Plasma Parathyroid Hormone-related Protein Research Articles

PTH/PTHrP Receptor and Mid-molecule PTHrP Regulation of Intrauterine PTHrP: PTH/PTHrP Receptor Antagonism Increases SHR Fetal Weight

Parathyroid hormone-related protein (PTHrP) has important roles in fetal growth and development through stimulation of placental calcium transport, vasodilatation of the uteroplacental vasculature and regulation of cellular growth and differentiation. The growth restricted spontaneously hypertensive rat (SHR) has reduced fetal plasma, placental and amniotic fluid PTHrP concentrations compared to its progenitor, the Wistar Kyoto (WKY) rat. The aim of this study was to determine whether intrauterine PTHrP infusions can restore PTHrP levels and promote SHR fetal growth. PTHrP(1–34), midmolecule PTHrP(67–94), the PTH/PTHrP receptor antagonist [Asn 10, Leu 11]-PTHrP(7–34) or vehicle were infused via a mini-osmotic pump between 10 and 20 days of gestation into the uterine lumen of SHR and WKY rats. Uterine, placental, amniotic fluid and plasma (fetal and maternal) PTHrP were measured via N-terminal radioimmunoassay. PTH/PTHrP receptor antagonism and mid-molecule PTHrP(67–94) induced endogenous intrauterine PTHrP production with receptor antagonism eliciting a greater and more wide spread effect. The PTH/PTHrP receptor antagonist [Asn 10, Leu 11]-PTHrP(7–34) acting through a receptor other than the PTH/PTHrP receptor increased SHR fetal and placental weights above vehicle ( P<0.05) to that of the WKY and restored SHR amniotic fluid volume ( P<0.05). This was associated with a highly significant up regulation of placental, uterine and plasma (fetal and maternal) PTHrP ( P<0.05). Modest increases in placental and uterine PTHrP ( P<0.05) following intrauterine infusions of PTHrP(1–34) and PTHrP(67–94) had no effect on WKY and SHR fetal weight. Effective growth promoting actions of increased endogenous PTHrP were observed following PTH/PTHrP receptor antagonism rather than exogenous PTHrP administration. A novel finding was that mid-molecule PTHrP also up regulates endogenous intrauterine N-terminal PTHrP production supporting the existence of a mid-molecule receptor. This study highlights that an increase in endogenous uterine, placental and fetal plasma PTHrP following PTH/PTHrP receptor antagonism was associated with increased SHR fetal growth presumably by improving placental growth and function.

Elevation of circulating plasma cytokines in cancer patients with high plasma parathyroid hormone-related protein levels.

Parathyroid hormone (PTH) and PTH-related protein/peptide (PTHrP) bind to the same PTH/PTHrP receptor and stimulate osteoblasts to secrete pro-inflammatory cytokines like interleukin (IL)-6. In patients with primary hyperparathyroidism, elevation of plasma levels of tumor necrosis factor (TNF)-alpha and IL-6 was also described. We, therefore, postulated that PTHrP secreted from cancer cells stimulates the secretion of cytokines and causes increases in their blood levels. Blood concentrations of several cytokines (TNF-alpha, IL-1beta, IL-5, IL-6, IL-8, IL-11 and IL-12) in cancer-bearing patients with or without elevation of blood PTHrP were measured by ELISA. The patients with high plasma PTHrP levels (n=29, intact PTHrP: 8.5 +/- 1.4 pmol/l, normal: <1.1) had higher serum type 1 collagen C-telopeptide (ICTP). Twenty of the patients were hypercalcemic. Plasma concentrations of TNF-alpha, IL-6 and IL-8 were significantly increased in patients with high PTHrP, in either the presence or absence of hypercalcemia. The concentrations of TNF-alpha and IL-6 were also significantly correlated with those of PTHrP. Our observations indicate that high plasma levels of PTHrP in cancer-bearing patients contribute not only to the development of hypercalcemia, but also to the development of the syndrome caused by an excess of pro-inflammatory cytokines.

Impaired mammary function and parathyroid hormone-related protein during lactation in growth-restricted spontaneously hypertensive rats.

Evidence implicates pivotal roles for parathyroid hormone-related protein (PTHrP) during lactation, including stimulation of mammary and pup growth. As spontaneously hypertensive rat (SHR) pups are growth restricted compared with the control Wistar Kyoto (WKY), we examined the relative roles of pup suckling and maternal lactational environment on pup growth, mammary PTHrP, and milk PTHrP and calcium concentrations. SHR pups were lighter compared with the control from 6 days. SHR mammary PTHrP content and milk PTHrP were lower but maternal plasma PTHrP was raised compared with WKY. SHR mammary morphological development was also impaired compared with control. Cross fostering growth-restricted pups onto WKY mothers increased pup weight in association with normal mammary function and higher milk PTHrP and calcium. Control pups suckling on an SHR mother had reduced body weight. Both cross fostering groups were associated with increased maternal and milk PTHrP concentrations, indicating the importance of suckling, together with a functional mammary gland. The results suggested that impaired SHR mammary function and milk PTHrP are associated with a reduced SHR postnatal growth. Our data also indicated that milk and mammary PTHrP are regulated by different mechanisms but that they are influenced by the maternal lactational environment and the suckling pup.

Determination of tissue and plasma concentrations of PTHrP in fish: development and validation of a radioimmunoassay using a teleost 1–34 N-terminal peptide

A specific and sensitive radioimmunoassay (RIA) for the N-terminus of sea bream ( Sparus auratus) and flounder ( Platichthys flesus) parathyroid hormone-related protein (PTHrP) was developed. A (1–34) amino-terminal sequence of flounder PTHrP was synthesized commercially and used as the antigen to generate specific antiserum. The same sequence with an added tyrosine (1–35 Tyr) was used for iodination. Human (1–34) parathyroid hormone (PTH), human (1–34) PTHrP, and rat (1–34) PTHrP did not cross-react with the antiserum or displace the teleost peptide. Measurement of PTHrP in fish plasma was only possible after denaturing by heat treatment due to endogenous plasma binding activity. The minimum detectable concentration of (1–34) PTHrP in the assay was 2.5 pg/tube. The level of immunoreactive (1–34) PTHrP in plasma was 5.2 ± 0.44 ng/ml (mean ± SEM, n=20) for flounder and 2.5 ± 0.29 ng/ml ( n=64) for sea bream. Dilution curves of denatured fish plasma were parallel to the assay standard curve, indicating that the activity in the samples was indistinguishable immunologically from (1–34) PTHrP. Immunoreactivity was present, in order of abundance, in extracts of pituitary, oesophagus, kidney, head kidney, gills, intestine, skin, muscle, and liver. The pituitary gland and oesophagus contained the most abundant levels of PTHrP, 37.7 ± 6.1 ng/g wet tissue and 2.3 ± 0.7 ng/g wet tissue, respectively. The results suggest that in fish PTHrP may act in a paracrine and/or autocrine manner but may also be a classical hormone with the pituitary gland as a potential major source of the protein.

Parathyroid hormone-related protein (PTHrP)-(1-139) isoform is efficiently secreted in vitro and enhances breast cancer metastasis to bone in vivo

Parathyroid hormone-related peptide (PTHrP) is a mediator of local osteolysis due to breast cancer. Three isoforms of PTHrP, (1-139), (1-141), and (1-173), are products of alternative splicing in humans, but the specific contribution of each of these isoforms to osteolytic metastasis caused by breast cancer has not been evaluated. To determine the role of PTHrP isoforms in breast cancer metastasis to bone, the human breast cancer cell line MDA-MB-231 (MDA-231) was stably transfected with cDNAs for human prepro PTHrP-(1-139), -(1-141), or -(1-173). Stable MDA/PTHrP-(1-139) clones expressed more PTHrP mRNA and secreted more PTHrP protein, compared with MDA/PTHrP-(1-141), -(1-173), or parental MDA-231. Parental MDA-231 cells and clones expressing each isoform had similar growth rates in vitro. In a mouse model of bone metastases, the osteolytic lesion area of radiographs was greatest in mice bearing MDA/PTHrP-(1-139) compared with those bearing MDA/PTHrP-(1-141), -(1-173), or parental MDA-231. Ca ++ and plasma PTHrP concentrations were significantly higher in the MDA/PTHrP-(1-139) compared with the MDA/PTHrP-(1-141), -(1-173), or parental MDA-231 groups. These data demonstrate that the PTHrP-(1-139) isoform was produced to a greater extent than PTHrP-(1-141) or -(1-173), and in vivo enhanced osteolysis with increased plasma PTHrP concentrations and hypercalcemia compared with overexpression of PTHrP-(1-141) or -(1-173).

The Spontaneously Hypertensive Rat Fetus, Not the Mother, is Responsible for the Reduced Amniotic Fluid PTHrP Concentrations and Growth Restriction

Intrauterine parathyroid hormone-related protein (PTHrP) concentrations are reduced in association with growth restriction in the spontaneously hypertensive rat (SHR) compared to those of its normotensive control, the Wistar Kyoto (WKY) rat, implicating PTHrP as a pivotal fetal growth factor. The aim of this study was to examine, by embryo cross-transplanation between SHR and WKY, whether the mother, fetus, or both, are responsible for the suppressed SHR amniotic fluid PTHrP. One-day-old SHR embryos were gestated in either an SHR (SHR-in-SHR) or WKY (SHR-in-WKY) surrogate, similarly one-day-old WKY embryos were gestated in either an SHR (WKY-in-SHR) or WKY (WKY-in-WKY) mother. At 20 days gestation, maternal plasma and amniotic fluid samples were collected and assayed for PTHrP concentrations. Data were analysed by two-way ANOVA (mean±sem,n =5–9 mothers/group). There were no differences in litter number or maternal plasma PTHrP concentrations. Fetal weight (P< 0.009), fetal/placental weight ratio (P< 0.004) and amniotic fluid PTHrP concentrations (P< 0.001) were lower and amniotic fluid volume (P< 0.0001) was higher with an SHR fetus compared to the WKY fetus irrespective of maternal strain. Thus, the SHR fetus is growth restricted and has suppressed amniotic fluid PTHrP, which are largely determined by the fetus or gestational tissues and are independent of maternal hypertension or maternal PTHrP. We suggest that the low SHR amniotic fluid PTHrP may play a role in the development of SHR growth restriction.

Effects of water temperature and salinity on parathyroid hormone-related protein in the circulation and tissues of elasmobranchs

Parathyroid hormone-related protein (PTHrP) is a hypercalcemic factor in mammals. The PTHrP antigen has been localized in both bony and cartilaginous fish tissues. Sites of localization included gills, skin and kidney, organs involved in osmoregulation. Physiological and localization experiments were carried out in elasmobranchs to dissect PTHrP's possible role in osmoregulation. The effects of alterations in the external environment on PTHrP in sharks were examined by keeping juvenile animals under conditions of increased temperature or decreased salinity. There were no alterations in the PTHrP levels in either the circulation or tissues. Significant correlations between plasma PTHrP, electrolyte and urea levels were seen in the pretreatment samples. The localization of PTHrP by immunohistochemistry and in situ hybridization revealed conserved sites of distribution from elasmobranchs to mammals, including skin, kidney, muscle and skeleton.

Humoral Hypercalcemia of Malignancy: Severe Combined Immunodeficient/Beige Mouse Model of Adult T-Cell Lymphoma Independent of Human T-Cell Lymphotropic Virus Type-1 Tax Expression

The majority of patients with adult T-cell leukemia/lymphoma (ATL) resulting from human T-cell lymphotropic virus type-1 (HTLV-1) infection develop humoral hypercalcemia of malignancy (HHM). We used an animal model using severe combined immunodeficient (SCID)/beige mice to study the pathogenesis of HHM. SCID/beige mice were inoculated intraperitoneally with a human ATL line (RV-ATL) and were euthanized 20 to 32 days after inoculation. SCID/beige mice with engrafted RV-ATL cells developed lymphoma in the mesentery, liver, thymus, lungs, and spleen. The lymphomas stained positively for human CD45RO surface receptor and normal mouse lymphocytes stained negatively confirming the human origin of the tumors. The ATL cells were immunohistochemically positive for parathyroid hormone-related protein (PTHrP). In addition, PTHrP mRNA was highly expressed in lymphomas when compared to MT-2 cells (HTLV-1-positive cell line). Mice with lymphoma developed severe hypercalcemia. Plasma PTHrP concentrations were markedly increased in mice with hypercalcemia, and correlated with the increase in plasma calcium concentrations. Bone densitometry and histomorphometry in lymphoma-bearing mice revealed significant bone loss because of a marked increase in osteoclastic bone resorption. RV-ATL cells contained 1.5 HTLV-1 proviral copies of the tax gene as determined by quantitative real-time polymerase chain reaction (PCR). However, tax expression was not detected by Western blot or reverse transcriptase (RT)-PCR in RV-ATL cells, which suggests that factors other than Tax are modulators of PTHrP gene expression. The SCID/beige mouse model mimics HHM as it occurs in ATL patients, and will be useful to investigate the regulation of PTHrP expression by ATL cells in vivo.

Humoral Hypercalcemia of Malignancy in Female F344 Rats Implanted with a Transplantable Rat Pulmonary Carcinoma Line (IP).

A transplantable rat pulmonary carcinoma line (IP) in F344 rats is a useful animal model for humoral hypercalcemia of malignancy (HHM). The present study analyzed the degree of HHM by implanting IP into F344 female rats aged 6, 20 or 45 weeks. IP-bearing females developed elevated plasma parathyroid hormone-related protein levels, hypercalcemia and increased osteoclastic activity as well as calcification in various organs. The severity of such HHM differed depending on age; particularly, calcification showed age-dependent reduction. HHM development in IP-bearing females may be influenced by age-related factors.

Immunohistochemical Detection of Parathyroid Hormone-Related Protein in a Squamous Cell Carcinoma Arising from Mature Cystic Teratoma Causing Humoral Hypercalcemia of Malignancy

Background. Humoral hypercalcemia of malignancy is a cancer-related hypercalcemia caused by the production of humoral factors by malignant cells in patients without bone metastases. Squamous cell carcinomas are the tumors most frequently associated with humoral hypercalcemia of malignancy, and parathyroid hormone-related protein (PTH-rP) is the main humoral factor implicated. Squamous cell carcinoma arising from mature cystic teratoma is a rare diagnosis itself, much less the description of associated hypercalcemia, despite the fact that the normal keratinocytes produce parathyroid hormone-related protein.Case. We present a well-documented case of squamous cell carcinoma arising from mature cystic teratoma of the ovary, complicated by hypercalcemia in a patient with high levels of plasma parathyroid hormone-related protein and immunohistochemical evidence of parathyroid hormone-related protein expression by the tumor cells.Conclusion. In this case, the carcinoma cells had already produced PTH-rP in the primary tumor although the serum calcium levels had not been significantly high at surgery. It is therefore suggested that hypercalcemia may have occurred after PTH-rP production had overcome the homeostatic level during the terminal stage.

Relationship of plasma bone cytokines with hypercalcemia in cancer patients

The pathogenesis of cancer-associated hypercalcemia is not yet completely understood. This syndrome appears to be a consequence of the tumor production of humoral factors, mainly parathyroid hormone related protein (PTHrP). However, patients with humoral hypercalcemia of malignancy have features suggesting that factors other than PTHrP might play a role in this syndrome. We performed a case-control study in cancer patients with and without hypercalcemia. A total of 105 patients with a variety of tumors, 60 of them with hypercalcemia (corrected serum calcium over 2.6 mmol/l), and 45 without hypercalcemia. In a previous study, we demonstrated that plasma PTHrP was highly associated with hypercalcemia in these patients. In the present study, we measured the plasma levels of various bone cytokines: interleukin-1β (IL-1β), interleukin-6 (IL-6), transforming growth factor (TGF) α, and tumor necrosis factor (TNF) α, in these cancer patients. We also determined C-terminal type I procollagen (PICP) and C-terminal telopeptide of type I collagen (ICTP), bone formation and bone resorption markers, respectively, in serum in these patients. We found that these osteolytic cytokines do not increase in plasma by the presence of hypercalcemia. In fact, using a logistic regression analysis, a significant ( P<0.02) association was found between the low plasma levels of IL-1β and TGFα and hypercalcemia, independent of plasma PTHrP and the presence of bone metastasis, in these patients. No significant association between the plasma levels of IL-6 or TNFα and hypercalcemia was found in these cancer patients. Serum ICTP correlated ( r=0.35; P=0.008) with hypercalcemia in these patients, but none of the cytokines studied in plasma correlated with either ICTP or PICP in these hypercalcemic patients. Our data indicate that the circulating levels of several bone cytokines are not enhanced by PTHrP in hypercalcemic cancer patients. The mechanism responsible for the association between the low plasma levels of some of these cytokines and hypercalcemia in these patients remains obscure. However, this finding does not rule out the possible local bone effects of these cytokines, contributing to hypercalcemia in cancer patients.

Head and neck squamous cell carcinoma: Measurement of plasma parathyroid hormone-related protein and serum and urine calcium concentrations

Objectives: Parathyroid hormone-related protein (PTHrP) is expressed by squamous cell carcinomas. Our first objective was to examine the stability of PTHrP in normal human plasma. Our second objective was to determine whether plasma PTHrP could be used in patients with head and neck squamous cell carcinoma (HNSCC) as an indicator of tumor burden or relapse. Study Design and Setting: Blood and urine samples from 55 HNSCC patients undergoing tumor resection at The Ohio State University were measured for plasma PTHrP (1-86) concentration, serum ionized calcium concentration, and urine calcium/creatinine ratio. Results: Two of 55 HNSCC patients had detectable levels of plasma PTHrP. Serum ionized calcium concentrations and urinary calcium/creatinine ratios were within normal limits in all patients. Conclusions: Plasma PTHrP was not a valuable indicator of tumor presence or recurrence in our patient population. Significance: Plasma PTHrP is not a useful marker of tumor presence or recurrence in patients with stage II to IV or recurrent HNSCC. (Otolaryngol Head Neck Surg 2000;123:558-62.)

Reduced fetal, placental, and amniotic fluid PTHrP in the growth-restricted spontaneously hypertensive rat.

Evidence implicates pivotal roles for parathyroid hormone-related protein (PTHrP) in stimulating cell growth and differentiation, placental calcium transport, and placental vasodilatation. As spontaneously hypertensive rat (SHR) fetuses are growth restricted compared with those of its normotensive control, the Wistar Kyoto (WKY) rat, we examined intrauterine PTHrP and total and ionic calcium concentrations in these rats. Fetal plasma PTHrP concentrations, but not total calcium concentrations, were lower in the SHR compared with WKY (P < 0.05). SHR placental concentrations of PTHrP were lower than in WKY (P < 0.03) and failed to show the increase observed in WKY near term (P < 0.05). PTHrP concentrations in amniotic fluid from SHR were not raised near term and were lower compared with WKY (P < 0.0005). The increased ionic calcium concentrations in amniotic fluid in the WKY near term (P < 0.05) were not detected in the SHR. Thus SHR fetal plasma, placental, and amniotic fluid PTHrP concentrations were reduced and associated with fetal growth restriction. We suggest that PTHrP may play a role in the etiology of both growth restriction during pregnancy and hypertension later in life.

Parathyroid hormone-related protein as a potential target of therapy for cancer-associated morbidity.

Proinflammatory cytokines are involved in the genesis of cancer-associated cachexia. Parathyroid hormone-related protein (PTHrP) is the causative agent in humoral hypercalcemia of malignancy (HHM) and is frequently secreted from various kinds of solid tumors as well as from adult T-cell leukemia/lymphoma. PTHrP, like PTH, acts on PTH receptor type 1 (PTH1R). Activation of PTH1R may lead to stimulation of secretion of proinflammatory cytokines. It is expected, therefore, that PTHrP constitutes a key factor in the activation of the proinflammatory and cachectogenic cytokine network and consequently in the development of cachexia in patients with cancer. Two groups of cancer-bearing patients of similar clinical backgrounds were enrolled. Plasma concentrations of PTHrP and cytokines were measured with immunoradiometric assay and radioimmunoassay, respectively. Cancer tissues from patients with HHM were transplanted into nude mice or nude rats. The effects of humanized antihuman PTHrP antibody were examined. In clinical studies, Group B patients (with elevated plasma PTHrP), compared with Group A patients (with normal plasma PTHrP), tended to exhibit higher plasma levels of tumor necrosis factor (TNF)-alpha (P = 0.13), interleukin (IL)-5 (P = 0.08), and IL-8 (P = 0.08), and had significantly higher levels of IL-6 (P = < or =0.01). The levels of TNF-alpha and IL-6 correlated with those of PTHrP. In animal studies, the antibody caused a prompt and sustained decline in serum calcium. This response was accompanied by improvements in food intake, drinking, body weight gain, and general behavior. It also ameliorated the suppression of serum ADH. When those effects were compared with those induced either by bisphosphonate or calcitonin, it turned out that not all of the beneficial effects of the antibody were directly correlated with the depression of blood calcium. PTHrP is a promising molecular target for the development of a novel mode of treatment for patients with cancer-associated morbidity.

Parathyroid hormone-related protein, parathyroid hormone, and vitamin D in hypercalcemia of malignancy

The pathogenesis of cancer-associated hypercalcemia is not yet completely understood. In the majority of cancer patients, hypercalcemia appears to be a consequence of the tumor production of parathyroid hormone (PTH)-related protein (PTHrP). However, patients with humoral hypercalcemia of malignancy, in contrast to those with primary hyperparathyroidism, have an uncoupled bone turnover, and they usually have low circulating levels of 1,25(OH)2D3. We performed a case-control study to assess the relationship of plasma PTHrP, PTH and 1,25(OH)2D3 with hypercalcemia in cancer patients with a variety of tumors. Sixty of these patients had hypercalcemia, and 45 were normocalcemic. We measured PTHrP and PTH by immunoradiometric assay (Nichols), and 1,25(OH)2D3 by radioreceptor assay (Nichols), in plasma in both groups of cancer patients. Using a logistic regression analysis, we found that the higher PTHrP in plasma, the higher association with hypercalcemia occurred in these patients. In addition, the decreased plasma levels of PTH and 1,25(OH)2D3 in the majority of cancer patients were found to be significantly associated with hypercalcemia. Our results indicate that the combined determination of PTH, PTHrP and 1,25(OH)2D3 in plasma represents a more comprehensive approach to the investigation of hypercalcemia in cancer patients. Our data also support the role of PTHrP as a humoral factor responsible for hypercalcemia in these patients.

Comparison of two immunoradiometric assays for parathyroid hormone-related protein in the evaluation of cancer patients with and without hypercalcemia

Hypercalcemia is a common paraneoplastic syndrome due to the secretion by tumors of parathyroid hormone-related protein (PTHrP) and/or other osteolytic factors. In the present study, we have measured plasma PTHrP using two immunoradiometric assays for PTHrP, assay N (Nichols) and assay I (INCSTAR), recognizing the 1–86 domain of PTHrP, for the evaluation of malignancy-associated hypercalcemia. The study included 25 tumor patients with hypercalcemia (HCa) [corrected serum calcium (SCa) ≥2.70 mmol/L], 20 normocalcemic patients with cancer (NCa), and ten healthy control subjects. Plasma PTHrP was either undetectable or within the respective normal range in the majority of NCa patients and in the control subjects, with both assays. Plasma PTHrP was increased in 13 and 15 of HCa cases with assay N and assay I, respectively. PTHrP was elevated in plasma in 5/6 (assay N) and 3/6 (assay I) HCa patients with squamous tumors. However, plasma PTHrP was high in only 2/9 (assay N) and 1/9 (assay I) HCa cases with hematological tumors. Less than 40% of HCa patients with bone metastases, and >75% of those without bone involvement, had elevated plasma PTHrP with both assays. Detectable plasma PTHrP and SCa were significantly correlated using assay N ( p=0.025) and assay I ( p=0.01), in the HCa group. A highly significant correlation ( p<0.001) was found between detectable plasma PTHrP with both assays, and a high agreement between them based on simple kappa statistics ( p<0.001), in the latter group. Our results indicate that each assay may be similarly useful in detecting PTHrP hyperproduction in cancer patients.

Parathyroid hormone-related protein and hypercalcemia.

The discovery of parathyroid hormone-related protein (PTH-rP) arose from interest in the mechanisms by which certain cancers cause hypercalcemia without necessarily metastasizing to bone. The humoral hypercalcemia of malignancy (HHM) had for a long time been ascribed to inappropriate production of parathyroid hormone (PTH) by cancers. The amino-terminal portions of PTH-rP and PTH have essentially identical actions through a common receptor for PTH/PTH-rP: to elevate plasma calcium by promoting bone resorption and decreasing calcium excretion. Assays for plasma PTH-rP fail to detect protein convincingly in normal plasma, but measurable levels have been found in up to 100% of patients with HHM, in 75% of patients with breast carcinoma metastatic to bone, and in some hypercalcemic patients with miscellaneous cancers. Whereas PTH-rP clearly functions as a hormone in those cancers in which it is produced in excess, in normal circumstances it is produced locally in many tissues in which it is a paracrine effector. There appears to be little doubt that PTH-rP is the major mediator of hypercalcemia in patients with HHM, although it is possible that other factors (e.g., bone resorbing cytokines) also could contribute in some patients. In the case of breast carcinoma, another possible role arises for PTH-rP. The high incidence of PTH-rP production by primary breast carcinomas, elevated plasma levels in 60% of those with hypercalcemia and lytic metastases, and higher incidence of PTH-rP production in skeletal versus those with nonskeletal metastases have led to the hypothesis that PTH-rP might contribute to breast carcinoma growth in bone. Experimental evidence currently is available to support this hypothesis. The discovery of PTH-rP has contributed greatly to current understanding of the skeletal complications of cancer.

Parathyroid hormone and parathyroid hormone related protein assays in the investigation of hypercalcemic patients in hospital in a Chinese population.

There are many pathological causes and potential mechanisms for hypercalcemia. We measured intact parathyroid hormone (PTH) and parathyroid hormone related protein (PTHrP) in the hypercalcemic in-patients and attempted to evaluate the roles of PTH and PTHrP in hypercalcemia due to malignancy. We performed a prospective study of 178 patients with corrected serum calcium concentrations greater than 2.74 mmol/l in a hospital over a 3-year period. We measured calcium and albumin using a Hitachi 747 autoanalyzer, and we measured PTH and PTHrP by two-site immunoradiometric assays (IRMA). Hypercalcemia was attributed to malignancy alone in 93 patients (52.3%), primary hyperparathyroidism (HPT) alone in 28 patients (15.7%), uremia with hemodialysis in 23 patients (12.9%), unknown in 16 patients (9%), primary HPT coexisting with malignancy in 7 patients (3.9%) and other rare causes (6.2%). Plasma PTHrP levels were elevated in 71/93 (76.3%) patients with hypercalcemia due to malignancy, but the elevated PTHrP percentage differed for each kind of tumor. PTHrP levels were elevated in 100% of patients with squamous carcinomas (CA) in the lung, esophagus, skin, cholangiocarcinoma of liver, and breast CA. The positive bony metastatic rate was 44.1% (41/93). There was no correlation between high PTHrP and bony metastasis. There was a good correlation between the corrected serum calcium and PTHrP levels (r = 0.476, p < 0.001), but no correlation between survival time and serum calcium level or PTHrP level. There was no significant difference in life expectancy after cancer diagnosis between the high PTHrP group and normal PTHrP group, and there was no significant difference in life expectancy after the first occurrence of hypercalcemia between the two groups. Measurement of both PTH and PTHrP levels led to a change in the initial diagnosis in 7 patients. In routine practice, measurement of serum PTH alone is not enough. This study suggests that the appropriate combination of PTH and PTHrP assays results in a more accurate diagnosis of the hypercalcemic causes. In addition, especially high PTHrP levels should be screened for malignancy. However, the prognosis in cancer patients after hypercalcemia with high PTHrP group, as compared to those with the normal PTHrP group is not significantly different.

Parathyroid hormone-related protein in neonatal and reproductive goats determined by a sensitive time-resolved immunofluorometric assay.

High concentrations of parathyroid hormone-related protein (PTHrP) have been found in goat milk but it is not known whether it can enter the circulation of the neonate. In this study we have developed a sensitive two-site lanthanide immunofluorometric assay (IFMA) using dissociation and enhancement time-resolved fluorometry to address this question. Affinity-purified anti-PTHrP 38-67 raised in rabbit was biotinylated and immobilized in streptavidin-coated microtitration wells as a 'capture' antibody. As a signal, affinity-purified anti-PTHrP 1-34, raised in sheep, was labeled with an europium chelate. A sensitivity of 0.3 pmol/l was achieved. PTHrP levels were determined in the plasma of eleven neonatal, seven parturient and six non-pregnant, non-lactating goats as well as in goat milk. The circulating PTHrP levels (mean +/- S.D.) were significantly increased at day 1 (6.1 +/- 1.7 pmol/l: P < 0.01) and day 3 (3.5 +/- 0.6 pmol/l: P < 0.05) after birth in the male kids (n = 8) bottle-fed with milk from the dams, compared with before (2.2 +/- 0.7 pmol/l) and 30 min after (2.0 +/- 0.6 pmol/l) the first feeding and 14 days (2.4 +/- 0.8 pmol/l) later. In the female kids (n = 3) fed with formula there was no such increase and the concentrations remained between 1.6-1.9 pmol/l. In the parturient goats the mean +/- S.D. PTHrP levels before, during and after parturition were 2.9 +/- 1.7, 4.2 +/- 2.4 and 3.7 +/- 2.2 pmol/l respectively (n = 7) which demonstrated that plasma PTHrP was higher during and after parturition in comparison with before (P < 0.05). The levels in non-pregnant, non-lactating goats were 3.3 +/- 1.5 pmol/l (n = 6). PTHrP levels in goat milk were in the nanomolar range and were highest in the colostrum. A significant increase of plasma PTHrP was observed in goat kids fed with milk from their dams and this increase was not found in kids fed with formula. Plasma PTHrP was also increased during parturition.

Evidence for a causal role of parathyroid hormone-related protein in the pathogenesis of human breast cancer-mediated osteolysis.

Breast cancer almost invariably metastasizes to bone in patients with advanced disease and causes local osteolysis. Much of the morbidity of advanced breast cancer is a consequence of this process. Despite the importance of the problem, little is known of the pathophysiology of local osteolysis in the skeleton or its prevention and treatment. Observations in patients with bone metastases suggest that breast cancer cells in bone express parathyroid hormone-related protein (PTHrP) more frequently than in soft tissue sites of metastasis or in the primary tumor. Thus, the role of PTHrP in the causation of breast cancer metastases in bone was examined using human breast cancer cell lines. Four of eight established human breast cancer cell lines expressed PTHrP and one of these cell lines, MDA-MB-231, was studied in detail using an in vivo model of osteolytic metastases. Mice inoculated with MDA-MB-231 cells developed osteolytic bone metastasis without hypercalcemia or increased plasma PTHrP concentrations. PTHrP concentrations in bone marrow plasma from femurs affected with osteolytic lesions were increased 2.5-fold over corresponding plasma PTHrP concentrations. In a separate experiment, mice were treated with either a monoclonal antibody directed against PTHrP(1-34), control IgG, or nothing before tumor inoculation with MDA-MB-231 and twice per week for 26 d. Total area of osteolytic lesions was significantly lower in mice treated with PTHrP antibodies compared with mice receiving control IgG or no treatment. Histomorphometric analysis of bone revealed decreased osteoclast number per millimeter of tumor/bone interface and increased bone area, as well as decreased tumor area, in tumor-bearing animals treated with PTHrP antibodies compared with respective controls. These results indicate that tumor-produced PTHrP can cause local bone destruction in breast cancer metastatic to bone, even in the absence of hypercalcemia or increased circulating plasma concentrations of PTHrP. Thus, PTHrP may have an important pathogenetic role in the establishment of osteolytic bone lesions in breast cancer. Neutralizing antibodies to PTHrP may reduce the development of destructive bone lesions as well as the growth of tumor cells in bone.