Skeletal Alkaline Phosphatase Research Articles

Relationship between fluoride exposure, orthopedic injuries and bone formation markers in patients with coal-burning fluorosis

Chronic exposure to fluoride is a public health problem worldwide. We explored the relationship between fluoride exposure, orthopedic injuries and bone formation markers alkaline phosphatase (ALP), bone Gla protein (BGP) in participants with coal-burning fluorosis in Hehua Village (coal-burning fluorosis endemic area) in Zhijin County of Guizhou Province and Zhangguan Village (non-fluoride contaminated area) in Anshun City of Guizhou Province. Environmental samples were collected and fluoride contents were examined using a fluoride ion-selective electrode. Dental fluorosis and skeletal fluorosis of 295 participants from Hehua Village and 85 participants from Zhangguan Village were diagnosed with informed consent. Urinary samples and peripheral blood samples were collected from the participants to determine urinary fluoride (UF), ALP acti-vity, and BGP content. The results showed that fluoride contents in rice, pepper, corn, drinking water, clay, vegetable-grown soil, coal and indoor and outdoor air were significantly higher than those in the control area, but lower than the previously reported values. With the increases of UF concentration, the ALP activity and BGP content significantly increased, the severity of skeletal fluorosis was greater, but with no significant changes in dental fluorosis. There was positive correlation between the severity of skeletal fluorosis and ALP activity, BGP content. These results indicated that low fluoride exposure could cause orthopedic injuries. ALP and BGP could be used to eva-luate the bone turnover in patients with skeletal fluorosis, which would be useful in the auxiliary diagnosis and therapeutic evaluation of skeletal fluorosis.

Association of serum alkaline phosphatase with mortality in non-selected European patients with CKD5D: an observational, three-centre survival analysis

ObjectivesFor characterisation of mineral bone disease in chronic kidney disease (CKD), laboratory surrogates have been suggested. This observational should investigate the association of total and skeletal alkaline phosphatase (AP) with...

Associations of Serum Skeletal Alkaline Phosphatase with Elevated C-Reactive Protein and Mortality

Higher serum total alkaline phosphatase (AP) levels are associated with increased serum C-reactive protein (CRP) levels and mortality in the general and CKD populations. It is unclear to what extent these associations are related to bone disease. In a nationally representative sample of 10,707 adult participants from the 1999-2004 National Health and Nutrition Examination Survey, serum nonskeletal AP levels were estimated from the measured serum skeletal and total AP levels. The associations of serum skeletal AP and nonskeletal AP levels with elevated serum CRP concentrations (>3 mg/L) and mortality were examined in multivariable models. Skeletal AP was not associated with elevated CRP (for each doubling in non-CKD: odds ratio [OR], 1.00; 95% confidence interval [95% CI], 0.90-1.11; in CKD: OR, 1.19; 95% CI, 0.83-1.70) or mortality (for each doubling in non-CKD: hazard ratio [HR], 1.10; 95% CI, 0.94-1.29; in CKD: HR, 0.98; 95% CI, 0.75-1.28). In contrast, nonskeletal AP was associated with elevated CRP (for each doubling in non-CKD: OR, 4.51; 95% CI, 3.80-5.35; in CKD: OR, 5.98; 95% CI, 3.40-10.51). Nonskeletal AP was associated with mortality in non-CKD (for each doubling: HR, 1.96; 95% CI, 1.37-2.80) but not in CKD (for each doubling: HR, 0.92; 95% CI, 0.51-1.67) (interaction P=0.03). Bone disease is unlikely to account for the known associations of serum total AP with increased inflammation and mortality.

Tolerance, Bone Mineral Content, and Serum Vitamin D Concentration of Term Infants Fed Partially Hydrolyzed Whey-based Infant Formula

The objective of the study was to assess the tolerance (intake, incidence of spit up/vomit, and stool patterns), bone mineral status, and vitamin D status of healthy, term infants fed one of two partially hydrolyzed bovine whey protein infant formulas from birth to 56 or 84 days of age. The control formula was commercially available and was compared to an experimental formula. Eighty-nine term infants were enrolled in the study and 74 (83%) completed the study. The control formula had similar vitamin D but lower calcium and phosphorus content and contained palm olein oil and lactose compared to the experi- mental formula. Infants fed the experimental formula exhibited significantly greater serum 25-OH vitamin D levels at 2 months of age, significantly greater bone mineral content as assessed by dual-energy x-ray absorptiometry at 3 months of age and softer stools during the study period compared to infants fed the control formula. No differences were observed between groups for formula intake, incidence of spit up/vomit, anthropometric measurements, or serum concentrations of calcium, phosphorus, skeletal alkaline phosphatase, or parathyroid hormone. The results suggest that both study formulas are safe but differ in the metabolic response of infants fed the formula. Bone mineral content in these infants reflected differences in levels of nutrients important to calcium between two formulas over the short-term. Long-term implications and clinical relevance of these findings are unknown and require further study. These results provide additional knowledge regarding the typical vitamin D status as assessed by serum 25-OH vit- amin D of healthy term formula-fed infants.

BONE MINERAL CONTENT (BMC) AND SERUM VITAMIN D CONCENTRATIONS OF INFANTS FED PARTIALLY HYDROLYZED INFANT FORMULAS

The purpose of the study was to compare the bone status of healthy, term infants fed partially hydrolyzed whey formulas during the first 3 mo of life. Between 0‐8 d of age, 89 infants were randomized to Good Start Supreme® (GSS) or an experimental whey‐based formula (EF) to 84 d of age. BMC was assessed < 14 d and at 84 d of age. Blood biochemistries (serum Ca, P, skeletal alkaline phosphatase, parathyroid hormone and 25‐OH Vit D) were assessed at 56 d of age. BMC was similar at 0‐14 d. EF infants had significantly greater BMC than GSS infants at 84 d (mean+SEM) (117.2+4.5 g vs 110.8+4.4 g, respectively, p=0.0407). There were no differences in blood biochemistries between groups except EF infants had significantly higher serum 25‐OH Vit D levels than those fed GSS (31.0+0.9 vs 27.2+0.7 ng/mL, respectively, p=0.0010, Effect Size=0.76). The average serum Vit D level in the EF group was greater than the levels of 76% of the GSS group. 97% of all infants had Vit D levels >21 ng/mL. Ca and P content of GSS (542 mg Ca/L, 315 mg P/L) was lower than that of EF (869 mg Ca/L, 556 mg P/L) and likely resulted in the BMC differences observed. Vit D intakes appeared similar as Vit D contents of 2 batches of GSS were 518 and 538 IU/L, EF was 541 IU/L. The absence of palm olein oil in EF is one possible factor that may have contributed to improved Vit D bioavailability and status. (Supported by Abbott Nutrition, Abbott Laboratories)

Changes in bone density and metabolism in pregnancy

The impact of pregnancy on maternal bone density remains unclear. As a prerequisite to investigate the pathophysiology of gestational bone metabolism, we sought to document the changes in bone metabolism biochemistry in conjunction with those in selective trabecular/cortical osteodensitometry between early and late pregnancy. A prospective, controlled study in a university hospital was conducted with 43 healthy women, 34 of them during uneventful pregnancy. The main outcome measures are trabecular and cortical bone density measured in the first and third trimesters using peripheral quantitative computed tomography in conjunction with a panel of bone metabolism parameters, including blood parathyroid hormone, calcitonin, osteocalcin, skeletal alkaline phosphatase, and the urinary desoxypyridinoline/creatinine ratio. Cortical bone density was unaffected by pregnancy. Trabecular bone density changes showed wide interindividual variation, ranging from +1.3 to -20.7% per year, identified as fast losers (less than -3%) and slow losers (more than -3%). Serum osteocalcin levels were lower in slow versus fast bone losers in both trimesters (first: P=0.02, third: P=0.02) and were the only independent parameter to differentiate between fast and slow losers. Our data suggest that wide interindividual variation and the failure to provide a separate measure of trabecular bone density account for the conflicting evidence in earlier reports. Serum osteocalcin concentration during the first trimester distinguishes between fast and slow losers of trabecular bone and should be evaluated in future studies as predictor for later bone loss (osteoporosis).

Increased Serum Concentrations of Intestinal Alkaline Phosphatase in Peritoneal Dialysis

Patients suffering from chronic renal dysfunction are monitored by measurement of biochemical markers such as serum total alkaline phosphatase (ALP) to detect increased bone remodeling before the development of advanced renal osteodystrophy. There are at least five different isoforms/isoenzymes of ALP: hepatic, skeletal, intestinal, placental, and tumor-associated (1). These can be separated by electrophoresis and differ in their resistance to heat inactivation, with placental and tumor-associated ALP being the most resistant. Approximately 95% of the total ALP activity in serum is derived from bone and liver sources; these isoforms occur in an ∼1:1 ratio in healthy adults (2). Bone remodeling leads to release of skeletal ALP from osteoblasts and, hence, to increased total …

Effects of tunicamycin, mannosamine, and other inhibitors of glycoprotein processing on skeletal alkaline phosphatase in human osteoblast-like cells.

Skeletal alkaline phosphatase (sALP) is a glycoprotein- approximately 20% carbohydrate by weight, with five presumptive sites for N-linked glycosylation, as well as a carboxy-terminal site for attachment of the glycolipid structure (glycosylphosphatidylinositol, GPI), which anchors sALP to the outer surface of osteoblasts. The current studies were intended to characterize the effects of inhibiting glycosylation and glycosyl-processing on the synthesis, plasma membrane attachment, cellular-extracellular distribution, and reaction kinetics of sALP in human osteosarcoma (SaOS-2) cells. sALP synthesis, glycosylation, and GPI-anchor attachment were assessed as total protein synthesis/immunospecific sALP synthesis, sialic acid content (i.e., wheat germ agglutinin precipitation), and insolubility (i.e., temperature-dependent phase-separation), respectively. sALP reaction kinetics were characterized by analysis of dose-dependent initial velocity data, with a phosphoryl substrate. The results of these studies revealed that the inhibition of either N-linked glycosylation or oligosaccharide synthesis for GPI-anchor addition could affect the synthesis and the distribution of sALP, but not the kinetics of the phosphatase reaction. Tunicamycin-which blocks N-linked glycosylation by inhibiting core oligosaccharide synthesis-decreased cell layer protein and the total amount of sALP in the cells, while increasing the relative level of sALP in the cell-conditioned culture medium (CM, i.e., the amount of sALP released). These effects were attributed to dose- and time-dependent decreases in sALP synthesis and N-linked glycosylation, and an increase in apoptotic cell death (P <0.001 for each). In contrast to the effects of tunicamycin on N-linked glycosylation, the effects of mannosamine, which inhibits GPI-anchor glycosylation/formation, included (1) an increase in cell layer protein; (2) decreases in sALP specific activity, in the cells and in the CM; and (3) increases in the percentages of both anchorless and wheat germ agglutinin (WGA)-soluble sALP in the medium, but not in the cells (P <0.005 for each). These effects of mannosamine were, presumably, a consequence of inhibiting the insertion/attachment of sALP to the outside of the plasma membrane surface. Neither mannosammine nor tunicamycin had any effect on the reaction kinetics of sALP or on the apparent affinity (the value of KM) for the phosphoryl substrate.

Are bone turnover markers capable of predicting callus consolidation during bone healing?

The aim of this study was to determine the ability of the following bone turnover markers to monitor the course of callus consolidation during bone healing: Carboxy-terminal propeptide of procollagen type I (PICP), skeletal alkaline phosphatase (sALP), and amino-terminal propeptide of type III procollagen (PIlINP). Since interfragmentary movements have been proven to possess the ability to document the progression of bone healing in experimental studies, correlations between bone turnover markers and interfragmentary movements in vivo were investigated. Therefore, two different types of osteosyntheses representing different mechanical situations at the fracture site were compared in an ovine osteotomy model. Blood samples were taken preoperatively and postoperatively in weekly intervals over a nine-week healing period. At the same intervals, interfragmentary movements were measured in all sheep. After nine weeks, animals were sacrificed and the tibiae were evaluated both mechanically and histologically. Wide interindividual ranges were observed for all bone turnover markers. The systemic PICP level did not increase with callus consolidation. The bone-healing model seemed to influence the systemic level of PIIINP and sALP but no general correlation between bone turnover markers and interfragmentary movements could be detected. No differences between the different types of osteosyntheses and thus the different mechanical situations were observed. All analyzed markers failed as general predictors for the course of callus consolidation during bone healing.

A Toxicity Profile of Osteoprotegerin in the Cynomolgus Monkey

Osteoprotegerin (OPG) is a novel secreted glycoprotein of the tumor necrosis factor (TNF) receptor superfamily that acts as an antiresorptive agent inhibiting osteoclast maturation. OPG acts by competitively inhibiting the association of the OPG ligand with the RANK receptor on osteoclasts and osteoclast precursors. This inhibition of osteoclasts can lead to excess accumulation of newly synthesized bone and cartilage in vivo. The purpose of this study was to investigate the potential toxicity of a human recombinant form of OPG in the young cynomolgus monkey. OPG was administered by intravenous (IV) or subcutaneous (SC) injection three times per week for either 4 or 13 weeks. There were no deaths during the study, no clinical signs related to treatment, no effect on body weight, appetence, or ophthalmology. No toxicologically relevant changes in routine laboratory investigations, organ weights, or gross or histopathological findings were observed. Serum ionized calcium and phosphorus were decreased at all dose levels. Evaluations were performed to monitor biochemical markers of bone resorption (N-telopeptide [NTx], deoxypyridinoline [DPD]), bone formation (skeletal alkaline phosphatase [s ALP], osteocalcin [OC]), parathyroid hormone [PTH], and bone density of the proximal tibia and distal radius in vivo. Dose-related decreases in NTx and/or DPD were observed at each dose level, with up to a 90% decrease in NTx noted for animals treated IV or SC at 15 mg/kg. Similar decreases were observed for s ALP and OC. PTH was increased for animals treated at 5 and 15 mg/kg (IV or SC). Trabecular bone density was increased for the majority of males and females treated IV or SC at 15 mg/kg and males treated IV at 5 mg/kg. Microscopic examination of the sternebrae revealed corresponding increases in bone. Decreases in markers of bone turnover, and corresponding increases in bone density, were consistent with the pharmacological action of OPG as an osteoclast inhibitor. The no-observable-adverse-effect level (NOAEL) of OPG was 15 mg/kg.

A toxicity profile of osteoprotegerin in the cynomolgus monkey.

Osteoprotegerin (OPG) is a novel secreted glycoprotein of the tumor necrosis factor (TNF) receptor superfamily that acts as an antiresorptive agent inhibiting osteoclast maturation. OPG acts by competitively inhibiting the association of the OPG ligand with the RANK receptor on osteoclasts and osteoclast precursors. This inhibition of osteoclasts can lead to excess accumulation of newly synthesized bone and cartilage in vivo. The purpose of this study was to investigate the potential toxicity of a human recombinant form of OPG in the young cynomolgus monkey. OPG was administered by intravenous (i.v.) or subcutaneous (s.c.) injection three times per week for either 4 or 13 weeks. There were no deaths during the study, no clinical signs related to treatment, no effect on body weight, appetence, or ophthalmology. No toxicologically relevant changes in routine laboratory investigations, organ weights, or gross or histopathological findings were observed. Serum ionized calcium and phosphorus were decreased at all dose levels. Evaluations were performed to monitor biochemical markers of bone resorption (N-telopeptide [NTx], deoxypyridinoline [DPD]), bone formation (skeletal alkaline phosphatase [sALP], osteocalcin [OC]), parathyroid hormone [PTH], and bone density of the proximal tibia and distal radius in vivo. Dose-related decreases in NTx and/or DPD were observed at each dose level, with up to a 90% decrease in NTx noted for animals treated i.v. or s.c. at 15 mg/kg. Similar decreases were observed for sALP and OC. PTH was increased for animals treated at 5 and 15 mg/kg (i.v. or s.c.). Trabecular bone density was increased for the majority of males and females treated i.v. or s.c. at 15 mg/kg and males treated i.v. at 5 mg/kg. Microscopic examination of the sternebrae revealed corresponding increases in bone. Decreases in markers of bone turnover, and corresponding increases in bone density, were consistent with the pharmacological action of OPG as an osteoclast inhibitor. The no-observable-adverse-effect level (NOAEL) of OPG was 15 mg/kg.

A genomewide screening of N-ethyl- N-nitrosourea-mutagenized mice for musculoskeletal phenotypes☆

Chemical mutagenesis followed by screening for abnormal phenotypes in the mouse holds much promise as a method for revealing gene function. We describe a mouse N-ethyl- N-nitrosourea (ENU) mutagenesis program incorporating a genomewide screen of dominant as well as recessive mutations affecting musculoskeletal disorders in C3H/HeJ mice. In a primary screen, progeny of one-generation dominant mutations (F 1) and three-generation recessive (F 3) mutations were screened at 10 weeks of age for musculoskeletal disorders using dual-energy X-ray absorptiometery (DEXA) and biochemical markers affecting bone metabolism, such as osteocalcin, type I collagen breakdown product, skeletal alkaline phosphatase, and insulin-like growth factor I (IGF-I). Abnormal phenotypes were identified as ±3SD units different from baseline data collected from age- and sex-matched nonmutagenized control mice. A secondary screen at 16 weeks of age, which included peripheral quantitative computed tomography (pQCT) in addition to those parameters described in our primary screen, was used to confirm the abnormal phenotypes observed in the primary screen. The phenodeviant or outlier mice were progeny tested to determine whether their abnormality segregates bimodally in their offspring with the expected 1:1 or 1:3 Mendelian ratio, in dominant and recessive screens, respectively. With the above screening strategy, we were able to identify several mice with quantitative abnormalities in BMD, BMC, bone size, and bone metabolism. We have progeny tested and confirmed four outliers with low BMD, low bone size, and growth-related abnormality. Our results indicate that the magnitude of change in quantitative phenotypes in the ENU-mutagenized progeny was between 10 and 15%, and hence, the yield of outliers was dependent on the precision of the methods. So far, this ENU mutagenesis program has identified four outliers that can undergo positional cloning.

The Effect of Zinc Supplementation on Linear Growth, Body Composition, and Growth Factors in Preterm Infants

The aim of our study was to evaluate the effect of zinc supplementation on linear growth, body composition, and growth factors in premature infants. Thirty-six preterm infants (gestational age: 32.0 +/- 2.1 weeks, birth weight: 1704 +/- 364 g) participated in a longitudinal double-blind, randomized clinical trial. They were randomly allocated either to the supplemental (S) group fed with a standard term formula supplemented with zinc (final content 10 mg/L) and a small quantity of copper (final content 0.6 mg/L), or to the placebo group fed with the same formula without supplementation (final content of zinc: 5 mg/L and copper: 0.4 mg/L), from 36 weeks postconceptional age until 6 months corrected postnatal age. At each evaluation, anthropometric variables and bioelectrical impedance were measured, a 3-day dietary record was collected, and a blood sample was taken. We analyzed serum levels of total alkaline phosphatase, skeletal alkaline phosphatase (sALP), insulin growth factor (IGF)-I, IGF binding protein-3, IGF binding protein-1, zinc and copper, and the concentrations of zinc in erythrocytes. The S group had significantly higher zinc levels in serum and erythrocytes and lower serum copper levels with respect to the placebo group. We found that the S group had a greater linear growth (from baseline to 3 months corrected age: Delta score deviation standard length: 1.32 +/-.8 vs.38 +/-.8). The increase in total body water and in serum levels of sALP was also significantly higher in the S group (total body water: 3 months; corrected age: 3.8 +/-.5 vs 3.5 +/-.4 kg, 6 months; corrected age: 4.5 +/-.5 vs 4.2 +/-.4 kg; sALP: 3 months; corrected age: 140.2 +/- 28.7 vs 118.7 +/- 18.8 micro g/L). Zinc supplementation has a positive effect on linear growth in premature infants.

Gene expression between a congenic strain that contains a quantitative trait locus of high bone density from CAST/EiJ and its wild-type strain C57BL/6J.

Peak bone density is an important determining factor of future osteoporosis risk. We previously identified a quantitative trait locus (QTL) that contributes significantly to high bone density on mouse chromosome 1 from a cross between C57BL/6J (B6) and CAST/EiJ (CAST) mouse strains. We then generated a congenic strain, B6.CAST-1T, in which the chromosomal fragment containing this QTL had been transferred from CAST to the B6 background. The congenic mice have a significantly higher bone density than the B6 mice. In this study we performed cDNA microarray analysis to evaluate the gene expression profile that might yield insights into the mechanisms controlling the high bone density by this QTL. This study led to several interesting observations. First, approximately 60% of 8,734 gene accessions on GEM I chips were expressed in the femur of B6 mice. The expression and function of two-thirds of these expressed genes and ESTs have not been documented previously. Second, expression levels of genes related to bone formation were lower in congenic than in B6 mice. These data are consistent with a low bone formation in the congenic mice, a possibility that is confirmed by reduced skeletal alkaline phosphatase activity in serum compared with B6 mice. Third, expression levels of genes that might have negative regulatory action on bone resorption were higher in congenic than in B6 mice. Together these findings suggest that the congenic mice might have a lower bone turnover rate than B6 mice and raise the possibility that the high bone density in the congenic mice could be due to reduced bone resorption rather than increased bone formation.

A time course of bone response to jump exercise in C57BL/6J mice

Exercise, by way of mechanical loading, provides a physiological stimulus to which bone tissue adapts by increased bone formation. The mechanical stimulus due to physical activity depends on both the magnitude and the duration of the exercise. Earlier studies have demonstrated that jump training for 4 weeks produces a significant bone formation response in C57BL/6J mice. An early time point with significant increase in bone formation response would be helpful in: (1) designing genetic quantitative trait loci (QTL) studies to investigate genes regulating the bone adaptive response to mechanical stimulus; and (2) mechanistic studies to investigate early stimulus to bone tissue. Consequently, we investigated the bone structural response after 2, 3, and 4 weeks of exercise with a loading cycle of ten jumps a day. We used biochemical markers and peripheral quantitative computed tomography (pQCT) of excised femur to measure bone density, bone mineral content (BMC), and area. Four-week-old mice were separated into control ( n = 6) and jump groups ( n = 6), and the latter groups of mice were subjected to jump exercise of 2-week, 3-week, and 4-week duration. Data (pQCT) from a mid-diaphyseal slice were used to compare bone formation parameters between exercise and control groups, and between different time points. There was no statistically significant change in bone response after 2 weeks of jump exercise as compared with the age-matched controls. After 3 weeks of jump exercise, the periosteal circumference, which is the most efficient means of measuring adaptation to exercise, was increased by 3% ( P < 0.05), and total and cortical area were increased by 6% ( P < 0.05) and 11% ( P < 0.01), respectively. Total bone mineral density (BMD) increased by 11% ( P < 0.01). The biggest changes were observed in cortical and total BMC, with the increase in total BMC being 12% ( P < 0.01). Interestingly, the increase in BMC was observed throughout the length of the femur and was not confined to the mid-diaphysis. Consistent with earlier studies, mid-femur bone mass and area remained significantly elevated in the 4-week exercise group when compared with the control group of mice. The levels of the biochemical markers osteocalcin, skeletal alkaline phosphatase, and C-telopeptide were not significantly different between the exercise and control groups, indicating the absence of any systemic response due to the exercise. We conclude that a shorter exercise regimen, of 3 weeks, induced a bone response that was greater than or equal to that of 4 weeks of jump exercise reported earlier.

Osteoprotegerin in Serum as a Novel Marker of Bone Metastatic Spread in Prostate Cancer

Prostate cancer (PCa) is the most frequent carcinoma in men and is often complicated by skeletal metastasis (1). Because bone scintigraphy, the standard method of monitoring metastatic bone involvement, is expensive, lacks specificity, and is not particularly suitable for the follow-up of patients, various metabolic bone markers have been studied as indicators for bone metastasis in PCa patients (2)(3). Markers that reflect osteoblast proliferation, e.g., skeletal alkaline phosphatase (sALP), are reportedly useful, which is consistent with the osteoblastic reactions seen in the skeletal metastases (4). The balance between osteoblastic and osteoclastic activity in bone is essentially influenced by osteoclastogenesis. The latter is regulated by three proteins: receptor activator of nuclear factor-κB (RANK), which is expressed on osteoclast precursor cells; its ligand (RANKL), which is expressed on the surface of preosteoblastic and stromal cells; and osteoprotegerin (5)(6). The interaction of RANKL with RANK stimulates the differentiation of osteoclasts, whereas osteoprotegerin blocks this process by functioning as a decoy receptor for RANKL. This novel cytokine system appears to play an important role in the establishment of bone metastases in PCa patients (7). Osteoprotegerin has recently been found to be overexpressed in bone metastases of these patients (8). This overexpression could indirectly favor osteoblastic reactions by inhibiting osteoclastogenesis and might explain the bone lesions typically seen PCa patients. Because tissue overexpression of proteins often is reflected in blood, osteoprotegerin could be a potential serum marker for diagnosis of bone metastasis. Using a recently introduced novel osteoprotegerin assay, we performed the present study to evaluate the diagnostic validity of osteoprotegerin as a potential bone metastasis marker in PCa in comparison with sALP and cross-linked N-telopeptides of type I collagen (NTx), which represent osteoblastic and osteoclastic markers, respectively. The study included 36 male controls (mean age, 51.4 years) with no …

Circadian and longitudinal variation of serum C-telopeptide, osteocalcin, and skeletal alkaline phosphatase in C3H/HeJ mice

Inbred strains of mice are increasingly being used as an animal model to investigate skeletal disorders relevant to humans. In the bone field, one of the most convenient endpoints for evaluating genetic, physiological, or pharmaceutical perturbations is the use of biochemical markers. To apply biochemical markers in an effective manner, it is of key importance to establish the biological variation and appropriate sampling time. In this study, we evaluate two components: (i) circadian changes, and (ii) longitudinal variation for three serum markers, osteocalcin, C-telopeptide, and skeletal alkaline phosphatase (sALP), using 6-week-old C3H/HeJ (C3H) mice. To study circadian rhythms, the mice were randomly divided into eight groups of 15 mice each. Blood was collected at 3 h intervals, starting at 9:00 a.m. and continuing until 6:00 a.m. the next day. To determine whether circadian rhythm is intrinsically regulated or influenced by restricted food intake, it was also studied after a 12 h fasting period. Serum osteocalcin and C-telopeptide levels were measured by enzyme-linked immunoassay (ELISA) and skeletal alkaline phosphatase by a kinetic assay. The results demonstrated significant circadian variations in osteocalcin and C-telopeptide levels with a peak value between 0900 and 1200 h during daytime and a nadir between 15:00 and 18:00 h. The peak levels of C-telopeptide and osteocalcin were 26%–66% higher as compared with 24 h mean values. The pattern of the circadian variation of C-telopeptide and osteocalcin was similar in female and male animals and was not significantly affected by restricted food intake. The sALP levels were only marginally affected by the circadian rhythm. Longitudinal variations, expressed as coefficient of variation (CV), for osteocalcin, C-telopeptide, and sALP concentrations were 17%, 14%, and 16%, respectively. In addition, the longitudinal variations were not significantly influenced by the time of blood collection in sALP and osteocalcin levels, whereas C-telopeptide levels showed significantly higher within-subject day-to-day variation in morning samples, as compared with blood samples collected in the afternoon. The results highlight the importance of: (i) the timing of sample collection for appropriate interpretation of the bone marker data; and (ii) using the appropriate number of samples based on the variance obtained herein.

Quantitation of soluble and skeletal alkaline phosphatase, and insoluble alkaline phosphatase anchor-hydrolase activities in human serum

Background: The current studies were intended to compare the circulating levels of total and anchorless (soluble) skeletal and hepatic ALP isoenzyme activities, and insoluble ALP anchor-hydrolase activity in serum of postmenopausal women. Methods: Preliminary studies of the insoluble ALP anchor-hydrolase activity in serum revealed a pH optimum of pH 5–6.5, a sensitivity to inactivation by heat at temperatures >45 °C ( t 1/2=8–9 min at 60 °C), and an apparent K M (at pH 7.5) of 40–45 mU/ml of insoluble skeletal ALP activity. Results: Serum analyses showed that 94.5±0.5% (mean±SEM) of the ALP activity in serum was in the anchorless, soluble form. The data were also consistent with the notion that the amount of insoluble ALP anchor-hydrolase activity in serum, 52.8±0.8 U/l (mean±SEM), was sufficient for the conversion of anchor-intact (insoluble) ALP into the anchorless, soluble form, assuming activation by serum lipids and/or bile salts. Distributions of results for total, skeletal, hepatic, and insoluble ALP anchor-hydrolase activity were skewed toward the higher range and leptokurtotic ( p<0.01 for each). Total ALP activity ranged from 42% to 208% of the group mean value; skeletal, hepatic, and insoluble ALP anchor-hydrolase activities ranged from 5% to 306%, 33% to 277%, and 2% to 325%, respectively. In contrast, the soluble ALP fraction only ranged from 71% to 106% of the group mean value. Conclusions: The correlations between the total and both skeletal ( r=0.711, p<0.001) and hepatic ( r=0.782, p<0.001) ALP isoform activities were predictive. Although correlations were also observed between insoluble ALP anchor-hydrolase activity and total ( r=0.197, p<0.001), hepatic ( r=0.184, p<0.001) and skeletal ALP activities ( r=0.118, p<0.05), those relationships were not predictive ( r 2<0.04).

Apoptosis may determine the release of skeletal alkaline phosphatase activity from human osteoblast-line cells.

Although quantitative measurement of skeletal alkaline phosphatase (sALP) activity in serum can provide an index of the rate of bone formation, the metabolic process that determines the release of sALP - from the surface of osteoblasts, into circulation-is unknown. The current studies were intended to examine the hypothesis that the release of sALP from human osteoblasts is a consequence of apoptotic cell death. We measured the release of sALP activity from human osteosarcoma (SaOS-2) cells and normal human bone cells, under basal conditions and in response to agents that increased apoptosis (TNF-a, okadiac acid) and agents that inhibit apoptosis (IGF-I, calpain, and caspase inhibitors). Apoptosis was determined by the presence of nucleosomes (histone-associated DNA) in the cytoplasm of the cells by using a commercial kit. The results of these studies showed that TNF-a and okadiac acid caused dose- and time-dependent increases in apoptosis in the SaOS-2 cells (r = 0.78 for doses of TNF-a and r = 0.93 for doses of okadiac acid, P <0.005 for each), with associated decreases in cell layer protein (P <0.05 for each) and concomitant increases in the release of sALP activity (e.g., r = 0.89 for TNF-a and r = 0.75 for okadiac acid, P <0.001 for each). In contrast, caspase and calpain inhibitors reduced apoptosis, increased cell layer protein, and decreased the release of sALP activity (P <0.05 for each). Exposure to IGF-I also decreased apoptosis, in a time- and dose-dependent manner (e.g., r = 0.93, P <0.001 for IGF-I doses), with associated proportional effects to increase cell layer protein (P <0.001) and decrease the release of sALP activity (P <0.001). IGF-I also inhibited the actions of TNF-a and okadiac acid to increase apoptosis and sALP release. The associations between apoptosis and sALP release were not unique to osteosarcoma (i.e., SaOS-2) cells, but also seen with osteoblast-line cells derived from normal human bone. Together, these data demonstrate that the release of sALP activity from human osteoblast-line cells in vitro is associated with, and may be a consequence of, apoptotic cell death. These findings are consistent with the general hypothesis that the appearance of sALP activity in serum may reflect the turnover of osteoblast-line cells.

Diet- or warfarin-induced vitamin K insufficiency elevates circulating undercarboxylated osteocalcin without altering skeletal status in growing female rats.

To further characterize the skeletal role of vitamin K (K), markers of bone turnover, density, and strength were evaluated in rats with diet- or warfarin (W)-induced K insufficiency. One hundred two, 7-week-old, female rats were randomly assigned to low K (phylloquinone [K1], 20 microg/kg diet), control K (K1, 1300 microg/kg diet), low-dose W (W, 1.5 mg/kg control diet), or high-dose W plus K (W/K1, 10/100 mg/kg diet). Femur bone mineral content (BMC) and bone mineral density (BMD), plasma prothrombin time (PT) and prothrombin concentration (PC), and serum total alkaline phosphatase (ALP) and skeletal alkaline phosphatase (sALP) were measured at baseline and days 20, 40, 60, and 80. Serum total osteocalcin (OC) and undercarboxylated osteocalcin (ucOC) and femur length (FL) were measured at baseline and day 80. Left femur OC was measured and biomechanical testing of the right femur and third lumbar vertebral body was performed at day 80. Low dietary K elevated circulating ucOC (17% higher than control; p < 0.0001) at day 80. Furthermore, in both W groups, essentially all circulating OC was undercarboxylated and femur OC was lower than control (p < 0.0001). However, there was no change in femur percent ucOC, suggesting deposition of less newly synthesized OC. No between group differences were observed in PT, ALP, sALP, FL, BMC, BMD, or bone strength. In conclusion, skeletal K insufficiency can be induced by W or diet manipulation. This does not hinder peak bone mass attainment in female rats; however, W causes less newly synthesized OC to be deposited in bone.