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.jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117 Clin+J+Am+Soc+Nephrol
2010 ; 5
(7
): 1312-29
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Prospects for mTOR inhibitor use in patients with polycystic kidney disease and
hamartomatous diseases
#MMPMID20498248
Torres VE
; Boletta A
; Chapman A
; Gattone V
; Pei Y
; Qian Q
; Wallace DP
; Weimbs T
; Wüthrich RP
Clin J Am Soc Nephrol
2010[Jul]; 5
(7
): 1312-29
PMID20498248
show ga
Mammalian target of rapamycin (mTOR) is the core component of two complexes,
mTORC1 and mTORC2. mTORC1 is inhibited by rapamycin and analogues. mTORC2 is
impeded only in some cell types by prolonged exposure to these compounds. mTOR
activation is linked to tubular cell proliferation in animal models and human
autosomal dominant polycystic kidney disease (ADPKD). mTOR inhibitors impede cell
proliferation and cyst growth in polycystic kidney disease (PKD) models. After
renal transplantation, two small retrospective studies suggested that mTOR was
more effective than calcineurin inhibitor-based immunosuppression in limiting
kidney and/or liver enlargement. By inhibiting vascular remodeling, angiogenesis,
and fibrogenesis, mTOR inhibitors may attenuate nephroangiosclerosis, cyst
growth, and interstitial fibrosis. Thus, they may benefit ADPKD at multiple
levels. However, mTOR inhibition is not without risks and side effects, mostly
dose-dependent. Under certain conditions, mTOR inhibition interferes with
adaptive increases in renal proliferation necessary for recovery from injury.
They restrict Akt activation, nitric oxide synthesis, and endothelial cell
survival (downstream from mTORC2) and potentially increase the risk for
glomerular and peritubular capillary loss, vasospasm, and hypertension. They
impair podocyte integrity pathways and may predispose to glomerular injury.
Administration of mTOR inhibitors is discontinued because of side effects in up
to 40% of transplant recipients. Currently, treatment with mTOR inhibitors should
not be recommended to treat ADPKD. Results of ongoing studies must be awaited and
patients informed accordingly. If effective, lower dosages than those used to
prevent rejection would minimize side effects. Combination therapy with other
effective drugs could improve tolerability and results.
|Animals
[MESH]
|Disease Models, Animal
[MESH]
|Hamartoma/*drug therapy/enzymology
[MESH]
|Humans
[MESH]
|Intracellular Signaling Peptides and Proteins/*antagonists &
inhibitors/metabolism
[MESH]