Joshua Jisha, Schwaerzer Gerburg K, Kalyanaraman Hema, Cory Esther, Sah Robert L, Li Mofei, Vaida Florin, Boss Gerry R, Pilz Renate B
Departments of Medicine (J.J., G.K.S., H.K., G.R.B., R.B.P.), Bioengineering (E.C., R.S.S.), Mathematics (M.L.), and Family and Preventive Medicine (F.V.), University of California, San Diego, La Jolla, California 92093-0652.
Endocrinology. 2014 Dec;155(12):4720-30. doi: 10.1210/en.2014-1343. Epub 2014 Sep 4.
Osteoporosis is a major health problem leading to fractures that cause substantial morbidity and mortality. Current osteoporosis therapies have significant drawbacks, creating a need for novel bone-anabolic agents. We previously showed that the nitric oxide/cyclic GMP (cGMP)/protein kinase G pathway mediates some of the anabolic effects of estrogens and mechanical stimulation in osteoblasts and osteocytes, leading us to hypothesize that cGMP-elevating agents may have bone-protective effects. We tested cinaciguat, a prototype of a novel class of soluble guanylate cyclase activators, in a mouse model of estrogen deficiency-induced osteoporosis. Compared with sham-operated mice, ovariectomized mice had lower serum cGMP concentrations, which were largely restored to normal by treatment with cinaciguat or low-dose 17β-estradiol. Microcomputed tomography of tibiae showed that cinaciguat significantly improved trabecular bone microarchitecture in ovariectomized animals, with effect sizes similar to those obtained with estrogen replacement therapy. Cinaciguat reversed ovariectomy-induced osteocyte apoptosis as efficiently as estradiol and enhanced bone formation parameters in vivo, consistent with in vitro effects on osteoblast proliferation, differentiation, and survival. Compared with 17β-estradiol, which completely reversed the ovariectomy-induced increase in osteoclast number, cinaciguat had little effect on osteoclasts. Direct guanylate cyclase stimulators have been extremely well tolerated in clinical trials of cardiovascular diseases, and our findings provide proof-of-concept for this new class of drugs as a novel, anabolic treatment strategy for postmenopausal osteoporosis, confirming an important role of nitric oxide/cGMP/protein kinase G signaling in bone.
骨质疏松症是一个导致骨折的重大健康问题,骨折会引发严重的发病率和死亡率。目前的骨质疏松症治疗方法存在显著缺陷,因此需要新型的骨合成代谢药物。我们之前表明,一氧化氮/环磷酸鸟苷(cGMP)/蛋白激酶G途径介导雌激素和机械刺激在成骨细胞和骨细胞中的一些合成代谢作用,这使我们推测提高cGMP的药物可能具有骨保护作用。我们在雌激素缺乏诱导的骨质疏松症小鼠模型中测试了新型可溶性鸟苷酸环化酶激活剂类的原型药物西那吉肽。与假手术小鼠相比,去卵巢小鼠的血清cGMP浓度较低,用西那吉肽或低剂量17β-雌二醇治疗后,该浓度基本恢复正常。胫骨的微型计算机断层扫描显示,西那吉肽显著改善了去卵巢动物的小梁骨微结构,效应大小与雌激素替代疗法相似。西那吉肽与雌二醇一样有效地逆转了去卵巢诱导的骨细胞凋亡,并增强了体内的骨形成参数,这与对成骨细胞增殖、分化和存活的体外作用一致。与完全逆转去卵巢诱导的破骨细胞数量增加的17β-雌二醇相比,西那吉肽对破骨细胞几乎没有影响。直接鸟苷酸环化酶刺激剂在心血管疾病的临床试验中耐受性极佳,我们的研究结果为这类新型药物作为绝经后骨质疏松症的一种新型合成代谢治疗策略提供了概念验证,证实了一氧化氮/cGMP/蛋白激酶G信号在骨骼中的重要作用。