title: Mammalian Target of Rapamycin Inhibitors and Life-Threatening Conditions in Tuberous Sclerosis Complex.
abstract: Tuberous sclerosis complex (TSC) is a multisystem disease associated with an overall reduction in life expectancy due to the possible occurrence of different life-threatening conditions. Subjects affected by TSC are, in fact, at risk of hydrocephalus secondary to the growth of subependymal giant cell astrocytomas, or of sudden unexpected death in epilepsy. Other nonneurological life-threatening conditions include abdominal bleeding owing to renal angiomyolipomas rupture, renal insufficiency due to progressive parenchymal destruction by multiple cysts, pulmonary complications due to lymphangioleiomyomatosis, and cardiac failure or arrhythmias secondary to rhabdomyomas. In the last decades, there has been a great progress in understanding the pathophysiology of TSC-related manifestations, which are mainly linked to the hyperactivation of the so-called mammalian target of rapamycin (mTOR) pathway, as a consequence of the mutation in 1 of the 2 genes TSC1 or TSC2. This led to the development of new treatment strategies for this disease. In fact, it is now available as a biologically targeted therapy with everolimus, a selective mTOR inhibitor, which has been licensed in Europe and USA for the treatment of subependymal giant cell astrocytomas and angiomyolipomas in subjects with TSC. This drug also proved to benefit other TSC-related manifestations, including pulmonary lymphangioleiomyomatosis, cardiac rhabdomyomas, and presumably epileptic seizures. mTOR inhibitors are thus proving to be a systemic therapy able to simultaneously address different and potentially life-threatening complications, giving the hope of improving life expectation in individuals with TSC.
authors.affiliation: Child Neurology and Psychiatry Unit, Tor Vergata University Hospital of Rome, Rome, Italy; Child Neurology Unit, Neuroscience and Neurorehabilitation Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy. Electronic address: rominamoavero@hotmail.com.
authors.forename: Romina
authors.initials: R
authors.lastname: Moavero
authors.affiliation: Child Neurology and Psychiatry Unit, Tor Vergata University Hospital of Rome, Rome, Italy.
authors.forename: Gloria
authors.initials: G
authors.lastname: Romagnoli
authors.affiliation: Child Neurology and Psychiatry Unit, Tor Vergata University Hospital of Rome, Rome, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Graziola
authors.affiliation: Child Neurology and Psychiatry Unit, Tor Vergata University Hospital of Rome, Rome, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Curatolo
mesh_terms: D000818:Animals; D006801:Humans; D047428:Protein Kinase Inhibitors / Q000627:therapeutic use*; D058570:TOR Serine-Threonine Kinases / Q000037:antagonists & inhibitors* / Q000378:metabolism; D014402:Tuberous Sclerosis / Q000188:drug therapy* / Q000201:enzymology / Q000401:mortality
chemical_list: D047428:Protein Kinase Inhibitors; D058570:TOR Serine-Threonine Kinases