Myotubularin is a 3-phosphoinositide phosphatase that is mutated in X-linked myotubular myopathy, a severe neonatal disorder in which skeletal muscle development and/or regeneration is impaired. In this report we provide evidence that siRNA-mediated silencing of myotubularin expression markedly inhibits growth factor-stimulated Akt phosphorylation, leading to activation of caspase-dependent pro-apoptotic signaling in HeLa cells and primary human skeletal muscle myotubes. Myotubularin silencing also inhibits Akt-dependent signaling through the mammalian target of rapamycin complex 1 as assessed by p70 S6-kinase and 4E-BP1 phosphorylation. Similarly, phosphorylation of FoxO transcription factors is also significantly reduced in myotubularin-deficient cells. Our data further suggest that inhibition of Akt activation and downstream survival signaling in myotubularin-deficient cells is caused by accumulation of the MTMR substrate lipid phosphatidylinositol 3-phosphate generated from the type II phosphatidylinositol 3-kinase PIK3C2B. Our findings are significant because they suggest that myotubularin regulates Akt activation via a cellular pool of phosphatidylinositol 3-phosphate that is distinct from that generated by the type III phosphatidylinositol 3-kinase hVps34. Because impaired Akt signaling has been tightly linked to skeletal muscle atrophy, we hypothesize that loss of Akt-dependent growth/survival cues due to impaired myotubularin function may be a critical factor underlying the severe skeletal muscle atrophy characteristic of muscle fibers in patients with X-linked myotubular myopathy.Myotubularin is the archetypical member of a family of phosphoinositide 3-phosphatases. Mutations in the myotubularin gene are causative for X-linked recessive myotubular myopathy (XLMTM), 4 also known as "centronuclear myopathy." XLMTM is a severe neonatal disorder in which the maturation and/or regeneration of skeletal muscle fibers is compromised (1, 2). Myofibers from affected individuals display abnormal centrally located nuclei and are severely atrophic. Mice in which the myotubularin gene has been deleted exhibit a skeletal muscle phenotype consistent with that of XLMTM disease. Like XLMTM patients, early stages of myogenesis in these mice appear to occur normally, and it has been suggested that skeletal muscle maintenance or regeneration is affected rather than early myogenic differentiation (3). Mutations in two other MTMR family proteins, MTMR2 and MTMR13, are causative for the demyelinating peripheral neuropathy type 4B Charcot-Marie-Tooth disease (4 -6).The myotubularin-related protein (MTMR) family consists of 14 proteins including 8 catalytically active lipid phosphatases and 6 forms that are inactive due to germ-line substitutions of essential catalytic residues (7). Active MTMRs specifically remove the 3-phosphate moiety from phosphatidylinositol 3-phosphate and phosphatidylinositol 3,5-bisphosphate (PI(3,5)P 2 ), generating phosphatidylinositol (PI) and phosphatidylinositol 5-phosphate (PI(5)P), respectively (...