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Liu Y, Zhang L, Hu N, Shao J, Yang D, Ruan C, Huang S, Wang L, Lu WW, Zhang X, Yang F. An optogenetic approach for regulating human parathyroid hormone secretion. Nat Commun 2022; 13:771. [PMID: 35140213 PMCID: PMC8828854 DOI: 10.1038/s41467-022-28472-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Accepted: 01/25/2022] [Indexed: 02/08/2023] Open
Abstract
Parathyroid hormone (PTH) plays crucial role in maintaining calcium and phosphorus homeostasis. In the progression of secondary hyperparathyroidism (SHPT), expression of calcium-sensing receptors (CaSR) in the parathyroid gland decreases, which leads to persistent hypersecretion of PTH. How to precisely manipulate PTH secretion in parathyroid tissue and underlying molecular mechanism is not clear. Here, we establish an optogenetic approach that bypasses CaSR to inhibit PTH secretion in human hyperplastic parathyroid cells. We found that optogenetic stimulation elevates intracellular calcium, inhibits both PTH synthesis and secretion in human parathyroid cells. Long-term pulsatile PTH secretion induced by light stimulation prevented hyperplastic parathyroid tissue-induced bone loss by influencing the bone remodeling in mice. The effects are mediated by light stimulation of opsin expressing parathyroid cells and other type of cells in parathyroid tissue. Our study provides a strategy to regulate release of PTH and associated bone loss of SHPT through an optogenetic approach. Parathyroid hormone (PTH) plays a role in maintaining calcium and phosphorus homeostasis, and in secondary hyperparathyroidism excess PTH secretion contributes to bone loss. Here the authors report an optogenetic approach to inhibit PTH secretion in human hyperplastic parathyroid cells, and prevented hyperplastic parathyroid tissue-induced bone loss in mice.
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Affiliation(s)
- Yunhui Liu
- The Brain Cognition and Brain Disease Institute (BCBDI), Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences (CAS), Shenzhen-Hong Kong Institute of Brain Science-Shenzhen Fundamental Research Institutions, Shenzhen, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Lu Zhang
- The Brain Cognition and Brain Disease Institute (BCBDI), Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences (CAS), Shenzhen-Hong Kong Institute of Brain Science-Shenzhen Fundamental Research Institutions, Shenzhen, China.,Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, China
| | - Nan Hu
- Department of Nephrology and Shenzhen Key Laboratory of Kidney Diseases, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University, Shenzhen, China
| | - Jie Shao
- The Brain Cognition and Brain Disease Institute (BCBDI), Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences (CAS), Shenzhen-Hong Kong Institute of Brain Science-Shenzhen Fundamental Research Institutions, Shenzhen, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Dazhi Yang
- Department of Orthopedics, Union Shenzhen Hospital, Huazhong University of Science and Technology, Shenzhen, China
| | - Changshun Ruan
- Research Center for Human Tissue and Organs Degeneration, Institute of Biomedicine and Biotechnology, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences (CAS), Shenzhen, China
| | - Shishu Huang
- Department of Orthopaedic Surgery and Orthopaedic Research Center, West China Hospital of Sichuan University, Chengdu, China
| | - Liping Wang
- The Brain Cognition and Brain Disease Institute (BCBDI), Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences (CAS), Shenzhen-Hong Kong Institute of Brain Science-Shenzhen Fundamental Research Institutions, Shenzhen, China
| | - William W Lu
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, China
| | - Xinzhou Zhang
- Department of Nephrology and Shenzhen Key Laboratory of Kidney Diseases, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University, Shenzhen, China.
| | - Fan Yang
- The Brain Cognition and Brain Disease Institute (BCBDI), Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences (CAS), Shenzhen-Hong Kong Institute of Brain Science-Shenzhen Fundamental Research Institutions, Shenzhen, China. .,University of Chinese Academy of Sciences, Beijing, China.
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Sanada J, Kamei S, Shimoda M, Tatsumi F, Kimura T, Obata A, Kohara K, Nakanishi S, Kaku K, Mune T, Kaneto H. Amelioration of hypercalcemia by cinacalcet treatment in a subject with relapsing acquired hypocalciuric hypercalcemia: A case report. Medicine (Baltimore) 2021; 100:e27579. [PMID: 34678905 PMCID: PMC8542107 DOI: 10.1097/md.0000000000027579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 10/07/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Hypocalciuric hypercalcemia is classified as acquired hypocalciuric hypercalcemia (AHH) and familial hypocalciuric hypercalcemia (FHH). While FHH is inherited as an autosomal dominant trait, AHH is one of the rare acquired diseases and is usually treated with prednisolone. Here, we report a case with relapsing AHH which was well controlled with cinacalcet therapy. PATIENT CONCERN A 68-year-old Japanese man was referred to our institution because of hypercalcemia. Despite such hypercalcemia, he was almost asymptomatic. DIAGNOSTICS We diagnosed him as AHH due to the following reason. First, the ratio of calcium (Ca)/creatinine clearance was very low which met the criteria. Second, there was no overt family history of hypercalcemia. Third, his serum Ca level was within the normal range 3 years before. Fourth, despite hypercalcemia, he was almost asymptomatic and had no evidence of primary hyperparathyroidism. INTERVENTIONS Although it is known that steroid therapy is useful for AHH, optimal treatment remains unknown and cinacalcet therapy is very much limited for the treatment of AHH. In this subject, we introduced cinacalcet therapy for the treatment of relapsing AHH. OUTCOMES Serum Ca and parathyroid hormone levels were normalized after such therapy with cinacalcet. CONCLUSIONS We should bear in mind that cinacalcet treatment is effective for the treatment of relapsing AHH.
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Abstract
Calcium (Ca+2) is a divalent cation that plays a critical role in numerous body functions such as skeletal mineralization, signal transduction, nerve conduction, muscle contraction, and blood coagulation. Ca+2 metabolism is linked to magnesium (Mg+2) and phosphate metabolism. Ca+2 homeostasis is dependent on intestinal absorption, bone turnover, and renal reabsorption. The hormonal regulators of these processes are the parathyroid hormone (PTH), calcitriol {1,25-dihydroxyvitamin D [1,25(OH)2D]}, and serum ionized Ca+2. Cloning of the Ca+2-sensing receptor (CaSR) has greatly advanced the understanding of Ca+2 metabolism. Disorders of Ca+2 metabolism are easily recognized because Ca+2 is included in routine chemistry panels. Measurement of ionized Ca+2 is the preferred way to ascertain the diagnosis of hypocalcemia and hypercalcemia.
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Affiliation(s)
- Mohammad Tinawi
- Medicine, Indiana University School of Medicine Northwest-Gary, Gary, USA.,Nephrology, Nephrology Specialists, Munster, USA
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Miñambres I, Corcoy R, Weetman AP, Kemp EH. Autoimmune Hypercalcemia Due to Autoantibodies Against the Calcium-sensing Receptor. J Clin Endocrinol Metab 2020; 105:5822860. [PMID: 32311038 DOI: 10.1210/clinem/dgaa219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 04/17/2020] [Indexed: 11/19/2022]
Abstract
CONTEXT Autoimmune hypocalciuric hypercalcemia (AHH) is an acquired disorder caused by the presence of blocking autoantibodies against the calcium-sensing receptor (CaSR). Few cases of this condition have been described to date in the literature. OBJECTIVE The objectives of this study were to describe 2 patients in whom the presence of AHH was suspected and to assess the patients for the presence of CaSR antibodies. METHODS CaSR antibodies were detected and characterised by immunoprecipitation assays, CaSR peptide ELISAs, and functional assays based on the calcium-stimulated accumulation of inositol-1-phosphate in a mammalian cell line expressing the CaSR. RESULTS Both patients presented with an acquired form of hypocalciuric hypercalcemia. Mutational analyses of CASR, GNA11, and AP2S1 for familial hypocalciuric hypercalcemia were negative. According to the presence of Hashimoto's disease in 1 patient and latent autoimmune diabetes of adulthood and thyroid autoimmunity in the other, AHH was suspected. Immunoprecipitation assays detected CaSR antibodies in both patients. Analysis of the antibody binding sites revealed 2 main epitopes at amino acids 41-69 and 114-126. Preincubation with purified CaSR antibodies against epitope 114-126 resulted in a significant decrease in inositol-1-phophate accumulation upon calcium-stimulation of mammalian cells expressing the CaSR, suggesting that the antibodies had receptor-blocking activity. CONCLUSIONS AHH is to be suspected in patients with an acquired biochemical pattern of PTH-dependant hypocalciuric hypercalcemia, especially in those with other concomitant autoimmune diseases. Diagnosis by means of detecting CaSR antibodies may help to better characterise this probably under-reported condition.
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Affiliation(s)
- Inka Miñambres
- Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Departament of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- CIBER de Diabetes y Enfermedades Metabólicas (CIBER-DEM), Spain
| | - Rosa Corcoy
- Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Departament of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- CIBER de Bioingeniería, Biomateriales y Nanotecnología (CIBER-BBN), Spain
| | - Anthony P Weetman
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - E Helen Kemp
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
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Makita N, Ando T, Sato J, Manaka K, Mitani K, Kikuchi Y, Niwa T, Ootaki M, Takeba Y, Matsumoto N, Kawakami A, Ogawa T, Nangaku M, Iiri T. Cinacalcet corrects biased allosteric modulation of CaSR by AHH autoantibody. JCI Insight 2019; 4:126449. [PMID: 30996138 DOI: 10.1172/jci.insight.126449] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 03/12/2019] [Indexed: 12/13/2022] Open
Abstract
Biased agonism is a paradigm that may explain the selective activation of a signaling pathway via a GPCR that activates multiple signals. The autoantibody-induced inactivation of the calcium-sensing receptor (CaSR) causes acquired hypocalciuric hypercalcemia (AHH). Here, we describe an instructive case of AHH in which severe hypercalcemia was accompanied by an increased CaSR antibody titer. These autoantibodies operated as biased allosteric modulators of CaSR by targeting its Venus flytrap domain near the Ca2+-binding site. A positive allosteric modulator of CaSR, cinacalcet, which targets its transmembrane domain, overcame this autoantibody effect and successfully corrected the hypercalcemia in this patient. Hence, this is the first study to our knowledge that identifies the interaction site of a disease-causing GPCR autoantibody working as its biased allosteric modulator and demonstrates that cinacalcet can correct the AHH autoantibody effects both in vitro and in our AHH patient. Our observations provide potentially new insights into how biased agonism works and how to design a biased allosteric modulator of a GPCR. Our observations also indicate that the diagnosis of AHH is important because the severity of hypercalcemia may become fatal if the autoantibody titer increases. Calcimimetics may serve as good treatment options for some patients with severe AHH.
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Affiliation(s)
- Noriko Makita
- Department of Endocrinology and Nephrology, The University of Tokyo School of Medicine, Tokyo, Japan
| | - Takao Ando
- Division of Endocrinology and Metabolism, Nagasaki Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Junichiro Sato
- Department of Endocrinology and Nephrology, The University of Tokyo School of Medicine, Tokyo, Japan
| | - Katsunori Manaka
- Department of Endocrinology and Nephrology, The University of Tokyo School of Medicine, Tokyo, Japan
| | - Koji Mitani
- Department of Endocrinology and Nephrology, The University of Tokyo School of Medicine, Tokyo, Japan
| | - Yasuko Kikuchi
- Department of Breast and Endocrine Surgery, The University of Tokyo School of Medicine, Tokyo, Japan
| | - Takayoshi Niwa
- Department of Breast and Endocrine Surgery, The University of Tokyo School of Medicine, Tokyo, Japan
| | - Masanori Ootaki
- Department of Pharmacology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Yuko Takeba
- Department of Pharmacology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Naoki Matsumoto
- Department of Pharmacology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Atsushi Kawakami
- Division of Endocrinology and Metabolism, Nagasaki Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Toshihisa Ogawa
- Breast Center, Dokkyo Medical University Koshigaya Hospital, Saitama, Japan
| | - Masaomi Nangaku
- Department of Endocrinology and Nephrology, The University of Tokyo School of Medicine, Tokyo, Japan
| | - Taroh Iiri
- Department of Endocrinology and Nephrology, The University of Tokyo School of Medicine, Tokyo, Japan.,Department of Pharmacology, St. Marianna University School of Medicine, Kawasaki, Japan
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Chamberlin M, Kemp EH, Weetman AP, Khadka B, Brown EM. Immunosuppressive therapy of autoimmune hypoparathyroidism in a patient with activating autoantibodies against the calcium-sensing receptor. Clin Endocrinol (Oxf) 2019; 90:214-221. [PMID: 30358904 DOI: 10.1111/cen.13886] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 08/15/2018] [Accepted: 10/18/2018] [Indexed: 12/31/2022]
Abstract
CONTEXT Activating antibodies directed at the extracellular calcium-sensing receptor (CaSR) have been described in autoimmune hypoparathyroidism in the setting of isolated hypoparathyroidism or autoimmune polyglandular syndrome type 1. MATERIALS AND METHODS A 34-year-old female presented with hypocalcaemia (6.0 mg/dL) and hypomagnesaemia (1.1 mg/dL) accompanied by low serum PTH (2.4 pg/mL) as well as urinary calcium and magnesium wasting. She was diagnosed with hypoparathyroidism, which was refractory to standard therapy. She was started on 60 mg prednisone and 150 mg azathioprine treatment daily on suspicion of an autoimmune aetiology. The patient was tested for CaSR antibodies. RESULTS The patient was positive for CaSR antibodies of the IgG1 subtype, which stimulated phosphorylation of extracellular signal-regulated kinases 1 and 2 (ERK1/2) and inositol phosphate (IP) accumulation. Post-treatment with prednisone and azathioprine, her serum calcium and magnesium normalized, as did her CaSR antibody titre and antibody-mediated stimulation of ERK1/2 phosphorylation and IP accumulation. CONCLUSION This is the first demonstration of CaSR antibody-mediated hypoparathyroidism responsive to immunosuppressive therapy, adding to the evidence that autoimmune hypoparathyroidism can be, in some cases, reversible and not the result of autoimmune parathyroid destruction.
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Affiliation(s)
| | - E Helen Kemp
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Anthony P Weetman
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | | | - Edward M Brown
- Division of Endocrinology, Diabetes, and Hypertension, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
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Song L, Liu L, Miller RT, Yan SX, Jackson N, Holt SA, Maalouf NM. Glucocorticoid-responsive lymphocytic parathyroiditis and hypocalciuric hypercalcemia due to autoantibodies against the calcium-sensing receptor: a case report and literature review. Eur J Endocrinol 2017; 177:K1-K6. [PMID: 28515208 DOI: 10.1530/eje-17-0172] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 04/16/2017] [Accepted: 04/21/2017] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Autoimmune lymphocytic parathyroiditis and acquired hypocalciuric hypercalcemia associated with autoantibodies against the calcium-sensing receptor (anti-CaSR) are rare and poorly understood conditions. Here, we describe a patient with acquired parathyroid hormone (PTH)-dependent hypercalcemia with associated hypocalciuria, found to have true lymphocytic parathyroiditis on histopathology, and circulating anti-CaSR antibodies in serum. DESIGN AND METHODS A 64-year-old woman was referred to our clinic for persistent hypercalcemia after a subtotal parathyroidectomy. She was normocalcemic until the age of 63 years when she was diagnosed with primary hyperparathyroidism. She underwent subtotal parathyroidectomy with appropriate intraoperative PTH decline. Two weeks post-parathyroidectomy, she presented with persistent hypercalcemia and hyperparathyroidism. Urine studies revealed an inappropriately low 24-h urine calcium (Ca)/creatinine clearance ratio. Surgical pathology was consistent with true lymphocytic parathyroiditis with lymphoid follicles. The presence of circulating anti-CaSR antibodies was detected by immunoprecipitation of CaSR by the patient's serum. After a 4-week course of prednisone, serum Ca and PTH normalized, and her anti-CaSR titers declined. She remains normocalcemic 10 months after the discontinuation of glucocorticoid therapy. We present this patient in the context of the relevant published literature on lymphocytic parathyroiditis and acquired hypocalciuric hypercalcemia related to anti-CaSR antibodies. CONCLUSIONS Autoimmune lymphocytic parathyroiditis and acquired hypocalciuric hypercalcemia associated with anti-CaSR antibodies is a very rare yet important condition to be considered in a patient with acquired PTH-dependent hypercalcemia with inappropriate hypocalciuria. Although subtotal parathyroidectomy is unlikely to correct the hypercalcemia, this entity may respond to a short course of prednisone therapy.
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Affiliation(s)
- Li Song
- Department of Internal Medicine
- Divisions of Mineral Metabolism and Endocrinology
| | - Liping Liu
- Department of Internal Medicine
- Division of NephrologyUniversity of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - R Tyler Miller
- Department of Internal Medicine
- Division of NephrologyUniversity of Texas Southwestern Medical Center, Dallas, Texas, USA
- Dallas VA Medical CenterDallas, Texas, USA
- Charles & Jane Pak Center for Mineral Metabolism & Clinical Research
| | | | - Nancy Jackson
- SurgeryUniversity of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Shelby A Holt
- SurgeryUniversity of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Naim M Maalouf
- Department of Internal Medicine
- Divisions of Mineral Metabolism and Endocrinology
- Charles & Jane Pak Center for Mineral Metabolism & Clinical Research
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