mTOR signalling mediates the spinal osteoblast pathotype at the curve apex in adolescent idiopathic scoliosis

Adolescent idiopathic scoliosis (AIS) is associated with dysregulated bone remodelling, yet the molecular underpinnings remain unclear. To investigate site-specific osteoblast phenotypes at the spinal curve apex, we performed bulk RNA sequencing on primary matched osteoblasts isolated from the convex, concave, and non-curved regions of AIS patients. Principal component analysis revealed distinct transcriptional clustering by spinal site, independent of patient-specific factors. Differential expression analysis identified region-specific molecular profiles in convex and concave osteoblasts compared to non-curve controls, with the mTOR pathway being highlighted as one of the most dysregulated. Rapamycin, an mTOR inhibitor, reduced Alkaline phosphatase (ALP) activity, Osteoprotegerin (OPG) secretion, and mineralization, while modulating osteogenic gene expression, including sustained upregulation of RUNX2 and COL1A1 . In AIS patient-derived osteoblasts, rapamycin elicited pronounced inhibition of mTOR signalling and osteogenic activity in convex cells compared to control. Convex osteoblasts also showed elevated mTOR expression but reduced downstream translation-related signalling, suggesting dysregulated or uncoupled mTOR activity. Notably, mTOR expression level correlated with curve severity, reinforcing the link between mTOR dysregulation and AIS pathology. These findings identify mTOR signalling as a key regulatory pathway in AIS osteoblast dysfunction and highlight rapamycin as a potential, though complex, therapeutic candidate.