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Schott C, Dilliott AA, Wang J, McIntyre AD, Son S, Colaiacovo S, Baker C, Gunaratnam L, House AA, Susan Huang SH, Iyer H, Johnson J, Lotfy K, Masellis M, Munoz DP, Rehman F, Roshanov PS, Swartz RH, Weir MA, Hegele RA, Connaughton DM. Vascular calcification in chronic kidney disease associated with pathogenic variants in ABCC6. Gene 2024; 927:148731. [PMID: 38944164 DOI: 10.1016/j.gene.2024.148731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 06/07/2024] [Accepted: 06/24/2024] [Indexed: 07/01/2024]
Abstract
Vascular calcification is prevalent in chronic kidney disease (CKD). Genetic causes of CKD account for 10-20% of adult-onset disease. Vascular calcification is thought to be one of the most important risk factors for increased cardiovascular morbidity and mortality in CKD patients and is detectable in 80% of patients with end stage kidney disease (ESKD). Despite the high prevalence of vascular calcification in CKD, no single gene cause has been described. We hypothesized that variants in vascular calcification genes may contribute to disease pathogenesis in CKD, particularly in families who exhibit a predominant vascular calcification phenotype. We developed a list of eight genes that are hypothesized to play a role in vascular calcification due to their involvement in the ectopic calcification pathway: ABCC6, ALPL, ANK1, ENPP1, NT5E, SLC29A1, SLC20A2, and S100A12. With this, we assessed exome data from 77 CKD patients, who remained unsolved following evaluation for all known monogenic causes of CKD. We also analyzed an independent cohort (Ontario Neurodegenerative Disease Research Initiative (ONDRI), n = 520) who were screened for variants in ABCC6 and compared this to a control cohort of healthy adults (n = 52). We identified two CKD families with heterozygous pathogenic variants (R1141X and A667fs) in ABCC6. We identified 10 participants from the ONDRI cohort with heterozygous pathogenic or likely pathogenic variant in ABCC6. Replication in a healthy control cohort did not reveal any variants. Our study provides preliminary data supporting the hypothesis that ABCC6 may play a role in vascular calcification in CKD. By screening CKD patients for genetic causes early in the diagnostic pathway, patients with genetic causes associated with vascular calcification can potentially be preventatively treated with new therapeutics with aims to decrease mortality.
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Affiliation(s)
- Clara Schott
- Department of Biochemistry, Schulich School of Medicine & Dentistry, Western University, 1151 Richmond St, London, ON N6A 5C1, Canada.
| | - Allison A Dilliott
- Department of Neurology and Neurosurgery, Montreal Neurological Institute-Hospital, McGill University, 845 Sherbrooke Street, West Montreal, QC H3A 0G4, Canada
| | - Jian Wang
- Robarts Research Institute, Schulich School of Medicine & Dentistry, Western University, 1151 Richmond St, London, ON N6A 3K7, Canada
| | - Adam D McIntyre
- Robarts Research Institute, Schulich School of Medicine & Dentistry, Western University, 1151 Richmond St, London, ON N6A 3K7, Canada
| | - Surim Son
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, 1151 Richmond St, London, ON N6A 5C1, Canada
| | - Samantha Colaiacovo
- Division of Medical Genetics, Department of Pediatrics, Victoria Hospital, London Health Science Center, 800 Commissioners Rd E, London, ON N6A 5W9, Canada
| | - Cadence Baker
- London Health Sciences Centre, 339 Windermere Rd, London N6A 3K7, ON, Canada
| | - Lakshman Gunaratnam
- Department of Medicine, Schulich School of Medicine & Dentistry, Western University, 1151 Richmond St, London, ON N6A 5C1, Canada
| | - Andrew A House
- London Health Sciences Centre, 339 Windermere Rd, London N6A 3K7, ON, Canada; Department of Medicine, Schulich School of Medicine & Dentistry, Western University, 1151 Richmond St, London, ON N6A 5C1, Canada
| | - Shih-Han Susan Huang
- Department of Medicine, Schulich School of Medicine & Dentistry, Western University, 1151 Richmond St, London, ON N6A 5C1, Canada
| | - Hariharan Iyer
- Department of Medicine, Schulich School of Medicine & Dentistry, Western University, 1151 Richmond St, London, ON N6A 5C1, Canada
| | - John Johnson
- Department of Medicine, Schulich School of Medicine & Dentistry, Western University, 1151 Richmond St, London, ON N6A 5C1, Canada
| | - Khaled Lotfy
- Department of Medicine, Schulich School of Medicine & Dentistry, Western University, 1151 Richmond St, London, ON N6A 5C1, Canada
| | - Mario Masellis
- LC Campbell Cognitive Neurology Research Unit, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, 2075 Bayview Ave, Toronto, ON M4N 3M5, Canada
| | - Douglas P Munoz
- Centre for Neuroscience Studies, Queen's University, 18 Stuart St, Kingston, ON K7L 3N6, Canada
| | - Faisal Rehman
- Department of Medicine, Schulich School of Medicine & Dentistry, Western University, 1151 Richmond St, London, ON N6A 5C1, Canada
| | - Pavel S Roshanov
- Department of Medicine, Schulich School of Medicine & Dentistry, Western University, 1151 Richmond St, London, ON N6A 5C1, Canada
| | - Richard H Swartz
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre and Department of Medicine (Neurology), University of Toronto, 2075 Bayview Ave, Toronto, ON M4N 3M5, Canada
| | - Matthew A Weir
- Department of Medicine, Schulich School of Medicine & Dentistry, Western University, 1151 Richmond St, London, ON N6A 5C1, Canada
| | - Robert A Hegele
- Robarts Research Institute, Schulich School of Medicine & Dentistry, Western University, 1151 Richmond St, London, ON N6A 3K7, Canada; Department of Medicine, Schulich School of Medicine & Dentistry, Western University, 1151 Richmond St, London, ON N6A 5C1, Canada
| | - Dervla M Connaughton
- Department of Biochemistry, Schulich School of Medicine & Dentistry, Western University, 1151 Richmond St, London, ON N6A 5C1, Canada; Division of Medical Genetics, Department of Pediatrics, Victoria Hospital, London Health Science Center, 800 Commissioners Rd E, London, ON N6A 5W9, Canada; London Health Sciences Centre, 339 Windermere Rd, London N6A 3K7, ON, Canada; Department of Medicine, Schulich School of Medicine & Dentistry, Western University, 1151 Richmond St, London, ON N6A 5C1, Canada
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Wu L, Xue X, He C, Lai Y, Tong L. Cell death‑related molecules and targets in the progression of urolithiasis (Review). Int J Mol Med 2024; 53:52. [PMID: 38666544 PMCID: PMC11090264 DOI: 10.3892/ijmm.2024.5376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 04/02/2024] [Indexed: 05/04/2024] Open
Abstract
Urolithiasis is a high‑incidence disease caused by calcium oxalate (mainly), uric acid, calcium phosphate, struvite, apatite, cystine and other stones. The development of kidney stones is closely related to renal tubule cell damage and crystal adhesion and aggregation. Cell death, comprising the core steps of cell damage, can be classified into various types (i.e., apoptosis, ferroptosis, necroptosis and pyroptosis). Different crystal types, concentrations, morphologies and sizes cause tubular cell damage via the regulation of different forms of cell death. Oxidative stress caused by high oxalate or crystal concentrations is considered to be a precursor to a variety of types of cell death. In addition, complex crosstalk exists among numerous signaling pathways and their key molecules in various types of cell death. Urolithiasis is considered a metabolic disorder, and tricarboxylic acid cycle‑related molecules, such as citrate and succinate, are closely related to cell death and the inhibition of stone development. However, a literature review of the associations between kidney stone development, metabolism and various types of cell death is currently lacking, at least to the best of our knowledge. Thus, the present review summarizes the major advances in the understanding of regulated cell death and urolithiasis progression.
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Affiliation(s)
- Liping Wu
- Department of Pharmacy, Ganzhou People's Hospital, Ganzhou, Jiangxi 341099, P.R. China
| | - Xiaoyan Xue
- Department of Pharmacy, Ganzhou People's Hospital, Ganzhou, Jiangxi 341099, P.R. China
| | - Chengwu He
- Department of Urology, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, Guangdong 518033, P.R. China
| | - Yongchang Lai
- Department of Urology, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, Guangdong 518033, P.R. China
- Department of Pharmaceutical Management, School of Medical Business, Guangdong Pharmaceutical University, Guangzhou, Guangdong 510006, P.R. China
| | - Lingfei Tong
- Department of Pharmacy, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi 330006, P.R. China
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Opdebeeck B, Van den Branden A, Adriaensen S, Orriss IR, Patel JJ, Geryl H, Zwijsen K, D’Haese PC, Verhulst A. β,γ-Methylene-ATP and its metabolite medronic acid affect both arterial media calcification and bone mineralization in non-CKD and CKD rats. JBMR Plus 2024; 8:ziae057. [PMID: 38764790 PMCID: PMC11102572 DOI: 10.1093/jbmrpl/ziae057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 03/07/2024] [Accepted: 03/26/2024] [Indexed: 05/21/2024] Open
Abstract
Arterial media calcification or pathological deposition of calcium-phosphate crystals in the vessel wall contributes significantly to the high mortality rate observed in patients with CKD. Extracellular nucleotides (ie, ATP or UTP) regulate the arterial calcification process by interacting with (1) purinergic receptors and (2) breakdown via ecto-nucleotidases, such as ectonucleotide pyrophosphatase/phosphodiesterase NPP1 or NPP3, affecting the local levels of calcification inhibitor, pyrophosphate, and stimulator inorganic phosphate (PPi/Pi ratio). Also, it has been shown that ATP analogs (ie, β,γ-methylene-ATP [β,γ-meATP]) inhibit vascular smooth muscle cell calcification in vitro. In the first experiment, daily dosing of β,γ-meATP (2 mg/kg) was investigated in rats fed a warfarin diet to trigger the development of non-CKD-related arterial medial calcifications. This study showed that β,γ-meATP significantly lowered the calcium scores in the aorta and peripheral vessels in warfarin-exposed rats. In a second experiment, daily dosing of 4 mg/kg β,γ-meATP and its metabolite medronic acid (MDP) was analyzed in rats fed an adenine diet to promote the development of CKD-related arterial medial calcification. Administration of β,γ-meATP and MDP did not significantly decrease aortic calcification scores in this model. Moreover, both compounds induced deleterious effects on physiological bone mineralization, causing an imminent risk for worsening the already compromised bone status in CKD. Due to this, it was not possible to raise the dosage of both compounds to tackle CKD-related arterial calcification. Again, this points out the difficult task of targeting solely ectopic calcifications without negatively affecting physiological bone mineralization. On the other hand, aortic mRNA expression of Enpp1 and Enpp3 was significantly and positively associated with aortic calcification scores, suggesting that normalizing the aortic NPP1/3 activity to control values might be a possible target to treat (CKD-induced) arterial media calcifications.
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Affiliation(s)
- Britt Opdebeeck
- Laboratory of Pathophysiology, Department of Biomedical Sciences, University of Antwerp, Antwerp 2610, Belgium
| | - Astrid Van den Branden
- Laboratory of Pathophysiology, Department of Biomedical Sciences, University of Antwerp, Antwerp 2610, Belgium
| | - Saar Adriaensen
- Laboratory of Pathophysiology, Department of Biomedical Sciences, University of Antwerp, Antwerp 2610, Belgium
| | - Isabel R Orriss
- Department of Comparative Biomedical Science, Royal Veterinary College, London NW1 0TU, United Kingdom
| | - Jessal J Patel
- Department of Comparative Biomedical Science, Royal Veterinary College, London NW1 0TU, United Kingdom
| | - Hilde Geryl
- Laboratory of Pathophysiology, Department of Biomedical Sciences, University of Antwerp, Antwerp 2610, Belgium
| | - Kathleen Zwijsen
- Laboratory of Experimental Medicine and Pediatrics, Inflamed Center of Excellence, University of Antwerp, Antwerp 2610, Belgium
| | - Patrick C D’Haese
- Laboratory of Pathophysiology, Department of Biomedical Sciences, University of Antwerp, Antwerp 2610, Belgium
| | - Anja Verhulst
- Laboratory of Pathophysiology, Department of Biomedical Sciences, University of Antwerp, Antwerp 2610, Belgium
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Pfau K, Lengyel I, Ossewaarde-van Norel J, van Leeuwen R, Risseeuw S, Leftheriotis G, Scholl HPN, Feltgen N, Holz FG, Pfau M. Pseudoxanthoma elasticum - Genetics, pathophysiology, and clinical presentation. Prog Retin Eye Res 2024; 102:101274. [PMID: 38815804 DOI: 10.1016/j.preteyeres.2024.101274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 05/17/2024] [Accepted: 05/20/2024] [Indexed: 06/01/2024]
Abstract
Pseudoxanthoma elasticum (PXE) is an autosomal-recessively inherited multisystem disease. Mutations in the ABCC6-gene are causative, coding for a transmembrane transporter mainly expressed in hepatocytes, which promotes the efflux of adenosine triphosphate (ATP). This results in low levels of plasma inorganic pyrophosphate (PPi), a critical anti-mineralization factor. The clinical phenotype of PXE is characterized by the effects of elastic fiber calcification in the skin, the cardiovascular system, and the eyes. In the eyes, calcification of Bruch's membrane results in clinically visible lesions, including peau d'orange, angioid streaks, and comet tail lesions. Frequently, patients must be treated for secondary macular neovascularization. No effective therapy is available for treating the cause of PXE, but several promising approaches are emerging. Finding appropriate outcome measures remains a significant challenge for clinical trials in this slowly progressive disease. This review article provides an in-depth summary of the current understanding of PXE and its multi-systemic manifestations. The article offers a detailed overview of the ocular manifestations, including their morphological and functional consequences, as well as potential complications. Lastly, previous and future clinical trials of causative treatments for PXE are discussed.
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Affiliation(s)
- Kristina Pfau
- Department of Ophthalmology, University Hospital Basel, Basel, Switzerland; Department of Ophthalmology, University Hospital Bonn, Bonn, Germany.
| | - Imre Lengyel
- Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry and Biomedical Science, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom; Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | | | - Redmer van Leeuwen
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Sara Risseeuw
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Georges Leftheriotis
- University Hospital Nice, Vascular Physiology and Medicine Unit, 06000, Nice, France
| | | | - Nicolas Feltgen
- Department of Ophthalmology, University Hospital Basel, Basel, Switzerland
| | - Frank G Holz
- Department of Ophthalmology, University Hospital Bonn, Bonn, Germany
| | - Maximilian Pfau
- Department of Ophthalmology, University Hospital Basel, Basel, Switzerland; Institute of Molecular and Clinical Ophthalmology Basel, Basel, Basel-Stadt, Switzerland
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5
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Bartstra JW, van den Beukel T, Kranenburg G, Geurts LJ, den Harder AM, Witkamp T, Wolterink JM, Zwanenburg JJM, van Valen E, Koek HL, Mali WPTM, de Jong PA, Hendrikse J, Spiering W. Increased Intracranial Arterial Pulsatility and Microvascular Brain Damage in Pseudoxanthoma Elasticum. AJNR Am J Neuroradiol 2024; 45:386-392. [PMID: 38548304 DOI: 10.3174/ajnr.a8212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 12/02/2023] [Indexed: 04/10/2024]
Abstract
BACKGROUND AND PURPOSE Carotid siphon calcification might contribute to the high prevalence of cerebrovascular disease in pseudoxanthoma elasticum through increased arterial flow pulsatility. This study aimed to compare intracranial artery flow pulsatility, brain volumes, and small-vessel disease markers between patients with pseudoxanthoma elasticum and controls and the association between arterial calcification and pulsatility in pseudoxanthoma elasticum. MATERIALS AND METHODS Fifty patients with pseudoxanthoma elasticum and 40 age- and sex-matched controls underwent 3T MR imaging, including 2D phase-contrast acquisitions for flow pulsatility in the assessment of ICA and MCA and FLAIR acquisitions for brain volumes, white matter lesions, and infarctions. All patients with pseudoxanthoma elasticum underwent CT scanning to measure siphon calcification. Flow pulsatility (2D phase-contrast), brain volumes, white matter lesions, and infarctions (3D T1 and 3D T2 FLAIR) were compared between patients and controls. The association between siphon calcification and pulsatility in pseudoxanthoma elasticum was tested with linear regression models. RESULTS Patients with pseudoxanthoma elasticum (mean age, 57 [SD, 12] years; 24 men) had significantly higher pulsatility indexes (1.05; range, 0.94-1.21 versus 0.94; range, 0.82-1.04; P = .02), lower mean GM volumes (597 [SD, 53] mL versus 632 [SD, 53] mL; P < .01), more white matter lesions (2.6; range, 0.5-7.5 versus 1.1; range, 0.5-2.4) mL; P = .05), and more lacunar infarctions (64 versus 8, P = .04) than controls (mean age, 58 [SD, 11] years; 20 men). Carotid siphon calcification was associated with higher pulsatility indexes in patients with pseudoxanthoma elasticum (β = 0.10; 95% CI, 0.01-0.18). CONCLUSIONS Patients with pseudoxanthoma elasticum have increased intracranial artery flow pulsatility and measures of small-vessel disease. Carotid siphon calcification might underlie the high prevalence of cerebrovascular disease in pseudoxanthoma elasticum.
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Affiliation(s)
- J W Bartstra
- From the Department of Radiology (J.W.B., T.v.d.B., L.J.G., A.M.d.H., T.W., J.J.M.Z., W.P.T.M.M., P.A.d.J., J.H.), University Medical Center Utrecht, Utrecht /University, the Netherlands
| | - T van den Beukel
- From the Department of Radiology (J.W.B., T.v.d.B., L.J.G., A.M.d.H., T.W., J.J.M.Z., W.P.T.M.M., P.A.d.J., J.H.), University Medical Center Utrecht, Utrecht /University, the Netherlands
| | - G Kranenburg
- Department of Vascular Medicine (G.K., W.S.), University Medical Center Utrecht, Utrecht University, the Netherlands
| | - L J Geurts
- From the Department of Radiology (J.W.B., T.v.d.B., L.J.G., A.M.d.H., T.W., J.J.M.Z., W.P.T.M.M., P.A.d.J., J.H.), University Medical Center Utrecht, Utrecht /University, the Netherlands
| | - A M den Harder
- From the Department of Radiology (J.W.B., T.v.d.B., L.J.G., A.M.d.H., T.W., J.J.M.Z., W.P.T.M.M., P.A.d.J., J.H.), University Medical Center Utrecht, Utrecht /University, the Netherlands
| | - T Witkamp
- From the Department of Radiology (J.W.B., T.v.d.B., L.J.G., A.M.d.H., T.W., J.J.M.Z., W.P.T.M.M., P.A.d.J., J.H.), University Medical Center Utrecht, Utrecht /University, the Netherlands
| | - J M Wolterink
- Department of Applied Mathematics (J.M.W., E.v.V., H.L.K.), Technical Medical Centre, University of Twente, Enschede, the Netherlands
| | - J J M Zwanenburg
- From the Department of Radiology (J.W.B., T.v.d.B., L.J.G., A.M.d.H., T.W., J.J.M.Z., W.P.T.M.M., P.A.d.J., J.H.), University Medical Center Utrecht, Utrecht /University, the Netherlands
| | - E van Valen
- Department of Applied Mathematics (J.M.W., E.v.V., H.L.K.), Technical Medical Centre, University of Twente, Enschede, the Netherlands
- Department of Geriatrics (E.v.V., H.L.K.), University Medical Center Utrecht, Utrecht University, the Netherlands
| | - H L Koek
- Department of Applied Mathematics (J.M.W., E.v.V., H.L.K.), Technical Medical Centre, University of Twente, Enschede, the Netherlands
- Department of Geriatrics (E.v.V., H.L.K.), University Medical Center Utrecht, Utrecht University, the Netherlands
| | - W P T M Mali
- From the Department of Radiology (J.W.B., T.v.d.B., L.J.G., A.M.d.H., T.W., J.J.M.Z., W.P.T.M.M., P.A.d.J., J.H.), University Medical Center Utrecht, Utrecht /University, the Netherlands
| | - P A de Jong
- From the Department of Radiology (J.W.B., T.v.d.B., L.J.G., A.M.d.H., T.W., J.J.M.Z., W.P.T.M.M., P.A.d.J., J.H.), University Medical Center Utrecht, Utrecht /University, the Netherlands
| | - J Hendrikse
- From the Department of Radiology (J.W.B., T.v.d.B., L.J.G., A.M.d.H., T.W., J.J.M.Z., W.P.T.M.M., P.A.d.J., J.H.), University Medical Center Utrecht, Utrecht /University, the Netherlands
| | - W Spiering
- Department of Vascular Medicine (G.K., W.S.), University Medical Center Utrecht, Utrecht University, the Netherlands
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Du B, Ru J, Zhan Z, Lin C, Liu Y, Mao W, Zhang J. Insight into small-molecule inhibitors targeting extracellular nucleotide pyrophosphatase/phosphodiesterase1 for potential multiple human diseases. Eur J Med Chem 2024; 268:116286. [PMID: 38432057 DOI: 10.1016/j.ejmech.2024.116286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 02/06/2024] [Accepted: 02/24/2024] [Indexed: 03/05/2024]
Abstract
Extracellular nucleotide pyrophosphatase/phosphodiesterase 1 (ENPP1) has been identified as a type II transmembrane glycoprotein. It plays a crucial role in various biological processes, such as bone mineralization, cancer cell proliferation, and immune regulation. Consequently, ENPP1 has garnered attention as a promising target for pharmacological interventions. Despite its potential, the development of clinical-stage ENPP1 inhibitors for solid tumors, diabetes, and silent rickets remains limited. However, there are encouraging findings from preclinical trials involving small molecules exhibiting favorable therapeutic effects and safety profiles. This perspective aims to shed light on the structural properties, biological functions and the relationship between ENPP1 and diseases. Additionally, it focuses on the structure-activity relationship of ENPP1 inhibitors, with the intention of guiding the future development of new and effective ENPP1 inhibitors.
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Affiliation(s)
- Baochan Du
- Department of Neurology, Neuro-system and Multimorbidity Laboratory and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China; Department of Biotherapy, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Jinxiao Ru
- Department of Neurology, Neuro-system and Multimorbidity Laboratory and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China; Department of Biotherapy, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Zixuan Zhan
- Department of Neurology, Neuro-system and Multimorbidity Laboratory and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Congcong Lin
- Department of Medicinal Chemistry and Natural Medicine Chemistry, College of Pharmacy, Harbin Medical University, Harbin, 150081, China
| | - Yang Liu
- Department of Medical Oncology, The First Affiliated Hospital of Bengbu Medical College, Bengbu, 233004, China
| | - Wuyu Mao
- Department of Neurology, Neuro-system and Multimorbidity Laboratory and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
| | - Jifa Zhang
- Department of Neurology, Neuro-system and Multimorbidity Laboratory and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China; Department of Biotherapy, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041, China.
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7
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Kauffenstein G, Martin L, Le Saux O. The Purinergic Nature of Pseudoxanthoma Elasticum. BIOLOGY 2024; 13:74. [PMID: 38392293 PMCID: PMC10886499 DOI: 10.3390/biology13020074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 01/13/2024] [Accepted: 01/19/2024] [Indexed: 02/24/2024]
Abstract
Pseudoxanthoma Elasticum (PXE) is an inherited disease characterized by elastic fiber calcification in the eyes, the skin and the cardiovascular system. PXE results from mutations in ABCC6 that encodes an ABC transporter primarily expressed in the liver and kidneys. It took nearly 15 years after identifying the gene to better understand the etiology of PXE. ABCC6 function facilitates the efflux of ATP, which is sequentially hydrolyzed by the ectonucleotidases ENPP1 and CD73 into pyrophosphate (PPi) and adenosine, both inhibitors of calcification. PXE, together with General Arterial Calcification of Infancy (GACI caused by ENPP1 mutations) as well as Calcification of Joints and Arteries (CALJA caused by NT5E/CD73 mutations), forms a disease continuum with overlapping phenotypes and shares steps of the same molecular pathway. The explanation of these phenotypes place ABCC6 as an upstream regulator of a purinergic pathway (ABCC6 → ENPP1 → CD73 → TNAP) that notably inhibits mineralization by maintaining a physiological Pi/PPi ratio in connective tissues. Based on a review of the literature and our recent experimental data, we suggest that PXE (and GACI/CALJA) be considered as an authentic "purinergic disease". In this article, we recapitulate the pathobiology of PXE and review molecular and physiological data showing that, beyond PPi deficiency and ectopic calcification, PXE is associated with wide and complex alterations of purinergic systems. Finally, we speculate on the future prospects regarding purinergic signaling and other aspects of this disease.
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Affiliation(s)
- Gilles Kauffenstein
- UMR INSERM 1260, Regenerative Nanomedicine, University of Strasbourg, 67084 Strasbourg, France
| | - Ludovic Martin
- PXE Consultation Center, MAGEC Nord Reference Center for Rare Skin Diseases, Angers University Hospital, 49000 Angers, France
- MITOVASC-UMR CNRS 6015 INSERM 1083, University of Angers, 49000 Angers, France
| | - Olivier Le Saux
- Department of Cell and Molecular Biology, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI 96822, USA
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Yao R, Yang F, Zhang Q, Yu T, Yu Y, Chang G, Wang X. Clinical and Molecular Characterization of a Patient with Generalized Arterial Calcification of Infancy Caused by Rare ABCC6 Mutation. J Pers Med 2023; 14:54. [PMID: 38248755 PMCID: PMC10817667 DOI: 10.3390/jpm14010054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 12/19/2023] [Accepted: 12/25/2023] [Indexed: 01/23/2024] Open
Abstract
Generalized arterial calcification of infancy (GACI) is a rare autosomal-recessive disease characterized by extensive arterial calcification in infancy, with clinical manifestations such as arterial stenoses and heart failure. The ENPP1 inactivation mutation has been identified as a potential defect in most of the cases of GACI, while mutations in ABCC6 are demonstrated in patients who are genotyped as pseudoxanthoma elasticum and only limited cases of GACI are reported. Whole-exome sequencing was applied for the detection of pathogenic variants. Copy-number variants of pathogenic genes were also evaluated through a bioinformatic process and were further validated by real-time quantitative PCR. In this report, we described the clinical information and treatment of a patient with extensive arterial calcification. We have identified the underlying cause as biallelic mutations in ABCC6 (NM_00117: exon30, c.4223_4227dupAGCTC p.(Leu1410Serfs*56)) and a unique exonic deletion that spans from the first to the fourth exons of ABCC6 (chr16:16313388-16330869)). This discovery was made by utilizing a combined genetic testing approach. With the review of previously reported GACI patients with ABCC6 mutation, our work contributed to enriching the mutation spectrum of GACI and providing further information on this rare form of inherited disorder.
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Affiliation(s)
- Ruen Yao
- Department of Medical Genetics and Antenatal Diagnostic Center, Hainan Branch, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Sanya 572022, China; (R.Y.)
- Department of Medical Genetics and Molecular Diagnostic Laboratory, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Fan Yang
- Clinical Research Ward, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China; (F.Y.)
| | - Qianwen Zhang
- Department of Endocrinology and Metabolism, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Tingting Yu
- Department of Medical Genetics and Molecular Diagnostic Laboratory, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Ying Yu
- Department of Medical Genetics and Antenatal Diagnostic Center, Hainan Branch, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Sanya 572022, China; (R.Y.)
| | - Guoying Chang
- Clinical Research Ward, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China; (F.Y.)
- Department of Endocrinology and Metabolism, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Xiumin Wang
- Clinical Research Ward, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China; (F.Y.)
- Department of Endocrinology and Metabolism, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
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9
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Casemayou A, Belliere J, Letavernier E, Colliou E, El Hachem H, Zarowski J, Bazin D, Kounde C, Piedrafita A, Feuillet G, Schanstra JP, Faguer S. Abcc6 deficiency prevents rhabdomyolysis-induced acute kidney injury. Sci Rep 2023; 13:21513. [PMID: 38057332 PMCID: PMC10700332 DOI: 10.1038/s41598-023-47894-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 11/20/2023] [Indexed: 12/08/2023] Open
Abstract
Rhabdomyolysis is a risk factor for acute kidney injury, transition towards chronic kidney disease, and death. The role of calcium phosphate deposits in the mechanisms of rhabdomyolysis-induced acute kidney injury (RAKI) is still unclear. Better insight of the role calcium in RAKI could lead to new therapeutic avenues. Here, we show in a mice model of RAKI that calcium phosphate deposits were frequent in the kidney (hydroxyapatite) and partly correlated with the severity of the kidney injury. However, the intensity of deposits was highly heterogeneous between mice. Treatment with sodium chloride, sodium bicarbonate or inorganic pyrophosphate (PPi; an inhibitor of the calcium phosphate crystallization), or combinations thereof, did not improve kidney outcomes and hydroxyapatite deposition during RAKI. Unexpectedly, Abcc6 knockout mice (ko), characterized by PPi deficiency, developed less severe RAKI despite similar rhabdomyolysis severity, and had similar hydroxyapatite deposition suggesting alternative mechanisms. This improved kidney outcome at day 2 translated to a trend in improved glomerular filtration rate at month 2 in Abcc6-/-mice and to significantly less interstitial fibrosis. In addition, whereas the pattern of infiltrating cells at day 2 was similar between wt and ko mice, kidneys of Abcc6-/- mice were characterized by more CD19+ B-cells, less CD3+ T-cells and a lower R1/R2 macrophage ratio at month 2. In summary, kidney calcium phosphate deposits are frequent in RAKI but hydration with sodium bicarbonate or sodium chloride does not modify the kidney outcome. Blocking ABCC6 emerges as a new option to prevent RAKI and subsequent transition toward kidney fibrosis.
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Affiliation(s)
- Audrey Casemayou
- Department of Nephrology and Organ Transplantation, Reference Centre for Rare Kidney Diseases (SORARE), French Intensive Care Renal Network (FIRN), University Hospital of Toulouse, 1, Avenue du Pr. Jean Poulhes, 31059, Toulouse Cedex, France
- National Institute of Health and Medical Research (INSERM), Institute of Metabolic and Cardiovascular Diseases (I2MC), UMR 1297, Rangueil Hospital, 31000, Toulouse, France
- University Toulouse-3, 31000, Toulouse, France
| | - Julie Belliere
- Department of Nephrology and Organ Transplantation, Reference Centre for Rare Kidney Diseases (SORARE), French Intensive Care Renal Network (FIRN), University Hospital of Toulouse, 1, Avenue du Pr. Jean Poulhes, 31059, Toulouse Cedex, France
- National Institute of Health and Medical Research (INSERM), Institute of Metabolic and Cardiovascular Diseases (I2MC), UMR 1297, Rangueil Hospital, 31000, Toulouse, France
- University Toulouse-3, 31000, Toulouse, France
| | - Emmanuel Letavernier
- National Institute of Health and Medical Research, (INSERM) UMR S 1155, Tenon Hospital, 75020, Paris, France
- Sorbonne University, 75020, Paris, France
- Department of Physiology, Tenon Hospital, Assistance Publique - Hôpitaux de Paris, 75020, Paris, France
| | - Eloïse Colliou
- Department of Nephrology and Organ Transplantation, Reference Centre for Rare Kidney Diseases (SORARE), French Intensive Care Renal Network (FIRN), University Hospital of Toulouse, 1, Avenue du Pr. Jean Poulhes, 31059, Toulouse Cedex, France
- National Institute of Health and Medical Research (INSERM), Institute of Metabolic and Cardiovascular Diseases (I2MC), UMR 1297, Rangueil Hospital, 31000, Toulouse, France
- University Toulouse-3, 31000, Toulouse, France
| | - Hélène El Hachem
- Department of Nephrology and Organ Transplantation, Reference Centre for Rare Kidney Diseases (SORARE), French Intensive Care Renal Network (FIRN), University Hospital of Toulouse, 1, Avenue du Pr. Jean Poulhes, 31059, Toulouse Cedex, France
- National Institute of Health and Medical Research (INSERM), Institute of Metabolic and Cardiovascular Diseases (I2MC), UMR 1297, Rangueil Hospital, 31000, Toulouse, France
| | - Jeremy Zarowski
- Department of Physiology, Tenon Hospital, Assistance Publique - Hôpitaux de Paris, 75020, Paris, France
| | - Dominique Bazin
- Laboratory of Chemistry and Physics, CNRS UMR 8000, University Paris XI, 91405, Orsay, France
| | - Clément Kounde
- Department of Nephrology and Organ Transplantation, Reference Centre for Rare Kidney Diseases (SORARE), French Intensive Care Renal Network (FIRN), University Hospital of Toulouse, 1, Avenue du Pr. Jean Poulhes, 31059, Toulouse Cedex, France
- National Institute of Health and Medical Research (INSERM), Institute of Metabolic and Cardiovascular Diseases (I2MC), UMR 1297, Rangueil Hospital, 31000, Toulouse, France
| | - Alexis Piedrafita
- Department of Nephrology and Organ Transplantation, Reference Centre for Rare Kidney Diseases (SORARE), French Intensive Care Renal Network (FIRN), University Hospital of Toulouse, 1, Avenue du Pr. Jean Poulhes, 31059, Toulouse Cedex, France
- National Institute of Health and Medical Research (INSERM), Institute of Metabolic and Cardiovascular Diseases (I2MC), UMR 1297, Rangueil Hospital, 31000, Toulouse, France
- University Toulouse-3, 31000, Toulouse, France
| | - Guylène Feuillet
- National Institute of Health and Medical Research (INSERM), Institute of Metabolic and Cardiovascular Diseases (I2MC), UMR 1297, Rangueil Hospital, 31000, Toulouse, France
| | - Joost P Schanstra
- National Institute of Health and Medical Research (INSERM), Institute of Metabolic and Cardiovascular Diseases (I2MC), UMR 1297, Rangueil Hospital, 31000, Toulouse, France
- Department of Physiology, Tenon Hospital, Assistance Publique - Hôpitaux de Paris, 75020, Paris, France
| | - Stanislas Faguer
- Department of Nephrology and Organ Transplantation, Reference Centre for Rare Kidney Diseases (SORARE), French Intensive Care Renal Network (FIRN), University Hospital of Toulouse, 1, Avenue du Pr. Jean Poulhes, 31059, Toulouse Cedex, France.
- National Institute of Health and Medical Research (INSERM), Institute of Metabolic and Cardiovascular Diseases (I2MC), UMR 1297, Rangueil Hospital, 31000, Toulouse, France.
- Department of Physiology, Tenon Hospital, Assistance Publique - Hôpitaux de Paris, 75020, Paris, France.
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10
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Jacobs IJ, Li Q. Novel Treatments for PXE: Targeting the Systemic and Local Drivers of Ectopic Calcification. Int J Mol Sci 2023; 24:15041. [PMID: 37894722 PMCID: PMC10606721 DOI: 10.3390/ijms242015041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/02/2023] [Accepted: 10/06/2023] [Indexed: 10/29/2023] Open
Abstract
Pseudoxanthoma elasticum (PXE) is a heritable multisystem ectopic calcification disorder. The gene responsible for PXE, ABCC6, encodes ABCC6, a hepatic efflux transporter regulating extracellular inorganic pyrophosphate (PPi), a potent endogenous calcification inhibitor. Recent studies demonstrated that in addition to the deficiency of plasma PPi, the activated DDR/PARP signaling in calcified tissues provides an additional possible mechanism of ectopic calcification in PXE. This study examined the effects of etidronate (ETD), a stable PPi analog, and its combination with minocycline (Mino), a potent inhibitor of DDR/PARP, on ectopic calcification in an Abcc6-/- mouse model of PXE. Abcc6-/- mice, at 4 weeks of age, before the development of ectopic calcification, were treated with ETD, Mino, or both for 18 weeks. Micro-computed tomography, histopathologic examination, and quantification of the calcium content in Abcc6-/- mice treated with both ETD and Mino revealed further reduced calcification than either treatment alone. The effects were associated with reduced serum alkaline phosphatase activity without changes in plasma PPi concentrations. These results suggest that ETD and Mino combination therapy might provide an effective therapeutic approach for PXE, a currently intractable disease.
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Affiliation(s)
- Ida Joely Jacobs
- Biomedical Sciences MS Program, Jefferson College of Life Sciences, Thomas Jefferson University, Philadelphia, PA 19107, USA;
- Department of Biochemistry and Molecular Biology, Thomas Jefferson University, Philadelphia, PA 19107, USA
- PXE International Center of Excellence in Research and Clinical Care, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Qiaoli Li
- Department of Biochemistry and Molecular Biology, Thomas Jefferson University, Philadelphia, PA 19107, USA
- PXE International Center of Excellence in Research and Clinical Care, Thomas Jefferson University, Philadelphia, PA 19107, USA
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11
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Gao Z, Wang Q, Guo K, Li X, Huang Y. Enpp1 deficiency caused chondrocyte apoptosis by inhibiting AMPK signaling pathway. J Orthop Surg Res 2023; 18:462. [PMID: 37370114 DOI: 10.1186/s13018-023-03923-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 06/11/2023] [Indexed: 06/29/2023] Open
Abstract
OBJECTIVE AND BACKGROUND The deficiency of ectonucleotide pyrophosphatase/phosphodiesterase 1 (Enpp1) causes the phenotype similar to knee osteoarthritis (OA). However, the molecular mechanism is poorly understood. METHOD The global deletion of Enpp1 (Enpp1-/-) mice was created to analyze the role of Enpp1 in the progress of knee OA. The apoptosis, proliferation and chondrogenic differentiation ability of chondrocytes from wild-type (WT) and Enpp1-/- joints were compared. According to the results of high-throughput quantitative molecular measurements, the proteins of chondrocytes from WT and Enpp1-/- mice were used to explore the mechanism of Enpp1 deficiency-associated knee OA. RESULT In Enpp1-/- knee joints, we found significant chondrocyte apoptosis and proteomic results showed that abnormal expression of AMP-activated protein kinase (AMPK) signaling pathway may contribute to this phenotype. In primary chondrocyte cultures in vitro, Enpp1 deletion dramatically enhancing chondrocyte apoptosis. Meanwhile, we found Enpp1 deletion inhibits the phosphorylation of AMPK (P-AMPK). We also found that decreased level of P-AMPK and chondrocyte apoptosis, which are caused by Enpp1 deficiency, can be reversed by Acadesine (AICAR), the activator of AMPK. CONCLUSION Consequently, Enpp1 deficiency plays an essential role in knee OA by regulating AMPK signaling pathway.
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Affiliation(s)
- Zhiqiang Gao
- Department of Spine Surgery, Shanghai East Hospital, School of Medicine, Tongji University, 150 Jimo Rd, Shanghai, 200092, China
| | - Qiang Wang
- Department of Spine Surgery, Shanghai East Hospital, School of Medicine, Tongji University, 150 Jimo Rd, Shanghai, 200092, China
| | - Kai Guo
- Department of Spine Surgery, Shanghai East Hospital, School of Medicine, Tongji University, 150 Jimo Rd, Shanghai, 200092, China
| | - Xinhua Li
- Department of Orthopedics, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, People's Republic of China.
| | - Yufeng Huang
- Department of Spine Surgery, Shanghai East Hospital, School of Medicine, Tongji University, 150 Jimo Rd, Shanghai, 200092, China.
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12
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Murcia Casas B, Carrillo Linares JL, Baquero Aranda I, Rioja Villodres J, Merino Bohórquez V, González Jiménez A, Rico Corral MÁ, Bosch R, Sánchez Chaparro MÁ, García Fernández M, Valdivielso P. Lansoprazole Increases Inorganic Pyrophosphate in Patients with Pseudoxanthoma Elasticum: A Double-Blind, Randomized, Placebo-Controlled Crossover Trial. Int J Mol Sci 2023; 24:ijms24054899. [PMID: 36902331 PMCID: PMC10003519 DOI: 10.3390/ijms24054899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 02/26/2023] [Accepted: 02/28/2023] [Indexed: 03/06/2023] Open
Abstract
Pseudoxanthoma elasticum (PXE) is characterized by low levels of inorganic pyrophosphate (PPi) and a high activity of tissue-nonspecific alkaline phosphatase (TNAP). Lansoprazole is a partial inhibitor of TNAP. The aim was to investigate whether lansoprazole increases plasma PPi levels in subjects with PXE. We conducted a 2 × 2 randomized, double-blind, placebo-controlled crossover trial in patients with PXE. Patients were allocated 30 mg/day of lansoprazole or a placebo in two sequences of 8 weeks. The primary outcome was the differences in plasma PPi levels between the placebo and lansoprazole phases. 29 patients were included in the study. There were eight drop-outs due to the pandemic lockdown after the first visit and one due to gastric intolerance, so twenty patients completed the trial. A generalized linear mixed model was used to evaluate the effect of lansoprazole. Overall, lansoprazole increased plasma PPi levels from 0.34 ± 0.10 µM to 0.41 ± 0.16 µM (p = 0.0302), with no statistically significant changes in TNAP activity. There were no important adverse events. 30 mg/day of lansoprazole was able to significantly increase plasma PPi in patients with PXE; despite this, the study should be replicated with a large number of participants in a multicenter trial, with a clinical end point as the primary outcome.
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Affiliation(s)
- Belén Murcia Casas
- Internal Medicine Unit, Hospital Universitario Virgen de la Victoria, 29010 Málaga, Spain
| | - Juan Luis Carrillo Linares
- Internal Medicine Unit, Hospital Universitario Virgen de la Victoria, 29010 Málaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Málaga, Spain
| | - Isabel Baquero Aranda
- Ophtalmology Unit, Hospital Universitario Virgen de la Victoria, 29010 Málaga, Spain
| | - José Rioja Villodres
- Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Málaga, Spain
- Centro de Investigaciones Médico-Sanitarias (CIMES), Universidad de Málaga, 29071 Málaga, Spain
| | | | | | | | - Ricardo Bosch
- Dermatology Unit, Hospital Universitario Virgen de la Victoria, 29010 Málaga, Spain
| | - Miguel Ángel Sánchez Chaparro
- Internal Medicine Unit, Hospital Universitario Virgen de la Victoria, 29010 Málaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Málaga, Spain
- Department of Medicine and Dermatology, University of Málaga, 29016 Málaga, Spain
| | - María García Fernández
- Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Málaga, Spain
- Department of Phisiology, Universidad de Málaga, 29016 Málaga, Spain
| | - Pedro Valdivielso
- Internal Medicine Unit, Hospital Universitario Virgen de la Victoria, 29010 Málaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Málaga, Spain
- Centro de Investigaciones Médico-Sanitarias (CIMES), Universidad de Málaga, 29071 Málaga, Spain
- Department of Medicine and Dermatology, University of Málaga, 29016 Málaga, Spain
- Correspondence: ; Tel.: +34-952131615
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13
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Ralph D, Levine M, Millán JL, Uitto J, Li Q. Weighing the Evidence for the Roles of Plasma Versus Local Pyrophosphate in Ectopic Calcification Disorders. J Bone Miner Res 2023; 38:457-463. [PMID: 36807615 PMCID: PMC10365072 DOI: 10.1002/jbmr.4791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 02/02/2023] [Accepted: 02/16/2023] [Indexed: 02/22/2023]
Abstract
Ectopic calcification is characterized by inappropriate deposition of calcium mineral in nonskeletal connective tissues and can cause significant morbidity and mortality, particularly when it affects the cardiovascular system. Identification of the metabolic and genetic determinants of ectopic calcification could help distinguish individuals at the greatest risk of developing these pathological calcifications and could guide development of medical interventions. Inorganic pyrophosphate (PPi ) has long been recognized as the most potent endogenous inhibitor of biomineralization. It has been intensively studied as both a marker and a potential therapeutic for ectopic calcification. Decreased extracellular concentrations of PPi have been proposed to be a unifying pathophysiological mechanism for disorders of ectopic calcification, both genetic and acquired. However, are reduced plasma concentrations of PPi a reliable predictor of ectopic calcification? This perspective article evaluates the literature in favor and against a pathophysiological role of plasma versus tissue PPi dysregulation as a determinant of, and as a biomarker for, ectopic calcification. © 2023 American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Douglas Ralph
- Genetics, Genomics and Cancer Biology Ph.D. Program, Jefferson College of Life Sciences, Thomas Jefferson University, Philadelphia, PA, USA.,Department of Dermatology and Cutaneous Biology, Sidney Kimmel Medical College, Jefferson Institute of Molecular Medicine, Thomas Jefferson University, Philadelphia, PA, USA.,PXE International Center of Excellence in Research and Clinical Care, Thomas Jefferson University, Philadelphia, PA, USA
| | - Michael Levine
- Division of Endocrinology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - José Luis Millán
- Sanford Children's Health Research Center, Sanford Burnham Prebys Medical Discovery Institute, La Jolla, CA, USA
| | - Jouni Uitto
- Department of Dermatology and Cutaneous Biology, Sidney Kimmel Medical College, Jefferson Institute of Molecular Medicine, Thomas Jefferson University, Philadelphia, PA, USA.,PXE International Center of Excellence in Research and Clinical Care, Thomas Jefferson University, Philadelphia, PA, USA
| | - Qiaoli Li
- Department of Dermatology and Cutaneous Biology, Sidney Kimmel Medical College, Jefferson Institute of Molecular Medicine, Thomas Jefferson University, Philadelphia, PA, USA.,PXE International Center of Excellence in Research and Clinical Care, Thomas Jefferson University, Philadelphia, PA, USA
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14
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Kozák E, Bartstra JW, de Jong PA, Mali WPTM, Fülöp K, Tőkési N, Pomozi V, Risseeuw S, Norel JOV, van Leeuwen R, Váradi A, Spiering W. Plasma Level of Pyrophosphate Is Low in Pseudoxanthoma Elasticum Owing to Mutations in the ABCC6 Gene, but It Does Not Correlate with ABCC6 Genotype. J Clin Med 2023; 12:jcm12031047. [PMID: 36769695 PMCID: PMC9917606 DOI: 10.3390/jcm12031047] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 01/04/2023] [Accepted: 01/22/2023] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Pseudoxanthoma elasticum (PXE), a monogenic disorder resulting in calcification affecting the skin, eyes and peripheral arteries, is caused by mutations in the ABCC6 gene, and is associated with low plasma inorganic pyrophosphate (PPi). It is unknown how ABCC6 genotype affects plasma PPi. METHODS We studied the association of ABCC6 genotype (192 patients with biallelic pathogenic ABCC6 mutations) and PPi levels, and its association with the severity of arterial and ophthalmological phenotypes. ABCC6 variants were classified as truncating or non-truncating, and three groups of the 192 patients were formed: those with truncating mutations on both chromosomes (n = 121), those with two non-truncating mutations (n = 10), and a group who had one truncating and one non-truncating ABCC6 mutation (n = 61). The hypothesis formulated before this study was that there was a negative association between PPi level and disease severity. RESULTS Our findings confirm low PPi in PXE compared with healthy controls (0.53 ± 0.15 vs. 1.13 ± 0.29 µM, p < 0.01). The PPi of patients correlated with increasing age (β: 0.05 µM, 95% CI: 0.03-0.06 per 10 years) and was higher in females (0.55 ± 0.17 vs. 0.51 ± 0.13 µM in males, p = 0.03). However, no association between PPi and PXE phenotypes was found. When adjusted for age and sex, no association between PPi and ABCC6 genotype was found. CONCLUSIONS Our data suggest that the relationship between ABCC6 mutations and reduced plasma PPi may not be as direct as previously thought. PPi levels varied widely, even in patients with the same ABCC6 mutations, further suggesting a lack of direct correlation between them, even though the ABCC6 protein-mediated pathway is responsible for ~60% of this metabolite in the circulation. We discuss potential factors that may perturb the expected associations between ABCC6 genotype and PPi and between PPi and disease severity. Our findings support the argument that predictions of pathogenicity made on the basis of mutations (or on the structure of the mutated protein) could be misleading.
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Affiliation(s)
- Eszter Kozák
- Institute of Enzymology, Research Center for Natural Sciences, Hungarian Academy of Sciences Center of Excellence, 1117 Budapest, Hungary
| | - Jonas W. Bartstra
- Department of Radiology, University Medical Center Utrecht, Utrecht University, 3584 CX Utrecht, The Netherlands
| | - Pim A. de Jong
- Department of Radiology, University Medical Center Utrecht, Utrecht University, 3584 CX Utrecht, The Netherlands
| | - Willem P. T. M. Mali
- Department of Radiology, University Medical Center Utrecht, Utrecht University, 3584 CX Utrecht, The Netherlands
| | - Krisztina Fülöp
- Institute of Enzymology, Research Center for Natural Sciences, Hungarian Academy of Sciences Center of Excellence, 1117 Budapest, Hungary
| | - Natália Tőkési
- Institute of Enzymology, Research Center for Natural Sciences, Hungarian Academy of Sciences Center of Excellence, 1117 Budapest, Hungary
| | - Viola Pomozi
- Institute of Enzymology, Research Center for Natural Sciences, Hungarian Academy of Sciences Center of Excellence, 1117 Budapest, Hungary
| | - Sara Risseeuw
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht University, 3584 CX Utrecht, The Netherlands
| | | | - Redmer van Leeuwen
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht University, 3584 CX Utrecht, The Netherlands
| | - András Váradi
- Institute of Enzymology, Research Center for Natural Sciences, Hungarian Academy of Sciences Center of Excellence, 1117 Budapest, Hungary
| | - Wilko Spiering
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, 3584 CX Utrecht, The Netherlands
- Correspondence: ; Tel.: +31-88-7571188
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15
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Lundkvist S, Niaziorimi F, Szeri F, Caffet M, Terry SF, Johansson G, Jansen RS, van de Wetering K. A new enzymatic assay to quantify inorganic pyrophosphate in plasma. Anal Bioanal Chem 2023; 415:481-492. [PMID: 36400967 PMCID: PMC9839608 DOI: 10.1007/s00216-022-04430-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 11/03/2022] [Accepted: 11/08/2022] [Indexed: 11/21/2022]
Abstract
Inorganic pyrophosphate (PPi) is a crucial extracellular mineralization regulator. Low plasma PPi concentrations underlie the soft tissue calcification present in several rare hereditary mineralization disorders as well as in more common conditions like chronic kidney disease and diabetes. Even though deregulated plasma PPi homeostasis is known to be linked to multiple human diseases, there is currently no reliable assay for its quantification. We here describe a PPi assay that employs the enzyme ATP sulfurylase to convert PPi into ATP. Generated ATP is subsequently quantified by firefly luciferase-based bioluminescence. An internal ATP standard was used to correct for sample-specific interference by matrix compounds on firefly luciferase activity. The assay was validated and shows excellent precision (< 3.5%) and accuracy (93-106%) of PPi spiked into human plasma samples. We found that of several anticoagulants tested only EDTA effectively blocked conversion of ATP into PPi in plasma after blood collection. Moreover, filtration over a 300,000-Da molecular weight cut-off membrane reduced variability of plasma PPi and removed ATP present in a membrane-enclosed compartment, possibly platelets. Applied to plasma samples of wild-type and Abcc6-/- rats, an animal model with established low circulating levels of PPi, the new assay showed lower variability than the assay that was previously in routine use in our laboratory. In conclusion, we here report a new and robust assay to determine PPi concentrations in plasma, which outperforms currently available assays because of its high sensitivity, precision, and accuracy.
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Affiliation(s)
- Stefan Lundkvist
- Department of Dermatology and Cutaneous Biology, Jefferson Institute of Molecular Medicine and PXE International Center of Excellence in Research and Clinical Care, Sidney Kimmel Medical College, Thomas Jefferson University, 233 S 10th Street, PA, 19107, Philadelphia, USA
- Department of Chemistry (BMC), Uppsala University, Uppsala, Sweden
| | - Fatemeh Niaziorimi
- Department of Dermatology and Cutaneous Biology, Jefferson Institute of Molecular Medicine and PXE International Center of Excellence in Research and Clinical Care, Sidney Kimmel Medical College, Thomas Jefferson University, 233 S 10th Street, PA, 19107, Philadelphia, USA
| | - Flora Szeri
- Department of Dermatology and Cutaneous Biology, Jefferson Institute of Molecular Medicine and PXE International Center of Excellence in Research and Clinical Care, Sidney Kimmel Medical College, Thomas Jefferson University, 233 S 10th Street, PA, 19107, Philadelphia, USA
- Research Centre for Natural Sciences, Institute of Enzymology, Budapest, Hungary
- Department of Biochemistry, Semmelweis University, Budapest, Hungary
| | | | | | - Gunnar Johansson
- Department of Chemistry (BMC), Uppsala University, Uppsala, Sweden
| | - Robert S Jansen
- Department of Microbiology, Radboud University, Nijmegen, The Netherlands
| | - Koen van de Wetering
- Department of Dermatology and Cutaneous Biology, Jefferson Institute of Molecular Medicine and PXE International Center of Excellence in Research and Clinical Care, Sidney Kimmel Medical College, Thomas Jefferson University, 233 S 10th Street, PA, 19107, Philadelphia, USA.
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16
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Bernabei I, So A, Busso N, Nasi S. Cartilage calcification in osteoarthritis: mechanisms and clinical relevance. Nat Rev Rheumatol 2023; 19:10-27. [PMID: 36509917 DOI: 10.1038/s41584-022-00875-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2022] [Indexed: 12/14/2022]
Abstract
Pathological calcification of cartilage is a hallmark of osteoarthritis (OA). Calcification can be observed both at the cartilage surface and in its deeper layers. The formation of calcium-containing crystals, typically basic calcium phosphate (BCP) and calcium pyrophosphate dihydrate (CPP) crystals, is an active, highly regulated and complex biological process that is initiated by chondrocytes and modified by genetic factors, dysregulated mitophagy or apoptosis, inflammation and the activation of specific cellular-signalling pathways. The links between OA and BCP deposition are stronger than those observed between OA and CPP deposition. Here, we review the molecular processes involved in cartilage calcification in OA and summarize the effects of calcium crystals on chondrocytes, synovial fibroblasts, macrophages and bone cells. Finally, we highlight therapeutic pathways leading to decreased joint calcification and potential new drugs that could treat not only OA but also other diseases associated with pathological calcification.
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Affiliation(s)
- Ilaria Bernabei
- Service of Rheumatology, Department of Musculoskeletal Medicine, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Alexander So
- Service of Rheumatology, Department of Musculoskeletal Medicine, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland.
| | - Nathalie Busso
- Service of Rheumatology, Department of Musculoskeletal Medicine, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Sonia Nasi
- Service of Rheumatology, Department of Musculoskeletal Medicine, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
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17
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Szeri F, Miko A, Navasiolava N, Kaposi A, Verschuere S, Molnar B, Li Q, Terry SF, Boraldi F, Uitto J, van de Wetering K, Martin L, Quaglino D, Vanakker OM, Tory K, Aranyi T. The pathogenic c.1171A>G (p.Arg391Gly) and c.2359G>A (p.Val787Ile) ABCC6 variants display incomplete penetrance causing pseudoxanthoma elasticum in a subset of individuals. Hum Mutat 2022; 43:1872-1881. [PMID: 36317459 PMCID: PMC9772137 DOI: 10.1002/humu.24498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 09/30/2022] [Accepted: 10/24/2022] [Indexed: 11/06/2022]
Abstract
ABCC6 promotes ATP efflux from hepatocytes to bloodstream. ATP is metabolized to pyrophosphate, an inhibitor of ectopic calcification. Pathogenic variants of ABCC6 cause pseudoxanthoma elasticum, a highly variable recessive ectopic calcification disorder. Incomplete penetrance may initiate disease heterogeneity, hence symptoms may not, or differently manifest in carriers. Here, we investigated whether incomplete penetrance is a source of heterogeneity in pseudoxanthoma elasticum. By integrating clinical and genetic data of 589 patients, we created the largest European cohort. Based on allele frequency alterations, we identified two incomplete penetrant pathogenic variants, c.2359G>A (p.Val787Ile) and c.1171A>G (p.Arg391Gly), with 6.5% and 2% penetrance, respectively. However, when penetrant, the c.1171A>G (p.Arg391Gly) manifested a clinically unaltered severity. After applying in silico and in vitro characterization, we suggest that incomplete penetrant variants are only deleterious if a yet unknown interacting partner of ABCC6 is mutated simultaneously. The low penetrance of these variants should be contemplated in genetic counseling.
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Affiliation(s)
- Flora Szeri
- Department of Dermatology and Cutaneous Biology, The Sidney Kimmel Medical College, and The PXE International Center of Excellence in Research and Clinical Care, Thomas Jefferson University, Philadelphia, PA, USA,Institute of Enzymology, Research Centre for Natural Sciences, Budapest, Hungary,Department of Biochemistry, Semmelweis University, Budapest, Hungary
| | - Agnes Miko
- MTA-SE Lendület Nephrogenetic Laboratory, Budapest, Hungary,1st Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Nastassia Navasiolava
- PXE Consultation Center, MAGEC Nord Reference Center for Rare Skin Diseases, Angers University Hospital, Angers, France
| | - Ambrus Kaposi
- MTA-SE Lendület Nephrogenetic Laboratory, Budapest, Hungary,1st Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Shana Verschuere
- Center for Medical Genetics, Ghent University Hospital, Ghent, Belgium
| | - Beatrix Molnar
- Institute of Enzymology, Research Centre for Natural Sciences, Budapest, Hungary
| | - Qiaoli Li
- Department of Dermatology and Cutaneous Biology, The Sidney Kimmel Medical College, and The PXE International Center of Excellence in Research and Clinical Care, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Federica Boraldi
- Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Jouni Uitto
- Department of Dermatology and Cutaneous Biology, The Sidney Kimmel Medical College, and The PXE International Center of Excellence in Research and Clinical Care, Thomas Jefferson University, Philadelphia, PA, USA
| | - Koen van de Wetering
- Department of Dermatology and Cutaneous Biology, The Sidney Kimmel Medical College, and The PXE International Center of Excellence in Research and Clinical Care, Thomas Jefferson University, Philadelphia, PA, USA
| | - Ludovic Martin
- PXE Consultation Center, MAGEC Nord Reference Center for Rare Skin Diseases, Angers University Hospital, Angers, France
| | - Daniela Quaglino
- Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy,Interuniversity Consortium for Biotechnologies (CIB), Italy
| | | | - Kalman Tory
- MTA-SE Lendület Nephrogenetic Laboratory, Budapest, Hungary,1st Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Tamas Aranyi
- Institute of Enzymology, Research Centre for Natural Sciences, Budapest, Hungary,Department of Molecular Biology, Semmelweis University, Budapest, Hungary.,Corresponding author:
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18
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Soma K, Watanabe K, Izumi M. Anticalcification effects of DS-1211 in pseudoxanthoma elasticum mouse models and the role of tissue-nonspecific alkaline phosphatase in ABCC6-deficient ectopic calcification. Sci Rep 2022; 12:19852. [PMID: 36400944 PMCID: PMC9674622 DOI: 10.1038/s41598-022-23892-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 11/07/2022] [Indexed: 11/19/2022] Open
Abstract
Pseudoxanthoma elasticum (PXE) is a multisystem, genetic, ectopic mineralization disorder with no effective treatment. Inhibition of tissue-nonspecific alkaline phosphatase (TNAP) may prevent ectopic soft tissue calcification by increasing endogenous pyrophosphate (PPi). This study evaluated the anticalcification effects of DS-1211, an orally administered, potent, and highly selective small molecule TNAP inhibitor, in mouse models of PXE. Calcium content in vibrissae was measured in KK/HlJ and ABCC6-/- mice after DS-1211 administration for 13-14 weeks. Pharmacokinetic and pharmacodynamic effects of DS-1211 were evaluated, including plasma alkaline phosphatase (ALP) activity and biomarker changes in PPi and pyridoxal-phosphate (PLP). Anticalcification effects of DS-1211 through TNAP inhibition were further evaluated in ABCC6-/- mice with genetically reduced TNAP activity, ABCC6-/-/TNAP+/+ and ABCC6-/-/TNAP+/-. In KK/HlJ and ABCC6-/- mouse models, DS-1211 inhibited plasma ALP activity in a dose-dependent manner and prevented progression of ectopic calcification compared with vehicle-treated mice. Plasma PPi and PLP increased dose-dependently with DS-1211 in ABCC6-/- mice. Mice with ABCC6-/-/TNAP+/- phenotype had significantly less calcification and higher plasma PPi and PLP than ABCC6-/-/TNAP+/+ mice. TNAP plays an active role in pathomechanistic pathways of dysregulated calcification, demonstrated by reduced ectopic calcification in mice with lower TNAP activity. DS-1211 may be a potential therapeutic drug for PXE.
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Affiliation(s)
- Kaori Soma
- grid.410844.d0000 0004 4911 4738Daiichi Sankyo Co., Ltd, 1-2-58, Hiromachi, Shinagawa-Ku, Tokyo, 140-8710 Japan
| | - Kengo Watanabe
- grid.410844.d0000 0004 4911 4738Daiichi Sankyo Co., Ltd, 1-2-58, Hiromachi, Shinagawa-Ku, Tokyo, 140-8710 Japan
| | - Masanori Izumi
- grid.410844.d0000 0004 4911 4738Daiichi Sankyo Co., Ltd, 1-2-58, Hiromachi, Shinagawa-Ku, Tokyo, 140-8710 Japan
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19
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Soma K, Izumi M, Yamamoto Y, Miyazaki S, Watanabe K. In Vitro and In Vivo Pharmacological Profiles of DS-1211, a Novel Potent, Selective, and Orally Bioavailable Tissue-Nonspecific Alkaline Phosphatase Inhibitor. J Bone Miner Res 2022; 37:2033-2043. [PMID: 36054139 PMCID: PMC9826446 DOI: 10.1002/jbmr.4680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 08/05/2022] [Accepted: 08/13/2022] [Indexed: 01/11/2023]
Abstract
Inhibition of tissue-nonspecific alkaline phosphatase (TNAP) may prevent ectopic soft tissue calcification by increasing endogenous pyrophosphate (PPi). DS-1211 is a potent and selective novel small molecule TNAP inhibitor with well-characterized pharmacokinetics (PKs) in rodent and monkey. Herein, we report a comprehensive summary of studies establishing the pharmaceutical profile of DS-1211. In vitro studies characterized the mode of inhibition and inhibitory effects of DS-1211 on three human alkaline phosphatase (ALP) isozymes-TNAP, human intestinal ALP, human placental ALP-and on ALP activity across species in mouse, monkey, and human plasma. In vivo PK and pharmacodynamic (PD) effects of a single oral dose of DS-1211 in mice and monkeys were evaluated, including biomarker changes in PPi and pyridoxal 5'-phosphate (PLP). Oral bioavailability (BA) was determined through administration of DS-1211 at a 0.3-mg/kg dose in monkeys. In vitro experiments demonstrated DS-1211 inhibited ALP activity through an uncompetitive mode of action. DS-1211 exhibited TNAP selectivity and potent inhibition of TNAP across species. In vivo studies in mice and monkeys after single oral administration of DS-1211 showed linear PKs, with dose-dependent inhibition of ALP activity and increases in plasma PPi and PLP. Inhibitory effects of DS-1211 were consistent in both mouse and monkey. Mean absolute oral BA was 73.9%. Overall, in vitro and in vivo studies showed DS-1211 is a potent and selective TNAP inhibitor across species. Further in vivo pharmacology studies in ectopic calcification animal models and clinical investigations of DS-1211 in patient populations are warranted. © 2022 Daiichi Sankyo, Inc. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
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20
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Ralph D, Levine MA, Richard G, Morrow M, Flynn E, Uitto J, Li Q. Mutation update: Variants of the ENPP1 gene in pathologic calcification, hypophosphatemic rickets, and cutaneous hypopigmentation with punctate keratoderma. Hum Mutat 2022; 43:1183-1200. [PMID: 35475527 PMCID: PMC9357117 DOI: 10.1002/humu.24391] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/07/2022] [Accepted: 04/22/2022] [Indexed: 11/11/2022]
Abstract
ENPP1 encodes ENPP1, an ectonucleotidase catalyzing hydrolysis of ATP to AMP and inorganic pyrophosphate (PPi), and an endogenous plasma protein physiologically preventing ectopic calcification of connective tissues. Mutations in ENPP1 have been reported in association with a range of human genetic diseases. In this mutation update, we provide a comprehensive review of all the pathogenic variants, likely pathogenic variants, and variants of unknown significance in ENPP1 associated with three autosomal recessive disorders-generalized arterial calcification of infancy (GACI), autosomal recessive hypophosphatemic rickets type 2 (ARHR2), and pseudoxanthoma elasticum (PXE), as well as with a predominantly autosomal dominant disorder-Cole disease. The classification of all variants is determined using the latest ACMG guidelines. A total of 140 ENPP1 variants were curated consisting of 133 previously reported variants and seven novel variants, with missense variants being the most prevalent (70.0%, 98/140). While the pathogenic variants are widely distributed in the ENPP1 gene of patientsgen without apparent genotype-phenotype correlation, eight out of nine variants associated with Cole disease are confined to the somatomedin-B-like (SMB) domains critical for homo-dimerization of the ENPP1 protein.
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Affiliation(s)
- Douglas Ralph
- Department of Dermatology and Cutaneous Biology, Sidney Kimmel Medical College, Jefferson Institute of Molecular Medicine, Thomas Jefferson University, Philadelphia, PA
- Genetics, Genomics and Cancer Biology Ph.D. Program, Jefferson College of Life Sciences, Thomas Jefferson University, Philadelphia, PA
- PXE International Center of Excellence in Research and Clinical Care, Thomas Jefferson University, Philadelphia, PA
| | - Michael A. Levine
- Division of Endocrinology and Diabetes, Children’s Hospital of Philadelphia, Philadelphia, PA
| | | | | | | | - Jouni Uitto
- Department of Dermatology and Cutaneous Biology, Sidney Kimmel Medical College, Jefferson Institute of Molecular Medicine, Thomas Jefferson University, Philadelphia, PA
- PXE International Center of Excellence in Research and Clinical Care, Thomas Jefferson University, Philadelphia, PA
| | - Qiaoli Li
- Department of Dermatology and Cutaneous Biology, Sidney Kimmel Medical College, Jefferson Institute of Molecular Medicine, Thomas Jefferson University, Philadelphia, PA
- PXE International Center of Excellence in Research and Clinical Care, Thomas Jefferson University, Philadelphia, PA
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21
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Van de Perre E, Bazin D, Estrade V, Bouderlique E, Wissing KM, Daudon M, Letavernier E. Randall’s plaque as the origin of idiopathic calcium oxalate stone formation: an update. CR CHIM 2022. [DOI: 10.5802/crchim.102] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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22
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Laurain A, Rubera I, Razzouk-Cadet M, Bonnafous S, Albuquerque M, Paradis V, Patouraux S, Duranton C, Lesaux O, Lefthériotis G, Tran A, Anty R, Gual P, Iannelli A, Favre G. Arterial Calcifications in Patients with Liver Cirrhosis Are Linked to Hepatic Deficiency of Pyrophosphate Production Restored by Liver Transplantation. Biomedicines 2022; 10:1496. [PMID: 35884801 PMCID: PMC9312703 DOI: 10.3390/biomedicines10071496] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 06/11/2022] [Accepted: 06/14/2022] [Indexed: 11/24/2022] Open
Abstract
Liver fibrosis is associated with arterial calcification (AC). Since the liver is a source of inorganic pyrophosphate (PPi), an anti-calcifying compound, we investigated the relationship between plasma PPi ([PPi]pl), liver fibrosis, liver function, AC, and the hepatic expression of genes regulating PPi homeostasis. To that aim, we compared [PPi]pl before liver transplantation (LT) and 3 months after LT. We also assessed the expression of four key regulators of PPi in liver tissues and established correlations between AC, and scores of liver fibrosis and liver failure in these patients. LT candidates with various liver diseases were included. AC scores were assessed in coronary arteries, abdominal aorta, and aortic valves. Liver fibrosis was evaluated on liver biopsies and from non-invasive tests (FIB-4 and APRI scores). Liver functions were assessed by measuring serum albumin, ALBI, MELD, and Pugh−Child scores. An enzymatic assay was used to dose [PPi]pl. A group of patients without liver alterations from a previous cohort provided a control group. Gene expression assays were performed with mRNA extracted from liver biopsies and compared between LT recipients and the control individuals. [PPi]pl negatively correlated with APRI (r = −0.57, p = 0.001, n = 29) and FIB-4 (r = −0.47, p = 0.006, n = 29) but not with interstitial fibrosis index from liver biopsies (r = 0.07, p = 0.40, n = 16). Serum albumin positively correlated with [PPi]pl (r = 0.71; p < 0.0001, n = 20). ALBI, MELD, and Pugh−Child scores correlated negatively with [PPi]pl (r = −0.60, p = 0.0005; r = −0.56, p = 0.002; r = −0.41, p = 0.02, respectively, with n = 20). Liver fibrosis assessed on liver biopsies by FIB-4 and by APRI positively correlated with coronary AC (r = 0.51, p = 0.02, n = 16; r = 0.58, p = 0.009, n = 20; r = 0.41, p = 0.04, n = 20, respectively) and with abdominal aorta AC (r = 0.50, p = 0.02, n = 16; r = 0.67, p = 0.002, n = 20; r = 0.61, p = 0.04, n = 20, respectively). FIB-4 also positively correlated with aortic valve calcification (r = 0.40, p = 0.046, n = 20). The key regulator genes of PPi production in liver were lower in patients undergoing liver transplantation as compared to controls. Three months after surgery, serum albumin levels were restored to physiological levels (40 [37−44] vs. 35 [30−40], p = 0.009) and [PPi]pl was normalized (1.40 [1.07−1.86] vs. 0.68 [0.53−0.80] µmol/L, p = 0.0005, n = 12). Liver failure and/or fibrosis correlated with AC in several arterial beds and were associated with low plasma PPi and dysregulation of key proteins involved in PPi homeostasis. Liver transplantation normalized these parameters.
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Affiliation(s)
- Audrey Laurain
- Department of Nephrology, Pasteur 1 University Hospital, 06001 Nice, France;
- Faculty of Medicine, Tour Pasteur, 28 Avenue de Valombrose, University of Côte d’Azur, 06000 Nice, France; (I.R.); (S.B.); (S.P.); (C.D.); (G.L.); (A.T.); (R.A.); (P.G.); (A.I.)
- LP2M CNRS UMR 7370, Tour Pasteur, 28 Avenue de Valombrose, 06000 Nice, France
| | - Isabelle Rubera
- Faculty of Medicine, Tour Pasteur, 28 Avenue de Valombrose, University of Côte d’Azur, 06000 Nice, France; (I.R.); (S.B.); (S.P.); (C.D.); (G.L.); (A.T.); (R.A.); (P.G.); (A.I.)
- LP2M CNRS UMR 7370, Tour Pasteur, 28 Avenue de Valombrose, 06000 Nice, France
| | | | - Stéphanie Bonnafous
- Faculty of Medicine, Tour Pasteur, 28 Avenue de Valombrose, University of Côte d’Azur, 06000 Nice, France; (I.R.); (S.B.); (S.P.); (C.D.); (G.L.); (A.T.); (R.A.); (P.G.); (A.I.)
- Team 8 “Chronic Liver Diseases Associated with Obesity and Alcohol” Inserm, U1065, Centre Méditerranéen de Médecine Moléculaire (C3M) Bâtiment Universitaire ARCHIMED? 151 Route Saint Antoine de Ginestière BP 2 3194, 06204 Nice, France
- Digestive Unit, Archet 2 University Hospital, 06200 Nice, France
| | - Miguel Albuquerque
- Pathology Department, Beaujon University Hospital, AP-HP, 92110 Clichy, France; (M.A.); (V.P.)
- Inserm U1149, Beaujon University Hospital, 92110 Clichy, France
| | - Valérie Paradis
- Pathology Department, Beaujon University Hospital, AP-HP, 92110 Clichy, France; (M.A.); (V.P.)
- Inserm U1149, Beaujon University Hospital, 92110 Clichy, France
| | - Stéphanie Patouraux
- Faculty of Medicine, Tour Pasteur, 28 Avenue de Valombrose, University of Côte d’Azur, 06000 Nice, France; (I.R.); (S.B.); (S.P.); (C.D.); (G.L.); (A.T.); (R.A.); (P.G.); (A.I.)
- Pathology Department, Pasteur 1 University Hospital, 06000 Nice, France
| | - Christophe Duranton
- Faculty of Medicine, Tour Pasteur, 28 Avenue de Valombrose, University of Côte d’Azur, 06000 Nice, France; (I.R.); (S.B.); (S.P.); (C.D.); (G.L.); (A.T.); (R.A.); (P.G.); (A.I.)
- LP2M CNRS UMR 7370, Tour Pasteur, 28 Avenue de Valombrose, 06000 Nice, France
| | - Olivier Lesaux
- Department Cell and Molecular Biology, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI 96813-5534, USA;
| | - Georges Lefthériotis
- Faculty of Medicine, Tour Pasteur, 28 Avenue de Valombrose, University of Côte d’Azur, 06000 Nice, France; (I.R.); (S.B.); (S.P.); (C.D.); (G.L.); (A.T.); (R.A.); (P.G.); (A.I.)
- LP2M CNRS UMR 7370, Tour Pasteur, 28 Avenue de Valombrose, 06000 Nice, France
- Department of Vascular Medicine and Surgery, Pasteur 1 University Hospital, 06000 Nice, France
| | - Albert Tran
- Faculty of Medicine, Tour Pasteur, 28 Avenue de Valombrose, University of Côte d’Azur, 06000 Nice, France; (I.R.); (S.B.); (S.P.); (C.D.); (G.L.); (A.T.); (R.A.); (P.G.); (A.I.)
- Team 8 “Chronic Liver Diseases Associated with Obesity and Alcohol” Inserm, U1065, Centre Méditerranéen de Médecine Moléculaire (C3M) Bâtiment Universitaire ARCHIMED? 151 Route Saint Antoine de Ginestière BP 2 3194, 06204 Nice, France
- Digestive Unit, Archet 2 University Hospital, 06200 Nice, France
| | - Rodolphe Anty
- Faculty of Medicine, Tour Pasteur, 28 Avenue de Valombrose, University of Côte d’Azur, 06000 Nice, France; (I.R.); (S.B.); (S.P.); (C.D.); (G.L.); (A.T.); (R.A.); (P.G.); (A.I.)
- Team 8 “Chronic Liver Diseases Associated with Obesity and Alcohol” Inserm, U1065, Centre Méditerranéen de Médecine Moléculaire (C3M) Bâtiment Universitaire ARCHIMED? 151 Route Saint Antoine de Ginestière BP 2 3194, 06204 Nice, France
- Digestive Unit, Archet 2 University Hospital, 06200 Nice, France
| | - Philippe Gual
- Faculty of Medicine, Tour Pasteur, 28 Avenue de Valombrose, University of Côte d’Azur, 06000 Nice, France; (I.R.); (S.B.); (S.P.); (C.D.); (G.L.); (A.T.); (R.A.); (P.G.); (A.I.)
- Team 8 “Chronic Liver Diseases Associated with Obesity and Alcohol” Inserm, U1065, Centre Méditerranéen de Médecine Moléculaire (C3M) Bâtiment Universitaire ARCHIMED? 151 Route Saint Antoine de Ginestière BP 2 3194, 06204 Nice, France
| | - Antonio Iannelli
- Faculty of Medicine, Tour Pasteur, 28 Avenue de Valombrose, University of Côte d’Azur, 06000 Nice, France; (I.R.); (S.B.); (S.P.); (C.D.); (G.L.); (A.T.); (R.A.); (P.G.); (A.I.)
- Team 8 “Chronic Liver Diseases Associated with Obesity and Alcohol” Inserm, U1065, Centre Méditerranéen de Médecine Moléculaire (C3M) Bâtiment Universitaire ARCHIMED? 151 Route Saint Antoine de Ginestière BP 2 3194, 06204 Nice, France
- Digestive Unit, Archet 2 University Hospital, 06200 Nice, France
| | - Guillaume Favre
- Department of Nephrology, Pasteur 1 University Hospital, 06001 Nice, France;
- Faculty of Medicine, Tour Pasteur, 28 Avenue de Valombrose, University of Côte d’Azur, 06000 Nice, France; (I.R.); (S.B.); (S.P.); (C.D.); (G.L.); (A.T.); (R.A.); (P.G.); (A.I.)
- LP2M CNRS UMR 7370, Tour Pasteur, 28 Avenue de Valombrose, 06000 Nice, France
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23
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Kawai K, Sato Y, Kawakami R, Sakamoto A, Cornelissen A, Mori M, Ghosh S, Kutys R, Virmani R, Finn AV. Generalized Arterial Calcification of Infancy (GACI): Optimizing Care with a Multidisciplinary Approach. J Multidiscip Healthc 2022; 15:1261-1276. [PMID: 35677616 PMCID: PMC9167688 DOI: 10.2147/jmdh.s251861] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 04/22/2022] [Indexed: 11/23/2022] Open
Abstract
It is very unusual to see evidence of arterial calcification in infants and children, and when detected, genetic disorders of calcium metabolism should be suspected. Generalized arterial calcification of infancy (GACI) is a hereditary disease, which is characterized by severe arterial calcification of medium sized arteries, mostly involving the media with marked intimal proliferation and ectopic mineralization of the extravascular tissues. It is caused by inactivating variants in genes encoding either ENPP1, in a majority of cases (70–75%), or ABCC6, in a minority (9–10%). Despite similar histologic appearances between ENPP1 and ABCC6 deficiencies, including arterial calcification, organ calcification, and cardiovascular calcification, mortality is higher in subjects carrying the ENPP1 versus ABCC6 variants (40% vs 10%, respectively). Overall mortality in individuals with GACI is high (55%) before the age of 6 months, with 24.4% dying in utero or being stillborn. Rare cases show spontaneous regression with age, while others who survive into adulthood often manifest musculoskeletal complications (osteoarthritis and interosseous membrane ossification), enthesis mineralization, and cervical spine fusion. Despite recent advances in the understanding of the genetic mechanisms underlying this disease, there is still no ideal therapy for the resolution of vascular calcification in GACI. Although bisphosphonates with anti-calcification properties have been commonly used for the treatment of CAGI, their benefit is controversial, with favorable results reported at one year and questionable benefit with delayed initiation of treatment. Enzyme replacement therapy with administration of recombinant form of ENPP1 prevents calcification and mortality, improves hypertension and cardiac function, and prevents intimal proliferation and osteomalacia in mouse models of ENPP1 deficiency. Therefore, newer treatments targeting genes are on the horizon. In this article, we review up to date knowledge of the understanding of GACI, its clinical, pathologic, and etiologic understanding and treatment in support of more comprehensive care of GACI patients.
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Affiliation(s)
| | - Yu Sato
- CVPath Institute, Gaithersburg, MD, USA
| | | | | | | | | | | | | | | | - Aloke V Finn
- CVPath Institute, Gaithersburg, MD, USA
- University of Maryland, School of Medicine, Baltimore, MD, USA
- Correspondence: Aloke V Finn, 19 Firstfield Road, Gaithersburg, MD, 20878, USA, Tel +301.208.3570, Fax +301.208.3745, Email
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24
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Villa-Bellosta R. Role of the extracellular ATP/pyrophosphate metabolism cycle in vascular calcification. Purinergic Signal 2022:10.1007/s11302-022-09867-1. [PMID: 35511317 DOI: 10.1007/s11302-022-09867-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 04/19/2022] [Indexed: 10/18/2022] Open
Abstract
Conventionally, ATP is considered to be the principal energy source in cells. However, over the last few years, a novel role for ATP as a potent extracellular signaling molecule and the principal source of extracellular pyrophosphate, the main endogenous inhibitor of vascular calcification, has emerged. A large body of evidence suggests that two principal mechanisms are involved in the initiation and progression of ectopic calcification: high phosphate concentration and pyrophosphate deficiency. Pathologic calcification of cardiovascular structures, or vascular calcification, is a feature of several genetic diseases and a common complication of chronic kidney disease, diabetes, and aging. Previous studies have shown that the loss of function of several enzymes and transporters involved in extracellular ATP/pyrophosphate metabolism is associated with vascular calcification. Therefore, pyrophosphate homeostasis should be further studied to facilitate the design of novel therapeutic approaches for ectopic calcification of cardiovascular structures, including strategies to increase pyrophosphate concentrations by targeting the ATP/pyrophosphate metabolism cycle.
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Affiliation(s)
- Ricardo Villa-Bellosta
- Center for Research in Molecular Medicine and Chronic Diseases (CiMUS), Av Barcelona, Campus Vida, Universidade de Santiago de Compostela, 15782, Santiago de Compostela, Spain. .,Department of Biochemistry and Molecular Biology, Universidade de Santiago de Compostela, Plaza do Obradoiro s/n, Santiago de Compostela, Spain.
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Leftheriotis G, Navasiolava N, Clotaire L, Duranton C, Le Saux O, Bendahhou S, Laurain A, Rubera I, Martin L. Relationships between Plasma Pyrophosphate, Vascular Calcification and Clinical Severity in Patients Affected by Pseudoxanthoma Elasticum. J Clin Med 2022; 11:jcm11092588. [PMID: 35566717 PMCID: PMC9100273 DOI: 10.3390/jcm11092588] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 04/28/2022] [Accepted: 04/30/2022] [Indexed: 12/10/2022] Open
Abstract
Pseudoxanthoma elasticum (PXE; OMIM 264800) is an autosomal recessive metabolic disorder characterized by progressive calcification in the skin, the Bruch’s membrane, and the vasculature. Calcification in PXE results from a low level of circulating pyrophosphate (PPi) caused by ABCC6 deficiency. In this study, we used a cohort of 107 PXE patients to determine the pathophysiological relationship between plasma PPi, coronary calcification (CAC), lower limbs arterial calcification (LLAC), and disease severity. Overall, our data showed a deficit in plasma PPi in PXE patients compared to controls. Remarkably, affected females showed higher PPi levels than males, but a lower LLAC. There was a strong correlation between age and PPi in PXE patients (r = 0.423, p < 0.0001) but not in controls (r = 0.059, p = 0.828). A weak correlation was found between PPi and CAC (r = 0.266, p < 0.02); however, there was no statistically significant connection with LLAC (r = 0.068, p = 0.518) or a severity score (r = 0.077, p = 0.429). Surprisingly, we found no significant correlation between plasma alkaline phosphatase activity and PPi (r = 0.113, p = 0.252) or between a 10-year cardiovascular risk score and all other variables. Multivariate analysis confirmed that LLAC and CAC were strongly dependent on age, but not on PPi. Our data showed that arterial calcification is only weakly linked to circulating PPi levels and that time (i.e., age) appears to be the major determinant of disease severity and calcification in PXE. These data are important to better understand the natural history of this disease but also for the follow-up and management of patients, and the design of future clinical trials. Our results also show that PPi is not a good biomarker for the evaluation of disease severity and progression.
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Affiliation(s)
- Georges Leftheriotis
- University Hospital Nice, Vascular Physiology and Medicine Unit, 06000 Nice, France
- Université Côte d’Azur, LP2M, UMR CNRS 7370, LabEx ICST, 06107 Nice, France; (L.C.); (C.D.); (S.B.); (A.L.); (I.R.)
- Correspondence: or
| | - Nastassia Navasiolava
- PXE Reference Center, MAGEC Nord, University Hospital of Angers, 49000 Angers, France; (N.N.); (L.M.)
| | - Laetitia Clotaire
- Université Côte d’Azur, LP2M, UMR CNRS 7370, LabEx ICST, 06107 Nice, France; (L.C.); (C.D.); (S.B.); (A.L.); (I.R.)
| | - Christophe Duranton
- Université Côte d’Azur, LP2M, UMR CNRS 7370, LabEx ICST, 06107 Nice, France; (L.C.); (C.D.); (S.B.); (A.L.); (I.R.)
| | - Olivier Le Saux
- Department of Cell and Molecular Biology, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI 96817, USA;
| | - Saïd Bendahhou
- Université Côte d’Azur, LP2M, UMR CNRS 7370, LabEx ICST, 06107 Nice, France; (L.C.); (C.D.); (S.B.); (A.L.); (I.R.)
| | - Audrey Laurain
- Université Côte d’Azur, LP2M, UMR CNRS 7370, LabEx ICST, 06107 Nice, France; (L.C.); (C.D.); (S.B.); (A.L.); (I.R.)
| | - Isabelle Rubera
- Université Côte d’Azur, LP2M, UMR CNRS 7370, LabEx ICST, 06107 Nice, France; (L.C.); (C.D.); (S.B.); (A.L.); (I.R.)
| | - Ludovic Martin
- PXE Reference Center, MAGEC Nord, University Hospital of Angers, 49000 Angers, France; (N.N.); (L.M.)
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26
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New Therapeutics Targeting Arterial Media Calcification: Friend or Foe for Bone Mineralization? Metabolites 2022; 12:metabo12040327. [PMID: 35448514 PMCID: PMC9027727 DOI: 10.3390/metabo12040327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 03/31/2022] [Accepted: 04/03/2022] [Indexed: 01/27/2023] Open
Abstract
The presence of arterial media calcification, a highly complex and multifactorial disease, puts patients at high risk for developing serious cardiovascular consequences and mortality. Despite the numerous insights into the mechanisms underlying this pathological mineralization process, there is still a lack of effective treatment therapies interfering with the calcification process in the vessel wall. Current anti-calcifying therapeutics may induce detrimental side effects at the level of the bone, as arterial media calcification is regulated in a molecular and cellular similar way as physiological bone mineralization. This especially is a complication in patients with chronic kidney disease and diabetes, who are the prime targets of this pathology, as they already suffer from a disturbed mineral and bone metabolism. This review outlines recent treatment strategies tackling arterial calcification, underlining their potential to influence the bone mineralization process, including targeting vascular cell transdifferentiation, calcification inhibitors and stimulators, vascular smooth muscle cell (VSMC) death and oxidative stress: are they a friend or foe? Furthermore, this review highlights nutritional additives and a targeted, local approach as alternative strategies to combat arterial media calcification. Paving a way for the development of effective and more precise therapeutic approaches without inducing osseous side effects is crucial for this highly prevalent and mortal disease.
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27
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Zheng A, Thibodeau PH. Commentary on Variants in the ABCC6 Gene Implicated in Pseudoxanthoma Elasticum, a Heritable Ectopic Mineralization Disorder. J Invest Dermatol 2022; 142:1002-1003. [DOI: 10.1016/j.jid.2022.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 02/16/2022] [Accepted: 02/16/2022] [Indexed: 11/25/2022]
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Hsu VM, Kozák E, Li Q, Bocskai M, Schlesinger N, Rosenthal A, McClure ST, Kovács L, Bálint L, Szamosi S, Szücs G, Carns M, Aren K, Goldberg I, Váradi A, Varga J. Inorganic pyrophosphate is reduced in patients with systemic sclerosis. Rheumatology (Oxford) 2022; 61:1158-1165. [PMID: 34152415 PMCID: PMC9052889 DOI: 10.1093/rheumatology/keab508] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 06/12/2021] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE The pathogenesis of calcinosis cutis, a disabling complication of SSc, is poorly understood and effective treatments are lacking. Inorganic pyrophosphate (PPi) is a key regulator of ectopic mineralization, and its deficiency has been implicated in ectopic mineralization disorders. We therefore sought to test the hypothesis that SSc may be associated with reduced circulating PPi, which might play a pathogenic role in calcinosis cutis. METHODS Subjects with SSc and age-matched controls without SSc were recruited from the outpatient rheumatology clinics at Rutgers and Northwestern Universities (US cohort), and from the Universities of Szeged and Debrecen (Hungarian cohort). Calcinosis cutis was confirmed by direct palpation, by imaging or both. Plasma PPi levels were determined in platelet-free plasma using ATP sulfurylase to convert PPi into ATP in the presence of excess adenosine 5' phosphosulfate. RESULTS Eighty-one patients with SSc (40 diffuse cutaneous, and 41 limited cutaneous SSc) in the US cohort and 45 patients with SSc (19 diffuse cutaneous and 26 limited cutaneous SSc) in the Hungarian cohort were enrolled. Calcinosis was frequently detected (40% of US and 46% of the Hungarian cohort). Plasma PPi levels were significantly reduced in both SSc cohorts with and without calcinosis (US: P = 0.003; Hungarian: P < 0.001). CONCLUSIONS Circulating PPi are significantly reduced in SSc patients with or without calcinosis. Reduced PPi may be important in the pathophysiology of calcinosis and contribute to tissue damage with chronic SSc. Administering PPi may be a therapeutic strategy and larger clinical studies are planned to confirm our findings.
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Affiliation(s)
- Vivien M Hsu
- Rheumatology Division, Department of Medicine, Rutgers-RWJ Medical School, New Brunswick, NJ, USA
| | - Eszter Kozák
- Institute of Enzymology, Research Center for Natural Sciences, Hungarian Academy of Sciences Centre of Excellence, Budapest, Hungary
| | - Qiaoli Li
- The Sidney Kimmel Medical College, The PXE International Center of Excellence in Research and Clinical Care, and Jefferson Institute of Molecular Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - Márta Bocskai
- Department of Rheumatology and Immunology, University of Szeged, Szeged, Hungary
| | - Naomi Schlesinger
- Rheumatology Division, Department of Medicine, Rutgers-RWJ Medical School, New Brunswick, NJ, USA
| | - Ann Rosenthal
- Rheumatology Division, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Scott T McClure
- Department of Statistics, Shenandoah University, Winchester, VA
- Rebel Analytics, LLC, Laguna Hills, CA, USA
| | - László Kovács
- Department of Rheumatology and Immunology, University of Szeged, Szeged, Hungary
| | - László Bálint
- Genomic Medicine and Bioinformatic Core Facility, Department of Biochemistry and Molecular Biology, University of Debrecen, Hungary University of Szeged, Szeged
| | - Szilvia Szamosi
- Division of Rheumatology, University of Debrecen, Debrecen, Hungary
| | - Gabriella Szücs
- Division of Rheumatology, University of Debrecen, Debrecen, Hungary
| | - Mary Carns
- Divisions of Rheumatology and Pulmonary and Critical Care Medicine, Department of Medicine, Northwestern University, Chicago, IL
| | - Kathleen Aren
- Divisions of Rheumatology and Pulmonary and Critical Care Medicine, Department of Medicine, Northwestern University, Chicago, IL
| | - Isaac Goldberg
- Divisions of Rheumatology and Pulmonary and Critical Care Medicine, Department of Medicine, Northwestern University, Chicago, IL
| | - András Váradi
- Institute of Enzymology, Research Center for Natural Sciences, Hungarian Academy of Sciences Centre of Excellence, Budapest, Hungary
| | - John Varga
- Divisions of Rheumatology and Pulmonary and Critical Care Medicine, Department of Medicine, Northwestern University, Chicago, IL
- Rheumatology Division, Department of Medicine, University of Michigan, Ann Arbor, MI, USA
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29
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Ralph D, van de Wetering K, Uitto J, Li Q. Inorganic Pyrophosphate Deficiency Syndromes and Potential Treatments for Pathologic Tissue Calcification. THE AMERICAN JOURNAL OF PATHOLOGY 2022; 192:762-770. [PMID: 35182493 PMCID: PMC9088198 DOI: 10.1016/j.ajpath.2022.01.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/19/2022] [Accepted: 01/24/2022] [Indexed: 02/08/2023]
Abstract
Pathologic soft tissue calcification can occur in both genetic and acquired clinical conditions, causing significant morbidity and mortality. Although the pathomechanisms of pathologic calcification are poorly understood, major progress has been made in recent years in defining the underlying genetic defects in Mendelian disorders of ectopic calcification. This review presents an overview of the pathophysiology of five monogenic disorders of pathologic calcification: pseudoxanthoma elasticum, generalized arterial calcification of infancy, arterial calcification due to deficiency of CD73, ankylosis, and progeria. These hereditary disorders, caused by mutations in genes encoding ATP binding cassette subfamily C member 6, ectonucleotide pyrophosphatase/phosphodiesterase 1, CD73, progressive ankylosis protein, and lamin A/C proteins, respectively, are inorganic pyrophosphate (PPi) deficiency syndromes with reduced circulating levels of PPi, the principal physiologic inhibitor of calcium hydroxyapatite deposition in soft connective tissues. In addition to genetic diseases, PPi deficiency has been encountered in acquired clinical conditions accompanied by pathologic calcification. Because specific and effective treatments are lacking for pathologic calcification, the unifying finding of PPi deficiency suggests that PPi-targeted therapies may be beneficial to counteract pathologic soft tissue calcification in both genetic and acquired diseases.
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Affiliation(s)
- Douglas Ralph
- Genetics, Genomics, and Cancer Biology Ph.D. Program, Jefferson College of Life Sciences, Thomas Jefferson University, Philadelphia, Pennsylvania; Department of Dermatology and Cutaneous Biology, Sidney Kimmel Medical College, Jefferson Institute of Molecular Medicine, and the PXE International Center of Excellence in Research and Clinical Care, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Koen van de Wetering
- Department of Dermatology and Cutaneous Biology, Sidney Kimmel Medical College, Jefferson Institute of Molecular Medicine, and the PXE International Center of Excellence in Research and Clinical Care, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jouni Uitto
- Department of Dermatology and Cutaneous Biology, Sidney Kimmel Medical College, Jefferson Institute of Molecular Medicine, and the PXE International Center of Excellence in Research and Clinical Care, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Qiaoli Li
- Department of Dermatology and Cutaneous Biology, Sidney Kimmel Medical College, Jefferson Institute of Molecular Medicine, and the PXE International Center of Excellence in Research and Clinical Care, Thomas Jefferson University, Philadelphia, Pennsylvania.
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30
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Huang J, Ralph D, Boraldi F, Quaglino D, Uitto J, Li Q. Inhibition of the DNA Damage Response Attenuates Ectopic Calcification in Pseudoxanthoma Elasticum. J Invest Dermatol 2022; 142:2140-2148.e1. [PMID: 35143822 PMCID: PMC9329183 DOI: 10.1016/j.jid.2022.01.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 01/25/2022] [Accepted: 01/28/2022] [Indexed: 12/27/2022]
Abstract
Pseudoxanthoma elasticum (PXE) is a heritable ectopic calcification disorder with multi-organ clinical manifestations. The gene at default, ABCC6, encodes an efflux transporter, ABCC6, which is a new player regulating the homeostasis of inorganic pyrophosphate (PPi), a potent endogenous anti-calcification factor. Previous studies suggested that systemic PPi deficiency is the major, but not the exclusive, cause of ectopic calcification in PXE. In this study, we demonstrate that the DNA damage response (DDR) and poly(ADP-ribose) (PAR) pathways are involved locally in PXE at sites of ectopic calcification. Genetic inhibition of PARP1, the predominant PAR-producing enzyme, showed a 54% reduction of calcification in the muzzle skin in Abcc6-/-Parp1-/- mice, as compared to age-matched Abcc6-/-Parp1+/+ littermates. Subsequently, oral administration of minocycline, an inhibitor of DDR/PAR signaling, resulted in an 86% reduction of calcification in the muzzle skin of Abcc6-/- mice. Minocycline treatment also attenuated the DDR/PAR signaling and reduced calcification of dermal fibroblasts derived from PXE patients. The anti-calcification effect of DDR/PAR inhibition was not accompanied by alterations in plasma PPi concentrations. These results suggest that local DDR/PAR signaling in calcification-prone tissues contributes to PXE pathogenesis, and its inhibition might provide a promising treatment strategy for ectopic calcification in PXE, a currently intractable disease.
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Affiliation(s)
- Jianhe Huang
- Jefferson Institute of Molecular Medicine, Thomas Jefferson University, Philadelphia, PA 19107, USA; Department of Dermatology and Cutaneous Biology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA; PXE international Center of Excellence in Research and Clinical Care, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Douglas Ralph
- Jefferson Institute of Molecular Medicine, Thomas Jefferson University, Philadelphia, PA 19107, USA; Department of Dermatology and Cutaneous Biology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA; PXE international Center of Excellence in Research and Clinical Care, Thomas Jefferson University, Philadelphia, PA 19107, USA; Genetics, Genomics and Cancer Biology Ph.D. Program, Jefferson College of Life Sciences, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Federica Boraldi
- Department of Life Science, University of Modena and Reggio Emilia, Modena 41125, Italy
| | - Daniela Quaglino
- Department of Life Science, University of Modena and Reggio Emilia, Modena 41125, Italy
| | - Jouni Uitto
- Jefferson Institute of Molecular Medicine, Thomas Jefferson University, Philadelphia, PA 19107, USA; Department of Dermatology and Cutaneous Biology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA; PXE international Center of Excellence in Research and Clinical Care, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Qiaoli Li
- Jefferson Institute of Molecular Medicine, Thomas Jefferson University, Philadelphia, PA 19107, USA; Department of Dermatology and Cutaneous Biology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA; PXE international Center of Excellence in Research and Clinical Care, Thomas Jefferson University, Philadelphia, PA 19107, USA.
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Boneski PK, Madhu V, Tomlinson RE, Shapiro IM, van de Wetering K, Risbud MV. Abcc6 Null Mice—a Model for Mineralization Disorder PXE Shows Vertebral Osteopenia Without Enhanced Intervertebral Disc Calcification With Aging. Front Cell Dev Biol 2022; 10:823249. [PMID: 35186933 PMCID: PMC8850990 DOI: 10.3389/fcell.2022.823249] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 01/03/2022] [Indexed: 12/12/2022] Open
Abstract
Chronic low back pain is a highly prevalent health condition intricately linked to intervertebral disc degeneration. One of the prominent features of disc degeneration that is commonly observed with aging is dystrophic calcification. ATP-binding cassette sub-family C member 6 (ABCC6), a presumed ATP efflux transporter, is a key regulator of systemic levels of the mineralization inhibitor pyrophosphate (PPi). Mutations in ABCC6 result in pseudoxanthoma elasticum (PXE), a progressive human metabolic disorder characterized by mineralization of the skin and elastic tissues. The implications of ABCC6 loss-of-function on pathological mineralization of structures in the spine, however, are unknown. Using the Abcc6−/− mouse model of PXE, we investigated age-dependent changes in the vertebral bone and intervertebral disc. Abcc6−/− mice exhibited diminished trabecular bone quality parameters at 7 months, which remained significantly lower than the wild-type mice at 18 months of age. Abcc6−/− vertebrae showed increased TRAP staining along with decreased TNAP staining, suggesting an enhanced bone resorption as well as decreased bone formation. Surprisingly, however, loss of ABCC6 resulted only in a mild, aging disc phenotype without evidence of dystrophic mineralization. Finally, we tested the utility of oral K3Citrate to treat the vertebral phenotype since it is shown to regulate hydroxyapatite mechanical behavior. The treatment resulted in inhibition of the osteoclastic response and an early improvement in mechanical properties of the bone underscoring the promise of potassium citrate as a therapeutic agent. Our data suggest that although ectopic mineralization is tightly regulated in the disc, loss of ABCC6 compromises vertebral bone quality and dysregulates osteoblast-osteoclast coupling.
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Affiliation(s)
- Paige K. Boneski
- Department of Orthopedic Surgery, Thomas Jefferson University, Philadelphia, PA, United States
| | - Vedavathi Madhu
- Department of Orthopedic Surgery, Thomas Jefferson University, Philadelphia, PA, United States
| | - Ryan E. Tomlinson
- Department of Orthopedic Surgery, Thomas Jefferson University, Philadelphia, PA, United States
| | - Irving M. Shapiro
- Department of Orthopedic Surgery, Thomas Jefferson University, Philadelphia, PA, United States
| | - Koen van de Wetering
- Department of Dermatology and Cutaneous Biology, Jefferson Institute of Molecular Medicine and PXE International Center of Excellence in Research and Clinical Care, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States
| | - Makarand V. Risbud
- Department of Orthopedic Surgery, Thomas Jefferson University, Philadelphia, PA, United States
- *Correspondence: Makarand V. Risbud,
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Yunfeng L, Tongyan H, Jing W, Xiaomei T. Case Report: A Novel Genetic Mutation Causes Idiopathic Infantile Arterial Calcification in Preterm Infants. Front Genet 2022; 12:763916. [PMID: 35003211 PMCID: PMC8733597 DOI: 10.3389/fgene.2021.763916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 12/07/2021] [Indexed: 01/01/2023] Open
Abstract
Idiopathic infantile arterial calcification (IIAC), also known as generalized arterial calcification of infancy (GACI), is a heritable ectopic mineralization disorder that results in diffuse arterial calcifications and or stenosis, which are attributed to mutations in the ENPP1 gene. In this case study, we report the development of IIAC in a 2-month-old male preterm infant. The patient presented with severe hypertension and seizures, which revealed diffused calcifications and c.130C > T and c.1112A > T mutations in the ENPP1 gene. With biphosphonate, antihypertensive, and control epilepsy therapy, his blood pressure was maintained at 110–120/50–60 mmHg. Intellectual motor development retardation was anticipated in this patient. To the best of our knowledge, this is the first case in which a novel c.130C > T mutation in the ENPP1 gene has been identified, and the administration of bisphosphonates to patients with IIAC has been assessed.
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Affiliation(s)
- Liu Yunfeng
- Department of Pediatrics, Peking University Third Hospital, Beijing, China
| | - Han Tongyan
- Department of Pediatrics, Peking University Third Hospital, Beijing, China
| | - Wang Jing
- Department of Pediatrics, Peking University Third Hospital, Beijing, China
| | - Tong Xiaomei
- Department of Pediatrics, Peking University Third Hospital, Beijing, China
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33
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Therapy of Pseudoxanthoma Elasticum: Current Knowledge and Future Perspectives. Biomedicines 2021; 9:biomedicines9121895. [PMID: 34944710 PMCID: PMC8698611 DOI: 10.3390/biomedicines9121895] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/05/2021] [Accepted: 12/07/2021] [Indexed: 12/24/2022] Open
Abstract
Pseudoxanthoma elasticum (PXE) is a rare, genetic, metabolic disease with an estimated prevalence of between 1 per 25,000 and 56,000. Its main hallmarks are characteristic skin lesions, development of choroidal neovascularization, and early-onset arterial calcification accompanied by a severe reduction in quality-of-life. Underlying the pathology are recessively transmitted pathogenic variants of the ABCC6 gene, which results in a deficiency of ABCC6 protein. This results in reduced levels of peripheral pyrophosphate, a strong inhibitor of peripheral calcification, but also dysregulation of blood lipids. Although various treatment options have emerged during the last 20 years, many are either already outdated or not yet ready to be applied generally. Clinical physicians often are left stranded while patients suffer from the consequences of outdated therapies, or feel unrecognized by their attending doctors who may feel uncertain about using new therapeutic approaches or not even know about them. In this review, we summarize the broad spectrum of treatment options for PXE, focusing on currently available clinical options, the latest research and development, and future perspectives.
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34
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Kozák E, Fülöp K, Tőkési N, Rao N, Li Q, Terry SF, Uitto J, Zhang X, Becker C, Váradi A, Pomozi V. Oral supplementation of inorganic pyrophosphate in pseudoxanthoma elasticum. Exp Dermatol 2021; 31:548-555. [PMID: 34758173 DOI: 10.1111/exd.14498] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 10/29/2021] [Accepted: 11/06/2021] [Indexed: 01/19/2023]
Abstract
Pseudoxanthoma elasticum (PXE; OMIM 264800) is a rare heritable multisystem disorder, characterized by ectopic mineralization affecting elastic fibres in the skin, eyes and the cardiovascular system. Skin findings often lead to early diagnosis of PXE, but currently, no specific treatment exists to counteract the progression of symptoms. PXE belongs to a group of Mendelian calcification disorders linked to pyrophosphate metabolism, which also includes generalized arterial calcification of infancy (GACI) and arterial calcification due to CD73 deficiency (ACDC). Inactivating mutations in ABCC6, ENPP1 and NT5E are the genetic cause of these diseases, respectively, and all of them result in reduced inorganic pyrophosphate (PPi ) concentration in the circulation. Although PPi is a strong inhibitor of ectopic calcification, oral supplementation therapy was initially not considered because of its low bioavailability. Our earlier work however demonstrated that orally administered pyrophosphate inhibits ectopic calcification in the animal models of PXE and GACI, and that orally given Na4 P2 O7 is absorbed in humans. Here, we report that gelatin-encapsulated Na2 H2 P2 O7 has similar absorption properties in healthy volunteers and people affected by PXE. The sodium-free K2 H2 P2 O7 form resulted in similar uptake in healthy volunteers and inhibited calcification in Abcc6-/- mice as effectively as its sodium counterpart. Novel pyrophosphate compounds showing higher bioavailability in mice were also identified. Our results provide an important step towards testing oral PPi in clinical trials in PXE, or potentially any condition accompanied by ectopic calcification including diabetes, chronic kidney disease or ageing.
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Affiliation(s)
- Eszter Kozák
- Institute of Enzymology, Research Centre for Natural Sciences, Hungarian Academy of Sciences Centre of Excellence, Budapest, Hungary
| | - Krisztina Fülöp
- Institute of Enzymology, Research Centre for Natural Sciences, Hungarian Academy of Sciences Centre of Excellence, Budapest, Hungary
| | - Natália Tőkési
- Institute of Enzymology, Research Centre for Natural Sciences, Hungarian Academy of Sciences Centre of Excellence, Budapest, Hungary
| | - Nidhi Rao
- Institute of Enzymology, Research Centre for Natural Sciences, Hungarian Academy of Sciences Centre of Excellence, Budapest, Hungary
| | - Qiaoli Li
- Department of Dermatology and Cutaneous Biology, PXE International Center of Excellence in Research and Clinical Care, Sidney Kimmel Medicine College, Jefferson Institute of Molecular Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Sharon F Terry
- PXE International, Washington, District of Columbia, USA
| | - Jouni Uitto
- Department of Dermatology and Cutaneous Biology, PXE International Center of Excellence in Research and Clinical Care, Sidney Kimmel Medicine College, Jefferson Institute of Molecular Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Xiaoming Zhang
- Theratrophix, Sunnyvale, California, USA.,Pyrogenyx, Sunnyvale, California, USA
| | - Cyrus Becker
- Theratrophix, Sunnyvale, California, USA.,Pyrogenyx, Sunnyvale, California, USA
| | - András Váradi
- Institute of Enzymology, Research Centre for Natural Sciences, Hungarian Academy of Sciences Centre of Excellence, Budapest, Hungary
| | - Viola Pomozi
- Institute of Enzymology, Research Centre for Natural Sciences, Hungarian Academy of Sciences Centre of Excellence, Budapest, Hungary
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Chronic Kidney Disease-Induced Arterial Media Calcification in Rats Prevented by Tissue Non-Specific Alkaline Phosphatase Substrate Supplementation Rather Than Inhibition of the Enzyme. Pharmaceutics 2021; 13:pharmaceutics13081138. [PMID: 34452102 PMCID: PMC8399849 DOI: 10.3390/pharmaceutics13081138] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 07/02/2021] [Accepted: 07/19/2021] [Indexed: 11/30/2022] Open
Abstract
Patients with chronic kidney disease (CKD) suffer from arterial media calcification and a disturbed bone metabolism. Tissue-nonspecific alkaline phosphatase (TNAP) hydrolyzes the calcification inhibitor pyrophosphate (PPi) into inorganic phosphate (Pi) and thereby stimulates arterial media calcification as well as physiological bone mineralization. This study investigates whether the TNAP inhibitor SBI-425, PPi or the combination of both inhibit arterial media calcification in an 0.75% adenine rat model of CKD. Treatments started with the induction of CKD, including (i) rats with normal renal function (control diet) treated with vehicle and CKD rats treated with either (ii) vehicle, (iii) 10 mg/kg/day SBI-425, (iv) 120 µmol/kg/day PPi and (v) 120 µmol/kg/day PPi and 10 mg/kg/day SBI-425. All CKD groups developed a stable chronic renal failure reflected by hyperphosphatemia, hypocalcemia and high serum creatinine levels. CKD induced arterial media calcification and bone metabolic defects. All treatments, except for SBI-425 alone, blocked CKD-related arterial media calcification. More important, SBI-425 alone and in combination with PPi increased osteoid area pointing to a less efficient bone mineralization. Clearly, potential side effects on bone mineralization will need to be assessed in any clinical trial aimed at modifying the Pi/PPi ratio in CKD patients who already suffer from a compromised bone status.
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Shimada BK, Pomozi V, Zoll J, Kuo S, Martin L, Le Saux O. ABCC6, Pyrophosphate and Ectopic Calcification: Therapeutic Solutions. Int J Mol Sci 2021; 22:ijms22094555. [PMID: 33925341 PMCID: PMC8123679 DOI: 10.3390/ijms22094555] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 04/20/2021] [Accepted: 04/21/2021] [Indexed: 12/11/2022] Open
Abstract
Pathological (ectopic) mineralization of soft tissues occurs during aging, in several common conditions such as diabetes, hypercholesterolemia, and renal failure and in certain genetic disorders. Pseudoxanthoma elasticum (PXE), a multi-organ disease affecting dermal, ocular, and cardiovascular tissues, is a model for ectopic mineralization disorders. ABCC6 dysfunction is the primary cause of PXE, but also some cases of generalized arterial calcification of infancy (GACI). ABCC6 deficiency in mice underlies an inducible dystrophic cardiac calcification phenotype (DCC). These calcification diseases are part of a spectrum of mineralization disorders that also includes Calcification of Joints and Arteries (CALJA). Since the identification of ABCC6 as the “PXE gene” and the development of several animal models (mice, rat, and zebrafish), there has been significant progress in our understanding of the molecular genetics, the clinical phenotypes, and pathogenesis of these diseases, which share similarities with more common conditions with abnormal calcification. ABCC6 facilitates the cellular efflux of ATP, which is rapidly converted into inorganic pyrophosphate (PPi) and adenosine by the ectonucleotidases NPP1 and CD73 (NT5E). PPi is a potent endogenous inhibitor of calcification, whereas adenosine indirectly contributes to calcification inhibition by suppressing the synthesis of tissue non-specific alkaline phosphatase (TNAP). At present, therapies only exist to alleviate symptoms for both PXE and GACI; however, extensive studies have resulted in several novel approaches to treating PXE and GACI. This review seeks to summarize the role of ABCC6 in ectopic calcification in PXE and other calcification disorders, and discuss therapeutic strategies targeting various proteins in the pathway (ABCC6, NPP1, and TNAP) and direct inhibition of calcification via supplementation by various compounds.
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Affiliation(s)
- Briana K Shimada
- Department of Cell and Molecular Biology, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI 96817, USA
| | - Viola Pomozi
- Institute of Enzymology, RCNS, Hungarian Academy of Sciences, 1117 Budapest, Hungary
| | - Janna Zoll
- Department of Cell and Molecular Biology, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI 96817, USA
| | - Sheree Kuo
- Department of Pediatrics, Kapi'olani Medical Center for Women and Children, University of Hawaii, Honolulu, HI 96826, USA
| | - Ludovic Martin
- PXE Consultation Center, MAGEC Reference Center for Rare Skin Diseases, Angers University Hospital, 49100 Angers, France
- BNMI, CNRS 6214/INSERM 1083, University Bretagne-Loire, 49100 Angers, France
| | - Olivier Le Saux
- Department of Cell and Molecular Biology, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI 96817, USA
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Bartstra JW, Risseeuw S, de Jong PA, van Os B, Kalsbeek L, Mol C, Baas AF, Verschuere S, Vanakker O, Florijn RJ, Hendrikse J, Mali W, Imhof S, Ossewaarde-van Norel J, van Leeuwen R, Spiering W. Genotype-phenotype correlation in pseudoxanthoma elasticum. Atherosclerosis 2021; 324:18-26. [PMID: 33812167 DOI: 10.1016/j.atherosclerosis.2021.03.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 02/26/2021] [Accepted: 03/10/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIMS Pseudoxanthoma elasticum (PXE) is caused by variants in the ABCC6 gene. It results in calcification in the skin, peripheral arteries and the eyes, but has considerable phenotypic variability. We investigated the association between the ABCC6 genotype and calcification and clinical phenotypes in these different organs. METHODS ABCC6 sequencing was performed in 289 PXE patients. Genotypes were grouped as two truncating, mixed, or two non-truncating variants. Arterial calcification mass was quantified on whole body, low dose CT scans; and peripheral arterial disease was measured with the ankle brachial index after treadmill test. The presence of pseudoxanthoma in the skin was systematically scored. Ophthalmological phenotypes were the length of angioid streaks as a measure of Bruchs membrane calcification, the presence of choroidal neovascularizations, severity of macular atrophy and visual acuity. Regression models were built to test the age and sex adjusted genotype-phenotype association. RESULTS 158 patients (median age 51 years) had two truncating variants, 96 (median age 54 years) a mixed genotype, 18 (median age 47 years) had two non-truncating variants. The mixed genotype was associated with lower peripheral (β: 0.39, 95%CI:-0.62;-0.17) and total (β: 0.28, 95%CI:-0.47;-0.10) arterial calcification mass scores, and lower prevalence of choroidal neovascularizations (OR: 0.41 95%CI:0.20; 0.83) compared to two truncating variants. No association with pseudoxanthomas was found. CONCLUSIONS PXE patients with a mixed genotype have less severe arterial and ophthalmological phenotypes than patients with two truncating variants in the ABCC6 gene. Research into environmental and genetic modifiers might provide further insights into the unexplained phenotypic variability.
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Affiliation(s)
- Jonas W Bartstra
- Department of Radiology, University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Sara Risseeuw
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Pim A de Jong
- Department of Radiology, University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Bram van Os
- Department of Radiology, University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Lianne Kalsbeek
- Department of Radiology, University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Chris Mol
- Department of Radiology, University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Annette F Baas
- Department of Genetics, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Shana Verschuere
- Center for Medical Genetics, Ghent University Hospital, Ghent, Belgium
| | - Olivier Vanakker
- Center for Medical Genetics, Ghent University Hospital, Ghent, Belgium
| | - Ralph J Florijn
- Department of Clinical Genetics, Academic Medical Center, Amsterdam, the Netherlands
| | - Jeroen Hendrikse
- Department of Radiology, University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Willem Mali
- Department of Radiology, University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Saskia Imhof
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht University, the Netherlands
| | | | - Redmer van Leeuwen
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Wilko Spiering
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, the Netherlands.
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Czimer D, Porok K, Csete D, Gyüre Z, Lavró V, Fülöp K, Chen Z, Gyergyák H, Tusnády GE, Burgess SM, Mócsai A, Váradi A, Varga M. A New Zebrafish Model for Pseudoxanthoma Elasticum. Front Cell Dev Biol 2021; 9:628699. [PMID: 33768091 PMCID: PMC7985086 DOI: 10.3389/fcell.2021.628699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 02/16/2021] [Indexed: 11/30/2022] Open
Abstract
Calcification of various tissues is a significant health issue associated with aging, cancer and autoimmune diseases. There are both environmental and genetic factors behind this phenomenon and understanding them is essential for the development of efficient therapeutic approaches. Pseudoxanthoma elasticum (PXE) is a rare genetic disease, a prototype for calcification disorders, resulting from the dysfunction of ABCC6, a transport protein found in the membranes of cells. It is identified by excess calcification in a variety of tissues (e.g., eyes, skin, arteries) and currently it has no cure, known treatments target the symptoms only. Preclinical studies of PXE have been successful in mice, proving the usefulness of animal models for the study of the disease. Here, we present a new zebrafish (Danio rerio) model for PXE. By resolving some ambiguous assemblies in the zebrafish genome, we show that there are two functional and one non-functional paralogs for ABCC6 in zebrafish (abcc6a, abcc6b.1, and abcc6b.2, respectively). We created single and double mutants for the functional paralogs and characterized their calcification defects with a combination of techniques. Zebrafish deficient in abcc6a show defects in their vertebral calcification and also display ectopic calcification foci in their soft tissues. Our results also suggest that the impairment of abcc6b.1 does not affect this biological process.
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Affiliation(s)
- Dávid Czimer
- Department of Genetics, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Klaudia Porok
- Department of Genetics, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Dániel Csete
- Department of Physiology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Zsolt Gyüre
- Department of Genetics, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Viktória Lavró
- Division of Biosciences, University College London, London, United Kingdom
| | - Krisztina Fülöp
- Institute of Enzymology, Research Centre for Natural Sciences, Budapest, Hungary
| | - Zelin Chen
- Key Laboratory of Tropical Marine Bio-resources and Ecology, South China Sea Institute of Oceanology, Chinese Academy of Sciences, Guangzhou, China
| | - Hella Gyergyák
- Institute of Enzymology, Research Centre for Natural Sciences, Budapest, Hungary
| | - Gábor E Tusnády
- Institute of Enzymology, Research Centre for Natural Sciences, Budapest, Hungary
| | - Shawn M Burgess
- Translational and Functional Genomics Branch, National Human Genome Research Institute, Bethesda, MD, United States
| | - Attila Mócsai
- Department of Physiology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - András Váradi
- Institute of Enzymology, Research Centre for Natural Sciences, Budapest, Hungary
| | - Máté Varga
- Department of Genetics, ELTE Eötvös Loránd University, Budapest, Hungary
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Brampton C, Pomozi V, Chen LH, Apana A, McCurdy S, Zoll J, Boisvert WA, Lambert G, Henrion D, Blanchard S, Kuo S, Leftheriotis G, Martin L, Le Saux O. ABCC6 deficiency promotes dyslipidemia and atherosclerosis. Sci Rep 2021; 11:3881. [PMID: 33594095 PMCID: PMC7887252 DOI: 10.1038/s41598-021-82966-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 01/25/2021] [Indexed: 02/08/2023] Open
Abstract
ABCC6 deficiency promotes ectopic calcification; however, circumstantial evidence suggested that ABCC6 may also influence atherosclerosis. The present study addressed the role of ABCC6 in atherosclerosis using Ldlr-/- mice and pseudoxanthoma elasticum (PXE) patients. Mice lacking the Abcc6 and Ldlr genes were fed an atherogenic diet for 16 weeks before intimal calcification, aortic plaque formation and lipoprotein profile were evaluated. Cholesterol efflux and the expression of several inflammation, atherosclerosis and cholesterol homeostasis-related genes were also determined in murine liver and bone marrow-derived macrophages. Furthermore, we examined plasma lipoproteins, vascular calcification, carotid intima-media thickness and atherosclerosis in a cohort of PXE patients with ABCC6 mutations and compared results to dysmetabolic subjects with increased cardiovascular risk. We found that ABCC6 deficiency causes changes in lipoproteins, with decreased HDL cholesterol in both mice and humans, and induces atherosclerosis. However, we found that the absence of ABCC6 does not influence overall vascular mineralization induced with atherosclerosis. Decreased cholesterol efflux from macrophage cells and other molecular changes such as increased pro-inflammation seen in both humans and mice are likely contributors for the phenotype. However, it is likely that other cellular and/or molecular mechanisms are involved. Our study showed a novel physiological role for ABCC6, influencing plasma lipoproteins and atherosclerosis in a haploinsufficient manner, with significant penetrance.
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Affiliation(s)
- Christopher Brampton
- Department of Cell and Molecular Biology, John A. Burns School of Medicine, University of Hawaii, 651 Ilalo St. BSB222E, Honolulu, HI, USA
- Bio-Rad Laboratories, Inc., Hercules, CA, USA
| | - Viola Pomozi
- Department of Cell and Molecular Biology, John A. Burns School of Medicine, University of Hawaii, 651 Ilalo St. BSB222E, Honolulu, HI, USA
| | - Li-Hsieh Chen
- Department of Cell and Molecular Biology, John A. Burns School of Medicine, University of Hawaii, 651 Ilalo St. BSB222E, Honolulu, HI, USA
| | - Ailea Apana
- Department of Cell and Molecular Biology, John A. Burns School of Medicine, University of Hawaii, 651 Ilalo St. BSB222E, Honolulu, HI, USA
| | - Sara McCurdy
- Department of Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA
- Department of Medicine, University of California San Diego, San Diego, USA
| | - Janna Zoll
- Department of Cell and Molecular Biology, John A. Burns School of Medicine, University of Hawaii, 651 Ilalo St. BSB222E, Honolulu, HI, USA
| | - William A Boisvert
- Department of Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA
| | - Gilles Lambert
- University of La Réunion Medical School (France) INSERM UMR1188 DéTROI, Ste Clotilde, La Réunion, France
| | - Daniel Henrion
- MITOVASC Institute - UMR CNRS 6015 INSERM U1083, University of Angers, Angers, France
| | - Simon Blanchard
- Département d'Immunologie et d'Allergologie, University Hospital of Angers, 49000, Angers, France
- Inserm U1232, CRCINA, University of Angers, 44000, Nantes, France
| | - Sheree Kuo
- Department of Pediatrics Kapi'olani Medical Center for Women and Children, University of Hawaii, Honolulu, HI, USA
| | - Georges Leftheriotis
- Faculty of Medicine, University of Nice-Sophia Antipolis, 06107, Nice, France
- Laboratory of Physiology and Molecular Medicine (LP2M) UMR CNRS 7073, 06107, Nice, France
| | - Ludovic Martin
- PXE Consultation Center, MAGEC Reference Center for Rare Skin Diseases, Angers University Hospital, Angers, France
- BNMI, CNRS 6214/INSERM 1083, University Bretagne-Loire, Angers, France
| | - Olivier Le Saux
- Department of Cell and Molecular Biology, John A. Burns School of Medicine, University of Hawaii, 651 Ilalo St. BSB222E, Honolulu, HI, USA.
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Bäck M, Michel JB. From organic and inorganic phosphates to valvular and vascular calcifications. Cardiovasc Res 2021; 117:2016-2029. [PMID: 33576771 PMCID: PMC8318101 DOI: 10.1093/cvr/cvab038] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 11/26/2020] [Accepted: 02/03/2021] [Indexed: 02/06/2023] Open
Abstract
Calcification of the arterial wall and valves is an important part of the pathophysiological process of peripheral and coronary atherosclerosis, aortic stenosis, ageing, diabetes, and chronic kidney disease. This review aims to better understand how extracellular phosphates and their ability to be retained as calcium phosphates on the extracellular matrix initiate the mineralization process of arteries and valves. In this context, the physiological process of bone mineralization remains a human model for pathological soft tissue mineralization. Soluble (ionized) calcium precipitation occurs on extracellular phosphates; either with inorganic or on exposed organic phosphates. Organic phosphates are classified as either structural (phospholipids, nucleic acids) or energetic (corresponding to phosphoryl transfer activities). Extracellular phosphates promote a phenotypic shift in vascular smooth muscle and valvular interstitial cells towards an osteoblast gene expression pattern, which provokes the active phase of mineralization. A line of defense systems protects arterial and valvular tissue calcifications. Given the major roles of phosphate in soft tissue calcification, phosphate mimetics, and/or prevention of phosphate dissipation represent novel potential therapeutic approaches for arterial and valvular calcification.
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Affiliation(s)
- Magnus Bäck
- Division of Valvular and Coronary Disease, Department of Cardiology, Karolinska University Hospital, 141 86 Stockholm, Sweden.,Department of Medicine, Karolinska Institutet, Stockholm, Sweden.,University of Lorraine, Nancy University Hospital, INSERM U1116, Nancy, France
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Jacobs IJ, Li D, Ivarsson ME, Uitto J, Li Q. A phytic acid analogue INS-3001 prevents ectopic calcification in an Abcc6 -/- mouse model of pseudoxanthoma elasticum. Exp Dermatol 2021; 30:853-858. [PMID: 33523493 DOI: 10.1111/exd.14288] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 12/07/2020] [Accepted: 01/15/2021] [Indexed: 12/17/2022]
Abstract
Pseudoxanthoma elasticum (PXE), a prototype of heritable ectopic calcification disorders, affects the skin, eyes and the cardiovascular system due to inactivating mutations in the ABCC6 gene. There is no effective treatment for the systemic manifestations of PXE. In this study, the efficacy of INS-3001, an analogue of phytic acid, was tested for inhibition of ectopic calcification in an Abcc6-/- mouse model of PXE. In prevention study, Abcc6-/- mice, at 6 weeks of age, the time of onset of ectopic calcification, were treated with INS-3001 with 0.16, 0.8, 4, 20 or 100 mg/kg/day administered by subcutaneous implantation of osmotic pumps, as well as 4 mg/kg/day by subcutaneous injection thrice weekly or 14, 4 and 0.8 mg/kg/day once weekly subcutaneous injection. Mice were necropsied at 12 weeks of age. Histologic examination and quantitative calcium assay revealed that mice receiving 6 weeks of continuous INS-3001 administration via osmotic pumps showed dose-dependent inhibition of muzzle skin calcification with complete response at 4 mg/kg/day and a minimum effective dose at 0.8 mg/kg/day. INS-3001 plasma concentrations were dose-dependent and largely consistent during treatment for each dose. thrice weekly and once weekly subcutaneous injections of INS-3001 also prevented calcification. In established disease study, 12-week-old Abcc6-/- mice with extensive calcification were continuously administered INS-3001 at 4 mg/kg/day for a follow-up of 12 weeks. INS-3001 treatment was found to stabilize existing calcification that had developed at start of treatment. These results suggest that INS-3001 may provide a promising preventive treatment strategy for PXE, a currently intractable ectopic calcification disorder.
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Affiliation(s)
- Ida Joely Jacobs
- Department of Dermatology and Cutaneous Biology, PXE International Center of Excellence in Research and Clinical Care, Jefferson Institute of Molecular Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Diana Li
- Department of Dermatology and Cutaneous Biology, PXE International Center of Excellence in Research and Clinical Care, Jefferson Institute of Molecular Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Jouni Uitto
- Department of Dermatology and Cutaneous Biology, PXE International Center of Excellence in Research and Clinical Care, Jefferson Institute of Molecular Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Qiaoli Li
- Department of Dermatology and Cutaneous Biology, PXE International Center of Excellence in Research and Clinical Care, Jefferson Institute of Molecular Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
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Luo H, Li Q, Cao Y, Uitto J. Therapeutics Development for Pseudoxanthoma Elasticum and Related Ectopic Mineralization Disorders: Update 2020. J Clin Med 2020; 10:E114. [PMID: 33396306 PMCID: PMC7795895 DOI: 10.3390/jcm10010114] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 12/23/2020] [Accepted: 12/28/2020] [Indexed: 12/11/2022] Open
Abstract
Pseudoxanthoma elasticum (PXE), the prototype of heritable ectopic mineralization disorders, manifests with deposition of calcium hydroxyapatite crystals in the skin, eyes and arterial blood vessels. This autosomal recessive disorder, due to mutations in ABCC6, is usually diagnosed around the second decade of life. In the spectrum of heritable ectopic mineralization disorders are also generalized arterial calcification of infancy (GACI), with extremely severe arterial calcification diagnosed by prenatal ultrasound or perinatally, and arterial calcification due to CD73 deficiency (ACDC) manifesting with arterial and juxta-articular mineralization in the elderly; the latter disorders are caused by mutations in ENPP1 and NT5E, respectively. The unifying pathomechanistic feature in these three conditions is reduced plasma levels of inorganic pyrophosphate (PPi), a powerful endogenous inhibitor of ectopic mineralization. Several on-going attempts to develop treatments for these conditions, either with the goal to normalize PPi plasma levels or by means of preventing calcium hydroxyapatite deposition independent of PPi, are in advanced preclinical levels or in early clinical trials. This overview summarizes the prospects of treatment development for ectopic mineralization disorders, with PXE, GACI and ACDC as the target diseases, from the 2020 vantage point.
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Affiliation(s)
- Hongbin Luo
- Department of Dermatology and Cutaneous Biology, Sidney Kimmel Medical College and the PXE International Center for Excellence in Research and Clinical Care, Thomas Jefferson University, Philadelphia, PA 19107, USA; (H.L.); (Q.L.)
- Department of Dermatology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310006, China;
| | - Qiaoli Li
- Department of Dermatology and Cutaneous Biology, Sidney Kimmel Medical College and the PXE International Center for Excellence in Research and Clinical Care, Thomas Jefferson University, Philadelphia, PA 19107, USA; (H.L.); (Q.L.)
- Jefferson Institute of Molecular Medicine, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Yi Cao
- Department of Dermatology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310006, China;
| | - Jouni Uitto
- Department of Dermatology and Cutaneous Biology, Sidney Kimmel Medical College and the PXE International Center for Excellence in Research and Clinical Care, Thomas Jefferson University, Philadelphia, PA 19107, USA; (H.L.); (Q.L.)
- Jefferson Institute of Molecular Medicine, Thomas Jefferson University, Philadelphia, PA 19107, USA
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Sun J, She P, Liu X, Gao B, Jin D, Zhong TP. Disruption of Abcc6 Transporter in Zebrafish Causes Ocular Calcification and Cardiac Fibrosis. Int J Mol Sci 2020; 22:ijms22010278. [PMID: 33383974 PMCID: PMC7795442 DOI: 10.3390/ijms22010278] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 12/18/2020] [Accepted: 12/25/2020] [Indexed: 12/14/2022] Open
Abstract
Pseudoxanthoma elasticum (PXE), caused by ABCC6/MRP6 mutation, is a heritable multisystem disorder in humans. The progressive clinical manifestations of PXE are accompanied by ectopic mineralization in various connective tissues. However, the pathomechanisms underlying the PXE multisystem disorder remains obscure, and effective treatment is currently available. In this study, we generated zebrafish abcc6a mutants using the transcription activator-like effector nuclease (TALEN) technique. In young adult zebrafish, abcc6a is expressed in the eyes, heart, intestine, and other tissues. abcc6a mutants exhibit extensive calcification in the ocular sclera and Bruch's membrane, recapitulating part of the PXE manifestations. Mutations in abcc6a upregulate extracellular matrix (ECM) genes, leading to fibrotic heart with reduced cardiomyocyte number. We found that abcc6a mutation reduced levels of both vitamin K and pyrophosphate (PPi) in the serum and diverse tissues. Vitamin K administration increased the gamma-glutamyl carboxylated form of matrix gla protein (cMGP), alleviating ectopic calcification and fibrosis in vertebrae, eyes, and hearts. Our findings contribute to a comprehensive understanding of PXE pathophysiology from zebrafish models.
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Affiliation(s)
- Jianjian Sun
- State Key Laboratory of Genetic Engineering, School of Life Sciences, Fudan University, Shanghai 200438, China;
- Shanghai Key Laboratory of Regulatory Biology, Institute of Molecular Medicine, School of Life Sciences, East China Normal University, Shanghai 200241, China; (P.S.); (X.L.); (B.G.); (D.J.)
| | - Peilu She
- Shanghai Key Laboratory of Regulatory Biology, Institute of Molecular Medicine, School of Life Sciences, East China Normal University, Shanghai 200241, China; (P.S.); (X.L.); (B.G.); (D.J.)
| | - Xu Liu
- Shanghai Key Laboratory of Regulatory Biology, Institute of Molecular Medicine, School of Life Sciences, East China Normal University, Shanghai 200241, China; (P.S.); (X.L.); (B.G.); (D.J.)
| | - Bangjun Gao
- Shanghai Key Laboratory of Regulatory Biology, Institute of Molecular Medicine, School of Life Sciences, East China Normal University, Shanghai 200241, China; (P.S.); (X.L.); (B.G.); (D.J.)
| | - Daqin Jin
- Shanghai Key Laboratory of Regulatory Biology, Institute of Molecular Medicine, School of Life Sciences, East China Normal University, Shanghai 200241, China; (P.S.); (X.L.); (B.G.); (D.J.)
| | - Tao P. Zhong
- Shanghai Key Laboratory of Regulatory Biology, Institute of Molecular Medicine, School of Life Sciences, East China Normal University, Shanghai 200241, China; (P.S.); (X.L.); (B.G.); (D.J.)
- Correspondence: ; Tel.: +86-021-54345021
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Veiga-Lopez A, Sethuraman V, Navasiolava N, Makela B, Olomu I, Long R, van de Wetering K, Martin L, Aranyi T, Szeri F. Plasma Inorganic Pyrophosphate Deficiency Links Multiparity to Cardiovascular Disease Risk. Front Cell Dev Biol 2020; 8:573727. [PMID: 33363139 PMCID: PMC7755719 DOI: 10.3389/fcell.2020.573727] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 11/18/2020] [Indexed: 12/17/2022] Open
Abstract
Epidemiological studies indicate that elevated alkaline phosphatase activity is associated with increased cardiovascular disease risk. Other epidemiological data demonstrate that mothers giving multiple childbirths (multipara) are also at increased risk of developing late-onset cardiovascular disease. We hypothesized that these two associations stem from a common cause, the insufficient plasma level of the ectopic mineralization inhibitor inorganic pyrophosphate, which is a substrate of alkaline phosphatase. As alkaline phosphatase activity is elevated in pregnancy, we hypothesized that pyrophosphate concentrations decrease gestationally, potentially leading to increased maternal vascular calcification and cardiovascular disease risk in multipara. We investigated plasma pyrophosphate kinetics pre- and postpartum in sheep and at term in humans and demonstrated its shortage in pregnancy, mirroring alkaline phosphatase activity. Next, we tested whether multiparity is associated with increased vascular calcification in pseudoxanthoma elasticum patients, characterized by low intrinsic plasma pyrophosphate levels. We demonstrated that these patients had increased vascular calcification when they give birth multiple times. We propose that transient shortages of pyrophosphate during repeated pregnancies might contribute to vascular calcification and multiparity-associated cardiovascular disease risk threatening hundreds of millions of healthy women worldwide. Future trials are needed to assess if gestational pyrophosphate supplementation might be a suitable prophylactic treatment to mitigate maternal cardiovascular disease risk in multiparous women.
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Affiliation(s)
- Almudena Veiga-Lopez
- Department of Pathology, The University of Illinois at Chicago, Chicago, IL, United States.,Department of Animal Science, Michigan State University, East Lansing, MI, United States
| | - Visalakshi Sethuraman
- Department of Pediatrics and Human Development, Michigan State University, Lansing, MI, United States.,Department of Pediatrics, Texas Tech University Health Sciences Center, Odessa, TX, United States
| | | | - Barbara Makela
- Department of Animal Science, Michigan State University, East Lansing, MI, United States
| | - Isoken Olomu
- Department of Pediatrics and Human Development, Michigan State University, Lansing, MI, United States
| | - Robert Long
- Department of Obstetrics and Gynecology, Sparrow Hospital, Lansing, MI, United States
| | - Koen van de Wetering
- Department of Dermatology and Cutaneous Biology, PXE International Center of Excellence in Research and Clinical Care, Thomas Jefferson University, Philadelphia, PA, United States
| | - Ludovic Martin
- Department of Pediatrics, Texas Tech University Health Sciences Center, Odessa, TX, United States
| | - Tamas Aranyi
- Department of Molecular Biology, Semmelweis University, Budapest, Hungary.,Institute of Enzymology, Research Centre for Natural Sciences, Budapest, Hungary
| | - Flora Szeri
- Department of Dermatology and Cutaneous Biology, PXE International Center of Excellence in Research and Clinical Care, Thomas Jefferson University, Philadelphia, PA, United States.,Institute of Enzymology, Research Centre for Natural Sciences, Budapest, Hungary.,Department of Biochemistry, Semmelweis University, Budapest, Hungary
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45
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Terry SF. The Human Face of ABCC6. FEBS Lett 2020; 594:4151-4157. [DOI: 10.1002/1873-3468.14002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 11/09/2020] [Accepted: 11/10/2020] [Indexed: 01/08/2023]
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Laurain A, Rubera I, Duranton C, Rutsch F, Nitschke Y, Ray E, Vido S, Sicard A, Lefthériotis G, Favre G. Alkaline Phosphatases Account for Low Plasma Levels of Inorganic Pyrophosphate in Chronic Kidney Disease. Front Cell Dev Biol 2020; 8:586831. [PMID: 33425894 PMCID: PMC7793922 DOI: 10.3389/fcell.2020.586831] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 11/16/2020] [Indexed: 01/19/2023] Open
Abstract
Introduction Patients on dialysis and kidney transplant recipients (KTR) present the syndrome of mineral and bone disorders (MBD), which share common traits with monogenic calcifying diseases related to disturbances of the purinergic system. Low plasma levels of inorganic pyrophosphate (PPi) and ectopic vascular calcifications belong to these two conditions. This suggests that the purinergic system may be altered in chronic kidney disease with MBD. Therefore, we perform a transversal pilot study in order to compare the determinants of PPi homeostasis and the plasma levels of PPi in patients on dialysis, in KTR and in healthy people. Patients and Methods We included 10 controls, 10 patients on maintenance dialysis, 10 early KTR 3 ± 1 months after transplantation and nine late KTR 24 ± 3 months after transplantation. We measured aortic calcifications, plasma and urine levels of PPi, the renal fractional excretion of PPi (FePPi), nucleoside triphosphate hydrolase (NPP) and ALP activities in plasma. Correlations and comparisons were assessed with non-parametric tests. Results Low PPi was found in patients on dialysis [1.11 (0.88–1.35), p = 0.004], in early KTR [0.91 (0.66–0.98), p = 0.0003] and in late KTR [1.16 (1.07–1.45), p = 0.02] compared to controls [1.66 (1.31–1.72) μmol/L]. Arterial calcifications were higher in patients on dialysis than in controls [9 (1–75) vs. 399 (25–526) calcium score/cm2, p < 0.05]. ALP activity was augmented in patients on dialysis [113 (74–160), p = 0.01] and in early KTR [120 (84–142), p = 0.002] compared to controls [64 (56–70) UI/L]. The activity of NPP and FePPi were not different between groups. ALP activity was negatively correlated with PPi (r = −0.49, p = 0.001). Discussion Patients on dialysis and KTR have low plasma levels of PPi, which are partly related to high ALP activity, but neither to low NPP activity, nor to increased renal excretion of PPi. Further work is necessary to explore comprehensively the purinergic system in chronic kidney disease.
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Affiliation(s)
- Audrey Laurain
- Faculty of Medicine, Côte d'Azur University, Nice, France.,UMR 7073, Laboratory of Physiology and Molecular Medicine (LP2M), Centre National de la Recherche Scientifique, Nice, France.,Nephrology Department, University Hospital, Nice, France
| | - Isabelle Rubera
- UMR 7073, Laboratory of Physiology and Molecular Medicine (LP2M), Centre National de la Recherche Scientifique, Nice, France
| | - Christophe Duranton
- UMR 7073, Laboratory of Physiology and Molecular Medicine (LP2M), Centre National de la Recherche Scientifique, Nice, France
| | - Frank Rutsch
- Department of General Pediatrics, Muenster University Children's Hospital, Muenster, Germany
| | - Yvonne Nitschke
- Department of General Pediatrics, Muenster University Children's Hospital, Muenster, Germany
| | - Elodie Ray
- Department of Vascular Medicine and Surgery, University Hospital, Nice, France
| | - Sandor Vido
- Nephrology Department, University Hospital, Nice, France
| | - Antoine Sicard
- Faculty of Medicine, Côte d'Azur University, Nice, France.,Nephrology Department, University Hospital, Nice, France
| | - Georges Lefthériotis
- Faculty of Medicine, Côte d'Azur University, Nice, France.,UMR 7073, Laboratory of Physiology and Molecular Medicine (LP2M), Centre National de la Recherche Scientifique, Nice, France.,Department of Vascular Medicine and Surgery, University Hospital, Nice, France
| | - Guillaume Favre
- Faculty of Medicine, Côte d'Azur University, Nice, France.,UMR 7073, Laboratory of Physiology and Molecular Medicine (LP2M), Centre National de la Recherche Scientifique, Nice, France.,Nephrology Department, University Hospital, Nice, France
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Verschuere S, Van Gils M, Nollet L, Vanakker OM. From membrane to mineralization: the curious case of the ABCC6 transporter. FEBS Lett 2020; 594:4109-4133. [PMID: 33131056 DOI: 10.1002/1873-3468.13981] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 10/12/2020] [Accepted: 10/16/2020] [Indexed: 12/13/2022]
Abstract
ATP-binding cassette subfamily C member 6 gene/protein (ABCC6) is an ATP-dependent transmembrane transporter predominantly expressed in the liver and the kidney. ABCC6 first came to attention in human medicine when it was discovered in 2000 that mutations in its encoding gene, ABCC6, caused the autosomal recessive multisystemic mineralization disease pseudoxanthoma elasticum (PXE). Since then, the physiological and pathological roles of ABCC6 have been the subject of intense research. In the last 20 years, significant findings have clarified ABCC6 structure as well as its physiological role in mineralization homeostasis in humans and animal models. Yet, several facets of ABCC6 biology remain currently incompletely understood, ranging from the precise nature of its substrate(s) to the increasingly complex molecular genetics. Nonetheless, advances in our understanding of pathophysiological mechanisms causing mineralization lead to several treatment options being suggested or already tested in pilot clinical trials for ABCC6 deficiency. This review highlights current knowledge of ABCC6 and the challenges ahead, particularly the attempts to translate basic science into clinical practice.
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Affiliation(s)
- Shana Verschuere
- Center for Medical Genetics, Ghent University Hospital, Belgium.,Department of Biomolecular Medicine, Ghent University, Belgium.,Ectopic Mineralization Research Group Ghent, Ghent, Belgium
| | - Matthias Van Gils
- Center for Medical Genetics, Ghent University Hospital, Belgium.,Department of Biomolecular Medicine, Ghent University, Belgium.,Ectopic Mineralization Research Group Ghent, Ghent, Belgium
| | - Lukas Nollet
- Center for Medical Genetics, Ghent University Hospital, Belgium.,Department of Biomolecular Medicine, Ghent University, Belgium.,Ectopic Mineralization Research Group Ghent, Ghent, Belgium
| | - Olivier M Vanakker
- Center for Medical Genetics, Ghent University Hospital, Belgium.,Department of Biomolecular Medicine, Ghent University, Belgium.,Ectopic Mineralization Research Group Ghent, Ghent, Belgium
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Extracellular Nucleotides Regulate Arterial Calcification by Activating Both Independent and Dependent Purinergic Receptor Signaling Pathways. Int J Mol Sci 2020; 21:ijms21207636. [PMID: 33076470 PMCID: PMC7589647 DOI: 10.3390/ijms21207636] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 10/09/2020] [Accepted: 10/12/2020] [Indexed: 01/02/2023] Open
Abstract
Arterial calcification, the deposition of calcium-phosphate crystals in the extracellular matrix, resembles physiological bone mineralization. It is well-known that extracellular nucleotides regulate bone homeostasis raising an emerging interest in the role of these molecules on arterial calcification. The purinergic independent pathway involves the enzymes ecto-nucleotide pyrophosphatase/phosphodiesterases (NPPs), ecto-nucleoside triphosphate diphosphohydrolases (NTPDases), 5′-nucleotidase and alkaline phosphatase. These regulate the production and breakdown of the calcification inhibitor—pyrophosphate and the calcification stimulator—inorganic phosphate, from extracellular nucleotides. Maintaining ecto-nucleotidase activities in a well-defined range is indispensable as enzymatic hyper- and hypo-expression has been linked to arterial calcification. The purinergic signaling dependent pathway focusses on the activation of purinergic receptors (P1, P2X and P2Y) by extracellular nucleotides. These receptors influence arterial calcification by interfering with the key molecular mechanisms underlying this pathology, including the osteogenic switch and apoptosis of vascular cells and possibly, by favoring the phenotypic switch of vascular cells towards an adipogenic phenotype, a recent, novel hypothesis explaining the systemic prevention of arterial calcification. Selective compounds influencing the activity of ecto-nucleotidases and purinergic receptors, have recently been developed to treat arterial calcification. However, adverse side-effects on bone mineralization are possible as these compounds reasonably could interfere with physiological bone mineralization.
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Tőkési N, Kozák E, Fülöp K, Dedinszki D, Hegedűs N, Király B, Szigeti K, Ajtay K, Jakus Z, Zaworski J, Letavernier E, Pomozi V, Váradi A. Pyrophosphate therapy prevents trauma-induced calcification in the mouse model of neurogenic heterotopic ossification. J Cell Mol Med 2020; 24:11791-11799. [PMID: 32885586 PMCID: PMC7579705 DOI: 10.1111/jcmm.15793] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 07/19/2020] [Accepted: 07/31/2020] [Indexed: 12/18/2022] Open
Abstract
Trauma‐induced calcification is the pathological consequence of complex injuries which often affect the central nervous system and other parts of the body simultaneously. We demonstrated by an animal model recapitulating the calcification of the above condition that adrenaline transmits the stress signal of brain injury to the calcifying tissues. We have also found that although the level of plasma pyrophosphate, the endogenous inhibitor of calcification, was normal in calcifying animals, it could not counteract the acute calcification. However, externally added pyrophosphate inhibited calcification even when it was administered after the complex injuries. Our finding suggests a potentially powerful clinical intervention of calcification triggered by polytrauma injuries which has no effective treatment.
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Affiliation(s)
- Natália Tőkési
- Institute of Enzymology, Research Center for Natural Sciences, Hungarian Academy of Sciences Centre of Excellence, Budapest, Hungary
| | - Eszter Kozák
- Institute of Enzymology, Research Center for Natural Sciences, Hungarian Academy of Sciences Centre of Excellence, Budapest, Hungary
| | - Krisztina Fülöp
- Institute of Enzymology, Research Center for Natural Sciences, Hungarian Academy of Sciences Centre of Excellence, Budapest, Hungary
| | - Dóra Dedinszki
- Institute of Enzymology, Research Center for Natural Sciences, Hungarian Academy of Sciences Centre of Excellence, Budapest, Hungary
| | - Nikolett Hegedűs
- Department of Biophysics and Radiation Biology, Semmelweis University, Budapest, Hungary
| | - Bálint Király
- Department of Biophysics and Radiation Biology, Semmelweis University, Budapest, Hungary.,Department of Cellular and Network Neurobiology, Institute of Experimental Medicine, Budapest, Hungary
| | - Krisztián Szigeti
- Department of Biophysics and Radiation Biology, Semmelweis University, Budapest, Hungary
| | - Kitti Ajtay
- Department of Physiology, Semmelweis University, Budapest, Hungary
| | - Zoltán Jakus
- Department of Physiology, Semmelweis University, Budapest, Hungary
| | - Jeremy Zaworski
- Sorbonne Université, UPMC Univ Paris 06, Paris, France.,INSERM, UMR S 1155, Paris, France
| | - Emmanuel Letavernier
- Sorbonne Université, UPMC Univ Paris 06, Paris, France.,INSERM, UMR S 1155, Paris, France
| | - Viola Pomozi
- Institute of Enzymology, Research Center for Natural Sciences, Hungarian Academy of Sciences Centre of Excellence, Budapest, Hungary
| | - András Váradi
- Institute of Enzymology, Research Center for Natural Sciences, Hungarian Academy of Sciences Centre of Excellence, Budapest, Hungary
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In vitro and in vivo investigation of osteogenic properties of self-contained phosphate-releasing injectable purine-crosslinked chitosan-hydroxyapatite constructs. Sci Rep 2020; 10:11603. [PMID: 32665560 PMCID: PMC7360623 DOI: 10.1038/s41598-020-67886-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 05/18/2020] [Indexed: 01/05/2023] Open
Abstract
Bone fracture repair is a multifaceted, coordinated physiological process that requires new bone formation and resorption, eventually returning the fractured bone to its original state. Currently, a variety of different approaches are pursued to accelerate the repair of defective bones, which include the use of 'gold standard' autologous bone grafts. However, such grafts may not be readily available, and procedural complications may result in undesired outcomes. Considering the ease of use and tremendous customization potentials, synthetic materials may become a more suitable alternative of bone grafts. In this study, we examined the osteogenic potential of guanosine 5′-diphosphate-crosslinked chitosan scaffolds with the incorporation of hydroxyapatite, with or without pyrophosphatase activity, both in vitro and in vivo. First, scaffolds embedded with cells were characterized for cell morphology, viability, and attachment. The cell-laden scaffolds were found to significantly enhance proliferation for up to threefold, double alkaline phosphatase activity and osterix expression, and increase calcium phosphate deposits in vitro. Next, chitosan scaffolds were implanted at the fracture site in a mouse model of intramedullary rod-fixed tibial fracture. Our results showed increased callus formation at the fracture site with the scaffold carrying both hydroxyapatite and pyrophosphatase in comparison to the control scaffolds lacking both pyrophosphatase and hydroxyapatite, or pyrophosphatase alone. These results indicate that the pyrophosphatase-hydroxyapatite composite scaffold has a promising capacity to facilitate bone fracture healing.
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