Parathyroid cell growth in patients with advanced secondary hyperparathyroidism: Vitamin D receptor, calcium sensing receptor, and cell cycle regulating factors

Masanori Tokumoto, Masatomo Taniguchi, Dai Matsuo, Kazuhiko Tsuruya, Hideki Hirakata, Mitsuo Iida

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

The parathyroid gland (PTG) is a unique endocrine organ in which the quiescent glandular cells begin to proliferate in rsponse to the demand for maintaining calcium (Ca) homeostasis in the progressive course of renal failure, leading to secondary hypereparathyroidism (SHPT). SHPT is characterized with continuous over-secretion of parathyroid hormone (PTH) and high turn-over bone disease, osteitis fibrosa, and the major factors include a deficiency of active vitamin D, hypocalcemia, and phosphate retention. With long-term end-stage renal failure, SHPT becomes resistant to conventional medical treatment such as phosphate binders and active vitamin D supplementation, and the growth of the PTG accelerates with the pattern of hyperplasia changing from diffuse to nodular type. In this process, the sigmoid curve between extracellular Ca concentration (exCa) and the plasma level of PTH shifts to the upper-rightward, indicating both an absolute increase in PTH secretion and the resistance of PT cells to exCa. Many experimental and human studies have revealed down-regulation of vitamin D receptor (VDR), calcium-sensing receptor (CaSR), and retinoid X receptor (RXR) in PT cells. The sustained proliferation of PT cells after obtaining autonomicity is another characteristic feature of SHPT. In this context, it has been demonstrated that the cell cycle is markedly progressed, where the expression of cyclin-dependent kinase inhibitor (CDKI), p21 and p27, is depressed in a VDR-dependent manner. These pathological features are most evident in nodular hyperplasia, in which monoclonal proliferation is obvious, indicating the phenotypic changes have occured in PT cells. It has been observed by Fukagawa and colleagues that pharmacologically high dose of active vitamin D administered orally can cause small-size PTG hyperplasia to regress in patients with advanced SHPT. Successful renal transplantation may also restore VDR and CaSR expressions in the diffuse type, in association with increasing TUNEL-positive cells. Thus, it is important to vigorously treat SHPT when the PT cell proliferation is in the reversible stage of diffuse hyperplasia.

Original languageEnglish (US)
JournalTherapeutic Apheresis and Dialysis
Volume9
Issue numberSUPPL. 1
DOIs
StatePublished - Aug 2005

Fingerprint

Calcium-Sensing Receptors
Calcitriol Receptors
Secondary Hyperparathyroidism
Cell Cycle
Parathyroid Glands
Hyperplasia
Parathyroid Hormone
Growth
Vitamin D
Phosphates
Cell Proliferation
Cyclin-Dependent Kinase Inhibitor p21
Cyclin-Dependent Kinase Inhibitor p27
Calcium
Retinoid X Receptors
Osteitis
Vitamin D Deficiency
Hypocalcemia
Bone Diseases
In Situ Nick-End Labeling

Keywords

  • Calcium sensing receptor
  • Cyclin-dependent kinase inhibitor
  • Hyperplasia
  • Secondary hyperparathyroidism
  • Vitamin D receptor

ASJC Scopus subject areas

  • Hematology
  • Nephrology

Cite this

Parathyroid cell growth in patients with advanced secondary hyperparathyroidism : Vitamin D receptor, calcium sensing receptor, and cell cycle regulating factors. / Tokumoto, Masanori; Taniguchi, Masatomo; Matsuo, Dai; Tsuruya, Kazuhiko; Hirakata, Hideki; Iida, Mitsuo.

In: Therapeutic Apheresis and Dialysis, Vol. 9, No. SUPPL. 1, 08.2005.

Research output: Contribution to journalArticle

Tokumoto, Masanori ; Taniguchi, Masatomo ; Matsuo, Dai ; Tsuruya, Kazuhiko ; Hirakata, Hideki ; Iida, Mitsuo. / Parathyroid cell growth in patients with advanced secondary hyperparathyroidism : Vitamin D receptor, calcium sensing receptor, and cell cycle regulating factors. In: Therapeutic Apheresis and Dialysis. 2005 ; Vol. 9, No. SUPPL. 1.
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