1
|
Tay Donovan YK, Bilezikian JP. Interactions between PTH and adiposity: appetizing possibilities. J Bone Miner Res 2024; 39:536-543. [PMID: 38637302 DOI: 10.1093/jbmr/zjae056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 03/17/2024] [Accepted: 03/29/2024] [Indexed: 04/20/2024]
Abstract
Although parathyroid hormone (PTH) is best known for its role as a regulator of skeletal remodelling and calcium homeostasis, more recent evidence supports a role for it in energy metabolism and other non-classical targets. In this report, we summarize evidence for an effect of PTH on adipocytes. This review is based upon all peer-reviewed papers, published in the English language with PubMed as the primary search engine. Recent preclinical studies have documented an effect of PTH to stimulate lipolysis in both adipocytes and liver cells and to cause browning of adipocytes. PTH also reduces bone marrow adiposity and hepatic steatosis. Although clinical studies are limited, disease models of PTH excess and PTH deficiency lend support to these preclinical findings. This review supports the concept of PTH as a polyfunctional hormone that influences energy metabolism as well as bone metabolism.
Collapse
Affiliation(s)
- Yu Kwang Tay Donovan
- Department of Endocrinology, Sengkang General Hospital, SingHealth, 544886, Singapore
| | - John P Bilezikian
- Vagelos College of Physicians and Surgeons, Columbia University, 180 Fort Washington Ave Ste 904, New York, NY, 10032, United States
| |
Collapse
|
2
|
Cosman F, Peterson LR, Towler DA, Mitlak B, Wang Y, Cummings SR. Cardiovascular Safety of Abaloparatide in Postmenopausal Women With Osteoporosis: Analysis From the ACTIVE Phase 3 Trial. J Clin Endocrinol Metab 2020; 105:5870711. [PMID: 32658264 PMCID: PMC7500469 DOI: 10.1210/clinem/dgaa450] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 07/08/2020] [Indexed: 12/20/2022]
Abstract
CONTEXT Abaloparatide is a US Food and Drug Administration-approved parathyroid hormone-related peptide analog for treatment of osteoporosis in postmenopausal women at high risk of fracture. OBJECTIVES We assessed the cardiovascular safety profile of abaloparatide. DESIGN Review of heart rate (HR), blood pressure (BP), and cardiovascular-related adverse events (AEs), including major adverse cardiovascular events (MACEs) and heart failure (HF) from: (a) ACTIVE (NCT01343004), a phase 3 trial that randomized 2463 postmenopausal women with osteoporosis to abaloparatide, teriparatide, or placebo for 18 months; (b) ACTIVExtend (NCT01657162), where participants from the abaloparatide and placebo arms received alendronate for 2 years; and (c) a pharmacology study in 55 healthy adults. RESULTS Abaloparatide and teriparatide transiently increased HR relative to placebo. Following first dose, mean (standard deviation [SD]) HR change from pretreatment to 1 hour posttreatment was 7.9 (8.5) beats per minute (bpm) for abaloparatide, 5.3 (7.5) for teriparatide, and 1.2 (7.1) for placebo. A similar pattern was observed over subsequent visits. In healthy volunteers, HR increase resolved within 4 hours. The corresponding change in mean supine systolic and diastolic BP 1 hour posttreatment was -2.7/-3.6 mmHg (abaloparatide), -2.0/-3.6 (teriparatide), and -1.5/-2.3 (placebo). The percentage of participants with serious cardiac AEs was similar among groups (0.9%-1.0%). In a post hoc analysis, time to first incidence of MACE + HF was longer with abaloparatide (P = 0.02 vs placebo) and teriparatide (P = 0.04 vs placebo). CONCLUSIONS Abaloparatide was associated with transient increases in HR and small decreases in BP in postmenopausal women with osteoporosis, with no increase in risk of serious cardiac AEs, MACE, or HF.
Collapse
Affiliation(s)
- Felicia Cosman
- Department of Medicine, Columbia University, New York, New York
| | - Linda R Peterson
- Diabetic Cardiovascular Disease Center and Department of Medicine, Washington University, St Louis, Missouri
| | - Dwight A Towler
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas
| | - Bruce Mitlak
- Clinical Development, Radius Health, Inc., Waltham, Massachusetts
- Correspondence: Bruce Mitlak, MD, Vice President Clinical Development, Radius Health, Inc., 950 Winter Street, Waltham, MA 02451, USA. E-mail:
| | - Yamei Wang
- Biostatistics, Radius Health, Inc., Waltham, Massachusetts
| | - Steven R Cummings
- San Francisco Coordinating Center, Sutter Health, California; University of California, San Francisco, California
| |
Collapse
|
3
|
Arase H, Yamada S, Tanaka S, Tokumoto M, Tsuruya K, Nakano T, Kitazono T. Association Between Plasma Intact Parathyroid Hormone Levels and the Prevalence of Atrial Fibrillation in Patients With Chronic Kidney Disease - The Fukuoka Kidney Disease Registry Study. Circ J 2020; 84:1105-1111. [PMID: 32507801 DOI: 10.1253/circj.cj-19-1201] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Parathyroid hormone (PTH) has been associated with cardiovascular disorders; however, it is unknown whether plasma PTH concentrations are associated with atrial fibrillation (AF) in patients with chronic kidney disease (CKD).Methods and Results:The present cross-sectional study analyzed baseline data of 3,384 patients registered in the Fukuoka Kidney Disease Registry Study, a Japanese multicenter prospective cohort study of patients with non-dialysis-dependent CKD. The outcome was prevalence of AF, and the main risk factor was plasma intact PTH concentration. Associations between plasma intact PTH concentration quartiles (Q1-Q4, from lowest to highest) and the presence of AF were analyzed using logistic regression. In all, 185 patients had AF; 22, 34, 59, and 70 patients were in Q1, Q2, Q3, and Q4 of PTH concentrations, respectively. The prevalence of AF increased incrementally with increases in plasma intact PTH. In the logistic regression model, patients with higher plasma intact PTH concentrations (Q2-Q4) had higher adjusted odds ratios (95% confidence intervals) for the prevalence of AF relative to the reference group (Q1), namely 1.33 (0.76-2.34), 1.82 ([1.06-3.13), and 1.99 (1.08-3.64), respectively (P=0.016). CONCLUSIONS Higher plasma intact PTH concentrations were significantly and incrementally associated with an increased prevalence of AF in non-dialysis-dependent CKD patients.
Collapse
Affiliation(s)
- Hokuto Arase
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University
| | - Shunsuke Yamada
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University
| | - Shigeru Tanaka
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University
| | | | - Kazuhiko Tsuruya
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University.,Department of Nephrology, Nara Medical University
| | - Toshiaki Nakano
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University
| | - Takanari Kitazono
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University
| |
Collapse
|
4
|
MacDonald EA, Rose RA, Quinn TA. Neurohumoral Control of Sinoatrial Node Activity and Heart Rate: Insight From Experimental Models and Findings From Humans. Front Physiol 2020; 11:170. [PMID: 32194439 PMCID: PMC7063087 DOI: 10.3389/fphys.2020.00170] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 02/13/2020] [Indexed: 12/22/2022] Open
Abstract
The sinoatrial node is perhaps one of the most important tissues in the entire body: it is the natural pacemaker of the heart, making it responsible for initiating each-and-every normal heartbeat. As such, its activity is heavily controlled, allowing heart rate to rapidly adapt to changes in physiological demand. Control of sinoatrial node activity, however, is complex, occurring through the autonomic nervous system and various circulating and locally released factors. In this review we discuss the coupled-clock pacemaker system and how its manipulation by neurohumoral signaling alters heart rate, considering the multitude of canonical and non-canonical agents that are known to modulate sinoatrial node activity. For each, we discuss the principal receptors involved and known intracellular signaling and protein targets, highlighting gaps in our knowledge and understanding from experimental models and human studies that represent areas for future research.
Collapse
Affiliation(s)
- Eilidh A. MacDonald
- Department of Physiology and Biophysics, Dalhousie University, Halifax, NS, Canada
| | - Robert A. Rose
- Cumming School of Medicine, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada
| | - T. Alexander Quinn
- Department of Physiology and Biophysics, Dalhousie University, Halifax, NS, Canada
- School of Biomedical Engineering, Dalhousie University, Halifax, NS, Canada
| |
Collapse
|
5
|
Abstract
Calcium has long been known to be essential to cardiac electrical activity. Parathyroid hormone (PTH) is the main regulator of serum calcium and is central to calcium homeostasis. Although there are significant data linking parathyroid disease states with changes in cardiac electrophysiology, most data have focused on how PTH modulates serum calcium to produce these effects. Close scrutiny of early literature demonstrates that the relationship between PTH and electrocardiographic changes is not straightforward, and numerous studies have linked PTH to arrhythmia. Basic science research has demonstrated that there is a basis for a direct role of PTH on cardiac electrophysiology outside of its effect on serum calcium. Later studies in secondary hyperparathyroidism indicate that PTH disturbances could have important implications for broad categories of patients with cardiovascular disease. The current review summarizes the existing literature on PTH and electrophysiology based on clinical and basic science studies of various parathyroid states, providing directions for future study.
Collapse
|
6
|
Collier A, Ghosh S, Nowell S, Clark D. INCREASED MORTALITY IN PATIENTS WITH PRIMARY HYPERPARATHYROIDISM: DOES SURGERY MAKE A DIFFERENCE? Endocr Pract 2019; 25:335-339. [PMID: 30995426 DOI: 10.4158/ep-2018-0407] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: Primary hyperparathyroidism (PHPT) is functionally characterized by an inappropriately raised secretion of parathyroid hormone, leading to raised serum calcium levels. Some patients are referred for parathyroidectomy, and some are managed conservatively. The aim of the audit was to compare the mortality outcomes between the two groups. Methods: We retrospectively identified a cohort of inpatients with a main or secondary diagnosis of PHPT between 1986 and 2010 and followed them up to the end of 2011. The risk of mortality in PHPT patients compared to the background general population was estimated by calculating standardized mortality ratios (SMRs), adjusting for age, sex, and person-years at risk. Mortality in surgically treated patients was compared to conservatively treated patients using Cox regression, taking account of the Charlson Comorbidity Index. Results: A total of 2,589 patients (77.9% females) were diagnosed with PHPT in Scotland over this period. Of patients diagnosed with PHPT, 41.6% (1,077/2,589) had died by the end of 2011. The SMR was 1.58 (95% confidence interval [CI], 1.48 to 1.67). A total of 54.8% of the patients underwent surgery (SMR, 1.30; 95% CI, 1.18 to 1.43), while the rest were treated "conservatively" (SMR, 1.88; 95% CI, 1.73 to 2.03) (P<.001). When other significant variables including the Charlson Comorbidity Index were taken into account in the final model, the hazard ratio for the "conservatively" managed group was reduced to 1.49 (95% CI, 1.30 to 1.70; P<.0001). Conclusion: Our study confirmed that inpatients diagnosed with PHPT have increased mortality. The risk of mortality was lower in those treated surgically compared with patients treated conservatively. Abbreviations: CI = confidence interval; HR = hazard ratio; PHPT = primary hyperparathyroidism; PTX = parathyroidectomy; SMR = standard mortality ratio; SMR01 = Scottish Morbidity Records.
Collapse
|
7
|
Lee KH, Shin MH, Park HW, Cho JG, Kweon SS, Lee YH. Association between Serum Parathyroid Hormone Levels and the Prevalence of Atrial Fibrillation: the Dong-gu Study. Korean Circ J 2018; 48:159-167. [PMID: 29441748 PMCID: PMC5861006 DOI: 10.4070/kcj.2017.0187] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 10/17/2017] [Accepted: 11/08/2017] [Indexed: 12/30/2022] Open
Abstract
Background and Objectives We aimed to investigate the association between serum parathyroid hormone (PTH) levels and the prevalence of atrial fibrillation (AF) in a population based study. Methods This study included a total of 9,007 community-dwelling Koreans aged 50 years and over who were enrolled in the Dong-gu study from 2007 to 2010. Electrocardiograms were recorded from the subjects using the HP-PageWriter 200 M1771A. All potential cases of AF were determined by 2 cardiologists. PTH concentration was measured by a chemiluminescent microparticle immunoassay. Multiple logistic regression analysis was used to evaluate the relationship between the quartiles of PTH and AF, adjusting for potential confounders. Results The prevalence of AF was 2.41% in males and 0.9% in females and increased with advanced age in both genders. The median and interquartile range (IQR) of serum PTH was 39.5 pg/mL (IQR, 30.6–50.8), which was significantly higher in patients with AF than in patients without AF (p<0.001). The prevalence of AF increased with increasing PTH quartile (0.8%, 0.9%, 1.6%, and 2.8% in the lowest, second, third, and highest PTH quartiles, respectively; p<0.001). Multivariable logistic analysis adjusted for cardiovascular risk factors showed the highest quartile of serum PTH levels was associated with a higher prevalence of AF than the lowest quartile (odds ratio, 3.34; 95% confidence interval, 1.93–5.78). Conclusions Higher levels of serum PTH were associated with higher prevalence of AF. Further studies are needed to determine whether this association is present in other populations and in a prospective study setting.
Collapse
Affiliation(s)
- Ki Hong Lee
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Min-Ho Shin
- Department of Preventive Medicine, Chonnam National University Medical School, Hwasun, Korea
| | - Hyung Wook Park
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Jeong Gwan Cho
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Sun-Seog Kweon
- Department of Preventive Medicine, Chonnam National University Medical School, Hwasun, Korea
| | - Young-Hoon Lee
- Department of Preventive Medicine & Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, Iksan, Korea
| |
Collapse
|
8
|
Wu G, Wang X, Wang X, Jiang H, Wang L, Wang T, Liu J, An D, Cao L, Xia Y, Zong G. Serum Parathyroid Hormone Levels Predict Discharge and Readmission for Heart Failure. Genet Test Mol Biomarkers 2016; 20:328-34. [PMID: 27171246 DOI: 10.1089/gtmb.2015.0285] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS Parathyroid hormone (PTH) levels are useful as a prognostic factor of chronic heart failure (HF) and can predict hospitalization for HF. It is unknown whether serum PTH levels in hospitalized patients with HF can predict discharge and if admission, discharge, or change from admission to discharge PTH measure is the most important predictor of readmission and/or death. METHODS A total of 125 consecutive hospitalized patients with HF were enrolled into this study. The receiver operating characteristic (ROC) curves indicated the predicted values of PTH for readmission due to HF and the optimal cutoff points of PTH levels for discharge. The binary logistic regression model indicated an association between PTH levels and readmission due to HF. RESULTS The PTH level on admission was positively correlated with the New York Heart Association class and N-terminal pro-B-type natriuretic peptide level. The ROC curves showed that the PTH level at discharge (PTHdis) was of predictive value for readmission within 1 year due to HF. A PTHdis level <45.2 pg/mL was the best cutoff point for discharge, with a sensitivity of 72.1%, specificity of 61.5%, and area under the ROC curve of 0.693 (95% confidence interval [CI] 0.598-0.788). The results of logistic regression analysis showed that PTHdis had an odds ratio of 1.035 for readmission due to HF (95% CI 1.005-1.067). CONCLUSION Serum PTH levels in hospitalized patients with HF were shown to be an independent predictor of discharge and PTHdis was the best predictor of readmission and/or death within 1 year due to HF.
Collapse
Affiliation(s)
- Gangyong Wu
- Department of Cardiology, No. 101 Hospital of PLA; Wuxi Institute of Clinical, Anhui Medical University , Wuxi, Jiangsu Province, China
| | - Xiaoying Wang
- Department of Cardiology, No. 101 Hospital of PLA; Wuxi Institute of Clinical, Anhui Medical University , Wuxi, Jiangsu Province, China
| | - Xiao Wang
- Department of Cardiology, No. 101 Hospital of PLA; Wuxi Institute of Clinical, Anhui Medical University , Wuxi, Jiangsu Province, China
| | - Haibing Jiang
- Department of Cardiology, No. 101 Hospital of PLA; Wuxi Institute of Clinical, Anhui Medical University , Wuxi, Jiangsu Province, China
| | - Lulu Wang
- Department of Cardiology, No. 101 Hospital of PLA; Wuxi Institute of Clinical, Anhui Medical University , Wuxi, Jiangsu Province, China
| | - Tianxiao Wang
- Department of Cardiology, No. 101 Hospital of PLA; Wuxi Institute of Clinical, Anhui Medical University , Wuxi, Jiangsu Province, China
| | - Jie Liu
- Department of Cardiology, No. 101 Hospital of PLA; Wuxi Institute of Clinical, Anhui Medical University , Wuxi, Jiangsu Province, China
| | - Dongmei An
- Department of Cardiology, No. 101 Hospital of PLA; Wuxi Institute of Clinical, Anhui Medical University , Wuxi, Jiangsu Province, China
| | - Li Cao
- Department of Cardiology, No. 101 Hospital of PLA; Wuxi Institute of Clinical, Anhui Medical University , Wuxi, Jiangsu Province, China
| | - Yang Xia
- Department of Cardiology, No. 101 Hospital of PLA; Wuxi Institute of Clinical, Anhui Medical University , Wuxi, Jiangsu Province, China
| | - Gangjun Zong
- Department of Cardiology, No. 101 Hospital of PLA; Wuxi Institute of Clinical, Anhui Medical University , Wuxi, Jiangsu Province, China
| |
Collapse
|
9
|
Sugimoto T, Dohi K, Onishi K, Yamada T, Horiguchi M, Takamura T, Kawamura A, Seko T, Nakamura M, Kasai A, Ito M. Prognostic value of serum parathyroid hormone level in acute decompensated heart failure. Circ J 2014; 78:2704-10. [PMID: 25253620 DOI: 10.1253/circj.cj-14-0481] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Secondary hyperparathyroidism develops as a compensatory response to chronic heart failure (HF) and renal failure. The role of parathyroid hormone (PTH) level in acute decompensated HF remains unclear. The aim of this study was therefore to investigate the relationships among mortality, renal function, and serum PTH level in acute decompensated HF patients. METHODS AND RESULTS: A total of 266 consecutive patients admitted for acute decompensated HF without acute coronary syndrome (78±12 years; 48% male) were enrolled. Demographic, clinical, and laboratory characteristics were obtained on admission.During 1-year follow-up, 65 patients (24%) died. Serum PTH level on admission was within the normal range (10-65 pg/ml) in 108 patients (41%), of whom 39 (15%) had low-normal PTH (10-40 pg/ml). On Kaplan-Meier analysis all-cause mortality was significantly higher in patients with low-normal PTH than in those with high-normal (40-65 pg/ml) or high (>65 pg/ml) PTH (log-rank test). On univariate and multivariate Cox regression analysis, low-normal PTH was significantly associated with increased all-cause mortality (unadjusted HR, 2.88; 95% CI: 1.69-4.91; P<0.001; adjusted HR, 3.84; 95% CI: 1.54-9.57; P=0.004). CONCLUSIONS In patients with acute decompensated HF resulting in hospitalization, low-normal PTH on admission is associated with increased all-cause mortality, regardless of renal function.
Collapse
|
10
|
Burgazli KM, Foerster N, Meriçliler M, Chasan R, Parahuleva M, Erdogan A. Effects of parathyroid hormone-related peptide on the large conductance calcium-activated potassium channel and calcium homeostasis in vascular smooth muscle cells. Postgrad Med 2014; 126:76-85. [PMID: 24685970 DOI: 10.3810/pgm.2014.03.2742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIM To demonstrate the impact of the parathyroid hormone-related peptide (PTHrP) on the large conductance calcium-activated potassium (BKCa) channels in vascular smooth muscle cells (VSMC) and hyperpolarization of the cell membrane and its dependence on calcium. MATERIALS AND METHODS VSMC were isolated from rat aorta and further subcultured. Four experiments were conducted in calcium-release measurements and each of them consisted of a control group, PTHrP, chemical substance, and PTHrP + chemical substance. Chemical substances used were: iberiotoxin, xestospongin C, xestospongin D, and thapsigargin, respectively. Fura-2 imaging was used to determine changes in calcium release of VSMC. In membrane-potential experiments, groups were designed similarly to the Fura-2 imaging experiments: iberiotoxin, BAPTA, and xestospongin D were added, in respective order. Changes in the membrane potential were examined using the fluorescence dye (DiBAC). RESULTS Given in a dose between 0.01 and 1.0 μmol/L, PTHrP caused a concentration-dependent decrease in fluorescence intensity, with a maximum effect at 0.5 μmol/L. The decrease, therefore, demonstrated a PTHrP-induced hyperpolarization of the VSMC. The effect was blocked by use of iberiotoxin (100 nmol/L), a highly selective inhibitor of BKCa. Furthermore, when the calcium chelator BAPTA (10 μmol/L) was added, there was a significant reduction in PTHrP-induced hyperpolarization. Use of PTHrP (0.5 μmol/L) also decreased the fluorescence intensity of the indicator for intracellular calcium, Fura-2AM (a membrane-permeable derivative of Fura 2). This effect was re-blocked by use of iberiotoxin. Xestospongin C (3 μmol/L) and xestospongin D (6 μmol/L), both inhibitors of the inositol 1,4,5 trisphosphate-triggered calcium release, inhibited the effects of PTHrP. Additionally, thapsigargin (1 μmol/L), a sarcoplasmic/endoplasmic reticulum Ca2+-ATPase inhibitor, inhibited the effect of PTHrP. CONCLUSION The results of our study show that PTHrP induces hyperpolarization and activates BKCa in VSMC. The activation of BKCa channels is calcium dependent; activation is linked to the inositol 1,4,5 trisphosphate-triggered calcium release and is also dependent on the endo/sarcoplasmic reticulum calcium pump.
Collapse
Affiliation(s)
- Kamil Mehmet Burgazli
- Wuppertal Department of Internal Medicine and Angiology, Wuppertal Research and Medical Center, Wuppertal, Germany.
| | | | | | | | | | | |
Collapse
|
11
|
Poulikakos D, Malik M, Banerjee D. Parathyroid hormone and heart rate variability in haemodialysis patients. Nephron Clin Pract 2014; 126:110-5. [PMID: 24686193 DOI: 10.1159/000360542] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Accepted: 02/05/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Depressed heart rate variability (HRV) reflects abnormal cardiac autonomic regulation and has been linked with increased cardiovascular risk and sudden cardiac death. High parathyroid hormone (PTH) levels have also been associated with an increased risk of sudden cardiac death in haemodialysis (HD) patients. Our aim was to investigate the association between HRV indices and PTH in HD patients. METHODS Continuous intradialytic electrocardiograms were repeated in stable HD patients 5 times every 2 weeks. The absolute values of high-frequency (HF) and low-frequency (LF) HRV components were calculated every 5 min and averaged during the first and last hour of each recording (distinguished by subscripts F and L, respectively). Pre-HD PTH, corrected calcium, and phosphate levels were measured before the first recording. RESULTS Data were analysed for 75 subjects aged 60 ± 15, 32% females, 37% diabetics. Baseline biochemical parameters were PTH 44 ± 32 pmol/l, calcium 2.3 ± 0.2 mmol/l, and phosphate 1.6 ± 0.4 mmol/l. All HRV indices showed intra-subject stability over the 5 recordings. Diabetics had lower LFL compared to non-diabetics (-5.5 ± 0.5 vs. -5.2 ± 0.5 after logarithmic transformation, p = 0.012). In non-diabetics, PTH correlated negatively with LFL and HFL (LFL r = -0.340, p = 0.020, HFL r = -0.325, p = 0.026) and phosphate correlated negatively with LFF (r = -0.427, p = 0.003), HFF (r = -0.442, p = 0.002) and HFL (r = -0.307, p = 0.040). CONCLUSION High PTH and phosphate are associated with depressed HRV in non-diabetic dialysis patients. Prospective studies are needed to evaluate the role of mineral abnormalities in autonomic imbalance and arrhythmic risk in HD patients.
Collapse
Affiliation(s)
- Dimitrios Poulikakos
- Cardiovascular Sciences Research Centre, St. George's University of London, London, UK
| | | | | |
Collapse
|
12
|
Abstract
Secondary hyperparathyroidism in heart failure is a consequence of renin-angiotensin-aldosterone activation, chronic hyperaldosteronism, and loop diuretic usage, resulting in calcium excretion. The result is an inflammatory state with adverse effects on myocardial remodeling and systemic complications. Recent literature has suggested that elevated parathyroid hormone predicts adverse outcomes in patients with heart failure independent of serum calcium and phosphate, vitamin D deficiency, and renal insufficiency. Parathyroid hormone has been correlated with elevated brain natriuretic peptide levels, an established biomarker of heart failure severity. There are several limitations to the utilization of parathyroid hormone as a biomarker for heart failure, and further prospective studies need to be conducted to assess the value of multiple parathyroid hormone measurements over time and elucidate the role of parathyroid hormone in diastolic dysfunction. Pending further validation, there is promise for parathyroid hormone as a complementary biomarker in heart failure.
Collapse
|
13
|
Poulikakos D, Banerjee D, Malik M. T wave morphology changes during hemodialysis. J Electrocardiol 2013; 46:492-6. [DOI: 10.1016/j.jelectrocard.2013.07.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Indexed: 10/26/2022]
|
14
|
Luk A, Ezzat S, Butany J. Pathology, pathophysiology, and treatment strategies of endocrine disorders and their cardiac complications. Semin Diagn Pathol 2013; 30:245-62. [PMID: 24144293 DOI: 10.1053/j.semdp.2013.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The cardiovascular system is affected by a multitude of endocrine disorders, including dysfunction of the thyroid, calcium, glucocorticoids, insulin/glucose, and growth hormone axes. Since most of these changes in the cardiovascular system are reversible when treated, early diagnosis is important, as if left untreated, they may become fatal. This review focuses on the pathophysiology, clinical presentation, pathology, and treatment of patients with these endocrine diseases who present with a variety of cardiovascular manifestations. Neuroendocrine tumors presenting with the carcinoid syndrome and their cardiovascular manifestations are also discussed.
Collapse
Affiliation(s)
- Adriana Luk
- Department of Medicine, Toronto General Hospital/University Health Network, Toronto, Ontario, Canada
| | | | | |
Collapse
|
15
|
Fisher A, Srikusalanukul W, Davis M, Smith P. Cardiovascular diseases in older patients with osteoporotic hip fracture: prevalence, disturbances in mineral and bone metabolism, and bidirectional links. Clin Interv Aging 2013; 8:239-56. [PMID: 23460043 PMCID: PMC3585505 DOI: 10.2147/cia.s38856] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Considerable controversy exists regarding the contribution of mineral/bone metabolism abnormalities to the association between cardiovascular diseases (CVDs) and osteoporotic fractures. AIMS AND METHODS To determine the relationships between mineral/bone metabolism biomarkers and CVD in 746 older patients with hip fracture, clinical data were recorded and serum concentrations of parathyroid hormone (PTH), 25-hydroxyvitamin D, calcium, phosphate, magnesium, troponin I, parameters of bone turnover, and renal, liver, and thyroid functions were measured. RESULTS CVDs were diagnosed in 472 (63.3%) patients. Vitamin D deficiency was similarly prevalent in patients with (78.0%) and without (82.1%) CVD. The CVD group had significantly higher mean PTH concentrations (7.6 vs 6.0 pmol/L, P < 0.001), a higher prevalence of secondary hyperparathyroidism (SPTH) (PTH > 6.8 pmol/L, 43.0% vs 23.3%, P < 0.001), and excess bone resorption (urinary deoxypyridinoline corrected by creatinine [DPD/Cr] > 7.5 nmol/μmol, 87.9% vs 74.8%, P < 0.001). In multivariate regression analysis, SHPT (odds ratio [OR] 2.6, P = 0.007) and high DPD/Cr (OR 2.8, P = 0.016) were independent indictors of CVD. Compared to those with both PTH and DPD/Cr in the normal range, multivariate-adjusted ORs for the presence of CVD were 17.3 (P = 0.004) in subjects with SHPT and 9.7 (P < 0.001) in patients with high DPD/Cr. CVD was an independent predicator of SHPT (OR 2.8, P = 0.007) and excess DPD/Cr (OR 2.5, P = 0.031). CVD was predictive of postoperative myocardial injury, while SHPT was also an independent predictor of prolonged hospital stay and in-hospital death. CONCLUSION SHPT and excess bone resorption are independent pathophysiological mediators underlying the bidirectional associations between CVD and hip fracture, and therefore are important diagnostic and therapeutic targets.
Collapse
Affiliation(s)
- A Fisher
- Department of Geriatric Medicine, The Canberra Hospital, Canberra, ACT, Australia.
| | | | | | | |
Collapse
|
16
|
Birgander M, Juul-Möller S, Bondeson AG, Bondeson L, Rydberg E. Adrenergic and cardiac dysfunction in primary hyperparathyroidism. Clin Endocrinol (Oxf) 2012; 76:189-95. [PMID: 21740454 DOI: 10.1111/j.1365-2265.2011.04169.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Primary hyperparathyroidism (PHPT) is associated with cardiovascular morbidity and premature death, but the underlying mechanisms are incompletely understood. The aim of this study was to investigate whether adrenergic dysfunction may be a contributing factor. PATIENTS AND METHODS Forty-nine patients with mild PHPT (serum calcium 2·7 ± 0·1 mM) and 48 control subjects, matched for age and sex, were examined; patients within 1 month before parathyroidectomy (PTX) and 6 months postoperatively; control subjects at inclusion. Heart rate variability (HRV) was analysed in 24-h electrocardiograms, and plasma concentrations of epinephrine and norepinephrine were measured at rest and immediately after standardized physical tests. RESULTS At baseline, the patients showed, compared to the controls, reduced stress-related increase of circulating epinephrine (P < 0·05) and norepinephrine (P < 0·05). No significant change was observed 6 months after PTX. At baseline, there were no significant differences between patients and controls in HRV or heart rate, but 6 months after curative PTX, the patients showed significantly reduced HRV in both frequency and time domain, and their maximum and average heart rate had decreased (P = 0·011 and P = 0·018, respectively). The patients with the highest preoperative levels of circulating parathyroid hormone showed the greatest changes in heart rate and HRV postoperatively. CONCLUSIONS This study demonstrates a previously unknown impairment of catecholamine response to physical stress in PHPT along with changes of HRV, also indicating adrenergic dysfunction. These factors should be considered in the ongoing controversy regarding the management of patients with mild 'asymptomatic' PHPT.
Collapse
Affiliation(s)
- Mats Birgander
- Department of Clinical Sciences, Cardiology, Lund University, Skåne University Hospital, Malmö, Sweden.
| | | | | | | | | |
Collapse
|
17
|
Claes KJ, Heye S, Nuyens D, Bammens B, Kuypers DR, Vanrenterghem Y, Evenepoel P. Impact of vascular calcification on corrected QT interval at the time of renal transplantation. Am J Nephrol 2012; 35:24-30. [PMID: 22143191 DOI: 10.1159/000334597] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2011] [Accepted: 10/22/2011] [Indexed: 01/08/2023]
Abstract
BACKGROUND/AIMS Sudden death is the major cause of cardiac mortality in dialysis patients, accounting for approximately 60% of cardiovascular deaths. A prolonged QT interval and arterial calcification have been associated with increased cardiovascular morbidity and mortality in different patient populations including patients with chronic kidney disease (CKD). In the present study, we aimed to elucidate the association of vascular calcification with corrected QT interval duration in patients with end-stage renal disease. METHODS We performed a single-center cross-sectional study in patients referred for renal transplantation. Patients taking QT-prolonging agents or with conduction abnormalities were excluded. Aortic calcifications were scored by means of lumbar X-rays. RESULTS In the final analysis, 193 patients (118 men, 52 years old) were included. A prolonged QT interval was observed in 26% of the patients. Multivariate analysis showed an independent and direct association between corrected QT duration and the extent of aortic calcifications (p = 0.0004) independent of age, gender, cardiovascular history, electrolytes and parameters of mineral metabolism. CONCLUSIONS A prolonged QT interval is prevalent in patients with CKD stage 5D. Aortic calcification is associated with a prolonged QT duration, independent of traditional determinants.
Collapse
Affiliation(s)
- Kathleen J Claes
- Department of Nephrology and Renal Transplantation, University Hospital Gasthuisberg, Leuven, Belgium.
| | | | | | | | | | | | | |
Collapse
|
18
|
Elevation of parathyroid hormone levels in atrial fibrillation. J Am Coll Cardiol 2011; 57:2542-3. [PMID: 21679857 DOI: 10.1016/j.jacc.2011.01.041] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2010] [Revised: 11/23/2010] [Accepted: 01/11/2011] [Indexed: 12/29/2022]
|
19
|
Schierbeck LL, Jensen TS, Bang U, Jensen G, Køber L, Jensen JEB. Parathyroid hormone and vitamin D-markers for cardiovascular and all cause mortality in heart failure. Eur J Heart Fail 2011; 13:626-632. [DOI: 10.1093/eurjhf/hfr016] [Citation(s) in RCA: 97] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Affiliation(s)
- Louise Lind Schierbeck
- Department of Endocrinology, afsn.541; Hvidovre Hospital; Kettegård alle 30, 2650 Hvidovre Denmark
| | | | - Ulrich Bang
- Department of Endocrinology, afsn.541; Hvidovre Hospital; Kettegård alle 30, 2650 Hvidovre Denmark
| | - Gorm Jensen
- Department of Cardiology; Hvidovre University Hospital; Hvidovre Denmark
| | - Lars Køber
- Department of Cardiology, Rigshospitalet; University of Copenhagen; Copenhagen Denmark
| | - Jens-Erik Beck Jensen
- Department of Endocrinology, afsn.541; Hvidovre Hospital; Kettegård alle 30, 2650 Hvidovre Denmark
| |
Collapse
|
20
|
Pilz S, Tomaschitz A, Drechsler C, Ritz E, Boehm BO, Grammer TB, März W. Parathyroid hormone level is associated with mortality and cardiovascular events in patients undergoing coronary angiography. Eur Heart J 2010; 31:1591-8. [PMID: 20439261 DOI: 10.1093/eurheartj/ehq109] [Citation(s) in RCA: 120] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS Elevated parathyroid hormone (PTH) levels have been associated with increased cardiovascular risk in the general population. We aimed to elucidate whether PTH levels are associated with mortality and fatal cardiovascular events in patients referred for coronary angiography. METHODS AND RESULTS Intact PTH was measured in 3232 Caucasian patients from the LUdwigshafen RIsk and Cardiovascular Health (LURIC) study, who underwent coronary angiography at baseline (1997-2000). During a median follow-up time of 7.7 years, 742 patients died including 467 deaths due to cardiovascular causes. Unadjusted Cox proportional hazard ratios (HRs) (with 95% confidence intervals) in the fourth when compared to the first PTH quartile were 2.13 (1.75-2.60) for all-cause and 2.47 (1.92-3.17) for cardiovascular mortality. After adjustments for common cardiovascular risk factors, these HRs remained significant with 1.71 (1.39-2.10) for all-cause and 2.02 (1.55-2.63) for cardiovascular mortality. Among specific cardiovascular events we observed a particularly strong association of PTH with sudden cardiac death (SCD). The adjusted HR for SCD in the first vs. the fourth PTH quartile was 2.68 (1.71-4.22). CONCLUSION Our results among patients undergoing coronary angiography show that PTH levels are an independent risk factor for mortality and cardiovascular events warranting further studies to evaluate whether PTH modifying treatments reduce cardiovascular risk.
Collapse
Affiliation(s)
- Stefan Pilz
- Division of Endocrinology and Nuclear Medicine, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria.
| | | | | | | | | | | | | |
Collapse
|
21
|
Pinchot SN, Chen H. Nonoperative management of primary hyperparathyroidism: the exception rather than the rule. Expert Rev Endocrinol Metab 2009; 4:553-563. [PMID: 30780795 DOI: 10.1586/eem.09.50] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The spectrum of classical primary hyperparathyroidism (pHPT) has expanded from a disabling disease to a largely asymptomatic one, leading to considerable uncertainty regarding which patients with pHPT will truly benefit from operative therapy. In the hands of an experienced endocrine surgeon, parathyroidectomy (PTx) is associated with a greater than 95% cure rate and long-term complication rates of less than 5%. We believe that all patients with pHPT should be referred to an experienced endocrine surgeon for consideration of PTx. Furthermore, our preference is to offer surgical intervention to all patients with pHPT who do not have prohibitive medical comorbidities. The purpose of this article is to outline the anticipated benefits of PTx in patients with nonclassical symptoms of pHPT with regard to improvement of the present condition, prevention of future complications or both.
Collapse
Affiliation(s)
- Scott N Pinchot
- a Section of Endocrine Surgery, Department of Surgery, University of Wisconsin, H4/750 Clinical Science Center, 600 Highland Avenue, Madison, WI 53792, USA.
| | - Herbert Chen
- b Section of Endocrine Surgery, Department of Surgery, University of Wisconsin, H4/722 Clinical Science Center, 600 Highland Avenue, Madison, WI 53792, USA.
| |
Collapse
|
22
|
Ischemic injury activates PTHrP and PTH1R expression in human ventricular cardiomyocytes. Basic Res Cardiol 2009; 104:427-34. [DOI: 10.1007/s00395-008-0774-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2008] [Accepted: 12/02/2008] [Indexed: 10/21/2022]
|
23
|
Abstract
The heart automaticity is a fundamental physiological function in higher organisms. The spontaneous activity is initiated by specialized populations of cardiac cells generating periodical electrical oscillations. The exact cascade of steps initiating the pacemaker cycle in automatic cells has not yet been entirely elucidated. Nevertheless, ion channels and intracellular Ca(2+) signaling are necessary for the proper setting of the pacemaker mechanism. Here, we review the current knowledge on the cellular mechanisms underlying the generation and regulation of cardiac automaticity. We discuss evidence on the functional role of different families of ion channels in cardiac pacemaking and review recent results obtained on genetically engineered mouse strains displaying dysfunction in heart automaticity. Beside ion channels, intracellular Ca(2+) release has been indicated as an important mechanism for promoting automaticity at rest as well as for acceleration of the heart rate under sympathetic nerve input. The potential links between the activity of ion channels and Ca(2+) release will be discussed with the aim to propose an integrated framework of the mechanism of automaticity.
Collapse
Affiliation(s)
- Matteo E Mangoni
- Institute of Functional Genomics, Department of Physiology, Centre National de la Recherche Scientifique UMR5203, INSERM U661, University of Montpellier I and II, Montpellier, France.
| | | |
Collapse
|
24
|
Abstract
The classical actions of parathyroid hormone (PTH) are well recognized, but its effects on other target tissues, such as the cardiovascular system, are less appreciated. Several studies have evaluated the effects of PTH in patients with primary hyperparathyroidism in order to understand potential cardiovascular effects in terms of hypertension, cardiovascular mortality, left ventricular function, and endothelial function. We review these studies and evaluate the cellular mechanisms that may affect these outcomes.
Collapse
Affiliation(s)
- Lorraine A Fitzpatrick
- Research and Development, Musculoskeletal Diseases, GlaxoSmithKline, 2301 Renaissance Boulevard, RN0420, King of Prussia, PA 19406, USA.
| | | | | |
Collapse
|
25
|
Shor R, Tilis Y, Halabe A, Boaz M, Matas Z, Fux A. Serum parathyroid hormone-related protein levels before and after paroxysmal atrial fibrillation. Am J Emerg Med 2008; 26:361-3. [PMID: 18358950 DOI: 10.1016/j.ajem.2007.08.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2007] [Revised: 08/07/2007] [Accepted: 08/07/2007] [Indexed: 10/22/2022] Open
|
26
|
Intrakrine, parakrine und autokrine Funktionen des PTH/PTHrP-Systems. MOLEKULARMEDIZINISCHE GRUNDLAGEN VON PARA- UND AUTOKRINEN REGULATIONSSTÖRUNGEN 2006. [PMCID: PMC7144038 DOI: 10.1007/3-540-28782-5_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
27
|
Maioli E, Fortino V, Pacini A. Parathyroid Hormone-Related Protein in Preeclampsia: A Linkage Between Maternal and Fetal Failures. Biol Reprod 2004; 71:1779-84. [PMID: 15286039 DOI: 10.1095/biolreprod.104.030932] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Preeclampsia is a disorder associated with pregnancy that affects both the mother and the fetus. Typical features of the disease are maternal hypertension, proteinuria, and edema as well as fetal growth retardation. Although the etiological details are still being debated, a consensus exists that the starting point is deficient placentation in the first half of pregnancy. The crucial early steps are reduced trophoblast invasiveness and enhanced apoptotic death. In the present review, we demonstrate that parathyroid hormone-related protein is involved not only in the maternal and fetal failures but also in the etiological aspects of the disease. We hypothesize that reduced local production of the peptide is a major causative event.
Collapse
Affiliation(s)
- Emanuela Maioli
- Department of Physiology, Section of Immunoendocrinology and Reproductive Physiology, University of Siena, 8-53100 Siena, Italy.
| | | | | |
Collapse
|
28
|
Jansen J, Gres P, Umschlag C, Heinzel FR, Degenhardt H, Schluter KD, Heusch G, Schulz R. Parathyroid hormone-related peptide improves contractile function of stunned myocardium in rats and pigs. Am J Physiol Heart Circ Physiol 2003; 284:H49-55. [PMID: 12485816 DOI: 10.1152/ajpheart.01037.2001] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The effect of synthetic parathyroid hormone (PTH)-related peptide [PTHrP(1-34)] on regional myocardial function was studied in 11 anesthetized pigs. Intracoronary infusion of PTHrP (cumulative dose: 14 +/- 1 microg) decreased coronary resistance to 33 +/- 2% of baseline (P < 0.05) and regional myocardial function to 90 +/- 3% of baseline (not significant). Ischemia-reperfusion alters the activity of several kinases and therefore possibly the myocardial effects of PTHrP. In stunned myocardium, induced by 20-min ischemia and 30-min reperfusion, the dose of PTHrP reducing coronary resistance to a minimum of 29 +/- 2% was decreased to 8 +/- 2 microg (P < 0.05). Regional myocardial function was no longer decreased but increased to 132 +/- 9% (P < 0.05). The increase in regional myocardial function during PTHrP was inversely related to baseline function at 30-min reperfusion in vivo (r = 0.9) as well as in myocytes isolated from stunned pig hearts (r = 0.7). In isolated rat hearts subjected to 30-min global ischemia followed by 30-min reperfusion, blockade of endogenous PTHrP by d-Trp(12)-Tyr(34)-PTH(7-34) attenuated the recovery of left ventricular developed pressure by 30 +/- 14% (P < 0.05). Thus endogenous and exogenous PTHrP impact on the function of stunned myocardium.
Collapse
Affiliation(s)
- Johanna Jansen
- Institute of Pathophysiology, University of Essen, Germany
| | | | | | | | | | | | | | | |
Collapse
|
29
|
Clemens TL, Cormier S, Eichinger A, Endlich K, Fiaschi-Taesch N, Fischer E, Friedman PA, Karaplis AC, Massfelder T, Rossert J, Schlüter KD, Silve C, Stewart AF, Takane K, Helwig JJ. Parathyroid hormone-related protein and its receptors: nuclear functions and roles in the renal and cardiovascular systems, the placental trophoblasts and the pancreatic islets. Br J Pharmacol 2001; 134:1113-36. [PMID: 11704631 PMCID: PMC1573066 DOI: 10.1038/sj.bjp.0704378] [Citation(s) in RCA: 129] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2001] [Accepted: 09/10/2001] [Indexed: 11/09/2022] Open
Abstract
The cloning of the so-called 'parathyroid hormone-related protein' (PTHrP) in 1987 was the result of a long quest for the factor which, by mimicking the actions of PTH in bone and kidney, is responsible for the hypercalcemic paraneoplastic syndrome, humoral calcemia of malignancy. PTHrP is distinct from PTH in a number of ways. First, PTHrP is the product of a separate gene. Second, with the exception of a short N-terminal region, the structure of PTHrP is not closely related to that of PTH. Third, in contrast to PTH, PTHrP is a paracrine factor expressed throughout the body. Finally, most of the functions of PTHrP have nothing in common with those of PTH. PTHrP is a poly-hormone which comprises a family of distinct peptide hormones arising from post-translational endoproteolytic cleavage of the initial PTHrP translation products. Mature N-terminal, mid-region and C-terminal secretory forms of PTHrP are thus generated, each of them having their own physiologic functions and probably their own receptors. The type 1 PTHrP receptor, binding both PTH(1-34) and PTHrP(1-36), is the only cloned receptor so far. PTHrP is a PTH-like calciotropic hormone, a myorelaxant, a growth factor and a developmental regulatory molecule. The present review reports recent aspects of PTHrP pharmacology and physiology, including: (a) the identification of new peptides and receptors of the PTH/PTHrP system; (b) the recently discovered nuclear functions of PTHrP and the role of PTHrP as an intracrine regulator of cell growth and cell death; (c) the physiological and developmental actions of PTHrP in the cardiovascular and the renal glomerulo-vascular systems; (d) the role of PTHrP as a regulator of pancreatic beta cell growth and functions, and, (e) the interactions of PTHrP and calcium-sensing receptors for the control of the growth of placental trophoblasts. These new advances have contributed to a better understanding of the pathophysiological role of PTHrP, and will help to identify its therapeutic potential in a number of diseases.
Collapse
Affiliation(s)
- Thomas L Clemens
- Department of Medicine, University of Cincinnati, Cincinnati, Ohio, U.S.A
- Department of Molecular and Cellular Physiology, University of Cincinnati, Cincinnati, Ohio, U.S.A
| | - Sarah Cormier
- INSERM U 426 and Institut Federatif de Recherche ‘Cellules Epitheliales', Faculte de Medecine Xavier Bichat, Paris, France
| | - Anne Eichinger
- Section of Renovascular Pharmacology and Physiology, INSERM E0015-ULP, University Louis Pasteur School of Medicine, Strasbourg, France
| | - Karlhans Endlich
- Institut für Anatomie und Zellbiologie 1, Universität Heidelberg, Heidelberg, Germany
| | - Nathalie Fiaschi-Taesch
- Section of Renovascular Pharmacology and Physiology, INSERM E0015-ULP, University Louis Pasteur School of Medicine, Strasbourg, France
- Division of Endocrinology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, PA 15213, U.S.A
| | - Evelyne Fischer
- Department of Nephrology, University Hospital of Strasbourg, Strasbourg, France
| | - Peter A Friedman
- Department of Pharmacology, University of Pittsburgh School of Medicine, Pittsburgh, U.S.A
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, U.S.A
| | | | - Thierry Massfelder
- Section of Renovascular Pharmacology and Physiology, INSERM E0015-ULP, University Louis Pasteur School of Medicine, Strasbourg, France
| | - Jérôme Rossert
- INSERM U489 and Departments of Nephrology and Pathology, Paris VI University, France
| | | | - Caroline Silve
- INSERM U 426 and Institut Federatif de Recherche ‘Cellules Epitheliales', Faculte de Medecine Xavier Bichat, Paris, France
| | - Andrew F Stewart
- Division of Endocrinology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, PA 15213, U.S.A
| | - Karen Takane
- Division of Endocrinology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, PA 15213, U.S.A
| | - Jean-Jacques Helwig
- Section of Renovascular Pharmacology and Physiology, INSERM E0015-ULP, University Louis Pasteur School of Medicine, Strasbourg, France
| |
Collapse
|
30
|
Shimoyama M, Ogino K, Furuse Y, Uchida K, Kinugasa Y, Tomikura Y, Igawa O, Hisatome I, Bilezikian JP, Shigemasa C. Signaling pathway and chronotropic action of parathyroid hormone in isolated perfused rat heart. J Cardiovasc Pharmacol 2001; 38:491-9. [PMID: 11588519 DOI: 10.1097/00005344-200110000-00001] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Parathyroid hormone (PTH) activates both adenylyl cyclase and phospholipase C via the PTH-1 receptor. We previously reported that PTH increased heart rate and that this effect was mediated via the pacemaker current (I f ). However, it has been reported that PTH exerts its chronotropic effect via an interaction with adrenergic receptors or via L-type calcium channels. Thus, the objective of the study was to elucidate the exact mechanism of the chronotropic effect of PTH. We tested whether its chronotropic effects could be abolished by inhibitors of the following systems in isolated perfused rat hearts: alpha-adrenergic (prazosin); beta-adrenergic (propranolol); angiotensin II (CV11974); endothelin-1 (TAK044); calcium channel (verapamil); adenylyl cyclase (miconazole); phospholipase C (U73122) or I f (CsCl). In addition, we measured the cyclic adenosine monophosphate level of the heart after PTH administration. Whereas prazosin, propranolol, CV11974, TAK044, verapamil, and U73122 did not inhibit the chronotropic effect of PTH, CsCl or miconazole suppressed it significantly. PTH increased the cyclic adenosine monophosphate level of the atrium but not the left ventricle. These results indicate that the chronotropic actions of PTH are mediated via selective activation of adenylyl cyclase to increase the I f current.
Collapse
Affiliation(s)
- M Shimoyama
- Division of Cardiology, Department of Medicine, Faculty of Medicine, Tottori University, Yonago, Japan
| | | | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Abstract
Many physiologic roles of PTHrP are emerging. The protein functions locally in diverse tissues, often regulating the entry of cells into a differentiation pathway or acting as an epithelial signal in epithelial-mesenchymal interactions. To carry out these functions, PTHrP uses the receptor it shares with PTH or one of several PTHrP receptors that have evolved to recognize selectively the PTH-like region of PTHrP or other domains. Thus, PTHrP is a polyhormone. An exquisite selectivity barrier allows PTHrP to carry out its local tissue functions at the same time PTH uses their shared receptor to regulate systemic calcium homeostasis. This barrier is breached under pathologic circumstances, such as when malignant tumors secrete enough PTHrP into blood to cause PTH-like effects, including hypercalcemia. Powerful genetic models that have been developed in the past 7 years promise to give continuing insights into the physiology and pathophysiology of PTHrP.
Collapse
Affiliation(s)
- G J Strewler
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
32
|
Affiliation(s)
- G J Strewler
- Department of Medicine, Veterans Affairs Boston Health Care System, West Roxbury, Mass, USA
| |
Collapse
|
33
|
Schlüter KD. PTH and PTHrP: Similar Structures but Different Functions. NEWS IN PHYSIOLOGICAL SCIENCES : AN INTERNATIONAL JOURNAL OF PHYSIOLOGY PRODUCED JOINTLY BY THE INTERNATIONAL UNION OF PHYSIOLOGICAL SCIENCES AND THE AMERICAN PHYSIOLOGICAL SOCIETY 1999; 14:243-249. [PMID: 11390859 DOI: 10.1152/physiologyonline.1999.14.6.243] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Parathyroid hormone and parathyroid hormone-related peptide are two structurally similar peptide hormones that exert mainly identical effects on classical target cells of parathyroid hormone but remarkable differences in their effects on other target cells. This review focuses on their functional differences and the mechanisms underlying these effects.
Collapse
Affiliation(s)
- K.-D. Schlüter
- Physiologisches Institut, Aulweg 129, D-35392 Giessen, Germany
| |
Collapse
|
34
|
Shimoni Y. Hormonal control of cardiac ion channels and transporters. PROGRESS IN BIOPHYSICS AND MOLECULAR BIOLOGY 1999; 72:67-108. [PMID: 10446502 DOI: 10.1016/s0079-6107(99)00005-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Y Shimoni
- Department of Physiology and Biophysics, Faculty of Medicine, University of Calgary, Alta., Canada.
| |
Collapse
|
35
|
Piovesan A, Molineri N, Casasso F, Emmolo I, Ugliengo G, Cesario F, Borretta G. Left ventricular hypertrophy in primary hyperparathyroidism. Effects of successful parathyroidectomy. Clin Endocrinol (Oxf) 1999; 50:321-8. [PMID: 10435057 DOI: 10.1046/j.1365-2265.1999.00651.x] [Citation(s) in RCA: 166] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE The association between primary hyperparathyroidism (PHPT) and increased mortality mainly from cardiovascular disease is still debated. The increased mortality previously reported in PHPT was not confirmed in a recent population based study. A high prevalence of left ventricular (LV) hypertrophy was, however, reported in this disease. Although arterial hypertension is regarded as the principal factor, the pathogenesis of LV hypertrophy in PHPT is complex and not completely defined, moreover the effects of successful parathyroidectomy (PTX) are not fully elucidated. The aims of this study were: to ascertain the prevalence of LV hypertrophy in a series of patients with PHPT in comparison to a control population, to seek for relationship between biochemical markers of disease, blood pressure (BP) levels and LV measurements and to evaluate the effects of successful PTX on LV hypertrophy during short-term follow-up. SUBJECTS AND DESIGN Forty-three patients affected by active PHPT (16 males and 27 females, mean age 60.2 +/- 12.7 years) and 43 controls age- and sex-matched with the same prevalence of arterial hypertension were studied in a case-control analysis. Each subject underwent a M- and 2D mode echocardiographic evaluation and repeated BP measurement. In 21 PHPT submitted to surgery the echocardiographic measurement was repeated 6 months after successful PTX. MEASUREMENTS Serum concentrations of parathyroid hormone (PTH), total-(Ca) and ionized calcium (iCa), phosphate, creatinine, total alkaline phosphatase (TALP) were measured in patients with PHPT at diagnosis and six months after PTX in the subgroup operated on; BP values were measured in three different occasion; mono and 2D echocardiographic evaluation was performed in control subjects and patients with PHPT either before and after PTX. RESULTS LV hypertrophy, measured by LV mass index (LVMI), was present in 28/43 PHPT patients (65.1%) and in 15/43 (34.8%) controls, P < 0.05; among hypertensive subjects, 21/21 (100%) PHPT patients and 13/21 (61.9%) controls P < 0.05 were hypertrophic while among normotensive subjects, these figures were 7/22 (31.8%) for PHPT patients and 2/22 (9%) for controls, P = 0.67. At multiple regression analysis in a model including biochemical parameters and BP values, serum PTH levels were associated with LVMI values as the strongest predicting variable (0.46, P < 0.02). Six months after PTX, LVMI decreased (137.8 +/- 37.3 vs 113.0 +/- 28.5, P < 0.05) without changes in mean BP values and ratio of hypertensive patients. CONCLUSION The present data confirm the high prevalence of LV hypertrophy in primary hyperparathyroidism also in a group of patients with an asymptomatic clinical presentation. The correlation between PTH values and left ventricular mass index suggests an action of the hormone in the pathogenesis of LV hypertrophy confirmed also by the decrease of left ventricular mass index after the reduction of PTH levels. The reversal of left ventricular mass index after parathyroidectomy could affect mortality in primary hyperparathyroidism. An echocardiographic study could be suggested in the clinical work-up of primary hyperparathyroidism in order to evaluate heart involvement and the response to successful parathyroidectomy.
Collapse
Affiliation(s)
- A Piovesan
- Division of Endocrinology, Azienda Ospedaliera Santa Croce e Carle, Cuneo, Italy
| | | | | | | | | | | | | |
Collapse
|