Darier's disease (DD) is an autosomal dominant disorder caused by mutations in the ATP2A2 gene, encoding sarco/endoplasmic reticulum Ca 2؉ -ATPase pump type 2b isoform (SERCA2b). Although >100 mutations in the ATP2A2 gene were identified, no apparent relation between genotype/phenotype emerged. In this work, we analyzed 12 DD-associated mutations from all of the regions of SERCA2b to study the underlying pathologic mechanism of DD and to elucidate the role of dimerization in SERCA2b activity. Most mutations markedly affected protein expression, partially because of enhanced proteasome-mediated degradation. All of the mutants showed lower activity than the wild type pump. Notably, several mutants that cause relatively severe phenotype of DD inhibited the activity of the endogenous and the co-expressed wild type SERCA2b. Importantly, these effects were not attributed to changes in passive Ca 2؉ leak, inositol 1,4,5-trisphosphate receptor activity, or sensitivity to inositol 1,4,5-trisphosphate. Rather, co-immunoprecipitation experiments showed that SERCA2b monomers interact to influence the activity of each other. These findings reveal multiple molecular mechanisms to account for the plethora of pathologic states observed in DD and provide the first evidence for the importance of SERCA2b dimerization in pump function in vivo.Darier's disease (DD, 1 OMIM 124200), also known as keratosis follicularis, is an autosomal dominant skin disorder characterized by loss of adhesion between epidermal cells (acantholysis) and abnormal keratinization (1). DD is also associated with an increased prevalence of neuropsychiatric disorders including bipolar disorders, schizophrenia, epilepsy, and mental retardation (1). Recently, mutations in the ATP2A2 gene encoding the sarco/endoplasmic reticulum Ca 2ϩ -ATPase pump type 2b isoform (SERCA2b) have been identified as a cause of DD (2). SERCA2b is a housekeeping protein, which is expressed ubiquitously and is responsible for Ca 2ϩ uptake into the ER, including the agonist-mobilizable Ca 2ϩ pool (3, 4). By determining ER Ca 2ϩ load, the SERCA2 pumps modulate several parameters of the Ca 2ϩ signal. In resting cells, the SERCA2 pump provides the bulk of the dynamic Ca 2ϩ -buffering capacity to prevent large fluctuation in [Ca 2ϩ ] i (5). In stimulated cells, SERCA2 controls the activity of the store-operated Ca 2ϩ influx channel by preventing accumulation of Ca 2ϩ at the mouth of the channels and their inhibition by [Ca 2ϩ ] i (6). SERCA2b reloads the ER with Ca 2ϩ at the end of cell stimulation (5) and between Ca 2ϩ spikes to determine the frequency of Ca 2ϩ oscillations (7), and to control the diverse cellular functions regulated by [Ca 2ϩ ] i and Ca 2ϩ oscillations (8, 9). Alteration in SERCA2 pump function by overexpression in Chinese hamster ovary cells (10) or partial deletion in mice (7) lead to adaptation of the Ca 2ϩ signaling machinery and Ca 2ϩ -regulated cell functions that translates to nearly normal physiological response in the majority of organs and tissues. This co...