. 7. Cytoplasmic splicing. (A) Comparison
between nuclear and cytoplasmic splicing.
Conventional splicing is catalyzed by the
spliceosome in the nucleus, and there is a
consensus sequence at the exon–intron
boundary such as GU-AG or AU-AC. The
splicing reaction is sequential: the 5¢ site is
cleaved first, the lariat structure is formed,
and then the 3¢ site is cleaved. In contrast,
unconventional splicing is catalyzed by IRE1
and RNA ligase in the cytoplasm, there is a
characteristic stem–loop structure at the
boundary, and the splicing reaction is ran-
dom without forming a lariat structure. (B)
Biological significance of cytoplasmic spli-
cing. As nuclear splicing cannot splice pre-
mRNA exported to the cytoplasm, de novo
transcription is required to change the char-
acter of the protein encoded in the pre-
mRNA. In contrast, as cytoplasmic splicing
can splice pre-mRNA that is translated in
the cytoplasm, it can rapidly change the
character of a protein in response to exter-
nal or internal stimuli, without de novo
transcription.
H. Yoshida ERstressand diseases
FEBS Journal 274 (2007) 630–658 ª 2007 The Author Journal compilation ª 2007 FEBS 639
[...]... response to ERstress [143], whereas other pro-apoptotic factors, Bax (Bcl2-associated X protein) and Bak (Bcl-2 homologous antagonist ⁄ killer), are present in the ER membrane as well as the mitochondrial membrane [144,145] During ER stress, Bax and Bak oligomerize and activate caspase-12 Interestingly, Bax and Bak associate with IRE1a and modulate IRE1a function during ERstress [146] Bax and Bak are... the ERAD machinery, enhances degradation of polyQ proteins and suppresses polyQ protein-induced neurodegeneration [208] Judging from these findings, it is probable that ERstress is involved in the onset of polyQ diseases Pelizaeus-Merzbacher disease is a progressive neurodegenerative disorder characterized by a loss of coordination, motor abilities, and intellectual function [209] ERstressand diseases. .. [131] Transcription of IAP-2 andERstressanddiseases XIAP (inhibitor of apoptosis, X-linked), two other IAPs, is up-regulated during ER stress, and cells in which these IAPs have been knocked down are sensitive to ER stress- induced apoptosis [154] Cells overexpressing XIAP or HIAP1 are resistant to ERstress [122,155] These results suggest involvement of IAP proteins in ER stress- induced apoptosis c-Abl... ER quality control machinery and increased ERstress [265] Moreover, up-regulation of ER chaperones protected cardiomyocytes from ER stress- induced apoptosis [266] These findings strongly suggest that the ERstress response is essential for homeostasis of cardiomyocytes Liver diseases Hepatocytes have a well-developed ER structure that is essential for the vigorous synthesis of secretory proteins, and. .. response to ER stress, whereas an anti-apoptotic factor, Bcl-xL (Bcl-2-like 1), binds to Bim and inhibits its translocation [150] Bim-knockdown cells are resistant to ERstress The ER- localized anti-apoptotic factor BI-1 (Bax inhibitor-1) inhibits the activation of Bax during ER stress, and BI-1– ⁄ – mice are sensitive to ER stress, whereas mice overexpressing BI-1 are resistant [151] BIK (Bcl2-interacting... induced by ER stress, and knockdown or knockout of WFS1 causes ERstress in pancreatic b-cells [238,239] These findings strongly suggest that ERstress is deeply involved in the onset of IDDM There are several reports suggesting that ERstress is also involved in NIDDM First, obesity, one of the causes of NIDDM, evokes ER stress, and XBP1– ⁄ – mice develop insulin resistance [240], although the underlying... of inflammation is complicated, ERstress is involved in some types of inflammation In inflammation of the central nervous system, interferon-c induces ERstressand apoptosis of oligodendrocytes [250] Interestingly, PERK+ mice show enhanced central nervous system hypomyelination and oligodendrocyte loss, suggesting that the PERK pathway has a protective role against interferon-c-induced apoptosis In the... induces ERstress in neurons and activates the ATF6, IRE1 and PERK pathways [261], leading to the CHOP-mediated apoptosis of neurons [262] Ischemia also induces ERstressand the expression of ER chaperones in the heart, leading to degeneration of cardiomyocytes [263], suggesting that ERstress is involved in the development of ischemic heart disease (see below) Heart diseases It has been reported that ER. .. findings on how ERstress is involved in conformational diseases Neurodegenerative diseases Neurons are thought to be sensitive to protein aggregates, and there are many reports that ERstress is involved in neurodegenerative diseases [182–184] In fact, disruption of SIL1 ⁄ BAP, a cochaperone of BiP, results in the accumulation of protein aggregates and neurodegeneration [184] Most of these diseases are... FEBS 645 ERstressanddiseases H Yoshida ERstress is also involved in hepatocarcinogenesis [272–274] In human hepatocellular carcinoma, the ATF6 and IRE1 pathways are activated, and expression of BiP is markedly increased, suggesting that the transformation of hepatocytes induces ER stress, and cells cope with the stress by activating the ERstress response pathways cells of patients with hereditary . endoplasmic reticulum; ERAD, ER- associated
degradation; ERdj, ER dnaJ; ERO1, ER oxidoreductin; ERp72, ER protein 72; ERSE, ER stress response element; FKBP13,. hypoxia. ER dnaJ
(ERdj)1, ERdj3 ⁄ human ER- asociated dnaJ (HEDJ),
ERdj4, ERdj5, SEC63, and p58IPK are ER chaper-
ones belonging to the HSP40 family, and modulate