The seminal studies in
Drosophila, described above, and subsequent studies, strongly suggested that the TSC1–TSC2 complex inhibits cell growth by inhibiting the activation of S6K. In previous genetic studies, S6K was found to be a critical driver of cell growth, as
S6k mutant fruitflies were found to be smaller, a phenomenon due exclusively to a decrease in cell size [
24].
S6k loss-of-function mutations suppressed the eye-overgrowth phenotype of
Tsc2 mutants [
14,
25,
26], and
S6k overexpression suppressed the decreased-cell-size phenotype caused by
Tscl and
Tsc2 overexpression [
14,
19]. Importantly, loss-of-function mutations in the gene encoding
Drosophila TOR, an essential upstream activator of S6K, also suppressed
Tsc2 mutant phenotypes [
25], and mutations reducing TOR and S6K activity were found to rescue the lethality caused by
Tsc1 mutations [
26]. These studies demonstrated that the TSC1–TSC2 complex acts as an upstream inhibitor of S6K, perhaps through inhibition of TOR signalling.
TOR proteins are serine/threonine kinases of the PIKK (phosphoinositide 3-kinase-related kinase) family, with orthologues found in all eukaryotes. TOR proteins play an evolutionarily conserved role in the control of cell growth (i.e. an increase in cell size), but they have also been found to regulate aspects of cell proliferation, survival and metabolism in specific settings (for focused reviews on the function of TOR proteins, see [
27–
30]). TOR proteins are found in two functionally distinct complexes that coexist in cells from yeast to humans [
31] (). The best characterized of the two complexes is TORC1 (TOR complex 1), which comprises TOR, Raptor [regulatory associated protein of mTOR (mammalian target of rapamycin)] and LST8 (lethal with SEC13 protein 8). TORC2 is comprised of TOR, Rictor (rapamycin-insensitive companion of mTOR), SIN1 (stress-activated-protein-kinase-interacting protein 1) and LST8 (reviewed in [
29,
30]). Little is currently known regarding the regulation and function of TORC2. Although it has been shown to regulate aspects of the actin cytoskeleton [
32,
33], the only direct target of mTORC2 (mammalian TORC2) identified to date is Akt. mTORC2 phosphorylates Akt on a residue (Ser
473) within a hydrophobic motif C-terminal to its kinase domain, and this contributes to the full activation of Akt downstream of growth factors [
34]. TORC1 is strongly sensitive to inhibition by the naturally occurring compound rapamycin and by a large number of synthetic analogues (e.g. RAD001 and CCI779), whereas TORC2 is insensitive to acute rapamycin treatment. Rapamycin binds to FKBP12 (FK506-binding protein 12), a highly conserved peptidyl-prolyl isomerase of the immunophilin family [
35], and the FKBP12–rapamycin complex binds to and inhibits TOR within TORC1, but not TORC2 (reviewed in [
29]). Conclusions regarding TOR protein function have relied heavily on the use of rapamycin and are therefore probably specific to TORC1. However, prolonged rapamycin treatment affects mammalian TORC2 (mTORC2) assembly and can block mTORC2 function in some cells [
36].
mTORC1 (mammalian TORC1) has two well-characterized classes of downstream targets, the ribosomal S6 kinases S6K1 and S6K2, and 4E-BP1 and 4E-BP2 [eIF4E (eukaryotic translation initiation factor 4E)-binding proteins 1 and 2], which possess residues found to be directly phosphorylated by the mTOR kinase within this complex (; reviewed in [
27–
30]). S6K1 and S6K2 (referred to collectively here as S6K) are phosphorylated by mTORC1 on a hydrophobic motif that shows high similarity to that of Akt. Therefore S6K and Akt, which are members of the same kinase family, are phosphorylated on a similar motif by mTOR, but mTOR regulates these two kinases as part of two distinct complexes, namely mTORC1 and mTORC2 respectively. Phosphorylation of S6K on Thr
389 (numbering according to the 70 kDa isoform of S6K1) within this motif is required for its activation, and rapamycin treatment of cells leads to rapid loss of S6K phosphorylation and activity [
37,
38]. Once active, S6K phosphorylates downstream substrates, such as ribosomal S6 and eIF4B, to promote mRNA translation. 4E-BP1 is phosphorylated by mTORC1 on residues within a distinct motif from that found in S6K. Four separate proline-directed sites (
Ser/
Thr-Pro) on 4E-BP1 (Thr
37, Thr
47, Ser
65 and Thr
70) can be phosphorylated by mTORC1 and are sensitive to rapamycin treatment [
39,
40]. Phosphorylation of the 4E-BPs triggers their release from eIF4E at the 5′ 7-methyl-GTP cap of mRNAs, thereby precipitating events initiating cap-dependent translation. Therefore mTORC1 activation promotes cell growth, at least in part, by increasing the anabolic process of protein synthesis through activation of S6K and inhibition of 4E-BP [
41].
It is now recognized that the primary function of the TSC1–TSC2 complex is as a critical negative regulator of mTORC1 activation. The
Drosophila genetic experiments described above demonstrated that the TSC1–TSC2 complex inhibits S6K activation, suggesting that the complex might specifically inhibit TORC1 signalling. Indeed, subsequent experiments in mammalian cells demonstrated that mTORC1-mediated (i.e. rapamycin-sensitive) phosphorylation of both S6K1 and 4E-BP1 is inhibited by TSC1–TSC2 complex overexpression and is activated in cells lacking the TSC1–TSC2 complex [
21,
22,
25,
42–
45]. Most striking is the effect of
TSC gene disruption on mTORC1 signalling, which becomes robustly activated in a growth-factor-independent manner. Elevated mTORC1 activity has also been detected in all rodent and human tumours and tumour-derived cell lines lacking TSC1 or TSC2 (see, for example, [
42,
45–
50]).
Aberrant mTORC1 signalling is believed to be the driving force behind tumour formation triggered by loss of these tumour suppressors. In rodent models of TSC, short-term inhibition of mTORC1 with rapamycin (4 days or less) initiates apoptosis within tumours [
46,
51], and prolonged treatment with rapamycin, or its analogue CCI779, blocks tumour formation and causes tumour regression [
52,
53]. On the basis of our molecular understanding of this critical connection between the TSC1–TSC2 complex and mTORC1 inhibition, several clinical trials have been initiated over the past few years to test the efficacy of rapamycin and its analogues for the treatment of specific clinical manifestions of the TSC and LAM diseases. Although it is still early days with these trials, the results thus far demonstrate that mTORC1 inhibitors reproducibly decrease the size of tumours with TSC gene mutations [
54–
56].