Part of this paper has been published in Kidney International,62(4) pp. 1196–1207 and has been reproduced with the permission of the publisher.
Parathyroid Cell Growth in Patients with Advanced Secondary Hyperparathyroidism: Vitamin D Receptor, Calcium Sensing Receptor, and Cell Cycle Regulating Factors
Article first published online: 17 AUG 2005
Therapeutic Apheresis and Dialysis
Volume 9, Issue Supplement s1, pages S27–S34, August 2005
How to Cite
Tokumoto, M., Taniguchi, M., Matsuo, D., Tsuruya, K., Hirakata, H. and Iida, M. (2005), Parathyroid Cell Growth in Patients with Advanced Secondary Hyperparathyroidism: Vitamin D Receptor, Calcium Sensing Receptor, and Cell Cycle Regulating Factors. Therapeutic Apheresis and Dialysis, 9: S27–S34. doi: 10.1111/j.1744-9987.2005.00302.x
- Issue published online: 17 AUG 2005
- Article first published online: 17 AUG 2005
- calcium sensing receptor;
- cyclin-dependent kinase inhibitor;
- secondary hyperparathyroidism;
- vitamin D receptor
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.