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The PI3K/Akt/mTOR pathway in polycystic kidney disease: A complex interaction with polycystins and primary cilium
Jean Piero Margaria1, Carlo Cosimo Campa2, Maria Chiara De Santis1
1Molecular Biotechnology Center, Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino 10126, Italy.
Abstract:
Over-activation of the PI3K/Akt/mTOR network is a well-known pathogenic event that leads to hyper-proliferation. Pharmacological targeting of this pathway has been developed for the treatment of multiple diseases, including cancer. In polycystic kidney disease (PKD), the mTOR cascade promotes cyst growth by boosting proliferation, size and metabolism of kidney tubule epithelial cells. Therefore, mTOR inhibition has been tested in pre-clinical and clinical studies, but only the former showed positive results. This review reports recent discoveries describing the activity and molecular mechanisms of mTOR activation in tubule epithelial cells and cyst formation and discusses the evidence of an upstream regulation of mTOR by the PI3K/Akt axis. In particular, the complex interconnections of the PI3K/Akt/mTOR network with the principal signaling routes involved in the suppression of cyst formation are dissected. These interactions include the antagonism and the reciprocal negative regulation between mTOR complex 1 and the proteins whose deletion causes Autosomal Dominant PKD, the polycystins. In addition, the emerging role of phopshoinositides, membrane components modulated by PI3K, will be presented in the context of primary cilium signaling, cell polarization and protection from cyst formation. Overall, studies demonstrate that the activity of various members of the PI3K/Akt/mTOR network goes beyond the classical transduction of mitogenic signals and can impact several aspects of kidney tubule homeostasis and morphogenesis. These properties might be useful to guide the establishment of more effective treatment protocols to be tested in clinical trials.
Insights
Over-activation of the PI3K/Akt/mTOR pathway drives cell hyper-proliferation in polycystic kidney disease (PKD). Targeting mTOR shows promise, but its complex interactions with polycystins and phosphoinositides are key for effective PKD treatments.
Area of Science:
- Cell biology
- Molecular medicine
- Renal pathophysiology
Background:
- The PI3K/Akt/mTOR pathway is crucial for cell growth and metabolism.
- Aberrant activation of this network contributes to hyper-proliferation in diseases like cancer and polycystic kidney disease (PKD).
- In PKD, mTOR signaling promotes cystogenesis by increasing kidney tubule epithelial cell proliferation, size, and metabolism.
Purpose of the Study:
- To review recent findings on mTOR activation mechanisms in kidney tubule epithelial cells and cyst formation.
- To discuss the upstream regulation of mTOR by the PI3K/Akt axis in the context of PKD.
- To explore the interplay between the PI3K/Akt/mTOR network and cyst formation suppression pathways, including polycystins and phosphoinositides.
Main Methods:
- Literature review of pre-clinical and clinical studies on mTOR inhibition in PKD.
- Analysis of molecular mechanisms underlying mTOR activation in kidney tubule cells.
- Dissection of signaling network interactions, including PI3K/Akt/mTOR, polycystins, and phosphoinositides.
Main Results:
- mTOR cascade significantly contributes to cyst growth in PKD by enhancing cell proliferation, size, and metabolism.
- Pre-clinical studies show positive results with mTOR inhibition, while clinical trials have been less conclusive.
- Complex interactions exist between mTORC1 and polycystins, with reciprocal negative regulation observed.
- Phosphoinositides, modulated by PI3K, play emerging roles in primary cilium signaling, cell polarization, and cyst formation protection.
Conclusions:
- The PI3K/Akt/mTOR network's role in PKD extends beyond mitogenic signaling, impacting kidney tubule homeostasis and morphogenesis.
- Understanding these complex interactions is vital for developing more effective therapeutic strategies for PKD.
- Targeting the PI3K/Akt/mTOR pathway, considering its intricate connections, holds potential for future PKD clinical trials.
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