Over 30% of cellular proteins are synthesized in the endoplasmic reticulum (ER). Delayed or impaired protein folding causes misfolded proteins accumulation thereby triggering ER stress that is characterized by distension and loss of homeostasis. To overcome the toxicity associated with the accumulation of misfolded proteins and/or their aggregation, the ER induces a cascade of reactions called the unfolded protein response (UPR). Cellular response to UPR restores normal cell function/survival and includes (i) translational attenuation, (ii) induction of ER-resident proteins that assist in protein folding, notably chaperones, (iii) induction of ER-associated degradation machinery, and (iv) ER enlargement to accommodate the large load of unfolded proteins. Translational attenuation is mediated by the double-stranded RNA-activated protein-kinase-like endoplasmic reticulum kinase (PERK) signaling pathway that reduces the activity of the ribosomal initiating factor (eIF2
α) by phosphorylation of its
α-subunit. Induction of ER-resident proteins is mediated by activated transcription factor 6 (ATF6) and inositol requiring kinase 1 (IRE1) receptors. ATF6 activates the transcription of molecular chaperones such as BiP, and IRE1 induces the synthesis of a potent X-box-binding protein 1 (XBP1) and consequently activates the transcription of ER-associated degradation proteins such as EDEM (reviewed in [
43]). If the UPR response fails to restore cellular homeostasis, such as under conditions of prolonged UPR stress, the cell initiates apoptosis. Prolonged ER-stress-induced apoptosis is an important pathologic element of neurodegenerative diseases, diabetes, renal diseases, and atherosclerosis.
H11/HspB8 has basic chaperone activity. Original studies reported its interaction with HspB1 (HSP27) [
33] but this proved to be assay dependent and was not seen in cross-linking and immunoprecipitation assays [
31,
36] that in turn revealed its interaction with itself, HspB2, HspB6,
β-crystallin, HspB3, and HspB7 [
44]. Other proteins shown to interact with H11/HspB8 include Src-associated protein in mitosis 68

kDa (Sam68), which is involved in RNA transportation and processing [
45], Ddx20, that has helicase activity [
46], and
β-crystallin mutants associated with the development of desmin-related cardiomyopathy or myofibrillar myopathy [
47]. H11/HspB8 prevents in vivo aggregation of polyglutamine-containing proteins [
48] and binds amyloid
β-peptides (A 1–42 and A 1–40). However, it only inhibits the death of cardiovascular cells induced by Dutch-type A 1–40 mutants and the role that chaperone activity and/or UPR inhibition plays in protection is still poorly understood [
49]. Two missense mutations, K141E and K141N, correlate with development of distal hereditary motor neuropathy type II (dHMN) [
50] apparently related to decreased chaperone-like activity [
48].
The ability of H11/HspB8 to inhibit UPR is underscored by the finding that it can remove the misfolded mutant superoxide dismutase (mSOD1) [
51] that is involved in the development of familial amyotrophic lateral sclerosis (ALS). ALS is a relatively common and fatal adult motor neuron (MN) disease with a prevalence of 2 per 100,000 individuals. mSOD1 misfolds within the MN endoplasmic reticulum (ER) causing protein aggregates that also contain the proapoptotic transcription factor C/EBP homologous protein (CHOP) and activated (phosphorylated) p38MAPK (pp38MAPK). These aggregates activate UPR, which disrupts the normal protein quality control function of the ER and plays a definitive role in disease initiation [
52]. The mechanism whereby H11/HspB8 removes mSOD1 is still not fully understood and may involve interaction with the co-chaperone Bag-3, Hsc70, and CHIP (chaperone-associated ubiquitin ligase), thereby promoting autophagic removal by CHIP-mediated ubiquitylation [
53]. However, its protective potential in mSOD1 transgenic animals is unclear. Interestingly, ICP10PK has strong protective activity in mSOD1 transgenic animals, as defined by significantly delayed disease onset and progression (
P < 0.001 versus PBS), preserved neuromuscular junctions, and inhibition of MN degeneration (Laing et al., unpublished). Inhibition of mSOD1 aggregate formation () is associated with protection, and studies of neuronally differentiated N2a cells that were stably transfected with the mSOD1 mutant G85R (N2aG85R) indicate that ICP10PK inhibits the formation of protein aggregates that contain mSOD1, pp38MAPK, and CHOP, apparently through its ability to inhibit p38MAPK phosphorylation (). The contribution of the
α-crystallin domain, if any, is unclear, but H11/HspB8 and ICP10PK share the ability to inhibit UPR and regulate disease development.