Cell clones were derived by treatment of HL-60 cells with stepwise increasing concentrations of econazole (Ec), an imidazole antifungal that blocks Ca 2؉ influx and induces endoplasmic reticulum (ER) stress-related cell death in multiple mammalian cell types. Clones exhibit 20-to more than 300-fold greater resistance to Ec. Unexpectedly, they also display stable cross-resistance to tunicamycin, thapsigargin, dithiothreitol, and cycloheximide but not doxorubicin, etoposide, or Fas ligand. Phenotypic analysis indicates that the cells display increased store-operated calcium influx and resistance to ER Ca 2؉ store depletion by Ec. E2R2, the most resistant clone, was observed to maintain protein synthesis levels after treatment with Ec or thapsigargin. Expression of GRP78, an ER-based chaperone, was induced by these ER stress treatments but to equal degrees in HL-60 and E2R2 cells. By using microarray analysis, at least 15 ribosomal protein genes were found to be overexpressed in E2R2 compared with HL-60 cells. We also found that ribosomal protein content was increased by 30% in E2R2 as well as other clones. The resistance phenotype was partially reversed by the ribosome-inactivating protein saporin. Therefore, increased store-operated calcium influx, resistance to ER Ca 2؉ store depletion, and overexpression of ribosomal proteins define a novel phenotype of ER stress-associated multidrug resistance.Calcium signals play a central role in many cellular activities including cell movement, secretion, proliferation, gene transcription, and cell death (1, 2). In non-excitable cells, the endoplasmic reticulum (ER) 1 plays a key role in calcium signaling. Receptor-mediated activation of phospholipase C generates the second messenger inositol 1,4,5-triphosphate that diffuses rapidly through the cytosol to interact with inositol 1,4,5-triphosphate receptor on the ER membrane releasing calcium stored in the ER lumen. The resulting depletion of calcium within the ER triggers calcium entry from the extracellular milieu through the plasma membrane. This capacitive or store-operated calcium (SOC) influx (3) serves to both expand the initial calcium signal and replenish the emptied ER store (4, 5). Although the nature of SOC channel remains unclear, the importance of SOC influx in maintaining cell viability has been demonstrated in different studies (6 -13).In addition to its key role in Ca 2ϩ signaling, the ER is a site for protein synthesis, and these two functions intersect under conditions of ER stress. For instance, treatment of cells with thapsigargin (Tg), the inhibitor of the sarcoplasmic/endoplasmic Ca 2ϩ -ATPase responsible for transporting Ca 2ϩ into the ER, rapidly depletes ER Ca 2ϩ stores (14), inhibits the function of Ca 2ϩ -dependent chaperones, and triggers the unfolded protein response (15). Econazole (Ec) is an antifungal imidazole that depletes Ca 2ϩ from the ER of mammalian cells and blocks Ca 2ϩ influx (16, 17). These effects result in sustained depletion of Ca 2ϩ from ER stores and profound inhibition of prot...