Death Receptor 4

Death receptor 4 (DR4, TNFRSF10A, also TRAIL-R1 or CD261) is one of the two apoptosis-mediating receptors for TRAIL (TNF-related apoptosis-inducing ligand, TNFSF10). DR4 is a type I transmembrane protein with two extracellular cysteine-rich domains and a cytoplasmic death domain; upon TRAIL binding, receptor trimerization recruits FADD and procaspase-8 (or -10) into the death-inducing signaling complex, initiating the extrinsic apoptosis cascade that bypasses p53 and selectively kills transformed cells while sparing most normal tissues. DR4 is expressed broadly on transformed and primary tumor cells of lung, breast, colon, prostate and hematologic origin, forming the mechanistic basis for recombinant TRAIL and agonistic anti-DR4 antibodies (mapatumumab) developed as cancer therapeutics. Single-nucleotide polymorphisms in TNFRSF10A modulate cancer susceptibility and antitumor immunity; tumor resistance to DR4-mediated apoptosis frequently involves DR5 redundancy, c-FLIP overexpression, Bax/Bak defects or caspase-8 loss, prompting combination strategies with sensitizing agents.