Thesis (M.S.)--School of Dentistry. University of Missouri--Kansas City, 2008. / "A thesis in oral biology." Advisor: Mark L. Johnson. Typescript. Vita. Title from "catalog record" of the print edition Description based on contents viewed Aug. 07, 2008. Includes bibliographical references (leaves 57-65). Online version of the print edition.

Sclerostin, a protein coded for by the SOST gene, is an osteocyte-expressed negative regulator of bone formation. The absence of SOST in the genome may have an effect on bone formation both during skeletal maturation and full maturity. This study attempts to determine significant differences in the mechanical properties of bone that expresses SOST compared to bone that does not. One hundred femur samples from 6, 8, and 12 month old mice were obtained from Lawrence Livermore National Labs and loaded until failure using three-point bending. Results showed significant differences in treatment group effects for cross sectional area, yield force, and ultimate force. SOST knockout (KO) mice were found to have significantly higher values for these properties in comparison to transgenic (TG) and wildtype (WT) littermates. In addition, there was a noted effect dependent on the primary axis of loading, anterior-posterior versus medial-lateral. Lastly, data from this study support the existing hypothesis that there is no systematic side-to-side (left-right) difference in bone formation. This data may aid understanding of the role SOST has in bone formation. If the structural integrity and quality of bone resulting from the removal of the SOST gene is shown to be comparable to that of normal, healthy bone, the use of gene therapy to combat diseases/disorders such as osteoporosis may lead to important contributions to medical therapy.

Bone has several crucial functions including mechanical support of movement, hematopoiesis, maintenance of mineral homeostasis, and energy regulation. Bone also undergoes continuous remodeling to maintain its structural integrity, which suggests it has strong respiration and energy consumption capability. It has been shown that during development, bones, in particular, osteoblasts, rely on glucose uptake for proper skeletal development. However, the effect of energy utilization on osteocytes’ function is currently unknown. Osteocytes are terminally differentiated osteoblasts and are deeply embedded into the mineralized matrix of bone. Previous studies have shown that PTH promotes bone anabolism, in part, by stimulating osteoblasts anaerobic glycolysis while suppressing glucose oxidation through the TCA cycle. In osteocytes, PTH suppresses Sost expression (the gene encoding a potent inhibitor of bone formation) by inducing HDAC4/5 nuclear translocation and MEF2C inhibition. Recently, Scriptaid, an HDAC complex inhibitor, has been shown to induce Mef2 expression and exercise-like adaptation in mouse muscles. In myocytes, Scriptaid disrupts the HDACs co-repressor complex and induces nuclear export of HDAC4/5 with MEF2 activation. This will subsequently increase the expressions of several genes related to energy utilization such as Glut4 and Pdk4. Thus we hypothesized that Scriptaid might regulate Sost and Glut4 expression in osteocytes. To investigate the effect of Scriptaid on osteocytes, we treated a mouse osteocytic cell line, Ocy454-12H, with Scriptaid. Unexpectedly, Scriptaid potently suppressed Sost, whereas it increased Glut4 expression. Scriptaid stimulated osteocyte respiration and glucose consumption rate. Mechanistically, Scriptaid treatment of Ocy454-12H induced nuclear translocation of Hdac5 whereas it did not affect Hdac4. Silencing of Hdac5 expression with shRNA increased Sost basal expression and blocked Sost suppression induced by Scriptaid. However, Glut4 up-regulation by Scriptaid was independent of the HDAC4/5-MEF2C pathway. Glut4 luciferase reporter assays demonstrated that two additional transcription factors binding sites, O/E&NF1 and C/EBPα, may mediate Scriptaid-induced Glut4 up-regulation. Taken together, these data demonstrate that in osteocytes Scriptaid suppresses Sost expression through regulating HDAC5-MEF2C signaling. However, Scriptaid increases Glut4 expression through Hdac5-independent mechanisms, and dependent on O/E&NF1 and C/EBPα.

In the human genome, the SOST gene codes for a protein sclerostin. Sclerostin is an osteocyte-expressed negative regulator of bone formation. When the SOST gene is not coded, bone formation is reduced in individuals during skeletal maturation. This study utilizes nanoindentation methods to test for the mechanical properties of bones that both express and do not express the SOST gene. 100 transgenic murine femurs were obtained from Lawrence Livermore Labs in the form of 6 and 8 month SOST transgenic mice, 6 and 12 month SOST knockout mice, and wild type control littermates for each of the 4 age groups. Prior to nanoindentation the bones were broken in a previous experiment under three-point bending tests. Samples were embedded in epoxy and polished to a 0.05 micron level before indentation. Results showed significant difference amongst the treatment group effects for maximum load, hardness and elastic modulus. SOST KO mice had significantly higher values for these properties in comparison to the transgenic and wild type littermates. Additionally, side by side limb differences were examined in which there was a significant difference found amongst the treatment groups. Indentations were conducted in the 4 anatomical regions of each femur in expectation of examining any differences amongst them which resulted with no significant findings amongst them. Data from this study will support research which may result in potential new gene therapies targeted for the treatment of bone diseases such as osteoporosis.

INTRODUÇÃO: Os distúrbios minerais e ósseos da doença renal crônica (DMO-DRC) são influenciados por vários fatores, como idade, etiologia da DRC, toxinas urêmicas e modalidade dialítica. Os DMO-DRC são bem descritos em pacientes tratados com hemodiálise (HD). No entanto, na diálise peritoneal (DP) os estudos são escassos e, na maioria deles, não há dados de histologia óssea. OBJETIVOS: caracterizar os DMO-DRC em uma coorte de pacientes em DP; comparar os resultados com aqueles obtidos da HD; e analisar o desempenho de marcadores séricos para o diagnóstico das doenças de alto e baixo remodelamento ósseo. MÉTODOS: quarenta e um pacientes tratados com DP submeteram-se a avaliação clínica, bioquímica e biópsia óssea. RESULTADOS: a doença óssea adinâmica (DOA) foi o tipo de osteodistrofia renal (OR) predominante, correspondendo a 49% da amostra. Ao se analisar separadamente diabéticos e não diabéticos, a prevalência de DOA foi de 77,7% no primeiro grupo e 26% no segundo (p=0,001). Na comparação entre DP e HD, observou-se que os pacientes do primeiro grupo apresentavam 25(OH) vitamina D mais baixa, mineralização óssea mais comprometida e melhor volume ósseo. A fosfatase alcalina óssea (FAO) apresentou a melhor sensibilidade e especificidade tanto para o diagnóstico de alto, quanto de baixo remodelamento ósseo. CONCLUSÕES: a DOA é o tipo de OR mais prevalente na DP. No entanto, a influência do diabetes como fator de risco parece ser maior do que a própria modalidade dialítica / INTRODUCTION: Chronic kidney disease - mineral bone disorder (CKD-MBD) is a complex syndrome influenced by various factors, such as age, CKD etiology, uremic toxins and dialysis modality. CKD-MBD has been extensively studied in hemodialysis (HD) patients. However, for peritoneal dialysis (PD), only a few, older studies exist, most of which contain no bone biopsy data. The present study sought to: characterize CKD-MBD in a cohort of prevalent PD patients; compare the results with that obtained from HD patients; and analyse performance of bone turnover serum markers to make the diagnosis of high or low bone turnover disease in PD patients. METHODS: Forty-one PD patients underwent to a clinical evaluation, biochemical analysis and bone biopsy. RESULTS: The most prevalent pattern of renal osteodystrophy (ROD) was adynamic bone disease (ABD), comprising 49% of the sample population. When we separately analyzed diabetic and non-diabetic patients, the ABD prevalence was 77.7% in the former group and 26% in the latter group (p=0.001). The comparison between DP and HD patients revealed low 25(OH) vitamin D level, worst bone mineralization and better bone volume parameters in the former group. Bone alkaline phosphatase (BAP) demonstrated the best sensitivity and specificity values to detect both high and low turnover disease. CONCLUSION: ABD is the most frequent type of ROD. However, the effect of diabetes on the development of ABD is more important than the dialysis modality itself

INTRODUÇÃO: Os distúrbios minerais e ósseos da doença renal crônica (DMO-DRC) são influenciados por vários fatores, como idade, etiologia da DRC, toxinas urêmicas e modalidade dialítica. Os DMO-DRC são bem descritos em pacientes tratados com hemodiálise (HD). No entanto, na diálise peritoneal (DP) os estudos são escassos e, na maioria deles, não há dados de histologia óssea. OBJETIVOS: caracterizar os DMO-DRC em uma coorte de pacientes em DP; comparar os resultados com aqueles obtidos da HD; e analisar o desempenho de marcadores séricos para o diagnóstico das doenças de alto e baixo remodelamento ósseo. MÉTODOS: quarenta e um pacientes tratados com DP submeteram-se a avaliação clínica, bioquímica e biópsia óssea. RESULTADOS: a doença óssea adinâmica (DOA) foi o tipo de osteodistrofia renal (OR) predominante, correspondendo a 49% da amostra. Ao se analisar separadamente diabéticos e não diabéticos, a prevalência de DOA foi de 77,7% no primeiro grupo e 26% no segundo (p=0,001). Na comparação entre DP e HD, observou-se que os pacientes do primeiro grupo apresentavam 25(OH) vitamina D mais baixa, mineralização óssea mais comprometida e melhor volume ósseo. A fosfatase alcalina óssea (FAO) apresentou a melhor sensibilidade e especificidade tanto para o diagnóstico de alto, quanto de baixo remodelamento ósseo. CONCLUSÕES: a DOA é o tipo de OR mais prevalente na DP. No entanto, a influência do diabetes como fator de risco parece ser maior do que a própria modalidade dialítica / INTRODUCTION: Chronic kidney disease - mineral bone disorder (CKD-MBD) is a complex syndrome influenced by various factors, such as age, CKD etiology, uremic toxins and dialysis modality. CKD-MBD has been extensively studied in hemodialysis (HD) patients. However, for peritoneal dialysis (PD), only a few, older studies exist, most of which contain no bone biopsy data. The present study sought to: characterize CKD-MBD in a cohort of prevalent PD patients; compare the results with that obtained from HD patients; and analyse performance of bone turnover serum markers to make the diagnosis of high or low bone turnover disease in PD patients. METHODS: Forty-one PD patients underwent to a clinical evaluation, biochemical analysis and bone biopsy. RESULTS: The most prevalent pattern of renal osteodystrophy (ROD) was adynamic bone disease (ABD), comprising 49% of the sample population. When we separately analyzed diabetic and non-diabetic patients, the ABD prevalence was 77.7% in the former group and 26% in the latter group (p=0.001). The comparison between DP and HD patients revealed low 25(OH) vitamin D level, worst bone mineralization and better bone volume parameters in the former group. Bone alkaline phosphatase (BAP) demonstrated the best sensitivity and specificity values to detect both high and low turnover disease. CONCLUSION: ABD is the most frequent type of ROD. However, the effect of diabetes on the development of ABD is more important than the dialysis modality itself