Sirolimus therapy to halt the progression of ADPKD.

Abstract

Activation of mammalian target of rapamycin (mTOR) pathways may contribute to uncontrolled cell proliferation and secondary cyst growth in patients with autosomal dominant polycystic kidney disease (ADPKD). To assess the effects of mTOR inhibition on disease progression, we performed a randomized, crossover study (The SIRENA Study) comparing a 6-month treatment with sirolimus or conventional therapy alone on the growth of kidney volume and its compartments in 21 patients with ADPKD and GFR>or=40 ml/min per 1.73 m2. In 10 of the 15 patients who completed the study, aphthous stomatitis complicated sirolimus treatment but was effectively controlled by topical therapy. Compared with pretreatment, posttreatment mean total kidney volume increased less on sirolimus (46+/-81 ml; P=0.047) than on conventional therapy (70+/-72 ml; P=0.002), but we did not detect a difference between the two treatments (P=0.45). Cyst volume was stable on sirolimus and increased by 55+/-75 ml (P=0.013) on conventional therapy, whereas parenchymal volume increased by 26+/-30 ml (P=0.005) on sirolimus and was stable on conventional therapy. Percentage changes in cyst and parenchyma volumes were significantly different between the two treatment periods. Sirolimus had no appreciable effects on intermediate volume and GFR. Albuminuria and proteinuria marginally but significantly increased during sirolimus treatment. In summary, sirolimus halted cyst growth and increased parenchymal volume in patients with ADPKD. Whether these effects translate into improved long-term outcomes requires further investigation.

• Authors: Norberto Perico, Luca Antiga, Anna Caroli, Piero Ruggenenti, Giorgio Fasolini, Mariateresa Cafaro, Patrizia Ondei, Nadia Rubis, Olimpia Diadei, Giulia Gherardi, Silvia Prandini, Andrea Panozo, Rodolfo Flores Bravo, Sergio Carminati, Felipe Rodriguez De Leon, Flavio Gaspari, Monica Cortinovis, Nicola Motterlini, Bogdan Ene-Iordache, Andrea Remuzzi, Giuseppe Remuzzi
• Journal: Journal of the American Society of Nephrology : JASN (J Am Soc Nephrol) Vol. 21 Issue 6 Pg. 1031-40 (Jun 2010) ISSN: 1533-3450 [Electronic] United States
• PMID: 20466742 (Publication Type: Journal Article, Randomized Controlled Trial)

Chemical References

• Immunosuppressive Agents
• Intracellular Signaling Peptides and Proteins
• MTOR protein, human
• Protein Serine-Threonine Kinases
• TOR Serine-Threonine Kinases
• Sirolimus

Topics

• Adult
• Cell Proliferation (drug effects)
• Cross-Over Studies
• Disease Progression
• Female
• Glomerular Filtration Rate (drug effects, physiology)
• Humans
• Immunosuppressive Agents (adverse effects, pharmacology, therapeutic use)
• Intracellular Signaling Peptides and Proteins (metabolism)
• Kidney (drug effects, pathology)
• Male
• Middle Aged
• Polycystic Kidney, Autosomal Dominant (drug therapy, pathology, physiopathology)
• Protein Serine-Threonine Kinases (metabolism)
• Signal Transduction (drug effects, physiology)
• Sirolimus (adverse effects, pharmacology, therapeutic use)
• TOR Serine-Threonine Kinases
• Treatment Outcome