Thesis (Ph. D.)--Ohio State University, 2007. / Title from first page of PDF file. Includes bibliographical references (p. 176-216).

No description available.

Change particularities of the blood serum levels of vitamin D, calcitonin and parathyroid hormone were analysed in healthy cows of different feeding, age and productivity and in sick cows with metabolic diseases. It was investigated how biochemical indicators vary in cows with metabolic diseases (parturient paresis, osteomalacia and mastitis) and the most informative indicators for diagnostics of these diseases (for levels of calcium, phosphorus and magnesium) were determined. Obtained findings were processed statistically. The method of electrochemiluminescence analysis used for analysis of the blood serum levels of PTH in humans was applied. Compared with radioimmunic method, this method is not expensive and quite fast; in addition, this method is sensitive and reliable, because it permits to detect low levels of PTH in the blood serum (up to 0.127 pmol/l). The method of chemiluminescence immunometric analysis used to find the level of CT in humans was tested. Also the method of immunoferment analysis (ELISA) was tested to measure the blood serum level of 25-OH vitamin D in cattle using human antibodies.

Normal physiological functioning is highly dependent of calcium and the concentration range is very narrow. Normal calcium levels are so crucial to survival that the body will de-mineralize bone if the levels are insufficient. A prerequisite for normal calcium uptake is a normal Vitamin D level. Insufficient levels of Vitamin D are associated to several diseases. The aims of this thesis were to study the relationship between pregnancies and hyperparathyroidism (pHPT) (I), between pHPT and pregnancy with preeclampsia (II) and also to determine if disturbances in calcium homeostasis with vitamin D deficiency are apparent in preeclamptic women (III).  The aim was also to study calciumhomeostasis in obese patients before and after bariatric surgery (IV and V) with emphasis on vitamin D status, parathyroid secretion and bone mineral density (BMD). A correlation was found between a history of pHPT and pregnancy with preeclampsia, with an odds ratio of 6,89 ( 95% CI 2.30, 20.58).  Parathyroid hormone was significantly raised in preeclamptic pregnancies but vitamin D deficiency was present both in preeclamptic and healthy pregnancies. A certain polymorphism of the Vitamin D receptor (baT haplotype), overrepresented in pHPT, was not over expressed in preeclampsia. Hypovitaminosis D was present in more than 70% of bariatric patients preoperatively, which did not change after surgery, despite great weight loss and start of Vitamin D supplementation. BMD was significantly lower in bariatric patients with a negative correlation to the time elapsed since surgery. A small increase in BMD could be noted 10-13 years after bariatric surgery, possibly due to gradual weight gain. CiCa-clamping in obese patients demonstrated a disturbed calcium homeostasis with a left-shifted calcium-PTH relationship and a lower set-point of calcium. This disturbance persisted one year postoperatively. In conclusion, derangements in calcium homeostasis with decreased levels of Vitamin D are present in preeclampsia and obesity. A history of pHPT should be viewed as a risk factor for preeclampsia. Life long follow-up is necessary after bariatric surgery, and an individually adjusted high dose Vitamin D substitute is probably needed to avoid a development of osteoporosis.

Primary hyperparathyroidism (PHPT) is a common endocrine disease, existing in both genders and in all age groups. Postmenopausal women are at particular risk of developing the disease and estrogen decline after menopause is suggested to affect the progress. Although PHPT is mild in its presentation with subtle or no subjective symptoms, it is associated with an increased risk of associated morbidity and also mortality i.e cardiovascular complications, psychiatric instability, concomitant metabolic abnormalities, obesity and decrease in bone mineral density. The current cure is surgical removal of the diseased gland/s, but other medical alternatives have been investigated. The disease is thoroughly explored in postmenopausal women but less is known about other populations groups. Since progression of the disease generally is slow, the underlying disturbance of the calcium homeostasis can be suspected to have been established a long time prior to diagnose with potential to affect associated morbidity. The general aim of this thesis is to clarify the expression of PHPT in premenopausal women and in elderly men and to explore how frequent the disease in these populations occurs. The women and men were investigated through population-based studies. Baseline data and prevalence of PHPT in premenopausal women age 40-50 years were studied (Paper I), the prevalence was 5.1% in this population and was associated with decreased bone mineral density and associated obesity. In a three years follow up of the female cohort, the effects of menopausal transition and associated morbidity was investigated (Paper II). The prevalence and expression of PHPT in men between 69 and 81 years and impact on bone mineral density, physical performance, fall and fracture prevalence was explored through data from Mr Os Sweden (Papers III and IV). In this population prevalence of PHPT was 0.73% and associated with lower bone mineral density and inferior physical performance.

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...

Orientador: Silvana Pereira Barros / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-11T01:50:55Z (GMT). No. of bitstreams: 1 Marques_MarceloRocha_D.pdf: 1159258 bytes, checksum: b480791f2296297d8bf75042e1af33c1 (MD5) Previous issue date: 2007 / Resumo: O hormônio paratireóideo (PTH), um mediador da remodelação óssea, é o principal regulador da homeostasia do cálcio, sendo capaz de promover reabsorção e aposição ósseas. Em trabalhos realizados recentemente, foi verificado que o tratamento com PTH, administrado de maneira intermitente, diminuiu a perda óssea e também células inflamatórias no tecido gengival, em ratos com periodontite induzida. No intuito de melhor explicar os resultados obtidos nesses trabalhos, doença periodontal foi induzida em primeiros molares de ratos e após 15 e 30 dias de tratamento com PTH os animais foram sacrificados com o objetivo investigar o periodonto para: 1) avaliar a expressão gênica, por meio de RT-PCR, e localizar, por meio de reação imunohistoquímica, algumas citocinas inflamatórias (IL-1b, IL-6, TNF-alfa) e certas metaloproteinases da matriz (MMP-2 e MMP-9), 2) verificar, por meio de histoquímica, a atividade de fosfatase ácida tatarato resistente (TRAP) na superfície óssea alveolar, e 4) medir a atividade gelatinolítica das MMPs 2 e 9. Como resultados, observou-se que o PTH diminuiu a expressão de mRNA para MMP-2 (15 e 30 dias experimentais) e IL-6 (30 dias experimentais) nas gengivas dos animais estudados; que a localização de IL-1beta, MMP-2 e MMP-9 se deu basicamente no tecido conjuntivo da gengiva, e que a IL-6 foi detectada principalmente na superfície do osso alveolar. O número de células TRAPpositivas foi diminuído nos animais tratados 30 dias com PTH, e atividade gelatinolítica de MMP-9 foi diminuída após 15 dias de tratamento com o hormônio. Dentro dos limites deste estudo, pode-se concluir que a administração intermitente de PTH pôde modular moléculas (MMP-2, MMP-9, IL-6 e número de células TRAP-positivas) que têm relação com degradação tecidual na doença periodontal em ratos / Abstract: Intermittent Parathyroid hormone (PTH) administration has been used as an anabolic agent, and when it is administrated in rats with induced periodontitis, it is able to decrease alveolar bone loss, and reduce the inflammatory cells on the marginal gingival tissue. A possible action of the PTH in cytokines and metalloproteinase (MMPs), related with breakdown tissue in periodontitis, was hypothesized. After inducing periodontitis with cotton ligature in rats and PTH intermittent treatment during 15 and 30 days, inflamed gingival tissue was removed, and a decrease of IL-6 and MMP-2 mRNA expression was observed by semi-quantitative RT-PCR analysis. Zymography assay demonstrated that PTH treatment decreased MMP-9 activity after 15 experimental days. After jaw decalcification, TRAP positive cells were found in higher number on the alveolar bone surface in the group without PTH treatment, after 30 experimental days. Using immunohistochemistry, MMP-2, MMP-9, IL-beta and TNF-alpha were identified in all groups and they were found on the gingival tissue and IL-6 on alveolar bone surface. Within the limits of this study, it can be concluded that intermittent PTH administration may modulate IL-6, MMP-2, MMP-9 and TRAP-positive cells in experimental periodontitis / Doutorado / Histologia e Embriologia / Doutor em Biologia Buco-Dental

Introdução - A concentração sérica de vitamina D pode variar em indivíduos de diferentes grupos etários e de diversas regiões geográficas e pode ser influenciada pela exposição solar, estação do ano, bem como pelos valores de IMC e paratormônio (PTH). A classificação utilizada para definir concentração sérica adequada de vitamina D refere valores de 25(OH)D acima de 30 ng/mL. Porém, essa classificação pode estar inapropriada para a população brasileira, devido às particularidades climáticas e alimentares. Objetivo - Verificar as concentrações séricas médias de 25(OH)D e PTH e sua relação com IMC, exposição solar e estação do ano e identificar os valores de corte da 25(OH)D associados à elevação do paratormônio (PTH) em adultos e idosos de amostra representativa da população do município de São Paulo. Métodos - Para esta dissertação foi desenvolvido um artigo original. O artigo original descreve o estudo transversal realizado com indivíduos do estudo ISA-Capital, estudo multicêntrico e de base populacional, onde foram investigados 589 indivíduos, de ambos os sexos, dos grupos etários: 20 a 59 (adultos) e 60 e mais (idosos). Foram coletadas amostras de sangue, para dosagens de 25(OH)D e PTH. Os indivíduos que aceitaram participar da coleta de sangue, também responderam um questionário sobre exposição solar. A análise estatística incluiu a curva ROC, testes t de Student, correlação e ANOVA. Os cálculos foram realizados pelo software SPSS versão 17.0. e p 0,05 foi considerado significante. Resultados - No artigo original observou-se idade média de 54,83 (19,21) anos, sendo 61,3 por cento do sexo feminino e 38,7 por cento do sexo masculino. A concentração sérica média de 25(OH)D foi 50,02 (22,69) ng/mL, já entre os grupos foi de 47,48 (23,03) (adultos) e 52,68 (22,06) ng/mL (idosos) havendo diferença significativa entre eles (p=0,005). Observou-se variação sazonal da concentração sérica de 25(OH)D e correlação positiva entre 25(OH)D e IMC (r = 0,114, p = 0,006). O novo valor de corte 55.8 ng/mL, determinado pela análise da curva ROC, encontrou 67,6 por cento dos indivíduos insuficientes de 25(OH)D e entre os grupos 72,1 por cento (adultos) e 62,8 por cento (idosos). Conclusão - Os resultados demonstram a presença de variação sazonal nas concentrações séricas de 25(OH)D no municipio de São Paulo. O ponto de corte proposto para nossa população indicou elevada prevalência de insuficiência de vitamina D. Portanto, se faz necessário políticas públicas de prevenção de insuficiência de vitamina D visando os efeitos benéficos na saúde e qualidade de vida desta população. / Introduction - The serum concentration of vitamin D may vary in individuals of different age groups and geographic regions and may be influenced by sun exposure, season and by BMI and parathyroid hormone (PTH). The classification widely used as a cut-off for appropriate vitamin D status refers serum 25 (OH) D above 30 ng/mL. However, this classification may be inappropriate for the Brazilian population, due to the particular food and the climate of our population. Objective - To determine the mean serum concentrations of 25(OH)D and PTH and correlate them with BMI, sunlight exposure and season and to identify the cutoff values of 25 (OH) D associated with elevation in PTH. Methods For this dissertation, one original article were developed. Original article describe cross-sectional study performed with subjects from the ISA Capital, multicenter population-based. We investigated 589 individuals were of both sexes, age groups: 20-59 (adults) and 60 (elderly). Blood samples for laboratory measurements of 25(OH)D and PTH were collected. Individuals, who agreed to participate in blood collection, also answered a questionnaire on sunlight exposure. Statistical analysis included ROC curve, Student t test, correlation tests, ANOVA. The calculations were performed by the software SPSS version 17.0. and p 0.05 was considered significant. Results - In the original article, the mean age of participants was 54.83 (19.21) years, 61.3 per cent female and 38.7 per cent were male. The mean serum 25 (OH) D was 50.02 (22.69) ng/mL, between the groups was 47.48 (23.03) (adults) and 52.68 (22.06) ng/ mL (elderly) and significant difference between them (p = 0.005). A seasonal variation in serum 25 (OH) D was observed and positive correlation between 25(OH)D and BMI (r = 0.114, p = 0.006). The new cutoff value 55.8 ng / mL, determined by ROC curve analysis found 67.6 per cent of subjects insufficient 25 (OH) D and between groups 72.1 per cent (adults) and 62.8 per cent (elderly). Conclusion - The results demonstrate the presence of seasonal variation in serum 25 (OH) D in the municipality of Sao Paulo. The cutoff point proposed for our population showed a high prevalence of insufficient vitamin D. Therefore, public policy is needed to prevent vitamin D insufficiency in order to beneficial effects on health and quality of life in this population.

O hiperparatireoidismo (HPT) secundário é uma complicação da doença renal crônica. A paratireoidectomia total com autoimplante proporciona bons resultados no seu tratamento, mas alguns doentes não desenvolvem níveis adequados de hormônio da paratireóide (PTH) após a operação. Os objetivos, do presente estudo, foram analisar fatores que poderiam interferir no funcionamento do autoimplante de glândula paratireóide e quantificar a taxa de hipofunção segundo alguns critérios. Casuística e Métodos: em um estudo prospectivo e observacional, foram analisados a idade, sexo, peso, altura e a etnia. A causa da doença renal crônica (DRC), tempo de DRC antes da paratireoidectomia, tempo de diálise, antecedente de intoxicação por alumínio e tempo de diagnóstico do HPT. Os dados bioquímicos estudados foram os níveis pré-operatórios de fósforo, cálcio total, cálcio iônico, PTH e fosfatase alcalina e aos 6 meses e 1 ano de pós-operatório. Registrada a quantidade de cálcio (gluconato e carbonato) e calcitriol ofertada no pós-operatório sendo realizada durante a primeira semana, no primeiro, terceiro sexto mês de pós-operatório. A histologia da glândula implantada foi analisada. Os pacientes foram divididos, segundo os níveis preconizados de PTH para indivíduos normais e segundo as recomendações da Fundação Nacional do Rim dos Estados Unidos da América (K/DOQI), em grupos hipofuncionante (grupo 1) e funcionante ( grupo 2). Resultados: Entre julho de 2007 e dezembro de 2008, 48 pacientes (18 homens e 30 mulheres) foram submetidos à paratireoidectomia total com autoimplante imediato. A média de idade dos indivíduos foi 44,7 anos (EP: 12,6), a do tempo de diálise foi 9,6 anos (EP: 5,1), a média do tempo de diagnóstico do hiperparatireoidismo de 2,6 anos (EP: 2). A principal causa da doença renal crônica foi a hipertensão arterial em 16 indivíduos (33,3%) seguida de causa indefinida em 12 (25%), GESF em 5 (10,4%), diabetes mellitus em 4 (8,3%). Com relação ao número de fragmentos implantados, houve tendência a uma diferença entre os grupos 1 e 2 (p= 0,14). Houve tendência a uma diferença entre os grupos 1 e 2 (p= 0,1) no que diz respeito a histologia da glândula implantada. O índice de hipofunção do auto implante, em 1 ano, foi de 21,27% no critério do nível de PTH para indivíduos normais e de 72,9% segundo as recomendações do KDOIQ. As complicações e óbitos por causa cardiovascular não diferiram entre os grupos. CONCLUSÃO: a frequência de hipofunção do implante imediato de paratireóide foi de 21,27% e de 72,9% segundo as recomendações do KDOQ e não houve a identificação de fatores preditivos para sua hipofunção. / The secondary hyperparathyroidism (HPT) is a complication of chronic kidney disease. A total parathyroidectomy with autograft provides good results in treatment, but some patients do not develop adequate levels of parathyroid hormone (PTH) after operation. The objectives of study were to analyze factors that could interfere with the function of the parathyroid gland autograft and measure the rate of hypofunction according several criteria. Patients and Methods: a prospective observational study were analyzed age, sex, weight, height and ethnicity. The cause of chronic kidney disease (CKD), duration of CKD prior to parathyroidectomy, duration of dialysis, previous aluminum intoxication and time of diagnosis of HPT. The biochemical data studied : preoperative levels of phosphorus, total calcium, ionized calcium, PTH and alkaline phosphatase and 6 months and 1 year postoperatively. Recorded the amount of calcium (gluconate and carbonate) and calcitriol offered postoperative being held during the first week, the first, third, sixth month postoperatively. Histology of the implanted gland was analyzed. Patients were divided according to the recommended levels of PTH for normal individuals and in accordance with the recommendations of the National Foundation Kidney the United States of America (K / DOQI) in hypofunction groups (group 1) and functional (group 2). Results: Between July 2007 and December 2008, 48 patients (18 men and 30 women) underwent total parathyroidectomy with immediate autograft. The mean age was 44.7 years (SE: 12.6), the duration of dialysis was 9.6 years (SE: 5.1), the average time of diagnosis of hyperparathyroidism 2.6 years (EP: 2). The main cause of chronic renal disease was hypertension in 16 patients (33.3%) followed by unknown cause in 12 (25%), FSGS in 5 (10.4%), diabetes mellitus in 4 (8.3%.). The number of implanted fragments, there was a trend to a difference between groups 1 and 2 (p = 0.14). There was a trend to a difference between groups 1 and 2 (p = 0.1) as regards the histology of the gland implanted. The rate of self hypofunction implant at 1 year was 21.27% at the discretion of the PTH level in normal individuals and 72.9% according to the recommendations of KDOIQ. Complications and deaths from cardiovascular causes did not differ between groups. CONCLUSION: The rate of hypofunction of the parathyroid immediate implant was 21.27% and 72.9% according to the recommendations of KDOIQ and there was no identification of predictive factors for its hypofunction.

Orientador: Marcelo Rocha Marques / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-24T18:41:33Z (GMT). No. of bitstreams: 1 Guimaraes_GustavoNarvaes_D.pdf: 3246599 bytes, checksum: 781e1f21b54daff1efa5c67e98bb5e59 (MD5) Previous issue date: 2014 / Resumo: O hormônio paratireóideo (PTH) é o principal regulador da homeostasia dos íons minerais, cálcio e fosfato, no organismo, exercendo um papel chave no desenvolvimento e homeostase dos tecidos mineralizados. Recentemente nós demonstramos que durante a formação do incisivo de camundongos, a administração intermitente de PTH causou um aumento da taxa de aposição dentinária e resultou em mudanças nas propriedades mecânicas e materiais da dentina formada. Com isso, os estudos apresentados aqui se propuseram a investigar: 1) Os efeitos da exposição transiente (1 ou 24h/ciclo) ou contínua (48h) ao hPTH(1-34) na deposição mineral, na expressão gênica de Fosfatase Alcalina (ALP), Metaloproteinase 2 (MMP2), Biglican (BGN) e Colágeno tipo I (COL1), e na atividade de MMP2 e ALP em odontoblastos MDPC-23; 2) A participação das vias de sinalização dependentes de proteína quinase A (PKA) e proteína quinase C (PKC) na resposta proliferativa e apoptótica de odontoblastos MDPC-23 a diferentes tempos de exposição ao hPTH(1-34) (1, 24 ou 48 horas); 3) O efeito do tratamento do hPTH(1-34) na espessura dos cristais minerais formados durante a odontogênese de incisivos de camundongos. 4) Os efeitos da administração intermitente de hPTH(1-34) na dentinogênese terciária em camundongos. Os resultados mostram que a exposição transiente ao PTH diminuiu a deposição mineral e atividade de ALP. Já as expressões gênicas de ALP, BGN e COL1 estavam aumentadas no grupo 24h/ciclo, enquanto que o grupo Contínuo apresentou um aumento da expressão gênica de BGN e COL1. Também, os níveis de MMP2 secretados estavam aumentados no grupo 1h/ciclo e diminuídos no grupo Contínuo. A exposição ao PTH modula a resposta proliferativa e apoptótica de odontoblastos MDPC-23 de uma maneira dependente do tempo. Além disso, a via PKA atua na resposta a curta exposição ao PTH (1h), mantendo os níveis de proliferação e apoptose das células, enquanto que a via PKC é ativada nos tempos mais longos de exposição (24 e 48hs) levando a um aumento da apoptose e redução da proliferação celular. A administração intermitente de PTH não alterou a espessura dos cristais minerais da dentina de incisivos em formação e nem a quantidade de dentina terciária reacional em molares de camundongos. No entanto, o tratamento com PTH aumentou a concentração de zinco e diminuiu a concentração de cálcio na dentina de molares normais e em molares com indução de dentinogênese terciária. Com isso, pode-se concluir que o hPTH (1-34) modula a mineralização, apoptose e proliferação de odontoblastos MDPC-23 de maneira dependente do tempo, e que as vias de sinalização dependentes de PKA e PKC participam da resposta proliferativa e apoptótica. Além disso, nos modelos utilizados, a administração intermitente de PTH não teve efeito na espessura de cristais da dentina de incisivos, e também não demonstrou ser capaz de aumentar a formação de dentina terciária reacional em molares de camundongos / Abstract: Parathyroid hormone (PTH) is the major regulator of the calcium and phosphate ions in and plays a key role in the development and homeostasis of mineralized tissues. Recently we demonstrated that during the formation of the incisor of mice, intermittent PTH administration caused an increase of dentin apposition rate and it was associate to changes in the composition and in the mechanical properties of the formed dentin. Thus, the studies presented here were designed to investigate: 1) The effects of transient exposure (1 or 24h/cycle) or continuous (48h) to hPTH (1-34) in the mineral deposition and in the gene expression of alkaline phosphatase (ALP), metalloproteinase 2 (MMP2), Biglican (BGN) and type I collagen (COL1), and activity of MMP2 and ALP in odontoblast-like cells (MDPC-23); 2) The involvement of signaling pathways dependent of protein kinase A (PKA) and protein kinase C (PKC) in the proliferative and apoptotic response of MDPC-23 at different times of exposure to hPTH (1-34) (1, 24 or 48 hours); 3) The effect of the hPTH (1-34) treatment on the thickness of mineral crystals formed during dentinogenesis of the mice incisors. 4) The effects of intermittent hPTH (1-34) administration on the tertiary dentinogenesis in mice molars. The results showed that the transient exposure to PTH decreased the mineral deposition and ALP activity. The gene expressions of ALP, COL1 and BGN were higher in the group treated with PTH for 24h/cycle, while the PTH continuous administration group (48h) showed an increase in gene expression of COL1 and BGN. Also, the levels of secreted MMP2 were increased in 1h/cycle and decreased in the Continuous group (48h). The exposure to PTH modulates apoptotic and proliferative response of MDPC-23 in a time-dependent manner. Furthermore, the PKA pathway operates in response to short-term exposure to PTH (1h), maintaining levels of proliferation cell and apoptosis, whereas the PKC pathway is activated in longer exposure times (24 and 48h) leading to an increase apoptosis and decreased cell proliferation. The intermittent PTH administration did not change the thickness of the dentin mineral crystals of the incisors mice, and did not alter the deposition volume of the reactional tertiary dentin in the mice molars. However, treatment with PTH increased the concentration of zinc and decreased calcium concentration in normal dentin of molars with or without induction of tertiary dentinogenesis. Thus, it can be concluded that hPTH (1-34) modulates the mineral deposition, proliferation and apoptosis of the odontoblasts MDPC-23 in a time-dependent manner, and the signaling pathways PKA and PKC dependent participate of that proliferative and apoptotic response. Furthermore, in the models used here, the intermittent administration of PTH did not affect the thickness of the incisor dentinal crystals, and also not shown to be able to enhance the formation of reactional tertiary dentin in molar mice / Doutorado / Histologia e Embriologia / Doutor em Biologia Buco-Dental