22-Oxacalcitriol does not interfere with parathyroid hormone-induced phosphaturia or cyclic-AMP excretion

1,25-Dihydroxyvitamin D3-induced calcium efflux from calvaria is mediated by protein kinase C

1,25-dihydroxyvitamin D3 (1,25(OH)2D3) is an important regulator of bone metabolism involved in both formation and resorption. Traditionally it was assumed that vitamin D receptors are intracellular. Recent data indicate that vitamin D may also act through a membrane receptor, specifically raising intracellular calcium and inositol 1,4,5 triphosphate. The present study was undertaken to explore further the mechanism(s) of vitamin D-induced bone resorption in cultured bone. 1,25(OH)2D3 induced a dose-dependent increase of calcium efflux from cultured bone. This increase was completely obliterated by inhibition of protein kinase C (PKC) with either staurosporine or calphostin C. In cultured rat calvariae, 1,25(OH)2D3 also induced a dose-dependent translocation of PKC from cytosol to membrane. The activation of PKC by 1, 25(OH)2D3 occurred following a 30-s incubation, peaked at 1 minute, and disappeared by 5 minutes. 1,25(OH)2D3 did not increase cAMP production in similarly cultured calvaria. These results suggest that the action of 1,25(OH)2D3 on calcium flux from cultured bone is mediated, in part, via activation of PKC.

22-oxacalcitriol suppresses secondary hyperparathyroidism without inducing low bone turnover in dogs with renal failure

BACKGROUND

Calcitriol therapy suppresses serum levels of parathyroid hormone (PTH) in patients with renal failure but has several drawbacks, including hypercalcemia and/or marked suppression of bone turnover, which may lead to adynamic bone disease. A new vitamin D analogue, 22-oxacalcitriol (OCT), has been shown to have promising characteristics. This study was undertaken to determine the effects of OCT on serum PTH levels and bone turnover in states of normal or impaired renal function.

METHODS

Sixty dogs were either nephrectomized (Nx, N = 38) or sham-operated (Sham, N = 22). The animals received supplemental phosphate to enhance PTH secretion. Fourteen weeks after the start of phosphate supplementation, half of the Nx and Sham dogs received doses of OCT (three times per week); the other half were given vehicle for 60 weeks. Thereafter, the treatment modalities for a subset of animals were crossed over for an additional eight months. Biochemical and hormonal indices of calcium and bone metabolism were measured throughout the study, and bone biopsies were done at baseline, 60 weeks after OCT or vehicle treatment, and at the end of the crossover period.

RESULTS

In Nx dogs, OCT significantly decreased serum PTH levels soon after the induction of renal insufficiency. In long-standing secondary hyperparathyroidism, OCT (0.03 microg/kg) stabilized serum PTH levels during the first months. Serum PTH levels rose thereafter, but the rise was less pronounced compared with baseline than the rise seen in Nx control. These effects were accompanied by episodes of hypercalcemia and hyperphosphatemia. In animals with normal renal function, OCT induced a transient decrease in serum PTH levels at a dose of 0.1 microg/kg, which was not sustained with lowering of the doses. In Nx dogs, OCT reversed abnormal bone formation, such as woven osteoid and fibrosis, but did not significantly alter the level of bone turnover. In addition, OCT improved mineralization lag time, (that is, the rate at which osteoid mineralizes) in both Nx and Sham dogs.

CONCLUSIONS

These results indicate that even though OCT does not completely prevent the occurrence of hypercalcemia in experimental dogs with renal insufficiency, it may be of use in the management of secondary hyperparathyroidism because it does not induce low bone turnover and, therefore, does not increase the risk of adynamic bone disease.

Parathyroid hormone suppression by 22-oxacalcitriol in the severe parathyroid hyperplasia

The suppression of parathyroid hormone (PTH) secretion by the administration of 1,25-dihydroxyvitamin D [1,25(OH)2D3] and 22-oxacalcitriol (OCT) was evaluated in nude mice transplanted with human hyperplastic parathyroid tissue. The parathyroid tissue was obtained for transplantation from a patient with severe secondary hyperparathyroidism who had undergone a parathyroidectomy. Tissue specimens were transplanted into the gluteus muscle of female nude mice. Animals were divided into two groups; one group was fed a normal diet, and the other group was fed a low calcium diet during the administration of OCT and 1,25(OH)2D3. OCT and 1,25(OH)2D3 were intraperitoneally administered two times every week, for a total of eight times. Serum calcium and phosphate levels were significantly higher in the mouse administered 1,25(OH)2D3 than in the mouse administered OCT. Serum alkaline phosphatase activity was elevated similarly in the mouse administered either OCT or 1,25(OH)2D3. OCT strongly suppressed human PTH secretion from the graft in mice with normal serum calcium levels as did 1,25(OH)2D3. However, human PTH secretion from the graft was stimulated by the administration of a low-calcium diet, despite OCT and 1,25(OH)2D3 administration. In summary, OCT and 1,25(OH)2D3 suppress PTH secretion even from severe secondary hyperplastic parathyroid tissue only in mice with normal or high calcium serum levels.