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Cells froma human parathyroid adenoma were infected with simian virus 40 and maintained through 13 subcultures in monolayer tissue culture. For more than 9 months, these "transformed" cells contimed to produce parathyroid hormone which was identified by radioimmunoassay and density-gradient ultra centrifugation.
Unilateral neck exploration for primary hyperparathyroidism (pHPT) of old and high risk patients can be safely performed under local anesthesia, provided there is a correct preoperative side localization of the enlarged parathyroid gland. We performed large vein sampling and measured intact parathyroid hormones (PTH) with a new, highly sensitive immunoradiometric assay. The method was used before operation in 20 patients with pHPT. A unilateral positive gradient of serum PTH levels was obtained in 15 patients. At surgery, 13 of these (87%) proved to be correct, i.e., the adenoma was localized on the same side. Thus, the technique correctly lateralized the parathyroid adenoma in 65% of the patients. We conclude that large vein sampling with measurement of intact PTH is a potentially useful investigation for preoperative side localization of parathyroid adenomas in pHPT patients scheduled for unilateral surgery under local anesthesia. However, prior to routine bilateral neck exploration large vein sampling is not justified.
Lack of success in parathyroid surgery is usually due to failure to identify the abnormal parathyroid gland correctly at operation. The surgeon may be helped by rapid parathyroid hormone (PTH) assay in peripheral blood after removal of a suspected adenoma, and by frozen section histology, but these are not true localization techniques. We have adapted a non-isotopic immunoassay for rapid measurement of PTH in samples from the upper, middle and lower thyroid veins taken at operation, before exploration begins. Fifteen patients with primary hyperparathyroidism were operated on. In 10 the parathyroid adenoma was located easily, and was associated with high local venous PTH levels. In four patients the abnormal parathyroid was not immediately apparent but the assay indicated its location, which was confirmed after further exploration. In one patient there was no difference in PTH levels in the six venous samples. An ectopic adenomatous gland was successfully identified behind the thymus. The operation was successful in all patients as shown by a fall in the plasma calcium to the normal range. We conclude that intra-operative selective venous sampling and rapid PTH assay facilitates operative localization of parathyroid adenomas.
Recent evidence links osteoporosis, a disease of bone remodeling, to changes in the dynamics of parathyroid hormone secretion. We use nonlinear and linear time series prediction to characterize the secretory dynamics of parathyroid hormone in both healthy human subjects and patients with osteoporosis. Osteoporotic patients appear to lack the periods of high predictability found in normal humans. Our results may provide an explanation for why an intermittent administration of parathyroid hormone is effective in restoring bone mass in osteoporotic patients.
Parathyroid hormone has been measured by radioimmunoassay in eight patients with hyperparathyroidism due to parathyroid adenoma. Secretion of hormone by the adenomatas was demonstrated direct by estimating the arteriovenous gradient of parathyroid hormone across the tumours. Serial estimations following surgical removal of the adenoma showed a rapid fall in the concentration of circulating parathyroid hormone. The calculated half-life of endogenously secreted parathyroid hormone in man varied from 11.4 to 28.8 min., with a mean of 19.8 min.
During GH treatment of a 14 year-old girl with chronic renal failure and short stature, she developed hyperparathyroidism which was successfully treated by the oral agent 26,27-F6-1, 25-dihydroxyvitamin D3 (26,27-F6-1,25(OH)2vit D3). It is hypothesized that the elevation of serum PTH level was induced either by the rise in phosphorus levels induced by GH or by a direct stimulatory effect of IGF-I on PTH production. This seems to be the first report of this kind.
Parathyroid hormone and other bone resorptive agents function, at least in part, by inducing osteoblasts to secrete cytokines that stimulate both differentiation and resorptive activity of osteoclasts. We previously identified two potentially important cytokines by demonstrating that parathyroid hormone induces expression by osteoblasts of IL-6 and leukemia inhibitory factor without affecting levels of 14 other cytokines. Although parathyroid hormone activates multiple signal transduction pathways, induction of IL-6 and leukemia inhibitory factor is dependent on activation of adenyl cyclase. This study demonstrates that adenyl cyclase is also required for stimulation of osteoclast activity in cultures containing osteoclasts from rat long bones and UMR106-01 rat osteoblast-like osteosarcoma cells. Since the stimulation by parathyroid hormone of both cytokine production and bone resorption depends on the same signal transduction pathway, we hypothesized that IL-6 might be a downstream effector of parathyroid hormone. We found that addition of exogenous IL-6 mimics the ability of parathyroid hormone to stimulate bone resorption. More importantly, an antibody directed against the IL-6 receptor blocks moderate stimulation of osteoclast activity induced by the hormone. Interestingly, strong stimulation of resorption overcomes this dependence on IL-6. Thus, parathyroid hormone likely induces multiple, redundant cytokines that can overcome the IL-6 requirement associated with moderate stimulation. Taken together with studies showing that many other bone resorptive agents also stimulate IL-6 production, our results suggest that IL-6 may be a downstream effector of these agents as well as of parathyroid hormone.
Fibroblast growth factor-2 and parathyroid hormone are strong modulators of the maturation process of chondrocytes during endochondral ossification. To clarify whether and how these agents may exert stage-specific effects during this process, we analyzed the responsiveness and phenotypic consequences of treatment with fibroblast growth factor-2 or parathyroid hormone on chondrocytes at different stages of maturation. Populations of immature lower sternal, maturing upper sternal, and hypertrophic tibial growth plate chondrocytes were isolated from day 18-20 chick embryos and were allowed to resume the maturation process by growth in standard monolayer cultures. Treatment of immature lower sternal cultures with as little as 0.1 ng/ml of fibroblast growth factor-2 or 10(-10) M parathyroid hormone prevented both the emergence of mature type-X collagen-synthesizing chondrocytes and the ensuing enlargement of cells that occurred in control (untreated) cultures. Similarly, the treatment of cultured early maturing upper sternal cells with these factors severely reduced the synthesis of type-X collagen and alkaline phosphatase activity and the levels of their respective mRNAs. In sharp contrast, when the cultured upper sternal cells were allowed to grow and mature further before treatment, the responsiveness to fibroblast growth factor-2 was markedly reduced and the responsiveness to parathyroid hormone remained strong and largely unchanged. Cultures of hypertrophic tibial growth plate cells displayed a similar reduced sensitivity to fibroblast growth factor-2, as also indicated by the lack of mitogenic effects, and strong sensitivity to parathyroid hormone. The phenotypic changes induced by treatment with either of these factors were fully reversible when cultures that had been treated were placed in control medium. The results demonstrate that fibroblast growth factor-2 and parathyroid hormone are equally potent in affecting the early stages of maturation but exert differential effects as the cells progress along the maturation pathway. The factors appear to be part of sequentially acting mechanisms to ensure normal progression of chondrocyte maturation during endochondral ossification.
The immunological properties of human parathyroid hormone-)1-34) synthesized in accord with the sequence reported by Brewer et al. and the different sequence found by Niall et al. were compared with those of highly purified native human hormone-)1-84). Analyses were performed by radioimmunoassay using 7 anti-bovine parathyroid hormone antisera and bovine parathyroid hormone-)1-34) as tracer. Whereas human parathyroid hormone-(1-34) synthesized in accord with the sequence of Niall et al. was immunologically indistinguishable from native human hormone in all 7 assay systems, striking differences were seen between human parathyroid hormone-(1-34) synthesized in accord with the sequence of Brewer et al. and the native hormone. In none of the 7 assay systems did human parathyroid hormone-(1-34) synthesized in accord with the sequence of Brewer et al. give the same displacement slopes that the reference preparation gave. The observation that immunologic probes easily discriminate between the two different human parathyroid hormone-(1-34) peptides suggests that similar immunologic approaches will be of value in exploring several important issues, particularly those relating to the sequence and conformational properties of human parathyroid hormone and its synthetic peptides and to the question of the existence of isohormonal forms.
Parathyroid function at the end of gestation (day 21) was investigated by measuring plasma calcium (PCa), immunoreactive parathyroid hormone (iPTH), bioactive parathyroid hormone (bioPTH; cytochemical bioassay), and bone histology in intact and thyroparathyroidectomized (TPTX; day 12, ether anesthesia) rats and their fetuses. In pregnant intact rats, PCa was significantly lower, and iPTH, bioPTH, and osteoclast number were higher than in nonpregnant rats. In fetuses, PCa was higher than maternal PCa and correlated with fetal bioPTH. TPTX suppressed maternal bioPTH and decreased iPTH and osteoclast number, whereas fetal iPTH and bioPTH were decreased with no change in osteoclast number. Fetal PCa was near normal and was correlated with maternal PCa but not with fetal bioPTH. The fetomaternal calcium gradient was maintained and even increased. This study shows that there is maternal physiological hyperparathyroidism and functional fetal parathyroid glands at the end of gestation in the rat. Parathyroid hormone does not seem to be responsible for maintaining the high fetomaternal calcium gradient in TPTX animals.
Highly purified native parathyroid hormone was iodinated by the enzymatic method and separated from unlabeled hormone by isocratic HPLC. The separation system used also resolved iodohistidine, monoiodotyrosine, and diiodotyrosine forms of the hormone from one another. A simplified procedure for direct bioassay of the carrier-free, high specific activity, mono- and diiodinated parathyroid hormone (PTH) by the renal membrane adenylyl cyclase method was also developed. Both labeled forms of the hormone are very potent in this assay, but the iodinated forms appeared to give a lower Vmax than the native hormone. The methods for iodination, separation and biological characterization of this PTH tracer are exceptionally facile, inexpensive, and convenient.
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Peptides such as parathyroid hormone (PTH), somatostatin, and gastrin have been reported to stimulate mast cell mediator release. Preincubation of rat serosal mast cells with synthetic 1-34 bovine parathyroid hormone (1-34bPTH) significantly enhanced antigen-induced 5-hydroxytryptamine (5-HT) release. Enhancement of 5-HT release by 1-34bPTH was dose dependent between 5 and 2000 nM. In the absence of antigen, mean net 5-HT release was less than 1% when naive or passively sensitized mast cells were incubated with 1000 nM 1-34bPTH for time intervals up to 90 min. These findings indicate that 1-34bPTH, at relatively low concentration, potentiates antigen-induced 5-HT release from mast cells.
Parathyroid hormone and calcium were measured in plasma taken from pregnant women at term and from the umbilical veins of their infants at birth. Three assays were used to measure parathyroid hormone, a cytochemical bioassay of bioactivity and two immunoradiometric assays, one specific for the amino terminus, the other specific for the carboxy terminus of the parathyroid hormone molecule. Plasma calcium was significantly higher in the infants than in the mothers. Maternal parathyroid hormone bioactivity and the amino terminus were both slightly raised, but the carboxy terminus value was normal; these findings supported the view that late pregnancy is a time of mild physiological hyperparathyroidism. In the infants, the amino terminus was undetectable and the carboxy terminus was either undetectable or towards the lower end of the normal range: bioactivity of parathyroid hormone was considerably raised and was related to the gradient of calcium across the placenta. This suggests that the parathyroid glands are not suppressed during fetal life and that they may play an important part in the maintenance of high fetal plasma calcium concentrations.
Bovine parathyroid hormone has been isolated in homogeneous form, and its complete amino acid sequence determined. The bovine hormone is a single chain, 84 amino acids long. It contains amino-terminal alanine, and carboxyl-terminal glutamine. The bovine parathyroid hormone is approximately three times the length of the newly discovered hormone, thyrocalcitonin, whose action is reciprocal to parathyroid hormone.
Parathyroid hormone was measured in nine patients subjected to surgery under general anaesthesia not involving operative bone trauma. Total calcium concentration, ionized serum calcium and serum albumin was also analyzed pre- and post-operatively. An increase in serum parathyroid hormone was registered postoperatively without any accompanying decrease in ionized serum calcium. The measured changes are at present unexplained, but can be caused by other mechanisms than bone trauma.
Parathyroid hormone related protein (PTHRP) has been implicated in humoral hypercalcaemia of malignancy (HHM). We describe a patient with a renal carcinoma and hypercalcaemia, and for the first time have demonstrated a 4-fold PTHRP concentration gradient across a renal tumour bed. This provides further strong evidence that the primary tumour was the source of the PTHRP. The PTHRP 1-86 content of the tumour tissue was 4.8 ng/g, similar to that previously found in tumours associated with HHM. In PTHRP-secreting tumours, PTHRP may be a useful oncological marker after surgical resection.
Continuous parathyroid hormone secretion caused by primary hyperparathyroidism contributes to osteoporosis. Laboratory tests, in particular the intact PTH assay, make the diagnosis of hyperparathyroidism certain. In hyperparathyroidism, the bone damage primarily affects the cortical bone, especially the proximal one-third of the radius and to a lesser degree the upper femur; the lumbar spine is affected more rarely. Intermittent administration of parathyroid hormone stimulates bone formation and is useful in treating osteoporosis. Subcutaneous injections once daily administration of PTH stimulates bone formation on the surface of trabecular and cortical bone, by preferential stimulation of osteoblastic more than osteoclastic activity.