Chloride channels play an essential role in the physiology of the respiratory system, the gastrointestinal tract, and secretory glands. Their dysregulation underlies debilitating pathologies such as cystic fibrosis, asthma, and certain cancers. The CLCA (Chloride Channel Accessory) gene family is thought to determine severity of these diseases by modulating an unidentified Calcium-activated Chloride Channel (CaCC). Recent evidence indicates Ano1 to be the mediator of strong quintessential calcium-activated chloride current in several cell types. Ano1 is highly expressed in airway epithelium and downregulated in cystic fibrosis patients. Human CLCA2 is also expressed in epithelium of airways and mammary glands, and there it promotes calcium-activated chloride current. Hence, we hypothesized that CLCA2 modulates the conductance of Ano1. We tested this by introducing Ano1 and CLCA2 together or separately into HEK293 cells, which express endogenous Ano1 at a low level. Using whole-cell voltage clamp, we found that CLCA2 enhanced the conductance of the endogenous CaCC. This current was inhibited by a specific inhibitor of Ano1, tannic acid. CLCA2 also increased both the amplitude and the onset rate of the Ano1-mediated current. To determine the mechanism by which CLCA2 amplifies Ano1 mediated current, we used co-immunoprecipitation with or without a protein cross-linking agent and to test whether the interaction if any, was stable or transient, respectively. Neither any interaction, nor any change in Ano1 multimerization was found. We next tested whether CLCA2 enhanced Ano1 conductance by increasing its stability or surface localization. Surface-labelling the cells expressing Ano1 alone or both proteins with biotin, no difference in Ano1 level or surface expression was detected. Ano1 has recently been shown to be activated by intracellular calcium released from endoplasmic reticulum (ER) stores and by subsequent store-operated calcium entry (SOCE). Therefore, we investigated whether CLCA2 could increase intracellular calcium levels. With Fluo-4 dye calcium imaging, we found that CLCA2 expression enhanced both ER calcium stores and SOCE upon exhaustion of intracellular stores, and the SOCE response could be abolished by a specific inhibitor of SOCE, BTP-2. This inhibitor also abolished CLCA2-induced chloride current, establishing that CLCA2 enhances CaCC via SOCE. Moreover, knockdown of CLCA2 in MCF10A cells, that naturally express both proteins, reduced both ER calcium stores and SOCE. Mutations that abolished the metalloprotease activity of CLCA2 or deleted the cytoplasmic tail had little effect on its enhancement of chloride current or intracellular calcium, suggesting that the uncleaved ectodomain was responsible for both effects of CLCA2. Since, the ectodomain is the most conserved region of the protein, we found that another member of the CLCA family, CLCA1, was also effective in enhancing intracellular calcium storage and SOCE. Co-immunoprecipitation studies further revealed that CLCA2 interacts in a ternary complex with mediators of SOCE, STIM1 and ORAI1. These results explain the CaCC-enhancing effects of CLCA family members and suggest a broader role in other calcium-dependent processes. Understanding the modulatory relationship between these molecules may lead to better therapies for airway diseases and Ano1-dependent cancers. Furthermore, the discovery that CLCA2 regulates intracellular calcium levels may explain its effects on cellular differentiation, stress response, and cell death.

Head and neck squamous cell carcinoma (HNSCC) develops in mucous membranes that line the mouth, throat and sinuses. It is the sixth most common cancer worldwide with more than 600,000 new cases diagnosed every year. The 5 year survival of HNSCC patients is less than 50% after initial diagnosis, while median survival after relapse or metastasis is less than one year. Unfortunately, the prognosis of HNSCC has not changed in the last two decades, mostly due to the poor understanding of the mechanism of this disease. New therapeutic targets and agents are in urgent need.