IntroductionMantle cell lymphoma (MCL) represents ϳ 5%-10% of all nonHodgkin lymphomas. It is characterized by the expansion of mature B-clonal lymphocytes harboring the t(11;14)(q13;q32) translocation, which induces overexpression of cyclin D1, and consequent cell cycle deregulation. In addition, MCL tumor cells carry a high number of secondary chromosomal and molecular alterations affecting proteins involved in cell cycle progression, senescence, and cellular response to DNA damage. 1 The prognosis for this disease is in most cases extremely poor, with a median survival of 5-7 years. 2 Conventional chemotherapeutic regimens have been the standard treatment of MCL. However, all these strategies are rapidly confronted with the onset of resistance, and allogenic bone marrow transplantation represents the only potential curative approach in young patients. 3 Recently, new therapeutic approaches have been entered into the clinic, and the proteasome inhibitor bortezomib was approved for the treatment of relapsed/refractory MCL. 4 Bortezomib induces a p53-independent cytotoxicity, mediated by the proapoptotic BH3-only protein NOXA, and the generation of reactive oxygen species in MCL cells. 5 Further studies have shown a synergism between bortezomib and the BH3-mimetics, obatoclax and ABT-737, highlighting the relevance of NOXA induction to counteract the protective effect of MCL-1 accumulation in proteasomecompromised cells. 6,7 Hypotheses to explain how MCL cells can acquire resistance to bortezomib include the overexpression and/or accumulation of antiapoptotic BCL-2 proteins, the rise of a bortezomib-resistant nuclear factor-B activity, and an increased proteasomal activity. [8][9][10] Despite these studies, the precise mechanism by which bortezomib-resistant MCL cases could lose the capacity to undergo NOXA-mediated mitochondrial apoptosis remains unclear.A key defect might reside within the endoplasmic reticulum (ER) stress pathway, because its activation in MCL cells exposed to bortezomib has been recently shown to elicit NOXA transcription. 11 ER homeostasis is controlled by the immunoglobulin heavy chain binding protein (BiP), also referred as 78-kDa glucose-regulated protein (Grp78). BiP/Grp78 forms a large multiprotein complex with a set of other ER molecular chaperones, including the heat shock protein of 90 kDa (Hsp90) ER homolog, Grp94, protein disulfide isomerase, calcium binding protein, and cyclophilin B. 12 Under nonstressed conditions, BiP/Grp78 binds to and maintains in an inactive monomeric state the ER transmembrane PKR-like ER kinase, inositol requiring protein 1 (IRE1), and the bZIP activating transcription factor 6. 13,14 After proteasome inhibition, the accumulation of polyubiquitinated and misfolded proteins within the ER lumen leads to BiP/Grp78 dissociation from the luminal domains of these sensor proteins, leading to the initiation of the unfolded protein response (UPR): the cytosolic domain of activating transcription factor 6 is cleaved, enabling the protein to translocate and to activ...