Calcitonin levels in sera of infants and children: relations to age and periods of bone growth

Effect of PGE2 on TT cells viability and division

Previous studies have shown prostaglandin E2 (PGE2) produced a marked increase in calcitonin secretion in human C-cells derived from medullary thyroid carcinoma. However, it's unclear whether PGE2 can increase the growth of C cells. In this study, we use TT cells as a C cell model to investigate the effect of PGE2 on the growth of C cells. The results revealed that both PGE2 and arachidonic acid (AA) significantly increased the count of TT cells, whereas indomethacin and Dup697 reduced this count. Notably, an increase in the level of AA was associated with an increase in the number of proliferating TT cells, indicating a dose-response relationship. PGE2 and its receptor agonists (sulprostone and butaprost) enhanced the proliferation of TT cells. By contrast, 17-phenyl-trinor-PGE2 exerted no significant effect on TT cell proliferation, whereas L161982 suppressed it. The positive effect of AA on TT cell proliferation was inhibited by indomethacin, NS398, Dup697 (complete inhibition), and SC560. Both PGE2 and AA increased the level of p-STAT5a. The positive effect of AA on p-STAT5a was completely inhibited by Dup697 but not indomethacin, NS398, or SC560. Treatment with indomethacin or Dup697 alone reduced the level of STAT5a in TT cells. AA increased the level of STAT5a, but this effect was inhibited by indomethacin, NS398, and Dup697. Overall, this study confirms the effect of PGE2 on the proliferation of TT cells. This effect is likely mediated through EP2, EP3, and EP4 receptors and associated with an increase in p-STAT5a level within TT cells.

Age-Related Association of Calcitonin with Parameters of Anthropometry, Bone and Calcium Metabolism during Childhood

INTRODUCTION

The thyroid parafollicular hormone calcitonin (CT) shows particularly high blood levels in early childhood, a period of high bone turnover, which decrease with increasing age. Data about the physiological role of CT during infancy, childhood, and adolescence are contradictory or lacking.

OBJECTIVE

We hypothesize that CT demonstrates age-related correlations with parameters of bone growth and turnover as well as with parameters of calcium homeostasis.

METHODS

5,410 measurements of anthropometric data and venous blood samples were collected from 2,636 participants of the LIFE Child study, aged 2 months-18 years. Univariate correlations and multiple regression analysis were performed between serum CT and anthropometric indicators (height standard deviation scores [SDS] and BMI-SDS), markers of calcium (Ca) homeostasis (Ca, parathyroid hormone, 25-OH vitamin D, and phosphate [P]), bone formation (procollagen type 1 N-terminal propeptide [P1NP], osteocalcin), and bone resorption (β-CrossLaps).

RESULTS

CT was significantly associated with Ca (β = 0.26, p < 0.05) and P1NP/100 (β = 0.005, p < 0.05) in children aged 2 months-1.1 years. These relations were independent of age and sex and could not be confirmed in children aged 1.1-8 years. Independent of age, sex, puberty, P, and height SDS CT showed a significant positive relation to Ca (β = 0.26; p < 0.001) in children aged 8-18 years.

CONCLUSIONS

Our findings suggest a unique association between CT and Ca in periods of rapid bone growth and point to a possible involvement of CT in promoting bone formation during the first year of life.

Calcitonin measurement in pediatrics: reference ranges are gender-dependent, validation in medullary thyroid cancer and thyroid diseases

BACKGROUND

There is only limited information on serum reference ranges of calcitonin (CT) in infants, children and adolescents. This gap hampers valid diagnostics in patients with multiple endocrine neoplasia type 2 (MEN 2) and planned prophylactic thyroidectomy. In addition, age-dependent reference ranges for CT are necessary to define a cure in medullary thyroid carcinoma (MTC). We asked whether the reference ranges for CT levels were age- and gender-dependent in the serum of a pediatric cohort.

METHODS

A total of 6090 serum samples of 2639 subjects of the LIFE-Child cohort aged between 1 month and 17.9 years were analyzed by the CT electrochemiluminescence immunoassay (ECLIA). Reference intervals were estimated using the LMS method. For clinical validation the serum of 28 patients (61 samples) with MEN 2 and 106 patients (136 samples) with thyroid diseases were analyzed.

RESULTS

CT levels showed a clear age- and gender-dependence with significantly higher values in boys (p<0.01). An accelerated decline of CT levels from newborn to children at the age of 4 and 5 years was observed for both sexes. A cure for MTC was demonstrated in 71% of MEN 2 patients after thyroidectomy, whereas 5 patients remained suspicious for micrometastasis or relapse. Only 1.5% of our patients with thyroid diseases revealed increased CT levels.

CONCLUSIONS

This is the largest study to establish novel pediatric reference ranges from the CT values of healthy subjects. It allows a precise laboratory monitoring of CT in pediatric patients with MEN 2. Thyroid diseases did not have a relevant influence on CT levels in our pediatric cohort.

Calcitonin, the forgotten hormone: does it deserve to be forgotten?

Calcitonin is a 32 amino acid hormone secreted by the C-cells of the thyroid gland. Calcitonin has been preserved during the transition from ocean-based life to land dwellers and is phylogenetically older than parathyroid hormone. Calcitonin secretion is stimulated by increases in the serum calcium concentration and calcitonin protects against the development of hypercalcemia. Calcitonin is also stimulated by gastrointestinal hormones such as gastrin. This has led to the unproven hypothesis that postprandial calcitonin stimulation could play a role in the deposition of calcium and phosphate in bone after feeding. However, no bone or other abnormalities have been described in states of calcitonin deficiency or excess except for diarrhea in a few patients with medullary thyroid carcinoma. Calcitonin is known to stimulate renal 1,25 (OH)2 vitamin D (1,25D) production at a site in the proximal tubule different from parathyroid hormone and hypophosphatemia. During pregnancy and lactation, both calcitonin and 1,25D are increased. The increases in calcitonin and 1,25D may be important in the transfer of maternal calcium to the fetus/infant and in the prevention and recovery of maternal bone loss. Calcitonin has an immediate effect on decreasing osteoclast activity and has been used for treatment of hypercalcemia. Recent studies in the calcitonin gene knockout mouse have shown increases in bone mass and bone formation. This last result together with the presence of calcitonin receptors on the osteocyte suggests that calcitonin could possibly affect osteocyte products which affect bone formation. In summary, a precise role for calcitonin remains elusive more than 50 years after its discovery.

The cyclic AMP-dependent protein kinase A pathway is involved in progesterone effects on calcitonin secretion from TT cells

It is well known that gonadal steroid hormones influence the level of plasma calcitonin (CT), but the mechanism by which progesterone affects CT secretion is not clear. Immortalized TT cells are a reliable model system for studying the endocrine function of human parafollicular cells. In the present study, the effects of progesterone on CT secretion were examined in TT cells. TT cells were incubated in medium containing vehicle (DMSO), progesterone or BSA-progesterone for 60 or 150 min, and then the levels of CT in the medium, progesterone receptors, cAMP accumulation and CT mRNA expression were measured. To study the correlation between progesterone effects and the cAMP-dependent protein kinase A (PKA) pathway, cell lysates or cells in 24-well plates were treated with either vehicle or progesterone plus RU486, SQ22536, KT5720, or 3-isobutyl-1-methylxanthine. Then, adenylyl cyclase and protein kinase A (PKA) activities were measured in the cell lysates, and the CT levels were measured in the medium from the 24-well plate. The activated cAMP response element binding protein (P-CREB) was also measured by immunofluorescence. Administration of 1 microM progesterone or 500 nM BSA-progesterone increased the secretion of CT by 381% and 100%, respectively. Progesterone receptors A and B were downregulated by progesterone treatment. The cAMP concentration, adenylyl cyclase and PKA activity, CT mRNA expression, and nuclear P-CREB concentrations all showed an increase after progesterone treatment. RU486, SQ22536 and KT5720 inhibited the progesterone-stimulated effects. These results suggest that a cAMP-dependent PKA pathway is involved in progesterone-stimulated effects on CT secretion from TT cells.

Time to reevaluate the therapeutic use of calcitonin and biological role attributable to parafollicular (C) cells

There is rich anecdotal evidence that calcitonin significantly increases bone mineral density and reduces fracture risk. However, observation in a previous study of an increased bone formation in calcitonin-deficient mice has led us to reevaluate the therapeutic use of calcitonin and to investigate the primary role of parafollicular (C) cells of the thyroid gland. We found that C cells are involved mainly in the regulation of follicular cell activity in a paracrine manner and in doing so they may regulate the growth rate in newborn by affecting the thyroid hormone levels in the early postnatal period. In the light of reports that showed thyroid physiology is different between populations and it is affected by environmental factors we suggested that C cells may be involved in population differences in thyroid physiology and environmental adaptation. We conclude that C cells may facilitate the adaptation of the follicular cells to environmental changes, enabling more effective coordinated functions of the body and producing variations between populations.

Calcitonin administration in a rabbit distraction osteogenesis model

The effect of salmon calcitonin on the maturation of the regenerate bone was assessed in an experimental model in rabbits. Twenty-six New Zealand White male rabbits, approximately 5 months old and weighing 3 to 3.5 kg, were subjected to a mid-diaphyseal tibial osteotomy. After 5 days, the right tibia was lengthened gradually at a rate of 0.375 mm every 12 hours, for 10 days. Ten international units of salmon calcitonin were administered daily subcutaneously to the study group (14 animals), whereas the animals of the control group (12 animals) were injected with a placebo, for the duration of the experiment. The bone mineral density of the regenerate bone was assessed on Days 20, 35, 45, and 55 of the experiment, in both groups, using dual energy xray absorptiometry. No statistical significant difference was found in the dual energy xray absorptiometry measurements between the study and control groups regarding the change of the bone mineral density of the new bone relative to a preoperative baseline measurement. Characteristic time-related changes were observed in the bone mineral density of the regenerate bone during its maturation, which proved to be identical in both groups. It seems that the administration of calcitonin does not enhance regenerate bone mineralization rate and tendency during bone lengthening.

A high-fat diet increases calcitonin secretion in the rat

We have studied the effects of diet-induced obesity on thyroidal calcitonin, plasma calcitonin, calcium and phosphorus in rats. Twelve 9-week-old female rats were randomly divided into two groups. One group was fed a low-fat diet while the other was fed a high-fat diet. Both diets had 0.76% Ca, 0.56% P and 2.2 U/g vitamin D; however, the high-fat diet had hydrogenated vegetable oil added at 405 g/kg. All rats were pair-fed and consumed 11 g/day per rat for 27 weeks at which time the rats were fasted overnight and exsanguinated. The rats on the high-fat diet weighted 406 +/- 21 g (mean +/- SEM) versus 292 +/- 13 g for controls and had higher levels of serum calcitonin (104 +/- 12 versus 57 +/- 9 pg/ml). The obese rats also had increased thyroidal calcitonin by radioimmunoassay and increased thyroidal C-cells by immunohistology. The increased calcitonin levels occurred without a concomitant increase in calcium levels. These data indicate that a high-fat diet in rats stimulates C-cell growth and calcitonin secretion.