Birt-Hogg-Dube (BHD) is a tumor suppressor gene disorder characterized by skin hamartomas, cystic lung disease, and renal cell carcinoma. The fact that hamartomas, lung cysts, and renal cell carcinoma can also occur in tuberous sclerosis complex (TSC) suggests that the BHD and TSC proteins may function within a common pathway. To evaluate this hypothesis, we deleted the BHD homolog in Schizosaccharomyces pombe. Expression profiling revealed that six permease and transporter genes, known to be down-regulated in ⌬tsc1 and ⌬tsc2, were up-regulated in ⌬bhd, and levels of specific intracellular amino acids known to be low in ⌬tsc1 and ⌬tsc2 were elevated in ⌬bhd. This "opposite" profile was unexpected, given the overlapping clinical phenotypes. The TSC1/2 proteins inhibit Rheb in mammals, and Tsc1/Tsc2 inhibit Rhb1 in S. pombe. Expression of a hypomorphic allele of rhb1 ؉ dramatically increased permease expression levels in ⌬bhd but not in wild-type yeast. Loss of Bhd sensitized yeast to rapamycin-induced increases in permease expression levels, and rapamycin induced lethality in ⌬bhd yeast expressing the hypomorphic Rhb1 allele. In S. pombe, it is known that Rhb1 binds Tor2, and Tor2 inhibition leads to upregulation of permeases including those that are regulated by Bhd. Our data, therefore, suggest that Bhd activates Tor2. If the mammalian BHD protein, folliculin, similarly activates mammalian target of rapamycin, it will be of great interest to determine how mammalian target of rapamycin inhibition in BHD patients and mammalian target of rapamycin activation in TSC patients lead to overlapping clinical phenotypes.
Birt-Hogg-Dube (BHD)4 syndrome is an autosomal dominant disorder characterized by hamartomas of skin follicles, lung cysts, spontaneous pneumothorax, and renal cell carcinoma (1-3). The BHD gene was cloned in 2002 and encodes folliculin, which has no significant homology to other human proteins (4). BHD mRNA is expressed in many tissues, including skin, kidney, lung, brain, heart, placenta, testes, spleen, and pancreas. All reported human germline BHD mutations are predicted to result in premature protein truncation (4 -8).Inactivating mutations of the remaining allele have been identified in renal carcinomas from BHD patients, indicating that BHD is a tumor suppressor gene (8). Germline nonsense mutations in BHD can also cause isolated hereditary spontaneous pneumothorax with lung cysts (6), without the renal or skin manifestations of BHD. Consistent with the role of BHD as a tumor suppressor gene, somatic BHD mutations have also been detected in endometrial carcinomas (9). Disease-causing BHD mutations have also been noted in animals. A 1-base pair insertion mutation in the BHD rat homolog resulting in premature truncation causes renal carcinoma in the Nihon rat (10). In German shepherd dogs, a missense mutation, H255R, causes hereditary multifocal renal cancer, uterine leiomyoma, and skin lesions (11).Skin hamartomas, lung cysts, pneumothorax, and renal tumors, the clinical hallmarks of BHD, also occu...