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Tuberous sclerosis complex
Kellen Winden1, E Martina Bebin2, Shafali Jeste3
1Department of Neurology, Rosamund Stone Zander and Hansjoerg Wyss Translational Neuroscience Center, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
Tuberous sclerosis complex (TSC) is a rare genetic disorder. Rapalogues treat TSC manifestations, but TAND and refractory epilepsy remain challenging, highlighting an unmet therapeutic need.
Area of Science:
- Genetics
- Cell Biology
- Neurology
Background:
- Tuberous sclerosis complex (TSC) is a rare genetic disorder caused by TSC1 or TSC2 variants.
- It leads to benign tumors (hamartomas) in multiple organs and severe neurological issues like epilepsy and TAND.
- The TSC1/TSC2 complex regulates the mTOR signaling pathway, a key factor in TSC pathogenesis.
Purpose of the Study:
- To review the current understanding of TSC pathogenesis.
- To discuss the clinical management of TSC, focusing on mTOR inhibitors.
- To identify unmet needs in TSC treatment, particularly for TAND and refractory epilepsy.
Main Methods:
- Literature review of TSC pathogenesis and treatment.
- Analysis of the role of the TSC1/TSC2-mTOR pathway.
- Evaluation of current therapeutic strategies and their limitations.
Main Results:
- Rapamycin and its analogues (rapalogues) are effective for several TSC manifestations, including tumors and seizures.
- These treatments target the mTOR pathway, crucial in TSC.
- Despite progress, significant challenges remain in treating TSC-associated neuropsychiatric disorders (TAND) and refractory epilepsy.
Conclusions:
- The TSC1/TSC2-mTOR pathway is central to TSC and a target for rapalogue therapy.
- Approved rapalogue treatments exist for specific TSC symptoms.
- Effective treatments for TAND and refractory epilepsy in TSC patients are still needed.
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