The calcium-sensing receptor in human disease

The discovery of the calcium-sensing receptor (CaR), a G protein-coupled receptor, has led to the elucidation of the pivotal roles of the CaR in systemic calcium homeostasis. The receptor is situated on the chief cells of the parathyroid glands, where it senses the extracellular Ca2+ concentration and in turn alters the rate of secretion of parathyroid hormone (PTH). The intracellular signal pathways to which the CaR couples include, but are not limited to, phospholipase C (PLC), and mitogen-activated protein kinases. The receptor is widely expressed in various tissues and likely serves important cellular functions beyond that of maintaining systemic calcium homeostasis. Functionally important mutations in the receptor have been found to cause disorders in calcium homeostasis due both to changes in the set point for PTH secretion and to the control of renal calcium excretion. These mutations cause hypercalcemia when the mutation inactivates the receptor and cause hypocalcemia when the mutation activates the receptor. Recent studies have revealed the presence of circulating autoantibodies to the calcium-sensing receptor in humans, with the clinical presentation the same as that for diseases caused by mutations in the CaR. In renal secondary hyperparathyroidism, a drug that stimulates the receptor (calcimimetic) shows great promise as a medical treatment for this condition.

Evidence that Ca(2+) cycling by the plasma membrane Ca(2+)-ATPase increases the 'excitability' of the extracellular Ca(2+)-sensing receptor

The extracellular Ca(2+)-sensing receptor (CaR) is a widely expressed G-protein-coupled receptor that translates information about [Ca(2+)] in the extracellular milieu to the interior of the cell, usually via intracellular Ca(2+) signaling pathways. Using fura-2 imaging of cytoplasmic [Ca(2+)], we observed that HEK293 cells expressing CaR oscillated readily under conditions permissive for CaR activation. Spiking was also triggered in the absence of external Ca(2+) by the CaR agonist spermine (1 mM). Oscillating cells were typically located in clusters of closely apposed cells, but Ca(2+) spiking was insensitive to the gap junction inhibitor 18alpha-glycyrrhetinic acid. We hypothesized that Ca(2+) signals might be amplified, in part, through a positive feedback loop in which Ca(2+) extrusion via the plasma membrane Ca(2+)-ATPase (PMCA) activates CaRs on the same cell or adjacent cells through local increases in [Ca(2+)](out). In support of this idea, addition of exogenous Ca(2+) buffers (keeping free [Ca(2+)](out) constant) attenuated or eliminated Ca(2+) signals (manifested as oscillations), as did PMCA inhibitors (HgCl(2), orthovanadate and Caloxin 2A1). Measurement of extracellular [Ca(2+)] using the near membrane probe fura-C(18) revealed that external [Ca(2+)] rose following receptor activation, sometimes displaying an oscillatory pattern. Our data suggest that PMCA-mediated cycling of Ca(2+) across the plasma membrane leads to localized increases in [Ca(2+)](out) that increase the excitability of CaR.

Activation of the MAP kinase cascade by exogenous calcium-sensing receptor

In Rat-1 fibroblasts and ovarian surface epithelial cells, extracellular calcium induces a proliferative response which appears to be mediated by the G-protein coupled calcium-sensing receptor (CaR), as expression of the nonfunctional CaR-R795W mutant inhibits both thymidine incorporation and activation of the extracellular-regulated kinase (ERK) in response to calcium. In this report we utilized CaR-transfected HEK293 cells to demonstrate that functional CaR is necessary and sufficient for calcium-induced ERK activation. CaR-dependent ERK activation was blocked by co-expression of the Ras dominant-negative mutant, Ras N17, and by exposure to the phosphatidyl inositol 3' kinase inhibitors wortmannin and LY294002. In contrast to Rat-1 fibroblasts, CaR-mediated in vitro kinase activity of ERK2 was unaffected by tyrosine kinase inhibitor herbimycin in CaR-transfected HEK293 cells. These results suggest that usage of distinct pathways downstream of the CaR varies in a cell-type specific manner, suggesting a potential mechanism by which activation of the CaR could couple to distinct calcium-dependent responses.

Physiological and pharmacological agonists of the extracellular Ca2+-sensing receptor

Extracellular Ca(2+) concentration [Ca(2+)](o) is vital for a number of processes varying from blood clotting to regulation membrane permeability and excitability. For this reason [Ca(2+)](o) is under strict control of a complex homeostatic system that includes parathyroid glands, kidneys, bones and intestine. The extracellular Ca(2+)-sensing receptor is an essential component of this system, regulating parathyroid hormone secretion, Ca(2+) (and Mg(2+)) excretion by the kidney, bone remodeling and Ca(2+) reabsorption by the gastrointestinal tract. The Ca(2+)-sensing receptor is also present in organs without an obvious link with mineral ion metabolism. This review will describe the discovery of a novel class of ion-sensing receptor(s), receptor-effector coupling and the roles of the Ca(2+)-sensing receptor inside and outside the Ca(2+)(o) homeostatic system.

G-protein coupled receptors in bone

The skeleton is a dynamic structure that undergoes continuous remodeling, a prerequisite to meeting the constant loading demands placed upon it. This process is controlled by a multitude of systemic and local factors which interact with receptors presented on the surface of both osteoblasts and osteoclasts; the osteogenic and osteolytic cells of bone. The seven transmembrane G-protein coupled superfamily of receptors are amongst the most important expressed by bone cells. Many local and systemic factors, including prostaglandins and parathyroid hormone, initiate cellular processes via interaction with members of this receptor family. The diversity of signals and signaling cross talk generated by activated G-protein receptor complexes, facilitates a huge range of downstream responses essential in the remodeling of the skeleton. Indeed, agonist-activated signaling crosstalk provides a mechanism for integrating the activities of local and systemic factors, an essential requirement of focal remodeling. This review has focused on those currently known seven transmembrane receptors expressed by bone cells that couple to G-proteins, and describes the nature of receptor-G protein interaction and the resultant functional consequences of effector activation within bone cells.