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The integrated stress response pathway and neuromodulator signaling in the brain: lessons learned from dystonia
Nicole Calakos, Zachary F. Caffall
Nicole Calakos, Zachary F. Caffall
Published April 1, 2024
Citation Information: J Clin Invest. 2024;134(7):e177833. https://doi.org/10.1172/JCI177833.
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Review

The integrated stress response pathway and neuromodulator signaling in the brain: lessons learned from dystonia

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Abstract

The integrated stress response (ISR) is a highly conserved biochemical pathway involved in maintaining proteostasis and cell health in the face of diverse stressors. In this Review, we discuss a relatively noncanonical role for the ISR in neuromodulatory neurons and its implications for synaptic plasticity, learning, and memory. Beyond its roles in stress response, the ISR has been extensively studied in the brain, where it potently influences learning and memory, and the process of synaptic plasticity, which is a substrate for adaptive behavior. Recent findings demonstrate that some neuromodulatory neuron types engage the ISR in an “always-on” mode, rather than the more canonical “on-demand” response to transient perturbations. Atypical demand for the ISR in neuromodulatory neurons introduces an additional mechanism to consider when investigating ISR effects on synaptic plasticity, learning, and memory. This basic science discovery emerged from a consideration of how the ISR might be contributing to human disease. To highlight how, in scientific discovery, the route from starting point to outcomes can often be circuitous and full of surprise, we begin by describing our group’s initial introduction to the ISR, which arose from a desire to understand causes for a rare movement disorder, dystonia. Ultimately, the unexpected connection led to a deeper understanding of its fundamental role in the biology of neuromodulatory neurons, learning, and memory.

Authors

Nicole Calakos, Zachary F. Caffall

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Figure 1

ISR pathway and outcomes.

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ISR pathway and outcomes.
The ISR and its intersection, via PERK, with t...
The ISR and its intersection, via PERK, with the UPR (upper left) constitute the 2 major proteostasis pathways. Members of the EIF2α kinase family respond to proteotoxic stress in the ER (PERK), nutrient deficiency in the cytosol (GCN2), viral infections (PKR), and oxidative stress arising from mitochondrial dysfunction (HRI). These 4 kinases share the same substrate, the α subunit of the trimeric translation initiation factor eIF2. Phosphorylation of eIF2α induces broad reprogramming of translation within the cell, preferentially translating mRNAs with certain regulatory upstream open reading frames (uORFs) and broadly reducing the translation of mRNAs without uORFs (6, 7). In addition to marked reduction in total protein translation, this action reduces cellular stress through adaption mediated though preferential translation and transcription of chaperones, proteases, and amino acid synthesis and transport proteins (7). The ISR is kept in check by 2 dedicated phosphatases, CReP and Gadd34, which dephosphorylate eIF2α, either constitutively (CReP) or as a part of the adaptive response to ISR pathway activation (Gadd34). Activating transcription factor 4 (ATF4) is the best-characterized effector of the ISR and promotes diverse outcomes dependent on the duration of the pathway activation and the presence of diverse dimerization partners that determine the broader impact of ATF4 transcriptional activity (93). Prolonged ISR pathway activation may exceed the adaptive response of the cell and lead to controlled cell death via apoptosis. In the CNS, ISR pathway activation has roles beyond response to cellular stresses. In the brain, ISR signaling influences synaptic plasticity, such as long-term depression (LTD) and neuromodulator signaling involving dopamine (DA) and acetylcholine (Ach) (12, 65, 76, 79).

Copyright © 2025 American Society for Clinical Investigation
ISSN: 0021-9738 (print), 1558-8238 (online)

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