The Role of the Mammalian Target Of Rapamycin (mTOR) in... : Journal of the American Society of Nephrology (original) (raw)

UP FRONT MATTERS: Brief Reviews

*Department of Medicine, Stony Brook University Medical Center, Stony Brook, and Department of Medicine, Northport Veterans Administration, Northport, New York; and

†Department of Medicine, University of Illinois at Chicago, and Department of Medicine, Jesse Brown Veterans Administration Hospital, Chicago, Illinois

Correspondence: Dr. Wilfred Lieberthal, Stony Brook Medical Center, Health Sciences Center, 16-081B, Nicholls Road, Stony Brook, NY 11794-8166; Phone: 631-444-1227; Fax: 631-444-6174; E-mail: [email protected]

Abstract

The mammalian target of rapamycin (mTOR) is a serine/threonine kinase that plays a pivotal role in mediating cell size and mass, proliferation, and survival. mTOR has also emerged as an important modulator of several forms of renal disease. mTOR is activated after acute kidney injury and contributes to renal regeneration and repair. Inhibition of mTOR with rapamycin delays recovery of renal function after acute kidney injury. Activation of mTOR within the kidney also occurs in animal models of diabetic nephropathy and other causes of progressive kidney disease. Rapamycin ameliorates several key mechanisms believed to mediate changes associated with the progressive loss of GFR in chronic kidney disease. These include glomerular hypertrophy, intrarenal inflammation, and interstitial fibrosis. mTOR also plays an important role in mediating cyst formation and enlargement in autosomal dominant polycystic kidney disease. Inhibition of mTOR by rapamycin or one of its analogues represents a potentially novel treatment for autosomal dominant polycystic kidney disease. Finally, inhibitors of mTOR improve survival in patients with metastatic renal cell carcinoma.