In recent years, the intermittent, exogenous application of parathyroid hormone fragment has been established as a therapeutic agent for human osteoporosis. The present placebo-controlled trial evaluated the effects of intermittent, exogenous application of equine parathyroid hormone fragment (ePTH 1-37) on calcium homeostasis and bone metabolism in healthy horses. The dose-response relationship and an appropriate daily treatment scheme with ePTH (1-37) were assessed with 0.5, 1, 5, 10, and 40 µg ePTH (1-37)/kg BW to provide a basis for long-term ePTH (1-37) application. The dose selection of 0.5 µg ePTH (1-37)/kg KM for long-term application resulted from a short, temporary increase in the ionized blood calcium level after ePTH (1-37) injection and an unimpaired fractional calcium and phosphorus excretion. Higher dosages caused adverse events such as persisting hypercalcemia and general condition disturbance after 2 or 3 days of treatment. In a subsequent attempt, 6 horses each received either ePTH (1-37) or placebo for 120 days by daily subcutaneous injections. The diurnal response of calcium in blood reflected the responsiveness of the target cells to exogenous application of ePTH (1-37). During the observation period, cancellous bone mineral density increased significantly, but showed no differences between ePTH treatment and placebo. After long-term application, parathyroid response and endogenous intact parathyroid hormone release were investigated using Na2EDTA-induced hypocalcemia. Previously ePTH-treated horses showed moderately reduced levels of endogenous intact PTH when compared to those results obtained in the placebo group. Concomitant, ePTH-treated horses appeared to have a more rapid and improverd recovery of calcium homeostasis. In general, the long-term intermittent application of 0.5 µg ePTH (1-37)/kg BW seemed to have no negative effects in healthy horses. The potential area of ePTH application in horses could be osteoporotic stages, for instance, as observed in podotrochlosis and glucocorticoid-induced bone loss.

Hypophosphatasie (HPP) beschreibt eine seltene Erbkrankheit, die hauptsächlich durch heterozygote Mutationen im ALPL-Gen verursacht wird. Diese führen zu einer verminderten Aktivität der gewebeunspezifischen alkalischen Phosphatase (TNAP). Neben skelettalen Symptomen sind Zahnanomalien wie der vorzeitige Verlust von Milchzähnen ohne resorbierte Wurzel sowie eine gestörte Mineralisierung der Zahnhart-substanzen ein typisches Merkmal der HPP. Die zugrunde liegenden molekularen Mechanismen sind bisher noch nicht vollständig verstanden. In der vorliegenden Arbeit wurden Zelllinien des parodontalen Ligaments mit Mutationen im ALPL-Gen charakterisiert, um anschließend mögliche Therapiestrategien für die HPP auf molekularer Ebene zu untersuchen. Im Rahmen der basalen Charakterisierung wurden die Zelllinien hinsichtlich der TNAP-Expression (Immunhistochemie, Western Blot), des Stoffwechselprofils (ATP-Assay) und des osteogenen Differenzierungspotenzials (Alizarin-Färbung) analysiert. Von Interesse war auch, ob durch CRISPR/Cas9-basiertes Genediting Off-Target Mutationen entstanden sind. Zur Untersuchung der molekularen Auswirkungen von PTH, welches die ALPL-Expression steigern kann, wurden zwei Protokolle etabliert, die eine kontinuier-liche, kurzzeitige bzw. intermittierende Präsenz von PTH in-vitro imitieren. Anschließend wurde die ALPL-Expression (qPCR) sowie TNAP-Aktivität (CSPD-Assay) ermittelt. Die basale TNAP-Expression war variabel und reichte vom völligen Fehlen in den Zell-linien mit Deletionen bis hin zu einer starken TNAP-Expression in der Zelllinie mit einer heterogenen Punktmutation. Eine niedrige Expression ging mit einer verringerten Zell-proliferation sowie extrazellulären ATP einher. Es zeigte sich ein unterschiedliches Mineralisierungspotenzial, das hauptsächlich das TNAP-Expressionsniveau in den verschiedenen Zelllinien widerspiegelt, während die PTH-Stimulation keine Wirkung auf die Differenzierung hatte. Im Gegensatz zu klinischen Beobachtungen deuten die Ergebnisse auf eine hohe Korrelation zwischen Genotyp und Phänotyp in-vitro hin, die in-vivo noch bestätigt werden müssen. Die Sequenzierung bestätigte, dass durch die Geneditierung keine Off-Target Mutationen aufgetreten sind, welche somit keinen limitierenden Faktor hinsichtlich der Differenzierungskapazität darstellen können. Die Stimulation mit PTH führte zwar nicht zu einer gesteigerten ALPL-Expression, doch konnte die TNAP-Aktivität in den ALPL-defizienten Zelllinien punktuell gesteigert werden und bildet somit eine solide Basis für weitere Experimente, die zur Therapieentwicklung für die Odonto-HPP beitragen können. / Hypophosphatasia (HPP) describes a rare inherited disorder caused mainly by heterozygous mutations in the ALPL gene. These lead to impaired activity of tissue non-specific alkaline phosphatase (TNAP). In addition to skeletal symptoms, dental abnormalities such as premature loss of deciduous teeth without resorption of the roots and impaired mineralization of tooth hard tissues are typical features of HPP. The underlying molecular mechanisms are not yet fully understood. In the present study, cell lines of the periodontal ligament with mutations in the ALPL gene were characterized to subsequently investigate potential therapeutic strategies for HPP at the molecular level. As part of the basal characterization, the cell lines were analyzed with respect to TNAP expression (immunohistochemistry, Western blot), metabolic profile (ATP assay) and osteogenic differentiation potential (alizarin staining). Also of interest was whether off-target mutations resulted from CRISPR/Cas9-based gene editing. To investigate the molecular effects of Parathyroid Hormone (PTH), which can increase ALPL expression, two protocols were established that mimic continuous, short-term, and intermittent presence of PTH in-vitro. ALPL gene expression (qPCR), as well as TNAP activity (CSPD assay) were then determined. Basal TNAP expression was variable, ranging from complete absence in the cell lines with deletions to strong TNAP expression in the cell line with a heterogeneous point mutation. Low expression was associated with decreased cell proliferation as well as extracellular ATP. There was a differential mineralization potential mainly reflecting the TNAP expression level in the different cell lines, whereas PTH stimulation had no effect on differentiation. In contrast to clinical observations, the results indicate a high correlation between genotype and phenotype in-vitro, which remains to be confirmed in-vivo. Sequencing confirmed that no off-target mutations occurred as a result of gene editing, which thus cannot be a limiting factor with respect to differentiation capacity. Although stimulation with PTH did not result in increased ALPL expression, TNAP activity was selectively increased in the ALPL-deficient cell lines, providing a solid basis for further experiments that may contribute to therapy development for Odonto-HPP.

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Circadian rhythm of parathyroid hormone (PTH) is well documented, but its physiological role is not fully understood. In healthy individuals, biochemical markers of bone remodeling follow a similar circadian rhythm to PTH with a nocturnal rise in bone resorption and formation. The loss of PTH diurnal variation was observed not only in primary hyperparathyroidism, but also in patients with postmenopausal osteoporosis. Continuously elevated concentrations of PTH lead to excessive stimulation of bone resorption, whereas intermittent PTH administration has a strong osteoanabolic effect in patients with osteoporosis. It has not been examined whether the skeletal sensitivity to PTH action depends also on the time of its application. The aim of our study was to verify the hypothesis that the application of teriparatide (TPTD, recombinant human PTH [1-34]) at different times of the day in the context of its diurnal variability affects the physiological circadian rhythm of bone remodeling and also the bone mineral density (BMD) after the long-term TPTD treatment. Fourteen women with postmenopausal osteoporosis treated with 20 micrograms of TPTD daily, applied subcutaneously either in the morning or evening, were included in the first study. The concentration of serum C-terminal telopeptide of type I collagen...

Circadian rhythm of parathyroid hormone (PTH) is well documented, but its physiological role is not fully understood. In healthy individuals, biochemical markers of bone remodeling follow a similar circadian rhythm to PTH with a nocturnal rise in bone resorption and formation. The loss of PTH diurnal variation was observed not only in primary hyperparathyroidism, but also in patients with postmenopausal osteoporosis. Continuously elevated concentrations of PTH lead to excessive stimulation of bone resorption, whereas intermittent PTH administration has a strong osteoanabolic effect in patients with osteoporosis. It has not been examined whether the skeletal sensitivity to PTH action depends also on the time of its application. The aim of our study was to verify the hypothesis that the application of teriparatide (TPTD, recombinant human PTH [1-34]) at different times of the day in the context of its diurnal variability affects the physiological circadian rhythm of bone remodeling and also the bone mineral density (BMD) after the long-term TPTD treatment. Fourteen women with postmenopausal osteoporosis treated with 20 micrograms of TPTD daily, applied subcutaneously either in the morning or evening, were included in the first study. The concentration of serum C-terminal telopeptide of type I collagen...

In recent years, the intermittent, exogenous application of parathyroid hormone fragment has been established as a therapeutic agent for human osteoporosis. The present placebo-controlled trial evaluated the effects of intermittent, exogenous application of equine parathyroid hormone fragment (ePTH 1-37) on calcium homeostasis and bone metabolism in healthy horses. The dose-response relationship and an appropriate daily treatment scheme with ePTH (1-37) were assessed with 0.5, 1, 5, 10, and 40 µg ePTH (1-37)/kg BW to provide a basis for long-term ePTH (1-37) application. The dose selection of 0.5 µg ePTH (1-37)/kg KM for long-term application resulted from a short, temporary increase in the ionized blood calcium level after ePTH (1-37) injection and an unimpaired fractional calcium and phosphorus excretion. Higher dosages caused adverse events such as persisting hypercalcemia and general condition disturbance after 2 or 3 days of treatment. In a subsequent attempt, 6 horses each received either ePTH (1-37) or placebo for 120 days by daily subcutaneous injections. The diurnal response of calcium in blood reflected the responsiveness of the target cells to exogenous application of ePTH (1-37). During the observation period, cancellous bone mineral density increased significantly, but showed no differences between ePTH treatment and placebo. After long-term application, parathyroid response and endogenous intact parathyroid hormone release were investigated using Na2EDTA-induced hypocalcemia. Previously ePTH-treated horses showed moderately reduced levels of endogenous intact PTH when compared to those results obtained in the placebo group. Concomitant, ePTH-treated horses appeared to have a more rapid and improverd recovery of calcium homeostasis. In general, the long-term intermittent application of 0.5 µg ePTH (1-37)/kg BW seemed to have no negative effects in healthy horses. The potential area of ePTH application in horses could be osteoporotic stages, for instance, as observed in podotrochlosis and glucocorticoid-induced bone loss.

In recent years, the intermittent, exogenous application of parathyroid hormone fragment has been established as a therapeutic agent for human osteoporosis. The present placebo-controlled trial evaluated the effects of intermittent, exogenous application of equine parathyroid hormone fragment (ePTH 1-37) on calcium homeostasis and bone metabolism in healthy horses. The dose-response relationship and an appropriate daily treatment scheme with ePTH (1-37) were assessed with 0.5, 1, 5, 10, and 40 µg ePTH (1-37)/kg BW to provide a basis for long-term ePTH (1-37) application. The dose selection of 0.5 µg ePTH (1-37)/kg KM for long-term application resulted from a short, temporary increase in the ionized blood calcium level after ePTH (1-37) injection and an unimpaired fractional calcium and phosphorus excretion. Higher dosages caused adverse events such as persisting hypercalcemia and general condition disturbance after 2 or 3 days of treatment. In a subsequent attempt, 6 horses each received either ePTH (1-37) or placebo for 120 days by daily subcutaneous injections. The diurnal response of calcium in blood reflected the responsiveness of the target cells to exogenous application of ePTH (1-37). During the observation period, cancellous bone mineral density increased significantly, but showed no differences between ePTH treatment and placebo. After long-term application, parathyroid response and endogenous intact parathyroid hormone release were investigated using Na2EDTA-induced hypocalcemia. Previously ePTH-treated horses showed moderately reduced levels of endogenous intact PTH when compared to those results obtained in the placebo group. Concomitant, ePTH-treated horses appeared to have a more rapid and improverd recovery of calcium homeostasis. In general, the long-term intermittent application of 0.5 µg ePTH (1-37)/kg BW seemed to have no negative effects in healthy horses. The potential area of ePTH application in horses could be osteoporotic stages, for instance, as observed in podotrochlosis and glucocorticoid-induced bone loss.

Parathormon (PTH) aktiviert am PTH-1 Rezeptor (P1R) mindestens zwei Signalwege: Über Guanosintriphosphat-bindende Proteine (Gs) kommt es intrazellulär zu einem Anstieg von zyklischem Adenosinmonophosphat (cAMP) und zu einer Aktivierung der Proteinkinase A (PKA). Gq Protein-vermittelt erfolgt eine Aktivierung der Phospholipase C (PLC) und ein intrazellulärer Anstieg des Inositoltriphosphat (IP3). Der verwandte PTH-2 Rezeptor (P2R) wird einerseits durch seinen vermutlich physiologischen Liganden, das tuberoinfundibuläre Peptid (TIP39), und andererseits durch PTH aktiviert. Im Gegensatz zum P1R zeigt der P2R nur eine Ankopplung an den cAMP Signalweg und keine an den PLC Signalweg. Voruntersuchungen hatten gezeigt, dass intrazelluläre Abschnitte der zweiten und dritten Schleife sowie Bereiche des C-Terminus des P1R für die Aktivierung des PLC Signalweges verantwortlich sind. In der vorliegenden Dissertation erfolgte eine stufenweise Angleichung intrazellulärer Abschnitte des P2R an den P1R. Die generierten Hybridrezeptoren wurden hinsichtlich ihres Signaltransduktionsverhaltens untersucht. Mit der Bestimmung der akkumulierten Gesamtinositole und des intrazellulären Calciums [Ca]i konnte gezeigt werden, dass trotz einer 95%-igen Übereinstimmung der intrazellulären Aminosäuresequenzen der P2R-Hybridrezeptoren mit denen des P1R, die Ankopplung an den PLC Signalweg nicht übertragen werden kann. Diese Ergebnisse wurden für Stimulationen mit PTH und TIP39 nachgewiesen. Durch Hemmung der Proteinkinasen A und C konnte, wie erwartet, am P1R ein verstärktes IP3 Signal beobachtet werden. Eine Aktivierbarkeit des PLC Signalweges wurde auch hierbei für die Hybridrezeptoren nicht gesehen. Für die Aktivierung des cAMP Signalweges der Hybridrezeptoren konnte beobachtet werden, dass diese sich weitestgehend in Anlehnung zum P2R verhalten. Außerdem konnte gezeigt werden, dass für eine effiziente Ankopplung an den cAMP Signalweg alle aus dem P1R in den P2R einfügten Teilabschnitte (zweite, dritte Schleife und C-Terminus) zusammenwirken. Der Hybridrezeptor, an dem alle drei Teilabschnitte ausgetauscht wurden, führte zu einer signifikant besseren Ankopplung an den cAMP Signalweg, als die Einzelmutation des C-Terminus. Die Messung zum cAMP Signalweg wurden mit den Liganden TIP39 und PTH durchgeführt. Für die Aktivierung des Gs Protein-vermittelten cAMP Signalweg am P1R oder P2R sind daher vermutlich Interaktionen verschiedener Rezeptorabschnitte verantwortlich. Insgesamt konnten in dieser Arbeit weitere wichtige Erkenntnisse bezüglich unterschiedlicher Aspekte der Signaltransduktion des P1R und des P2R gewonnen werden. / Activation of the phospholipase C (PLC) pathway upon stimulation with PTH is unique to the PTH-1 receptor (P1R) and is virtually absent in the PTH-2 receptor (P2R). The sites of P1R mutations known to reduce PLC signaling may achieve this indirectly by disturbing coupling at other sites. We therefore chose a more stringent approach and attempt to reestablish PLC signaling in the closely (70%) related P2R by gradually adapting the P2Rs cytosolic interface to a P1R-like sequence by engineering hybrid P1R/P2R constructs. Key differing regions of the P1R´s second loop (DT272-273:EK), third loop (IW344-345:LR), and C-terminal tail (T440-end: K-end) were put into the P2R. A fourth chimeric P1R/P2R receptor, combining all these changes, thus had a > 90% sequence identity with the cytosolic interface of the P1R. All mutants were expressed on the cell surface of stably transfected HEK 293 cells, using a radioreceptor assay with [125I]-Nle8,21-Tyr34-rat PTH(1-34), with a similar density of 1.1 to 2.5 mio receptors/cell. Activation of the PLC pathway was assessed by: 1) accumulation of total inositol phosphates in myo[3H]-inositol-prelabeled cells. No increase was detectable in the P2R or any of the receptor chimeras, even after enhancing the possible response by blockade of protein kinases A and C, despite an up to 13-fold increase with the P1R upon PTH stimulation. 2) Similarly, a PTH-induced increase in intracellular calcium (detected by fluo-3) of the wildtype P1R with as little as 1 nM hPTH(1-34) was completely absent in all mutants as well as in the P2R. The PTH-induced max. response of the cyclic AMP pathway was virtually identical for the P1R and P2R. However, the max. response of the mutant with the P1R tail sequence was reduced to only 35% (PTH) and 26% (TIP39) of the P2R response. Surprisingly, this signaling loss could be overcome by introducing more P1R sequence into the second and third cytoplasmic loop of this P1R/P2R hybrid receptor thus regaining a max. cAMP response of 64% (PTH) and 85% (TIP39). Presumably, an interaction of P1R sequences seems to result in a more effective coupling to the cAMP signaling pathway. In conclusion, these results suggest that the activation of the IP / intracellular calcium signaling pathway by the P1R is highly dependent on a P1R-like intracellular contact interface, which can not be mimicked easily even in the presence of > 90% of P1R sequence in the cytosolic interface of the P2R.

Aufgrund der vielfältigen metabolischen Funktionen des Parathormons ist bisher keine befriedigende Behandlung des postoperativen Hypoparathyreoidismus vor allem nach Schilddrüsenoperationen möglich. Bisherige Behandlungsversuche durch Allotransplantation von humanem, parathyreoidalem Gewebe scheiterten letztlich immer aufgrund immunogener Abstossung. Die Mikroenkapsulierung parathyreoidaler Zellen mittels einer semipermeablen Membran ermöglicht einerseits den Austausch von Hormonen und Stoffwechselmetaboliten, andererseits bildet sie einen wirkungsvollen immunogenen Schutz. In einem Zellkulturmodell aus humanen Parathyreozyten wurden 30 Proben von Patienten vor allem mit sekundärem Hypoparathyreoidismus untersucht. Es wurde jeweils die PTH-Sekretion vor und nach Enkapsulierung mit Natriumcellulosesulfat (NaCS) und Polydiallyldimethylammoniumchlorid (Poly-DADMAC) analysiert. Die Zellviabilität stieg von 72(11,7% an Tag 1 auf 95(4,3% an Tag 3. Die physiologische Antwort der Parathormonzellen auf extrazelluläre Kalziumkonzentrationen blieb auch bei den enkapsulierten Zellen erhalten und war etwa vergleichbar mit den Ergebnissen der unverkapselten Vergleichsgruppe. Der mittlere Kapseldurchmesser war mit 0,33(0,02mm relativ einheitlich. Die durchschnittliche Porengröße wurde mit 1,39(0,04nm bestimmt. Die hergestellten Kapseln verfügten mit einer zum Zerplatzen aufzuwendenden Kraft von 2,84(1,36 N über eine hohe mechanische Stabilität. Die mit NaCS/Poly-DADMAC enkapsulierten Parathyreozyten zeigten im Vergleich zur Gruppe der unverkapselten Zellen einen nahezu linearen Anstieg der PTH-Sekretion während des gesamten Beobachtungszeitraumes. / Due to the various metabolic functions of parathyroid hormone satisfactory treatment of permanent hypoparathyroidism after thyroid and parathyroid surgery remains difficult. Previous trials with allotransplantation of human parathyroid tissue failed because of rejection. Besides their immunoissolation abilities semi-permeable membranes of microcapsules ensure access to nutritients or oxygen and transfer of peptide hormones. An established human parathyroid cell culture model was used to examine 30 cryopreserved specimens from patients with secondary hyperparathyroidism. We analysed PTH secretion and function before and after microencapsulation with sodiumcellulose sulphate (NaCS) and polydiallyldimethylammonium chloride (Poly-DADMAC). Cell viability of cryopreserved tissue in culture increased from 72(11,7% to 95(4,3% after two days. Physiological responsiveness to calcium suppression was still intact and comparable to the encapsulated group. Mean capsule diameter was 0,33(0,02mm, while pore size was 1,39(0,04nm. In comparison to the group of non-encapsulated cells the PTH-secretion increased in the group of the encapsulated cells approximately linear. This study shows that microencapsulation with NACS and Poly-DADMAC allows nutritive supply and endocrine secretion of human parathyroid cells.