LETTER TO THE EDITOR
|Year : 2020 | Volume
| Issue : 2 | Page : 164-165
Autism spectrum disorder and mammalian target of rapamycin system
Annio Posar1, Paola Visconti2
1 IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neuropsichiatria Infantile, Bologna, Italy; Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
2 IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neuropsichiatria Infantile, Bologna, Italy
|Date of Submission||21-Dec-2019|
|Date of Acceptance||19-Mar-2020|
|Date of Web Publication||30-Jun-2020|
Dr. Annio Posar
IRCCS Istituto delle Scienze Neurologiche di Bologna, via Altura 3, Bologna.
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Posar A, Visconti P. Autism spectrum disorder and mammalian target of rapamycin system. J Pediatr Neurosci 2020;15:164-5
Mammalian target of rapamycin (mTOR) is a protein kinase playing a critical regulation role in numerous cellular functions, including cell growth and proliferation, as well as lipid and protein synthesis. The hyperactivation of the mTOR system participates in the pathogenesis of several genetic conditions associated with syndromic autism spectrum disorder (ASD), including tuberous sclerosis, phosphatase and tensin homolog tumor hamartoma syndrome, fragile X syndrome, and neurofibromatosis type 1. This is already interesting from a therapeutic perspective, but today there are even more interesting data: Rosina et al., comparing 33 patients with idiopathic ASD versus 22 typical developed controls, found that an mTOR system dysfunction may be involved also in idiopathic ASD, correlating with autism severity. This is not so surprising given that the mTOR system plays a role also in the regulation of neurogenesis, corticogenesis, synaptogenesis, axonal orientation, and cell migration, which are hypothesized to be altered in ASD. There are, therefore, the conditions for studying the effects of drugs acting on the mTOR system targeting autistic symptoms by themselves, also because rapamycin (acting as a selective mTOR inhibitor) has produced encouraging results on animals regardless of the presence of cortical tubers and epilepsy.
Mizuguchi et al. carried out a randomized, double-blind, placebo-controlled trial, finding a favorable trend in autistic symptoms in a sample of children with tuberous sclerosis treated with everolimus (another selective mTOR inhibitor), but this trend was not supported by a statistical analysis of the data. Overwater et al. carried out another randomized, double-blind, placebo-controlled trial, finding no favorable cognitive or behavioral effects of everolimus in a sample of children with tuberous sclerosis. Note that statistical analysis was carried out in this study, which (also in other respects) appears more solid than the first one. In short, the data from these first trials do not seem encouraging.
But at this point, let us not forget about the time variable. Individuals involved in these two studies were relatively aged,, when probably the damage to neuronal development and neural networks was no longer reversible, therefore being too late to obtain significant improvements. Before issuing a final judgment on the efficacy of these innovative pharmacological approaches on autistic symptoms, we should test them on a younger population. This highlights once again the importance of an early clinical diagnosis aimed at a timely intervention. In this regard, Moavero et al. found that already at about 1 year of life it can be predicted with high accuracy whether an individual with tuberous sclerosis will develop ASD or not. Therefore, the real effects of drugs acting on the mTOR system should be tested both in syndromic and in idiopathic ASD cases at the earliest age possible.
The authors would like to thank Cecilia Baroncini for help in editing the text.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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