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Alsaleh B, Alanzi A, Aladel F. Incidentally discovered monostotic Paget's disease involving the scapula inducing brachial plexopathy: A diagnostic dilemma. Radiol Case Rep 2025; 20:2886-2890. [PMID: 40201054 PMCID: PMC11978289 DOI: 10.1016/j.radcr.2025.02.072] [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: 11/11/2024] [Revised: 02/16/2025] [Accepted: 02/17/2025] [Indexed: 04/10/2025] Open
Abstract
Paget disease of bone is a chronic skeletal disorder characterized by abnormal bone remodeling. This condition, which predominantly affects older adults, can result in a variety of complications, including bone pain, fractures, and deformities. This case report discusses the incidental discovery of monostotic Paget's disease involving the scapula, leading to brachial plexopathy in a 58-year-old female with a history of colon cancer. The patient had severe bilateral shoulder pain, predominantly on the left, for the past ten years. This pain, exacerbated by overhead activity and limiting daily functions, radiated to the upper limbs without causing weakness or sensory deficits. Clinical examination revealed 4/5 limb power and normal sensation, with significant pain on left shoulder movement and limited elevation. Radiographic investigations, including bilateral shoulder radiographs, contrast-enhanced computed tomography (CT), and cervical magnetic resonance imaging (MRI), identified no displaced fractures but showed diffuse enlargement of left shoulder muscles with fatty infiltration, medullary expansion of the scapula, and reduced left lung volume. MDP skeletal scintigraphy with SPECT/CT confirmed asymmetrical radiotracer uptake and medullary expansion in the left scapula. Further, MRI of both shoulders revealed left-sided expansion, cortical thickening, and fatty replacement of the rotator cuff and deltoid musculature due to denervation pseudohypertrophy from left brachial plexopathy. The right shoulder MRI showed rotator cuff tendinopathy and tears. The findings suggest a diagnosis of monostotic Paget's disease with secondary brachial plexopathy.
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Affiliation(s)
- Bano Alsaleh
- Radiology Department, King Hamad University Hospital, Muharraq, Kingdom of Bahrain
| | - Ahmed Alanzi
- Anaesthesia and Critical Care Depratment, King Hamad University Hospital, Muharraq, Kingdom of Bahrain
| | - Fouad Aladel
- Radiology Department, King Fahad Specialist Hospital, Dammam, Kingdom of Saudi Arabia
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2
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Park JW, Lee DH, Park KT, Kim SH, Lee YK. Epidemiology of Paget's disease of bone in South Korea. JBMR Plus 2025; 9:ziae171. [PMID: 39906256 PMCID: PMC11792072 DOI: 10.1093/jbmrpl/ziae171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2024] [Revised: 12/16/2024] [Accepted: 12/27/2024] [Indexed: 02/06/2025] Open
Abstract
Paget's disease of bone (PDB) is a chronic disorder characterized by abnormal bone remodeling, leading to enlarged and deformed bones, and commonly affecting older adults. The disease frequently involves the pelvis, skull, spine, and long bones. Despite significant geographical variations in PDB prevalence, data from Asian populations remain sparse. This study evaluates the incidence, skeletal distribution, comorbidities, and bisphosphonate use for PDB in South Korea from 2010 to 2020, using a retrospective analysis of the Korean Health Insurance Review and Assessment database. We identified 4252 patients diagnosed with PDB via ICD-10 codes (M880, M888, and M889) over the study period. The primary outcome measured was the incidence of PDB, stratified by sex and age, with secondary outcomes including anatomical site involvement, associated comorbidities, and bisphosphonate use. The mean age of patients was 56.3 ± 14.8 yr, with a mean prevalence of 1.20 per 100 000 and an age-adjusted incidence ranging from 0.38 to 1.26 per 100 000 person-years. The incidence of PDB decreased in men but showed a significant increase in women, especially after 2015. The spine (23.5%) and pelvis & femur (17.0%) were the most commonly affected sites. Gastritis and gastroesophageal reflux disease (91.6%), upper respiratory infections (78.9%), and endocrine disorders (69.5%) were frequent comorbidities. Despite the established efficacy of bisphosphonates in managing PDB, only 9.8% of patients received these treatments, predominantly etidronate (3.2%) and alendronate (2.2%). This study is the first comprehensive epidemiologic assessment of PDB in South Korea, highlighting a low but increasing incidence, particularly among women. The findings underscore the need for greater clinical awareness and more proactive management strategies, especially regarding the use of bisphosphonates to improve patient outcomes.
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Affiliation(s)
- Jung-Wee Park
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam 463-707, South Korea
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul 03080, South Korea
| | - Dong-Hoon Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam 463-707, South Korea
| | - Ki-Tae Park
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam 463-707, South Korea
| | - Sung Hwa Kim
- Department of Biostatistics, Yonsei University Wonju College of Medicine, Wonju 26426, South Korea
| | - Young-Kyun Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam 463-707, South Korea
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul 03080, South Korea
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3
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Rizvi AH, Mobeen H, Ahmad A, Saghir H, Farhan A. Paget's Disease of Bone: A Rare Incidence in Early Adult Life in Pakistan, Southeast Asia. Cureus 2023; 15:e50242. [PMID: 38192941 PMCID: PMC10772316 DOI: 10.7759/cureus.50242] [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] [Accepted: 12/05/2023] [Indexed: 01/10/2024] Open
Abstract
Paget's disease of bone (PDB) is a focal disorder of skeletal remodeling leading to alteration of bony structures and properties, uncommonly reported in people under the age of 40 years, particularly in the Southeast Asia region. In the literature, PDB has been well reported in regions of Europe, in contrast to Asia where there has been limited records of prevalence of PDM especially in the younger age population. Here, we report a 21-year-old male patient presenting with an advanced disease with complaints of auditory impairment, bone pain, and neurological signs due to compression of the interverbal disc developed progressively over two months, having an elevated serum alkaline phosphatase level of 601 IU/L. The patient was administered zoledronic acid that brought significant improvement in his health. We aim to signify the advanced presentation of PDB in our region to create awareness about the condition among physicians and aid in the prompt diagnosis and prevention of the most dreaded complications of the disease, such as osteosarcoma, secondary osteoarthritis, and fractures.
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Affiliation(s)
- Ali H Rizvi
- Internal Medicine, Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, PAK
| | - Hafsa Mobeen
- Internal Medicine, HBS Medical and Dental College, Islamabad, PAK
| | - Afaq Ahmad
- General Surgery, Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, PAK
| | - Hina Saghir
- Internal Medicine, HBS Medical and Dental College, Islamabad, PAK
| | - Ahmed Farhan
- Medicine, Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, PAK
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4
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Boock V, Roy B, Pfeffer G, Kimonis V. Therapeutic developments for valosin-containing protein mediated multisystem proteinopathy. Curr Opin Neurol 2023; 36:432-440. [PMID: 37678339 DOI: 10.1097/wco.0000000000001184] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
PURPOSE OF REVIEW Missense mutations in valosin-containing protein (VCP) can lead to a multisystem proteinopathy 1 (MSP1) with any combination of limb-girdle distribution inclusion body myopathy (IBM) (present in about 90% of cases), Paget's disease of bone, and frontotemporal dementia (IBMPFD). VCP mutations lead to gain of function activity with widespread disarray in cellular function, with enhanced ATPase activity, increased binding with its cofactors, and reduced mitofusin levels. RECENT FINDINGS This review highlights novel therapeutic approaches in VCP-MSP in in-vitro and in-vivo models. Furthermore, we also discuss therapies targeting mitochondrial dysfunction, autophagy, TDP-43 pathways, and gene therapies in other diseases with similar pathway involvement which can also be applicable in VCP-MSP. SUMMARY Being a rare disease, it is challenging to perform large-scale randomized control trials (RCTs) in VCP-MSP. However, it is important to recognize potential therapeutic targets, and assess their safety and efficacy in preclinical models, to initiate RCTs for potential therapies in this debilitating disease.
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Affiliation(s)
- Victoria Boock
- Department of Pediatrics, University of California - Irvine School of Medicine, Orange, California
| | - Bhaskar Roy
- Department of Neurology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Gerald Pfeffer
- Hotchkiss Brain Institute, Department of Clinical Neurosciences, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
| | - Virginia Kimonis
- Department of Pediatrics, University of California - Irvine School of Medicine, Orange, California
- Department of Neurology
- Department of Pathology, University of California - Irvine School of Medicine, Orange, California, USA
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5
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Okagu IU, Ezeorba TPC, Aguchem RN, Ohanenye IC, Aham EC, Okafor SN, Bollati C, Lammi C. A Review on the Molecular Mechanisms of Action of Natural Products in Preventing Bone Diseases. Int J Mol Sci 2022; 23:ijms23158468. [PMID: 35955603 PMCID: PMC9368769 DOI: 10.3390/ijms23158468] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 07/23/2022] [Accepted: 07/25/2022] [Indexed: 12/10/2022] Open
Abstract
The drugs used for treating bone diseases (BDs), at present, elicit hazardous side effects that include certain types of cancers and strokes, hence the ongoing quest for the discovery of alternatives with little or no side effects. Natural products (NPs), mainly of plant origin, have shown compelling promise in the treatments of BDs, with little or no side effects. However, the paucity in knowledge of the mechanisms behind their activities on bone remodeling has remained a hindrance to NPs’ adoption. This review discusses the pathological development of some BDs, the NP-targeted components, and the actions exerted on bone remodeling signaling pathways (e.g., Receptor Activator of Nuclear Factor κ B-ligand (RANKL)/monocyte/macrophage colony-stimulating factor (M-CSF)/osteoprotegerin (OPG), mitogen-activated protein kinase (MAPK)s/c-Jun N-terminal kinase (JNK)/nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB), Kelch-like ECH-associated protein 1 (Keap-1)/nuclear factor erythroid 2–related factor 2 (Nrf2)/Heme Oxygenase-1 (HO-1), Bone Morphogenetic Protein 2 (BMP2)-Wnt/β-catenin, PhosphatidylInositol 3-Kinase (PI3K)/protein kinase B (Akt)/Glycogen Synthase Kinase 3 Beta (GSK3β), and other signaling pathways). Although majority of the studies on the osteoprotective properties of NPs against BDs were conducted ex vivo and mostly on animals, the use of NPs for treating human BDs and the prospects for future development remain promising.
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Affiliation(s)
- Innocent U. Okagu
- Department of Biochemistry, Faculty of Biological Sciences, University of Nigeria, Nsukka 410001, Nigeria; (I.U.O.); (T.P.C.E.); (R.N.A.); (E.C.A.)
| | - Timothy P. C. Ezeorba
- Department of Biochemistry, Faculty of Biological Sciences, University of Nigeria, Nsukka 410001, Nigeria; (I.U.O.); (T.P.C.E.); (R.N.A.); (E.C.A.)
| | - Rita N. Aguchem
- Department of Biochemistry, Faculty of Biological Sciences, University of Nigeria, Nsukka 410001, Nigeria; (I.U.O.); (T.P.C.E.); (R.N.A.); (E.C.A.)
| | - Ikenna C. Ohanenye
- School of Nutrition Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON K1H 8M5, Canada;
| | - Emmanuel C. Aham
- Department of Biochemistry, Faculty of Biological Sciences, University of Nigeria, Nsukka 410001, Nigeria; (I.U.O.); (T.P.C.E.); (R.N.A.); (E.C.A.)
- Natural Science Unit, School of General Studies, University of Nigeria, Nsukka 410001, Nigeria
- School of Environment and Safety Engineering, Jiangsu University, Zhenjiang 212013, China
| | - Sunday N. Okafor
- Department of Pharmaceutical and Medicinal Chemistry, University of Nigeria, Nsukka 410001, Nigeria;
| | - Carlotta Bollati
- Department of Pharmaceutical Sciences, University of Milan, via Mangiagalli 25, 20133 Milano, Italy;
| | - Carmen Lammi
- Department of Pharmaceutical Sciences, University of Milan, via Mangiagalli 25, 20133 Milano, Italy;
- Correspondence: ; Tel.: +39-02-5031-9372
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Cardozo B, Karatza E, Karalis V. Osteoporosis treatment with risedronate: a population pharmacokinetic model for the description of its absorption and low plasma levels. Osteoporos Int 2021; 32:2313-2321. [PMID: 34002251 DOI: 10.1007/s00198-021-05944-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 03/31/2021] [Indexed: 10/21/2022]
Abstract
UNLABELLED To develop a population pharmacokinetic model that describes the absorption and low plasma levels of risedronate in the body. The impact of patients' characteristics on risedronate kinetics is investigated. Simulations revealed the high variability in the concentration levels after different dosage schemes. No dosage adjustment is required in renal impairment. INTRODUCTION Risedronate exhibits very low plasma levels and high residence time in the body. The aim of this study is to describe and explain the risedronate transit through the body. The impact of volunteers' characteristics on the kinetics of risedronate is also investigated. Simulations are used to compare the risedronate plasma levels after different dosage schemes and assess the need for dose adjustment in patients with impaired kidney functionality. METHODS Plasma concentration-time data were obtained from a four-period, two sequence, single-dose, crossover bioequivalence study. The effects of several covariates (e.g., weight, albumin, creatinine, alkaline phosphatase, and calcium) on model parameters were tested. Non-linear mixed-effect modeling was applied and a variety of models were evaluated placing emphasis on absorption and disposition properties. The modeling and simulation work was implemented in MonolixTM 2020R1. RESULTS Following oral administration, the kinetics of risedronate was best described by a two-compartment model with lag time, first-order absorption, and elimination. The extent of peripheral distribution (i.e., bones) was found to be remarkably high. No volunteer characteristics were identified to affect significantly the disposition of risedronate. Using simulations, risedronate plasma profiles were obtained for different doses and frequencies of administration. CONCLUSION The absorption and disposition kinetics of risedronate were successfully characterized. Simulations revealed the high discrepancy in the concentration levels observed after different dosage regimens, implying the safety profile of risedronate. In virtual patients with renal impairment, the blood levels of risedronate are increased, but not in an extent requiring dose adaptation.
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Affiliation(s)
- B Cardozo
- Aix-Marseille University, Marseille, France
| | - E Karatza
- Department of Pharmacy, School of Health Sciences, National and Kapodistrian University of Athens, 15784, Athens, Greece
| | - V Karalis
- Department of Pharmacy, School of Health Sciences, National and Kapodistrian University of Athens, 15784, Athens, Greece.
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Barale M, Sigrist S, Bioletto F, Maiorino F, Ghigo E, Mazzetti R, Procopio M. Long-Term Efficacy of Intensive Zoledronate Therapy and Predictors of Retreatment in Paget's Disease of Bone. Calcif Tissue Int 2021; 109:383-392. [PMID: 33876253 PMCID: PMC8429167 DOI: 10.1007/s00223-021-00848-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 03/31/2021] [Indexed: 11/03/2022]
Abstract
Despite the current debate on the best therapeutic approach, i.e. symptomatic vs intensive strategy, one zoledronate (Zol) infusion is effective in most patients with Paget's disease of bone (PDB), whereas few need retreatment, whose predictors are not well established. We aimed to evaluate long-term efficacy of intensive Zol therapy and predictors of retreatment in PDB. Pagetic complications, clinical and biochemical response to Zol together with frequency of retreatment were retrospectively assessed in forty-seven PDB patients (age, mean ± SD: 72.5 ± 8.9 years, M/F: 24/23; symptomatic/asymptomatic: 16/31). Statistical analysis for retreatment prediction were based on Mann-Whitney U test, Pearson's Χ2 and ROC curve analysis. During seven-year follow-up, all patients achieved pain relief and only one underwent arthroplasty. Bone alkaline phosphatase (BAP) detected three non-responder (6%) and six relapsing (13%) patients needing retreatment. Retreated patients had less old age (66.1 ± 11.2 vs 74.0 ± 7.7 years), higher frequency of polyostotic disease (78% vs 40%) and higher baseline (96.5 ± 24.8 vs 44.9 ± 27.7 mcg/l) and post-Zol nadir BAP levels (24.7 ± 24.1 vs 8.1 ± 4.1 mcg/l) than patients treated once (p < 0.05 for all comparisons). In multivariate analysis both serum baseline and post-Zol nadir BAP significantly predicted retreatment (OR 1.09, 95%CI 1.01-1.17 and 1.29, 1.03-1.62, respectively), with ROC curve analysis showing the greatest accuracies for threshold values of 75.6 and 9.9 mcg/l (sensitivity 88 and 90%, specificity 94 and 86%, AUC 0.92 and 0.93, respectively). Our data in mostly asymptomatic, metabolically active PDB patients treated with intensive Zol therapy show a negligible incidence of pagetic complications and long-term optimal disease control, with BAP being the best predictor of retreatment.
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Affiliation(s)
- Marco Barale
- Division of Endocrinology, Department of General and Specialty Medicine, Diabetology and Metabolic Diseases, Molinette Hospital, University of Turin, Cso Dogliotti, 14, 10126, Turin, Italy.
| | - Sarah Sigrist
- Division of Endocrinology, Diabetology, Osteology and Metabolic Diseases, Kantonsspital St.Gallen, Rorschacher Strasse, 95, 9007, St.Gallen, CH, Switzerland
| | - Fabio Bioletto
- Division of Endocrinology, Department of General and Specialty Medicine, Diabetology and Metabolic Diseases, Molinette Hospital, University of Turin, Cso Dogliotti, 14, 10126, Turin, Italy
| | - Federica Maiorino
- Division of Endocrinology, Department of General and Specialty Medicine, Diabetology and Metabolic Diseases, Molinette Hospital, University of Turin, Cso Dogliotti, 14, 10126, Turin, Italy
| | - Ezio Ghigo
- Division of Endocrinology, Department of General and Specialty Medicine, Diabetology and Metabolic Diseases, Molinette Hospital, University of Turin, Cso Dogliotti, 14, 10126, Turin, Italy
| | - Riccardo Mazzetti
- Radiology Unit, Department of Diagnostic Imaging and Interventional Radiology, Molinette Hospital, University of Turin, Cso Dogliotti, 14, 10126, Turin, Italy
| | - Massimo Procopio
- Division of Endocrinology, Department of General and Specialty Medicine, Diabetology and Metabolic Diseases, Molinette Hospital, University of Turin, Cso Dogliotti, 14, 10126, Turin, Italy
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Maatallah K, Ben Nessib D, Labbène E, Ferjani H, Bouaziz M, Kaffel D, Hamdi W. Paget's Disease of Bone in Patients under 40 Years: Two case reports and review of the literature. Sultan Qaboos Univ Med J 2021; 21:e127-e131. [PMID: 33777435 PMCID: PMC7968898 DOI: 10.18295/squmj.2021.21.01.019] [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: 02/27/2020] [Revised: 06/11/2020] [Accepted: 07/12/2020] [Indexed: 12/04/2022] Open
Abstract
Paget’s disease of bone (PDB) is a focal disorder of accelerated skeletal remodelling that is uncommon in patients under the age of 40 years; it is more prevalent in older individuals. We report two cases of PDB diagnosed in early adulthood at the Mohamed Kassab Institute of Orthopedics, La Manouba, Tunisia. The first case was a 35-year-old male patient who presented in 2011 with a seven-month history of hip pain. The second case was a 39-year-old female patient who presented 2014 with chronic lower back pain. The PDB diagnosis was confirmed with clinical, biological and radiological investigations. Both patients were doing well on follow-up. Some previous cases have been reported in the literature, differing from the presented cases in some aspects; data of PDB features at differing ages is still insufficient. Early recognition of this clinical entity in young patients is important as early treatment can affect the progression of the disease.
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Affiliation(s)
- Kaouther Maatallah
- Department of Rheumatology, Mohamed Kassab Institute of Orthopedics, La Manouba, Tunisia
| | - Dorra Ben Nessib
- Department of Rheumatology, Mohamed Kassab Institute of Orthopedics, La Manouba, Tunisia
| | - Emna Labbène
- Department of Rheumatology, Mohamed Kassab Institute of Orthopedics, La Manouba, Tunisia
| | - Hanene Ferjani
- Department of Rheumatology, Mohamed Kassab Institute of Orthopedics, La Manouba, Tunisia
| | - Mouna Bouaziz
- Department of Rheumatology, Mohamed Kassab Institute of Orthopedics, La Manouba, Tunisia
| | - Dhia Kaffel
- Department of Rheumatology, Mohamed Kassab Institute of Orthopedics, La Manouba, Tunisia
| | - Wafa Hamdi
- Department of Rheumatology, Mohamed Kassab Institute of Orthopedics, La Manouba, Tunisia
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9
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Barbosa JS, Almeida Paz FA, Braga SS. Bisphosphonates, Old Friends of Bones and New Trends in Clinics. J Med Chem 2021; 64:1260-1282. [PMID: 33522236 DOI: 10.1021/acs.jmedchem.0c01292] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Bisphosphonates, used for a long time in osteoporosis management, are currently the target of intensive research, from pre-formulation studies to more advanced stages of clinical practice. This review presents an overview of the contributions of this family of compounds to human health, starting with the chemistry and clinical uses of bisphosphonates. Following this, their pharmacology is described, highlighting administration-borne handicaps and undesirable effects. The last three sections of the review describe the research efforts that seek to curb delivery-related issues and expand bisphosphonate use. Innovative routes and strategies of administration, such as nano-encapsulation for oral intake or injectable cements for local or in-bone delivery are presented, as well as the latest results of case studies or preclinical studies proposing new therapeutic indications for the clinically approved bisphosphonates. Finally, a selection of anti-infectious bisphosphonate new drug candidates is shown, with focus on the molecules reported in the last two decades.
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Affiliation(s)
- Jéssica S Barbosa
- CICECO-Aveiro Institute of Materials, University of Aveiro, 3810-193 Aveiro, Portugal.,LAQV-Requimte, Department of Chemistry, University of Aveiro, 3810-193 Aveiro, Portugal
| | - Filipe A Almeida Paz
- CICECO-Aveiro Institute of Materials, University of Aveiro, 3810-193 Aveiro, Portugal
| | - Susana Santos Braga
- LAQV-Requimte, Department of Chemistry, University of Aveiro, 3810-193 Aveiro, Portugal
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10
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Abstract
PURPOSE OF REVIEW Recent evidence from clinical trials and observational studies raises the possibility that bisphosphonate use might confer a lower risk of cardiovascular disease and cancer, resulting in a mortality benefit. This review summarizes clinical and preclinical studies examining the non-skeletal effects of bisphosphonates. RECENT FINDINGS Data from clinical trials are conflicting regarding whether or not bisphosphonates have beneficial effects on mortality, cardiovascular events, or cancer incidence. No clinical trials have assessed these outcomes as primary endpoints, and most trials were shorter than 4 years. Observational data suggest that bisphosphonate users may have lower mortality, delayed progression of vascular calcification and atherosclerotic burden, and reduced incidence of breast and colorectal cancer compared to non-users. Preclinical studies confirm that bisphosphonates can be taken up by macrophages and monocytes, and nitrogen-containing bisphosphonates have the ability to disrupt the mevalonate pathway within these cells. In this manner, bisphosphonates exert anti-atherogenic and anti-cancer effects. Bisphosphonates also appear to exert protective effects on vascular smooth muscle cells and endothelial cells and may have direct cytotoxic effects on cancer cells. The balance of evidence does not support bisphosphonate treatment for the primary purpose of improving non-skeletal outcomes, although appropriately designed controlled trials that further explore this possibility are both justified and required. Patients with skeletal indications for bisphosphonate therapy can be reassured that these agents are not associated with increased mortality, cardiovascular disease, or cancer incidence.
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Affiliation(s)
- Emma O Billington
- Division of Endocrinology & Metabolism, Cumming School of Medicine, University of Calgary, Calgary, Canada.
- Richmond Road Diagnostic & Treatment Centre, 1820 Richmond Road SW, Calgary, Alberta, T2T 5C7, Canada.
| | - Ian R Reid
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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11
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Shaik NA, Nasser KK, Alruwaili MM, Alallasi SR, Elango R, Banaganapalli B. Molecular modelling and dynamic simulations of sequestosome 1 (SQSTM1) missense mutations linked to Paget disease of bone. J Biomol Struct Dyn 2020; 39:2873-2884. [PMID: 32329415 DOI: 10.1080/07391102.2020.1758212] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The Paget disease (PDB; OMIM is 167250) is a chronic bone disease caused by pathogenic mutations in Sequestome1/p62 (SQSTM1) gene. This study has aimed to interpret the relationship of PDB linked SQSTM1 mutations with protein structure and its molecular dynamic features. The disease causative missense mutations were initially collected, and then analyzed for their, exonic and domain distribution, impact on secondary and tertiary structures, and their ability on protein-ligand interactions, using a combination of systems biology approaches. Our results show that most PDB linked SQSTM1 missense mutations affect amino acid residues clustered within or near the UBA domain (aa 389-434), which participates in the ubiquitination of substrates. We also report that the majority mutations occurred in α-helices over β-strands but their effects on the secondary structure were mostly neutral. Global tertiary structure deviations were minimal; however, at amino acid residue level minor structural changes were evident. The molecular dynamics simulation analysis showed that both PB1 and UBA domains were under constant structural fluctuations resulting in closed form conformation of SQSMT1 protein structure, when it is bound to PRKCI ligand. We also found salt bridge conformation changes in the UBA domain of SQSTM1 mutants when they bound to the PRKCI interactor protein. This finding suggests the possibility that mutations in SQSTM1 could impair its ability to ubiquitinate the substrates, eventually affecting autophagy and apoptosis, especially in mature osteoclasts. This study presents the additional insight into structure and function relationship between SQSTM1 mutations and PDB pathogenesis. Communicated by Ramaswamy H. Sarma.
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Affiliation(s)
- Noor Ahmad Shaik
- Department of Genetic Medicine, Faculty of Medicine, King Abdulaziz University, Saudi Arabia.,Princess Al-Jawhara Al-Brahim Center of Excellence in Research of Hereditary Disorders, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Khalidah K Nasser
- Princess Al-Jawhara Al-Brahim Center of Excellence in Research of Hereditary Disorders, King Abdulaziz University, Jeddah, Saudi Arabia.,Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Muteb Muidh Alruwaili
- Department of Genetic Medicine, Faculty of Medicine, King Abdulaziz University, Saudi Arabia
| | - Sami Raja Alallasi
- Department of Genetic Medicine, Faculty of Medicine, King Abdulaziz University, Saudi Arabia
| | - Ramu Elango
- Department of Genetic Medicine, Faculty of Medicine, King Abdulaziz University, Saudi Arabia.,Princess Al-Jawhara Al-Brahim Center of Excellence in Research of Hereditary Disorders, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Babajan Banaganapalli
- Department of Genetic Medicine, Faculty of Medicine, King Abdulaziz University, Saudi Arabia.,Princess Al-Jawhara Al-Brahim Center of Excellence in Research of Hereditary Disorders, King Abdulaziz University, Jeddah, Saudi Arabia
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