mTOR signaling cascade: novel clinical implications in HLA and non-HLA antibody-mediated vasculopathies?

Antibodies targeting endothelial antigens represent major threats to the integrity of endothelial vasculature, contributing to development of organ transplant rejection and vasculopathies. In this issue, Catar et al. present the mechanisms by which non-human leukocyte antigen angiotensin II type 1 receptor and endothelin-1 type A receptor antibodies mediate impairment of endothelial repair via β2-arrestin link to the mammalian target of rapamycin pathway. This commentary discusses the mechanisms of human leukocyte antigen and non-human leukocyte antigen antibody-endothelium interactions, and the clinical implications and challenges of the use of mammalian target of rapamycin signaling activation as biomarker and therapeutic target in vasculopathies.