Department of Monitored Pharmacotherapy, Medical University of Bialystok, Mickiewicza 2C, 15-222 Bialystok, Poland.
Department of Pharmacodynamics, Medical University of Bialystok, Mickiewicza 2C, 15-222 Bialystok, Poland.
Cytokine. 2018 Jun;106:19-28. doi: 10.1016/j.cyto.2018.03.002. Epub 2018 Mar 9.
Osteoprotegerin (OPG), receptor activator of NF-κB ligand (RANKL), and parathyroid hormone (PTH) play a central role in the regulation of bone turnover in chronic kidney disease (CKD), but their influence on bone mineral density (BMD) and strength remains unclear, particularly in children. We studied the clinical significance of OPG and RANKL in relation to PTH, femur weight, BMD, and bone biomechanical properties in growing rats after one month (CKD-1) and three months (CKD-3) of surgically-induced mild CKD. Gene expression of parathyroid hormone 1 receptor (PTH1R) and activating transcription factor 4 (ATF4), major regulators of anabolic PTH response in bone, was also determined. Serum PTH and bone PTH1R/ATF4 expression was elevated in CKD-3 compared with other groups, and it positively correlated with femur weight, BMD, and the biomechanical properties of the femoral diaphysis reflecting cortical bone strength. In contrast, bone RANKL/OPG ratios were decreased in CKD-3 rats compared with other groups, and they were inversely correlated with PTH and the other abovementioned bone parameters. However, the PTH-PTH1R-ATF4 axis exerted an unfavorable effect on the biomechanical properties of the femoral neck. In conclusion, this study showed for the first time an inverse association between serum PTH and the bone RANKL/OPG system in growing rats with mild CKD. A decrease in the RANKL/OPG ratio, associated with PTH-dependent activation of the anabolic PTH1R/ATF4 pathway, seems to be responsible for the unexpected, beneficial effect of PTH on cortical bone accrual and strength. Simultaneously, impaired biomechanical properties of the femoral neck were observed, making this bone site more susceptible to fractures.
骨保护素(OPG)、核因子-κB 配体受体激活剂(RANKL)和甲状旁腺激素(PTH)在慢性肾脏病(CKD)中骨转换的调节中发挥核心作用,但它们对骨密度(BMD)和骨强度的影响仍不清楚,特别是在儿童中。我们研究了 OPG 和 RANKL 与 PTH、股骨重量、BMD 和骨生物力学特性在手术后诱导的轻度 CKD 1 个月(CKD-1)和 3 个月(CKD-3)的生长大鼠中的临床意义。甲状旁腺激素 1 受体(PTH1R)和激活转录因子 4(ATF4)的基因表达,骨中合成代谢 PTH 反应的主要调节剂,也被确定。与其他组相比,CKD-3 大鼠的血清 PTH 和骨 PTH1R/ATF4 表达升高,且与股骨重量、BMD 和反映皮质骨强度的股骨骨干生物力学特性呈正相关。相比之下,与其他组相比,CKD-3 大鼠的骨 RANKL/OPG 比值降低,且与 PTH 和上述其他骨参数呈负相关。然而,PTH-PTH1R-ATF4 轴对股骨颈的生物力学特性产生了不利影响。总之,本研究首次在轻度 CKD 的生长大鼠中显示血清 PTH 与骨 RANKL/OPG 系统之间呈负相关。骨 RANKL/OPG 比值降低,与依赖 PTH 的合成代谢 PTH1R/ATF4 途径的激活相关,似乎是 PTH 对皮质骨积累和强度产生意外有益作用的原因。同时,观察到股骨颈的生物力学特性受损,使该骨部位更容易发生骨折。