Abstract
The 90 kDa ribosomal s6 kinases (RSKs) are a group of serine/threonine kinases consisting of 4 RSK isoforms (RSK1-4), of which RSK1 is also named as p90RSK. p90RSK is directly phosphorylated and activated by its immediate upstream mediator extracellular signal-regulated kinase (Erk1/2), followed by activating various signaling pathways through phosphorylating selective downstream substrates. Aberrant induction of p90RSK has been reported in various human diseases including kidney disease suggesting a pathogenic role of p90RSK in these diseases. In response to pathogenic cues, p90RSK not only mediates intracellular signal events leading to cell-specific phenotypes but also modulates intercellular communication impacting the adjacent cellular responses. In this review, we provide an update on the current knowledge regarding the roles of p90RSK-mediated intercellular and intracellular signaling in the pathogenesis and progression of kidney diseases.
1 Introduction
The 90 kDa ribosomal s6 kinases (RSKs) are a group of serine/threonine kinases that were initially found in Xenopus to be responsible for phosphorylating ribosomal protein S6 (). There are 4 isoforms in the RSK family, including RSK1, RSK2, RSK3 and RSK4 respectively. RSK1 is also designated as p90RSK. RSK1-3 have similar expression patterns and abundance in adult tissues such as heart, brain, lung, kidney, and pancreas (). In contrast, expression of RSK4 takes place during development and its deletions are common in x-linked intellectual disability (). RSKs play important roles in the Ras-mitogen-activated protein kinase (MAPK) signaling cascade and are the direct downstream effectors of extracellular signal-regulated kinase (Erk1/2). Erk1/2 activation directly phosphorylates and activates RSKs (; ), which, in turn, activate various intracellular signaling events through selection of different phosphorylation substrates to modulate diverse cellular processes (), such as cell proliferation, survival, and motility, and/or mediate intercellular signaling relays to regulate the phenotypes of other cells.
2 Structure and activation
All RSKs share a similar structure with around 75% of which being identical. The crystal structure of human p90RSK was recently released (). These RSKs contain two functionally diverse domains: the N terminal kinase domain (NTKD) and the C terminal kinase domain (CTKD). The NTKD is part of the kinase AGC family, while the CTKD belongs to the calcium calmodulin dependent kinase (CaMK) family. Functionally, CTKD receives signals from ERK1/2 to auto-phosphorylate RSK, which is important to activate NTKD. Upon activation, NTKD will phosphorylate downstream substrates (). The CTKD and NTKD domains are bridged by a linker region about approximately 100 amino acids containing regulatory elements (). Of note, all RSKs contain an ERK1/2 docking domain facilitating their activation by ERK1/2 (). An adjacent location is also important for RSK autophosphorylation, which may play a role in ERK1/2 dissociation and subsequently RSK signal relay () (Figure 1).
FIGURE 1
Human RSKs have four conserved phosphorylation sites: Ser221, Ser363, Ser380 and Thr573 () (Figure 1). The mechanisms of RSK activation are phosphorylation site dependent. Ser221 in the NTKD is phosphorylated by phosphoinositide-dependent kinase-1 (PDK1), a constitutively active serine threonine kinase (). Ser363 and Ser380 are both located in the linker region between the two kinase domains. Ser363 is activated by ERK 1/2 phosphorylation, while Ser380 is phosphorylated by CTKD (). Notably, Ser380, when phosphorylated, also serves as a docking site for PDK1, which in turn activates Ser221 (). Thr573 in the CTKD is also phosphorylated by ERK1/2 (). Additionally, RSKs are also regulated by p38 MAPK and fibroblast growth factor receptor-3 (FGFR3). p38 MAPK has been shown to activate RSK in dendritic cells via CTKD activated by MAPK-activated kinases M2 and M3 (). FGFR3 can interact with RSK2 through tyrosine phosphorylation, which induces its activation by enhancing ERK binding ().
3 Downstream substrates
RSKs regulate diverse cellular processes through phosphorylation of selected downstream substrates from a constantly growing list. Both p90RSK (i.e. RSK1) and RSK2 have been shown to promote cell proliferation and growth (), however, it appears that they regulate distinct transcription programs of cell proliferation and growth (). p90RSK phosphorylates and inhibits GSK3β, causing the release of Cyclin D1 and cell proliferation () and inducing translation initiation factor eIF4B and protein synthesis (; ). p90RSK phosphorylates Max dimerization protein-1 (Mad1) resulting in release of its suppression of Myc and increased proliferation (). p90RSK also regulates cell growth and protein synthesis through modulating mTOR pathway. It has been shown to modulate mTOR by phosphorylating both tuberous sclerosis complex 2 (TSC2) and Raptor (; ). Additionally, RSKs have been shown to interact with c-Fos, an important transcription factor in cell cycle G1 phase (); and phosphorylate p27kip1 to induce cell cycle G1 phase progression (; ).
p90RSK also plays an important role in cell survival, as it has been shown to phosphorylate Bad to decrease apoptosis, and phosphorylate tumor suppressor death-associated protein kinase (DAPK) to cause its inactivation (; ; ). p90RSK has been shown to influence inflammation through phosphorylating NF-κB inhibitors, IκBα and IκBβ (; ; ), and through phosphorylating p38 MAPK to induce M1 macrophage survival (). Moreover, p90RSK phosphorylates downstream substrates filamin A and phosphorylating SH3 domain-containing protein (SH3P2) to induce cell motility and migration (; ). Activated p90RSK phosphorylates Thr368 of sentrin/SUMO-specific protease 2 (SENP2), induces SENP2 nuclear export, and reduces the SENP2 activity, which then increases nuclear ERK5 and p53 SUMOylation, leading to endothelial cell (EC) apoptosis and inflammation (; ; ). In a model of diabetic heart disease, activated p90RSK induces ERK5 Ser496 phosphorylation, inhibits the association of ERK5 and CHIP ubiquitin ligase by binding to ERK5, which decreases the CHIP ubiquitin ligase activity, suppresses inducible cAMP early repressor (ICER) ubiquitination and degradation, and finally promotes cardiac apoptosis (). Activated p90RSK also increases NF-kB activation, VCAM-1 expression, and EC apoptosis through phosphorylating ERK5 Ser496 and regulating its transcriptional activity (). Recently, p90RSK has been shown to bind and phosphorylate the E3 ubiquitin ligase MDM2, which increases the stability of MDM2 leading to its binding and ubiquitinating p53 and cell survival ().
4 Intercellular p90RSK signaling and kidney disease
Normal kidney structure and environment depend on epithelial integrity and interactions between epithelial cells and other kidney cells. Obstructive nephropathy (ON) is the major cause of chronic kidney disease (CKD) leading to renal failure in children () and also happens in adults. However, surgical correction of renal ureteral obstruction does not stop CKD progressing to renal failure in ON patients (; ), suggesting a pathogenic role of intrinsic pathway in obstruction-induced CKD. Both interstitial fibroblasts and tubular epithelial cells play essential roles in ON pathogenesis and progression. In response to injury, epithelial cells, especially proximal tubular epithelial cells, not only initiate inflammatory response by producing proinflammatory chemokines, but also undergo apoptotic death, leading to kidney parenchymal destruction. Structurally, fibroblasts reside in the renal interstitium surrounding the tubules formed by epithelial cells. This proximity facilitates interstitial fibroblast-epithelial communication and interactions that are fundamental in maintaining the integrity of the kidney structure and environment, as well as fine-regulated process of adaptation to pathogenic cues (; ). Our recent work, using a novel fibroblast-specific wildtype p90RSK-transgenic mouse model, has discovered that p90RSK accelerates obstruction-induced renal fibrogenesis by inducing fibroblast-mediated epithelial apoptosis and transdifferentiation through reactive oxygen species (ROS) (; ) and forkhead box class O1 (FOXO1) pathway () (Figure 2). Notably, p90RSK-mediated interactions between inflammatory cells and kidney parenchymal cells remain largely unknown, future investigations are needed for these areas.
FIGURE 2
4.1 Fibroblast p90RSK signaling in tubular epithelial apoptosis
Our recent work has found that fibroblast-specific p90RSK induces tubular epithelial apoptosis and promotes kidney fibrosis (
FOXO1, a member of FOXO transcription factor family, controls multiple cellular processes including cell cycle and survival (
4.2 Fibroblast p90RSK signaling in tubular epithelial transdifferentiation
In normal kidney, tubules formed by epithelial cells are surrounded by interstitial fibroblasts, supporting epithelial integrity and functions. In response to chronic pathogenic cues, such as oxidative stress, tubular epithelial cells not only undergo apoptotic death, leading to kidney parenchymal destruction, but also contribute to the population of active fibroblasts through a transdifferentiation process known as epithelial-mesenchymal transition (EMT). EMT, is a reversible process involving loss of epithelial integrity indicated by loss of Ecadherin and gain of contractility and mobility by induction of mesenchymal markers including αSMA, that transiently changes epithelial cells into active fibroblasts, i.e. myofibroblasts, with significantly enhanced matrix-producing capability (
4.3 Extracellular vesicles (EVs) and intercellular p90RSK signaling
EVs are a group of nanosized lipid-bound vesicles derived from various cellular origins and are secreted by all cell types and organisms. Although EVs have been subcategorized into several subgroups based on their biogenesis pathway and size, the most common two subsets are exosomes and microvesicles (MVs, also called as ectosomes or microparticles) (
Our recent works demonstrate an important role of H2O2 in mediating intercellular p90RSK signaling between interstitial fibroblasts and tubular epithelial cells. Given the significant role of EVs in cell-cell communication, we have conducted a pilot study to test whether p90RSK-overexpressing fibroblast-derived EVs could be deliverable into co-cultured tubular epithelial cells. Briefly, primary mouse RSK-Tg fibroblasts, as well as their wildtype counterparts (RSK-wt), were labeled by PKH26 red fluorescence, followed by coculture with mouse TKPT tubular epithelial cells for 72 h. Then epithelial cells were extracted for intracellular EVs assay and quantitation by flow cytometry. There were dramatically increased RSK-Tg fibroblasts-derived EVs in TKPT epithelial cells (Figure 3) confirming that EVs derived from RSK-Tg fibroblasts were delivered into cocultured epithelial cells. Thus, EVs may also play an important role in mediating intercellular p90RSK signaling between interstitial fibroblasts and tubular epithelial cells. Further investigations are warranted to determine the responsible EV cargo mediators in p90RSK-mediated fibroblast-epithelial communication.
FIGURE 3

EVs modulate p90RSK-mediated fibroblast-epithelial communication. (A) Primary mouse RSK-Tg and RSK-wt fibroblasts were labeled by PKH26 red fluorescence, followed by coculture with mouse TKPT tubular epithelial cells for 72 h. EVs in the epithelial cells were measured and quantified by flow cytometry. (B) Representative flow cytometry results. (C) Quantification of intraepithelial EV abundance. N = 3, ***P < 0.001.
5 Intracellular p90RSK signaling and kidney disease
p90RSK signaling is activated in a mouse model of unilateral ureter obstruction (UUO), a classic CKD model. After UUO injury, immune staining shows that phosphorylation of p90RSK and its upstream signaling such as Erk1/2 is markedly induced in the damaged kidneys. The activation of p90RSK, i.e. phosphorylation of p90RSK, correlates with the severity of kidney fibrosis as indicated by induction of matrix proteins and destroyed kidney structure (
5.1 Kidney fibrosis
Kidney fibrosis is histologically characterized by excessive renal deposition of matrix proteins. Interstitial fibroblasts, as well as their activated form of myofibroblasts, are the primary matrix-producing cells in the kidney. The number of interstitial fibroblasts and myofibroblasts, which is determined by the balance between proliferation and cell death, closely correlates with the severity of tubulointerstitial fibrosis and concomitant decline of kidney function (
FIGURE 4

p90RSK modulates intracellular signaling in kidney disease. Receptor-mediated Erk1/2 activation leads to phosphorylation and activation of p90RSK, which then phosphorylates downstream substrates to initiate various cellular processes and the resultant kidney diseases.
5.2 Kidney inflammation
Macrophage plays a critical role in kidney inflammation and its accumulation is one of the histological hallmarks of CKD. In diseased conditions, macrophages, including resident and bone marrow monocyte-derived macrophages (
5.3 Diabetic nephropathy (DN)
DN is histologically characterized by thickened tubular basal (TBM) and glomerular basement (GBM) membranes, excessive ECM deposition and progressive mesangial hypertrophy. DN is one of the leading causes of end stage renal disease (
Oxidative stress plays an important role in DN pathogenesis and progression. In monocytes/macrophages treated with various combination antiretroviral therapies (cARTs), p90RSK is activated, which then phosphorylates Ser496 of ERK5, inhibits NRF2-ARE activity, reduces the telomere length and decreases antioxidant expression, resulting in increased sensitivity of monocytes/macrophages to oxidative stress. Activated macrophage intracellular p90RSK signaling cascade also induces the expression of pro-inflammatory genes such as TNFα, and decreases the expression of efferocytosis-related genes, such as Gas6, causing inflammation, matrix deposition, and sclerosis (
5.4 Glomerular diseases
Most glomerular diseases are presented with proteinuria. In physiological condition, the healthy glomerular filtration barrier, consisting of endothelium, GBM, and podocytes, only allows the passthrough of metabolic wastes but not proteins larger than albumin from plasma inside the glomerular capillaries into resultant urine within Bowman’s capsule. Podocytes cover the outer surface of the GBM, and their long-interdigitated foot processes form filtration slits and are critical for the integrity of glomerular filtration barrier. As terminally differentiated cells, podocytes cannot regenerate when injured. In a puromycin aminonucleoside (PAN)-induced injury model, podocytes undergo apoptosis and detach from GBM, leading to glomerular filtration barrier integrity disruption and proteinuria (
5.5 Other kidney diseases
Epithelial intracellular p90RSK signaling has also been implicated in other kidney diseases including hypocitraturia, kidney stone, virus-induced kidney injury, as well as renal cell carcinoma (RCC). p90RSK has been shown to mediate IL11-induced tubular epithelial dedifferentiation (
Acidified media has been shown to activate the citrate transporter NaDC-1 through Raf1, ERK1/2 and p90RSK signaling in the opossum kidney proximal tubule cells, suggesting an important role of p90RSK signaling in hypocitraturia and kidney stone formation (
6 Conclusion and future perspectives
Emerging evidences support an essential role of p90RSK in mediating a complex intercellular and intracellular signaling network to modulate diverse cellular processes to initiate various progressive kidney diseases. Notably, the roles of p90RSK in kidney diseases are context dependent, because its induction is an initial finely regulated wound-healing response until the sustained damage-caused chaotic signal and cellular reactions leading to aberrant activation of p90RSK signal cascades and subsequent tissue destruction and scar formation. Currently, the role of p90RSK in kidney disease remains largely unknown. Future investigations should not only further clarify its renal pathogenic roles but also focus on its roles in mediating interactions between inflammatory cells and renal parenchymal cells during CKD pathogenesis and progression, as well as the development of p90RSK-specific treatment.
Statements
Author contributions
LL: Conceptualization, Data curation, Resources, Writing – review and editing, Supervision, Funding acquisition, Project administration, Formal Analysis, Investigation, Methodology, Writing – original draft, Validation. KH: Methodology, Formal Analysis, Supervision, Project administration, Data curation, Resources, Writing – review and editing, Writing – original draft, Investigation, Conceptualization, Funding acquisition, Validation.
Funding
The author(s) declare that financial support was received for the research and/or publication of this article. LL is supported by American Heart Association Career Development Award (941281). KH is supported by the Pennsylvania Department of Health Tobacco CURE Funds (4100085731).
Acknowledgments
We thank Chaowen Shi for technical assistance in EV evaluation.
Conflict of interest
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision.
Generative AI statement
The author(s) declare that no Generative AI was used in the creation of this manuscript.
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Summary
Keywords
p90RSK, intracellular signaling, intercellular signaling, extracellular vesicles, kidney diseases
Citation
Lin L and Hu K (2025) p90RSK modulates inter-and intracellular signaling in kidney diseases. Front. Cell Dev. Biol. 13:1593914. doi: 10.3389/fcell.2025.1593914
Received
14 March 2025
Accepted
30 May 2025
Published
05 June 2025
Volume
13 - 2025
Edited by
David A. Tumbarello, University of Southampton, United Kingdom
Reviewed by
Shristi Pawnikar, Deep Apple Therapeutics, Inc., United States
Valentina De Falco, National Research Council (CNR), Italy
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© 2025 Lin and Hu.
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*Correspondence: Ling Lin, llin1@pennstatehealth.psu.edu; Kebin Hu, kebinhu@pennstatehealth.psu.edu
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