RAPAMYCIN THERAPY OF RENAL ANGIOMYOLIPOMAS

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This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Approximately one out of 5,000 individuals has tuberous sclerosis complex (TSC), representing approximately 56,000 patients in the United States and 1 million patients worldwide. This disease process does not cluster in ethnic groups and has no gender predilection. Renal failure has been reported to be the leading cause of death in adult tuberous sclerosis patients, in most cases due to replacement of healthy kidney tissue by fatty tumors called angiomyolipomas. Approximately 40% of female patients with TSC also develop a pulmonary disease called lymphangioleiomyomatosis (LAM). LAM is characterized by smooth muscle cell infiltration in the lungs leading to cystic degeneration of lung tissue, impaired gas exchange, respiratory failure and death. There is recent evidence that LAM may be caused by metastases of angiomyolipoma cells to the lung. Angiomyolipoma cells are uniquely vulnerable to treatments that select for the presence of the correct gene product from the TSC genes. The gene products of TSC1, hamartin, and TSC2, tuberin, are key players in a pathway that regulates cell growth. Rapamycin mimics the function of the tuberin/hamartin complex, which is dysfunctional in TSC. Rapamycin inhibits the growth of tuberin and hamartin deficient cells from humans, rats, mice and flies, and produces tumor regression in rats and mice. Thus, the aim of this study is to determine if the administration of Rapamycin can reduce or eliminate angiomyolipomas in patients with TSC and sporadic LAM as it does in human cell culture and animal models.