Most
cancer deaths result from progression of
therapy resistant disease, yet our understanding of this phenotype is limited.
Cancer therapies generate stress signals that act upon mitochondria to initiate apoptosis. Mitochondria isolated from
neuroblastoma cells were exposed to tBid or Bim, death effectors activated by therapeutic stress. Multidrug-resistant
tumor cells obtained from children at relapse had markedly attenuated Bak and Bax oligomerization and
cytochrome c release (surrogates for apoptotic commitment) in comparison with patient-matched
tumor cells obtained at diagnosis. Electron microscopy identified reduced ER-mitochondria-associated membranes (MAMs; ER-mitochondria contacts, ERMCs) in
therapy-resistant cells, and genetically or biochemically reducing MAMs in
therapy-sensitive
tumors phenocopied resistance. MAMs serve as platforms to transfer Ca2+ and bioactive
lipids to mitochondria. Reduced Ca2+ transfer was found in some but not all resistant cells, and inhibiting transfer did not attenuate apoptotic signaling. In contrast, reduced
ceramide synthesis and transfer was common to resistant cells and its inhibition induced stress resistance. We identify ER-mitochondria-associated membranes as physiologic regulators of apoptosis via
ceramide transfer and uncover a previously unrecognized mechanism for
cancer multidrug resistance.