(12) United States Patent (10) Patent No.: US 7,981,419 B2 Yamashita Et Al

Total Page:16

File Type:pdf, Size:1020Kb

(12) United States Patent (10) Patent No.: US 7,981,419 B2 Yamashita Et Al US007981419B2 (12) United States Patent (10) Patent No.: US 7,981,419 B2 Yamashita et al. (45) Date of Patent: Jul. 19, 2011 (54) METHOD FOR TREATING EP 0314161 A1 10/1988 HYPOPHOSPHATEMICUSING FGF-23 ANTIBODY BONE DISEASES g;JP 561478926 :1 11/1986 JP H-02-117920 2/1990 (75) Inventors: Takeyoshi Yamashita, Tokyo (JP); W0 WO 99/60017 11/1999 TakashiSatoru Mizutani, Shimada, Yokohama Brookline, (JP); MA Seiji(US); $8W0 $8WO 00/73454 AlA1 120000 Fukumoto, Tokyo (JP) W0 WO 01/40466 A2 6/2001 W0 WO 01/42451 A2 6/2001 (73) Assignee: KyoWa Hakko Kirin Co., Ltd., Tokyo W0 WO 01/49740 A1 7/2001 (JP) W0 WO 01/60850 A1 8/2001 W0 WO 01/61007 A2 8/2001 ( * ) Notice: patentSubject' 1s to extendedany disclaimer, or adjusted the term under of this 35 W0 WO 02/08271 A1 1/2002 U.S.C. 154(1)) by 173 days. W0 WO 02/14504 A1 2/2002 W0 WO 02/76467 A1 3/2002 . W0 W0 02/088358 A2 11/2002 (21) Appl' No" 1262551 W0 W0 03/057733 A1 1/2003 . W0 WO 02/43478 5/2004 (22) Flledi Dec-1, 2008 W0 WO 2006/078072 A1 7/2006 WO WO-2008/057683 A2 5/2008 (65) Prior Publication Data W0 WO 2008/092019 A1 7/2008 US 2009/0110677 A1 Apr. 30, 2009 OTHER PUBLICATIONS Notice of Allowance for Korean Patent Application 10-2003 Related US. Application Data 7001931 Dated Nov. 26, 2008. (63) Continuation of application No. 10/344,339, ?led as Kenneth E. White et al., “Molecular cloning of a novel human UDP application No. PCT/JP01/06944 on Aug. 10, 2001, GaINAczpolypeptide N-acetylgalactosaminyltransferase, GaINAc T8, and analysis as a candidate autosomal dominant noW abandoned. hypophophatemic rickets (ADHR) gene”, Gene 246 (2000), 347 356. (30) Foreign Application Priority Data NCBI GenBank Accession No. NPi065689 (Mar. 25, 2007). NCBI GenBank Accession No. NMi020638 (Mar. 25, 2007). Aug. 11, 2000 (JP) ............................... .. 2000-245144 NCBI GenBank Accession No. AY566236 (Mar. 16, 2004). Sep. 21, 2000 2000-287684 Non-Final Of?ce Action dated Dec. 29,2009, issued in related U.S. Dec. 22, 2000 (JP) ............................... .. 2000-391077 Appl. No. 10/500,296. Apr. 19,2001 (JP) ............................... .. 2001-121527 International Search Report of PCT Patent Application No. PCT/ J P03/ 000 17 dated Feb. 5, 2003iinternational, counterpart to related (51) Int. Cl. U.S.App1. No. 10/500,296. A61K 39/395 (2006.01) International Search Report of PCT Patent Application No. PCT/ JP2008/052918 dated Mar. 13, 2008iinternationa1, counterpart to C07K 16/22 (2006.01) related U.S. Appl. No. l2/030,593. (52) US. Cl. ................................ .. 424/1391; 530/3879 Preissner et al., “Evaluation of the Immutopics Human FGF-23 (58) Field of Classi?cation Search ...................... .. None (C-term) ELISA Kit”, Clinical Chemistry, vol. 52, No. 6, Suppl. S, See application ?le for complete search history. Jun. 2006, p. A174. Supplementary European Search Report EP 08 71 1707 dated Feb. 9, (56) References Cited 2010. Japanese Of?ce Action Application No. JP 2003-558047 dated Jan. U.S. PATENT DOCUMENTS 26, 2010. Takashi Shimada et al., “Possible Roles of Fibroblast Growth Factor 5,585,089 A 12/1996 Queen et a1. 23 in Developing X-Linked Hypophosphatemia”, Clin. Pediatr. 5,958,879 A 9/1999 Kopchick et al. Endocrinol. 2005; 14(Suppl23) 33-37. 6,001,358 A 12/1999 Black et a1. 6,617,118 B2 9/2003 Ro?ler et a1. 7,094,551 B2 8/2006 Zahradnik et a1. (Continued) 7,223,563 B2 5/2007 Econs et al. 7,314,618 B2 l/2008 Econs et al. Primary Examiner * Christine J Saoud 2002/0156001 A1 10/2002 Econs et al. (74) Attorney, Agent, or Firm * Stephen A. Bent; Foley & 2004/0082506 A1 4/2004 Yamashita et a1. Lardner LLP 2004/0171825 A1 9/ 2004 Bougueleret et al. 2005/0048058 A1 3/2005 YamaZaki et al. 2006/0160181 A1 7/ 2006 Luethy et al. (57) ABSTRACT 2009/0110677 A1 4/2009 Yamashita et a1. A method for treating a hypophosphatemic bone disease, 2009/0148461 A1 6/2009 Yamazaki et a1. such as X-linked hypophosphatemia (XLH). The method FOREIGN PATENT DOCUMENTS entails administering to a subject a pharmaceutical composi CA 2418215 l/2002 tion, Which contains an antibody that binds to an FGF-23 CN 1446227 A 10/2003 polypeptide and a pharmaceutically acceptable carrier. EP 120694 10/1984 EP 125023 ll/l984 1 Claim, 37 Drawing Sheets US 7,981,419 B2 Page 2 OTHER PUBLICATIONS Fishwild, et al., “High-avidity Human IgGK Monoclonal Antibodies from a Novel Strain of Minilocus Transgenic Mice,” NatBiotechnol., Satoshi Toyoshima, “Experiment Techniques II”, Hirokawa Publish Jul. 1996, vol. 14, No. 7, pp. 845-851. ing Co., 1995, ?rst edition, pp. 110-113. Fukagawa, et al., “FGF23: its Role in Renal Bone Disease”, Pediat. Non-Final Of?ce Action U.S. Appl. No. 12/030,593 dated Apr. 6, Nephrol, 2006, vol. 21, pp. 1802-1806. 2010. Goding, J. W., Monoclonal Antibodies.‘ Principles and Practice, Marc DreZner, Reviews in Endocrine & Metabolic Disorders 2001;2: Academic Press, 1993 and 1995. 175 -186. Gupta, et al., “FGF-23 is Elevated by Chronic Hyperphosphatemia,” RaZZaque et al., Nephrol Dial Transplant, Oct. 2005; 20(10):2032 .I. Clin. Endocrinol.& Metab., 2004. vol. 89, No. 9, pp. 4489-4492. 2035. Imel, et al., “FGF23 Concentrations Vary with Disease Status in Inaba et al., Osteoporos Int. Oct. 2006; 17(10): 1506-1513. Autosomal Dominant Hypophosphatemic Rickets,” .I.of Bone and Vajdos et al., J. Mol. Biol. Jul. 5, 2002; 320(2):415-428. Mineral Research, 2007, vol. 22, pp. 520-526. Webster’s New World Dictionary, Third College Edition, 1988, pp. Ishida & Lonberg, IBC’s 11th Antibody Engineering, Abstract 2000. Jonsson, et al., “Fibroblast Growth Factor 23 in Oncogenic 1067-1068. Osteomalacia and X-Linked Hypophosphatemia,” N. Engl. .I. Med., Kobayashi et al., Eur J. Endocrinol. Jan. 2006;154(1)93-99. Apr. 24, 2003, vol. 348, No. 17, pp. 1656-1663. Canadian Patent Of?ce Action for 2,418,802 dated Feb. 13, 2009. Karlsson, et al., “Kinetic Analysis of Monoclonal Antibody-Antigen First Of?ce Action Chinese Application No. 2008100866831 dated Interactions with a New Biosensor Based Analytical System,” Jour Mar. 8, 2010. nal ofImmunological Methods, 1991, vol. 145, pp. 229-240. Human Fibroblast Growth Factor-23 (FGF-23) Elisa Kit 96-Well Kearney, et al., “A New Mouce Myeloma Cell Line that has Lost Plate, EZHFG23-32K, Millipore, Feb. 3, 2009 (17 pgs.). Immunoglobulin Expression but Permits the Construction of Anti Human Intact FGF-23 Elisa Kit, Enzyme-Linked ImmunoSorbent body-Secreting Hybrid Cell Lines”, J Immunology, Sep. 1979, vol. Assay (ELISA) for the Determination of Human Fibroblas Growth 123, No. 3, pp. 1548-1550. Factor 23 Levels in Plasma or Cell Culture, 96 Test Kit, Cat. No. King, D.J., Applications and Engineering ofMonoclonal Antibodies, 60-6500, Immotopics, Inc., Oct. 2008 (4 pgs.). T. J. International Ltd, 1998. Monoclonal Anti-human FGF-23 Antibody, R&D Systems. Cat. No. Kitamura, et al., “A B Cell-de?cient Mouse by Targeted Distribution MAB2604, Apr. 18, 2005. of the Membrane Exon of the Immunoglobulin u Chain Gene,” Monoclanal Anti-human/mouse FGF-23 Antibody, R&D Systems, Nature, 1991, vol. 350, No. 4, pp. 423-426. Cat. No. MAB2629, Sep. 13, 2007. Kohler, et al., “Derivation of Speci?c Antibody-producing Tissue Monoclonal Anti-mouse FGF-23 Antibody, R&D Systems, Cat. No. Culture and Tumor Lines by Cell Fusion”, European .I. Immunology, MAB26291, Mar. 20, 2007. 1966, vol. 6, pp. 511-519. Final Of?ce Action for US. Appl. No. 10/500,296 dated Apr. 10, Lah, et al., “Phage Surface Presentation and Secretion of Antibody Fragments using an Adaptable Phagemid Vector,” Human Antibodies 2009. &Hybridomas, 1994, vol. 5, Nos. 1 and 2, pp. 48-56. Non-Final Of?ce Action for US. Appl. No. 10/500,296 dated Jul. 24, Larsson, et al., “Circulating Concentration of FGF-23 Increases as 2008. Renal Function Declines in Patients with Chronic Kidney Disease, Advisory Action for US. Appl. No. 10/500,296 dated Mar. 28, 2008. but does not Change in Response to Variation in Phosphate Intake in Final Of?ce Action for US. Appl. No. 10/500,296 dated Oct. 19, Healthy Voluneers,” Kidney International, 2003, vol. 64, pp. 2272 2007. 2279. Non-Final Of?ceAction for US. Appl. No. 10/500,296 dated Jan. 30, LorenZ-Depiereux, et al., The Autosomal Dominant 2007. Hypophosphatemic Rickets (ADHR) Gene is a Secreted Fibroblast Non-Final Of?ceAction for US. Appl. No. 10/500,296 dated Jan. 13, Growth Factor (FGF23), Eur .I. Human Genetics, 2001, vol. 9, 2006. Supplement 1, P0772, 10’h International Congress of Human Genet Aono et al., “The improving effect of anti FGF23 neutralizing anti ics, Vienna Austria, May 15-19, 2001. body on hypophosphatemia and rickets of Hyp mice”, The Japanese LorenZ-Depiereux, et al., “DMPl Mutations in Auto somal Recessive Society forBone and Mineral Research (.ISBMR), Annual Meeting of Hypophosphatemia Implicate a Bone Matrix Protein in the Regula the JSBMR, 22” Program, Aug. 2004, vol. 22, pp. 137. (English tion of Phosphate Homeostasis,”Nature Genetics, Nov. 2006, vol. 38, translation provided). No. 11, pp. 1248-1250. Ando, et al., Tan-Clone-Kotai-Jikken-Manual (“Experimental Mark, et al., “Site-speci?c Mutagenesis of the Human Fibroblast Manual for Monoclonal Antibody”) (written by and published by Interferon Gene”, Proc NatlAcad Sci U.S.A., Sep. 1984, vol. 81, No. Kodansha Scienti?c, Ltd., Tokyo, Japan (1991). 18, pp. 5662-5666. Antibody Engineering, A Practical Approach, IRL Press, 1996.
Recommended publications
  • Effects of Tumor-Induced Osteomalacia on the Bone Mineralization Process
    Calcif Tissue Int (2009) 84:313–323 DOI 10.1007/s00223-009-9216-z Effects of Tumor-Induced Osteomalacia on the Bone Mineralization Process K. Nawrot-Wawrzyniak Æ F. Varga Æ A. Nader Æ P. Roschger Æ S. Sieghart Æ E. Zwettler Æ K. M. Roetzer Æ S. Lang Æ R. Weinkamer Æ K. Klaushofer Æ N. Fratzl-Zelman Received: 24 October 2008 / Accepted: 4 January 2009 / Published online: 14 February 2009 Ó The Author(s) 2009. This article is published with open access at Springerlink.com Abstract Fibroblast growth factor 23 (FGF23) overex- distribution using quantitative backscattered electron pression has been identified as a causative factor for tumor- imaging were performed on the bone biopsy. The data induced osteomalacia (TIO) characterized by hypophos- showed important surface osteoidosis and a slightly phatemia due to increased renal phosphate wasting, low increased osteoblast but markedly decreased osteoclast 1,25(OH)2D3 serum levels, and low bone density. The number. The mineralized bone volume (-11%) and miner- effects of long-lasting disturbed phosphate homeostasis on alized trabecular thickness (-18%) were low. The mean bone mineralization are still not well understood. We report degree of mineralization of the bone matrix (-7%), the most on a patient with a 12-year history of TIO, treated with frequent calcium concentration (-4.1%), and the amounts of 1,25(OH)2D3 and phosphate, who finally developed hyper- fully mineralized bone (-40.3%) were distinctly decreased, parathyroidism with gland hyperplasia before the tumor while the heterogeneity of mineralization (?44.5%) and the could be localized in the scapula and removed.
    [Show full text]
  • Renal Phosphate Wasting Due to Tumor-Induced (Oncogenic) Osteomalacia
    Open Access Case Report DOI: 10.7759/cureus.15507 Renal Phosphate Wasting Due to Tumor-Induced (Oncogenic) Osteomalacia Eluwana A. Amaratunga 1 , Emily B. Ernst 1 , James Kamau 1 , Ragarupa Kotala 1 , Richard Snyder 1 1. Internal Medicine, St. Luke’s University Health Network, Easton, USA Corresponding author: Eluwana A. Amaratunga, [email protected] Abstract Osteomalacia is a widely prevalent bone disorder that is caused by an imbalance in body calcium and phosphate. Tumor-induced osteomalacia (TIO) is a rare form of osteomalacia that is associated with mesenchymal tumors. It is caused by overproduction of fibroblast growth factor 23 (FGF-23), a hormone involved in phosphate regulation. A 59-year-old male with a history of factor V Leiden mutation, pulmonary embolism, and deep vein thrombosis was diagnosed with oncogenic osteomalacia in 2008 following laboratory findings significant for low phosphorus and elevated FGF-23 levels. He underwent a resection of a right suprascapular notch mass with the biopsy confirming a phosphaturic mesenchymal tumor. He was maintained on oral phosphorus and calcitriol replacements with a regular follow-up with oncology and nephrology. Eight years later, the patient’s phosphorus levels started declining despite replacement. A repeat test showed FGF-23 levels once again elevated. A whole-body magnetic resonance imaging (MRI) scan showed no significant findings. The patient was continued on oral replacement therapy with a close follow-up. Two years later, urine phosphorus excretion was elevated at 2494 mg per 24 hours with low plasma phosphorus (1.2 mg/dL) and an elevated FGF-23 level of 1005 relative units (RU)/mL.
    [Show full text]
  • Rickets and Osteomalacia Management )
    Rule Category: Medical ` Ref: No: 2013-MN-0010 Version Control: Version No.3.0 Effective Date: 08-02-2019 Revision Date: February 2020 Rickets and Osteomalacia Management ) Adjudication Guideline Table of content Abstract Scope Adjudication Policy Denial codes Appendices Page 1 Page 2 Page 2 Page 3 Page 3 Approved by: Daman Abstract Responsible: Medical Standards & Research For Members Related Adjudication Guidelines: None Rickets and Osteomalacia are the two disorder caused by insufficient level of vitamins D in the body. When vitamin D deficiency occurs in children is termed as rickets, whereas deficient mineralization of the growth plate in adult termed Disclaimer Osteomalacia. By accessing these Daman Adjudication Guidelines, you acknowledge that you have read and understood the terms of use set out in the disclaimer below: Rickets symptoms aches, bone pain, and sometimes enlargement occurs in The information contained in this Adjudication Guideline is intended to outline the procedures of bones at joints, such as the wrists. Fracture may occur without any known adjudication of medical claims as applied by the trauma. National Health Insurance Company – Daman PJSC (hereinafter “Daman”). The Adjudication Guideline is not intended to be comprehensive, should not be used as treatment guidelines and should only be In Osteomalacia bone pain and muscle weakness are the classical symptoms. used for the purpose of reference or guidance for adjudication procedures and shall not be construed Fractures may also take place with little or no recognized trauma. as conclusive. Daman in no way interferes with the treatment of patient and will not bear any responsibility for treatment decisions interpreted Causes of Rickets and Osteomalacia can be lack of vitamins D intake or less through Daman Adjudication Guideline.
    [Show full text]
  • Oncogenic Osteomalacia
    ONCOGENIC_Martini 14/06/2006 10.27 Pagina 76 Case report Oncogenic osteomalacia Giuseppe Martini choice; if the tumour cannot be found or if the tumour is unre- Fabrizio Valleggi sectable for its location, chronic administration of phosphate Luigi Gennari and calcitriol is indicated. Daniela Merlotti KEY WORDS: oncogenic osteomalacia, hypophosphoremia, fractures, oc- Vincenzo De Paola treotide scintigraphy. Roberto Valenti Ranuccio Nuti Introduction Department of Internal Medicine, Endocrine-Metabolic Sciences and Biochemistry, University of Siena, Italy Osteomalacia is a metabolic bone disorder characterized by reduced mineralization and increase in osteoid thickness. Address for correspondence: This disorder typically occurs in adults, due to different condi- Prof. Giuseppe Martini tions impairing matrix mineralization. Its major symptoms are Dipartimento di Medicina Interna e Malattie Metaboliche diffuse bone pain, muscle weakness and bone fractures with Azienda Ospedaliera Senese minimal trauma. When occurs in children, it is associated with Policlinico “S. Maria alle Scotte” a failure or delay in the mineralization of endochondral new Viale Bracci 7, 53100 Siena, Italy bone formation at the growth plates, causing gait distur- Ph. 0577586452 bances, growth retardation, and skeletal deformities, and it is Fax 0577233446 called rickets. E-mail: [email protected] Histologically patients with osteomalacia present an abun- dance of unmineralized matrix, sometimes to the extent that whole trabeculae appeared to be composed of only osteoid
    [Show full text]
  • Oncogenic Osteomalacia
    ONCOGENIC OSTEOMALACIA THE SEARCH, THE TREATMENT, AND THE CURE OF A DEBILITATING TUMOR NEW ENGLAND AACE ANNUAL MEETING October 14, 2017 Christopher W. Lee, MD, Endocrinology Fellow Boston University School of Medicine Boston Medical Center Department of Medicine Section of Endocrinology, Diabetes, Nutrition and Weight Management Disclosures • No financial or other conflicts of interest to disclose Objectives • Recognize the clinical features of patients with oncogenic osteomalacia • Describe the role of FGF23 in the pathophysiology of the disease • Understand an algorithmic approach to diagnosis and treatment of oncogenic osteomalacia Case Presentation • 48 year-old Haitian man presented to the hospital with several months of increasing lower back pain, debilitating fatigue, and progressive weakness of all four extremities • Acetaminophen, gabapentin, muscle relaxants provided no relief • Physical therapy provided mild relief • Denied any glucocorticoid use in the past • Review of Systems: • Endorsed diffuse joint and bone pains • No fevers, chills, headaches, hearing difficulties, weight loss, change in libido, or history of kidney stones Case Presentation • PMH: • Allergies: • L1-L3 laminectomy in Haiti 3 • None years prior (for unclear reasons) • Family History: • Post-surgery, he had initially been dependent on crutches • No thyroid disease, and has had progressive autoimmune disorders, or muscle weakness to the point disorders of bone metabolism he is now wheelchair dependent • Social History: • Medications: • Single • Non-smoker • Acetaminophen prn • No children • Cyclobenzaprine prn Physical Exam • Vital Signs: Afebrile, BP 129/76, HR 71, Wt 135 lbs, BMI 23. • General: Sitting in wheelchair. NAD. A&Ox3. • HEENT: EOMI. PERRL. No stare or lid lag. MMM. Temporal wasting. • Thyroid: Normal size, soft, non-tender.
    [Show full text]
  • Oncogenic Hypophosphatemic Osteomalacia Principal Discussant: ZALMAN S
    View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Elsevier - Publisher Connector Kidney International, Vol. 24 (1983), pp. 113—123 NEPHROLOGY FORUM Oncogenic hypophosphatemic osteomalacia Principal discussant: ZALMAN S. AGUS University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania muscle weakness and subsequently was treated with I rg/day of I aOH Editors vitamin D and 3 g/day of elemental phosphorus. On this regimen, the serum phosphate varied between 1.8 and 2.1 mg/dl, the serum calcium JORDANJ.COHEN level ranged between 8.2 and 8.6 mg/dl, and the PTH increased from 9 JOHN T.HARRINGION to 12 tlEq/ml. Treatment with calcium carbonate was reinstituted, but JEROME P. KASSIRER after 6 months of therapy the patient was readmitted for evaluation NICOLAOS E. MADIAS because of continuing bone pain. On admission, she complained of new discomfort and pressure in the left plantar area. The blood pressure was 140/86 mm Hg; pulse, 72; and Managing Editor weight, 186 lbs. Funduscopic examination showed minimal arteriolar CHERYL J. ZUSMAN narrowing, sharp discs, and no hemorrhages or exudates. The rib cage was diffusely tender to palpation. Examination of the heart and lungs MichaelReese Hospital and Medical Center was normal. Neither hepatosplenomegaly nor costovertebral angle tenderness was present. There was a firm, slightly tender, small nodule University of Chicago Pritzker School of Medicine barely palpable in the sole of the left foot. and The BUN was 12 mg/dl and the serum creatinine was 1.1 mg/dl. New EnglandMedical Center Blood chemistry studies revealed: sodium, 136 mEq/liter; potassium, Tufts University School of Medicine 3.6, mEq/liter; chloride, 104 mEq/liter; and bicarbonate, 27 mEq/liter.
    [Show full text]
  • Oncogenic Osteomalacia: a New Observation N
    Open Access Journal of Internal Medicine Volume 1, Issue 1, 2018, PP: 41-42 Oncogenic Osteomalacia: A New Observation N. Boussetta, S. Hamrouni, Rim Dhahri, N. Gueddiche, F. Ajili, B. Louzir Internal Medicine Deaprtment, Military Hospital of Tunis, Tunisia. [email protected] *Corresponding Author: Najah Boussetta, Internal Medicine Deaprtment, Military Hospital of Tunis, Tunisia. Abstract Oncogenic osteomalacia is a rare paraneoplastic syndrome resulting from an increased secretion of a fibroblast growth factor 23 (FGF23), generally by a benign mesenchymal tumor. We report a case of a 60 years old female patient who had chronic bone pain. A Diagnosis of osteomalacia was made based on the following: difficulty walking, waddling gait, bone pain, a normal rate of calcemia PTH and of 25 OH vitamin D3 associated with an increased alkaline phosphatase rate, hypophosphoremia and a decrease in the rate of tubular reabsorption of phosphates. The neoplastic origin was suspected in the presence of a biological inflammatory syndrome and was confirmed by a high level of FGF23. The tumor could not be located and the patient received calcitriol and phosphorus Introduction evidenced by X-rays which revealed hypertransparency with blurred bone, Looser-Milkman streaks at the ribs Tumor-induced osteomalacia, also known as oncogenic and neck of the left femur, and biconcave vertebrae. osteomalacia (OO), is a rare paraneoplastic syndrome The patient had osteoporosis with a T-score factor 23 (FGF23) by a benign and small-sized to -4.4.Scintigraphy revealed numerous foci of mesenchymalcaused by the tumor.overproduction This syndrome of fibroblast results growthfrom a cartilidge, the decrease in the 1-hydroxylation capacity of the 25 left acetabulum and the right femur.
    [Show full text]
  • Oncogenic Osteomalacia: an Approach to Diagnosis with a Case Report Pathology Section
    DOI: 10.7860/JCDR/2017/25055.9634 Case Report Oncogenic Osteomalacia: An Approach to Diagnosis with a Case Report Pathology Section BISWAJIT DEY1, DEBASIS GOCHHAIT2, HEMA SUBRAMANIAN3, MADHUSUDHANAN PONNUSAMY4 ABSTRACT Oncogenic osteomalacia, also known as tumour induced osteomalacia, is a rare paraneoplastic syndrome caused by mesenchymal tumours secreting Fibroblast Growth Factor-23 (FGF-23). The characteristic biochemical findings include hypophosphatemia and low 1,25-dihydroxy vitamin D. The differential diagnosis for hypophosphatemia are varied. We present a case of oncogenic osteomalacia in a 29-year-old female, who presented with complaints of generalized diffuse bone pain and walking difficulty for six months duration. Thus, we have discussed the approach to diagnosis in such a case. Keywords: Fibroblast growth factor-23, Phosphaturic mesenchymal tumour, Scintigraphy CASE REPORT glomerular filtration rate (TmPO4/GFR) was 1.0 (NR, 2.7– 4.4). Thus We present the case of a 29-year-old female arriving with an antalgic renal wasting of phosphate was confirmed by low TRP and TmPO4/ gait, who presented with complaints of generalized diffuse bone GFR. Absent urinary sugars and protein ruled out the possibility of pain and walking difficulty for six months duration. She had no prior renal Fanconi syndrome being the cause of phosphaturia. Her serum history of fall or trauma and her dietary milk intake was adequate. Her C-terminal FGF-23 level was 257 RU/ml (NR, 0–150). An elevated childhood was uneventful with normal developmental milestones. serum FGF-23 level confirmed its role in renal phosphate wasting in She was taking over-the-counter painkillers for the same.
    [Show full text]
  • Download HMJ Jul11.Pdf Here
    HAWAI‘I MEDICAL JOURNAL A Journal of Asia Pacific Medicine July 2011, Volume 70, No. 7, ISSN: 0017-8594 EDITORIAL COMMENTARY & APPRECIATION 136 S. Kalani Brady MD and Michael J. Meagher MD CESAREAN SCAR DEHISCENCE ASSOCIATED WITH INTRAUTERINE BALLOON TAMPONADE PLACEMENT AFTER A SECOND TRIMESTER DILATION AND EVACUATION 137 Reni Soon MD; Tod Aeby MD; and Bliss Kaneshiro MD, MPH DUAL PARANEOPLASTIC SYNDROMES: SMALL CELL LUNG CARCINOMA-RELATED ONCOGENIC OSTEOMALACIA, AND SYNDROME OF INAPPROPRIATE ANTIDIURETIC HORMONE SECRETION: REPORT OF A CASE AND REVIEW OF THE LITERATURE 139 Ekamol Tantisattamo MD and Roland C.K. Ng MD KOCH’S POSTULATES, CARNIVOROUS COWS, AND TUBERCULOSIS TODAY 144 Frank L. Tabrah MD BREAST CANCER WORRY AMONG WOMEN AWAITING MAMMOGRAPHY: IS IT UNFOUNDED? DOES PRIOR COUNSELING HELP? 149 Susan K. Steinemann MD, FACS; Maria B.J. Chun PhD, CHC, CPC-A; Dustin H. Huynh MD; and Katherine Loui BA MEDICAL SCHOOL HOTLINE 152 Training the Next Generation of Minority Health Scientists: A STEP-UP in the Right Direction George S. Hui PhD and Kae M. Pusic BS WEATHERVANE 154 Russell T. Stodd MD “ At MIEC, our policyholders are our primary marketing resources and our staff is our number one retention tool.” Underwriter Maya Campaña Service and Value MIEC takes pride in both. For 30 years, MIEC has been steadfast in our protection of Hawaii physicians. With conscientious Underwriting, excellent Claims management and hands-on Loss Prevention services, we’ve partnered with policyholders to keep premiums low. Added value: ����Zero-profit carrier with low overhead ����Dividends with an average savings on 2011 premiums of 35.4%* For more information or to apply: ����www.miec.com ����Call 800.227.4527 ����Email questions to [email protected] * (On premiums at $1/3 million limits.
    [Show full text]
  • Diagnosis of a Patient with Oncogenic Osteomalacia Using a Phosphate Uptake Bioassay of Serum and Magnetic Resonance Imaging
    European Journal of Endocrinology (2001) 145 469±476 ISSN 0804-4643 CASE REPORT Diagnosis of a patient with oncogenic osteomalacia using a phosphate uptake bioassay of serum and magnetic resonance imaging Anne E Nelson1,2,3, Rebecca S Mason1,2, Bruce G Robinson1,3, Jeremy J Hogan1,2, Erin A Martin1,2, HaÊkan AhlstroÈm5, Gunnar AÊ stroÈm5, Tobias Larsson4, Kenneth Jonsson4, Lars Wibell4 and Osten Ljunggren4 1Cancer Genetics Department, Kolling Institute of Medical Research, Royal North Shore Hospital, Sydney 2065, Australia, 2Department of Physiology and Institute for Biomedical Research, 3Department of Medicine, University of Sydney, Sydney 2006, Australia, 4Department of Internal Medicine and 5Department of Radiology, University Hospital, Uppsala, Sweden (Correspondence should be addressed to Anne E Nelson, Cancer Genetics Department, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, NSW 2065, Australia; Email: [email protected]) Abstract A previously healthy man with no family history of fractures presented with muscle pain, back pain and height loss. Investigations revealed hypophosphataemia, phosphaturia, undetectable serum 1,25- dihydroxyvitamin D and severe osteomalacia on bone biopsy, suggestive of a diagnosis of oncogenic osteomalacia. Thorough physical examination did not locate a tumour. Support for the diagnosis was obtained by detection of phosphate uptake inhibitory activity in a blinded sample of the patient's serum using a renal cell bioassay. On the basis of detection of this bioactivity, a total body magnetic resonance (MR) examination was performed. A small tumour was located in the right leg. Removal of the tumour resulted in the rapid reversal of symptoms and the abnormal biochemistry typical of oncogenic osteomalacia.
    [Show full text]
  • Molecular Imaging in Diagnosis of Tumor-Induced Osteomalacia
    Current Problems in Diagnostic Radiology 48 (2019) 379À386 Current Problems in Diagnostic Radiology journal homepage: www.cpdrjournal.com Molecular Imaging in Diagnosis of Tumor-induced Osteomalacia Ming Yang, MDa,*, Krupa B. Doshi, MDb, Michael C. Roarke, MDa, Ba D. Nguyen, MDa a Department of Radiology, Mayo Clinic, AZ b Division of Endocrinology, Department of Internal Medicine, Mayo Clinic, AZ Tumor induced osteomalacia (TIO) is a rare paraneoplastic syndrome caused by overproduction of fibroblast growth factor 23 (FGF23) secreted by benign mes- enchymal neoplasm. Due to its nonspecific clinical presentation or lack of awareness, the diagnosis of TIO is often significantly delayed resulting in patients' prolonged physical suffering or psychological distress. Successful detection or complete surgical resection of the causative tumor typically leads to rapid resolution of symptoms or reversal of biochemical imbalance. Nuclear medicine and molecular imaging have been playing a promising role as the first- line imaging modalities in the diagnosis and localization of occult FGF23 secreting mesenchymal tumor, especially with the emerging whole-body, head-to-toe Ga68-DOTATATE PET/CT technique. Combined focused diagnostic CT and/or MRI are imperative for accurate delineation of tumor and surgical guidance. © 2018 Elsevier Inc. All rights reserved. Introduction imaging modality in the localization and diagnosis of this rare clinical disorder. Tumor-induced osteomalacia (TIO), also known as oncogenic oste- omalacia, is an uncommon paraneoplastic
    [Show full text]
  • REVIEW the Emerging Role of the Fibroblast Growth Factor-23–Klotho
    1 REVIEW The emerging role of the fibroblast growth factor-23–klotho axis in renal regulation of phosphate homeostasis Mohammed S Razzaque and Beate Lanske Department of Developmental Biology, Harvard School of Dental Medicine, Research and Education Building, Room # 304, 190 Longwood Avenue, Boston, Massachusetts 02115, USA (Requests for offprints should be addressed to M S Razzaque; Email: [email protected]) Abstract Normal mineral ion homeostasis is tightly controlled by hormone activities, 4) most of the FGF23 functions are numerous endocrine factors that coordinately exert effects on conducted through the activation of FGF receptors, and 5) intestine, kidney, and bone to maintain physiological balance. such receptor activation needs klotho, as a cofactor to The importance of the fibroblast growth factor (FGF)-23– generate downstream signaling events. These observations klotho axis in regulating mineral ion homeostasis has been clearly suggest the emerging roles of the FGF23–klotho axis proposed from recent research observations. Experimental in maintaining mineral ion homeostasis. In this brief article, studies suggest that 1) FGF23 is an important in vivo regulator we will summarize how the FGF23–klotho axis might of phosphate homeostasis, 2) FGF23 acts as a counter coordinately regulate normal mineral ion homeostasis, and regulatory hormone to modulate the renal 1a-hydroxylase how their abnormal regulation could severely disrupt such and sodium–phosphate cotransporter activities, 3) there is a homeostasis to induce disease pathology. trend of interrelationship between FGF23 and parathyroid Journal of Endocrinology (2007) 194, 1–10 Introduction 2,3-diphosphoglycerate, which partly controls the O2 release to tissues by hemoglobin in red cells.
    [Show full text]