protein misfolding diseases
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Most proteins in the cell adopt a compact, globular fold that determines their stability and function. Partial protein unfolding under conditions of cellular stress results in the exposure of hydrophobic regions normally buried in the interior of the native structure.
Interactions involving the exposed hydrophobic surfaces of misfolded protein conformers lead to the formation of toxic aggregates (protein aggregation), including oligomers, protofibrils and amyloid fibrils.
A significant number of human diseases (e.g. Alzheimer disease, Parkinson disease, Huntington disease, amyotrophic lateral sclerosis and type II diabetes) are characterised by protein misfolding and protein aggregation.
Folding in the endoplasmic reticulum (ER) must couple protein-synthesis pathways operating outside of the compartment with ER-assisted folding (ERAF) pathways in the lumen.
Chaperone-mediated folding imbalances that are associated with numerous misfolding diseases, including diabetes, trigger the unfolded-protein response (UPR), using both transcriptional and translational pathways to correct the problem.
Protein Folding Associated Diseases
| Disease | OMIM | Main aggregate component |
| Neurodegenerative diseases | - | - |
| amyotrophic lateral sclerosis 1 (ALS1) | MIM.105400 | Superoxide dismutase 1 (SOD1) (wt or mutant) + Unknown Proteins |
| Alzheimer disease | * | AB peptides (plaques) (APP); tau protein (MAPT) (neurofibrillary tangles NFTs) |
| spongiform encephalopathies | * | Prion protein PrP |
| Parkinson disease | * | alpha-synuclein (SNCA) (wt or mutant) |
| frontotemporal dementias (FTDs) | * | Tau (wt or mutant) (MAPT) |
| familial amyloid polyneuropathy I | * | transthyretin (over 45 mutants) (TTR) |
| familial amyloid polyneuropathy III | MIM.107680 | Apolipoprotein AI (fragments) (APOA1) |
| polyglutamine repeat diseases with neurodegeneration | - | - |
| Huntington disease | MIM.143100 | huntingtin (HTT) |
| X-linked spinal and bulbar muscular atrophy 1 (SMAX1) | MIM.313200 | Androgen receptor (AR) [whole or poly(Q) fragments] |
| spinocerebellar ataxias (SCAs) | * | Ataxins [whole or poly(Q) fragments] |
| spinocerebellar ataxia 17 | MIM.607136 | TATA box-binding protein (TBP) [whole or poly(Q) fragments] |
| amyloidoses | - | - |
| atrial amyloidosis | - | atrial natriuretic factor (ANF) |
| hereditary amyloidosis type 5 (finnish type) | MIM.105120 | gelsolin (GSN) (71 amino acid fragment) |
| familial visceral amyloidosis (amyloidosis type 8) | - | lysozyme (LYZ) (whole or fragments) |
| hemodialysis-related amyloidosis | - | B2-microglobulin |
| hereditary renal amyloidosis | - | Fibrinogen A alpha chain (FGA), transthyretin (TTR), apolipoproteins A1 (APOA1)and A2 (APOA2), lysozyme (LYZ), gelsolin (GSN), cystatin C (CST3) |
| hereditary cerebral amyloid angiopathy | - | cystatin C (CST3) (minus a 10-residue fragment) |
| injection-localised amyloidosis | - | insulin (ISN) |
| medullary carcinoma of the thyroid | - | calcitonin (CALCA) (fragment) |
| primary systemic amyloidosis | - | Ig light chains (IGL and IGK) (whole or fragments) |
| secondary systemic amyloidosis | - | serum amyloid A (SAA) (whole or 76-residue fragment) |
| senile systemic amyloidosis | - | transthyretin (TTR) (whole or fragments) |
| type 2 diabetes | - | amylin (fragment) |
Therapeutics
Over the past five years, outstanding progress has been made in the development of therapeutic strategies targeting these diseases. Three promising approaches include: (1) inhibiting protein aggregation with peptides or small molecules identified via structure-based drug design or high-throughput screening; (2) interfering with post-translational modifications that stimulate protein misfolding and aggregation; and (3) upregulating molecular chaperones or aggregate-clearance mechanisms.
Small-molecule inhibitors could be useful to help rebalance protein synthesis with ERAF pathways through the ribosomal initiating factor eIF2alpha.
Reprogramming stress pathways with drugs provides a potential new approach for balancing ER-protein load with cellular-folding capacity, thus correcting disease.
See also
References
Stefani M.Generic cell dysfunction in neurodegenerative disorders: role of surfaces in early protein misfolding, aggregation, and aggregate cytotoxicity. Neuroscientist. 2007 Oct;13(5):519-31. PMID: 17901260
Rochet JC. Novel therapeutic strategies for the treatment of protein-misfolding diseases. Expert Rev Mol Med. 2007 Jun 28;9(17):1-34. PMID: 17597554
Wiseman RL, Balch WE. A new pharmacology?drugging stressed folding pathways. Trends Mol Med. 2005 Aug;11(8):347-50. PMID: 16005683
Stefani M. Protein misfolding and aggregation: new examples in medicine and biology of the dark side of the protein world. Biochim Biophys Acta. 2004 Dec 24;1739(1):5-25. Review. PMID: 15607113
Stefani M, Dobson CM. Protein aggregation and aggregate toxicity: new insights into protein folding, misfolding diseases and biological evolution. J Mol Med. 2003 Nov;81(11):678-99. PMID: 12942175
Soto C: Protein misfolding and disease; protein refolding and therapy. FEBS Lett 498:204, 2001.