Osteoclasts can be induced in fish having an acellular bony skeleton

Kelp bass (Paralabrax clathratus) and leopard sharks (Triakis semifasciata) are characterized by an acellular (anosteocytic) bony skeleton and a focally calcified cartilaginous endoskeleton, respectively. These skeletal forms are not considered to function as mineral reservoirs. Previous studies showed that implanted bone particles are resorbed in rats by large multinucleated cells with ultrastructural features (ruffled borders) characteristic of osteoclasts. We tested the ability of fish to resorb bone matrix and to adapt to reduced salinity conditions. Bone particles were implanted in sharks and bass maintained in seawater (34 ppt, 40.5 mg of calcium per dl) or in diluted seawater (26 ppt, 28.5 mg of calcium per dl). Sera and elicited tissues were harvested 4 weeks later. In sharks, bone particles were not resorbed, and multinucleated cells were not evident under either normal or hyposalinity conditions. Shark sera were isoosmolar with the seawater or diluted seawater, with serum chemistries of the hyposalinity group reflecting the 23% reduction in environmental minerals and electrolytes, compared to sharks in normal seawater. In marked contrast, bass adapted to diluted seawater resorbed bone particles and maintained normal serum chemistries. Electron microcopy showed that the bone particles were surrounded by large, foamy multinucleated cells, many with membrane specializations typical of osteoclasts from higher vertebrates, i.e., extensive clear zones apposed to intact bone matrix and active ruffled borders overlying areas of matrix undergoing dissolution. Although osteoclasts had not been described in these fish, this study shows that bass have stem cells that can be stimulated to differentiate into bone-resorbing osteoclasts.

Coherent expression chromosome cluster analysis reveals differential regulatory functions of amino-terminal and distal parathyroid hormone-related protein domains in prostate carcinoma

Parathyroid hormone-related protein (PTHrP) has a number of cancer-related actions. While best known for causing hypercalcemia of malignancy, it also has effects on cancer cell growth, apoptosis, and angiogenesis. Studying the actions of PTHrP in human cancer is complicated because there are three isoforms and many derived peptides. Several peptides are biologically active at known or presumed cell surface receptors; in addition, the PTHrP-derived molecules can exert effects at the cell nucleus. To address this complexity, we studied gene expression in a DU 145 prostate cancer cell line that was stably transfected with control vector, PTHrP 1-173 and PTHrP 33-173. With this model, regulatory effects of the amino-terminal portion of PTHrP would result only from transduction with the full-length molecule, while effects pertaining to distal sequences would be evident with either construct. Analysis of the expression profiles by microarrays demonstrated nonoverlapping groups of differentially expressed genes. Amino-terminal PTHrP affected groups of genes involved in apoptosis, prostaglandin and sex steroid metabolism, cell-matrix interactions, and cell differentiation, while PTHrP 33-173 caused substantial increases in MHC class I antigen expression. This work demonstrates the distinct biological actions of the amino-terminus compared to distal mid-molecule or carboxy-terminal sequences of PTHrP in prostate carcinoma cells and provides targets for further study of the malignant process.

Serum bone Gla protein and other biochemical estimates of bone turnover in early postmenopausal women during prophylactic treatment for osteoporosis

Serum bone Gla protein (BGP) and conventional biochemical indices of bone metabolism were determined in 66 early postmenopausal women during a double-blind therapeutic trial performed to investigate the effect of oestrogen, calcium and 1,25 (OH)2D3 on postmenopausal osteoporosis. The biochemical variables were determined before, during and after withdrawal of therapy. We found a very high correlation between serum BGP and serum alkaline phosphatase--a measure of bone formation, less high correlation between serum BGP and the remaining parameters--indices of bone resorption. It is concluded that serum BGP probably reflects bone formation and may prove to be a useful new biochemical marker.

Chondrocyte calcium-sensing receptor expression is up-regulated in early guinea pig knee osteoarthritis and modulates PTHrP, MMP-13, and TIMP-3 expression

OBJECTIVE

Growth plate chondrocytes up-regulate calcium-sensing receptor (CaR) expression as they mature to hypertrophy. In cells other than chondrocytes, extracellular calcium-sensing via the CaR functions partly to promote expression of parathyroid hormone-related protein (PTHrP), a critical regulator of endochondral development. Moreover, PTHrP is up-regulated in human osteoarthritis (OA) and surgically induced rabbit OA cartilages and may promote both chondrocyte proliferation and osteophyte formation therein. Hence, we examined chondrocyte CaR-mediated calcium-sensing in OA pathogenesis.

METHODS

We studied spontaneous knee OA in male Hartley guinea pigs. We also evaluated cultured bovine knee chondrocytes and immortalized human articular chondrocytes (CH-8 cells), employing the CaR calcimimetic agonist NPS R-467 or altering physiologic extracellular calcium (1.8 mM).

RESULTS

Immunohistochemistry revealed that CaR expression became up-regulated in the superficial zone at 4 months of age in the guinea pig medial tibial plateau cartilage as early OA developed. CaR expression later became up-regulated in the middle zone. PTHrP content, measured by immunoassay, was significantly increased in the medial tibial plateau cartilage as OA developed and progressed. In cultured chondrocytic cells, CaR-mediated extracellular calcium-sensing, stimulated by the calcimimetic NPS R-467, induced PTHrP and matrix metalloproteinase (MMP)-13 expression and suppressed expression of tissue inhibitor of metalloproteinase (TIMP)-3 dose-dependently, effects shared by elevated extracellular calcium (3 mM). Extracellular calcium-sensing appeared essential for PTHrP and interleukin (IL)-1 to induce MMP-13 and for PTHrP 1-34 to suppress TIMP-3 expression.

CONCLUSIONS

Chondrocyte CaR expression becomes up-regulated early in the course of spontaneous guinea pig knee OA. Chondrocyte CaR-mediated extracellular calcium-sensing promotes PTHrP expression, modulates the effects of PTHrP and IL-1, and promotes MMP-13 expression and TIMP-3 depletion. Our results implicate up-regulated extracellular calcium-sensing via the CaR as a novel mediator of OA progression.

Monitoring of skeletal progression of prostate cancer by GFP imaging, X-ray, and serum OPG and PTHrP

BACKGROUND

Prostate cancers (PCas) produce factors that can serve as biomarkers for tumor metastasis and bone progression. Transduced GFP expression by cancer cells can be imaged to monitor therapy. We exploited both concepts by developing a GFP-expressing PCa cell line that expresses PTHrP and studying it in an animal model of malignancy with methods that assess the skeletal progression of this tumor.

METHODS

We developed a GFP-producing PCa cell line by stable transduction of PC-3 PCa cells. This PC-3 variant was used to study tumor progression in an immunocompromised mouse model. Skeletal progression of the PCa cells and the effects of pamidronate administration were evaluated radiologically, fluorometrically, and by measurement of serum tumor markers.

RESULTS

The PC-3 cells produced extensive bone lesions when injected into the tibia of immunocompromised mice. The skeletal progression of the PC-3 cells could be monitored by GFP optical imaging, X-ray, and by measurements of tumor products in serum, notably PTHrP and OPG. Pamidronate treatment reduced tumor burden as assessed at autopsy by imaging and biomarkers.

CONCLUSIONS

Pamidronate treatment exhibited anti-tumor effects that were reflected by decreases in serum PTHrP, OPG, and by GFP and radiological imaging procedures. Imaging of GFP expression enables real-time monitoring of tumor growth in the bone. PTHrP and OPG may be useful as tumor biomarkers for PCa that has metastasized to bone. This novel human PCa model can be used to study the clinical potential of diagnostic and therapeutic modalities in the skeletal progression of PCas.

Parathyroid hormone-related protein and lung injury after pulmonary thromboendarterectomy

Parathyroid hormone-related protein (PTHrP) is an autocrine growth and differentiation factor for alveolar type II epithelial cells. Type II cells secrete pulmonary surfactant and are pluripotent cells with a role in alveolar epithelial repair after lung injury. The goals of this study were to investigate whether the levels of PTHrP in bronchoalveolar lavage liquid (BAL) varied between patients who did and did not develop lung injury after pulmonary thromboendarterectomy (PTE). BAL was performed in 48 patients undergoing PTE for unresolved pulmonary emboli. Samples were obtained following induction of anesthesia, following separation from cardiopulmonary bypass, and 48 h postoperatively. PTHrP was measured by radioimmunoassay. Lung injury was diagnosed in 23 patients on the basis of hypoxemia (PaO(2)/FIO(2) < 300) and the presence of lung infiltrates in the absence of infection or atelectasis. Patients with lung injury had significantly lower preoperative BAL levels of PTHrP, 21 (21-30) pg/ml (median, interquartile gap), compared to patients without lung injury, 34 (21-41) pg/ml (P < 0.05). Preoperative BAL PTHrP levels < 32 pg/ml predicted lung injury with a positive predictive value of 60% and negative predictive value of 82%. The odds of developing lung injury for patients with preoperative PTHrP levels below this cutpoint were 6 times the odds for patients with higher levels.

Parathyroid hormone-related protein regulates the growth of orthotopic human lung tumors in athymic mice

BACKGROUND

Parathyroid hormone-related protein (PTHrP) has growth regulatory effects for many malignant cells and may influence the progression of carcinomas of the breast, prostate, and lung. In the current study, the authors investigated the in vivo and in vitro effects of PTHrP neutralizing antibody and PTHrP treatment on the growth of BEN cells, a human lung squamous cell carcinoma line that expresses PTHrP and its receptor.

METHODS

Orthotopic lung tumors were produced in 20 athymic mice with BEN-GFP cells (a clonal line that stably expresses green fluorescent protein [GFP]) by instilling suspensions of 3 x 10(6) cells per mouse into the lungs of anesthetized animals. The mice were divided into 2 groups receiving either subcutaneous mouse antihuman PTHrP antibodies or irrelevant mouse immunoglobulin (Ig) G (150 microg) twice weekly.

RESULTS

After 30 days, 6 of 10 mice receiving anti-PTHrP antibodies had lung tumors visible on macroscopic inspection, but only 1 of the 10 mice treated with irrelevant IgG had a lung tumor that was of that size (P < 0.01). GFP fluorescence was significantly greater in lung homogenates of the PTHrP antibody-treated mice than in the mice treated with IgG (6006 +/- 411 vs. 2907 +/- 282 relative fluorescent units, respectively; P < 0.001). Although neutralizing antibodies stimulated BEN cell lung tumor growth, exogenous PTHrP 1-34 treatment (0.01-1 nM) inhibited the growth of cultured BEN cells by approximately 40%.

CONCLUSIONS

Although PTHrP expression has been reported to be associated with more aggressive malignancies, the data from the current study suggest that PTHrP 1-34 was a paracrine growth inhibitor in BEN human lung carcinoma cells. The growth-related effects of PTHrP are complex, and can be both stimulatory and inhibitory.

Proteolysis of ProPTHrP(1-141) by "prohormone thiol protease" at multibasic residues generates PTHrP-related peptides: implications for PTHrP peptide production in lung cancer cells

The parathyroid hormone-related protein (PTHrP) precursor requires proteolytic processing to generate PTHrP-related peptide products that possess regulatory functions in the control of PTH-like (parathyroid-like) actions and cell growth, calcium transport, and osteoclast activity. Biologically active peptide domains within the PTHrP precursor are typically flanked at their NH2- and COOH-termini by basic residue cleavage sites consisting of multibasic, dibasic, and monobasic residues. These basic residues are predicted to serve as proteolytic cleavage sites for converting the PTHrP precursor into active peptide products. The coexpression of the prohormone processing enzyme PTP ("prohormone thiol protease") in PTHrP-containing lung cancer cells, and the lack of PTP in cell lines that contain little PTHrP, implicate PTP as a candidate processing enzyme for proPTHrP. Therefore, in this study, PTP cleavage of recombinant proPTHrP(1-141) precursor was evaluated by MALDI mass spectrometry to identify peptide products and cleavage sites. PTP cleaved the PTHrP precursor at the predicted basic residue cleavage sites to generate biologically active PTHrP-related peptides that correspond to the NH2-terminal domain (residues 1-37) that possesses PTH-like and growth regulatory activities, the mid-region domain (residues 38-93) that regulates calcium transport, and the COOH-terminal domain (residues 102-141) that modulates osteoclast activity. Lack of cleavage at other types of amino acids demonstrated the specificity of PTP processing at basic residue cleavage sites. Overall, these results demonstrate the ability of PTP to cleave the PTHrP precursor at multibasic, dibasic, and monobasic residue cleavage sites to generate active PTHrP-related peptides. The presence of PTP immunoreactivity in PTHrP-containing lung cancer cells suggests PTP as a candidate processing enzyme for the PTHrP precursor.

Comparative tissue distribution of the processing enzymes "prohormone thiol protease," and prohormone convertases 1 and 2, in human PTHrP-producing cell lines and mammalian neuroendocrine tissues

Peptide hormones are generated by proteolytic processing of their respective protein precursors by several prohormone processing proteases. The peptide hormone PTHrP is widely expressed in normal and malignant tissues, where proPTHrP undergoes proteolytic processing to generate PTHrP peptides with distinct biological actions. In this study, the tissue distribution of the prohormone processing enzymes PTP, PC1, and PC2 were compared by immunohistochemistry in human PTHrP-producing cancer cell lines, and in mammalian neuroendocrine and other tissues from rat and bovine that contain peptide hormones. PTP, PC1, and PC2 were prominently expressed in PTHrP-expressing human cancer cell lines originating from tumors of the breast, lung, prostate, as well as lymphoma. These processing enzymes also showed significant expression in normal mammalian neuroendocrine tissues from bovine and rat, including pituitary, hypothalamus, adrenal medulla, pancreas, and other tissues. Most neuroendocrine tissues contained prominent levels of at least two of the three processing enzymes examined, and all tissues contained at least one of these three enzymes. Differential expression of processing enzyme proteins was also demonstrated by Western blots. The differential expression of PTP, PC1, and PC2 observed in certain cancer and normal neuroendocrine cell types postulates selective roles for these processing enzymes in different tissues for generating biologically active peptide hormones. These results support the importance of these processing enzymes in their hypothesized roles in prohormone processing.

Harvard v. Canada: the myc mouse that still squeaks in the maze of biopatent law

The Canadian Supreme Court will soon make a decision about Harvard University's long-standing application for a Canadian patent on a mouse transgenic for the myc oncogene. That decision could reignite in North America the controversy that continues in Europe and elsewhere to surround the patenting of life forms. The tortuous steps in this 15-year patent maze are marked by the arguments about life patents that attended the U.S. Supreme Court's decision in Diamond v. Chakrabarty. This patent dispute about oil-digesting bacteria cracked open the door for animal patents in the United States and other countries, even though the legal arguments involved were based on patent applications for corn seeds and oysters, not mammals. The patent challenge to the Harvard mouse by the Canadian government now threatens to close this door in Canada. The arguments against life patents are commonly based on moral and religious grounds that regard the sanctity of life and oppose its commodification. The most compelling arguments for such patents are based on the benefits they deliver through commercial exploitation of inventions. The debate about patenting animals has been more heated outside North America and cacaphonic in the Third World. However, the Canadian debate could be amplified by the U.S. Supreme Court's recent entry on the biopatent stage through the side door of a new corn seed patent dispute. A narrow legal analysis by the Canadian Supreme Court would award the mouse patent to Harvard, while a policy analysis might support the government's challenge of the patent. Although the impact of the Harvard mouse patent process in Canada could be just a squeak, opponents of patenting life can mount the myc mouse to once again roar their opposition to animal patents. And the sound could resonate through the arguments about both biopatents and human cloning, with potentially important effects for academia, industry, and the public.

High-efficiency non-viral transfection of primary chondrocytes and perichondrial cells for ex-vivo gene therapy to repair articular cartilage defects

BACKGROUND

Primary perichondrial cells and chondrocytes have been used to repair articular cartilage defects in tissue engineering studies involving various animal models. Transfection of these cells with a gene that induces chondrocytic phenotype may form an ideal method to affect tissue engineering of articular cartilage.

DESIGN

A protocol for high-efficiency transfection of primary perichondrial and cartilage cells was optimized. Plasmids carrying the marker beta-galactosidase (beta-gal), PTHrP and TGF-beta1 genes driven by a strong mammalian promoter were transfected into primary perichondrial cells and chondrocytes. A three-step method was used to achieve high efficiency of transfection: (1) permeabilization of primary cells using a mild detergent, (2) association of plasmid DNAs with a polycationic (poly-l-lysine) core covalently linked to a receptor ligand (transferrin), (3) introduction of cationic liposomes to form the quaternary complex. For in-vivo assessment, polylactic acid (PLA) scaffolds seeded with beta-gal transfected perichondrial cells were implanted into experimentally created osteochondral defects in rabbit knees for 1 week.

RESULTS

The efficiency of transfection was determined to be over 70%in vitro. The transformed cells continued to express beta-gal, in vivo for the entire test period of 7 days. Furthermore, primary perichondrial cells transfected with TGF-beta1 and PTHrP over-expressed their cognate gene products.

CONCLUSION

The ability to transfect autologous primary perichondrial cells and chondrocytes with high efficiency using a non-viral system may form a first step towards tissue engineering with these transformed cells to repair articular cartilage defects.

Parathyroid hormone-related protein induces interleukin 8 production by prostate cancer cells via a novel intracrine mechanism not mediated by its classical nuclear localization sequence

PTHrP (parathyroid hormone-related protein) overexpression by prostate carcinoma cells has been implicated in tumor progression. Although the biological effects of PTHrP can be mediated by the G-protein-coupled PTH/PTHrP receptor, PTHrP also has intracrine actions mediated by a nuclear localization sequence at residues 87-107. We investigated the effect of PTHrP transfection and treatment on production by prostate carcinoma cells of IL (interleukin)-8, which can regulate prostate cancer growth by angiogenic activity and growth-promoting effects. Six prostate cancer cell lines exhibited constitutive expression of PTHrP and IL-8 that were significantly correlated (r = 0.93; P < 0.01). We transfected wild-type and mutant PTHrP into these cells. Wild-type PTHrP1-173 and PTHrP33-173 lacking the PTH/PTHrP receptor-binding domain induced a 3-fold stimulation of IL-8 production but not production of another angiogenic factor, vascular endothelial growth factor. Transfection of the COOH-terminal truncation mutant PTHrP1-87 induced a 5-fold simulation of IL-8 and a 3-fold increase in IL-8 mRNA. Cells transfected with PTHrP1-87 and 1-173 also showed increased cell proliferation. In contrast, exogenous PTHrP1-34 and 1-86 peptides did not significantly affect IL-8 production; moreover, PTHrP-neutralizing antibodies did not inhibit the production of IL-8 by transfected PTHrP. Additional transfection studies with progressively COOH-terminally truncated PTHrP1-87 defined a 23-amino acid sequence, PTHrP65-87, required for PTHrP1-87 to robustly stimulate IL-8 in prostate cancer cells. Confocal microscopy and immunoassay demonstrated PTHrP1-87 nuclear localization. Our results demonstrate that PTHrP acts to induce IL-8 production in prostate cancer cells via an intracrine pathway independent of its classical nuclear localization sequence. This novel pathway could mediate the effects of PTHrP on the progression of prostate cancer.

Human pancreatic adenocarcinomas express parathyroid hormone-related protein

PTH-related protein (PTHrP) is expressed in many common malignancies such as breast and prostate cancer and can regulate their growth. Little is known, however, about the role of PTHrP in pancreatic adenocarcinoma. To study PTHrP in pancreatic exocrine cancer, we studied its expression in pancreatic cancer cell lines and surgical specimens. Eight human pancreatic adenocarcinoma cell lines were evaluated: AsPC-1, BxPC-3, Capan-1, CFPAC-1, MIA PaCa-2, PANC-1, PANC-28, and PANC-48. Murine monoclonal antibodies to the amino-terminal (1-34), mid-region (38-64), and carboxyl-terminal peptides (109-141) of PTHrP were used to identify cellular PTHrP and secreted PTHrP, including Western blotting and immunocytochemical staining for PTHrP from each cell line. Cellular PTHrP was detected in all cell line extracts by both Western blotting and immunoassay. CFPAC-1, derived from a pancreatic liver metastasis, had the highest concentration of PTHrP, and MIA PaCa-2, derived from primary pancreatic adenocarcinoma, had the lowest. PTHrP was localized by immunocytochemical staining in the cytoplasm in all but one cell line, and both nuclear and cytoplasmic immunostaining were observed in the MIA PaCa-2 and PANC-1 cells. Secretion of PTHrP into cell medium was also observed for each cell line and paralleled intracellular PTHrP levels. Evidence for differential processing of PTHrP expression was provided by studies demonstrating different patterns of PTHrP among the cell lines when assessed by PTHrP immunoassays directed against different PTHrP peptides. In specific, PTHrP secretion measured by a PTHrP-(38-64) assay was highest for BxPC-3, whereas the highest levels of secreted PTHrP-(109-141) occurred in CFPAC-1 and PANC-1. Growth of AsPC-1 cells was stimulated in a dose-dependent manner by PTHrP-(1-34). Immunostaining from archival tissue of patients with pancreatic adenocarcinoma revealed strong PTHrP expression in all 14 specimens. All patients were eucalcemic preoperatively. These results demonstrate that PTHrP is commonly expressed in pancreatic cancer. Our data suggest that PTHrP may have growth-regulating properties in pancreatic adenocarcinoma cells, but further studies are required.

Hypercalcemia due to parathyroid hormone-related protein secretion by melanoma

About 1-2% of melanoma patients develop hypercalcemia. We report hypercalcemia without bone metastasis in a 46-year-old woman with advanced melanoma. The hypercalcemia was associated with elevated serum parathyroid hormone-related protein (PTHrP) levels. An even higher concentration (10 times the serum level) in pleural effusion caused by pleural metastases implied that the source of the increased circulating PTHrP was the melanoma. Immunohistochemical staining of paraffin sections, performed using a monoclonal antibody (9H7) against the peptide sequence 109-141 of human PTHrP, detected PTHrP in the cytoplasm and nucleoli of melanoma cells in an autopsy specimen but not in specimens from this patient prior to onset of hypercalcemia. Considering the evidence, it is very likely that PTHrP production by melanoma caused hypercalcemia in this patient.

Splenic, thymic, bony and lymph node metastases from orthotopic human lung carcinomas in immunocompromised mice

In orthotopic animal models of human lung cancer, bone and lymph node metastases have been observed with high frequency after periods of a few weeks, but metastases to other organs are rare. This study evaluated development of distant metastases over a six-month period in a model of orthotopic lung carcinoma in immunocompromised mice. Human A549 lung adenocarcinoma cells were stably transfected to express high levels of green fluorescent protein. Suspensions of 1 x 10(6) cells were instilled into the lungs of athymic and SCID mice to produce orthotopic human lung carcinomas. All animals had primary tumors at termination of the experiment six months later. Splenic metastases and lymph node metastases were present in 70% of the animals and two of the three SCID mice had thymic metastases. Three animals had bony metastases. Thus, a high percentage of immunocompromised mice with orthotopic lung carcinomas ultimately develop metastases.

Calcitonin and calcitonin gene-related peptide in the human prostate gland

BACKGROUND

Calcitonin-related peptides have been found in the human prostate, and calcitonin (CT) and calcitonin gene-related peptide (CGRP) have been demonstrated in subpopulations of neuroendocrine (NE) cells. The purpose of this study was to determine the concentrations of CT and CGRP as well as the densities of NE cells in normal prostates, benign prostatic hyperplasia (BPH), and carcinoma of the prostate (CAP).

METHODS

In 42 specimens of radical prostatectomy, the number of CT- and CGRP-immunoreactive NE cells in areas of normal and BPH tissue was determined, and compared with CAP tissue using immunocytochemistry. In addition, by radioimmunoassay (RIA), tissue levels of CT and CGRP were analyzed in extracts from areas of normal, BPH, and CAP tissue, as verified by adjacent histologic sections.

RESULTS

A significant decrease in CT-immunoreactive NE cells was observed in hyperplastic nodules of BPH in comparison to normal tissue. These findings were in parallel with a significant reduction in tissue CT level in BPH compared to normal tissue. There was also a marked, but statistically nonsignificant, reduction in CT levels in CAP tissue. In contrast, levels of CGRP in BPH and CAP tissue did not show any significant differences compared to normal tissue.

CONCLUSIONS

CT and CGRP are present in NE cells of the human prostate. Calcitonin levels are significantly reduced in BPH, in parallel with a decreased number of CT-immunoreactive NE cells, whereas no significant changes in tissue levels of CGRP were observed. The functional significance of these findings is discussed.

Parathyroid hormone-related protein reduces alveolar epithelial cell proliferation during lung injury in rats

Parathyroid hormone-related protein (PTHrP) is a growth inhibitor for alveolar type II cells and could be a regulatory factor for alveolar epithelial cell proliferation after lung injury. We investigated lung PTHrP expression in rats exposed to 85% oxygen. Lung levels of PTHrP were significantly decreased between 4 and 8 days of hyperoxia, concurrent with increased expression of proliferating cell nuclear antigen and increased incorporation of 5-bromo-2'-deoxyuridine (BrdU) into DNA in lung corner cells. PTHrP receptor was present in both normal and hyperoxic lung. To test whether the fall in PTHrP was related to cell proliferation, we instilled PTHrP into lungs on the fourth day of hyperoxia. Eight hours later, BrdU labeling in alveolar corner cells was 3.2 +/- 0.4 cells/high-power field in hyperoxic PBS-instilled rats compared with 0.5 +/- 0.3 cells/high-power field in PTHrP-instilled rats (P < 0. 01). Thus PTHrP expression changes in response to lung injury due to 85% oxygen and may regulate cell proliferation.

Prostate carcinoma: production of bioactive factors

BACKGROUND

Many molecular mechanisms regulate prostate carcinoma pathogenesis, proliferation, and progression to bone metastases. The basic molecular mechanisms are endocrine, paracrine, autocrine, and intracrine. These mechanisms can be mediated by a variety of agents, including gonadal and adrenal steroids, retinoic acid and vitamin D derivatives, neuroendocrine factors, growth factors, cytokines, lymphokine, and bone factors. Prominent among them is parathyroid hormone-related protein (PTHrP).

METHODS

The author studied the expression and regulation of PTHrP production in prostate carcinoma cells with nucleic acid and immunochemical probes for the polypeptide. The robust expression of this oncoprotein by prostate carcinoma has been demonstrated. In the current study the author reviews his results and the studies of other investigators regarding PTHrP and the variety of bioactive factors produced by prostate cells.

RESULTS

PTHrP is expressed by most prostate carcinoma. It also is expressed by normal and hyperplastic prostate cells, and there is a gradient of expression that peaks in malignant prostate cells. PTHrP is processed by carcinoma cells into peptides that have unique biologic effects. Among them are regulation of growth and cytokine expression. It has been observed that the effect of PTHrP can be mediated by novel intracrine pathways in prostate carcinoma. These mechanisms influence transduction of growth regulatory signaling pathways, cell proliferation, immunoregulation, and angiogenesis.

CONCLUSIONS

The current study identified PTHrP among the bioactive prostate factors that appear to participate in prostate carcinoma pathogenesis and progression. This oncofetal protein is commonly expressed by prostate carcinoma, and its regulatory interactions with other bioactive prostate cell products play an important role in the pathobiology of prostate carcinoma. Understanding these regulatory interactions among prostate carcinoma, its cell products, and the skeleton continues to provide insights into the pathogenesis of this disease entity and may provide clues to clinical management.

The effect of electroporation on iontophoretic transdermal delivery of calcium regulating hormones

Electrically-assisted delivery by iontophoresis and/or electroporation was used in vitro to deliver the calcium regulating hormones, salmon calcitonin (sCT) and parathyroid hormone (1-34) (PTH) through human epidermis. Such delivery could be useful for chronic treatment of post-menopausal osteoporosis and other clinical indications as a superior alternative to parenteral delivery. sCT (50 microg/ml) or PTH (1-34) (100 microg/ml) formulation was prepared in citrate buffer (pH 4.0 or 5.0, respectively). Epidermis separated from human cadaver skin was used. Iontophoresis was applied using a constant current power source and electroporation with an exponential pulse generator. Silver/silver chloride electrodes were used. A combination of electroporation and iontophoresis resulted in higher transdermal permeation than either one technique alone. Electroporation also shortened the lag time of iontophoretic transdermal delivery of salmon calcitonin. Pulsing at lower voltages followed by iontophoresis did not result in increased transport (over iontophoresis alone), perhaps because the transdermal voltage was very low. The transdermal transport of salmon calcitonin by pulsing with 15 pulses (1 ppm) of 500 V (200 ms) followed by iontophoresis led to a quick input and high flux. The average transdermal voltage was only about 50 V for a 500 V study.

Transdermal iontophoretic delivery of salmon calcitonin

Electrically enhanced transdermal delivery of salmon calcitonin could be useful for chronic treatment of postmenopausal osteoporosis and other clinical indications as a superior alternative to parenteral delivery. Calcitonin (50 microg/ml) formulation was prepared in citrate buffer (pH 4.0). Epidermis separated from human cadaver skin was used. Most iontophoresis studies were done at a current density of 0.5 m A cm2. Silver/silver-chloride electrodes were used and calcitonin was found to be best delivered under the anode. The relationship between calcitonin flux and current density during iontophoresis was linear. Passive flux was zero. Flux increased with increasing concentration up to 250 microg/ml but then it levels off. Thus, transdermal delivery of salmon calcitonin may be accomplished to achieve therapeutic levels.

Quantitative computed tomography in the evaluation of spinal osteoporosis following spinal cord injury

Disuse osteoporosis occurs in the lower extremities of patients with spinal cord injury (SCI). However, spinal osteoporosis is not usually observed in these patients. We investigated lumbar spine bone mineral density (BMD) in SCI patients using single energy quantitative computed tomography (QCT) and dual-energy X-ray absorptiometry (DXA). Our study population consisted of 64 patients with long-standing SCI. Spine BMD (g/cm3) was assessed by QCT at four vertebrae ranging from T11 to L4 with single mid-vertebral CT slices 1 cm thick parallel to the vertebral end-plates. Confounding variables affecting normal trabecular bone pattern, such as compression fractures, surgical hardware or fat replacement, were excluded. For a subset of 29 patients, DXA values of the spine and femoral neck were also measured, and QCT and DXA Z-scores were compared On the average, the 64 SCI patients had Z-scores 2.0 +/- 1.2 below those of age-matched controls. In the subset of 29 patients with both QCT and DXA measurements, the QCT and DXA Z-scores were 2.4 +/- 1.1 below and 1.3 +/- 2.3 above the mean, respectively (p < 0.0001). Our results indicate that QCT reveals osteoporosis of the spine after SCI, in contrast to DXA. We postulate that QCT is more valuable for evaluating spinal osteoporosis following SCI than DXA and thus recommend QCT for spinal BMD studies in SCI.

Medical and scientific organizations and scientific evidence in U.S. trials: lessons from European legal theory

Medical and scientific societies and organizations could help to solve the problem that the U.S. judicial system has with trials involving scientific evidence. This problem is exemplified by infamous trials in which opposing high-paid experts present contradictory legal theories based on the same scientific facts. The conflicting conclusions of such experts often confuse rather than clarify the issues for the jury and even the judge. Dissatisfaction with these "battles of the experts" in both civil (e.g., breast-implant litigation) and criminal (e.g., forensic use of DNA evidence) trials ranges from concern to harsh criticism. Many critics identify as models for reform the European legal systems, where scientific evidence is presented in a relatively objective manner by experts appointed by the trial court. Since they are often selected from lists of the faculties of universities, European experts are more likely to represent prevailing views of the relevant scientific community. Most American judges are reluctant to appoint experts, but there are some examples of their increasing use, and legal mechanisms and procedures exist that would allow this approach. Professional organizations of scientists and physicians could serve an important role in fostering the forensic use of neutral expertise by developing lists of experts for the courts; this would at least provide the potential for unbiased experts in complex cases that involve scientific and medical evidence. Such expertise could help American courts in their quests for scientific and legal truths.

Parathyroid hormone-related proteins is abundant in osteoarthritic cartilage, and the parathyroid hormone-related protein 1-173 isoform is selectively induced by transforming growth factor beta in articular chondrocytes and suppresses generation of extracellular inorganic pyrophosphate

OBJECTIVE

Parathyroid hormone-related protein (PTHrP) is a major, locally expressed regulator of growth cartilage chondrocyte proliferation, differentiation, synthetic function, and mineralization. Because mechanisms that limit cartilage chondrocytes from maturing and mineralizing are diminished in osteoarthritis (OA), we studied PTHrP expression by articular chondrocytes.

METHODS

PTHrP was studied in normal knee cartilage samples and cultured articular chondrocytes, and in cartilage specimens from knees with advanced OA, obtained at the time of joint replacement.

RESULTS

PTHrP was more abundant in OA than in normal human knee articular cartilage. Both demonstrated PTH/PTHrP receptor expression. PTHrP 1-173, one of three alternatively spliced PTHrP isoforms, was exclusively expressed and induced by transforming growth factor beta in cultured chondrocytes. Chondrocytes mainly used the GC-rich P2 alternative promoter to express PTHrP messenger RNA. Inhibition by PTHrP 1-173, but not by PTHrP 1-146 or PTHrP 1-87, of inorganic pyrophosphate (PPi) elaboration suggested selective functional properties of the 1-173 isoform. Exposure to a neutralizing antibody to PTHrP increased PPi elaboration by articular chondrocytes.

CONCLUSION

Increased expression of PTHrP, including the 1-173 isoform, has the potential to contribute to the pathologic differentiated functions of chondrocytes, including mineralization, in OA.

Parathyroid hormone-related protein in patients with primary breast cancer and eucalcemia

Parathyroid hormone-related protein (PTHrP) is a causative factor of humoral hypercalcemia in breast cancer and other malignancies. We studied circulating PTHrP levels with three different immunoassays directed against different parts of the PTHrP molecule in 48 patients with breast cancer and eucalcemia. The methods used were: (a) a RIA with antibodies directed toward the midregion (63-78); (b) an immunofluorometric assay with two antibodies against 1-34 and 38-67; and (c) an immunoradiometric assay with antibodies against 1-40 and 1-72. Although most patients had PTHrP levels indistinguishable from normal when measured by all three methods, four patients had increased serum levels in the IFMA. PTHrP was detected by immunohistochemistry in tumors from nearly all patients. One patient with elevated PTHrP in plasma measured by IFMA showed intense staining of tumor by immunohistochemistry; the tumor was histologically graded as III (severe) and was the largest of all tumors in this patient group. The IFMA can identify increased serum PTHrP in some patients with breast cancer who are not hypercalcemic. This assay may be especially useful in screening patients for this tumor during a relative early phase of the disease.

Influence of heterotopic ossification of the hip on bone densitometry: a study in spinal cord injured patients

OBJECTIVE

To evaluate (1) the magnitude of falsely elevated bone density results caused by heterotopic ossification (HO) around the hip and (2) effect of age of patients when the measurement was taken, age of patients at injury, and age of injury (time since event) to the prevalence of HO.

SUBJECTS AND METHODS

We blindly analyzed plain radiographs of the hip [(obtained within 1 month of dual energy X-ray absorptiometry (DEXA)] in 107 spinal cord injured (SCI) patients for HO and matched the result to the three regions of interest (ROI): the femoral neck, Ward's triangle, and the trochanter. The influence of HO on bone densitometric values was determined by the analysis of variance (ANOVA) and post-hoc analysis.

RESULTS

Nineteen (18%) patients had HO; overlying the femoral neck (79%), trochanter (74%) and Ward's triangle (37%), respectively. Significant elevation of densitometric values (P < 0.05 or less) was observed in a various magnitude at each ROI, with the greatest elevation at Ward's triangle. The prevalence of HO was high when the patients were injured at age range of 20-39 years.

CONCLUSIONS

HO around the hip can cause significantly elevated bone densitometry results at all ROIs, which can obscure underlying osteoporosis, leading to underestimation of fracture risk. Determination of bone density in this region with corresponding plain radiographs would be of help. In SCI patients, prevalence of HO was high when the age of patients at injury was 20-39 years.

The evolving duty to disclose the presence of genetic disease to relatives

Under the aegis of the Human Genome Project, research laboratories are identifying the genetic bases of human diseases almost daily. This explosion in molecular biology has raised many medical-legal issues about genetic information, such as privacy, discrimination, and insurability. Less appreciated is another issue that faces physicians who deal with genetic information in their practices--their duty to disclose a genetic disease to relatives of their patients who have the disease. Few cases have addressed the issue directly, and there has been little statutory and policy development in this area. However, because a physician's diagnosis of a genetic disease could have such a profound impact on the patient's relatives, there is a developing duty to consider disclosing genetic information to relatives. The case law and policy that support such disclosure reflect the evolution of medicine and the law away from paternalism toward an expanded concept of legal and moral duty. Since genetic information is presumed to be confidential by the law, as is essentially all medical information, guidelines need be developed regarding a physician's duty to disclose a genetic disease to a patient's relatives. These guidelines should consider the patient, the genetic test, the disease, and the third-party relative. Disclosure should be considered for a disease that is serious or fatal, treatable or curable, and transmitted dominantly with high penetrance. Specifics notwithstanding, these policies should be developed by physicians who care for patients and their families, not by lawyers and ethicists with no clinical training.

Granin-A, parathyroid hormone-related protein, and calcitonin gene products in neuroendocrine prostate cancer

BACKGROUND

The importance of the expression of granin A (GRN-A, chromogranin-A), calcitonin (CT) gene products (CGPs), and parathyroid hormone-related protein (PTHrP) has become appreciated in the neuroendocrine (NE) differentiation of prostate cancer. We have studied the prostate expression of these three NE cell products with in vivo and in vitro methods.

METHODS

GRN-A secretion was measured by immunoassay in serum samples from patients with prostate cancer. Immunohistology procedures were used to assess GRN-A, CGPs, and PTHrP expression in paraffin-embedded prostate tissue samples. Serum and tumor findings were evaluated according to the patient's clinical status. All three substances were also studied in prostate cancer cell cultures.

RESULTS

GRN-A, PTHrP, and CGPs were all secreted products of prostate cancer. Our studies demonstrated that GRN-A can serve as a prostate cancer serum and tumor marker with clinical value for both diagnosis and prognosis. Elevated serum GRN-A levels identified patients with prostate cancer, including some who did not have elevated serum prostate-specific antigen (PSA) levels. Serum GRN-A concentrations also had prognostic value for prostate cancer. PTHrP and CGPs were expressed in prostate cancer in addition to GRN-A, and all three were secreted by prostate cells in culture. Each had effects on prostate cell growth.

CONCLUSIONS

GRN-A, PTHrP, and CGPs are produced and secreted by prostate cells. These three NE cell products can serve as tumor and markers for prostate cancer that have diagnostic and prognostic value. In addition, their derived peptides regulate prostate cell growth. However, studies more conclusive than the preliminary observations of our group and of other investigators are needed to define the roles of PTHrP, GRN-A, and CGPs in prostate cancer.

Bone morphogenetic proteins and bFGF exert opposing regulatory effects on PTHrP expression and inorganic pyrophosphate elaboration in immortalized murine endochondral hypertrophic chondrocytes (MCT cells)

A fundamental question in endochondral development is why the expression of parathyroid hormone-related protein (PTHrP), which inhibits chondrocyte maturation and mineralization, becomes attenuated at the stage of chondrocyte hypertrophy. To address this question, we used clonal, phenotypically stable SV40-immortalized murine endochondral chondrocytes that express a growth-arrested hypertrophic phenotype in culture (MCT cells). Addition of individual cytokines to the medium of MCT cells revealed that bone morphogenetic protein (BMP)-6, which commits chondrocytes to hypertrophy, markedly inhibited PTHrP production. This activity was shared by three other osteogenic bone morphogenetic proteins (BMP-2, BMP-4, and BMP-7) and by transforming growth factor beta (TGF-beta), which all inhibited the level of PTHrP mRNA. In contrast, basic fibroblast growth factor (bFGF), an inhibitor of chondrocyte maturation to hypertrophy, induced PTHrP in MCT cells and antagonized the effects of BMP-2, BMP-4, BMP-6, and BMP-7 and TGF-beta on PTHrP expression. Opposing effects of bFGF and BMPs also were exerted on the elaboration of inorganic pyrophosphatase (PPi), which regulates the ability of hypertrophic chondrocytes to mineralize the matrix. Specifically, BMP-2 and BMP-4, but not BMP-6 and BMP-7, shared the ability of TGF-beta to induce PPi release, and this activity was inhibited by bFGF in MCT cells. Our results suggest that effects on PTHrP expression could contribute to the ability of BMP-6 to promote chondrocyte maturation. BMPs and bFGF exert opposing effects on more than one function in immortalized hypertrophic chondrocytes. Thus, the normal decrease in bFGF responsiveness that accompanies chondrocyte hypertrophy may function in part by removing the potential for bFGF to induce PTHrP expression and to oppose the effects of BMPs. MCT cells may be useful in further understanding the mechanisms regulating the differentiation and function of hypertrophic chondrocytes.

Parathyroid hormone-related protein in tracheal aspirates of newborn infants

PTH-related protein (PTHrP) is found with its receptor in a variety of normal mammalian embryonic tissues where it apparently regulates cellular growth and differentiation. PTHrP stimulates phosphatidylcholine synthesis in rat fetal lung explants, suggesting a role in fetal type II alveolar maturation and surfactant production. We investigated PTHrP levels in tracheal aspirates of newborn infants. We collected tracheal aspirates from 40 intubated newborn infants within the first 24 h of life. PTHrP levels were measured by a RIA using rabbit antisera to PTHrP peptide 38-64. We found significantly lower PTHrP levels in tracheal aspirates from infants born at less than 35 wk of gestation (p = 0.02) and with a birth weight less than 2 kg (p = 0.04). We also found significantly lower PTHrP levels in male preterm (<35 wk of gestation) infants compared with female infants (p = 0.01), and in preterm infants who required multiple doses of surfactant (p = 0.005). Preterm infants exposed to antenatal steroids had significantly higher levels of PTHrP in tracheal aspirates (p = 0.02). PTHrP is associated with various indices of lung maturation and may prove to be a mediator of differentiation and growth.

Granins and prostate cancer

OBJECTIVES

The importance of the expression of granin A (GRN-A, chromogranin-A) has become appreciated in the neuroendocrine differentiation of prostate cancer. We studied the expression of GRN-A in prostate cancer using serum immunoassay and tissue immunohistology procedures for this protein in order to define the clinical value of its measurements.

METHODS

GRN-A production was measured by immunoassay in serum samples from patients with prostate cancer. Immunohistology procedures were used to assess GRN-A expression in paraffin-embedded prostate tissue samples. Serum and tumor findings were evaluated according to the patient's clinical status in studies by us and others.

RESULTS

These studies demonstrated that GRN-A can serve as a prostate cancer serum and tumor marker with clinical value for both diagnosis and prognosis. Serum GRN-A was increased in early- and late-stage disease. Elevated serum GRN-A levels identified some patients with prostate cancer who did not have elevated serum prostate-specific antigen levels. In addition to their diagnostic value, increased serum GRN-A concentrations had prognostic value.

CONCLUSIONS

Our own studies as well as those of others support the clinical potential of GRN-A as a marker for early, progressive, and recurrent prostate cancer. This demonstration of clinical utility notwithstanding, further studies are needed to clearly define the clinical value of GRN-A as a serum and tumor marker for this common cancer.

Characterization of the cell-specific expression of parathyroid hormone-related protein in normal and neoplastic prostate tissue

OBJECTIVES

Parathyroid hormone-related protein (PTHrP) is a primary factor in the pathogenesis of malignancy-associated hypercalcemia. By alternative splicing, the human PTHrP gene can generate three different species of mRNA that encode three initial translational isoforms of 139, 173, and 141 amino acids. We recently reported that PTHrP was present in normal prostatic neuroendocrine cells and was overexpressed in prostate cancer tissue as demonstrated by immunostaining. This study was undertaken to further clarify the complex expression of PTHrP gene in normal prostate tissue and prostate cancer.

METHODS

PTHrP mRNA in samples prepared from normal prostate tissue, prostate cancer, and three prostate cancer cell lines, PC3, LNCaP, and DU145 was assessed using Northern hybridization. Expressed PTHrP isoforms were deduced from differential reverse transcription-polymerase chain reaction (RT-PCR) assays with exon-specific primers. Further localization of different species of PTHrP mRNA was performed using nonradioactive in situ hybridization with exon-specific probes on consecutive sections of normal and neoplastic prostate tissue.

RESULTS

Northern hybridization showed that the PTHrP expression level was higher in prostate cancer than in normal prostate tissue. All three PTHrP isoforms could be detected in normal prostate tissues and prostate cancer with differential RT-PCR. Further analysis using in situ hybridization with exon-specific probes revealed that all three PTHrP isoforms were present in prostatic neuroendocrine cells and only PTHrP-1-139 isoform could be clearly detected in prostate cancer tissue. Two androgen-insensitive cell lines, PC3 and DU145, derived from a bone metastasis and a brain metastasis, respectively, expressed all three mRNA species encoding for the three isoforms, but DU145 cells expressed less than PC3 cells. Androgen-sensitive LNCaP cells exhibited a low level of expression of mRNA species encoding for PTHrP-1-139 and PTHrP-1-173, and no expression of PTHrP1-141 isoform.

CONCLUSIONS

All three initial translational isoforms of PTHrP are produced by prostatic neuroendocrine cells. The mature products of PTHrP might exert their effects on other prostatic epithelial cells in a paracrine fashion and also participate in the homeostatic regulation of the ejaculate. In prostate cancer, differential expression of these three isoforms is evident and PTHrP-1-139 isoform is more abundant than the other two forms. These findings are valuable for designing future research studies to further elucidate the biological functions of PTHrP in normal prostatic glands and prostate cancer.

Coexpression of parathyroid hormone-related protein and its receptor in breast carcinoma: a potential autocrine effector system

Parathyroid hormone-related protein (PTHrP), the pathogenic factor in most cases of humoral hypercalcemia of malignancy, is also expressed by many normal tissues. Its diverse biologic activities in these tissues are mediated by the PTH/PTHrP receptor through autocrine and paracrine mechanisms. Recent data suggest that PTHrP and its receptor might also influence the growth and metastatic spread of some cancers through similar local actions. Accordingly, immunohistochemical studies using murine monoclonal antibodies to detect coexpression of PTHrP and the PTH/PTHrP receptor were performed on 52 invasive breast carcinomas to assess the existence of this potential autocrine effector system. All of the 52 invasive breast carcinomas expressed reactivity for PTHrP, and 50 (96%) of these tumors also expressed reactivity for the receptor. Although additional investigations are necessary for evaluation of the role of PTHrP and PTH/PTHrP receptor in tumor pathogenesis, our current study demonstrates the presence of this potential autocrine effector system in the great majority of invasive breast carcinomas.

Bone mineral density and indexes of bone metabolism in spinal cord injury

We evaluated the pattern of osteoporosis after spinal cord injury, determined the time-frame of the changes, and elucidated the relationship among parathyroid hormone levels, biochemical markers of bone formation, and the pattern of bone mass loss. We included 176 subjects with spinal cord injury and 62 subjects without spinal cord injury as controls in the study. Bone mineral density of the spine and the proximal femur was measured. The participants' age, level of injury, and length of time since injury were compared with the nonspinal cord-injured controls and with each other. Serum levels of calcium, calcitonin, biochemical markers of bone formation, and parathyroid hormone were determined. Our results revealed that bone mineral density of the proximal femur declined and reached fracture threshold at one to five years after injury. The decline was detected at 12 months after injury in all age groups. Spinal bone mineral density neither declined significantly nor reached fracture threshold. Parathyroid hormone levels declined before the end of the first year postinjury and increased at one to nine years postinjury in the 20- to 39-year age group. The increase correlated with the initial decline of bone mineral density of the proximal femur. Our studies in spinal cord-injured subjects revealed a pattern of osteoporosis similar to age and parathyroid dysfunction-related osteoporosis. No other correlation was detected between indexes of bone metabolism and bone mineral density measurements.

Intrapulmonary drug delivery of salmon calcitonin

Calcitonin (CT) and other bone-active peptides have been restrained in clinical use by the need for parenteral administration. Although nasal and other transmucosal routes can be used for CT treatment, bioavailability and bioactivity of the peptide thus delivered are limited. We have evaluated the intrapulmonary route (IP) for the delivery of salmon calcitonin (SCT) in normal subjects. SCT was administered with a dry powder delivery inhaler. For comparison, each subject also received intramuscular (IM) SCT. Inhaled SCT produced significant hypocalcemia in all subjects as did injected SCT, and the peptide could be readily measured in serum by immunoassay. Compared by dose, IP SCT had 66% of the bioactivity and 28% of the bioavailability of IM SCT. This intrapulmonary route of administration should enhance the clinical acceptability of SCT and could also be applicable to other bone-active peptides.

Densitometric patterns of spinal cord injury associated bone loss

The purpose of the study was to use dual energy X-ray absorptiometry to measure bone mineral density (BMD) in the lumbar spine, the femoral neck, Ward's triangle, and the greater trochanter in 204 men (69 able-bodies controls and 135 spinal cord injured patients) stratified according to age (20-39, 40-59, and 60+ years old) in order to determine whether changes in BMD were age related, and to determine when these changes began to appear. The BMDs of the lumbar spine of both the 40-59 year old and the 60+ year old patients were significantly higher (P < or = 0.012) than the 40-59 year old and 60+ year old controls, respectively. The femoral region BMDs of the 20-39 year old and the 40-59 year old patients were all significantly lower (P < or = 0.027) than the 20-39 year old and 40-59 year old controls, respectively. When patients were grouped according to the time since their injury (0-1, 1-5, 6-9, 10-19, 20-29, 30-39, 40-49, and 50-59 years post injury) within the various age categories different results were obtained. In all the age categories, BMD loss occurred starting one year after spinal cord injury in the hip region. This bone loss took place gradually, reaching a significant plateau (P < or = 0.017) at 19 years post injury and then started improving. The spine BMD in our patient population never significantly decreased, and started improving as the age of the injury increased. Findings presented for the femoral regions were similar to other investigators' findings; however, the steady bone mass maintained in the lumbar area, which increased with age regardless of the age of the injury, with the bone mass loss in the hip area, were the most notable new findings.

Influence of spondylopathy on bone densitometry using dual energy X-ray absorptiometry

Spinal cord injury (SCI), as well as other neuromuscular disorders, not only results in osteopenia but also induces various patterns of osseous, articular, and soft tissue alterations. In the spinal column, a variety of abnormalities occur. To evaluate the magnitude of discrepancy of bone densitometry results caused by spondylopathy in SCI patients, we analyzed anteroposterior (AP) radiographs of the lumbar spine [obtained within 1 month of dual energy X-ray absorptiometry (DXA)] in 116 SCI patients for various manifestations of spondylopathy, and matched the result to each vertebral level (L1, 2, 3, 4). The dataset was stratified by individual vertebra (totally 463 vertebrae) as valid (no demonstrable other abnormal density on plain radiograph except osteopenia), abnormal without, and abnormal with hardware. The influence of spondylopathy on bone densitometry results was determined by the analysis of variance (ANOVA) and post hoc analysis. Our results showed that 227 (49%) vertebrae were abnormal. Significant elevation (15%, 15%, 18%, 20%; P < 0.001-P < 0.05) of bone mineral density (BMD; g/cm2) was observed at all levels (L1, 2, 3, 4, respectively), particularly at those abnormal vertebrae without hardware compared with valid (no other abnormal density on radiograph except osteopenia (Table 1). The L4 level was most severely affected. We concluded that in SCI patients, owing to various secondary progressive skeletal abnormalities, particularly neuropathic spondylopathy, can have strongly and significantly elevated vertebral bone densitometry results, which can obscure underlying osteoporosis, leading to misinterpretation and underestimation of fracture risk. DXA, although characterized by improving spatial resolution, cannot replace radiography in establishing the magnitude of this skeletal pathology. Therefore, determination of bone density in this region with corresponding plain radiographs is highly recommended.

Demineralization in tetraplegic and paraplegic man over time

The aim of the present study was to compare bone mineral density (BMD in g/cm2) in the lumbar spine and three hip regions of male spinal cord injured subjects at various times post injury to age-matched able-bodied controls and to correlate their BMDs to their age and level of their spinal cord lesion. Patients and controls were stratified into three 20 years age groups (20-39, 40-59, and 60+ years of age). BMD measurements were obtained using dual energy X-ray absorptiometry (DEXA, Lunar Model DPX). BMD levels taken within the first year of injury were not significantly lower than the age-matched able-bodies controls. The 20-39 year old patients injured longer than 1 year had significantly lower (P < or = 0.01) BMDs in their femoral region than both their age matched controls and the 20-39 year old acutely injured (injured for less than 1 year) patients. Although femoral BMDs of both paraplegic and quadriplegic patients 40-59 and 60+ years of age decreased over time, none showed significant bone loss in this regions until 10 years after their injury. These results indicate that spinal cord injury associated bone loss occurs most dramatically in the femoral region of young men. These results also indicate that initial bone mass loss does not occur prior to 1 year post-injury to the extent that it is detectable by densitometry, or at least it did not occur in our patients.

Parathyroid hormone-related protein is not an autocrine growth factor for normal prostatic epithelial cells

BACKGROUND

Parathyroid hormone-related protein (PTHrP) is the primary factor responsible for humoral hypercalcemia of malignancy. The hypercalcemic actions of PTHrP occur via stimulation of renal distal tubular calcium reabsorption and increased osteoclastic bone resorption. These effects of PTHrP are thought to be mediated through a common parathyroid hormone (PTH)/PTHrP receptor. In addition to the well-established role of PTHrP in bone remodeling, PTHrP is believed to be an important mediator of cellular growth and differentiation in a number of nonbony tissues. We recently demonstrated abundant expression of PTHrP in normal and malignant human prostatic tissues, and in cultured prostatic epithelial cells.

METHODS

In vitro assays were used to test growth-regulatory activity of synthetic and endogenous PTHrP peptides on normal prostatic epithelial cells.

RESULTS

No growth-regulatory activity could be demonstrated.

CONCLUSIONS

PTHrP is not an autocrine growth factor for normal prostatic epithelial cells.

Prostate cancer progression, metastasis, and gene expression in transgenic mice

We previously reported that a transgenic mouse line containing the fetal globin promoter linked to the SV40 T antigen (T Ag) viral oncogene (Ggamma/T-15) resulted in prostate tumors. In this study, we further explored tumor origin, frequency, invasiveness, androgen sensitivity, and gene expression pattern. T Ag was detected in adult but not fetal and neonatal prostates, suggesting a role for androgens in tumor progression. However, castration shortly after prostate morphogenesis did not prevent tumor development, suggesting an androgen-independent phenotype. Tumors originated within ventral or dorsal prostate lobes and involved intraepithelial neoplasia, rapid growth in the pelvic region, and metastasis to lymph nodes and distant sites. In addition, the primary cancers could be propagated in nude mice or nontransgenic mice. Seventy-five percent of hemizygous and 100% of homozygous transgenic males developed prostate tumors, suggesting a T Ag dosage effect. Biochemical characterization of advanced tumors revealed markers of both neuroendocrine and epithelial phenotypes; markers of terminal differentiation are lost early in tumorigenesis. Tumor suppressor genes (p53 and Rb), normally bound to T Ag, were up-regulated; bcl-2 proto-oncogene, which prevents apoptosis, was slightly up-regulated. Myc, a stimulus to cell cycle progression, was unchanged. We propose the Ggamma/T-15 transgenic line as a model of highly aggressive androgen-independent metastatic prostate carcinoma with features similar to end-stage prostate cancer in humans.

Parathyroid hormone-related protein, an autocrine growth inhibitor of alveolar type II cells

Parathyroid hormone-related protein (PTHRP) is an autocrine regulator of differentiation for type II pneumocytes [R. H. Hastings, D. Summers-Torres, T. C. Cheung, L. S. Ditmer, D. W. Burton, E. M. Petrin, R. G. Spragg, J. Li, and L. J. Deftos. Am. J. Physiol. 270 (Lung Cell. Mol. Physiol. 14): L353-L361, 1996]. We investigated autocrine effects on growth by decreasing endogenous PTHRP in rat type II cells. Cultured cells were incubated with antibodies against PTHRP-(1-34) (8B12) or PTHRP-(109-141) (9H7) or an irrelevant antibody (1 microg/ml) for 3 days. Conditioned media from the irrelevant antibody group contained 143 +/- 8 fg PTHRP/ 100,000 cells. The 8B12 and 9H7 reduced levels to 45 +/- 8 and 88 +/- 16 fg PTHRP/100,000 cells, respectively (n = 4 cell isolations, P < 0.05). Cells treated with the PTHRP antibodies nearly tripled in number. The irrelevant antibody had no effect on growth. Exogenous PTHRP-(1-34) (2.5 nM) blocked the growth-stimulating effect of 9H7. Instilled intratracheal 8B12 and 9H7 induced expression of proliferating cell nuclear antigen in clusters of alveolar cells in rats. Clustered cells expressed surfactant apoproteins and cytokeratin 19. These data suggest that endogenous PTHRP-(1-34) inhibits proliferation of type II cells in vivo and in vitro.

Two-site immunofluorometric assay of intact salmon calcitonin with improved sensitivity

We recently developed a two-site immunofluorometric assay (IFMA) of salmon calcitonin (SCT) by DELFIA (dissociation enhancement lanthanide fluoroimmunoassay) technique using the same polyclonal antibodies both for "catching" the antigen and for signaling. In the present study we used a monoclonal antibody to SCT 1-11 as the capture antibody. This antibody was biotinylated before use in streptavidin-coated microtitration plates. The polyclonal antibody labeled with Eu chelate was used as a signaling marker. This combination of antibodies resulted in an assay that was three to four times more sensitive than the previous IFMA, with a detection limit of 0.3 pmol/L serum. Intact SCT 1-32 was detected by the assay (recoveries 94-96%), but not the fragments SCT 1-11 and SCT 10-32 or human calcitonin. Dilutions of plasma samples containing SCT were parallel to the calibration curve of SCT 1-32. Pharmacokinetic studies of SCT, 100 IU administered intramuscularly to 10 men, indicated peak serum concentrations of 32-128 pmol/L within 10-20 min with apparent half-life of 56+/-18 min (mean+/-SD). This new assay will allow study of the pharmacokinetics of new calcitonin preparations that do not require injection.

Hypercalcemia: mechanisms, differential diagnosis, and remedies

The urgency for treatment of hypercalcemia is assessed by determining the severity of symptoms and complications and the degree of elevation of serum calcium. Increased bone resorption is the most common pathophysiologic mechanism for hypercalcemia, and several agents are used to inhibit this resorption, including calcitonin and bisphosphonates. However, inhibition of bone resorption controls hypercalcemia for only a limited time, and prompt definitive treatment of the underlying cause, such as primary hyperparathyroidism or malignancy, is essential.

Hypercalcemia and systemic lupus erythematosus

Hypercalcemia is commonly caused by the increased production of parathyroid hormone-related protein (PTHrP) by a malignancy. In fact, the demonstration of increased PTHrP production in a patient with hypercalcemia is virtually pathognomonic of malignancy. We studied a patient with systemic lupus erythematosus (SLE), generalized lymphadenopathy, and hypercalcemia. Immunohistology of 2 biopsied lymph nodes revealed the abundant expression of PTHrP and the absence of malignant transformation. Although apparently rare, PTHrP production by non-malignant lymphoid tissue may occur in SLE and should be considered in the differential diagnosis of hypercalcemia.

Transcriptional regulation of the human chromogranin A gene by its 5' distal regulatory element: novel effects of orientation, structure, flanking sequences, and position on expression

In previous studies of human chromogranin A (hCgA) gene expression, we had identified a 27 bp distal regulatory element (DRE) located between -576 and -550 bp that interacts with a CRE-containing promoter to enhance gene transcription specifically in neuroendocrine (NE) cells. To characterize the DRE we have now mutated its various parts and assessed the effects on protein binding by electrophoretic mobility shift assays (EMSAs) and hCgA transcription within BEN cells. We found that the sequence TGACTAA, an AP-1 binding site that we refer to as DRE-AP-1, was necessary but not sufficient to produce the DRE's enhancer effect. Moreover, while AP-1 (Jun/Fos) bound this site, binding was not correlated with transcriptional effects. Protein binding by the DRE-AP-1 could be attenuated by mutations of its flanking sequences, and transcriptional enhancement by the DRE was dependent on its orientation and spatial relationship to the hCgA proximal promoter. Mutation of the DRE-AP-1 to a consensus AP-1 did not produce greater transcriptional activity, even though it increased binding of nuclear factors. Co-transfection with c-jun and/or c-fos expression plasmids showed that the DRE was unresponsive to the over-expressed AP-1 proteins. Co-transfection with wild-type DRE oligonucleotides competitively inhibited DRE-mediated transcription, while co-transfection with mutant DRE oligonucleotides had a lesser effect. Our studies indicate that transcriptional enhancement of hCgA by the DRE is dependent on a unique NE-specific DRE-binding factor, which we refer to as DBF, that specifically and directionally binds the DRE to assemble and synergize a functional transcription complex.