Cells

α2-Macroglobulin (A2M), a large tetrameric glycoprotein with a molecular weight of approximately 720 kDa, is a key member of the α-macroglobulin superfamily. Its origin dates back 600–700 million years, positioning A2M as an evolutionary link within the α-macroglobulin family and complement components C3, C4, and C5. Structural predictions of A2M across different species reveal a remarkably high degree of conservation between invertebrates and vertebrates. A2M is abundantly present in the body fluids of both vertebrates and invertebrates, and its diverse biological functions are governed by five key functional domains within its molecular structure. The most well-established role of A2M is the entrapment and inhibition of proteases. Beyond that, it interacts with cytokines, growth factors, and membrane receptors, thereby playing a broad role in immune and inflammatory responses, hemostasis and coagulation, as well as in disease mechanisms and therapeutic processes. This review summarizes the origin and evolution of A2M, its molecular structure and functional domains, principal mechanisms of action, and research progress regarding its functions in both invertebrates and vertebrates. Our goal is to provide new insights and directions for further exploring the functional potential of A2M and its future applications in the treatment of clinical diseases.

The maintenance of endoplasmic reticulum (ER) Ca²⁺ homeostasis is intrinsically linked to the fidelity of protein folding, forming a functional tether that, when disrupted, triggers the Unfolded Protein Response (UPR). This bidirectional axis serves as a critical rheostat for cellular viability, yet its chronic dysregulation underpins the molecular etiology of numerous pathologies, including neurodegeneration, heart failure, and malignant transformation. This review provides a comprehensive interrogation of the Ca²⁺-ER Stress–UPR network, delineating how primary stress sensors—PERK, IRE1alpha, and ATF6—engage in complex feedback loops that either reinstate equilibrium or commit the cell to apoptosis. We specifically examine the PERK-CHOP-SERCA2b inhibitory circuit as a central driver of persistent Ca²⁺ depletion and discuss the role of Mitochondria-Associated Membranes (MAMs) in governing lethal Ca²⁺ transfer. Notably, we move beyond the classical paradigm of CHOP as a terminal apoptotic executioner, incorporating emerging evidence of its context-dependent adaptive functions. By synthesizing mechanistic insights across diverse disease models, this work highlights the transition from adaptive to maladaptive UPR as a universal pathological checkpoint. Ultimately, we evaluate the therapeutic potential of ‘axis-targeted’ interventions, such as SERCA activators and selective UPR modulators, aimed at resolving the underlying Ca²⁺ signaling defects in ER stress-related disorders.

Hepatocellular carcinoma (HCC) remains one of the leading causes of cancer-related mortality; its progression is strongly linked to the liver’s immune microenvironment. T-helper (Th) cells, including Th1, Th2, Th17, and regulatory T cells (Tregs), play pivotal roles in modulating tumour immunity, either promoting or inhibiting tumour growth depending on their functional states and interactions within the tumour microenvironment. Imbalances in Th cell subsets, particularly between pro-inflammatory and immunosuppressive populations, have been associated with HCC progression and poor prognosis. Numerous studies have explored the therapeutic potential of restoring balance among Th cell subsets, focusing on modulating immune responses to improve HCC treatment outcomes. This paper reviews the differentiation and functional roles of Th cell subsets in HCC, exploring their contributions to tumour progression and immune suppression. Furthermore, this study discusses emerging immunotherapies aimed at modulating Th cell populations to improve clinical outcomes for HCC patients. Understanding the intricate roles of Th cells in the tumour microenvironment provides valuable insights for developing novel therapeutic strategies for liver cancer.