Abstract
Calreticulin is a pleiotropic molecule that normally resides in the lumen of the endoplasmic reticulum (ER). Here, it has various functions, ranging from regulation of calcium homeostasis to ensuring proper protein folding. More recently, calreticulin gained special interest for its extracellular functions, where it has direct immunomodulatory activity. In this respect, calreticulin activates dendritic cells and macrophages. In addition, certain anti-cancer therapies induce the translocation of calreticulin from the ER to the cell surface of dying cancer cells, where calreticulin dictates the immunogenicity of these cells. Interestingly, treatment with tumor necrosis factor (TNF)-related apoptosis inducing ligand (TRAIL) also induces membrane calreticulin exposure on cancer cells. As shown here, calreticulin directly interacts with TRAIL and its receptor-signaling complex, as well as with other TNF family members. Of note, TRAIL is a well known immunomodulatory molecule, and is expressed on the surface of natural killer T-cells. Therefore, calreticulin may have an as yet unrecognized wide(r) impact on immunity, with the TNF-ligand family modulating virtually all aspects of the immune response.
Introduction
The endoplasmic reticulum (ER)-resident protein calreticulin is a pleiotropic molecule with many functions in the ER, ranging from protein folding, calcium homeostasis, and regulation of loading of antigenic peptides into major histocompatibility class I (MHCI) (, ). Thus, ER-resident calreticulin has an important impact on development and correct execution of immunity. However, in recent years, calreticulin has taken center stage not for its ER-related functions, but for its newly uncovered immunomodulatory effects in the extracellular space. It has become evident that ER chaperones such as calreticulin function as danger associated molecular pattern molecules (DAMPs) once outside the cell (). For instance, when present on the cell surface of dendritic cells (DCs) calreticulin functions as a receptor for autocrine-produced complement factor 1q (C1q), which is upregulated during CD40L/CD40 signaling, a key T helper signal required for effective DC maturation (). In addition, soluble calreticulin promotes differentiation of CD1dhi CD5+ B-cells into antibody-secreting cells (). Further, soluble calreticulin induced TNF-α and IL-6 release from macrophages, which was regulated by scavenger receptor A ().
A further prominent pro-immunogenic feature of extracellular calreticulin is its key role in the process of immunogenic cell death (ICD) (). ICD is a type of apoptosis that is induced by certain chemotherapeutics or radiation, which promotes phagocytic uptake of apoptotic cells by professional antigen presenting cells, i.e., myeloid-derived DCs. Briefly, anthracycline or radiation therapy trigger the translocation of calreticulin to the pre-apoptotic tumor cell surface, which is dependent on the induction of an ER-stress response (, ). Cell surface exposed calreticulin then promotes clearance of the dying cancer cells by DCs, with subsequent release of ATP, HMGB1, and HSP70 from late apoptotic cells giving requisite cues for DC maturation and clonal T-cell expansion ().
Immunogenic cell death has been described in a preclinical setting for an ever-expanding set of cytotoxic therapies, including many chemotherapeutics, radiation therapy, and photodynamic therapy. Interestingly, also treatment of cancer cells with a recombinant form of the tumor necrosis factor (TNF)-related apoptosis inducing ligand (TRAIL) was reported to induce calreticulin exposure and ICD (). TRAIL is a member of the TNF superfamily that can bind to a set of five receptors; TRAILR1 (DR4), TRAILR2 (DR5), TRAIL-R3 (DcR1, TRID), TRAIL-R4 (DcR2, TRUNDD), and soluble osteoprotegerin. Binding of TRAIL to its agonistic receptors TRAILR1 and TRAILR2 induces assembly of the so-called death inducing signaling complex (DISC) to the intracellular death domain (DD). The DISC contains the adaptor molecule Fas-associated protein with death domain (FADD) and the pro-form of initiator caspase-8, which is auto-proteolytically processed in the DISC. Activation of caspase-8 triggers a proteolytic caspase cascade that ultimately leads to the execution of apoptosis. Of note, the pro-apoptotic signaling of the DISC can be inhibited by recruitment of additional regulators, such as cFLIP ().
TNF-related apoptosis inducing ligand is an important immune effector molecule that is expressed on various types of immune cells including natural killer (NK) cells, T-cells, and natural killer T-cells (NKT cells) (). Expression of TRAIL on T-cells is further increased during T-cell receptor (TCR) stimulation in the presence of interferon-γ (IFNγ) (). Similarly, IFNγ-mediated activation of NK-cells, monocytes, and DCs enhances the expression of TRAIL on these cells (, ). TRAIL and its receptors (TRAILRs) play an important role in anti-tumor immunity, e.g., being involved in the immune surveillance for (metastatic) cancer cells by liver NK-cells (). Thus, the induction of calreticulin exposure upon treatment with recombinant TRAIL may be related to a possible immunoregulatory effect of TRAIL in the context of its normal role on immune effector cells. Interestingly, calreticulin can also interact directly with TRAIL in a catching-type ELISA, as well as with the immunoregulatory TNF family members such as CD40 ligand (CD40L) and FasL (). In contrast, calreticulin did not interact with TNF-α, adiponectin, or CD30L. The reported activation of ICD upon treatment with recombinant TRAIL suggests that calreticulin may regulate the pro-immunogenic effect of TRAIL during anti-tumor immunity.
Calreticulin Directly Interacts with Pro-Apoptotic TNF-Ligands and Receptor Complexes
Calreticulin was recently reported to bind to TNF family member FasL in the synovial fluid of rheumatoid arthritis (RA) patients. This FasL/calreticulin interaction inhibited FasL-induced apoptosis of Jurkat T-cells (). Since patients with RA have elevated levels of calreticulin in their serum, this might inhibit apoptosis of inflammatory T-cells in this particular disease. Our own studies confirm a similar direct interaction of calreticulin with TRAIL, as evidenced by, e.g., fluorescent microscopy for calreticulin and TRAIL on the cell surface of TRAIL-treated A375M melanoma cells and not in control cells (Figure 1A). This is in line with the reported translocation of calreticulin to the cell surface of apoptotic HeLa cells by recombinant TRAIL (). Interestingly, calreticulin also strongly co-localized with TRAILR2 on TRAIL-treated A375M cells (Figures 1B,C), with calreticulin, TRAIL, and TRAILR2 all being in one complex co-precipitated upon anti-HA-TRAIL immunoprecipitation experiments (Figure 1D). Similarly, calreticulin was immunoprecipitated in the FasL/Fas DISC (data not shown). The association of calreticulin with TRAILR2 occurs in a clear patched pattern on the cell surface (Figures 1B,C), a pattern corresponding to that of the patched foci to which calreticulin redistributed on the cell membrane of apoptotic neutrophils (), on mitoxantrone treated CT26 colon cancer cells (), and hypericin-treated bladder cancer cells ().
Figure 1
The recruitment of calreticulin in distinct patches on the cell membrane has been shown to facilitate engulfment of apoptotic cells by phagocytes induced by UV radiation or anthracycline therapy (
Figure 2

Immunomodulatory role of calreticulin in cancer immunity (A). In (tumor) cells, calreticulin predominantly resides in the ER. Upon induction of immunogenic cell death (ICD) by, for instance, anthracycline or radiation therapy, calreticulin translocates to the surface of pre-apoptotic cells. In addition, surface exposed calreticulin (eat me signal) dissociates from CD47 (don’t eat me signal), whereupon the apoptotic cancer cells can be recognized and taken up by DCs. (B) The binding of TRAIL to its receptor (TRAILR2) results in the translocation of calreticulin to the cell surface of cancer cells, whereby a complex is formed between TRAIL, TRAILR2–DISC, and calreticulin. Simultaneously, calreticulin dissociates from CD47. The formation of the TRAIL/TRAILR2/Calreticulin-complex may have different outcomes: (1) As described for the concept of ICD, cell surface exposure of calreticulin and dissociation from CD47 induced by TRAIL treatment may facilitate phagocytic uptake by DCs. (2) the binding of calreticulin to TRAIL and TRAILR2 may impair phagocytic clearance by DCs, as calreticulin may be segregated away from the membrane microdomains in which it can partake in the phagocytic uptake by DCs.
Calreticulin is Recruited to Active Signaling Complexes of the TNFR Superfamily
In an earlier study on TNFR-signaling, surface expressed calreticulin was reported to be recruited to TNF receptor 1 (TNFR1) and its adaptor TNFR-associated death domain (TRADD) upon treatment with bacterial peptidoglycan N-acetylmuramyl-l-alanyl-d-isoglutamine (l,d-MDP) (
Calreticulin Association with the TRAILR2–DISC Depends on Raft Reorganization but is Independent of Apoptotic Signaling
During ICD with mitoxantrone, the maximum level of surface exposed calreticulin was observed within 15 min, and remained at stable levels for at least 24 h (
During ICD, the actin cytoskeleton was required for translocation of calreticulin to the pre-apoptotic cell surface (
Conclusion/Future Directions
It is clear from literature that treatment of cancer cells with TRAIL can induce calreticulin relocalization to the cell surface. Further, as evidenced by the data in the current manuscript, surface calreticulin is recruited to the TRAIL/TRAILR/DISC complex and dissociates from CD47. Together, these observations suggest that calreticulin could promote phagocytosis of apoptotic cells upon TRAIL-mediated killing (Figure 2B). On the other hand, its association with the TRAILR2–DISC might render calreticulin unable to effectuate pro-immunogenic removal of target cells by DCs. In this respect, it is tempting to speculate that by binding to the TRAILR2–DISC, calreticulin is segregated away from the membrane microdomains in which it can partake in the phagocytic uptake of target cells by DCs or other phagocytes (Figure 2B). These findings would be consistent with the non-immunogenic clearance of cells undergoing TRAIL-mediated programed cell death (
The inhibition of FasL-mediated T-cell death by calreticulin, the direct induction of apoptosis by l,d-MDP-bound calreticulin via TNFR1 and the here described association of calreticulin to TRAILR2 during TRAIL-mediated cell death suggest a much broader role for calreticulin in the antitumor immune response than as a mediator of ICD. By directly modulating apoptosis and associating with key apoptotic players, calreticulin could function as a bridge between innate and adaptive immunity. In this paradigm, induction of programed cell death by immune effector molecules, such as TRAIL and FasL, induces a rapid pre-apoptotic translocation of calreticulin to the cell surface. On the cell surface, calreticulin can then either modulate induction of cell death as described for FasL (
Calreticulin exposure can further trigger activation of the adaptive immune response by promoting immunogenic DC-uptake of apoptotic cells during ICD. In this respect, it is also of interest that of all the TNF ligands it was found to interact with in a catching-type ELISA, calreticulin most strongly associated with CD40L. Thus, recruitment of calreticulin to CD40L/CD40 signaling complexes may impact DC activity. Whether calreticulin directly associates with TNF family members beyond CD40, FasL, and TRAIL has not been identified, to date. However, the reported interaction of calreticulin with several TNF-ligand family members points to the possibility that calreticulin may have an as yet unrecognized wide(r) impact on immunity, with the TNF ligand family modulating virtually all aspects of the immune response.
Statements
Acknowledgments
This work was supported by Dutch Cancer Society grants RUG 2009-4355 (EB), RUG2009-4542, RUG2011-5206, RUG2012-5541, RUG2013-6209 (to EB/WH), the Netherlands Organization for Scientific Research (EB), and the European Communities Seventh Framework Programme (FP7/2007-2013) under grant agreement 215009 RedCat (PE).
Conflict of interest
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
References
1
MichalakMMilnerREBurnsKOpasM. Calreticulin. Biochem J (1992) 285:681–92.
2
EggletonPMichalakM. Calreticulin for better or for worse, in sickness and in health, until death do us part. Cell Calcium (2013) 54:126–31.10.1016/j.ceca.2013.05.006
3
KryskoDVGargADKaczmarekAKryskoOAgostinisPVandenabeeleP. Immunogenic cell death and DAMPs in cancer therapy. Nat Rev Cancer (2012) 12:860–75.10.1038/nrc3380
4
BaruahPDumitriuIEMalikTHCookHTDysonJScottDet alC1q enhances IFN-gamma production by antigen-specific T cells via the CD40 costimulatory pathway on dendritic cells. Blood (2009) 113:3485–93.10.1182/blood-2008-06-164392
5
ZhangTXiaYZhangLBaoWHongCGaoXM. CD1d(hi)CD5(+) B cells differentiate into antibody-secreting cells under the stimulation with calreticulin fragment. Protein Cell (2013) 4:872–81.10.1007/s13238-013-3062-5
6
DuoCCGongFYHeXYLiYMWangJZhangJPet alSoluble calreticulin induces tumor necrosis factor-alpha (TNF-alpha) and interleukin (IL)-6 production by macrophages through mitogen-activated protein kinase (MAPK) and NFkappaB signaling pathways. Int J Mol Sci (2014) 15:2916–28.10.3390/ijms15022916
7
ObeidMTesniereAGhiringhelliFFimiaGMApetohLPerfettiniJLet alCalreticulin exposure dictates the immunogenicity of cancer cell death. Nat Med (2007) 13:54–61.10.1038/nm1523
8
MartinsIKeppOSchlemmerFAdjemianSTaillerMShenSet alRestoration of the immunogenicity of cisplatin-induced cancer cell death by endoplasmic reticulum stress. Oncogene (2011) 30:1147–58.10.1038/onc.2010.500
9
GargADKryskoDVVerfaillieTKaczmarekAFerreiraGBMarysaelTet alA novel pathway combining calreticulin exposure and ATP secretion in immunogenic cancer cell death. EMBO J (2012) 31:1062–79.10.1038/emboj.2011.497
10
ApetohLGhiringhelliFTesniereAObeidMOrtizCCriolloAet alToll-like receptor 4-dependent contribution of the immune system to anticancer chemotherapy and radiotherapy. Nat Med (2007) 13:1050–9.10.1038/nm1622
11
PanaretakisTKeppOBrockmeierUTesniereABjorklundACChapmanDCet alMechanisms of pre-apoptotic calreticulin exposure in immunogenic cell death. EMBO J (2009) 28:578–90.10.1038/emboj.2009.1
12
BremerE. Targeting of the tumor necrosis factor receptor superfamily for cancer immunotherapy. ISRN Oncol (2013) 2013:371854.10.1155/2013/371854
13
FalschlehnerCSchaeferUWalczakH. Following TRAIL’s path in the immune system. Immunology (2009) 127:145–54.10.1111/j.1365-2567.2009.03058.x
14
KayagakiNYamaguchiNNakayamaMEtoHOkumuraKYagitaH. Type I interferons (IFNs) regulate tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) expression on human T cells: a novel mechanism for the antitumor effects of type I IFNs. J Exp Med (1999) 189:1451–60.10.1084/jem.189.9.1451
15
GriffithTSWileySRKubinMZSedgerLMMaliszewskiCRFangerNA. Monocyte-mediated tumoricidal activity via the tumor necrosis factor-related cytokine, TRAIL. J Exp Med (1999) 189:1343–54.10.1084/jem.189.8.1343
16
FangerNAMaliszewskiCRSchooleyKGriffithTS. Human dendritic cells mediate cellular apoptosis via tumor necrosis factor-related apoptosis-inducing ligand (TRAIL). J Exp Med (1999) 190:1155–64.10.1084/jem.190.8.1155
17
CretneyETakedaKYagitaHGlaccumMPeschonJJSmythMJ. Increased susceptibility to tumor initiation and metastasis in TNF-related apoptosis-inducing ligand-deficient mice. J Immunol (2002) 168:1356–61.10.4049/jimmunol.168.3.1356
18
DuusKPaghRTHolmskovUHojrupPSkovSHouenG. Interaction of calreticulin with CD40 ligand, TRAIL and Fas ligand. Scand J Immunol (2007) 66:501–7.10.1111/j.1365-3083.2007.01999.x
19
TarrJMWinyardPGRyanBHarriesLWHaighRVinerNet alExtracellular calreticulin is present in the joints of patients with rheumatoid arthritis and inhibits FasL (CD95L)-mediated apoptosis of T cells. Arthritis Rheum (2010) 62:2919–29.10.1002/art.27602
20
GardaiSJMcPhillipsKAFraschSCJanssenWJStarefeldtAMurphy-UllrichJEet alCell-surface calreticulin initiates clearance of viable or apoptotic cells through trans-activation of LRP on the phagocyte. Cell (2005) 123:321–34.10.1016/j.cell.2005.08.032
21
PanaretakisTJozaNModjtahediNTesniereAVitaleIDurchschlagMet alThe co-translocation of ERp57 and calreticulin determines the immunogenicity of cell death. Cell Death Differ (2008) 15:1499–509.10.1038/cdd.2008.67
22
GargADKryskoDVVandenabeelePAgostinisP. Hypericin-based photodynamic therapy induces surface exposure of damage-associated molecular patterns like HSP70 and calreticulin. Cancer Immunol Immunother (2012) 61:215–21.10.1007/s00262-011-1184-2
23
de BruynMRybczynskaAAWeiYSchwenkertMFeyGHDierckxRAet alMelanoma-associated chondroitin sulfate proteoglycan (MCSP)-targeted delivery of soluble TRAIL potently inhibits melanoma outgrowth in vitro and in vivo. Mol Cancer (2010) 9:301.10.1186/1476-4598-9-301
24
PaidassiHTacnet-DelormePVerneretMGaboriaudCHouenGDuusKet alInvestigations on the C1q-calreticulin-phosphatidylserine interactions yield new insights into apoptotic cell recognition. J Mol Biol (2011) 408:277–90.10.1016/j.jmb.2011.02.029
25
ObeidM. ERP57 membrane translocation dictates the immunogenicity of tumor cell death by controlling the membrane translocation of calreticulin. J Immunol (2008) 181:2533–43.10.4049/jimmunol.181.4.2533
26
ChaoMPJaiswalSWeissman-TsukamotoRAlizadehAAGentlesAJVolkmerJet alCalreticulin is the dominant pro-phagocytic signal on multiple human cancers and is counterbalanced by CD47. Sci Transl Med (2010) 2:63ra94.10.1126/scitranslmed.3001375
27
JaiswalSJamiesonCHPangWWParkCYChaoMPMajetiRet alCD47 is upregulated on circulating hematopoietic stem cells and leukemia cells to avoid phagocytosis. Cell (2009) 138:271–85.10.1016/j.cell.2009.05.046
28
ChenDTexadaDEDugganCLiangCRedenTBKooragayalaLMet alSurface calreticulin mediates muramyl dipeptide-induced apoptosis in RK13 cells. J Biol Chem (2005) 280:22425–36.10.1074/jbc.M413380200
29
GreenDRFergusonTZitvogelLKroemerG. Immunogenic and tolerogenic cell death. Nat Rev Immunol (2009) 9:353–63.10.1038/nri2545
30
DiehlGEYueHHHsiehKKuangAAHoMMoriciLAet alTRAIL-R as a negative regulator of innate immune cell responses. Immunity (2004) 21:877–89.10.1016/j.immuni.2004.11.008
Summary
Keywords
calreticulin, TNF, tumor necrosis factor related apoptosis inducing ligand, immunomodulation, immunogenic cell death, complex formation
Citation
de Bruyn M, Wiersma VR, Helfrich W, Eggleton P and Bremer E (2015) The Ever-Expanding Immunomodulatory Role of Calreticulin in Cancer Immunity. Front. Oncol. 5:35. doi: 10.3389/fonc.2015.00035
Received
11 December 2014
Accepted
31 January 2015
Published
20 February 2015
Volume
5 - 2015
Edited by
Marek Michalak, University of Alberta, Canada
Reviewed by
Stephan Gasser, National University of Singapore, Singapore; Mohey Eldin El Shikh, Queen Mary University of London, UK; Antonella Sistigu, Istituto Superiore di Sanità, Italy
Copyright
© 2015 de Bruyn, Wiersma, Helfrich, Eggleton and Bremer.
This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Edwin Bremer, Department of Surgery, Translational Surgical Oncology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, BA44, Groningen 9713 GZ, Netherlands e-mail: e.bremer@umcg.nl
†Marco de Bruyn and Valerie R. Wiersma have contributed equally to this work.
This article was submitted to Tumor Immunity, a section of the journal Frontiers in Oncology.
Disclaimer
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.