Reitsma P H, Teitelbaum S L, Bijvoet O L, Kahn A J
J Clin Invest. 1982 Nov;70(5):927-33. doi: 10.1172/jci110704.
The bisphosphonates (3-amino-1-hydroxypropylidene)-1,1-bisphosphonate (APD) and disodium dichloromethylidene bisphosphonate (Cl(2)MDP) effectively inhibit the accelerated bone resorption associated with some skeletal disorders, e.g., Paget's disease. However, it has not been established whether these compounds exert their inhibitory effect by rendering the bone mineral more resistant to degradation, by diminishing the activity of resorbing cells, or through some combination of both activities. In this study, we have tested these possibilities using an in vitro resorption assay system consisting of elicited rat peritoneal macrophages co-cultured with particles of (45)Ca-labeled, devitalized rat bone. This assay system permits the quantitative assessment of the action of APD and Cl(2)MDP on the two major phases of bone resorption (cell-substrate attachment and osteolysis) under circumstances where the drugs are present continuously or, most importantly for the issues in question, after the separate pretreatment of the particles or the resorbing cells. Our data indicate that (a) Both APD and Cl(2)MDP at concentrations >/=5 x 10(-6) M diminish macrophage-mediated (45)Ca release (i.e., bone resorption) in a log dose-dependent fashion. (b) A 10-min pretreatment of bone particles with either bisphosphonate (P-C-P) similarly inhibits resorptive activity, but is most pronounced with Cl(2)MDP. However, only APD is effective in reducing resorption when cells are preincubated (for 24 h) with P-C-P. (c) In cultures containing both labeled and unlabeled bone, significant inhibition occurs only when the labeled particles are coated with P-C-P (indicating that the action of P-C-P-treated bone is highly localized). (d) P-C-P does not diminish cell-bone particle attachment, an essential step in the resorptive process. On the other hand, delaying the addition of P-C-P until after cell-bone attachment is completed significantly reduces the resorption-inhibiting effect of these compounds. (e) Cl(2)MDP reduces culture DNA content in proportion to its inhibitory effect on resorption, and both the inhibitory and cytotoxic actions of this P-C-P are dependent upon the presence of bone. On the other hand, APD is cytotoxic only at very high concentrations (10(-4) M), acts independently of the presence of bone, and inhibits resorption without killing cells. We conclude that the mechanisms of action of APD and Cl(2)MDP are markedly different. Cl(2)MDP is a potent cytotoxin in the presence of bone and apparently exerts its inhibitory effect in this manner. APD is noncytotoxic at levels adequate to suppress resorption and, therefore, must inhibit macrophage activity by some other mechanism. Neither P-C-P appears to limit resorption by decreasing the solubility of mineralized bone matrix.
双膦酸盐类药物(3-氨基-1-羟基亚丙基)-1,1-双膦酸盐(APD)和二氯亚甲基双膦酸二钠(Cl₂MDP)能有效抑制与某些骨骼疾病(如佩吉特病)相关的加速骨吸收。然而,这些化合物是通过使骨矿物质更耐降解、降低吸收细胞的活性,还是通过这两种活性的某种组合来发挥其抑制作用,目前尚未明确。在本研究中,我们使用了一种体外吸收测定系统来测试这些可能性,该系统由诱导的大鼠腹腔巨噬细胞与(⁴⁵)Ca标记的失活大鼠骨颗粒共同培养组成。该测定系统允许在药物持续存在的情况下,或者对于所讨论的问题最重要的是在对颗粒或吸收细胞进行单独预处理之后,定量评估APD和Cl₂MDP对骨吸收两个主要阶段(细胞-底物附着和骨溶解)的作用。我们的数据表明:(a)浓度≥5×10⁻⁶ M的APD和Cl₂MDP均以对数剂量依赖性方式减少巨噬细胞介导的(⁴⁵)Ca释放(即骨吸收)。(b)用任何一种双膦酸盐(P-C-P)对骨颗粒进行10分钟的预处理同样会抑制吸收活性,但对Cl₂MDP最为明显。然而,只有当细胞与P-C-P预孵育(24小时)时,APD才有效地减少吸收。(c)在含有标记和未标记骨的培养物中,只有当标记颗粒用P-C-P包被时才会出现显著抑制(表明P-C-P处理的骨的作用高度局部化)。(d)P-C-P不会减少细胞-骨颗粒附着,这是吸收过程中的一个关键步骤。另一方面,将P-C-P的添加延迟到细胞-骨附着完成后会显著降低这些化合物的吸收抑制作用。(e)Cl₂MDP按其对吸收的抑制作用比例降低培养物中的DNA含量,并且这种P-C-P的抑制和细胞毒性作用均依赖于骨的存在。另一方面,APD仅在非常高的浓度(10⁻⁴ M)下才具有细胞毒性,其作用独立于骨的存在,并且在不杀死细胞的情况下抑制吸收。我们得出结论,APD和Cl₂MDP的作用机制明显不同。Cl₂MDP在有骨存在时是一种有效的细胞毒素,显然以这种方式发挥其抑制作用。APD在足以抑制吸收的水平下无细胞毒性,因此,它必须通过其他机制抑制巨噬细胞活性。两种P-C-P似乎都不是通过降低矿化骨基质的溶解度来限制吸收的。