The proteasome and its subunits are of clinical significance for at least two reasons: (1) a compromised complex assembly or a dysfunctional proteasome can be associated with the underlying pathophysiology of specific diseases, and (2) they can be exploited as drug targets for therapeutic interventions. More recently, more effort has been made to consider the proteasome for the development of novel diagnostic markers and strategies. An improved and comprehensive understanding of the pathophysiology of the proteasome should lead to clinical applications in the future. The proteasomes form a pivotal component for the
ubiquitin–proteasome system (UPS) and corresponding cellular Protein Quality Control (PQC). Protein
ubiquitination and subsequent
proteolysis and degradation by the proteasome are important mechanisms in the regulation of the
cell cycle,
cell growth and differentiation, gene transcription, signal transduction and
apoptosis. Subsequently, a compromised proteasome complex assembly and function lead to reduced proteolytic activities and the accumulation of damaged or misfolded protein species. Such protein accumulation may contribute to the pathogenesis and phenotypic characteristics in neurodegenerative diseases, cardiovascular diseases, inflammatory responses and autoimmune diseases, and systemic DNA damage responses leading to
malignancies. Several experimental and clinical studies have indicated that aberrations and deregulations of the UPS contribute to the pathogenesis of several neurodegenerative and myodegenerative disorders, including
Alzheimer's disease,
Parkinson's disease and
Pick's disease,
Amyotrophic lateral sclerosis (ALS), and motor neuron diseases, polyglutamine (PolyQ) diseases,
Muscular dystrophies and several rare forms of neurodegenerative diseases associated with
dementia. As part of the
ubiquitin–proteasome system (UPS), the proteasome maintains cardiac protein homeostasis and thus plays a significant role in cardiac
ischemic injury,
ventricular hypertrophy and
heart failure. Additionally, evidence is accumulating that the UPS plays an essential role in malignant transformation. UPS proteolysis plays a major role in responses of cancer cells to stimulatory signals that are critical for the development of cancer. Accordingly, gene expression by degradation of
transcription factors, such as
p53,
c-jun,
c-Fos,
NF-κB,
c-Myc, HIF-1α, MATα2,
STAT3, sterol-regulated element-binding proteins and
androgen receptors are all controlled by the UPS and thus involved in the development of various malignancies. Moreover, the UPS regulates the degradation of tumor suppressor gene products such as
adenomatous polyposis coli (
APC) in colorectal cancer,
retinoblastoma (Rb). and
von Hippel–Lindau tumor suppressor (VHL), as well as a number of
proto-oncogenes (
Raf,
Myc,
Myb,
Rel,
Src,
Mos,
ABL). The UPS is also involved in the regulation of inflammatory responses. This activity is usually attributed to the role of proteasomes in the activation of NF-κB which further regulates the expression of pro inflammatory
cytokines such as
TNF-α, IL-β,
IL-8,
adhesion molecules (
ICAM-1,
VCAM-1,
P-selectin) and
prostaglandins and
nitric oxide (NO). Lastly,
autoimmune disease patients with
SLE,
Sjögren syndrome and
rheumatoid arthritis (RA) predominantly exhibit circulating proteasomes which can be applied as clinical biomarkers. During the antigen processing for the major histocompatibility complex (MHC) class-I, the proteasome is the major degradation machinery that degrades the antigen and present the resulting peptides to cytotoxic T lymphocytes. The immunoproteasome has been considered playing a critical role in improving the quality and quantity of generated class-I ligands. The PSMB8 protein has a significant clinical role in
autoimmune diseases and
inflammatory reactions. For instance, patients with a homozygous
missense mutation (G197V) in the
immunoproteasome subunit, β type 8 (PSMB8) suffered from autoinflammatory responses that included recurrent fever and nodular
erythema together with
lipodystrophy. This mutation increased assembly intermediates of immunoproteasomes, resulting in decreased proteasome function and ubiquitin-coupled protein accumulation in the patient's tissues. In the patient's skin and
B cells,
IL-6 was also highly expressed, and there was a reduced expression of PSMB8. Furthermore, downregulation of PSMB8 also inhibited the differentiation of murine and human
adipocytes in vitro, while an injection of
siRNA against Psmb8 in mouse skin could reduce adipocyte tissue volume. Thus, PSMB8 may be an essential component and regulator not only for inflammation, but also in the differentiation of adipocytes, hereby indicating that immunoproteasomes may have pleiotropic functions to maintain the homeostasis of a variety of cell types. Subsequently, in addition to autoimmune diseases the PSMB8 protein also has been linked in the diagnosis of lipodystrophy syndrome. Glycosylation disorders are sometimes involved. Some genetically determined forms have recently been found to be due to autoinflammatory syndromes linked to a proteasome anomaly through PSMB8. They result in a lipodystrophy syndrome that occurs secondarily with fever,
dermatosis and
panniculitis, and Nakajo-Nishimura syndrome, a distinct inherited inflammatory and wasting disease that is originated from Japan. Patients with Nakajo-Nishimura syndrome, develop periodic high fever and nodular erythema-like eruptions, and gradually progress lipomuscular
atrophy in the upper body, mainly the face and the upper extremities, to show the characteristic thin facial appearance and long
clubbed fingers with joint contractures. == References ==