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. == Interactions ==