Synthetic and partially-purified adenylate cyclase-stimulating proteins from tumors associated with humoral hypercalcemia of malignancy inhibit phosphate transport in a PTH-responsive renal cell line

Parathyroid hormone-related protein: primary osteolytic factor produced by breast tumor cells in vitro?

Tumor cells in bone metastases are thought to induce bone resorption primarily by releasing paracrine factors. Parathyroid hormone related protein (PTHrp) has been proposed to mediate osteolytic activity of many tumors. PTHrp is produced by 40% to 60% of breast tumors and is elevated in the serum of up to 50% of patients with breast cancer metastases to bone. Most biologic processes in humans are heterogeneous in nature, so the purpose of this study was to investigate the hypothesis that paracrine factors other than PTHrp could mediate bone resorption by breast tumor cells. Serum-free conditioned medium (CM) was collected from five human breast tumor cell lines and tested for bone resorption-stimulating activity (BRSA) in mouse calvaria organ cultures. CM from all tumor cells studied produced significant bone resorption, comparable to that produced by 10 nM PTH. Small amounts of immunoreactive PTHrp (1.4-12.5 pM) were produced by all breast tumor cell lines. When tested in vitro, equivalent amounts of human PTHrp [1-36] did not produce significant bone resorption. Indomethacin (1 microM) significantly blocked BRSA by CM from all cell lines but did not decrease BRSA by PTHrp. In contrast PTHrp antibody (130 micrograms/ml) completely blocked BRSA by 1 nM PTHrp but did not modify BRSA by CM of breast tumor cells. The results of this study support the hypothesis that breast cancer cells release paracrine factors in vitro that stimulate bone resorption by a mechanism that is partially dependent on prostaglandin synthesis and at least in part different from that of PTHrp.(ABSTRACT TRUNCATED AT 250 WORDS)

Involvement of alkaline phosphatase in the modulation of receptor signaling in osteoblasts: evidence for a difference between human parathyroid hormone-related protein and human parathyroid hormone

We have previously reported that alkaline phosphatase (ALPase) is functionally involved in calcium uptake by several osteoblast-like cell lines. We have extended these studies to investigate the actions of ALPase on the cAMP response to and the receptor binding of human parathyroid hormone (hPTH) and human parathyroid hormone-related protein (hPTHrP). Pretreatment of human osteoblast-like SaOS-2 cells with human placental ALPase (hpALPase) inhibited the cAMP response to hPTH(1-34) but had no effect on the actions of hPTHrP(1-34) or vasoactive intestinal peptide. The inhibitory effect was reversed by L-Phe-Gly-Gly, an inhibitor of hpALPase. Treatment of SaOS-2 cells with hpALPase modestly reduced the binding of hPTH to 70% of control values, with little or no effect on the binding of hPTHrP. Bovine kidney and calf intestine ALPases were without effect on either the cAMP response or binding of hPTH or hPTHrP in SaOS-2 cells. In rat osteoblast-like ROS 17/2.8 cells, hpALPase had no effect on cAMP production stimulated by hPTH(1-34) or hPTHrP(1-34), arguing against a nonspecific effect of hpALPase. We suggest that, in SaOS-2 cells, the common PTH/PTHrP receptor can differentiate between the agonist activities of hPTH and hPTHrP by a mechanism that is sensitive to hpALPase.

Parathyroid hormone-related peptide in plasma of patients with hypercalcemia and malignant lesions

We developed and validated a radioimmunoassay for circulating human parathyroid hormone-related peptide (PTHrP), based on a commercial antiserum to the synthetic 1-34 fragment of PTHrP, 125I-Tyr degrees-PTHrP(1-34) as radioligand, and prior extraction of the native peptide from plasma with C-2 cartridges. We determined immunoreactive PTHrP concentrations in plasma samples from 48 healthy persons (mean +/- SD, 3.1 +/- 1.0 pmol/liter; range, less than 2 to 5 pmol/liter), 8 patients with primary hyperparathyroidism, 36 patients with hypercalcemia and a concurrent malignant lesion, and 9 normocalcemic patients with cancer and increased serum levels of carcinoembryonic antigen or prostate-specific antigen. PTHrP was normal in samples from patients with primary hyperparathyroidism (3.2 +/- 1.1 pmol/liter), secondary hyperparathyroidism (2.5 +/- 1.3 pmol/liter), and cancer without hypercalcemia (2.4 +/- 1.0 pmol/liter). In contrast, plasma immunoreactive PTHrP levels were increased (6.0 to 85.0 pmol/liter) in 47% of patients with hypercalcemia and cancer of various types, with or without bone metastatic lesions. Large amounts of PTHrP were also found in conditioned medium from cultured human prostatic carcinoma cells. Thus, PTHrP may be a causative factor for hypercalcemia associated with a malignant lesion in at least half of the cases. Measurement of circulating PTHrP may be of differential diagnostic help in hypercalcemic states.

Human PTH-(3-34) inhibited the effects of human parathyroid hormone-related protein on phosphate uptake in a cultured renal cell line (OK cells)

The action mechanism of hPTH and hPTHrP-(1-34) on phosphate uptake in opossum kidney (OK) cells was studied using [Nle8,18Tyr34]hPTH-(3-34)-NH2, a potent competivie inhibitor of adenylate cyclase-coupled PTH receptor. We examined the effects of hPTH-(1-34), hPTHrP-(1-34), and hPTH-(3-34) separately or in combination on the change in renal cyclic AMP production and phosphate uptake in OK cells. Both hPTH-(1-34) and hPTHrP-(1-34) stimulated intracellular cyclic AMP production to the same degree at concentrations between 10(-10) and 10(-7) M and inhibited phosphate uptake equipotently on a molar basis (27.5 +/- 2.0 and 33.2 +/- 1.2% inhibition at 10(-7) M, respectively). Both exogenous addition of (Bu)2cAMP and endogenous stimulation of cAMP by forskolin inhibited phosphate uptake in a dose-dependent manner. Cyclic AMP production induced by either hPTH-(1-34) or hPTHrP-(1-34) was inhibited by both [Nle8,18Tyr34]-hPTH-(3-34)-NH2 and [Tyr34]-hPTH-(7-34)-NH2. However, [Nle8,18Tyr34]hPTH-(3-34)-NH2 and [Tyr34]-hPTH-(7-34)-NH2 inhibited hPTH-induced cAMP production more strongly. The inhibitory action of phosphate uptake by hPTH-(1-34) and hPTHrP-(1-34) was prevented in the presence of a 100-fold greater concentration of [Nle8,18Tyr34]hPTH-(3-34)-NH2. The antagonistic action of [Nle8,18Tyr34]hPTH-(3-34)-NH2 on the inhibition of phosphate uptake induced by hPTH-(1-34) and hPTHrP-(1-34) became weaker with time (0-120 minutes), and [Nle8,18Tyr34]hPTH-(3-34)-NH2 did not antagonize the inhibition of phosphate uptake induced by hPTHrP-(1-34) at 120 minutes of incubation.(ABSTRACT TRUNCATED AT 250 WORDS)

Quantitative evaluation of anticalciuretic effects of synthetic parathyroid hormonelike peptides

The PTH-like peptide (PTHLP) responsible for hypercalcemia in many patients with humoral hypercalcemia of malignancy (HHM) acts on PTH receptors in bone and kidney, and large doses of PTHLPs have been shown to reduce urinary calcium excretion. However, PTHLPs have not been assessed quantitatively for effects on renal calcium excretion at concentrations (5-100 pM) now known to be found in the serum of patients with HHM. We perfused isolated rat kidneys with synthetic [tyr-36] PTHLP-(1-36)amide [PTHLP-(1-36)], PTHLP-(1-74), and synthetic bovine PTH-(1-34). The ratio of calcium to sodium clearances (CCa/CNa), a measure of distal tubular calcium transport, was reduced to the same extent by PTH, PTHLP-(1-36), and PTHLP-(1-74) (54.3 +/- 3.9, 52.9 +/- 3.9, and 52.7 +/- 1.3% reductions from control), respectively) at maximal doses (35-50 pM and higher), with half-maximal effects at 10, 18, and 32 pM, respectively. PTH, PTHLP-(1-36), and PTHLP-(1-74) all increased fractional phosphate excretion over control (p less than 0.05 each). All three peptides were natriuretic, at least doubling fractional Na excretion (p less than 0.05 or less). Urinary cAMP excretion was increased by all three. None had any effect on GFR or renal vascular resistance. These results indicate that clinically relevant concentrations of PTHLPs are anticalciuretic and natriuretic, with maximal effects similar to those of PTH. Differences in anticalciuretic potencies are small but may explain differences among patients, depending on the size(s) and concentrations of the native circulating form(s) of the peptide.

The effects of human parathyroid hormone-related peptide on cytosolic free calcium and cAMP production in opossum kidney cell

The effects of three synthetic amino-terminal fragments of human parathyroid hormone-related peptide (hPTHrP) on cytosolic free calcium ([Ca2+]i) mobilization and intracellular cAMP production were investigated and compared with those of human PTH(1-34) in opossum kidney (OK) cells. The mean basal [Ca2+]i in OK cells was 115 +/- 7.8 nM (mean +/- SE, n = 30). Human PTHrP(1-34), [40Tyr]hPTHrP(1-40) and hPTH(1-34) significantly (P less than 0.01) raised [Ca2+]i to 149 +/- 3, 150 +/- 5 and 148 +/- 6% of the basal value, respectively (mean +/- SE, n = 3). These three peptides showed similar dose dependency at concentrations between 10(-10) and 10(-7) M. These increases appeared to be, in part, due to mobilization from intracellular calcium stores. On the other hand, these three peptides also stimulated intracellular cAMP production in an equipotent manner in OK cells. However, both 10(-3) M dibutyryl cAMP and 10(-5) M forskolin failed to cause an increase in [Ca2+]i. Furthermore, [40Tyr]hPTHrP(3-40) neither affected the intracellular cAMP content significantly nor caused an increase in [Ca2+]i. These results indicate that hPTHrP mimics PTH by activating a dual second messenger system ([Ca2+]i and cAMP) in OK cells, and that [Ca2+]i stimulation by hPTHrP and hPTH is independent of cAMP production. Additionally, N-terminal amino acid position 1 to 2 of hPTHrP appears to play a crucial role in both [Ca2+]i stimulation and cAMP production.

Hypercalcaemia of malignancy

Hypercalcaemia in malignancy is a major clinical problem. It contributes significantly to morbidity and mortality and can present difficult diagnostic and management dilemmas. Direct bony invasion by tumour cells rather than humorally mediated hypercalcaemia is probably the most common cause of malignant hypercalcaemia. Yet even in this situation the mechanism of bone resorption or the reason that the normal homeostatic mechanisms cannot cope with the calcium load are poorly understood. It is likely that the humoral and paracrine factors produced by tumours which result in hypercalcaemia or in osteosclerotic bone metastases, are interposing themselves into the normal regulatory processes and deranging them. Humoral hypercalcaemia of malignancy is an important model for studying these questions, and it also provides some insight into the normal regulation of bone turnover. This review will examine the animal models and human syndromes of malignant hypercalcaemia and show how animal models, although helpful, fail to delineate the relative importance of the various potential humoral factors. A most interesting recent development in this area is the description of a new hormone, the parathyroid hormone-related peptide, which may explain many of the cases of humoral hypercalcaemia of malignancy. It is also a useful model with multiple sites of action within the bone and calcium homeostatic process. The active hormonal form of vitamin D3, 1,25-dihydroxyvitamin D3, may also be involved in a small proportion of cases, but again it is a useful model of some of the factors that may operate. Of considerable interest are the tumour derived factors, such as the transforming growth factors, and the cytokines, such as tumour necrosis factors, interleukins, and haemopoietic colony stimulating factors. Prostanoids are seldom of major importance, but may be important in certain tumour types. Osteosclerotic metastases, although seldom associated with hypercalcaemia, may provide insight into osteoblast regulating factors. Treatment of hypercalcaemia is discussed to show ways in which response to treatment may shed light on underlying pathophysiological mechanisms. Most effective treatments have many potential modes of action, and further study of the interactions of these agents and tumour types may help to unravel some of the enigmas in this human syndrome. The major advances in this complex problem involve the realisation of the necessity of multiple sites of action, including renal calcium handling as well as relative increases in bone resorption and/or intestinal calcium absorption.(ABSTRACT TRUNCATED AT 400 WORDS)

Native and a synthetic analogue of the malignancy-associated parathyroid hormone-like protein have in vitro transforming growth factor-like properties

A human parathyroid-like protein (PLP) has recently been isolated and cloned from human tumors associated with the paraneoplastic syndrome, humoral hypercalcemia of malignancy. PLP shares NH2-terminal amino acid sequence similarity with PTH but has a unique primary structure thereafter. Studies reported to date have indicated that both native and synthetic amino-terminal PLP polypeptides display actions in vivo and in vitro that are similar to those of PTH. We report here that purified native PLP and synthetic 36Tyr(1-36)amide human PLP induce epidermal growth factor-dependent transformation of NRK 49F cells in soft agar. Further, the synthetic peptide induces a significant increase in the biosynthesis of fibronectin by human dermal fibroblasts. (1-34)PTH does not display either of these biological activities. These data indicate that there are qualitative differences between PTH and the recently identified PLP. The latter hormone appears to possess transforming growth factor-like properties that may be relevant to its physiological actions.

Effect of hypercalcemia-producing tumor on 1,25(OH)2D3 biosynthesis in athymic mice

Serum 1,25-dihydroxyvitamin D3 [1,25(OH)2D3] levels are low in patients with malignancy-associated hypercalcemia (MAH), whereas murine models of MAH have high circulating 1,25(OH)2D3. To determine the effects of a hypercalcemia-producing tumor on circulating 1,25(OH)2D3, in vitro 25-hydroxyvitamin D1-hydroxylase (1OHase) activity was measured in kidneys from BALB/c athymic mice implanted with a hypercalcemia-producing human lung tumor. Twelve days of low-phosphorus diet (LPD) in control animals lowered serum phosphorus to levels found in tumor-bearing mice fed normal phosphorus diet (NPD; 4.1 +/- 0.3 vs. 4.4 +/- 0.7 mg/dl, P = NS) and increased 1OHase activity (1.6 +/- 0.2 vs. 3.9 +/- 0.7 pmol.mg protein-1.5 min-1, NPD vs. LPD, P less than 0.05). 1OHase activity was greater in tumor-bearing animals fed NPD compared with control animals fed LPD (8.4 +/- 0.6 vs. 3.9 +/- 0.7 pmol.mg protein-1.5 min-1, P less than 0.01). High-phosphorus intake suppressed 1OHase activity in both control and tumor-bearing animals. Seven days of parathyroid hormone infusion in control animals fed NPD raised serum calcium (9.4 +/- 0.2 vs. 13.3 +/- 1.6 mg/dl, P less than 0.05) and suppressed 1OHase activity (0.25 +/- 0.02 vs. 0.02 +/- 0.002 pmol.mg protein-1.5 min-1, P less than 0.001). The inverse relationship of serum phosphorus and 1OHase activity was much steeper in the tumor-bearing animals, with greater enzyme activity at comparable levels of serum phosphorus. The present study indicates that 1) factors produced by the tumor stimulate 1OHase activity, and 2) hypophosphatemia is required for expression of enhanced enzyme activity.

Tumors of the parathyroid gland and circulating parathyroid hormone-related protein associated with persistent hypercalcemia

Neoplasms of the parathyroid glands are uncommon in all species of laboratory and domestic animals, but occur in low incidence in rats, Syrian hamsters, and dogs and rarely in mice. Proliferative lesions of the parathyroid gland include hyperplasia (diffuse and focal), adenomas, and carcinomas. The tumors may be functional or nonfunctional. Trophic atrophy of remaining parathyroid tissue is present around functional tumors. Humoral hypercalcemia of malignancy (HHM) is a syndrome that occurs in human and animal patients with certain malignant neoplasms and is characterized by hypercalcemia, hypophosphatemia, and increased osteoclastic bone resorption. The syndrome is thought to be due to the release of parathyroid hormone (PTH)-like factors by the tumor cells which bind to PTH receptors in bone and kidney and result in the clinical manifestations of HHM. Parathyroid hormone-related protein (PTHrP) is a newly purified and sequenced protein which originated from human tumors associated with HHM. PTHrP has been shown to stimulate in vitro and in vivo effects similar to PTH-like proteins isolated from tumors associated with HHM. Well characterized animal models of HHM include a rat Leydig cell tumor line (Rice-500), the rat Walker mammary carcinosarcoma, and the canine apocrine adenocarcinoma. All 3 models have been found to contain 3 biologic activities which are thought to be important in the pathogenesis of HHM, viz., in vitro bone resorbing activity, adenylate cyclase-stimulating activity of bone and kidney cells, and transforming growth factor activity. The first 2 activities are due to PTH-like proteins which are able to compete for binding to the PTH receptor. The complete spectrum of functional disturbances in patients with HHM may be the result of the combined effects of a PTH-like protein (i.e., PTHrP) and transforming growth factors.

Effects of infusion of human parathyroid hormone-related protein-(1-40) in nude mice: histomorphometric and biochemical investigations

Female nude mice were infused with 5.0, 3.0, or 1.0 micrograms/day of synthetic human parathyroid hormone-related protein (PTHrP) or control diluent with subcutaneous Alzet miniosmotic pumps for 7 days. Serum calcium was increased (p less than 0.01) on days 3 (13.9 mg/dl), 5 (13.6 mg/dl), and 7 (12.9 mg/dl) in mice infused with PTHrP at 5.0 micrograms/day compared with control nude mice (8.8 mg/dl). Serum calcium was significantly increased to a lesser degree in mice infused with 1.0 micrograms/day PTHrP (day 3) or 3.0 micrograms/day (days 3 and 7). Serum phosphorus was decreased (p less than 0.01) in all three groups of mice infused with PTHrP (4.6 mg/dl, 5.0 micrograms/day; 6.7 mg/dl, 3.0 micrograms/day; and 6.4 mg/dl, 1.0 micrograms/day) compared with controls (8.5 mg/dl). Serum 1,25-dihydroxycholecalciferol was increased (2.4-fold) in mice infused with PTHrP (5.0 and 3.0 micrograms/day). The urinary calcium-creatinine ratio (0.74 compared with 0.034 in controls) was increased (p less than 0.03) in mice infused with PTHrP (5.0 micrograms/day), but the urinary phosphorus-creatinine ratio was not different from that in controls. The urinary cAMP-creatinine ratio was increased (1.6-fold) in mice infused with PTHrP (5.0 micrograms/day). Static bone histomorphometry revealed increased (p less than 0.01) trabecular bone area, osteoblast perimeter, osteoid perimeter, osteoid width, wall width, osteoclast area, number of osteoclasts, and osteoclast perimeter in trabecular bone of lumbar vertebrae from mice infused with PTHrP. Dynamic bone histomorphometry demonstrated increased (p less than 0.01) double-labeled perimeter, mineralizing perimeter, and bone formation rate. The results of this study indicated that PTHrP increased serum calcium and 1,25-dihydroxycholecalciferol, decreased serum phosphorus, increased urinary excretion of calcium, phosphorus, and cAMP, and increased both bone resorption and formation in nude mice. PTHrP mimics the action of native PTH in vivo and is likely to be an important protein in the pathogenesis of humoral hypercalcemia of malignancy.