Circulating Sclerostin in Disorders of Parathyroid Gland Function
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ORIGINAL ARTICLE Endocrine Research Circulating Sclerostin in Disorders of Parathyroid Gland Function Aline G. Costa, Serge Cremers, Mishaela R. Rubin, Donald J. McMahon, James Sliney, Jr., Marise Lazaretti-Castro, Shonni J. Silverberg, and John P. Bilezikian Department of Medicine (A.G.C., S.C., M.R.R., D.J.M., J.S., S.J.S., J.P.B.), Division of Endocrinology, Metabolic Bone Diseases Unit, College of Physicians and Surgeons, Columbia University, New York, New Downloaded from https://academic.oup.com/jcem/article/96/12/3804/2834946 by guest on 26 September 2021 York 10032; and Department of Medicine (A.G.C., M.L.-C.), Division of Endocrinology, Sa˜ o Paulo Federal University, Sa˜ o Paulo 04044, Brazil Context: Sclerostin, a protein encoded by the SOST gene in osteocytes and an antagonist of the Wnt signaling pathway, is down-regulated by PTH administration. Disorders of parathyroid function are useful clinical settings to study this relationship. Objective: The objective of the study was to evaluate sclerostin in two different disorders of parathyroid function, primary hyperparathyroidism and hypoparathyroidism, and to analyze the relationship between sclerostin and PTH, bone markers, and bone mineral density. Design: This is a cross-sectional study. Setting: The study was conducted at a clinical research center. Patients: Twenty hypoparathyroid and 20 hyperparathyroid patients were studied and compared to a reference control group. Results: Serum sclerostin was significantly higher in hypoparathyroid subjects than in hyperparathy- roid subjects (P Ͻ 0.0001) and controls (P Ͻ 0.0001). PTH was negatively associated with sclerostin, achieving statistical significance in hypoparathyroidism (r ϭϪ0.545; P ϭ 0.02). The bone turnover markers, cross-linked C-telopeptide of type I collagen (CTX) and amino-terminal propeptide of type I collagen (P1NP), were differently associated with sclerostin according to the parathyroid disorder. In primary hyperparathyroidism, bone turnover markers were associated negatively with sclerostin (for P1NP, r ϭϪ0.490; P ϭ 0.03). In hypoparathyroidism, bone turnover markers were associated positively with sclerostin (for CTX, r ϭϩ0.571; P ϭ 0.01). Although there was no significant correlation between bone mineral density and sclerostin in either parathyroid disorder, there was a significant positive relationship between sclerostin and bone mineral content in hypoparathyroidism. Conclusions: The results are consistent with the hypothesis that PTH is a regulator of sclerostin in human disorders of parathyroid function. In addition, the results suggest that bone mineral content may be another factor that influences sclerostin. (J Clin Endocrinol Metab 96: 3804–3810, 2011) clerostin is a secretory product of the osteocyte, the mental influences, the osteocyte signals the two other key S most abundant cell in the skeleton (1, 2). Long con- bone cells, the osteoblast and the osteoclast, by producing sidered to be an outdated osteoblast, inactive and “en- molecules such as sclerostin (3–5). tombed” in the mineralized matrix of bone, the osteocyte Sclerostin, a glycoprotein encoded by the osteocyte is now acknowledged to be a master skeletal signaling cell. SOST gene, regulates the activities of the mature osteo- Responding to mechanical stress and to other environ- blast as well as the osteoblast lineage pathway. Inactivat- ISSN Print 0021-972X ISSN Online 1945-7197 Abbreviations: BAP, Bone-specific alkaline phosphatase; BMC, bone mineral content; BMD, Printed in U.S.A. bone mineral density; CTX, cross-linked C-telopeptide of type I collagen; DXA, dual-energy Copyright © 2011 by The Endocrine Society x-ray absorptiometry; FN, femoral neck; HypoPT, hypoparathyroidism; LS, lumbar spine; 25- doi: 10.1210/jc.2011-0566 Received March 3, 2011. Accepted August 29, 2011. OHD, 25-hydroxyvitamin D; PHPT, primary hyperparathyroidism; P1NP, serum amino-terminal First Published Online September 20, 2011 propeptide of type I collagen; 1/3 radius, one third distal radius; TH, total hip. 3804 jcem.endojournals.org J Clin Endocrinol Metab, December 2011, 96(12):3804–3810 J Clin Endocrinol Metab, December 2011, 96(12):3804–3810 jcem.endojournals.org 3805 ing mutations of the SOST gene lead to exuberant bone Serum measurements growth, as demonstrated in the human disorders scleros- Blood samples were prepared, and sera were immediately Ϫ teosis and van Buchem’s disease (6–9). Affected individ- frozen at 70 C. Serum sclerostin levels were measured using an ELISA developed by TECOmedical Group. This ELISA uses a uals have exceedingly dense bones as assessed by radio- biotinylated polyclonal antibody as well as a horseradish per- graphic and dual-energy x-ray absorptiometry (DXA) oxidase-labeled secondary monoclonal antibody that specifi- measurements, but they are of normal quality, and frac- cally recognizes human sclerostin. The detection limit of the as- tures have not been reported. A phenotype similar to say is 0.15 ng/ml. No study subjects demonstrated sclerostin sclerosteosis is seen in a mouse Sost knockout model (10). levels below this detection limit. Intra- and interassay precision Sclerostin’s control of osteoblast action and develop- are 1.6 and 2.7%, respectively. Results for the sclerostin mea- surements are reported throughout in nanograms per milliliter ment is mediated by the anabolic Wnt and BMP signaling (multiply by 44 to convert to picomoles per liter). Downloaded from https://academic.oup.com/jcem/article/96/12/3804/2834946 by guest on 26 September 2021 pathways. By binding to the LRP5/LRP6 receptor com- PTH was measured in duplicate using the immunoradiomet- plex, sclerostin inhibits the activity of molecules such as ric assay for the quantitative determination of human total intact the Wnt pathway’s -catenin, a major activator of ana- PTH as developed by Scantibodies Laboratories, Inc. (Santee, bolic genes in the nucleus of the osteoblast (2, 11–14). CA). Normal range is 14–66 pg/ml. Interassay precision is 8.4%, and the intraassay precision is 5.7%. Serum amino-terminal pro- Sclerostin also has been shown to inhibit BMP7 secretion peptide of type I collagen (P1NP), cross-linked C-telopeptide of by osteocytes in mice (15). type I collagen (CTX), and 25-hydroxyvitamin D (25-OHD) PTH has increasingly been implicated as one of the were measured simultaneously by immunochemiluminescence factors involved in the regulation of sclerostin (16). Evi- assays on the IDS-iSYS Multi-Discipline automated analyzer dence that PTH regulates sclerostin expression comes (Immunodiagnostics Systems, Scottsdale, AZ). Normal range for P1NP is 27.7–127.6 ng/ml. Sensitivity is below 1 ng/ml, and from human and animal studies at both the cellular and intra- and interassay precision are below 4% and below 6%, molecular level (17–20). Diseases characterized by exces- respectively. Dynamic range for CTX is 0.033–6.000 ng/ml, and sive or deficient PTH provide a useful model to further intra- and interassay precision is 4.9 and 8.8%, respectively. explore the relationship between PTH and sclerostin. In Normal reference values for 25-OHD are set at above 30 ng/ml, this study, we measured circulating sclerostin levels in pa- with sensitivity of 5.5 ng/ml and intra- and interassay precision tients with overproduction or deficient PTH, namely pri- of below 8% and below 10%, respectively. mary hyperparathyroidism (PHPT) or hypoparathyroid- Bone mineral density (BMD) ism (HypoPT). BMD was measured at the lumbar spine (LS; L1–L4), total hip (TH), femoral neck (FN), and distal one-third radius (1/3 radius) by DXA (Hologic 4500W; Hologic Inc., Bedford, MA). The Subjects and Methods short-term in vivo precision error (root-mean-square SD) was 0.026 g/cm2 for L1–L4, 0.032 g/cm2 for the TH, 0.041 g/cm2 for Subjects the FN, and 0.033 g/cm2 for the forearm. Serum samples were obtained from ongoing HypoPT and PHPT studies at the Metabolic Bone Diseases Unit of Columbia Statistical analysis University Medical Center. A convenience sample consisting Results are expressed as mean Ϯ SEM. Serum chemistry mea- of 20 subjects (10 postmenopausal women and 10 men) with sures were log-transformed before analysis, and tests were ad- HypoPT and 20 subjects (10 postmenopausal women and 10 justed for age and unequal variances when appropriate. HypoPT men) with PHPT was chosen. HypoPT was defined as chronic and PHPT groups were evaluated by two-sided independent t- hypocalcemia in association with levels of PTH below the PTH tests. Each clinical group was compared with controls by inde- assay reference range (Ͻ10 pg/ml). PHPT was defined by hyper- pendent t-test also. Pearson correlations were used to assess the calcemia in association with levels of PTH in the upper range or association between sclerostin and bone mineral indices. Linear above the PTH assay reference range (Ͼ65 pg/ml). Exclusion regression was used to fit a least squares prediction line between criteria included: liver or kidney disease, Paget’s disease, rheu- sclerostin (log10) and CTX (log10) and P1NP (log10) separately matoid arthritis, diabetes mellitus, Cushing’s syndrome, multi- for each group. A value of P Ͻ 0.05 was considered significant. ple myeloma or any other malignancy, current treatment with Statistical analysis was performed using SAS, version 9.2 (SAS any bisphosphonate, glucocorticoids, calcitonin, raloxifene, es- Institute, Inc., Cary, NC). trogens, fluoride, lithium, or methotrexate. Serum was obtained, and DXA measurements were made before any patient under- went pharmacological (PTH for HypoPT) or surgical (parathy- Results roidectomy for PHPT) treatment for their disease. Sclerostin se- rum of 31 healthy subjects (15 men and 16 postmenopausal Baseline biochemical and DXA data women; age range, 37 to 79 yr) were used as the control group Demographic data are shown in Table 1. HypoPT and (provided by TECOmedical AG, Sissach, Switzerland). The study was approved by the Institutional Review Board of Co- PHPT subjects were of similar age and body mass index.