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Ortega A, Olea-Herrero N, Arenas MI, Vélez-Vélez E, Moreno-Gómez-Toledano R, Muñoz-Moreno C, Lázaro A, Esbrit P, Tejedor A, Bosch RJ. Urinary excretion of parathyroid hormone-related protein correlates with renal function in control rats and rats with cisplatin nephrotoxicity. Am J Physiol Renal Physiol 2019; 317:F874-F880. [DOI: 10.1152/ajprenal.00091.2019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Parathyroid hormone-related protein (PTHrP) and its receptor are abundantly expressed throughout the renal parenchyma, where PTHrP exerts a modulatory action on renal function. PTHrP upregulation is a common event associated with the mechanism of renal injury and repair. However, no study has yet explored the putative excretion of PTHrP in urine, including its potential relationship with renal function. In the present study, we tested this hypothesis by studying the well-known rat model of acute renal injury induced by the chemotherapeutic agent cisplatin. Using Western blot analysis, we could detect a single protein band, corresponding to intact PTHrP, in the urine of both control and cisplatin-injected rats, whose levels were significantly higher in the latter group. PTHrP was detected in rat urine by dot blot, and its quantification with two specific ELISA kits showed that, compared with control rats, those treated with cisplatin displayed a significant increase in urinary PTHrP (expressed as the PTHrP-to-creatinine ratio or 24-h excretion). In addition, a positive correlation between urinary PTHrP excretion and serum creatinine was found in these animals. In conclusion, our data demonstrate that PTHrP is excreted in rat urine and that this excretion is higher with the decrease of renal function. This suggests that urinary PTHrP levels might be a renal function marker.
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Affiliation(s)
- Arantxa Ortega
- Laboratory of Renal Physiology and Experimental Nephrology, Department of Biological Systems/Physiology, University of Alcala, Madrid, Spain
| | - Nuria Olea-Herrero
- Laboratory of Renal Physiology and Experimental Nephrology, Department of Biological Systems/Physiology, University of Alcala, Madrid, Spain
| | - M. Isabel Arenas
- Department of Biomedicine and Biotechnology, University of Alcala, Madrid, Spain
| | - Esperanza Vélez-Vélez
- Fundación Jiménez Díaz School of Nursing, Autonomous University of Madrid, Jiménez Díaz Foundation IDC Salud, Madrid, Spain
| | - Rafael Moreno-Gómez-Toledano
- Laboratory of Renal Physiology and Experimental Nephrology, Department of Biological Systems/Physiology, University of Alcala, Madrid, Spain
| | - Carmen Muñoz-Moreno
- Laboratory of Renal Physiology and Experimental Nephrology, Department of Biological Systems/Physiology, University of Alcala, Madrid, Spain
| | - Alberto Lázaro
- Renal Physiopathology Laboratory, Department of Nephrology, Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain
| | - Pedro Esbrit
- Bone and Cartilage Unit, Instituto de Investigación Sanitaria, Fundación Jiménez Díaz, Madrid, Spain
| | - Alberto Tejedor
- Renal Physiopathology Laboratory, Department of Nephrology, Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain
| | - Ricardo J. Bosch
- Laboratory of Renal Physiology and Experimental Nephrology, Department of Biological Systems/Physiology, University of Alcala, Madrid, Spain
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2
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Hochane M, Raison D, Coquard C, Imhoff O, Massfelder T, Moulin B, Helwig JJ, Barthelmebs M. Parathyroid hormone-related protein is a mitogenic and a survival factor of mesangial cells from male mice: role of intracrine and paracrine pathways. Endocrinology 2013; 154:853-64. [PMID: 23284101 DOI: 10.1210/en.2012-1802] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Glomerulonephritis is characterized by the proliferation and apoptosis of mesangial cells (MC). The parathyroid-hormone related protein (PTHrP) is a locally active cytokine that affects these phenomena in many cell types, through either paracrine or intracrine pathways. The aim of this study was to evaluate the effect of both PTHrP pathways on MC proliferation and apoptosis. In vitro studies were based on MC from male transgenic mice allowing PTHrP-gene excision by a CreLoxP system. MC were also transfected with different PTHrP constructs: wild type PTHrP, PTHrP devoid of its signal peptide, or of its nuclear localization sequence. The results showed that PTHrP deletion in MC reduced their proliferation even in the presence of serum and increased their apoptosis when serum-deprived. PTH1R activation by PTHrP(1-36) or PTH(1-34) had no effect on proliferation but improved MC survival. Transfection of MC with PTHrP devoid of its signal peptide significantly increased their proliferation and minimally reduced their apoptosis. Overexpression of PTHrP devoid of its nuclear localization sequence protected cells from apoptosis without changing their proliferation. Wild type PTHrP transfection conferred both mitogenic and survival effects, which seem independent of midregion and C-terminal PTHrP fragments. PTHrP-induced MC proliferation was associated with p27(Kip1) down-regulation and c-Myc/E2F1 up-regulation. PTHrP increased MC survival through the activation of cAMP/protein kinase A and PI3-K/Akt pathways. These results reveal that PTHrP is a cytokine of multiple roles in MC, acting as a mitogenic factor only through an intracrine pathway, and reducing apoptosis mainly through the paracrine pathway. Thus, PTHrP appears as a probable actor in MC injuries.
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Affiliation(s)
- Mazène Hochane
- Institut National de la Santé et de la Recherche Médicale U682, Equipe Cancer du Rein et Physiopathologie Rénale, Faculté de Médecine, 11 rue Humann, F-67085 Strasbourg, France.
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3
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Romero M, Ortega A, Olea N, Arenas MI, Izquierdo A, Bover J, Esbrit P, Bosch RJ. Novel role of parathyroid hormone-related protein in the pathophysiology of the diabetic kidney: evidence from experimental and human diabetic nephropathy. J Diabetes Res 2013; 2013:162846. [PMID: 23984429 PMCID: PMC3747478 DOI: 10.1155/2013/162846] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Accepted: 07/04/2013] [Indexed: 11/17/2022] Open
Abstract
Parathyroid hormone-related protein (PTHrP) and its receptor type 1 (PTH1R) are extensively expressed in the kidney, where they are able to modulate renal function. Renal PTHrP is known to be overexpressed in acute renal injury. Recently, we hypothesized that PTHrP involvement in the mechanisms of renal injury might not be limited to conditions with predominant damage of the renal tubulointerstitium and might be extended to glomerular diseases, such as diabetic nephropathy (DN). In experimental DN, the overexpression of both PTHrP and the PTH1R contributes to the development of renal hypertrophy as well as proteinuria. More recent data have shown, for the first time, that PTHrP is upregulated in the kidney from patients with DN. Collectively, animal and human studies have shown that PTHrP acts as an important mediator of diabetic renal cell hypertrophy by a mechanism which involves the modulation of cell cycle regulatory proteins and TGF- β 1. Furthermore, angiotensin II (Ang II), a critical factor in the progression of renal injury, appears to be responsible for PTHrP upregulation in these conditions. These findings provide novel insights into the well-known protective effects of Ang II antagonists in renal diseases, paving the way for new therapeutic approaches.
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Affiliation(s)
- Montserrat Romero
- Laboratory of Renal Physiology and Experimental Nephrology, Department of Biological Systems/Physiology Unit, University of Alcalá, Alcalá de Henares, Madrid, Spain
| | - Arantxa Ortega
- Laboratory of Renal Physiology and Experimental Nephrology, Department of Biological Systems/Physiology Unit, University of Alcalá, Alcalá de Henares, Madrid, Spain
| | - Nuria Olea
- Laboratory of Renal Physiology and Experimental Nephrology, Department of Biological Systems/Physiology Unit, University of Alcalá, Alcalá de Henares, Madrid, Spain
| | - María Isabel Arenas
- Department of Biomedicine and Biotechnology/Cell Biology Unit, University of Alcalá, Alcalá de Henares, Madrid, Spain
| | - Adriana Izquierdo
- Laboratory of Renal Physiology and Experimental Nephrology, Department of Biological Systems/Physiology Unit, University of Alcalá, Alcalá de Henares, Madrid, Spain
| | - Jordi Bover
- Nephrology Department, Fundació Puigvert, Barcelona, Spain
| | - Pedro Esbrit
- Bone and Mineral Metabolism Laboratory, Instituto de Investigación Sanitaria-Fundación Jiménez Díaz, Madrid, Spain
| | - Ricardo J. Bosch
- Laboratory of Renal Physiology and Experimental Nephrology, Department of Biological Systems/Physiology Unit, University of Alcalá, Alcalá de Henares, Madrid, Spain
- Department of Biomedicine and Biotechnology/Cell Biology Unit, University of Alcalá, Alcalá de Henares, Madrid, Spain
- *Ricardo J. Bosch:
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Bai XY, Ma Y, Ding R, Fu B, Shi S, Chen XM. miR-335 and miR-34a Promote renal senescence by suppressing mitochondrial antioxidative enzymes. J Am Soc Nephrol 2011; 22:1252-61. [PMID: 21719785 DOI: 10.1681/asn.2010040367] [Citation(s) in RCA: 161] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The molecular basis for aging of the kidney is not well understood. MicroRNAs (miRNAs) contribute to processes such as development, differentiation, and apoptosis, but their contribution to the aging process is unknown. Here, we analyzed the miRNA expression profile of young (3-month) and old (24-month) rat kidneys and identified the biologic pathways and genes regulated by differentially expressed miRNAs. We observed upregulation of 18 miRNAs with aging, mainly regulating the genes associated with energy metabolism, cell proliferation, antioxidative defense, and extracellular matrix degradation; in contrast, we observed downregulation of 7 miRNAs with aging, principally targeting the genes associated with the immune inflammatory response and cell-cycle arrest. Bioinformatics analysis suggested that superoxide dismutase 2 (SOD2) and thioredoxin reductase 2 (Txnrd2), located in the mitochondria, are potential targets of miR-335 and miR-34a, respectively. Aging mesangial cells exhibited significant upregulation of miR-335 and miR-34a and marked downregulation of SOD2 and Txnrd2. miR-335 and miR-34a inhibited expression of SOD2 and Txnrd2 by binding to the 3'-untranslated regions of each gene, respectively. Overexpression of miR-335 and miR-34a induced premature senescence of young mesangial cells via suppression of SOD2 and Txnrd2 with a concomitant increase in reactive oxygen species (ROS). Conversely, antisense miR-335 and miR-34a inhibited senescence of old mesangial cells via upregulation of SOD2 and Txnrd2 with a concomitant decrease in ROS. In conclusion, these results suggest that miRNAs may contribute to renal aging by inhibiting intracellular pathways such as those involving the mitochondrial antioxidative enzymes SOD2 and Txnrd2.
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Affiliation(s)
- Xue-Yuan Bai
- Chinese PLA Institute of Nephrology, Chinese PLA General Hospital and Military Medical Postgraduate College, 28 Fuxing Road, Beijing 100853, People's Republic of China
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5
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A transgenic mouse model for studying the role of the parathyroid hormone-related protein system in renal injury. J Biomed Biotechnol 2010; 2011:290874. [PMID: 21052497 PMCID: PMC2967837 DOI: 10.1155/2011/290874] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2010] [Accepted: 10/11/2010] [Indexed: 01/15/2023] Open
Abstract
Parathyroid hormone- (PTH-) related protein (PTHrP) and its receptor, the PTH1 receptor (PTH1R), are widely expressed in the kidney, where PTHrP exerts a modulatory action on renal function. PTHrP is known to be upregulated in several experimental nephropathies such as acute renal failure (ARF), obstructive nephropathy (ON) as well as diabetic nephropathy (DN). In this paper, we will discuss the functional consequences of chronic PTHrP overexpression in the damaged kidney using a transgenic mouse strain overexpressing PTHrP in the renal proximal tubule. In both ARF and ON, PTHrP displays proinflammatory and profibrogenic actions including the induction of epithelia to mesenquima transition. Moreover, PTHrP participates in the mechanisms of renal hypertrophy as well as proteinuria in experimental DN. Angiotensin II (Ang II), a critical factor in the progression of renal injury, appears to be, at least in part, responsible for endogenous PTHrP upregulation in these pathophysiological settings. These findings provide novel insights into the well-known protective effects of Ang II antagonists in renal diseases, paving the way for new therapeutic approaches.
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6
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Thamilselvan V, Menon M, Thamilselvan S. Oxalate-induced activation of PKC-alpha and -delta regulates NADPH oxidase-mediated oxidative injury in renal tubular epithelial cells. Am J Physiol Renal Physiol 2009; 297:F1399-410. [PMID: 19692488 DOI: 10.1152/ajprenal.00051.2009] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Oxalate-induced oxidative stress contributes to cell injury and promotes renal deposition of calcium oxalate crystals. However, we do not know how oxalate stimulates reactive oxygen species (ROS) in renal tubular epithelial cells. We investigated the signaling mechanism of oxalate-induced ROS formation in these cells and found that oxalate significantly increased membrane-associated protein kinase C (PKC) activity while at the same time lowering cytosolic PKC activity. Oxalate markedly translocated PKC-alpha and -delta from the cytosol to the cell membrane. Pretreatment of LLC-PK1 cells with specific inhibitors of PKC-alpha or -delta significantly blocked oxalate-induced generation of superoxide and hydrogen peroxide along with NADPH oxidase activity, LDH release, lipid hydroperoxide formation, and apoptosis. The PKC activator PMA mimicked oxalate's effect on oxidative stress in LLC-PK1 cells as well as cytosol-to-membrane translocation of PKC-alpha and -delta. Silencing of PKC-alpha expression by PKC-alpha-specific small interfering RNA significantly attenuated oxalate-induced cell injury by decreasing hydrogen peroxide generation and LDH release. We believe this is the first demonstration that PKC-alpha- and -delta-dependent activation of NADPH oxidase is one of the mechanisms responsible for oxalate-induced oxidative injury in renal tubular epithelial cells. The study suggests that the therapeutic approach might be considered toward attenuating oxalate-induced PKC signaling-mediated oxidative injury in recurrent stone formers.
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7
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Rámila D, Ardura J, Esteban V, Ortega A, Ruiz-Ortega M, Bosch R, Esbrit P. Parathyroid hormone-related protein promotes inflammation in the kidney with an obstructed ureter. Kidney Int 2008; 73:835-47. [DOI: 10.1038/sj.ki.5002775] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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8
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Izquierdo A, López-Luna P, Ortega A, Romero M, Guitiérrez-Tarrés MA, Arribas I, Alvarez MJR, Esbrit P, Bosch RJ. The parathyroid hormone-related protein system and diabetic nephropathy outcome in streptozotocin-induced diabetes. Kidney Int 2006; 69:2171-7. [PMID: 16783882 DOI: 10.1038/sj.ki.5000195] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The pathophysiology of the diabetic kidney (e.g., hypertrophy, increase urinary albumin excretion (UAE) is still ill-defined. Parathyroid hormone-related protein (PTHrP) is overexpressed in several nephropathies, but its role remains unclear. We evaluated the effect of high glucose on PTHrP and the PTH1 receptor (PTH1R) protein (by Western blot and immunohistochemistry) in the kidney of mice ith streptozotocin-induced diabetes, and in several mouse renal cells in vitro. Diabetic mice showed a significantly increased renal expression of PTHrP and PTH1R proteins with 2-8 weeks from the onset of diabetes. These animals exhibited an intense immunostaining for both proteins in the renal tubules and glomeruli. Using transgenic mice overexpressing PTHrP targeted to the renal proximal tubule, we found a significant increase in the renal hypertrophy index and in UAE in these diabetic mice relative to their control littermates. Moreover, logistic regression analysis showed a significant association between both PTHrP and PTH1R protein levels and UAE in all diabetic mice throughout the study. High-glucose (25 mm) medium was found to increase PTHrP and PTH1R in tubuloepithelial cells, mesangial cells and podocytes in vitro. Moreover, this increase in PTHrP (but not that of PTH1R) was inhibited by the AT1 receptor antagonist losartan. Collectively, these results indicate that the renal PTHrP/PTH1R system is upregulated in streptozotozin-induced diabetes in mice, and appears to adversely affect the outcome of diabetic renal disease. Our findings also suggest that angiotensin II might have a role in the PTHrP upregulation in this condition.
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MESH Headings
- Angiotensin II/physiology
- Angiotensin II Type 1 Receptor Blockers/pharmacology
- Animals
- Blood Glucose/physiology
- Blotting, Western
- Cell Line
- Diabetes Mellitus, Experimental/complications
- Diabetes Mellitus, Experimental/physiopathology
- Diabetic Nephropathies/etiology
- Diabetic Nephropathies/physiopathology
- Epithelial Cells/chemistry
- Epithelial Cells/pathology
- Epithelial Cells/physiology
- Gene Expression Regulation/drug effects
- Gene Expression Regulation/physiology
- Hypertrophy/pathology
- Hypertrophy/physiopathology
- Immunohistochemistry
- Kidney Tubules/chemistry
- Kidney Tubules/pathology
- Kidney Tubules/physiopathology
- Losartan/pharmacology
- Mesangial Cells/chemistry
- Mesangial Cells/pathology
- Mesangial Cells/physiology
- Mice
- Mice, Transgenic
- Parathyroid Hormone-Related Protein/analysis
- Parathyroid Hormone-Related Protein/drug effects
- Parathyroid Hormone-Related Protein/genetics
- Parathyroid Hormone-Related Protein/physiology
- Podocytes/chemistry
- Podocytes/pathology
- Podocytes/physiology
- Receptor, Parathyroid Hormone, Type 1/analysis
- Receptor, Parathyroid Hormone, Type 1/drug effects
- Receptor, Parathyroid Hormone, Type 1/genetics
- Receptor, Parathyroid Hormone, Type 1/physiology
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Affiliation(s)
- A Izquierdo
- Laboratory of Renal Physiology and Experimental Nephrology, Department of Physiology, University of Alcalá, Alcalá de Henares, Spain
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9
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Talon I, Lindner V, Sourbier C, Schordan E, Rothhut S, Barthelmebs M, Lang H, Helwig JJ, Massfelder T. Antitumor effect of parathyroid hormone-related protein neutralizing antibody in human renal cell carcinoma in vitro and in vivo. Carcinogenesis 2005; 27:73-83. [PMID: 16081513 DOI: 10.1093/carcin/bgi203] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Functional inactivation of the von Hippel-Lindau (VHL) tumor suppressor gene occurs in 40-80% of human conventional renal cell carcinomas (RCCs). We showed recently that VHL-deficient RCCs expressed large amounts of parathyroid hormone-related protein (PTHrP), and that PTHrP, acting through the PTH1 receptor (PTH1R), plays an essential role in tumor growth. We also showed that PTHrP expression is negatively regulated by the VHL gene products (pVHL). Our goal was to determine whether blocking the PTHrP/PTH1R system might be of therapeutic value against RCC, independent of VHL status and PTHrP expression levels. The antitumor activity of PTHrP neutralizing antibody and of PTH1R antagonist were evaluated in vitro and in vivo in a panel of human RCC lines expressing or not pVHL. PTHrP is upregulated compared with normal tubular cells. In vitro, tumor cell growth and viability was decreased by up to 80% by the antibody in all cell lines. These effects resulted from apoptosis. Exogenously added PTHrP had no effect on cell growth and viability, but reversed the inhibitory effects of the antibody. The growth inhibition was reproduced by a specific PTH1R antagonist in all cell lines. In vivo, the treatment of nude mice bearing the Caki-1 RCC tumor with the PTHrP antibody inhibited tumor growth by 80%, by inducing apoptosis. Proliferation and neovascularization were not affected by the antiserum. Anti-PTHrP treatment induced no side effects as assessed by animal weight and blood chemistries. Current therapeutic strategies are only marginally effective against metastatic RCC, and adverse effects are common. This study provides a rationale for evaluating the blockade of PTHrP signaling as therapy for human RCC in a clinical setting.
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Affiliation(s)
- Isabelle Talon
- INSERM U727, Section of Renal Pharmacology and Physiopathology, University Louis Pasteur, School of Medicine, and Department of Pathology, Hôpitaux Universitaires de Strasbourg, Strasbourg, 67091 France
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10
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Massfelder T, Lang H, Schordan E, Lindner V, Rothhut S, Welsch S, Simon-Assmann P, Barthelmebs M, Jacqmin D, Helwig JJ. Parathyroid hormone-related protein is an essential growth factor for human clear cell renal carcinoma and a target for the von Hippel-Lindau tumor suppressor gene. Cancer Res 2004; 64:180-8. [PMID: 14729622 DOI: 10.1158/0008-5472.can-03-1968] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Clear cell renal carcinoma (CCRC) is responsible for 2% of cancer-related deaths worldwide and is resistant to virtually all therapies, indicating the importance of a search for new therapeutic targets. Parathyroid hormone-related protein (PTHrP) is a polyprotein derived from normal and malignant cells that regulates cell growth. In the current study, we show that blocking PTHrP with antibodies or antagonizing the common parathyroid hormone (PTH)/PTHrP receptor, the PTH1 receptor, dramatically blunts the expansion of human CCRC in vitro by promoting cell death. Importantly, in nude mice, anti-PTHrP antibodies induced complete regression of 70% of the implanted tumors by inducing cell death. In addition, we demonstrate that the von Hippel-Lindau tumor suppressor protein, which functions as a gatekeeper for CCRC, negatively regulates PTHrP expression at the post-transcriptional level. These studies indicate that PTHrP is an essential growth factor for CCRC and is a novel target for the von Hippel-Lindau tumor suppressor protein. Taken together, these results strongly suggest that targeting the PTHrP/PTH1 receptor system may provide a new avenue for the treatment of this aggressive cancer in humans.
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Affiliation(s)
- Thierry Massfelder
- Section of Renovascular Pharmacology and Physiology, Institut National de la Santé et de la Recherche Médicale-University Louis Pasteur, University Louis Pasteur School of Medicine, Strasbourg, France.
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11
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Santos S, Bosch RJ, Ortega A, Largo R, Fernández-Agulló T, Gazapo R, Egido J, Esbrit P. Up-regulation of parathyroid hormone-related protein in folic acid-induced acute renal failure. Kidney Int 2001; 60:982-95. [PMID: 11532093 DOI: 10.1046/j.1523-1755.2001.060003982.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Parathyroid hormone (PTH)-related protein (PTHrP) is present in many normal tissues, including the kidney. Current evidence supports that PTHrP is involved in renal pathophysiology, although its role on the mechanisms of renal damage and/or repair is unclear. Our present study examined the changes in PTHrP and the PTH/PTHrP receptor (type 1) in folic acid-induced acute renal failure in rats. The possible role of PTHrP on the process of renal regeneration following folic acid administration, and potential interaction between angiotensin II (Ang II) and endothelin-1, and PTHrP, were examined in this animal model. METHODS PTHrP, PTH/PTHrP receptor, ACE, and preproendothelin-1 (preproET-1) mRNA levels in the rat kidney were analyzed by reverse transcription-polymerase chain reaction (RT-PCR) and/or RNase protection assay. Immunohistochemistry also was performed for PTHrP, the PTH/PTHrP receptor, and Ang II in the renal tissue of folic acid-injected rats. The role of PTHrP on tubular cell proliferation following folic acid injury was investigated in vitro in rat renal epithelial cells (NRK 52E). PTHrP secretion in the medium conditioned by these cells was measured by an immunoradiometric assay specific for the 1-36 sequence. RESULTS Using RT-PCR, PTHrP mRNA was rapidly (1 hour) and maximally increased (3-fold) in the rat kidney after folic acid, decreasing after six hours. At 72 hours, renal function was maximally decreased in these rats, associated with an increased PTHrP immunostaining in both renal tubules and glomeruli. In contrast, the PTH/PTHrP receptor mRNA (RNase protection assay) decreased shortly after folic acid administration. Moreover, PTH/PTHrP receptor immunostaining dramatically decreased in renal tubular cell membranes after folic acid. A single subcutaneous administration of PTHrP (1-36), 3 or 50 microg/kg body weight, shortly after folic acid injection increased the number of tubular cells staining for proliferating cell nuclear antigen by 30% (P < 0.05) or 50% (P < 0.01), respectively, in these rats at 24 hours, without significant changes in either renal function or calcemia. On the other hand, this peptide failed to modify the increase (2-fold over control) in ACE mRNA, associated with a prominent Ang II staining into tubular cell nuclei, in the kidney of folic acid-treated rats at this time period. The addition of 10 mmol/L folic acid to NRK 52E cells caused a twofold increase in PTHrP mRNA at six hours, without significant changes in the PTH/PTHrP receptor mRNA. The presence of two anti-PTHrP antibodies, with or without folic acid, in the cell-conditioned medium decreased (40%, P < 0.01) cell growth. CONCLUSIONS Renal PTHrP was rapidly and transiently increased in rats with folic acid-induced acute renal failure, featuring as an early response gene. In addition, changes in ACE and Ang II expression were also found in these animals. PTHrP induces a mitogenic response in folic acid-damaged renal tubular cells both in vivo and in vitro. Our results support the notion that PTHrP up-regulation participates in the regenerative process in this model of acute renal failure and is a common event associated with the mechanisms of renal injury and repair.
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Affiliation(s)
- S Santos
- Bone and Mineral Metabolism Laboratory, Fundación Jiménez Díaz, Madrid, Spain
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12
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Ye Y, Falzon M, Seitz PK, Cooper CW. Overexpression of parathyroid hormone-related protein promotes cell growth in the rat intestinal cell line IEC-6. REGULATORY PEPTIDES 2001; 99:169-74. [PMID: 11384779 DOI: 10.1016/s0167-0115(01)00248-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The rat intestinal cell line, IEC-6, was used as a model to study effects of parathyroid hormone-related protein (PTHrP) on crypt cell growth. Studies showed that addition of PTHrP analogs (1-34), (67-86), or (107-139) to growth medium did not affect proliferation of cells grown in either high (10% Nu-Serum) or low serum (1% Nu-Serum). However, studies on clonal lines of IEC-6 cells stably transfected with PTHrP cDNA and overexpressing PTHrP showed that increased PTHrP production enhanced cell growth and 3H-thymidine incorporation in high, but not low, serum. Additional studies examined the role of the nuclear localization sequence (NLS) of PTHrP in mediating the growth effect. In three clonal IEC-6 lines transfected with PTHrP cDNA bearing a mutated NLS, the ability of PTHrP to stimulate 3H-thymidine incorporation and cell growth was lost. The results suggest that endogenously produced PTHrP can promote proliferation of IEC-6 cells and that the integrity of the NLS of PTHrP is required for its growth effects.
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Affiliation(s)
- Y Ye
- Department of Pharmacology and Toxicology, The University of Texas Medical Branch, Galveston, TX 77555-1031, USA
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13
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Escande B, Lindner V, Massfelder T, Helwig JJ, Simeoni U. Developmental aspects of parathyroid hormone-related protein biology. Semin Perinatol 2001; 25:76-84. [PMID: 11339669 DOI: 10.1053/sper.2001.23194] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Parathyroid hormone-related protein (PTHrP) has been discovered as a parathyroid hormone (PTH)-like factor responsible for the humoral hypercalcaemia of malignancies. Further studies revealed that PTHrP is ubiquitously expressed, in mature as well as in developing normal tissues from various species. Although not completely understood, the biological roles of PTHrP concern a variety of domains, including calcium phosphorus metabolism and bone mineralization, smooth muscle relaxation, cell growth and differentiation, and embryonic development. As a poly-hormone, PTHrP is now acknowledged to act via the paracrine, autocrine, and even the intracrine pathways. This review focuses on the main developmental features of the biology of PTHrP. During embryonic development, PTHrP is considered to be involved as a growth factor that promotes cell proliferation and delays cell terminal maturation. PTHrP has been shown to intervene in the development of various tissues and organs such as the skeleton, skin, hair follicles, tooth, pancreas, and the kidney. In addition, through its midregion sequence, which is able to promote an active transplacental calcium transport, PTHrP may intervene indirectly in the mineralization of the foetal skeleton. PTHrP has also been shown to be necessary for the normal development of the mammary gland, while huge amounts of PTHrP are found in the human milk. Finally, observations of physiologic, vasodilating effects of PTHrP in the kidney suggest its involvment in the control of renal hemodynamics, especially in the perinatal period.
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Affiliation(s)
- B Escande
- Section of Renovascular Pharmacology & Physiology (INSERM-MENRT), Louis Pasteur University School of Medicine, Strasbourg, France
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Esbrit P, Egido J. The emerging role of parathyroid hormone-related protein as a renal regulating factor. Nephrol Dial Transplant 2000; 15:1109-11. [PMID: 10910428 DOI: 10.1093/ndt/15.8.1109] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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15
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Aya K, Tanaka H, Ichinose Y, Kobayashi M, Seino Y. Expression of parathyroid hormone-related peptide messenger ribonucleic acid in developing kidney. Kidney Int 1999; 55:1696-703. [PMID: 10231431 DOI: 10.1046/j.1523-1755.1999.00417.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Parathyroid hormone (PTH)-related peptide (PTHrP), originally identified as a causative agent of hypercalcemia of malignancy, has been implicated in the regulation of growth and differentiation of endochondral bone, hair follicle, and breast as an autocrine/paracrine factor. Although some experiments indicate that PTHrP works as a growth factor for primary renal cells in vitro, the role of PTHrP in the kidney in vivo is not yet known. METHODS We examined the amounts of PTHrP and PTH/ PTHrP receptor (PTHR) mRNA in the mouse kidney developmental process by reverse transcription-polymerase chain reaction, and investigated which cells produce PTHrP and PTHR in vivo by in situ hybridization. RESULTS We observed high levels of PTHrP mRNA during mouse kidney maturation. PTHrP mRNA was expressed in the collecting duct, urothelium of the pelvis, and immature elements in the cortex of the developing kidney, including the S-shaped body, ureteric bud, and glomerulus. However, the expression of PTHR mRNA was lower during maturation than after the completion of the maturation process, and it was not detected in the collecting duct, urothelium of the pelvis, or nephrogenic zone in embryonic day 16 or 0-day-old mouse kidneys. CONCLUSION These findings suggest that PTHrP has a role in mouse kidney maturation or glomerular development.
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Affiliation(s)
- K Aya
- Department of Pediatrics, Okayama University Medical School, Japan
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Amizuka N, Kwan MY, Goltzman D, Ozawa H, White JH. Vitamin D3 differentially regulates parathyroid hormone/parathyroid hormone-related peptide receptor expression in bone and cartilage. J Clin Invest 1999; 103:373-81. [PMID: 9927498 PMCID: PMC407892 DOI: 10.1172/jci3265] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/1998] [Accepted: 12/18/1998] [Indexed: 11/17/2022] Open
Abstract
Transcription of the mouse parathyroid hormone (PTH)/PTH-related peptide (PTHrP) receptor (PTHR) gene is controlled by promoters P1 and P2. We performed transcript-specific in situ hybridization and found that P2 is the predominant promoter controlling PTHR gene expression in bone and cartilage. Treatment with 1alpha, 25-dihydroxyvitamin D3 (D3) in vivo specifically downregulated P2-specific transcripts in osteoblasts, but not in chondrocytes, under conditions where it enhanced bone resorption. Treatment of the osteoblastic cell line MC3T3-E1 with D3 in vitro reduced expression of both P2-specific transcripts and PTHR protein. This effect was not blocked by cycloheximide, indicating that D3 inhibits PTHR expression by downregulating transcription of the P2 promoter. A similar inhibitory effect of D3 was not observed in the chondrocytic cell line CFK2. Gene-transfer experiments showed that P2, but not P1, is active in both MC3T3-E1 and CFK2 cells, and that D3 specifically inhibited P2 promoter activity in MC3T3-E1, but not in CFK2 cells. Inhibition of P2 activity by D3 required promoter sequences lying more that 1.6 kb upstream of the P2 transcription start site. Thus, the P2 promoter controls PTHR gene expression in both osteoblasts and chondrocytes. D3 downregulates PTHR gene transcription in a cell-specific manner by inhibiting P2 promoter activity in osteoblasts, but not in chondrocytes.
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Affiliation(s)
- N Amizuka
- Department of Oral Anatomy, Niigata University School of Dentistry, Niigata 951-8514, Japan
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Largo R, Gómez-Garre D, Santos S, Peñaranda C, Blanco J, Esbrit P, Egido J. Renal expression of parathyroid hormone-related protein (PTHrP) and PTH/PTHrP receptor in a rat model of tubulointerstitial damage. Kidney Int 1999; 55:82-90. [PMID: 9893116 DOI: 10.1046/j.1523-1755.1999.00241.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND PTHrP, which appears to act as a growth/differentiation factor in a variety of tissues, is present in the kidney; however, its role is unclear. METHODS The expression of PTHrP and the PTH/PTHrP receptor were investigated by reverse transcription-polymerase chain reaction (RT-PCR) and immunohistochemistry in the remnant kidney of uninephrectomized (UNX) rats after protein overloading [1 g/day of bovine serum albumin (BSA)]. RESULTS Compared with UNX-control rats, proteinuria in BSA-overloaded animals was detected within the first 24 hours and increased during the entire study period (28 days). Kidney examination by light microscopy showed no significant renal lesions at day 1 of BSA treatment, whereas at days 8 and 28, tubular lesions, infiltration of mononuclear cells, and mesangial expansion were observed. PTHrP mRNA expression in the renal cortex was already increased at day 1 (fourfold) and plateaued between days 8 and 28 (12- and 15-fold, respectively) in BSA-overloaded animals compared with UNX-control rats. At day 8, immunohistochemical analysis with two different anti-PTHrP antibodies showed a dramatic increase of PTHrP staining in the damaged proximal and distal tubules from BSA-overloaded rats with respect to UNX-control rats. Moreover, intense PTHrP immunostaining was also observed in glomerular mesangial and endothelial cells in BSA-overloaded rats, but not in the UNX-control rats. A reciprocal decrease of PTH/PTHrP receptor mRNA and immunostaining, without significant changes in the cellular localization (proximal and distal tubule, and glomerular mesangial and epithelial cells) of the PTH/PTHrP receptor positivity was found to occur in the renal cortex of BSA-overloaded rats. At day 8, coinciding with the up-regulation of PTHrP, an increase in the angiotensin converting enzyme and preproendothelin-1 gene expression was observed in the renal cortex of BSA-overloaded rats compared with UNX-control rats. CONCLUSIONS These results indicate that PTHrP can be added to the group of genes that are up-regulated in proximal tubular cells in response to intense proteinuria. Our results, together with previous findings, suggest that the vasoactive hormones angiotensin II and endothelin-1 could participate in the PTHrP production in the renal cortex of BSA-overloaded rats. Further experiments are required to clarify the mechanisms of PTHrP up-regulation and its possible role in the response to renal damage in this animal model.
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Affiliation(s)
- R Largo
- Renal Research Laboratory and Metabolic Research Unit, Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Hospital Clínico, Universidad Complutense, Madrid, Spain
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Matsushita H, Hara M, Endo Y, Shishiba Y, Hara S, Ubara Y, Nakazawa H, Suzuki N, Kawaminami K, Kido T, Li Q, Grimelius L. Proliferation of parathyroid cells negatively correlates with expression of parathyroid hormone-related protein in secondary parathyroid hyperplasia. Kidney Int 1999; 55:130-8. [PMID: 9893121 DOI: 10.1046/j.1523-1755.1999.00230.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Parathyroid hormone-related protein (PTHrP) is now suspected to act as an autocrine or paracrine regulator of cell growth or differentiation, although it was originally reported as a hypercalcemic substance in malignancies. This study was performed to assess the relationship between PTHrP expression and cell proliferation in human parathyroid glands. METHODS The localization of PTH and PTHrP was studied in 42 samples of hyperplastic parathyroid from 14 long-term hemodialysis cases with immunohistochemistry and in situ hybridization. Results were compared with proliferative activity (proliferating cell nuclear antigen index: counts of proliferating cell nuclear antigen-positive cells/100 cells). The localization of the PTH/PTHrP receptor was also examined. Ten normal glands were studied as controls. RESULTS In hyperplasia, cells positive for PTH, PTHrP, or both were observed immunohistochemically. The areas expressing PTHrP mRNA completely coincided with those positive for PTHrP immunohistochemically. Oxyphilic or transitional oxyphilic cells were consistently positive for PTHrP. PTH/PTHrP receptors were located in the cytoplasmic membrane in most parathyroid cells. Proliferating cell nuclear antigen-positive cells were rare in normal glands with an index of 0. 22 +/- 0.09 (mean +/- sem). They were significantly increased in hyperplastic cases but less for PTHrP-positive than for -negative cells (1.25 +/- 0.16 as compared with 7.80 +/- 0.52; P < 0.0001). CONCLUSION The observed low level of proliferation of PTHrP-positive cells suggests a functional role for PTHrP as a possible growth suppressor in the human parathyroid.
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Affiliation(s)
- H Matsushita
- Departments of Pathology, Endocrinology, Nephrology, Endocrine Surgery, and the Epidemiological Research Center, Toranomon Hospital, Minatoko, Japan.
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García-Ocaña A, Gómez-Casero E, Peñaranda C, Esbrit P. Parathyroid hormone-related protein increases DNA synthesis in proximal tubule cells by cyclic AMP- and protein kinase C-dependent pathways. Life Sci 1998; 62:2267-73. [PMID: 9651115 DOI: 10.1016/s0024-3205(98)00207-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The present study was performed to characterize the possible involvement of cAMP synthesis and protein kinase C (PKC) activation in the DNA synthesis-stimulating effect of parathyroid hormone-related protein (PTHrP) in proximal tubule cells. We found that DNA synthesis was stimulated by 10 microM 8BrcAMP, and 1 microM Sp-cDBIMPS, two cAMP analogs, and also by 1 microM phorbol 12-myristate 13-acetate (PMA) and 100 microM 1,2-dioctanoyl-sn-glycerol, two PKC activators, and 10 nM [Cys23] human (h)PTHrP (24-35) amide in rabbit proximal tubule cells (PTC). Both Sp-cDBIMPS and PMA, at 1 microM, also increased DNA synthesis in SV40-immortalized mouse proximal tubule cells MCT. Human PTHrP (7-34) amide [PTHrP (7-34)] dose dependently stimulated DNA synthesis in a similar manner as [34Tyr]PTHrP (1-34) amide [PTHrP (1-34)], in PTC. PMA pre-treatment for 20 h, which downregulates PKC, completely blocked the effect induced by PTHrP (7-34), but not that of PTHrP (1-34), in the latter cells. In contrast, the same PMA pre-treatment abolished the DNA synthesis stimulation by PTHrP (1-34) and PTHrP (7-34) in MCT cells, which appear to have PTH receptors mainly coupled to phospholipase C and not adenylate cyclase. Our results indicate that the stimulatory effect of PTHrP on DNA synthesis in proximal tubule cells is mediated by a cAMP- and PKC-dependent mechanism.
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Cros M, Silve C, Graulet A, Morieux C, Ureña P, de Vernejoul M, Bouizar Z. Estrogen stimulates PTHrP but not PTH/PTHrP receptor gene expression in the kidney of ovariectomized rat. J Cell Biochem 1998. [DOI: 10.1002/(sici)1097-4644(19980701)70:1<84::aid-jcb9>3.0.co;2-#] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Magali Cros
- INSERM U349, Hôpital Lariboisière, Paris, France
| | | | | | | | - Pablo Ureña
- Clinique de l'Orangerie, Aubervilliers, France
| | | | - Zhor Bouizar
- INSERM U349, Hôpital Lariboisière, Paris, France
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Garcia-Ocaña A, Gomez-Casero E, Peñaranda C, Sarasa JL, Esbrit P. Cyclosporine increases renal parathyroid hormone-related protein expression in vivo in the rat. Transplantation 1998; 65:860-3. [PMID: 9580169 DOI: 10.1097/00007890-199803270-00015] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Clinical use of cyclosporine (CsA) is limited by its known nephrotoxicity. Parathyroid hormone (PTH)-related protein (PTHrP) increases after acute renal ischemia and stimulates proliferation of renal cells in culture. Herein, we have examined whether the renal expression of PTHrP and its PTH/PTHrP receptor is affected by chronic CsA nephrotoxicity. METHODS Rats were randomly assigned to receive daily intramuscular injections of either CsA (25 mg/kg) or the same volume of the vehicle olive oil (control) for 3 weeks. At this time interval, under ether anesthesia, rat blood and kidneys were obtained for analytical determinations, and total RNA isolation or immunohistochemistry, respectively. RESULTS Serum urea was 11+/-2 and 6+/-1 mmol/L (P < 0.01) in CsA-treated and control rats, respectively. We found that PTH/PTHrP receptor mRNA was unchanged, but PTHrP mRNA, and also transforming growth factor-beta1 mRNA expression as positive control, was about twofold increased in the kidney of CsA-treated rats. This was accompanied by increased PTHrP immunostaining in renal cortical tubules, associated with tubule vacuolation. CONCLUSION This study demonstrates an up-regulation of PTHrP, associated with chronic CsA-induced nephrotoxicity. Our findings support a role for PTHrP in the CsA-injured kidney.
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Affiliation(s)
- A Garcia-Ocaña
- Department of Pathology, Fundación Jiménez Díaz, Madrid, Spain
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Li H, Seitz PK, Selvanayagam P, Rajaraman S, Cooper CW. Alteration of secretion of parathyroid hormone-related peptide and expression of its mRNA in a human hepatoma cell line (HEP G2) treated with agents that affect cell growth. Endocrine 1996; 5:323-30. [PMID: 21153084 DOI: 10.1007/bf02739066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/1996] [Revised: 08/30/1996] [Accepted: 08/30/1996] [Indexed: 10/22/2022]
Abstract
Previously, using human hepatoma cells (HepG2), we found that immunoneutralization of secreted PTHrP increased cell growth. Here we asked whether PTHrP production was affected by agents that alter growth of Hep G2 cells. Immunoreactive PTHrP in medium and PTHrP mRNA expression were examined. Treatment of cells with 10 μM hydrocortisone or 1 ng/mL TGF-β1 for 72 h inhibited cell growth by 28±6 and 36±2% and increased PTHrP in medium by 128±10 and 525 ±27%, respectively. The increase in PTHrP produced by both agents was dose-and time-dependent, and the increased PTHrP was accompanied by dose-and time-dependent enhanced expression of PTHrP mRNA. In contrast, 10% fetal bovine serum (FBS) for 72 h increased cell growth by 38±6% (vs serum-free medium) and decreased PTHrP production by 49±4% whereas culture in high glucose (3-4g/L) increased cell growth by 43±1% (vs 1 g/L glucose) and decreased PTHrP by 55±0.4%. Inhibition of PTHrP by both FBS and glucose was dose-dependent; FBS also inhibited PTHrP mRNA. The results show that increased cell growth was associated with decreased PTHrP production, while decreased growth was accompanied by increased PTHrP production. The findings imply that PTHrP may help mediate growth effects of these agents on Hep G2 cells.
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Affiliation(s)
- H Li
- Department of Pharmacology and Toxicology, University of Texas Medical Branch, 77555, Galveston, TX
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Amizuka N, Goltzman D, Ozawa H. The Biologic Action of Parathyroid Hormone-Related Peptide on Bone and Cartilage Cells. ACTA ACUST UNITED AC 1996; 2:277-87. [DOI: 10.1089/ten.1996.2.277] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Norio Amizuka
- Department of Oral Anatomy, Niigata University School of Dentistry, Niigata, 951, Japan
| | - David Goltzman
- Dpartment of Medicine, McGill University, Calcium Research Laboratory, Royal Victoria Hospital, Montreal, Canada
| | - Hidehiro Ozawa
- Department of Oral Anatomy, Niigata University School of Dentistry, Niigata, 951, Japan
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