Project Summary Charcot-Marie-Tooth Disease (CMT) is a common debilitating hereditary peripheral neuropathy. The hallmark of CMT pathology is severely defective PNS myelin. There is currently no treatment or cure for this disease. Roughly 75% of all cases of CMT are caused by Schwann cell overexpression of wild type (WT) peripheral myelin protein (PMP22) due to trisomy (type 1A CMT), underexpression of PMP22 (for the WT/null case), or genetically dominant heterozygous (WT/mutant) mutations that alter the PMP22 protein sequence (type E CMT or the more severe Dejerine-Sottas Syndrome--DSS). Important questions remain regarding the molecular mechanisms by which these different classes of defects in PMP22 result in different forms of CMT. Here we propose to address key outstanding questions regarding the molecular bases for the different forms of CMT. Aim 1. How does the trafficking and mis-trafficking of WT PMP22 under CMT1A WT overexpression conditions differ from a folding-defective DSS mutant form of PMP22? We will test the hypothesis that misfolded WT PMP22 ends up in the cytosol, whereas DSS mutants such as L16P PMP22 are trapped in the ER or ER-to-Golgi intermediate compartment (ERGIC). Aim 2. Determine the role of the BAG6 complex (BAG6/GET4/UBL4A) in the cytosolic trafficking of WT PMP22. Our preliminary data suggests that WT PMP22, but not DSS mutant forms of PMP22 interacts with the cytosolic BAG6 complex. This aim will test the hypothesis that the BAG6 complex serves as a holdase for misfolded WT PMP22 to facilitate its healthy shuttling to the proteasome, but that excess PMP22 in CMT1A overwhelms the proteasome, resulting in formation of aggresomes, which are eventually degraded by BAG6-induced autophagy. Aim 3. Determine if excess WT PMP22 inhibits specific proteasome complexes and/or induces phosphorylation of eIF2α in myelinating SCs. Prompted by our preliminary data, this Aim will test the hypothesis that overexpression of WT PMP22 in SCs inhibits the 26S proteasome and activates an integrated stress response (ISR), resulting in phosphorylation of eIF2α to suppress protein translation.