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Milan KL, Jayasuriya R, Harithpriya K, Anuradha M, Sarada DVL, Siti Rahayu N, Ramkumar KM. Vitamin D resistant genes - promising therapeutic targets of chronic diseases. Food Funct 2022; 13:7984-7998. [PMID: 35856462 DOI: 10.1039/d2fo00822j] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Vitamin D is an essential vitamin indispensable for calcium and phosphate metabolism, and its deficiency has been implicated in several extra-skeletal pathologies, including cancer and chronic kidney disease. Synthesized endogenously in the layers of the skin by the action of UV-B radiation, the vitamin maintains the integrity of the bones, teeth, and muscles and is involved in cell proliferation, differentiation, and immunity. The deficiency of Vit-D is increasing at an alarming rate, with nearly 32% of children and adults being either deficient or having insufficient levels. This has been attributed to Vit-D resistant genes that cause a reduction in circulatory Vit-D levels through a set of signaling pathways. CYP24A1, SMRT, and SNAIL are three genes responsible for Vit-D resistance as their activity either lowers the circulatory levels of Vit-D or reduces its availability in target tissues. The hydroxylase CYP24A1 inactivates analogs and prohormonal and/or hormonal forms of calcitriol. Elevation of the expression of CYP24A1 is the major cause of exacerbation of several diseases. CYP24A1 is rate-limiting, and its induction has been correlated with increased prognosis of diseases, while loss of function mutations cause hypersensitivity to Vit-D. The silencing mediator of retinoic acid and thyroid hormone receptor (SMRT) and its corepressor are involved in the transcriptional repression of VDR-target genes. SNAIL1 (SNAIL), SNAIL2 (Slug), and SNAIL3 (Smuc) are involved in transcriptional repression and binding to histone deacetylases and methyltransferases in addition to recruiting polycomb repressive complexes to the target gene promoters. An inverse relationship between the levels of calcitriol and the epithelial-to-mesenchymal transition is reported. Studies have demonstrated a strong association between Vit-D deficiency and chronic diseases, including cardiovascular diseases, diabetes, cancers, autoimmune diseases, infectious diseases, etc. Vit-D resistant genes associated with the aforementioned chronic diseases could serve as potential therapeutic targets. This review focuses on the basic structures and mechanisms of the repression of Vit-D regulated genes and highlights the role of Vit-D resistant genes in chronic diseases.
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Affiliation(s)
- Kunnath Lakshmanan Milan
- Department of Biotechnology, School of Bioengineering, SRM Institute of Science and Technology, Kattankulathur 603 203, Tamil Nadu, India.
| | - Ravichandran Jayasuriya
- Department of Biotechnology, School of Bioengineering, SRM Institute of Science and Technology, Kattankulathur 603 203, Tamil Nadu, India.
| | - Kannan Harithpriya
- Department of Biotechnology, School of Bioengineering, SRM Institute of Science and Technology, Kattankulathur 603 203, Tamil Nadu, India.
| | - Murugesan Anuradha
- Department of Obstetrics & Gynaecology, SRM Medical College Hospital and Research Centre, Kattankulathur 603 203, Tamil Nadu, India
| | - Dronamraju V L Sarada
- Department of Biotechnology, School of Bioengineering, SRM Institute of Science and Technology, Kattankulathur 603 203, Tamil Nadu, India.
| | - Nadhiroh Siti Rahayu
- Department of Nutrition, Faculty of Public Health, Universitas Airlangga, Indonesia
| | - Kunka Mohanram Ramkumar
- Department of Biotechnology, School of Bioengineering, SRM Institute of Science and Technology, Kattankulathur 603 203, Tamil Nadu, India.
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Chacar FC, Kogika MM, Zafalon RVA, Brunetto MA. Vitamin D Metabolism and Its Role in Mineral and Bone Disorders in Chronic Kidney Disease in Humans, Dogs and Cats. Metabolites 2020; 10:E499. [PMID: 33291777 PMCID: PMC7761928 DOI: 10.3390/metabo10120499] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/21/2020] [Accepted: 11/24/2020] [Indexed: 11/17/2022] Open
Abstract
Some differences regarding Vitamin D metabolism are described in dogs and cats in comparison with humans, which may be explained by an evolutionary drive among these species. Similarly, vitamin D is one of the most important regulators of mineral metabolism in dogs and cats, as well as in humans. Mineral metabolism is intrinsically related to bone metabolism, thus disturbances in vitamin D have been implicated in the development of chronic kidney disease mineral and bone disorders (CKD-MBD) in people, in addition to dogs and cats. Vitamin D deficiency may be associated with Renal Secondary Hyperparathyroidism (RSHPT), which is the most common mineral disorder in later stages of CKD in dogs and cats. Herein, we review the peculiarities of vitamin D metabolism in these species in comparison with humans, and the role of vitamin D disturbances in the development of CKD-MBD among dogs, cats, and people. Comparative studies may offer some evidence to help further research about vitamin D metabolism and bone disorders in CKD.
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Affiliation(s)
- Fernanda C. Chacar
- Department of Internal Medicine, Federal Institute of Education, Science and Technology of South of Minas Gerais (IFSULDEMINAS), Muzambinho 37890-000, Brazil;
| | - Márcia M. Kogika
- Department of Internal Medicine, School of Veterinary Medicine and Animal Science, University of Sao Paulo, Sao Paulo 05508-270, Brazil;
| | - Rafael V. A. Zafalon
- Pet Nutrology Research Center, Nutrition and Production Department, School of Veterinary Medicine and Animal Science, University of São Paulo, Pirassununga 13635-900, Brazil;
| | - Marcio A. Brunetto
- Pet Nutrology Research Center, Nutrition and Production Department, School of Veterinary Medicine and Animal Science, University of São Paulo, Pirassununga 13635-900, Brazil;
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Pietrement C, Allain-Launay E, Bacchetta J, Bertholet-Thomas A, Dubourg L, Harambat J, Vieux R, Deschênes G. [Diagnosis and management of chronic kidney disease in children: Guidelines of the French Society of Pediatric Nephrology]. Arch Pediatr 2016; 23:1191-1200. [PMID: 27743765 DOI: 10.1016/j.arcped.2016.08.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 07/11/2016] [Accepted: 08/27/2016] [Indexed: 12/13/2022]
Abstract
These guidelines are intended to assist physicians in the care of children with chronic kidney disease (CKD), defined in children as in adults, regardless of its cause. Often silent for a long time, CKD can evolve to chronic renal failure or end-stage renal disease. Its management aims at slowing disease progression and treating CKD complications as soon as they appear. The different aspects of pediatric CKD care are addressed in these guidelines (screening, treatment, monitoring, diet, quality of life) as proposed by the French Society of Pediatric Nephrology. Highly specialized care provided in the hospital setting by pediatric nephrologists is not detailed.
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Affiliation(s)
- C Pietrement
- Unité de néphrologie pédiatrique, hôpital Américain, CHU de Reims, 45, rue Cognacq-Jay, 51092 Reims cedex, France.
| | - E Allain-Launay
- Unité de néphrologie pédiatrique, CHU de Nantes, 44093 Nantes cedex 1, France
| | - J Bacchetta
- Centre de référence des maladies rénales rares néphrogones, unité de néphrologie et rhumatologie pédiatriques, hôpital Femme-Mère-Enfant, hospices civils de Lyon, 69677 Bron cedex, France
| | - A Bertholet-Thomas
- Centre de référence des maladies rénales rares néphrogones, unité de néphrologie et rhumatologie pédiatriques, hôpital Femme-Mère-Enfant, hospices civils de Lyon, 69677 Bron cedex, France
| | - L Dubourg
- Exploration fonctionnelle rénale et métabolique, hôpital Femme-Mère-Enfant, 69677 Bron cedex, France
| | - J Harambat
- Centre de référence des maladies rénales rares SORARE, unité de néphrologie pédiatrique, CHU de Bordeaux, 33076 Bordeaux cedex, France
| | - R Vieux
- Unité de néphrologie pédiatrique, CHRU de Besançon, 25030 Besançon cedex, France
| | - G Deschênes
- Centre de référence des maladies rénales rares MARHEA, unité de néphrologie pédiatrique, hôpital Robert-Debré, AP-HP, 75793 Paris cedex 19, France
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Nichols KR, Knoderer CA, Johnston B, Wilson AC. Cinacalcet administration by gastrostomy tube in a child receiving peritoneal dialysis. J Pediatr Pharmacol Ther 2014; 19:202-5. [PMID: 25309151 DOI: 10.5863/1551-6776-19.3.202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
A 2-year-old male with chronic kidney disease with secondary hyperparathyroidism developed hypercalcemia while receiving calcitriol, without achieving a serum parathyroid hormone concentration within the goal range. Cinacalcet 15 mg (1.2 mg/kg), crushed and administered via gastrostomy tube, was added to the patient's therapy. This therapy was effective in achieving targeted laboratory parameters in our patient despite instructions in the prescribing information that cinacalcet should always be taken whole.
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Affiliation(s)
- Kristen R Nichols
- Department of Pharmacy Practice, College of Pharmacy and Health Sciences, Butler University, Indianapolis, Indiana ; Department of Pharmacy, Riley Hospital for Children, Indiana University Health, Indianapolis, Indiana
| | - Chad A Knoderer
- Department of Pharmacy Practice, College of Pharmacy and Health Sciences, Butler University, Indianapolis, Indiana
| | - Bethanne Johnston
- Department of Pediatrics, Section of Pediatric Nephrology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Amy C Wilson
- Department of Pediatrics, Section of Pediatric Nephrology, Indiana University School of Medicine, Indianapolis, Indiana
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Adams JS, Ramin J, Rafison B, Windon C, Windon A, Liu PT. Redefining Human Vitamin D Sufficiency: Back to the Basics. Bone Res 2013; 1:2-10. [PMID: 25285234 DOI: 10.4248/br201301002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Affiliation(s)
- John S Adams
- Orthopaedic Hospital Research Center, UCLA-Orthopaedic Hospital Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA ; Department of Molecular, Cell and Developmental Biology, Division of Life Sciences, College of Letters and Science, UCLA
| | - Jonathan Ramin
- Orthopaedic Hospital Research Center, UCLA-Orthopaedic Hospital Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA
| | - Brandon Rafison
- Orthopaedic Hospital Research Center, UCLA-Orthopaedic Hospital Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA
| | - Charles Windon
- Orthopaedic Hospital Research Center, UCLA-Orthopaedic Hospital Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA
| | - Annika Windon
- Orthopaedic Hospital Research Center, UCLA-Orthopaedic Hospital Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA
| | - Philip T Liu
- Orthopaedic Hospital Research Center, UCLA-Orthopaedic Hospital Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA
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St-Arnaud R, Arabian A, Akhouayri O, Knutson JC, Strugnell SA. Differential effects of oral doxercalciferol (Hectorol) or paricalcitol (Zemplar) in the Cyp27b1-null mouse model of uremia. Nephron Clin Pract 2011; 119:e67-74. [PMID: 21849802 DOI: 10.1159/000329663] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2010] [Accepted: 05/20/2011] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND/AIMS Kidney disease patients experience declining calcitriol levels and develop secondary hyperparathyroidism (SHPT). Animal models of uremia based on 5/6 nephrectomy (NTX) do not consistently reproduce this calcitriol deficiency. We developed an animal model, the NTX Cyp27b1-null mouse, which completely lacks endogenous calcitriol, and examined the suitability of this model for evaluation of treatment with vitamin D analogs in uremia. METHODS NTX was performed at 2 months of age. One week post-NTX, animals were treated for 4 weeks with vehicle; doxercalciferol at 30, 100 or 300 pg/g body weight (b.w.); or paricalcitol at 100, 300 or 1,000 pg/g b.w. by gavage 3 times per week. RESULTS Serum blood urea nitrogen and creatinine were elevated. Vehicle-treated NTX null mice had hypocalcemia and SHPT. Doxercalciferol at 100 or 300 pg/g b.w. normalized serum calcium and parathyroid hormone (PTH) levels. Paricalcitol at 300 or 1,000 pg/g normalized serum calcium, but PTH levels remained elevated. Osteomalacia was corrected by 100 pg/g b.w. of doxercalciferol or 1,000 pg/g b.w. of paricalcitol. The highest dose of doxercalciferol, but not of paricalcitol, significantly reduced osteitis fibrosa. CONCLUSION Our results reveal the differential efficacy of doxercalciferol and paricalcitol in this novel animal model incorporating both calcitriol deficiency and renal insufficiency.
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Affiliation(s)
- René St-Arnaud
- Genetics Unit, Shriners Hospital for Children, Montreal, Qué., Canada
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Maeng HJ, Durk MR, Chow ECY, Ghoneim R, Pang KS. 1α,25-dihydroxyvitamin D3 on intestinal transporter function: studies with the rat everted intestinal sac. Biopharm Drug Dispos 2011; 32:112-25. [PMID: 21341280 DOI: 10.1002/bdd.742] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2010] [Revised: 11/09/2010] [Accepted: 11/23/2010] [Indexed: 12/13/2022]
Abstract
Previous studies have shown that 1α,25-dihydroxyvitamin D3 (1,25(OH)2D3) treatment (2.56 nmol/kg i.p. daily×4) increased PepT1, Mrp2, Mrp4, Asbt, but not Mdr1/P-gp in the rat small intestine. In this study, the intestinal everted sac technique, together with various select probes: mannitol (paracellular transport), glycylsarcosine (PepT1), 5(and 6)-carboxy-2',7'-dichlorofluorescein (CDF) diacetate (precursor of CDF for Mrp2), adefovir dipivoxil (precursor of adefovir for Mrp4) and digoxin (P-gp) was used to examine the functional changes of these transporters. After establishing identical permeabilities (Papp) of mannitol for the apical-to-basolateral (A-to-B) and basolateral-to-apical (B-to-A) directions at 20 min in 1,25(OH)2D3-treated vs. vehicle-treated duodenal, jejunal and ileal everted sacs, a significant enhancement of net A-to-B transport of glycylsarcosine in the duodenum, increased B-to-A transport of CDF and A-to-B and B-to-A transport of adefovir in the jejunum were observed with 1,25(OH)2 D3 treatment. However, the A-to-B and B-to-A transport of digoxin in the ileum was unchanged. These changes in transporter function in the rat intestinal everted sac corresponded well to changes in proteins that were observed previously. This study confirms that the rat intestinal PepT1, Mrp2 and Mrp4, but not P-gp are functionally induced by 1,25(OH)2D3 treatment via the vitamin D receptor (VDR).
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Affiliation(s)
- Han-Joo Maeng
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada M5S 3M2
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Querfeld U, Mak RH. Vitamin D deficiency and toxicity in chronic kidney disease: in search of the therapeutic window. Pediatr Nephrol 2010; 25:2413-30. [PMID: 20567854 DOI: 10.1007/s00467-010-1574-2] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2009] [Revised: 04/08/2010] [Accepted: 04/09/2010] [Indexed: 01/14/2023]
Abstract
Both vitamin D deficiency and vitamin D toxicity are associated with cardiovascular complications in chronic kidney disease (CKD). Clinical and experiment data indicate that the association of vitamin D levels with cardiovascular disease is best illustrated as a biphasic, or U-shaped, curve. Children and adolescents with CKD need vitamin D due to the demands of a growing skeleton, to prevent renal rickets. However, this therapy carries the risk of severe side effects and chronic toxicity. Observational studies show that vitamin D deficiency and toxicity are frequently present in patients with CKD. In view of the importance of cardiovascular complications for the long-term survival of young patients, these findings demand a judicious use of vitamin D preparations. In clinical practice, the therapeutic window is rather small, presenting a therapeutic challenge to avoid both vitamin D deficiency and toxicity.
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Affiliation(s)
- Uwe Querfeld
- Department of Pediatric Nephrology, Charite Universitaetsmedizin Berlin, Augustenburger Platz 1, Berlin, Germany.
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Chow ECY, Sondervan M, Jin C, Groothuis GMM, Pang KS. Comparative effects of doxercalciferol (1α-hydroxyvitamin D₂) versus calcitriol (1α,25-dihydroxyvitamin D₃) on the expression of transporters and enzymes in the rat in vivo. J Pharm Sci 2010; 100:1594-604. [PMID: 20967888 DOI: 10.1002/jps.22366] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2010] [Revised: 07/29/2010] [Accepted: 08/31/2010] [Indexed: 01/05/2023]
Abstract
Effects of 1.28 nmol/kg doxercalciferol [1α(OH)D₂], a synthetic vitamin D₂ analog that undergoes metabolic activation to 1α,25-dihydroxyvitamin D₂, the naturally occurring, biologically active form of vitamin D₂, on rat transporters and enzymes were compared with those of 1α,25-dihydroxyvitamin D₃ [1,25(OH)₂D₃, active form of vitamin D₃; 4.8 and 6.4 nmol/kg] given on alternate days intraperitoneally for 8 days. Changes were mostly confined to the intestine and kidney where the vitamin D receptor (VDR) was highly expressed: increased intestinal Cyp24 and Cyp3a1 messenger RNA (mRNA) and a modest elevation of apical sodium-dependent bile salt transporter (Asbt) and P-glycoprotein (P-gp) protein; increased renal VDR, Cyp24, Cyp3a9, Mdr1a, and Asbt mRNA, as well as Asbt and P-gp protein expression; and decreased renal PepT1 and Oat1 mRNA expression. In comparison, 1α(OH)D₂ treatment exerted a greater effect than 1,25(OH)₂D₃ on Cyp3a and Cyp24 mRNA. However, the farnesoid X receptor -related repressive effects on liver Cyp7a1 were absent because intestinal Asbt, FGF15 and portal bile acid concentrations were unchanged. Rats on the alternate day regimen showed milder changes and lessened signs of hypercalcemia and weight loss compared with rats receiving daily injections (similar or greater amounts of 0.64-2.56 nmol/kg daily ×4) described in previous reports, showing that the protracted pretreatment regimen was associated with milder inductive and lesser toxic effects in vivo.
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Affiliation(s)
- Edwin C Y Chow
- Department of Pharmaceutical Sciences, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
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Treatment of secondary hyperparathyroidism in ESRD: a 2-year, single-center crossover study. Kidney Int 2010:S33-6. [DOI: 10.1038/ki.2010.191] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Waller S, Ridout D, Rees L. Effect of haemodialysis on markers of bone turnover in children. Pediatr Nephrol 2007; 22:586-92. [PMID: 17216258 DOI: 10.1007/s00467-006-0378-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2006] [Revised: 09/07/2006] [Accepted: 10/09/2006] [Indexed: 11/26/2022]
Abstract
'Intact' parathyroid hormone (iPTH) assays are used to measure serum PTH levels in haemodialysis patients to diagnose and monitor secondary hyperparathyroidism and consequent renal osteodystrophy (ROD); these assays exhibit cross-reactivity with long carboxyl-terminal PTH fragments (C-PTH) that accumulate in end stage renal failure (ESRF) and antagonise the biological activity of the whole molecule, 1-84 PTH. The effects of haemodialysis on C-PTH are not known. We investigated how haemodialysis affects serum concentrations of calcium, iPTH, 1-84 PTH, C-PTH, and other markers of bone turnover; bone-specific alkaline phosphatase (BALP) and type 1 collagen cross-linked telopeptide (CTx). Fifteen patients, mean (range) age 13.9 (4.3-17.6) years, haemodialysed for a median of 16.3 (4-41) months, had pre- and post-dialysis serum samples collected for routine biochemistry, BALP, CTx, iPTH and 1-84 PTH assays. Changes to serum concentrations and relationships between these biochemical surrogate markers of ROD were investigated. Serum phosphate and PTH levels (measured by both assays) fell significantly during dialysis, whereas serum calcium, C-PTH, the 1-84 PTH: C-PTH ratio and BALP and CTx concentrations were not significantly changed. 1-84 PTH levels were related to pre but not post dialysis serum calcium levels and changes to 1-84 PTH levels during dialysis were related to changes in serum calcium levels. 1-84 PTH and iPTH were reduced by haemodialysis, whereas levels of BALP and CTx remained stable post-dialysis. The relationship between BALP and CTx and bone histology requires investigation to determine whether they are more useful markers of bone turnover in this patient group.
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Affiliation(s)
- Simon Waller
- Department of Nephro-Urology, Institute of Child Health and Great Ormond Street Hospital for Children NHS Trust, London, UK.
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Paricalcitol therapy for secondary hyperparathyroidism in patients on maintenance hemodialysis previously treated with calcitriol: A single-center crossover study. Kidney Int 2006. [DOI: 10.1038/sj.ki.5001981] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Dennis VC, Albertson GL. Doxercalciferol treatment of secondary hyperparathyroidism. Ann Pharmacother 2006; 40:1955-65. [PMID: 17062838 DOI: 10.1345/aph.1g523] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To review the pharmacology, pharmacokinetics, effectiveness, safety, and therapeutic considerations related to the use of doxercalciferol in the treatment of secondary hyperparathyroidism. DATA SOURCES A MEDLINE search (1966-June 2006) was conducted using the key words vitamin D, ergocalciferols, and secondary hyperparathyroidism. Text word searches were also performed for the terms 1-alpha-hydroxy-vitamin D(2), 1-alpha-hydroxyergocalciferol, Hectorol, and doxercalciferol. Searches were limited to studies published in English and conducted in human subjects. STUDY SELECTION AND DATA EXTRACTION All published clinical studies evaluating the safety and effectiveness of doxercalciferol in secondary hyperparathyroidism were reviewed, and anecdotal patient reports were also evaluated. Selected clinical studies involving the use of calcitriol and/or paricalcitol in the treatment of secondary hyperparathyroidism were also included. DATA SYNTHESIS Doxercalciferol effectively reduces parathyroid hormone levels in patients with chronic kidney disease (CKD). Both oral and intravenous administration can significantly increase serum calcium and/or phosphorus levels as evidenced by placebo-controlled clinical trials. This agent has not been studied comparatively with calcitriol or paricalcitol to assess relative safety. CONCLUSIONS Doxercalciferol is approved for and effective in the treatment of secondary hyperparathyroidism related to CKD, both before and during dialysis, but has not demonstrated a lower incidence of hypercalcemia and/or hyperphosphatemia in relation to other vitamin D therapies. The drug is available in both oral and intravenous dosage forms. Doxercalciferol should be maintained as a formulary alternative for patients unresponsive to or intolerant of other vitamin D therapies, but comparative randomized studies are needed to differentiate its place in therapy.
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Affiliation(s)
- Vincent C Dennis
- Department of Pharmacy Clinical and Administrative Sciences, College of Pharmacy, The University of Oklahoma Health Sciences Center, Oklahoma City, OK 73190-5040, USA.
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Seeherunvong W, Nwobi O, Abitbol CL, Chandar J, Strauss J, Zilleruelo G. Paricalcitol versus calcitriol treatment for hyperparathyroidism in pediatric hemodialysis patients. Pediatr Nephrol 2006; 21:1434-9. [PMID: 16900383 DOI: 10.1007/s00467-006-0204-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2006] [Revised: 04/03/2006] [Accepted: 04/18/2006] [Indexed: 12/30/2022]
Abstract
Secondary hyperparathyroidism (SHPT) remains a treatment dilemma in pediatric dialysis patients. Recent experience with paricalcitol (P), a vitamin D analogue, in adults with SHPT has shown equal efficacy and improved survival compared to traditional treatment with calcitriol (C). We present our experience with (C) compared to (P) treatment in our pediatric dialysis patients with SHPT. Twenty-one patients (mean age 11.5+/-5 years) with SHPT (intact parathyroid hormone (iPTH) averaging 1,228+/-496 pg/ml) were studied. Seventeen received (C) followed by (P); while an additional four were treated with either (C=1) or (P=3) alone. After 26+/-8 weeks, average percent (%) decrease in iPTH was similar with (C) and (P) (-60.4+/-34% versus -65.4+/-28%, respectively; p=0.6). In the (P) group, the effective dose in children was greater than in adult trials based on kilogram weight. Episodes of hypercalcemia between the treatment groups were not different. However, episodes of elevated calcium x phosphorus product (CaxP)> or =70 mg(2)/dl(2) occurred more frequently in the (C) group (odds ratio=1.5; p=0.01). Paricalcitol appears to be safe and effective in pediatric patients. Data suggest that dosing should be gauged according to degree of SHPT. This should serve as impetus for future pharmacokinetic studies in pediatric dialysis patients.
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Affiliation(s)
- Wacharee Seeherunvong
- Division of Pediatric Nephrology, Department of Pediatrics, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Sasaki H, Akiyama H, Yoshida Y, Kondo K, Amakura Y, Kasahara Y, Maitani T. Sugihiratake Mushroom (Angel's Wing Mushroom)-Induced Cryptogenic Encephalopathy may Involve Vitamin D Analogues. Biol Pharm Bull 2006; 29:2514-8. [PMID: 17142993 DOI: 10.1248/bpb.29.2514] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
In autumn 2004, many Japanese patients with renal failure developed cryptogenic encephalopathy by consuming sugihiratake mushroom, a Japanese delicacy. To elucidate the relationship between the cryptogenic cases and this mushroom, we conducted a multivariate analysis of metabolites in 'Probably Toxic' sugihiratake collected from the area of encephalopathy outbreaks, and 'Probably Safe' sugihiratake collected from unaffected areas using UPLC/ToF MS. The results indicate that the presence of milligram quantities of vitamin D-like compounds per 10 g of dried sugihiratake from the areas of encephalopathy outbreaks. Two hypotheses to induce the encephalopathy are proposed: the found metabolites are (1) vitamin D agonists, which induce acute and severe hypercalcemia and/or hyperammonemia and/or vitamin D toxicity, or (2) vitamin D antagonists, which induce acute and severe hypocalcemia.
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Abstract
PURPOSE OF REVIEW It is possible to control the secondary hyperparathyroidism and osteitis fibrosa of patients with chronic kidney disease by calcitriol when given early and in appropriate doses. However, this control is often achieved at the price of unacceptably high plasma calcium and phosphorus levels, the induction of adynamic bone disease, and soft tissue calcification. To avoid these side effects, so-called 'nonhypercalcemic' vitamin D analogs have been developed. Their possible advantages and their precise place in the treatment and prevention of secondary hyperparathyroidism remain a matter of debate. RECENT FINDINGS A large US multicenter study showed that the administration of the vitamin D analog paricalcitol to hemodialysis patients, as compared with calcitriol, was associated with better survival. In a subsequent large US multicenter study paricalcitol-treated hemodialysis patients experienced fewer hospitalizations and hospital days compared with calcitriol-treated patients. In a third, smaller study from Japan, regular alfacalcidol users among hemodialysis patients had better cardiovascular survival than nonusers. Finally, in a recent historical control study the mortality of a large hemodialysis patient cohort was analyzed as a function of previous vitamin D treatment. Patients on active vitamin D compounds at any time had a 2-year survival advantage over vitamin D-naive patients. It must be pointed out, however, that all four studies were retrospective in nature. SUMMARY The development of vitamin D analogs with less side effects than with calcitriol is of major theoretical interest. Practically speaking, however, we still need to be convinced that this goal can be achieved in chronic kidney disease patients.
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Affiliation(s)
- Tilman B Drüeke
- Inserm Unit 507 and Service de Néphrologie, Hôpital Necker, Paris, France.
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