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Anabolic effect of human parathyroid hormone fragment on trabecular bone in involutional osteoporosis: a multicentre trial.

After baseline studies, 21 patients with osteoporosis were treated with human parathyroid hormone fragment (PTH 1-34) given as once-daily subcutaneous injections for 6-24 months. The dose used did not cause hypercalcaemia even in the first few hours after injection. Calcium and phosphate balances improved in some patients, but there was no significant improvement in the group values. There were, however, substantial increases in iliac trabecular bone volume: the mean increase, confirmed by repeat blind measurements, was 70% above mean baseline volume. The new bone was histologically normal. Those patients who had the largest increases in 47Ca-kinetic and histomorphometric indices of new bone formation showed the greatest increases in trabecular bone volume, suggesting that treatment with human parathyroid hormone fragment caused a dissociation between formation and resorption rates that was confined to trabecular bone. Since vertebrae are four-fifths composed of trabecular bone, this hormone fragment may prove useful in treating patients with the crush fracture syndrome.

Aged↗

Parathyroid hormone as a calcium ionophore in bone cells: tests of specificity.

Parathyroid Hormone (PTH) stimulates calcium entry into bone cells in vitro, and this effect has been proposed to mediate the actions of PTH on bone. Using cells harvested from infant rat calvaria by collagenase digestion, we evaluated the sensitivity and specificity of this phenomenon. Calcium uptake was temperature dependent, and was increased by PTH over the concentration range 0.01 to 0.50 units/ml. A series of nonhormonal peptides obtained during the purification of a single batch of PTH was found to stimulate calcium uptake. In addition, isoproterenol, ACTH, calcitonin, and glucagon stimulated calcium uptake. In no case, however, was the degree of stimulation as great as that produced by biologically active PTH. Prostaglandins are also potent resorbers of bone, and a series of prostaglandins also stimulated calcium uptake into bone cells. These results are compatible with a calcium ionophore model of PTH and prostaglandin action on bone.

Animals↗

Effect of phorbol myristate acetate on secretion of parathyroid hormone.

The influence of phorbol myristate acetate (PMA), an activator of protein kinase c, on the secretion of parathyroid hormone from collagenase-dispersed bovine parathyroid cells was tested. The cells were incubated at low (0.5 mM) or high (2.0 mM) concentrations of calcium in the medium, and the hormone secreted into the medium was measured by a radioimmunoassay that recognizes both intact and C-terminal fragments of hormone. At low calcium, the secretory rate averaged 32 +/- 3.8 ng.h-1.(10(5) cells)-1. The addition of 1.6 microM PMA did not affect secretion. At high calcium there was a significant suppression of secretion by 38% to 19.8 +/- 3 ng.h-1.(10(5) cells)-1. The addition of 1.6 microM PMA significantly stimulated hormone secretion to 35.8 +/- 8 ng.h-1.(10(5) cells)-1, a rate indistinguishable from low calcium. This stimulatory effect of PMA at high calcium was seen at PMA concentrations as low as 1.6 nM, did not occur with a biologically inactive 4 alpha-isomer of phorbol ester, and was independent of changes in cellular adenosine 3',5'-cyclic monophosphate levels. Examination of 32P-labeled phosphoproteins by two-dimensional gel electrophoresis revealed acidic proteins of approximately 20,000 and 100,000 Da that were phosphorylated at low and high calcium + 1.6 microM PMA but not at high calcium alone. The protein kinase c activity associated with the membrane fraction of parathyroid cells significantly decreased 40% when the cells were incubated at high vs. low calcium. The data suggest that calcium may regulate parathyroid hormone secretion through changes in protein kinase c activity of the membrane fraction of the cell and protein phosphorylation.

Animals↗

Functional importance of Myc-associated zinc finger protein for the human parathyroid hormone (PTH)/PTH-related peptide receptor-1 P2 promoter constitutive activity.

The aim of the present study was to analyze the functional importance for the parathyroid hormone (PTH)/PTH-related peptide (PTHrP) receptor (PTHR1) gene P2 promoter activity of the putative proximal Myc-associated zinc finger protein (MAZ) site localized at position bp -45 to -39 bp, taking advantage of a G/A mutation identified at position -40 in the human sequence. Wild-type 'full-length' (1285P2) and truncated (760P2) promoter sequences were inserted upstream to the luciferase basic (pLucB) and enhancer (pLucE) reporter gene expression vectors. Transient transfections in osteoblast-like SaOS-2 cells and renal cells (RC.SV3A2) showed that the -40 G/A mutation significantly impaired transcriptional activity of wild-type 1285P2-pLucB and 760P2-pLucE promoter constructs. Further truncation of the P2 sequence demonstrated that the sequence -109/-37 bp was essential for promoter activity. Co-transfection with a MAZ expression vector did not modify the wild-type 1285P2-pLucB construct reporter activity but significantly increased 2-fold the mutated construction activity (P<0.05). Electrophoretic mobility shift assays using SaOS-2 nuclear extracts and a double-stranded DNA fragment encompassing the -45 to -39 putative MAZ site (ds-MAZ-oligo) disclosed two specific DNA-protein complexes. Complex II (fast moving) had a lower affinity for the mutated MAZ motif than for the wild-type MAZ motif while complex I (slow moving) had the same affinity for both wild-type or mutated MAZ sequences. Competition studies with Sp1 consensus oligonucleotide (ds-Sp1-oligo) markedly reduced complex I intensity, with a concomitant increase in that of complex II. Finally, ribonuclease protection assays showed that P2-specific PTHR1 mRNA transcript expression was significantly decreased in SaOS-2 cells transfected with ds-MAZ-oligo as compared with that for control (P<0.001) and ds-Sp1-oligo (P<0.05). Taken together, our studies suggest that the putative -45 to -39 MAZ-binding site regulates the constitutive activity of human PTHR1 P2 promoter.

Cell Nucleus↗

Intraoperative quick parathyroid hormone assay in the surgical management of hyperparathyroidism.

Intraoperative quick parathyroid hormone (QPTH) assay is claimed to prevent failure during parathyroidectomy for hyperparathyroidism. The causes of operative failure have included multiglandular disease, ectopic parathyroid glands, supernumerary parathyroid glands, errors in frozen section evaluations, and missed diagnosis. A QPTH assay has been recognized as a useful method of determining whether hyperfunctioning tissues have been completely excised. However, an intraoperative QPTH assay may fail to detect the presence of double parathyroid adenomas. Use of this assay in conjunction with preoperative and intraoperative localization studies has led to the advocacy of more directed cervical procedures, such as limited, video-assisted, and endoscopic parathyroidectomy.

Biological Assay↗

Decreased parathyroid function in hyperthyroidism: interrelationships between serum parathyroid hormone, calcium-phosphorus metabolism and thyroid function.

Serum immunoreactive parathyroid hormone (S-iPTH) was measured together with serum and urinary calcium and phosphorus in 45 hyperthyroid patients in order to assess parathyroid fe of hyperthyroidism. The prevalence of hypercalcaemia was 51.1% using serum calcium values corrected for individual variations in serum albumin concentration compared to 15.6% using the uncorrected calcium values. S-iPTH was decreased and inversely correlated to serum calcium values. S-iPTH was decreased and inversely correlated to serum calcium (corrected). Subnormal levels of S-iPTH were found in 28.9% of the patients. The urinary excretion of calcium and phosphorus was increased and positively correlated to the degree of hyperthyroidism. The tubular reabsorption of calcium (TRCa%) was decreased, positively correlated to S-iPTH and inversely correlated to serum calcium. Increased mobilisation of bone mineral in hyperthyroidism is suggested mainly to be responsible for the elevated serarathyroid function.

Adolescent↗

The mid-region of parathyroid hormone (1-34) serves as a functional docking domain in receptor activation.

Elucidating the bimolecular interface between parathyroid hormone (PTH) and its cognate G protein-coupled receptor (PTHR1) should yield insights into the basis of molecular recognition and the mechanism of ligand-mediated intracellular signaling for a system that is critically important in regulating calcium levels in blood. We used photoaffinity scanning (PAS) to identify key ligand-receptor interactions for residues from the unstructured mid-region domain of PTH-(1-34). Four PTH analogues, containing a single photoreactive p-benzoylphenylalanine (Bpa) residue in position 11, 15, 18, or 21, were found to photo-cross-link within receptor regions [165-176], [183-189], [190-298], and [165-176], respectively. Addition of these mid-region contacts as constraints to our previously proposed model of the PTH-PTHR1 complex and extensive molecular simulation experiments enables substantial refinement of the model. Specifically, (1) the overall receptor-bound conformation of the hormone is not extended, but bent; (2) helix [169-176] of the N-terminal extracellular domain (N-ECD) of the receptor is redirected toward the heptahelical bundle; and (3) the hormone traverses between the top of transmembrane (TM) helices 1 and 2, rather than between TM-7 and TM-1. This significantly alters the model of both the receptor-bound tertiary structure of the hormone and the topological orientation of the C-terminus of the N-ECD in the hormone-receptor bimolecular complex. We propose that the mid-region of PTH-(1-34) has a role in fixing, by extensive contacts with the receptor, the entry of the N-terminal helix of the hormone into the heptahelical bundle between TM-1 and TM-2. This anchorage would orient the amino terminus into position to activate the receptor.

Animals↗

Role of 1,25-dihydroxyvitamin D on the skeletal resistance to parathyroid hormone.

Hypocalcemia in chronic renal failure (CRF) has been attributed in part to a skeletal resistance (S.R.) to the calcemic action of parathyroid hormone (PTH) as a consequence of low levels of 1,25(OH)2D3. To further elucidate the role of 1,25(OH)2D3 in the genesis of S.R., the calcemic effect of infusion of synthetic b-PTH 1-34 was examined in dogs before and after 7, 90 and 180 days of CRF. The maximum increment in ionized calcium after the infusion of PTH in the normal dogs was 1.15 +/- 0.13 mg/dl, decreased to 0.84 +/- 0.09 after 7 days, 0.68 +/- 0.1 after 90 days and to 0.66 +/- 0.11 mg/dl after 180 days of CRF. Thereafter, the dogs received 1,25(OH)2D3, 0.5 microgram daily for seven days and the studies were repeated. No improvement in the calcemic response to PTH was observed (0.57 +/- 0.26 mg/100 ml). Subsequently, a parathyroidectomy (PTX) was performed and 24 hours later the studies were repeated. After the infusion of PTH the calcemic response returned to normal (0.93 +/- 0.14 mg/dl). Further studies were performed in a group of four uremic dogs receiving no 1,25(OH)2D3, in which a PTX was performed 24 hours prior to the infusion of PTH. For this group, the increase in serum ionized calcium was 0.99 +/- 0.11 mg/dl. These values were not statistically different from normal dogs. In summary: (1) renal insufficiency was characterized by an abnormal calcemic response to PTH; (2) the administration of 1,25(OH)2D3 did not correct the S.R. to PTH; and (3) PTX performed 24 hours before the infusion of PTH restored the calcemic response to normal. These data suggest that high levels of endogenous parathyroid hormone desensitized the skeleton to the administration of exogenous PTH. These studies indicate that low values of 1,25(OH)2D3 are not directly responsible for the skeletal resistance to PTH in chronic renal failure.

Animals↗

The renal parathyroid hormone receptor-adenylate cyclase system in vitro and in vivo.

High affinity parathyroid hormone (PTH) receptors in chicken renal plasma membranes were identified and quantitated using bPTH((1-34) labeled by electrolytic iodination and purified by a membrane absorption procedure. Parallel studies of PTH-receptor binding and activation of adenylate cyclase indicated that these activities were coupled. The PTH sensitivity of the renal receptor-adenylate cyclase system was similar in vivo and in vitro (Km congruent to 20 nM), whereas a 'physiologic' concentration of circulating bPTH (1-34) infused into thyroparathyroidectomized/ultimobranchial-ectomized chickens was estimated to be at least 40 times lower. Small increments in cellular cyclic AMP levels are apparently sufficient to mediate actions of PTH on the kidney.

Adenylyl Cyclases↗

[Preoperative localization diagnosis of parathyroid adenomas in 72 cases of primary hyperparathyroidism by selective catheterization of neck veins and parathyroid hormone determination].

In 72 cases of primary hyperparathyroidism, selective venous catheterization was performed preoperatively to localize parathyroid adenomas. Diagnosis of primary hyperparathyroidism was proved by operation in all but 5 cases, in which no adenomas could be found intraoperatively. By venous catheterization of the neck and upper region of the thorax, an average of 10 blood samples per patient were taken. Parathyroid hormone was estimated by radioimmunoassay with high sensitivity against the intact PTH-molecule and carboxy-terminal fragments. Only in 24 out of 72 cases was localization of parathyroid adenomas prognosticated correctly with respect to side and height, while in a total of 38 cases localization on the right or left side only could be determined preoperatively. These unsatisfactory results can be improved only by a much more extensive catheterization technic which would be justified only in patients already operated on before without success. The final evaluation of non-invasive methods, e.g. ultrasonics and computerized tomography, is still under discussion.

Adenoma↗

ATP activation of parathyroid hormone cleavage catalyzed by cathepsin D from bovine kidney.

The acid protease which is activated by ATP and which catalyzes production of fragments of parathyroid hormone similar to those produced in vivo was shown to be cathepsin D. Purified cathepsin D from bovine kidney and spleen is activated by ATP and other nucleoside triphosphates, and to a much lesser extent by nucleoside diphosphates and pyrophosphate. These findings suggest that cathepsin D may be involved in parathyroid hormone metabolism in vivo and that this lysosomal enzyme may be regulated by the energy status of the cell.

Adenosine Triphosphate↗

A theoretical study of the structure of parathyroid hormone.

Theoretical analysis of the tertiary and secondary structure of parathyroid hormone was conducted. By combining interpretations from this analysis with chemical data available in the literature, certain structural features of the hormone are consistently predicted. The proposed model for the hormone contains two domains dominated by hydrophobic clustering of critical residues within each domain and separated by an exposed linker region. In the prediction of two domains with a linker region, the model is similar to that proposed by Fiskin et al. [Fiskin, A.M., Cohn, D.M. & Peterson, G.S. (1977) J. Biol. Chem. 252, 8261-8268], but it differs significantly in other respects. The proposed structural features are apparent in the bovine, human, and porcine species of hormone.

Amino Acid Sequence↗

Vitamin D receptor (VDR) and parathyroid hormone messenger ribonucleic acid levels correspond to polymorphic VDR alleles in human parathyroid tumors.

Calcitriol, via its receptor (VDR) is a main regulator of PTH secretion and parathyroid cell proliferation. Recently, marked overrepresentation of the polymorphic VDR alleles b, a, and T was found in patients with primary hyperparathyroidism (pHPT), which suggests pathogenic importance in the disease. Using the ribonuclease protection assay, relative VDR and PTH messenger ribonucleic acid (mRNA) levels of parathyroid adenomas from 42 patients with sporadic pHPT were related to these VDR polymorphisms. The tumors of patients homozygous for the b, a, or T alleles demonstrated significantly lower VDR and higher PTH mRNA levels than those exhibiting the BB, AA, or tt genotypes (P < 0.0001-0.02), whereas heterozygotes had intermediate values. A similar discrepancy was found when comparing the baT and non-baT haplotypes (0.042 +/- 0.005 vs. 0.064 +/- 0.004 for VDR; 34.4 +/- 3.7 vs. 21.6 +/- 2.2 for PTH; both P < 0.005). The lower VDR mRNA levels associated with the b, a, and T alleles may affect the calcitriol-mediated control of parathyroid function and thereby contribute to the development of sporadic pHPT.

Adenoma↗

Effects of thyroparathyroidectomy, parathyroid hormone, and PTHrP on kidneys of ovine fetuses.

The fetal parathyroid glands and parathyroid hormone-related protein (PTHrP) have been shown to be important regulators of fetal calcium metabolism through their actions on the placenta and bone. This study examined the effects of fetal thyroparathyroidectomy (with thyroxine replacement) and exogenous infusion of human parathyroid hormone [PTH-(1-34)], PTHrP-(1-34), and PTHrP-(1-141) on the urinary excretion of calcium in chronically cannulated ovine fetuses during the last one-fifth of gestation. Fetal plasma total and ionized calcium concentrations were significantly lower in thyroparathyroidectomized (TxPTx) fetuses when compared with intact fetuses, but there were no significant differences in urinary excretion rates of total calcium. However, TxPTx produced a significant increase in the fractional excretion rate of total calcium and a significant decrease in the excretion of adenosine 3',5'-cyclic monophosphate (cAMP) compared with intact fetuses. Infusions of PTH-(1-34), PTHrP-(1-34), and PTHrP-(1-141) into the jugular vein of TxPTx fetuses (n = 5) at the rate of 1 nmol/h for 2 h, after a 1-nmol loading dose, significantly decreased the excretion rate of total calcium and increased the excretion rate of cAMP in fetal urine. Infusions of all three peptides resulted in significant increases in the concentration of total calcium in fetal plasma but had no effect on the plasma concentrations or urinary excretion rates of phosphate. Infusion of either PTH-(1-34), PTHrP-(1-34), or PTHrP-(1-141) also resulted in an increase in fetal urine osmolality and pH and a decrease in free water clearance in TxPTx fetuses.(ABSTRACT TRUNCATED AT 250 WORDS)

Absorption↗

Menin inactivation leads to loss of transforming growth factor beta inhibition of parathyroid cell proliferation and parathyroid hormone secretion.

Primary hyperparathyroidism is a common endocrine disorder caused by parathyroid gland enlargement and excessive parathyroid hormone (PTH) secretion. However, the precise mechanisms of tumorigenesis of the parathyroids are unknown. Here we have investigated the roles of transforming growth factor (TGF)-beta and menin, the product of the multiple endocrine neoplasia type 1 (Men1) gene, in the proliferation and PTH production of parathyroid cells from either patients with secondary hyperparathyroidism or Men1. TGF-beta was expressed in the parathyroid endocrine cells. Addition of TGF-beta to parathyroid cells from patients with secondary hyperparathyroidism inhibited their proliferation and PTH secretion. These responses to TGF-beta were lost when menin was specifically inactivated by antisense oligonucleotides. Moreover, TGF-beta did not affect the proliferation and PTH production of parathyroid cells from a Men1 patient. These results indicate that menin is required for TGF-beta action in the parathyroid. We conclude that TGF-beta is an important autocrine/paracrine negative regulator of parathyroid cell proliferation and PTH secretion and that loss of TGF-beta signaling due to menin inactivation contributes to parathyroid tumorigenesis.

Cell Division↗

Early effects of parathyroid hormone on membrane potential of rat osteoblasts in culture: role of cAMP and Ca2+.

Microelectrodes were used to investigate the possible involvement of cAMP and Ca2+ ions in the parathyroid hormone's, bPTH(1-34), effect on the membrane potential of rat osteoblasts in primary culture. Parathyroid hormone (10(-7) M) depolarized cell membrane by 25.0 +/- 6.1 mV (mean +/- standard deviation, SD; n = 17). Blocking Ca2+ influx with the Ca channel blocker cobalt revealed two phases in the hormone effect: a rapid and slight membrane hyperpolarization followed by sustained depolarization. In addition, cobalt significantly (p less than 0.01) decreased the magnitude of the PTH depolarizing action. The addition of dibutyryl-cAMP (10(-3) M) to the perfusion solution also resulted in a biphasic effect. At a lower concentration (10(-4) M), dibutyryl-cAMP produced only membrane hyperpolarization, suggesting a cAMP dose dependence of the opposite membrane potential changes. Forskolin (10(-5) M) and the phosphodiesterase inhibitor isobutylmethylxanthine (IBMX) (10(-4) M) mimicked the depolarizing effect of PTH. IBMX at a low concentration (5 x 10(-6) M) potentiated the depolarizing effect of PTH. Increases in [Ca2+]i using Ca2+ ionophore A23187 and intracellular injection of CaCl2 or inositol trisphosphate decreased the PTH depolarizing action, whereas intracellular injection of EGTA enhanced this effect. These results indicate that PTH evokes a biphasic change in rat osteoblast membrane potential that seems to be mediated by an increase in cAMP and modulated by intracellular calcium.

1-Methyl-3-isobutylxanthine↗

Magnesium deficit in major burns: role in hypoparathyroidism and end-organ parathyroid hormone resistance.

Children and adults who are severely burned develop magnesium(Mg) depletion, hypocalcemia, hypoparathyroidism and renal resistance to the administration of exogenous parathyroid hormone(PTH). This same spectrum of findings is seen with both Mg depletion and hypermagnesemia. We reported that in a group of ten children burned at least 30 per cent of total body surface area that 70-80 per cent of serum levels of ionized calcium and Mg were low. In three of the patients studies when serum Mg returned to normal, retention of a standard Mg infusion was abnormally high in two of them, suggesting persistence of Mg depletion despite normal serum Mg levels. Mg intake in these children conforms to the recommended dietary intake for age suggesting that excessive Mg losses may contribute to the observed Mg depletion. These losses are through the burn wound and possibly through abnormal intestinal secretion. Increased metabolic rate seen in burn patients may also promote intracellular Mg uptake to support the increased energy requirements of cells. It is hypothesized that since Mg is an important cofactor in the production of cyclic AMP, Mg deficiency may block intracellular cyclic AMP generation in parathyroid cells to block the secretion of parathyroid hormone and in renal tubular cells to block the renal generation may improve PTH secretion and hypocalcemia in non-burned patients, preliminary data in burned children suggest that the cause of hypocalcemia and hypoparathyroidism is more complex.

Adult↗

[A parathyroid hormone related protein (PTHrP) implicated in hypercalcemia associated with malignancy: research of the PTHrP for novel hormonal tumor marker].

A cDNA complementary to the parathyroid hormone related protein (PTHrP), the humoral hypercalcemia factor in malignancy, was recently isolated and sequenced. PTHrP expression in human carcinomas was examined (determined) by Northern blot hybridization, Southern blot hybridization and radioimmunoassay (RIA). Expression of PTHrP mRNA was detected in three out of four lung squamous cell carcinomas, two out of ten breast carcinomas and the one adenosquamous carcinoma of the maxilla. No clinical hypercalcemia was found in these PTHrP mRNA positive carcinomas. No expression of PTHrP was detected in normal human or rat tissues. In Southern blot hybridization, no amplification of PTHrP gene was found in PTHrP positive cases. An insertion in one allele of promotor region of the gene was identified in one PTHrP positive lung squamous cell carcinoma. The serum level of PTHrP was examined using human PTHrP (1-34) RIA in lung carcinomas. We found no correlation between the level of PTHrP and clinical hypercalcemia or the histopathological diagnosis. We discuss some problems of the PTHrP assay as a novel tumor marker for malignancies. A new RIA assay study using recombinant human PTHrP expressed in Escherichia coli is also reported.

Biomarkers, Tumor↗