Current Molecular Medicine 2011, 11, ???-??? 1
1566-5240/11 $58.00+.00 © 2011 Bentham Science Publishers Ltd.
Converging Pathways in the Occurrence of Endoplasmic
Reticulum (ER) Stress in Huntington’s Disease
R. Vidal1,2, B. Caballero1,2, A. Couve2 and C. Hetz*,1,2,3,4
1Institute of Biomedical Sciences, FONDAP Center for Molecular Studies of the Cell (CEMC); 2Biomedical
Neuroscience Institute, Faculty of Medicine, University of Chile, Santiago, Chile; 3Neurounion Biomedical
Foundation, Santiago, Chile; 4Department of Immunology and Infectious diseases, Harvard School of Public
Health, Boston MA, USA
Abstract: A variety of neurological diseases including Huntington’s disease (HD), Alzheimer’s disease and
Parkinson’s disease share common neuropathology, primarily featuring the presence of abnormal protein
inclusions containing specific misfolded proteins. Mutations leading to expansion of a poly-glutamine track in
Huntingtin cause HD, and trigger its misfolding and aggregation. Recent evidence indicates that alterations in
the secretory pathway, in particular the endoplasmic reticulum (ER), are emerging features of HD. Although it
is not clear how cytoplasmic/nuclear located mutant Huntingtin alters the function of the ER, several reports
indicate that mutant Huntingtin affects many essential processes related to the secretory pathway, including
inhibition of ER-associated degradation, altered ER/Golgi vesicular trafficking and axonal transport, disrupted
autophagy and abnormal ER calcium homeostasis. All these alterations are predicted to have a common
pathological outcome associated to disturbance of protein folding and maturation pathways at the ER,
generating chronic ER stress and neuronal dysfunction. Here, we review recent evidence involving ER stress
in HD pathogenesis and discuss possible therapeutic strategies to target organelle function in the context of
Keywords: Huntington's disease, ER stress, protein misfolding, Unfolded protein response, Huntingtin,
Huntington's disease (HD) is a late-onset autosomal
progressive motor abnormalities and cognitive defects.
The onset of psychiatric symptoms and dementia occur
during early to mid-adult life, and continue in a
relentless downhill course with death usually occurring
twelve to fifteen years after the appearance of the
disease symptoms [1, 2]. Currently, it is not clear what
molecular events trigger the onset of HD and there is
no effective treatment for this pathology.
HD is characterized by a widespread neuronal
dysfunction and selective neurodegeneration in the
central nervous system, particularly in the striatum .
An expansion of a polyglutamine stretch (poly(Q))
within the N-terminal region of Huntingtin (Htt) above
~40 repeats confers dominant toxic properties to the
protein that are deleterious to neurons and possibly
detrimental to normal Htt biological activities [2, 3]. HD
represents one of a growing number of poly(Q)-related
diseases that cause
degeneration, including spinobulbar muscular atrophy,
spinocerebellar ataxias, Machado-Joseph Disease [4,
5]. The human population exhibits an average poly(Q)
of ~18 glutamines on the Huntingtin gene, which does
not confer neurotoxic activity,
exceeding 35 glutamines result in disease development
*Address correspondence to this author at the Institute of Biomedical
Sciences, University of Chile. Independencia 1027, Santiago,
P.O.BOX 70086, Chile; Tel: 56-2-9786506; Fax: 56-2-9786871:
E-mail: firstname.lastname@example.org, email@example.com
in most cases. A direct correlation is observed between
the length of the poly(Q) and the average age of
disease onset , where increased poly(Q) length
accelerates disease onset, and individuals with more
than 60 tandem glutamines usually develop the
disease before the age of twenty .
Since identification of the htt gene mutations in HD
patients, multiple murine genetic models have been
generated to study the mechanisms involved in HD
pathogenesis and to evaluate potential therapies in
preclinical trials . These models include the
generation of transgenic mice expressing N-terminal
fragments of mutant Htt, full length human Htt with
artificial chromosomes or knock-in mouse models with
an expanded poly(Q) track inserted into the mouse htt
gene. Due to the complexity and high degree of
variability in the phenotypes of these animal models in
terms of survival, motor impairment and kinetics of
histological alterations, it is difficult to consolidate most
HD-related experimental findings. For a comprehensive
understanding of the data discussed in this review, we
summarize the fundamental characteristics of the HD
animal models in Table 1.
One of the major histopathological features
observed in HD is the co-localization of Htt inclusions
with ubiquitin [8-10]. In many cases, the formation of
intracellular Htt inclusions precedes neuronal loss [11,
12] and increasing evidence suggests that abnormal
Htt oligomerization (from small soluble oligomers to
large aggregates) is one of the key events leading to
neurotoxicity [11-13]. Nevertheless the pathological
2 Current Molecular Medicine, 2011, Vol. 11, No. 1 Vidal et al.
mechanisms underlying neurodegeneration in HD still
need further research. Different models have been put
forward to explain the detrimental effects of mutant Htt
expression. These models include (i) excitotoxicity [14-
16], (ii) mitochondrial dysfunction/oxidative stress [17-
21], (iii) transcriptional disturbances [22-27], (iv)
proteasome dysfunction [28-30], and (v) altered axonal
transport [31-34]. Besides, increasing evidence in
different HD models suggests that alteration in the
function of the secretory pathway and protein folding
stress at the ER may contribute to the pathogenesis of
HD. Of note, ER stress has also been suggested as a
relevant factor in many other protein conformational
disorders associated with abnormal protein aggregation
(see examples in ). In this review we analyze the
key mechanisms related to adaptation of ER stress or
the elimination of irreversible damaged cells by
apoptosis, and then summarize the specific evidence
linking ER stress to HD pathogenesis. Possible
therapeutic interventions to revert these subcellular/
are discussed in the
THE UNFOLDED PROTEIN RESPONSE (UPR)
Correctly folded proteins that pass the quality
control are transported through the ER to reach their
final destination including the ER itself, the Golgi
apparatus, lysosomes, the endosomal system, the
plasma membrane or
Perturbing ER function
accumulation of unfolded proteins, a condition referred
to as ER stress. ER stress activates the unfolded
protein response (UPR),
transduction pathway that relays information regarding
the protein folding status at the ER lumen to the
nucleus by controlling the expression of specialized
transcription factors. Three distinct types of stress
sensors are located at the ER membrane, namely
double-stranded RNA-activated protein kinase (PKR)-
an integrated signal
like endoplasmic reticulum kinase (PERK), activating
transcription factor 6 (ATF6) ? and ?, and inositol
requiring kinase 1 (IRE1?) (reviewed in ).
Activation of PERK leads to the phosphorylation
and inhibition of eukaryotic translation initiation factor
2? (eIF2?), attenuating protein translation in the ER
and thus decreasing unfolded protein load [37-39]. In
addition, eIF2? phosphorylation augments the specific
translation the mRNA of Activation of Transcription-4
(ATF4), a UPR transcription factor essential for the
upregulation of many UPR-associated genes that
function in amino acid metabolism and redox
homeostasis . IRE1? and its downstream target, X-
Box-binding protein 1 (XBP-1), initiate the more
conserved adaptive response of the UPR. IRE1? is a
Serine/Threonine protein kinase and endoribonuclease
that upon activation initiates the unconventional
splicing of the mRNA encoding the transcription factor
XBP-1 [41-43]. Unconventional splicing leads to the
expression of a stable protein, XBP-1s (XBP-1 spliced),
which is targeted to the nucleus and controls the
upregulation of a subset of UPR-related genes,
including genes linked to folding, protein quality control,
folding, ER-associated degradation (ERAD) system,
and ER/Golgi biogenesis . Activation of ATF6 leads
to its translocation from the ER to the Golgi where it is
proteolytically processed. This event releases its
cytosolic domain which is then translocated to the
nucleus where it functions as a transcription factor that
upregulates several ER chaperones and ERAD-related
genes [44, 45]. In transcriptional control of ERAD
genes, ATF6 heterodimerizes with XBP-1s to form an
active transcription factor . In addition to catalyzing
XBP-1 mRNA processing, IRE1? has other functions in
cell signaling. The cytosolic domain of activated IRE1?
binds to the adaptor protein TRAF2 (TNFR-associated
factor 2), triggering the activation of the Apoptosis
Signal-regulating Kinase 1 (ASK1) and cJun-N terminal
kinase (JNK) pathway [47-49]. The amplitude and
kinetics of IRE1? signaling are modulated by the
Table 1. Summary of the Most Common Animal Models for the Study of HD
Onset Date Death Date Striatum Characteristics Motor Phenotypes Neuronal Loss
148 - 153 5-6 weeks
Early volume reduction.
Rapid Htt aggregation.
128 3 months No lethality
15% volume reduction (9
months). Slow and
progressive Htt aggregation.
Inclusions evident after 10
months of age
from 3-4 months
knock-in 111 - 92 4 months No lethality
Slight degeneration and
Intranuclear inclusions after
12 months of age
Gain deficits from
24 months of age
Hdh(CAG)150 knock-in 150 4 months No lethality
Increased gliosis (14
months) and nuclear
Gain and rotarod
Converging Pathways in the Occurrence of Endoplasmic Reticulum Current Molecular Medicine, 2011, Vol. 11, No. 1 3
formation of a protein complex referred as the
UPRosome (reviewed in [36, 50, 51]). Thus, the UPR is
a signaling mechanism that orchestrates adaptive
processes against ER stress to recover cellular
homeostasis, and it is mediated by specialized stress
sensors and transcription
transcriptional reprogramming to maintain protein
factors that allow
CHRONIC ER STRESS, THE APOPTOSIS
Under chronic ER stress, different pro-apoptotic
factors trigger cell death by apoptosis . At the
mitochondria activation of pro-apoptotic BCL-2 family
members, BAX and BAK, initiate intrinsic apoptosis
through the release of cytochrome c and assembly of
the apoptosome . Engagement of BAX/BAK is
mediated by the activation of a subgroup of pro-
apoptotic BCL-2 family members termed BH3-only
proteins . Two BH3-only proteins, PUMA and
NOXA, are strongly induced at the transcriptional level
in cells undergoing prolonged ER stress [55, 56]. In
addition, activation of BIM at the transcriptional and
post-translational level is essential to trigger apoptosis
under chronic ER stress in cellular and animal models
[49, 57]. Activation of ASK1 and its downstream target
JNK have been proposed to partially mediate
mitochondrial-mediated apoptosis under irreversible
ER stress in an analogous fashion to TNF receptor
signaling [58, 59].
Sustained PERK signaling may also have pro-
apoptotic effects under prolonged ER stress conditions
. Expression of ATF4 and possibly ATF6 regulate
the induction of pro-apoptotic genes such as the
CCAAT/enhancer binding protein (C/EBP) homologous
(CHOP), also identified as a growth arrest and DNA
damage-inducible gene (GADD153). The mechanism
by which CHOP leads to cell death is not completely
understood, but it may trigger apoptosis by down
regulating anti-apoptotic BCL-2 , inducing the
transcription of BIM , and by transcriptional control
of GADD34, which interacts with protein phosphatase I
to catalyze eIF2? dephosphorylation to promote the
resumption of protein synthesis in a cell already
burdened by unfolded proteins in the ER . In murine
cells, the proteolytic processing of the ER-resident
caspase-12, and its human homologue caspase-4, are
well accepted markers of ER stress, however their role
in apoptosis is under debate [63, 64]. Recent evidence
suggests that caspase-12 participates in inflammatory
responses and may not operate as a pro-apoptotic
protease like caspase-3 or caspase-9 [64, 65]. Other
components involved in the ER stress-apoptosis
response have been reviewed elsewhere [66, 67].
ER STRESS IN HD MODELS
Htt is expressed in most cell types, and
experimental data suggest that it has essential
functions in brain development in mice . Current
attempts to understand the function of wild type htt
gene indicate that inhibition of its expression with small
interfering RNAs drastically alters the structure of the
ER network and ER trafficking , suggesting that the
physiological function of Htt may be related to the
morphogenesis of this organelle. The occurrence of
UPR downstream responses was recently described in
post-mortem brain samples from HD patients by
observing the transcriptional upregulation of three
UPR-responsive genes, Chop, BiP and Herp . The
17 amino terminal region of Htt forms an amphipathic
?-helical membrane-binding domain that can reversibly
associate with the ER [3, 71]. The Htt/membrane
interaction is dynamic because it is affected by ER
stress [71, 72]. A single point mutation in Htt N-terminal
region predicted to disrupt the ?-helical structure
displayed a striking phenotype of complete inhibition of
poly(Q)-mediated aggregation. This phenotype was
associated with increased Htt nuclear accumulation
and higher mutant Htt toxicity in a striatal-derived
mouse cell line [71, 72]. Atwal and co-workers
proposed the hypothesis that Htt has a physiological
function as an ER-associated protein that alternates
between the nucleus and the ER in response to
cellular/organelle stress .
An early report from Ichijo and co-workers
demonstrated that ER stress activates ASK1 in models
of HD, and cells lacking this protein are protected from
the toxicity of poly(Q)79 peptides . Similarly, the
levels of ASK1 protein and ER stress markers are
increased in the striatum and cortex in HD (R6/2)
transgenic mice  (Fig. 1). Remarkably, inhibition of
ASK1 prevents the translocation of Htt fragments to the
nucleus and improves motor dysfunction in mice. At the
molecular level, a physical interaction between of ASK1
and mutant Htt fragments was detected, which
prevented the translocation of the Htt fragments to the
nucleus, correlating with improved motor function and
reduced neuronal atrophy . Therefore, experimental
strategies to modulate the activity of ASK1 may have
therapeutic benefits in HD patients.
Additional studies in cellular models of HD support
the concept that chronic ER stress contributes to HD-
related neurodegeneration. Expression of expanded
poly(Q) peptides resembling the mutations observed in
Htt triggers the activation of the stress sensors IRE1?
and PERK, and activation of UPR downstream targets
including JNK, ASK1, upregulation of Grp78/Bip,
CHOP, and caspase-12 processing [47, 74, 75].
Induction of the proapoptotic protein BIM has been also
linked to neuronal loss in cellular and animal models of
HD [57, 76-78].
A recent study described the occurrence of
spontaneous ER stress on a striatal cell line derived
from Htt knock-in mice, showing increased basal
expression of BiP, CHOP and PDI . These cells are
strongly sensitized to apoptosis triggered by ER stress-
inducing agents . SCAMP5 was recently identified
as a novel regulator of the accumulation of mutant Htt.
Expression of SCAMP5 is markedly increased in the
4 Current Molecular Medicine, 2011, Vol. 11, No. 1 Vidal et al.
striatum of HD patients and it is induced in cultured
striatal neurons by ER stress or by the expression of
mutant Htt  (Fig. 1). Moreover, down-regulation of
SCAMP5 alleviates ER stress-induced by mutant Htt
expression. Remarkably, intra striatum injection of the
ER stress agent tunicamycin increases mutant Htt
aggregation in two different HD mouse models .
Expression of Rrs1 is also involved in HD and ER
stress . The induction of Rrs1 expression is an
early event observed in knock-in HD mouse models,
and persists over the course of the disease. Rrs1 is
localized both in the nucleolus and the ER and its
expression is induced by ER stress  (Fig. 1). More
importantly, increased expression of Rrs1 was reported
in post mortem brain samples derived from HD patients
Until now, only three reports are available
describing the engagement of ER stress responses in
vivo in animal models of HD [70, 73, 80]. Besides, the
majority of these studies are correlative and no
functional data exists to demonstrate a functional role
of ER stress/UPR signaling in the progression of
disease in vivo. Genetic
manipulation of the UPR will contribute to understand
how ER stress is regulated in HD and the cellular
consequences of this process.
WHAT CAUSES ER STRESS IN HD?
Although different research groups have provided
evidence for the occurrence of ER stress in HD, the
actual causes of disturbances on the homeostasis of
the ER remain poorly understood. Solving this issue is
particularly relevant since mutant Htt has not been
described inside the ER lumen, although it interacts
with the cytosolic surface of organelle membranes.
This contrasts with observations in other neurological
diseases where mutant misfolded proteins directly
Fig. (1). Alterations of the secretory pathway function in HD: Mutant Htt (mHtt) alters the function of the secretary pathway
at different stages, which may all led to a common alteration of the protein folding status at the ER lumen, triggering chronic ER
stress and neuronal apoptosis. For example (1) mHtt expression increases the levels of ER stress associated with activation of
UPR stress sensors PERK and IRE1?, leading to the upregulation of CHOP, ATF6?, Rrs1 and SCAMP5 and the activation of
pro-apototic protein such as caspase-12 and JNK/ASK. ER stress induced by mHtt may be triggered by (2) ERAD dysfunction
due to a direct interaction with components of this pathway, blocking ERAD activity and accumulation of abnormally folded
protein at the ER. (3) mHtt also alters ER to Golgi apparatus trafficking, which may lead to accumulation in immature protein at
the ER. (4) mHtt disrupts the exit of clathrin coated vesicles from the Golgi apparatus and lysosomal degradation and general
trafficking of several proteins through the secretary pathway. (5) mHtt expression also impairs cargo recognition by
autophagosomes and also the initiation of the autophagy pathway possibly by inhibiting Beclin-1 expression, leading to a
general disturbance in protein homeostasis. (6) mHtt also affects the activity of the ER calcium channels IP3R, which may lead
to perturbed ER calcium homeostasis and abnormal chaperon activity at the ER lumen.
Converging Pathways in the Occurrence of Endoplasmic Reticulum Current Molecular Medicine, 2011, Vol. 11, No. 1 5
accumulate and interact with ER components (see
examples in [35, 81, 82]). Converging evidence
highlights the relevance of the secretory pathway in HD
models, including perturbations at the level of
ERAD/protein quality control mechanisms, ER/Golgi
trafficking, endocytosis, vesicular trafficking,
calcium homeostasis, and
mediated protein degradation (Table 2). All these
defects are predicted to impact the protein folding
status at the ER, generating ER stress. In the following
sections we summarize emerging alternatives to
explain the causes of protein folding stress at the ER in
i. Altered ERAD Generates ER Stress
ERAD is a major mechanism employed by the ER
protein quality control system and the calnexin cycle to
eliminate misfolded or unassembled proteins generated
during the folding process at the ER lumen and
alterations on this process are predicted to trigger ER
stress . The ERAD machinery includes chaperones,
enzymes that select, target, and retrotranslocate
misfolded proteins to the cytoplasm for degradation by
the proteasome system [39, 84, 85]. Susan Lindquist’s
laboratory reported that expression of mutant Htt leads
to a fast defect in ERAD in yeast and mammalian
models of HD  (Fig. 1). This was associated with an
entrapment of essential ERAD proteins by mutant Htt in
yeast, including Npl4, Ufd1, and p97. Ectopic
expression of ERAD components ameliorates mutant
Htt pathogenesis, and significantly reduced the
induction of ER stress in the model . This is the first
report that provides a mechanism to explain the
occurrence of ER stress in HD. The role of ERAD
impartment on Htt pathogenesis has been recently
confirmed . Mutant Htt interacts with gp78 in
mammalian cells. Gp78 is an ER membrane-anchored
ubiquitin ligase (E3) involved in ERAD. This physical
interaction negatively alters the function of gp78,
inhibiting ERAD and resulting in ER stress .
Besides, mutant Htt inhibits proteasome function [87,
88], which also precludes the degradation of ERAD
substrates. Currently, ERAD is the most direct
mechanism described to cause ER stress in HD
cellular models. Of note, another report suggests that a
similar mechanism of disease pathogenesis and ER
stress induction might operate in models of familial
amyotrophic lateral sclerosis [89, 90].
ii. Impairment of Vesicular Trafficking Leads to
Accumulation of Immature Proteins at the ER
The disruption of vesicular trafficking at different
stages, especially between the ER and the Golgi
apparatus, causes the accumulation of cargo vesicles
and may directly affect ER function. Vesicle trafficking
alterations are predicted to trigger the accumulation of
immature proteins at the ER, generating a traffic jam in
the secretory pathway [36, 91]. In fact, a classical
experimental paradigm of ER stress is the treatment of
cells with brefeldin A, which interferes with the
trafficking between the ER and the Golgi apparatus.
An important checkpoint in the secretory pathway is
the vesicular trafficking between the ER and the Golgi
apparatus. Cellular studies have demonstrated that
mutant Htt expression perturbs ER/Golgi trafficking
. Alterations of ER/Golgi trafficking is observed in
Parkinson’s disease models where mutant ?-Synuclein
blocks the exit of vesicles from the ER through
interactions with Rab1, triggering ER stress [86, 93]. Of
note, mutant Htt expression diminishes the ER/Golgi
trafficking of Val-BNDF in striatal mutant Htt knock-in
cell lines . Mutant Htt also perturbs the post-Golgi
trafficking of epidermal growth factor receptor and atrial
natriuretic factor  (Fig. 1). Furthermore, the post-
Golgi trafficking of clathrin-coat vesicles to lysosomes
is impaired in cells expressing mutant Htt  (Fig. 1).
In addition, alterations in the intracellular trafficking and
distribution of the excitatory neurotransmitter receptors
of N-methyl-D-aspartate receptor (NMDAR) subunit 2B
(NR2B) has been reported in models of HD, which may
reflect a general disturbance in secretory pathway
function (Fig. 2) [95-101]. Moreover, evidence for
abnormal trafficking of inhibitory neurotransmitter
receptors also is available in HD models (Fig. 2). A key
mediator of pathological alterations in protein trafficking
Table 2. Summary of the Evidence Describing a Perturbation on the Secretory Pathway Function in Different HD
Secretory Stage Cellular Animal model Human Postmortem
? ? ?
? ? ?
? ? ?
ER calcium homeostasis
6 Current Molecular Medicine, 2011, Vol. 11, No. 1 Vidal et al.
produced by mutant Htt is the inhibition of HAP1 [102-
106]. HAP1 operates as an adaptor that links
GABAARs to the KIF5 kinesin motor, forming a motor
protein complex for rapid delivery of GABAARs to
Htt also interacts with Rab5, an early endosomal
protein . Similarly, one of the Htt interacting
partners, Htt-interacting protein 1 (HIP1), functions as
an endocytic adaptor protein that plays a role in
clathrin-mediated endocytosis and the ligand-induced
internalization of AMPA receptors (AMPARs) [108,
109]. As mentioned before, SCAMP5 is induced in HD
models, and regulates the accumulation of mutant Htt
aggregates . Additionally, SCAMP5 expression
impairs endocytosis, and knocking down SCAMP5
recovers endocytic levels and alleviates ER stress-
induced by mutant Htt. This data suggest a functional
role of endocytosis impairment on the occurrence of
ER stress in HD. It remains to be determined whether
or not reversion of the trafficking defects observed in
HD models attenuates ER stress as shown for
Parkinson’s disease .
Alteration in axonal transport has been consistently
reported in models of HD [110-112], which may also
lead to traffic jam in earlier secretory compartments
(Fig. 2). For example, several studies suggest that wild-
type Htt plays a role in axonal transport and that
disease associated mutations interfere with this
function [103, 113-122]. Loss of Htt expression or the
expression of mutant Htt affect the axonal transport of
BDNF and the amyloid precursor protein (APP) .
Interestingly, Htt and its interacting partner HAP1 have
been reported to physically associate and alter the
function of components of both the anterograde and
Alternatively, mutant Htt may inhibit fast axonal
transport through a mechanism involving activation of
JNK3 and phosphorylation of kinesin-1 . A direct
contribution of axonal transport defects to the
engagement of ER stress responses in HD has not
been provided yet.
transport machinery [105, 124-126].
Compartments Lead to Accumulation of Abnormal
Lysosomal-mediated degradation can be viewed as
the final stage of the secretory pathway, responsible for
removing proteins that traffic through the secretory and
endocytic pathways [128-130]. Macroautophagy, here
referred as autophagy, is a major mechanism for the
components including damaged
organelles, toxic protein aggregates and intracellular
pathogens, and also operates as a survival pathway
against ER stress . Alterations in autophagy are
predicted to trigger the accumulation of misfolded
proteins and ER stress as recently shown in vivo .
Autophagy is characterized by the encapsulation of
cargo on a double-membrane vesicle to form the
autophagosome, in a process controlled by a large
family of autophagy-related genes (termed ATGs).
Autophagy was initially described as an adaptive
cellular mechanism triggered during metabolic stress
conditions, providing nutrients by recycling cellular
components. Recent studies, however, indicate a
crucial role of autophagy as a protein quality control
mechanism in the brain, based on the fact that
selective genetic inactivation of autophagy in the
Defects in Autophagosomal Vesicular
Fig. (2). Vesicle trafficking impairment in HD. mHtt disrupts the protein complex formation between the molecular motors
kinesin and dynein, adaptor proteins and cargo vesicles, inhibiting transport. This alteration in cargo trafficking may generate a
traffic jam during early steps of the secretary pathway triggering ER stress. Altered trafficking of protein such as APP, NMDAR,
BDNF, and GABAR has been reported in HD models.
Converging Pathways in the Occurrence of Endoplasmic Reticulum Current Molecular Medicine, 2011, Vol. 11, No. 1 7
nervous system triggers spontaneous neurodegenera-
tion associated with the accumulation of abnormal
protein inclusions in the brain [132, 133].
Yuan and co-workers demonstrated that mutant Htt
inclusions recruit an essential autophagy regulator,
Beclin-1, possibly impairing Beclin-1 pro-autophagy
activity. Beclin-1 exhibits inclusion-like distribution in
HD-derived post-mortem brain samples, co-localizing
with Htt  (Fig. 1). The authors speculated that this
event might lead to enhancement of mutant Htt
accumulation and general alterations of protein
homeostasis. Interestingly, Ana Maria Cuervo’s group
recently reported that mutant Htt expression leads to a
defect in the recognition of cargo by macroautophagy
in cellular and mouse models of HD  (Fig. 1). This
data was confirmed in lymphoblasts from patients
affected with HD and also in post mortem striatal
samples from HD-affected individuals , suggesting
a general alteration in protein degradation in the
Another recent report indicated that the expression
of full-length Htt lacking its poly(Q) stretch region in a
knock-in mouse model for HD reduces significantly
mutant Htt aggregates, ameliorates motor deficits and
extends lifespan in comparison to an HD mouse model
. This phenotype correlates with enhanced
autophagy by the expression Htt lacking the polyQ
region. Moreover, mice lacking the Htt polyQ region live
significantly longer than
suggesting that autophagy upregulation may be
beneficial both in diseases caused by toxic intracellular
aggregate-prone proteins and also as a lifespan
extender in normal mammals. Finally, in addition to
accumulation of abnormally folded proteins by inhibiting
autophagy, damaged or non-functional organelles,
including ER , may also accumulate in HD due to
summary, increasing evidence suggests that inefficient
autophagy in HD may lead to abnormal accumulation
of substrates, leading to altered protein homeostasis
and possibly to secretory pathway stress.
wild-type mice ,
iv. Deregulation of ER Calcium Homeostasis Alters
ER Protein Folding
Sustained calcium release from the ER negatively
affect the activity of different ER-resident chaperons,
leading to ER stress due to deficiency of protein folding
(reviewed in [138, 139]). ER calcium homeostasis is
primary controlled by different components including
inositol 1,4,5-triphosphate receptors (IP3R), ryanodine
receptors (RyR), the sarco-endoplasmic reticulum
calcium ATPase pump (SERCA) and components of
BCL-2 family proteins [140, 141]. It is interesting to
mention that one of the classical experimental
paradigms of ER stress is the treatment of cells with
thapsigargin, a SERCA inhibitor, which leads to
decreased ER luminal calcium levels.
Expression of mutant Htt also drastically affects
calcium homeostasis both at the level of the
cytosol/plasma membrane and the ER . The N-
terminal membrane targeting sequence of mutant Htt
disrupts cytosolic calcium levels
challenged cell cultures . In addition, cultured
neurons expressing mutant Htt show increased
susceptibility to apoptosis triggered by P2X7-receptor
stimulation . P2X7 are ATP-gated cation channels
known to modulate neurotransmitter release from
neuronal presynaptic terminals. Cultured striatal
neurons derived from full-length mutant Htt transgenic
mice lead to altered calcium signaling and apoptosis
[144, 145]. A yeast two-hybrid screen revealed that
mutant Htt interacts with the IP3R. Further studies
confirmed this interaction in vivo, and showed
enhanced IP3R activity upon interaction with mutant Htt
. These examples, which constitute a small
sample of a large body of literature relating mutant Htt
expression with calcium homeostasis disturbances
[147, 148], suggest a relevant role of disrupted calcium
homeostasis in HD models. Of note, a recent report
indicated that modulation of calcium homeostasis
actually has a clear impact on protein homeostasis on
the context of diseases .
v. Other Possible Mechanisms of ER Stress in HD
In addition to the mechanisms described in the
previous sections, other interesting possibilities remain
to be tested to explain the occurrence of ER stress in
HD. One of the well-documented pathological effects of
mutant Htt in the nucleus is the entrapment of
transcription factors, altering gene expression patterns
[22, 23, 150, 151]. It remains to be determined whether
or not mutant Htt interacts with UPR transcription
factors (i.e. XBP-1, ATF4, ATF6, CHOP). Remarkably,
a recent report suggested that processing of ATF6? is
impaired in both animal models and HD patients ,
which may diminish the ability of neurons to adapt to
ER stress. Besides, wild type Htt may operate as a
stress sensor at the ER membrane since its distribution
is modulated by ER stress . It may be also
interesting to test the possibility that wild type and/or
mutant Htt interacts with UPR stress sensors regulating
their activity. Of note, this mechanism has been shown
to operate in familial ALS models . Another
interesting hypothesis to explore could be related with
the observation that knocking down wild type Htt
specifically disrupts the ER network pattern [69, 154].
Mutant Htt may lead to loss of function of wild-type Htt,
altering the morphogenesis of this organelle and its
broad physiological functions.
Taken together the evidence reviewed above
suggests that mutations in Htt lead to impairment of
protein transport and processing at different stages of
the secretory pathway,
accumulation of immature proteins at the ER.
Therefore, multiple abnormal activities of mutant Htt
may converge to generate ER stress, a common
pathological outcome in the disease process.
possibly resulting in
8 Current Molecular Medicine, 2011, Vol. 11, No. 1 Vidal et al.
HD is a fatal neurodegenerative disease with no
effective treatment. Most clinical trials of drugs
designed and validated in HD mouse models have
failed to alleviate disease progression in HD patients.
This may be explained because they have often
focused in targeting truncated forms of mutant Htt with
high levels of expression or have been tested in
experimental mouse models with a pure genetic
background, a condition far removed from the scenario
observed in humans. The literature addressing the
molecular mechanism of HD is complex and diverse in
terms of possible targets and mechanisms of the
pathology. The key strategy toward designing new
therapeutic strategies may rest on molecular events
that are transversal to different cellular and animal HD
models, with a clear correlate in human HD-derived
In this review, we have attempted to perform a
systematic analysis to uncover a common molecular
feature observed in different cellular and animal HD
models. The data discussed here support an emerging
concept suggesting that secretory pathway-related
processes are major cellular events affected in HD.
Defects in HD neurons are observed almost at every
stage of the secretory pathway, including chaperone-
mediated protein folding, ERAD and related quality
control mechanisms, vesicular transport, ER network
patterning and lysosome-mediated degradation. Most
of these events may generate alterations in the protein
folding process, leading to chronic ER stress. Surely in
vivo and human post-mortem studies are needed to
help define the impact of secretory pathway stress in
HD. However, taken together these data suggest that
experimental strategies to alleviate ER stress or
improve secretory pathway function may benefit HD
Therapeutic strategies to alleviate ER stress may be
achieved by the use of pharmacological approaches
that include treatments with chemical chaperons, small
molecules to activate UPR components, or gene
therapy approaches to deliver key folding mediators
(i.e. chaperones and foldases) to express modulators
of the UPR or quality control mechanisms. In this line,
administration of chemical chaperones, including 4-
PBA and TUDCA [155, 156], delay HD progression in
animal models, and both drugs are efficacious in
decreasing ER stress levels in other disease models
[157-160]. Secondly, secretory pathway stress may be
reduced by targeting degradation or clearance
pathways of misfolded proteins such as ERAD or
autophagy, alleviating the load of unfolded proteins at
diverse stages or sub-compartments of the secretory
pathway. Increasing evidence indicates that mutant Htt
aggregates have a high dependency on autophagy for
their clearance, while wild-type species do not rely on
autophagy for their degradation , and different
pharmacological manipulations to enhance autophagy
increases the clearance of Htt aggregates and delays
the progression of HD in cellular and animal models
[134, 161-166]. Since protein misfolding and ER stress
is an emerging feature of diverse neurological
disorders with high incidence in the human population
including Parkinson and Alzheimer’s disease, it is
predicted that interesting new drug candidates will
emerge to improve progression of disease in HD
This work was primarily supported by High Q
Foundation and CHDI Foundation Inc. In addition we
thank support from FONDECYT no. 110017, FONDAP
grant no. 15010006, Millennium Nucleus no. P07-048-
F, Michael J. Fox Foundation for Parkinson's
Research, Alzheimer’s Association, Genzyme, and
ICGEB (CH); FONDECYT no. 1100137 (AC) and
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