A hipercalcemia associada à malignidade é descrita em 20 a 30% dos pacientes com câncer em alguma etapa da doença, e significa mau prognóstico. Os sintomas relacionados ao sistema nervoso central predominam, tais como progressivo declínio da capacidade cognitiva, estupor e coma. As alterações na função renal (incapacidade de concentrar a urina acarretando poliúria) e no trato gastrointestinal (anorexia, náuseas e vômitos) corroboram para a desidratação e agravam a hipercalcemia. A hipercalcemia causada pelo câncer é comumente classificada em: 1) hipercalcemia osteolítica local, decorrente da intensa reabsorção óssea osteoclástica nas áreas em torno das células malignas na medula óssea; 2) hipercalcemia humoral maligna, causada pela secreção do peptídeo relacionado ao paratormônio (PTHrP) pela neoplasia maligna; 3) hiperparatireoidismo ectópico; 4) produção de 1,25 (OH)2 D pelo tumor. O controle adequado da hipercalcemia é necessário para dar tempo de o paciente responder ao tratamento antineoplásico. A expansão de volume com solução salina corrige a desidratação, melhora a filtração glomerular e aumenta a excreção urinária de cálcio, que pode ser ampliada por diuréticos de alça. Os bisfosfonatos intravenosos são os medicamentos mais eficientes em controlar a hipercalcemia, uma vez que bloqueiam a osteólise osteoclástica e também possuem efeito anti-tumoral, diminuindo as metástases ósseas. Novas alternativas de tratamento das manifestações ósseas das malignidades são os anticorpos anti-PTHrP, anticorpos anti-RANKL e a osteoprotegerina, além de inibidores de proteossomo no caso do mieloma múltiplo.

A hipercalcemia é anormalidade metabólica comum, porém pouco diagnosticada por ser freqüentemente assintomática. Aproximadamente 90% dos casos são decorrentes de hiperparatireoidismo primário (HPT) ou doença maligna complicada por hipercalcemia, estando prevalentes em pacientes ambulatoriais e hospitalizados, respectivamente. Laboratorialmente, o HPT e hipercalcemia humoral maligna apresentam algumas semelhanças, tais como: aumento do AMPc nefrogênico, hipofosfatemia e hipercalciúria. Porém, o quadro clínico da hipercalcemia associada à malignidade é mais severo e, geralmente, o paciente apresenta-se clinicamente debilitado pela doença, com múltiplas metástases. A dosagem sérica de PTH intacto (PTHi) é fundamental para o diagnóstico definitivo, estando o PTHi elevado ou normal no HPT primário, e suprimido na malignidade. Os mecanismos de hipercalcemia da doença maligna são: secreção de fatores humorais que alteram a homeostase do cálcio e fatores locais produzidos pelos tumores metastáticos ou hematológicos no osso, causando aumento da reabsorção osteoclástica. A proteína relacionada ao hormônio da paratireóide (PTHrP) tem sido implicada na maioria dos casos de hipercalcemia devido a tumores sólidos. Outros fatores como interleucina-6, fator de crescimento tumoral, fator de necrose tumoral e interleucina-1 podem modular os efeitos do PTHrP nos órgãos-alvo, e em alguns tumores, ativam diretamente o osteoctastos como por exemplo no mieloma múltiplo. A hipercalcemia pode estar menos freqüentemente associada a algumas doenças endócrinas como tireotoxicose, feocromocitoma, doença de Addison e neoplasia endócrino múltipla tipos I e IIA. Algumas drogas podem causar esse distúrbio metabólica, merecendo destaque a vitamina D, os diuréticos tiazídicos e o lítio. A sarcoidose é exemplo de doença granulomatosa que pode associar-se à hipercalcemia em 10% dos casos e hipercalciúria em 50%. O diagnóstico diferencial das hipercalcemias é essencial para que haja uma abordagem terapêutica eficaz dessa anormalidade metabólica.

Biomateriais que possam atuar para um eficiente reparo do tecido ósseo na área maxilofacial permanecem limitados dentro da área cirúrgica. Neste âmbito pesquisadores têm sido atraídos para a administração sistêmica de fármacos, e principalmente análogos hormonais os quais possam acelerar o reparo ósseo e estimular a atividade osteoblástica. Um hormônio que interfere na fisiologia do processo de reparo ósseo é o hormônio de crescimento (GH). Apesar de haver estudos que demonstrem boas perspectivas do GH e osteo(neo)gênese, dados sobre a eficácia e segurança da terapia prolongada com GH em adultos são escassos, e as vias principais e alternativas que correspondem a expressão respectivamente de IGF-1 e TGF-1, que agem de maneira funcionalmente antagônica, não são abordadas de forma significativa. O objetivo deste estudo foi investigar a presença imunoistoquímica do IGF-1, TGF-1 e PTHrP nos leitos cirúrgicos tratados com osso autógeno na presença e ausência do GH. Nete estudo utilizaou-se 16 ratos machos, os animais foram aleatoriamente alocados em 2 grupos experimentais que consistiu em um grupo controle - que recebeu autoenxerto (OA), e outro teste, que além do autoenxerto recebeu doses alternadas de GH (uma dose irrigatória transcirúrgica de 0,02 mL e aplicações em dias alternados de 0,1 mL de análogo de GH) (grupo OA/GH). Os resultados da análise qualitativa da histologia mostraram que o Grupo (OA) apresentou regiões sugestivas de osteocondução e de neoformação óssea, enquanto o grupo (OA/GH) exibiu um defeito preenchido por fibras de tecido conjuntivo denso associada, discreto processo inflamatório crônico e áreas compatíveis com perda mineral. Esses efeitos coincidiram com similaridades da proteína IGF-1 para os grupos, mas com discrepâncias de TGF-B1 e PTHrP, os quais mostraramse exacerbados nos grupos OH/GH. Aqui, pôde-se concluir que o uso do análogo de GH conduz a expressão de proteínas TGF-B1 e PTHrP, que juntas não apenas cursa com ação osteolítica da área analisada, mas também parece ter efeito que sobrepõe a via IGF-1 que é anabólica. Assim GH em excesso pode levar a perda óssea por um mecanismo alternativa via TGF-B1.

Juvenile gilthead sea bream (Sparus auratus L.; 10–40·g body mass) were acclimatized in the laboratory to full strength (34‰) or dilute (2.5‰) seawater and fed normal, calcium-sufficient or calcium-deficient diet for nine weeks. Mean growth rate, whole-body calcium and phosphorus content and accumulation rates were determined, as well as plasma levels of ionic and total calcium, cortisol and parathyroid hormone related protein (PTHrP; a hypercalcemic hormone in fish). When confronted with limited calcium access (low salinity and calcium-deficient diet), sea bream show growth arrest. Both plasma cortisol and PTHrP increase when calcium is limited in water or diet, and a positive relationship was found between plasma PTHrP and plasma ionic calcium (R2=0.29, N=18, P<0.05). Furthermore, a strong correlation was found between net calcium and phosphorus accumulation (R2=0.92, N=16, P<0.01) and between body mass and whole-body calcium (R2=0.84, N=25, P<0.01) and phosphorus (R2=0.88, N=24, P<0.01) content. Phosphorus accumulation is strongly calcium dependent, as phosphorus accumulation decreases in parallel to calcium accumulation when the diet is calcium deficient but phosphorus sufficient. We conclude that PTHrP and cortisol are involved in the regulation of the hydromineral balance of these fish, with growthrelated calcium accumulation as an important target.

A quantitative PCR (Q-PCR) method has been established to measure the mRNA expression levels of parathyroid hormone–related protein (PTHrP), parathyroid hormone receptor type 1 (PTHR1), and calcium-sensing receptor (CaSR) in sea bream (Sparus aurata), using the housekeeping gene, - actin, as endogenous control. TaqMan primers and probes were designed using the Primer Express program, according to the published/unpublished sequences of the three target genes and -actin of sea bream. Different tissues including gill, kidney, duodenum, hindgut, rectum, liver, heart, brain, pituitary, skin, muscle, and gonad were removed and immediately snap-frozen from three juvenile sea bream (100–150 g) cultured in sea water. The mRNAs were extracted and reverse-transcribed into cDNAs, which were subsequently examined by the ABI 5700 system using an optimized Q-PCR method. Triplicate measures of each sample indicated consistency of the technique. However, the mRNA expression levels for each transcript in these tissues were variable between fish and also relatively low. Nevertheless, this methodology can be used in the future studies of factors that may alter gene expression in these tissues.

This paper reports cloning of the cDNA for sea bream (Sparus aurata) parathyroid hormone-related protein (PTHrP). The gene codes for a 125-amino acid mature protein with a 35-residue prepeptide. The total gene sequence is 1.8 kb with approximately 75% noncoding. The N-terminus of the protein resembles mammalian and chicken PTHrP peptides with 12 of the first 21 amino acids identical and for which there is homology with mammalian parathyroid hormone. Toward the C-terminus, the nuclear transporter region between residues 79 and 93 in sea bream is 73% homologous to tetrapod PTHrP, and the RNA binding domain, 96–117, is 50% homologous, moreover starting with the conserved lysine and terminating with the lysine/arginine sequence. Sea bream PTHrP differs significantly from mammalian and chicken PTHrP, having a novel 16-amino acid segment between residues 38 and 54 and completely lacking the terminal domain associated in mammals with inhibition of bone matrix lysis. RT-PCR and in situ hybridization of sea bream tissues show that the gene is expressed widely and the results confirm observations of a PTHrP-like factor in sea bream detected with antisera to human PTHrP.

The scales of bony fish represent a significant reservoir of calcium but little is known about their contribution, as well as of bone, to calcium balance and how calcium deposition and mobilization are regulated in calcified tissues. In the present study we report the action of parathyroid hormone-related protein (PTHrP) on calcium mobilization from sea bream (Sparus auratus) scales in an in vitro bioassay. Ligand binding studies of piscine 125I-(1 – 35tyr)PTHrP to the membrane fraction of isolated sea bream scales revealed the existence of a single PTH receptor (PTHR) type. RT-PCR of fish scale cDNA using specific primers for two receptor types found in teleosts, PTH1R, and PTH3R, showed expression only of PTH1R. The signalling mechanisms mediating binding of the N-terminal amino acid region of PTHrP were investigated. A synthetic peptide (10 8 M) based on the N-terminal 1 – 34 amino acid residues of Fugu rubripes PTHrP strongly stimulated cAMP synthesis and [3 H]myo-inositol incorporation in sea bream scales. However, peptides (10 8 M) with N-terminal deletions, such as (2 – 34), (3 – 34) and (7 – 34)PTHrP, were defective in stimulating cAMP production but stimulated [3 H]myo-inositol incorporation. (1 – 34)PTHrP induced significant osteoclastic activity in scale tissue as indicated by its stimulation of tartrate-resistant acid phosphatase. In contrast, (7 – 34)PTHrP failed to stimulate the activity of this enzyme. This activity could also be abolished by the adenylyl cyclase inhibitor SQ-22536, but not by the phospholipase C inhibitor U-73122. The results of the study indicate that one mechanism through which N-terminal (1 – 34)PTHrP stimulates osteoclastic activity of sea bream scales, is through PTH1R and via the cAMP/AC intracellular signalling pathway. It appears, therefore, that fish scales can act as calcium stores and that (1 – 34)PTHrP regulates calcium mobilization from them; it remains to be established if this mechanism contributes to calcium homeostasis in vivo.

n fish, vitellogenin is an important nutritional precursor protein produced solely in the liver and released into the blood where it binds calcium. In the gilthead sea bream (Sparus auratus) 17beta-Estradiol (E2) plays an important role in the synthesis of vitellogenin, but also the pituitary hormones prolactin (PRL) and growth hormone (GH) can stimulate vitellogenin induction in fish. Considering the emerging involvement of PTHrP in fish calcium metabolism and the importance of calcium regulation in reproduction, we investigated the possible role of PTHrP in vitellogenesis. E2-naïve and E2-primed sea bream hepatocytes were used in an in vitro primary hepatocyte culture and stimulated with a recombinant sea bream PTHrP (sbPTHrP) to establish the contribution of sbPTHrP alone or in combination with E2 to the regulation of hepatic vitellogenin synthesis. Hepatocytes stimulated solely with sbPTHrP were not affected in their vitellogenesis. However, in hepatocytes stimulated with E2 in combination with sbPTHrP a higher vitellogenin production was seen than with E2 alone. It is concluded that sbPTHrP has a potentiating effect on estradiol stimulation of vitellogenin production by sea bream hepatocytes. The sea bream provides a unique model where vitellogenesis regulation can be studied on E2-naïve liver cells, both in vivo and in vitro.

Juvenile gilthead sea bream were exposed to diluted seawater (2.5‰ salinity; DSW) for 3·h or, in a second experiment, acclimated to DSW and fed a control or calcium-deficient diet for 30·days. Branchial Ca2+ influx, drinking rate and plasma calcium levels were assessed. Sea bream plasma parathyroid hormone related protein (sPTHrP) was measured, and mRNAs of pthrp, its main receptor, pth1r, and the calcium-sensing receptor (casr) were quantified in osmoregulatory tissues and the pituitary gland. When calcium is limited in water or diet, sea bream maintain calcium balance; however, both plasma Ca2+ and plasma sPTHrP concentrations were lower when calcium was restricted in both water and diet. Positive correlations between plasma sPTHrP and plasma Ca2+ (R2=0.30, N=39, P<0.05), and plasma sPTHrP and body mass of the fish (R2=0.37, N=148, P<0.001) were found. Immunoreactive sPTHrP was demonstrated in pituitary gland pars intermedia cells that border the pars nervosa and co-localises with somatolactin. In the pituitary gland, pthrp, pth1r and casr mRNAs were downregulated after both short- and long-term exposure to DSW. A correlation between pituitary gland pthrp mRNA expression and plasma Ca2+ (R2=0.71, N=7, P<0.01) was observed. In gill tissue, pthrp and pth1r mRNAs were significantly upregulated after 30·days exposure to DSW, whereas no effect was found for casr mRNA expression. We conclude that in water of low salinity, declining pituitary gland pthrp mRNA expression accompanied by constant plasma sPTHrP levels points to a reduced sPTHrP turnover and that sPTHrP, through paracrine interaction, is involved in the regulation of branchial calcium handling, independently of endocrine pituitary gland sPTHrP.