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Xie S, Yu Y, Liu Y, Zhang S, Yuan S, Fan K, Tang B, Zhou Q, Sun Y, Liu R, Cao D, Chen Y, Wang Y, Liu G, Ma H, Tao C, Zeng L, Zhong L. Effectiveness and Safety of Ultrasound-Guided Local Paricalcitol Injection in Treating Secondary Hyperparathyroidism in ESRD: A Retrospective Study. J Clin Med 2022; 11:jcm11226860. [PMID: 36431337 PMCID: PMC9693598 DOI: 10.3390/jcm11226860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 11/16/2022] [Accepted: 11/19/2022] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To compare the safety and efficacy of percutaneous paricalcitol injection with intravenously administered paricalcitol in treating parathyroid hyperplasia in patients with secondary hyperparathyroidism (SHPT). METHODS This study was approved by the Ethics Committee of our institution. We retrospectively collected data on patients who received percutaneous paricalcitol injection (24 patients) and intravenously administered paricalcitol (22 patients) based on their intact parathyroid hormone (iPTH) level. Serum iPTH, calcium, phosphorus, and the volume of the parathyroid gland were measured at several indicated time points after treatment, and adverse events associated with the two treatments were evaluated. RESULTS After 6 months of follow-up, we found that patients from the percutaneous injection group had significantly decreased levels of iPTH (from 1887.81 ± 726.81 pg/mL to 631.06 ± 393.06 pg/mL), phosphate (from 1.94 ± 0.36 mmol/L to 1.71 ± 0.34 mmol/L), and volume of the parathyroid gland (from 0.87 ± 0.50 cm3 to 0.60 ± 0.36 cm3), with relief from ostealgia within 48-72 h. In the intravenously administered group, the levels of iPTH decreased from 686.87 ± 260.44 pg/mL to 388.47 ± 167.36 pg/mL; while there was no significant change in phosphate levels, the volume of the parathyroid gland and ostealgia relief were observed at the end of follow-up. The serum calcium level did not significantly change, and no severe complications were observed in both groups. In vitro fluorescence-activated single cell sorting (FACS) analysis indicated that paricalcitol induced parathyroid cell apoptosis in a dose-dependent manner. CONCLUSIONS Percutaneous paricalcitol injection is a selective treatment for SHPT in ESRD.
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Affiliation(s)
- Shuqin Xie
- Department of Nephrology, Second Affiliated Hospital, Chongqing Medical University, Chongqing 400010, China
| | - Yuan Yu
- Department of Nephrology, Second Affiliated Hospital, Chongqing Medical University, Chongqing 400010, China
| | - Yi Liu
- Department of Nephrology, Second Affiliated Hospital, Chongqing Medical University, Chongqing 400010, China
| | - Siliang Zhang
- Department of Nephrology, Second Affiliated Hospital, Chongqing Medical University, Chongqing 400010, China
| | - Shiyi Yuan
- Department of Nephrology, Yongchuan People’s Hospital of Chongqing, Chongqing 402160, China
| | - Kui Fan
- Department of Nephrology, Second Affiliated Hospital, Chongqing Medical University, Chongqing 400010, China
| | - Bin Tang
- Department of Nephrology, Second Affiliated Hospital, Chongqing Medical University, Chongqing 400010, China
| | - Qin Zhou
- Department of Nephrology, Second Affiliated Hospital, Chongqing Medical University, Chongqing 400010, China
| | - Yuqing Sun
- Department of Nephrology, Second Affiliated Hospital, Chongqing Medical University, Chongqing 400010, China
| | - Rui Liu
- Department of Nephrology, Dianjiang People’s Hospital of Chongqing, Chongqing 408300, China
| | - Dan Cao
- The Department of Nephrology, The Fifth Hospital of Chongqing, Chongqing 400062, China
| | - Yong Chen
- Department of Nephrology and Hematopathology, Second Affiliated Hospital at Fengjie, Chongqing Medical University, Chongqing 404600, China
| | - Yelei Wang
- Department of Nephrology, People’s Hospital of Pengshui County, Chongqing 409600, China
| | - Guangjun Liu
- Department of Nephrology, People’s Hospital of Shizhu County, Chongqing 409100, China
| | - Huan Ma
- Department of Nephrology, Dianjiang People’s Hospital of Chongqing, Chongqing 408300, China
| | - Chenghui Tao
- Department of Nephrology, Fengdu People’s Hospital, Chongqing 408200, China
| | - Li Zeng
- Department of Nephrology, Second Affiliated Hospital, Chongqing Medical University, Chongqing 400010, China
- Correspondence: (L.Z.); (L.Z.)
| | - Ling Zhong
- Department of Nephrology, Second Affiliated Hospital, Chongqing Medical University, Chongqing 400010, China
- Correspondence: (L.Z.); (L.Z.)
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Lim YS, You BH, Kim HB, Lim SH, Song JG, Bae MG, Han HK, Choi YH, Choi HS. A New Therapeutic Approach Using a Calcilytic (AXT914) for Postsurgical Hypoparathyroidism in Female Rats. Endocrinology 2020; 161:5898117. [PMID: 32852547 DOI: 10.1210/endocr/bqaa145] [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: 05/22/2020] [Accepted: 08/26/2020] [Indexed: 11/19/2022]
Abstract
Postsurgical hypoparathyroidism is the most common complication of thyroid surgery. Conventional therapy with high-dose calcium and vitamin D can correct hypocalcemia but can increase the risk of hypercalciuria, renal stones, or ectopic calcification. The aim of the present study was to investigate the efficacy of a calcium-sensing receptor antagonist, also called a calcilytic (AXT914), in rat models of postsurgical hypoparathyroidism. Two postsurgical hypoparathyroidism rat models were made by hemi-parathyroidectomy or total parathyroidectomy with autotransplantation in 10-week-old female Wistar rats. AXT914 or vehicle was administered orally for 2 to 3 weeks. Serum PTH, calcium, and phosphorus levels, and the urinary excretion of calcium were measured. Autotransplanted parathyroid tissues were collected and examined histologically. In the hemi-parathyroidectomy model, the oral administration of the calcilytic AXT914 (5 and 10 mg/kg) for 2 weeks increased serum PTH and calcium levels and decreased serum phosphorus levels and urinary calcium excretion. In the total parathyroidectomy with autotransplantation model, the oral administration of AXT914 (10 mg/kg) for 3 weeks increased serum PTH and calcium levels and decreased serum phosphorus levels. The serum PTH and calcium levels increased by AXT914 were maintained for 1 week, even after discontinuation of the drug. In conclusion, AXT914 increased PTH secretion in rat models of postsurgical hypoparathyroidism, thereby correcting abnormal calcium and phosphorus homeostasis. Furthermore, AXT914 improved the functional recovery of autotransplanted parathyroid tissues.
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Affiliation(s)
- Yun-Sung Lim
- Department of Otorhinolaryngology-Head and Neck Surgery, Dongguk University Ilsan Hospital, Koyang-si, Gyeonggi-do, Republic of Korea
| | - Byung Hoon You
- College of Pharmacy and Integrated Research Institute for Drug Development, Dongguk University-Seoul, Koyang-si, Gyeonggi-do, Republic of Korea
| | - Hee-Bok Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Dongguk University Ilsan Hospital, Koyang-si, Gyeonggi-do, Republic of Korea
| | - So Hyun Lim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Dongguk University Ilsan Hospital, Koyang-si, Gyeonggi-do, Republic of Korea
| | - Jae Geun Song
- College of Pharmacy and Integrated Research Institute for Drug Development, Dongguk University-Seoul, Koyang-si, Gyeonggi-do, Republic of Korea
| | - Min Goo Bae
- College of Pharmacy and Integrated Research Institute for Drug Development, Dongguk University-Seoul, Koyang-si, Gyeonggi-do, Republic of Korea
| | - Hyo-Kyung Han
- College of Pharmacy and Integrated Research Institute for Drug Development, Dongguk University-Seoul, Koyang-si, Gyeonggi-do, Republic of Korea
| | - Young Hee Choi
- College of Pharmacy and Integrated Research Institute for Drug Development, Dongguk University-Seoul, Koyang-si, Gyeonggi-do, Republic of Korea
| | - Han Seok Choi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Dongguk University Ilsan Hospital, Koyang-si, Gyeonggi-do, Republic of Korea
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Panizo S, Barrio-Vázquez S, Naves-Díaz M, Carrillo-López N, Rodríguez I, Fernández-Vázquez A, Valdivielso JM, Thadhani R, Cannata-Andía JB. Vitamin D receptor activation, left ventricular hypertrophy and myocardial fibrosis. Nephrol Dial Transplant 2013; 28:2735-44. [PMID: 24013683 DOI: 10.1093/ndt/gft268] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Left ventricular hypertrophy (LVH), a common complication in chronic kidney disease (CKD), is associated with high cardiovascular mortality. The aim of this experimental study was to analyze the effect of different vitamin D receptor activators (VDRAs) on both LVH and myocardial fibrosis in chronic renal failure (CRF). METHODS Male Wistar rats with CRF, carried out by 7/8 nephrectomy, were treated intraperitoneally with equivalent doses of VDRAs (calcitriol, paricalcitol and alfacalcidol, 5 days per week) during 4 weeks. A placebo group (CRF + vehicle) and a Sham group with normal renal function served as controls. Biochemical, morphological, functional and molecular parameters associated with LVH were evaluated, as well as cardiac fibrosis, collagen I, transforming growth factor β1 (TGFβ1) and matrix metalloproteinase-1 (MMP1) expression. RESULTS All VDRAs treatment prevented LVH, with values of cardiomyocyte size, LV wall and septum thickness and heart-body weight ratio similar to those observed in the Sham group. At molecular levels, all VDRAs attenuated atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) expression compared with CRF + vehicle. The phosphorylation of ERK1/2, a signal for activating growth, was stimulated in the CRF + vehicle group; VDRAs use prevented this activation. Paricalcitol was the only VDRA used that maintained in the normal range all parameters associated with myocardial fibrosis (total collagen, collagen I, TGFβ1 and MMP1). CONCLUSIONS Our findings demonstrated that the three VDRAs used induced similar changes in bone metabolic parameters and LVH. In addition, paricalcitol was the only VDRA which showed a relevant beneficial effect in the reduction of myocardial fibrosis, a key factor in the myocardial dysfunction in CKD patients.
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Affiliation(s)
- Sara Panizo
- Servicio de Metabolismo Óseo y Mineral. Instituto Reina Sofía de Investigación. REDinREN del ISCIII. Universidad de Oviedo. Hospital Universitario Central de Asturias, Oviedo, España
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Stubbs JR, Wetmore JB. Does it Matter How Parathyroid Hormone Levels are Suppressed in Secondary Hyperparathyroidism? Semin Dial 2011; 24:298-306. [DOI: 10.1111/j.1525-139x.2011.00935.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Shiizaki K, Hatamura I, Fukagawa M, Nakazawa E, Saji F, Watanabe Y, Akizawa T, Kusano E. Development of a technique for introduction of an expressed complementary deoxyribonucleic acid into parathyroid cells by direct injection. Endocrinology 2010; 151:4031-8. [PMID: 20519369 DOI: 10.1210/en.2010-0012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
PTH is a major mediator of bone and mineral metabolism. However, physiological and pathological investigations of parathyroid cells (PTCs) have been limited because of the lack of available cell lines and because the organ is too small for detailed studies. Here, we describe a novel method for adenovirus-mediated cDNA transfer into PTCs, and we show the accuracy of the method in a rat model of uremia-induced secondary hyperparathyroidism. Rats underwent a 5/6-nephrectomy and were fed with a high-phosphate diet for 8 wk. The parathyroid glands were surgically exposed and adenoviruses containing LacZ or Ca-sensing receptor (CaSR) were directly injected into the glands under a zoom-stereo microscope. The parathyroid glands were analyzed for infection of adenovirus and immunohistochemically for expression of CaSR. The functional activity of exogenous CaSR in PTCs after this treatment was investigated based on changes of the calcium and PTH curve. A virus concentration of more than 10(9) plaque-forming units/ml was required for adequate infection of PTCs within 7 d after treatment. Marked increase of CaSR-positive PTCs by 2.39 +/- 0.72 times relative to control treatment, and significant colocalization of CaSR overexpression and virus labeling, were observed in glands after gene introduction. The calcium and PTH curve was shifted to the left from the basal position (set point, 1.10 +/- 0.09 to 0.76 +/- 0.12 mm; P < 0.0001), indicating successful introduction of a functionally active cDNA into the PTCs. This technique may facilitate an elucidation of biological effects through targeting and identification of specific features of PTCs, which may provide the basis for new clinical approaches.
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MESH Headings
- Adenoviridae/genetics
- Animals
- DNA, Complementary/administration & dosage
- DNA, Complementary/analysis
- DNA, Complementary/genetics
- DNA, Complementary/metabolism
- Disease Models, Animal
- Expressed Sequence Tags
- Gene Transfer Techniques
- Genetic Vectors/administration & dosage
- Hyperparathyroidism, Secondary/genetics
- Hyperparathyroidism, Secondary/pathology
- Injections/methods
- Lac Operon
- Models, Biological
- Osmolar Concentration
- Parathyroid Glands/cytology
- Parathyroid Glands/metabolism
- Rats
- Rats, Sprague-Dawley
- Rats, Transgenic
- Receptors, Calcium-Sensing/administration & dosage
- Receptors, Calcium-Sensing/genetics
- Receptors, Calcium-Sensing/metabolism
- Uremia/genetics
- Uremia/pathology
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Affiliation(s)
- Kazuhiro Shiizaki
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan.
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Carrillo-López N, Román-García P, Fernández-Martín JL, Cannata-Andía JB. Parathyroid gland regulation: contribution of thein vivoandin vitromodels. Expert Opin Drug Discov 2010; 5:265-75. [DOI: 10.1517/17460441003615170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Natalia Carrillo-López
- Hospital Universitario Central de Asturias, Bone and Mineral Research Unit, Instituto Reina Sofía de Investigación, REDinREN del ISCIII, Universidad de Oviedo, C/Julián Clavería s/n, Oviedo 33006, Asturias, Spain +34 985106137 ; +34 985106142 ;
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Shiizaki K, Hatamura I, Negi S, Nakazawa E, Tozawa R, Izawa S, Akizawa T, Kusano E. Cellular changes following direct vitamin D injection into the uraemia-induced hyperplastic parathyroid gland. NDT Plus 2008; 1:iii42-iii48. [PMID: 25983973 PMCID: PMC4421129 DOI: 10.1093/ndtplus/sfn095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2008] [Accepted: 03/07/2008] [Indexed: 11/13/2022] Open
Abstract
Background. Hyperplasia of the parathyroid gland (PTG) is associated not only with excessive secretion of parathyroid hormone (PTH) but also with changes in the parathyroid cell (PTC) characteristics (i.e. hyperproliferative activity and low contents of vitamin D and calcium-sensing receptors). The control of PTG hyperplasia is most important in the management of secondary hyperparathyroidism (SHPT), because the advanced stage of hyperplasia is considered irreversible. For the better control of the PTH level in dialysis patients with such advanced SHPT, percutaneous vitamin D injection therapy (PDIT) under ultrasonographic guidance was developed and various cellular changes caused by this treatment were also investigated using an animal model. Methods. The PTGs of Sprague–Dawley rats, which had been 5/6-nephrectomized and fed a high-phosphate diet, were treated with the direct injections of vitamin D agents, and cellular effects focusing the above-mentioned characters were investigated. Results. An adequacy of the direct injection technique into the rats’ PTGs and the successful effects of this treatment in various biochemical parameters were confirmed. Such characteristics of advanced SHPT were simultaneously improved; in particular, it was confirmed that this treatment may be effective in controlling PTG hyperplasia by, at least in part, apoptosis-induced cell death. Conclusions. A locally high level of vitamin D strongly may suppress PTH secretion and regress hyperplasia, which is involved in the induction of apoptosis in PTCs, based on the simultaneous improvements of cellular characters of advanced SHPT. The PTH control introduced by this treatment successfully ameliorated osteitis fibrosa (high bone turnover rate).
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Affiliation(s)
- Kazuhiro Shiizaki
- Division of Nephrology, Department of Internal Medicine , Jichi Medical University , Shimotsuke 329-0498
| | | | - Shigeo Negi
- Division of Nephrology and Blood Purification Medicine , Wakayama Medical University , Wakayama 641-0012
| | - Eiko Nakazawa
- Division of Nephrology, Department of Internal Medicine , Jichi Medical University , Shimotsuke 329-0498
| | - Ryoko Tozawa
- Division of Nephrology, Department of Internal Medicine , Jichi Medical University , Shimotsuke 329-0498
| | - Sayoko Izawa
- Division of Nephrology, Department of Internal Medicine , Jichi Medical University , Shimotsuke 329-0498
| | - Tadao Akizawa
- Department of Nephrology , Showa University School of Medicine , Tokyo 142-0064 , Japan
| | - Eiji Kusano
- Division of Nephrology, Department of Internal Medicine , Jichi Medical University , Shimotsuke 329-0498
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Shiizaki K, Hatamura I, Nakazawa E, Ogura M, Masuda T, Akizawa T, Kusano E. Molecular and morphological approach of uremia-induced hyperplastic parathyroid gland following direct maxacalcitol injection. Med Mol Morphol 2008; 41:76-82. [PMID: 18592161 DOI: 10.1007/s00795-008-0399-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2008] [Accepted: 03/04/2008] [Indexed: 10/21/2022]
Abstract
The mechanisms explaining the clinical effects of direct maxacalcitol (OCT) injection into the hyperplastic parathyroid gland (PTG) in uremic patients with advanced secondary hyperparathyroidism (SHPT) were investigated by molecular and morphological examination. PTG of uremia-induced SHPT model rats were treated by a direct injection of OCT (DI-OCT) or vehicle (DI-vehicle). The changes in serum intact parathyroid hormone (intact-PTH) level, vitamin D and Ca-sensing receptor (VDR and CaSR, respectively) expression levels in PTG, and the calcium (Ca)-PTH response curve were examined; the induction of apoptosis in parathyroid cells (PTC) was also analyzed by the TUNEL method, DNA electrophoresis, and electron microscopic examination. Serum intact-PTH level following DI-OCT significantly decreased. Upregulation of both VDR and CaSR, a clear shift to the left downward in the Ca-PTH curve, and many apoptotic PTCs were observed in the DI-OCT-treated PTGs. However, these findings were not observed in the DI-vehicle-treated PTGs. Moreover, these effects were confirmed by the DI-OCT into one PTG and DI-vehicle alone into another PTG in the same rat. DI-OCT may introduce simultaneous VDR and CaSR upregulation and the regression of hyperplastic PTG, and these effects may provide a strategy for strongly suppressing PTH level in uremia-induced advanced SHPT.
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Affiliation(s)
- Kazuhiro Shiizaki
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, Japan.
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