The endoplasmic reticulum (ER) is a multifunctional organelle required for lipid biosynthesis,
calcium storage, and protein folding and processing. A number of physiological and
pathological conditions, as well as a variety of pharmacological agents, are able to disturb
proper ER function and thereby cause ER stress, which severely impairs protein folding and
therefore poses the risk of proteotoxicity. Specific triggers for ER stress include, for
example, particular intracellular alterations (e.g., calcium or redox imbalances), certain
microenvironmental conditions (e.g., hypoglycemia, hypoxia, and acidosis), high-fat and high-sugar
diet, a variety of natural compounds (e.g., thapsigargin, tunicamycin, and geldanamycin),
and several prescription drugs (e.g., bortezomib/Velcade, celecoxib/Celebrex,
and nelfinavir/Viracept). The cell reacts to ER stress by initiating a defensive process, called the
unfolded protein response (UPR), which is comprised of cellular mechanisms aimed at
adaptation and safeguarding cellular survival or, in cases of excessively severe stress, at
initiation of apoptosis and elimination of the faulty cell. In recent years, this dichotomic stress
response system has been linked to several human diseases, and efforts are underway to
develop approaches to exploit ER stress mechanisms for therapy. For example, obesity and
type 2 diabetes have been linked to ER stress-induced failure of insulin-producing
pancreatic beta cells, and current research efforts are aimed at developing drugs that
ameliorate cellular stress and thereby protect beta cell function. Other studies seek to
pharmacologically aggravate chronic ER stress in cancer cells in order to enhance
apoptosis and achieve tumor cell death. In the following, these principles will be presented
and discussed.