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Therapeutic targeting of BAG3: considering its complexity in cancer and heart disease
Jonathan A. Kirk, Joseph Y. Cheung, Arthur M. Feldman
Jonathan A. Kirk, Joseph Y. Cheung, Arthur M. Feldman
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Review

Therapeutic targeting of BAG3: considering its complexity in cancer and heart disease

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Abstract

Bcl2-associated athanogene-3 (BAG3) is expressed ubiquitously in humans, but its levels are highest in the heart, the skeletal muscle, and the central nervous system; it is also elevated in many cancers. BAG3’s diverse functions are supported by its multiple protein-protein binding domains, which couple with small and large heat shock proteins, members of the Bcl2 family, other antiapoptotic proteins, and various sarcomere proteins. In the heart, BAG3 inhibits apoptosis, promotes autophagy, couples the β-adrenergic receptor with the L-type Ca2+ channel, and maintains the structure of the sarcomere. In cancer cells, BAG3 binds to and supports an identical array of prosurvival proteins, and it may represent a therapeutic target. However, the development of strategies to block BAG3 function in cancer cells may be challenging, as they are likely to interfere with the essential roles of BAG3 in the heart. In this Review, we present the current knowledge regarding the biology of this complex protein in the heart and in cancer and suggest several therapeutic options.

Authors

Jonathan A. Kirk, Joseph Y. Cheung, Arthur M. Feldman

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Figure 3

Sarcomere protein quality control requires BAG3.

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Sarcomere protein quality control requires BAG3.
In the normal heart, th...
In the normal heart, the BAG3-hsp70-hspB8 complex localizes to the Z-disc, where it provides chaperone-assisted selective autophagy for sarcomere proteins, which helps to maintain normal contractile function. However, in heart failure (specifically heart failure with reduced ejection fraction, HFrEF), sarcomere-localized BAG3 levels drop, and thus ubiquitinated proteins are not removed and instead stay imbedded in the sarcomere lattice structure. These nuclear, stress-misfolded proteins contribute to the cellular contractile dysfunction observed in heart failure.

Copyright © 2026 American Society for Clinical Investigation
ISSN: 0021-9738 (print), 1558-8238 (online)

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