Proteostasis, an emerging therapeutic paradigm for managing inflammatory airway stress disease.

Airways stress diseases (ASDs), including chronic obstructive pulmonary disease (COPD), emphysema and asthma, are predicted to become the third leading cause of morbidity and mortality by 2020. An understanding and the treatment of these diseases will have a high impact on human health and the health system. An emerging area of heathspan impact is the link between ASDs and proteome homeostasis or 'proteostasis', a biological system comprised of > 2000 components that direct the generation, maintenance and removal of proteins to achieve normal function. Alpha-1 antitrypsin deficiency (αA1TD) aggregates activating extracellular folding stress pathways, dysregulation of nuclear factor erythroid 2-related factor 2 (Nrf2) and misprocessing by histone acetyltransferase (HAT)/histone deacetylase (HDAC) pathways represent key examples of proteostasis imbalance involved in ASDs. Common to these events in the lung is a chronic inflammatory response in response to nuclear factor-κB (NF-κB) signaling and protein folding stress associated with an excess of mucus secretion, tissue remodeling, peribronchiolar fibrosis, bronchoconstriction and aveolar destruction. All of these emergent properties of disease are a consequence of imbalance in the proteostasis system. Herein, we discuss the role of proteostasis and its consequences on lung pathophysiology in inflammatory ASDs, and suggest how manipulating the proteostasis network through pharmacological intervention of proteostasis pathways could provide multiple routes for the restoration of lung physiology.