Mechanisms, regulation and functions of the unfolded protein response
Open accessAbstract
Cellular stress induced by the abnormal accumulation of unfolded or misfolded proteins at the endoplasmic reticulum (ER) is emerging as a possible driver of human diseases, including cancer, diabetes, obesity and neurodegeneration. ER proteostasis surveillance is mediated by the unfolded protein response (UPR), a signal transduction pathway that senses the fidelity of protein folding in the ER lumen. The UPR transmits information about protein folding status to the nucleus and cytosol to adjust the protein folding capacity of the cell or, in the event of chronic damage, induce apoptotic cell death. Recent advances in the understanding of the regulation of UPR signalling and its implications in the pathophysiology of disease might open new therapeutic avenues. The unfolded protein response (UPR) comprises a network of signalling pathways that reprogramme transcription, translation and protein modifications to relieve the load of unfolded or misfolded proteins in the endoplasmic reticulum lumen and restore proteostasis. Understanding the regulation of the UPR and the role it has in the pathophysiology of various cell types and organs might open new therapeutic avenues.
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H2O2 accumulation triggers activation of both intrinsic (caspase-9-mediated) and extrinsic (caspase-8-mediated) apoptotic pathways, resulting in DNA fragmentation and cell cycle arrest.
“This triggers the activation of both intrinsic (caspase-9-mediated) and extrinsic (caspase-8-mediated) apoptotic pathways, ultimately resulting in DNA fragmentation and cell cycle arrest [45,46].”
From Role of Regulated Cell Death Pathways in Snakebite Envenomation: Mechanisms, Crosstalk, and Therapeutic Opportunities (2026) · cites this paper as [46]
The 'Cell death control under ER stress' section describes mitochondrial apoptosome formation and death-receptor-5/caspase-8 signalling in ER-stress-induced apoptosis. It does not establish that H2O2 accumulation activates both pathways, identify caspase-9, or link those pathways to DNA fragmentation and cell-cycle arrest. The 'DNA damage response' section mentions cell-cycle arrest in a different context; page numbers are unavailable in our copy. (LLM, conf=0.87)
Experimental — accuracy not yet measuredActivated UPR tries to rescue cells from ER stress by two pathways-PERK/EIF2AK3 reduces protein synthesis, and IRE1/ERN1 increases protein folding.
“This activated UPR tries to rescue cells from ER stress by two pathways—the PERK/EIF2AK3 pathway, which reduces protein synthesis, and the IRE1/ERN1 pathway, which increases protein folding [46].”
From Role of Regulated Cell Death Pathways in Snakebite Envenomation: Mechanisms, Crosstalk, and Therapeutic Opportunities (2026) · cites this paper as [46]
The PERK section says PERK transiently attenuates protein synthesis, and the IRE1α section says IRE1α activates XBP1, which upregulates genes involved in protein folding. But the section on the three UPR branches identifies ATF6α as a third main signalling cascade, so describing the response as occurring by two pathways is incomplete. The supplied copy gives section labels but no page numbers. (LLM, conf=0.86)
Experimental — accuracy not yet measuredCanonical stress responses induce a reduction in protein synthesis.
“Contrary to canonical stress responses that induce a reduction in protein synthesis5,6”
From Proteotoxic stress response drives T cell exhaustion and immune evasion (2025) · cites this paper as [5]
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ER Proteostasis Control of Neuronal Physiology and Synaptic Function
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Self-citationIRE1α–XBP1 signaling in leukocytes controls prostaglandin biosynthesis and pain
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MITOL prevents ER stress‐induced apoptosis by IRE1α ubiquitylation at ER–mitochondria contact sites
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Self-citationBAX inhibitor‐1 regulates autophagy by controlling the IRE1α branch of the unfolded protein response
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Self-citationThe Role of Brain-derived Neurotrophic Factor (BDNF)-induced XBP1 Splicing during Brain Development
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IRE1α prevents hepatic steatosis by processing and promoting the degradation of select microRNAs
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The Hyaluronidase, TMEM2, Promotes ER Homeostasis and Longevity Independent of the UPRER
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Self-citationTransmembrane bZIP Transcription Factors in ER Stress Signaling and the Unfolded Protein Response
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Self-citation
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Research works printed but not linked: 1
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RetractedAlangode, A., Rajasekhar, A., Sabu, J. J., Krishna, S., Anuja, D., Sreeja, A., Remesh, G., Kaladevi, A., & Nair, B. G. (2026) · International Journal of Molecular Sciences · doi:10.3390/ijms27156830
“This activated UPR tries to rescue cells from ER stress by two pathways—the PERK/EIF2AK3 pathway, which reduces protein synthesis, and the IRE1/ERN1 pathway, which increases protein folding [46].”
- Authors
- Hetz, C., Zhang, K., & Kaufman, R. J.
- Affiliations
- Buck Institute for Research on Aging (US)
- Wayne State University (US)
- Sanford Burnham Prebys Medical Discovery Institute (US)
- Corresponding author
- Hetz, Claudio
- Zhang, Kezhong
- Kaufman, Randal J.
- Venue
- Nature Reviews Molecular Cell Biology
- Published
- 2020-05-26
- Volume
- 21
- Issue
- 8
- Pages
- 421-438
- ISSN
- 1471-0072 (ISSN-L)
- 1471-0080
- PMC
- PMC8867924
- OpenAlex
- W3030834164
- Semantic Scholar
- e69807ca7949b3a6a61babc7fbc8afe4f0341b1e
- Cited by
- 2,666
- References
- 248
- Citations by year
- 2026: 480 · 2025: 586 · 2024: 555 · 2023: 412 · 2022: 356 · 2021: 229 · 2020: 44 · 2019: 1 · 2013: 1
- FWCI
- 30.36
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Nature Reviews Molecular Cell Biology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Universidad de Chile (submittedVersion)
- Funders
- National Institutes of Health (2r01dk090313-11a1)
- National Cancer Institute (R01CA198103, P30CA030199)
- National Institute of Diabetes and Digestive and Kidney Diseases (R01DK113171, R24DK110973, R01-DK-090313, R01DK103185, P30DK063491)
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (R01AR066634)
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Cell Biology › Endoplasmic Reticulum Stress and Disease
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Heat shock proteins research
- Life Sciences › Neuroscience › Sensory Systems › Ion Channels and Receptors
- Keywords
- unfolded protein response, endoplasmic reticulum stress, ER proteostasis, protein folding, apoptosis, transcriptional reprogramming, translational regulation, protein modification, disease pathophysiology, therapeutic target
- MeSH terms
- Animals, Endoplasmic Reticulum, Humans, Neoplasms, Proteins, Signal Transduction, Apoptosis, Protein Folding, Unfolded Protein Response, Endoplasmic Reticulum Stress
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