川芎嗪对类风湿性关节炎外周血RANK／RANKL／骨保护素途径干预作用的研究

目的观察川芎嗪对类风湿性关节炎（RA）模型大鼠RANK／RANKL／0PG在外周血中CD3^＋T淋巴细胞、中性粒细胞、CD14单核细胞的表达率及平均荧光强度,探讨川芎嗪在RA骨破坏和炎症过程巾的意义。方法大鼠随机分成5组,正常对照组、模型对照组、川芎嗪大剂量组、川芎嗪小剂量组、阳性药物对照组,每组10只。给药7d后,应用间接免疫荧光标记和流式细胞技术对各组大鼠外周血相关指标进行检测分析。结果与正常对照组相比,RA大鼠骨保护素（OPG）表达明显降低,从正常的24．7降至18．7（q=4．2,P〈0．05）,RANK、RANKL变化不明显,经过川芎嗪治疗后,大剂量组OPG有明显的回升,至23．8％（q=3．97,P〈0．05）,小剂量组变化不明显。RANK在CD3^＋细胞、中性粒细胞、CD14单核细胞上的平均荧光强度明显降低,分别为20．6、135．4、84．2,经川芎嗪大剂量治疗后明显升高,分别达到31．0、192．1、95．6（q=10．4、q=8．6、q=6．3,P〈0．05）。结论大剂量川芎嗪可以通过调节OPG／RANK／RANKL途径对RA起一定的作用。     

OPG/RANK/RANKL系统基因多态性与类风湿关节炎

类风湿关节炎(rheumatoid arthritis,RA)是临床常见的慢性全身性自身免疫性疾病,晚期往往造成严重的关节畸形和活动障碍,甚至残疾.RA是多因素疾病,基因遗传因素在RA发生与进展过程中起着重要作用.近年来,越来越多的研究证实,OPG/RANK/RANKL系统单核苷酸多态性与RA起病和进展过程中的骨代谢更新及骨矿物质密度密切相关.本文就OPG/RANK/RANKL系统及其单核苷酸多态性与RA关系的最新研究进展作一综述.

Abstract：

Rheumatoid arthritis ( RA ) is a common chronic systemic autoimmune disease, which often causes serious obstacles to joint deformity and activity, or even disability in the terminal stage. RA has been found to be a multi-factor disease, and genetic factors play significantly important roles in its pathogenesis. Recently, more and more studies confirm that single nucleotide polymorphisms (SNPs) of OPG/RANK/RANKL system are closely related to bone metabolism and bone mineral density in RA onset and progression. This article reviewed the latest advance in researches about SNPs of OPG/RANK/RANKL system, and were to clarify the relationship between SNPs and PA.     

补骨脂提取物干预骨质疏松模型大鼠骨密度及骨生物力学的变化

文题释义： RANKL/OPG通路：核因子κB受体活化因子配体(receptor activator of NF-κB Ligand,RANKL)/骨保护蛋白在维持成骨与破骨的动态平衡,调节骨代谢功能方面发挥着重要作用。RANKL 可与破骨细胞前体细胞膜表面的核因子κB受体活化因子结合,促进破骨细胞分化和激活,抑制其凋亡,最终促进骨吸收;骨保护蛋白作为RANKL的天然抗体,可与RANKL直接结合,竞争性抑制核因子κB受体活化因子与其的结合,进而抑制破骨细胞分化、成熟,最终抑制骨吸收。生理状态下,体内RANKL与骨保护蛋白的表达保持一定的比例,若二者表达比例失衡,则会造成骨代谢紊乱,导致骨相关疾病发生。 骨生物力学：是骨组织在外力作用下的力学生物学效应,对其进行检测可直接评价骨质量,是评价各种治疗骨丢失措施的最佳方案,其检测指标包括弹性模量、最大载荷、屈服载荷等。 背景：地塞米松作为一种糖皮质激素,长期应用会破坏成骨与破骨的动态平衡,降低骨密度,损伤骨生物力学,调控核因子κB受体活化因子配体(receptor activator of NF-κB ligand,RANKL)/骨保护蛋白通路可能影响地塞米松诱导的骨质疏松症大鼠骨密度及骨生物力学。 目的：探讨基于RANKL/骨保护蛋白通路研究补骨脂提取物对地塞米松诱导骨质疏松症大鼠骨密度及骨生物力学的影响。 方法：SPF级Wistar大鼠肌肉注射地塞米松,建立骨质疏松大鼠模型。选择1×10⁷ TU/mL浓度的慢病毒载体进行实验。将模型大鼠随机分为模型组、空载组(空慢病毒载体)、骨保护蛋白沉默组(含骨保护蛋白基因干扰片段的慢病毒载体)、补骨脂提取物组、补骨脂提取物+骨保护蛋白沉默组,每组12只,另取12只正常大鼠设为对照组。药物处理后,采用骨密度仪测定大鼠左侧股骨骨密度,采用力学实验测试机测定大鼠右侧股骨生物力学指标弹性模量、最大载荷、屈服载荷,测定大鼠股骨骨矿物盐含量,酶联免疫吸附法检测血清中RANKL、骨保护蛋白水平,蛋白免疫印迹法检测骨组织中RANKL、骨保护蛋白表达水平。实验方案经青海大学医学院动物实验伦理委员会批准(批准号为2017081501) 结果与结论：①大鼠骨密度、弹性模量、最大载荷、屈服载荷、骨矿物盐含量、血清中骨保护蛋白水平、骨组织中骨保护蛋白表达：模型组较对照组降低,骨保护蛋白沉默组较模型组降低,补骨脂提取物组较模型组升高,补骨脂提取物+骨保护蛋白沉默组较骨保护蛋白沉默组升高,较补骨脂提取物组降低(均P < 0.05);②大鼠血清中RANKL水平、骨组织中RANKL蛋白表达结果显示,模型组较对照组升高;骨保护蛋白沉默组较模型组升高,补骨脂提取物组较模型组降低,补骨脂提取物+骨保护蛋白沉默组较骨保护蛋白沉默组降低,较补骨脂提取物组升高(均P < 0.05);③模型组与空载组两组间各指标比较无明显变化(P > 0.05);④结果说明,补骨脂提取物可提高地塞米松诱导骨质疏松症大鼠的骨密度,改善其骨生物力学,可能是通过上调骨保护蛋白表达,下调RANKL表达实现的。 ORCID: 0000-0001-9896-6214(周倚墨) 中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程     

Safety of denosumab in postmenopausal women with osteoporosis or low bone mineral density: a meta-analysis

Purpose: The aim of this meta-analysis was to assess the safety of denosumab in postmenopausal women with osteoporosis or low bone mineral density (BMD). Methods: Safety of denosumab was compared with placebo or bisphosphonates. A systematic literature search without language restriction was conducted up to January, 2014. The RevMan 5.1 software was used for statistical analysis. Results: A total of 11 English literatures were eventually identified. The pooled data in the overall analysis revealed that there was no significant difference when compared denosumab with placebo or bisphosphonates in any adverse events (AAE) (RR=0.99, 95% CI=0.98-1.01, p=0.29), serious adverse event (SAE) (RR=1.05, 95% CI=0.98-1.13, p=0.18), neoplasm/cancer (RR=1.14, 95% CI=0.95-1.37, p=0.16) and deaths (RR=0.77, 95% CI=0.57-1.04, p=0.09). However, significant differences were found when compared denosumab with placebo or bisphosphonates in SAE related to infection (RR=1.23, 95% CI=1.00-1.52, p=0.05) and non-vertebral fracture (RR=0.86, 95% CI=0.74-1.00, p=0.05). Subgroup analysis was performed by the type of drugs which was used in the control group. The results of subgroup analysis did not demonstrate the differences between denosumab and bisphosphonates in SAE related to infection (RR=1.13, 95% CI=0.63-2.03) and non-vertebral fracture (RR=1.31, 95% CI=0.87-1.98). Conclusions: Compared to placebo, denosumab treatment significantly decreased the risk of non-vertebral fracture but increased the risk of SAE related to infection in the postmenopausal women with osteoporosis or low BMD. However, no difference between the safety of denosumab and bisphosphonates was found.     

Wnt signaling and osteoporosis

Major advances in understanding basic bone biology and the cellular and molecular mechanisms responsible for the development of osteoporosis, over the last 20 years, have dramatically altered the management of this disease. The purpose of this mini-review is to highlight the seminal role of Wnt signaling in bone homeostasis and disease and the emergence of novel osteoporosis therapies by targeting Wnt signaling with drugs.     

New therapeutic targets for osteoporosis: Beyond denosumab

Treatments for osteoporosis over the last few decades have largely focused on antiresorptive agents that effectively prevent bone loss. Beginning with hormone therapy, a variety of new potent antiresorptive agents were developed, including oral and intravenous bisphosphonates, raloxifene and other selective estrogen receptor modulators, nasal spray calcitonin, and denosumab. Teriparatide and PTH 1–84 are the only approved anabolic agents to date that primarily build new bone density. A variety of new biologic agents that focus on molecular targets important for the stimulation of new bone formation are being developed. Cathepsin K inhibitors appear to have mixed antiresorptive and anabolic actions because they inhibit one of the major osteoclast digestive enzymes without suppressing bone formation, thereby leading to anabolic effects on bone. New biologic agents in clinical trials include anti-sclerostin and anti-dickkopf antibodies that stimulate the Wnt/β-catenin pathway in osteoblasts, leading to new bone formation. These new agents will effectively stimulate new bone formation by different mechanisms, leading to improved bone mineral density and reduced fractures.     

Expression profile of osteoprotegerin, RANK and RANKL genes in the femoral head of patients with avascular necrosis

Introduction

Femoral head avascular necrosis (AVN) is a recalcitrant disease of the hip that leads to joint destruction. Osteoprotegerin (OPG), Receptor Activator of Nuclear Factor kappa-B (RANK) and RANK ligand (RANKL) regulate the balance between osteoclasts–osteoblasts. The expression of these genes affects the maturation and function of osteoblasts–osteoclasts and bone remodeling. In this study, we investigated the molecular pathways leading to AVN by studying the expression profile of OPG, RANK and RANKL genes.

Material and methods

Quantitative Real Time-PCR was performed for evaluation of OPG, RANK and RANKL expression. Analysis was based on parallel evaluation of mRNA and protein levels in normal/necrotic sites of 42 osteonecrotic femoral heads (FHs). OPG and RANKL protein levels were estimated by western blotting.

Results

The OPG mRNA levels were higher (insignificantly) in the necrotic than the normal site (p > 0.05). Although the expression of RANK and RANKL was significantly lower than OPG in both sites, RANK and RANKL mRNA levels were higher in the necrotic part than the normal (p < 0.05). Protein levels of OPG and RANKL showed no remarkable divergence.

Conclusions

Our results indicate that differential expression mechanisms for OPG, RANK and RANKL that could play an important role in the progress of bone remodeling in the necrotic area, disturbing bone homeostasis. This finding may have an effect on the resulting bone destruction and the subsequent collapse of the hip joint.     

Treatment of osteoporosis in women intolerant of oral bisphosphonates

In the past 15 years, oral bisphosphonate therapy has become the mainstay of pharmacological management in patients with osteoporosis. In the UK, alendronate is the drug of first choice, based on clinical efficacy data and cost. However, some patients are unable to take oral bisphosphonates for a number of reasons. In this article, we review the practical management of such cases, including strategies for monitoring adherence and switching to alternative oral agents (e.g. risedronate, strontium ranelate, raloxifene). In some cases, alternative parenteral agents may be considered, including intravenous bisphosphonates, parathyroid hormone therapies and denosumab. Specific concerns about safe prescribing are considered, when prescribing potent anti-resorptive medications, particularly relating to renal function and vitamin D deficiency. Finally, consideration is given to clinical risk factors, including aspects of lifestyle which may be modified to decrease fracture risk.     

Comparison of the anti-tumor effects of denosumab and zoledronic acid on the neoplastic stromal cells of giant cell tumor of bone

Abstract

Denosumab and Zoledronic acid (ZOL) are two antiresorptive drugs currently in use for treating osteoporosis. They have different mechanisms of action but both have been shown to delay the onset of skeletal-related events in patients with giant cell tumor of bone (GCT). However, the anti-tumor mechanisms of denosumab on the neoplastic GCT stromal cells remain unknown. In this study, we focused on the direct effects of denosumab on the neoplastic GCT stromal cells and compared with ZOL. The microscopic view demonstrated a reduced cell growth in ZOL-treated but not in denosumab-treated GCT stromal cells. ZOL was found to exhibit a dose-dependent inhibition in cell growth in all GCT stromal cell lines tested and cause apoptosis in two out of three cell lines. In contrast, denosumab only exerted a minimal inhibitory effect in one cell line and did not induce any apoptosis. ZOL significantly inhibited the mRNA expression of receptor activator of nuclear factor kappa-B ligand (RANKL) and osteoprotegerin (OPG) in two GCT stromal cell lines whereas their protein levels remained unchanged. On the contrary, denosumab did not regulate RANKL and OPG expression at both mRNA and protein levels. Moreover, the protein expression of Macrophage Colony-Stimulating Factor (M-CSF), Alkaline Phosphatase (ALP), and Collagen α1 Type I were not regulated by denosumab and ZOL either. Our findings provide new insights in the anti-tumor effect of denosumab on GCT stromal cells and raise a concern that tumor recurrence may occur after the withdrawal of the drug.     

Prevention of osteoporosis after breast cancer

Breast cancer is a devastating illness but cure rates are increasing and as they do the secondary effects of breast cancer treatment on bone are becoming more prominent. Of particular concern is the increased fracture rates and dramatic bone loss seen in studies of patients undergoing therapy with aromatase inhibitors. Recently a UK Expert Group has drawn up guidelines for the prevention of bone loss. The main recommendations can be summarised as follows:

•

Bone loss in women who experience a premature menopause due to treatment before the age of 45 or who are receiving ovarian suppression therapy is accelerated by the concomitant use of aromatase inhibitors. As they are at high risk of significant bone loss they should have a baseline dual energy X-ray absorptiometry (DXA) assessment of BMD.     

Effects of dietary-fiber levels on RANK/RANKL/OPG expression in the appendix of weanling rabbits

Background/purposeThe dietary fiber can regulate the intestinal mucosal immunity, and the M cell is the portal for initiating mucosal immunity. We investigated the effects of dietary fiber on the transport of Escherichia coli to assess the function of microfold (M) cells in the appendix.MethodA total of 150 New Zealand rabbits were fed three diets (high fiber (HF): 31.72%; control: 37.36%; low dietary fiber (LF): 41.84%; neutral detergent fiber (NDF). An infection model was established in vivo using E. coli containing green fluorescent protein as the indicator in appendix loops. Samples were collected before and after inoculation with indicator for 10, 30, or 60 min. The M cells number, differentiation-related genes and proteins were monitored by respectively using immunofluorescence, Q-PCR and Western-blot.ResultsThe number of M cells in HF group was significantly higher than that of LF group before and at 10 min, 30 min post injection with E.coli (P < 0.01), which has an opposite at 60 min. The number of fluorescent E. coli transported across the appendix was significantly increased in the HF group (P < 0.01) compared with the LF group at 30 min (P < 0.001); expression of RANKL gene and protein levels were no difference between HF and LF group. The variation tendency of RANK, OPG genes and proteins were consistent with the change of M cell transport indicator number in different time points.ConclusionOur study showed that a high-fiber diet can increase number of M cells and speed up antigen transfer under regulation of ANKL/OPG/RANK system.     

OPG-RANKL-RANK信号系统是调节破骨细胞及骨质疏松症的重要途径

背景：OPG-RANKL-RANK信号系统在破骨细胞对于骨吸收机制中的重要作用。 目的：归纳总结OPG-RANKL-RANK信号系统在破骨细胞、骨质疏松症中的表达,以及OPG-RANKL-RANK信号系统靶向治疗的前瞻性。 方法：在国内外期刊数据库中检索近10年内国内外文献,按关键词：骨保护素,RANKL,RANK,破骨细胞,骨质疏松症;OPG,osteoclast,osteoporosis,检索相关文献,筛选出符合纳入标准的文献,对文献进行质量评估后采纳。 结果与结论：OPG-RANKL-RANK信号系统以及相关联的信号途径是介导破骨细胞发育、成熟的重要信号途径,并且是导致骨质疏松症的机制,在基因及分子水平上,靶向治疗骨质疏松症已成为人们的关注点。基于OPG-RANKL-RANK信号系统靶向可成为治疗为骨质疏松症的研究提供平台,OPG-RANKL-RANK信号系统是调控破骨细胞及骨质疏松症的重要途径。  中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程     

Increased RANKL expression is related to tumour migration and metastasis of renal cell carcinomas

Receptor activator of NF‐κB ligand (RANKL) and its receptor, receptor activator of NF‐κB (RANK), play a key role in osteoclastogenesis, and osteoprotegerin (OPG) acts as a decoy receptor for RANKL. We investigated the role of the RANKL–RANK–OPG system in renal cell carcinomas (RCCs), which frequently metastasize to bones. Real‐time quantitative PCR revealed that RANKL mRNA expression was higher in clear cell RCCs than in papillary and chromophobe RCCs. Similarly, RANKL protein expression level in clear cell RCCs was higher than that in papillary and chromophobe RCCs, showing positive correlations with the primary tumour stage and distant metastasis. There was no significant association between the expression level of RANK, OPG and histological subtypes of RCC. RANKL and RANK expression was observed in metastatic RCCs in the bone and other organs, suggesting that they play a role in metastasis to the bone and other organs. Recombinant RANKL protein stimulated migration of a clear cell RCC cell line, Caki‐1, in vitro, and this enhanced migration was inhibited by the administration of recombinant OPG protein. Furthermore, multivariate Cox analysis revealed that elevated RANKL and RANK expression with low‐OPG expression was a significant and independent predictor of recurrence, bone metastasis and a poor prognosis. These data suggest that the RANKL–RANK–OPG system is involved not only in the bone metastasis of RCCs but also in metastasis to other organs through the stimulation of cancer cell migration. Copyright © 2009 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.     

Biochemical markers of bone metabolism in children with cow's milk allergy

Introduction

Patients with cow''s milk allergy (CMA) and following a cow milk protein-free diet for a long time are potentially at risk of developing bone abnormalities. To assess the balance between bone formation and resorption processes, we determined serum concentrations of osteocalcin (OC), bone alkaline phosphatase (BALP), C-terminal telopeptide of type I collagen (CTX), fetuin-A, osteoprotegerin (OPG) and receptor activator of nuclear factor κB ligand (RANKL) in children with CMA.

Material and methods

The study included 50 prepubertal children with diagnosed cow''s milk allergy, who were under systematic medical and nutritional care at the Institute of Mother and Child and 40 healthy counterparts as a control group. The concentrations of bone metabolism markers were determined by immunoenzymatic assays.

Results

The diets of all investigated children were correct in terms of phosphorus and magnesium contents but deficient in terms of calcium and vitamin D. Serum OC and CTX as well as fetuin-A concentrations were similar in both studied groups. The BALP activity was significantly (p < 0.05) higher in children with cow''s milk allergy than in the controls. Serum OPG concentration was comparable in both groups, but the RANKL level was higher (p < 0.05) in CMA children than in healthy ones. Hence, the ratio of OPG/RANKL was lower in children with CMA.

Conclusions

Our study demonstrates slight disturbances in the profile of bone metabolism markers in growing children with CMA. The increase in RANKL level and decrease in OPG/RANKL ratio may contribute to intensification of bone resorption in these patients.     

Spanish Menopause Society position statement: Use of denosumab in postmenopausal women

Denosumab is a new drug developed for the treatment of osteoporosis. Moreover, increasing evidences link denosumab with benefits in cancer, an area of interest for those in charge of the postmenopausal health. Denosumab has shown efficacy in the control of bone loss associated with hypogonadic states created by chemotherapy in breast and other cancers. Moreover, some studies reveal efficacy in reducing the progression of metastases. A panel of experts from the Spanish Menopause Society has met to develop usage recommendations based on the best available evidence.     

Management of osteoporosis in men on androgen deprivation therapy

Osteoporosis is a common consequence of androgen deprivation therapy (ADT) for prostate cancer. Up to 20% of men on ADT for localized prostate cancer will fracture within 5 years. Fortunately, generally safe and effect therapy is available. Although once considered non-controversial, there is some concern about calcium supplementation, but all studies of osteoporosis therapy in men have included calcium. In most older men, serum 25-hydroxyvitamin D levels are likely to be low, although again there is controversy about the ideal level. Many experts believe that all older men, including those on ADT, need to have a level of >30 ng/ml, which is easily accomplished. Bone mineral density (BMD) testing by dual energy X-ray absorptiometry (DXA) is indicated for men on ADT. Interestingly, forearm DXA may be particularly important in ADT men, in addition to spine and hip. Some experts have suggested that men on ADT with a T-score of ≤-1.5 should be treated. Alternatively FRAX or another risk calculator can be used. Oral and intravenous bisphosphonates are FDA approved treatments for men with osteoporosis and increase BMD in men on ADT. Potential off-label agents include raloxifene and toremifene. The latter and denosumab have been shown to increase bone density and decrease vertebral fractures in men on ADT. Raloxifene and denosumab are only FDA approved for postmenopausal osteoporosis. Thus, prevention of fractures can be accomplished in this high risk population.     

柚皮苷对骨质疏松大鼠拔牙创骨愈合的影响

文题释义：柚皮苷：是一种中药来源的单体化合物,主要存在于芸香科柑橘属植物的果皮和果肉中,具有抗炎和促成骨等作用。OPG/RANKL/RANK：是调节骨代谢的重要信号通路之一。OPG和RANKL由成骨细胞表达,RANKL与破骨细胞表面RANK结合促进破骨细胞分化和成熟,OPG竞争性抑制RANKL与RANK结合。背景：柚皮苷作为一种中药单体化合物,具有抗炎、促成骨的作用,但其对拔牙创愈合速度的影响并不明确。 目的：建立骨质疏松大鼠拔牙模型,通过体内实验探究柚皮苷对拔牙创愈合速度的影响。 方法：48只雌性SD大鼠随机分为假手术组14只与去势组34只。去势组去除双侧卵巢建立骨质疏松模型,6周后两组各随机取4只大鼠行MicroCT检测确认建模结果。建模成功后将剩余大鼠随机分为对照组、柚皮苷及雌二醇组,均拔除左上颌第二磨牙,柚皮苷组予以300 mg/(kg·d)柚皮苷灌胃,雌二醇组予以20 μg/(kg·d)17β雌二醇皮下注射,对照组予以等体积生理盐水处理。干预4周后,分离各组大鼠上颌骨进行苏木精-伊红染色、Masson染色、MicroCT检测,检测拔牙创周围骨组织骨保护素、核因子κB受体活化因子配体(receptor activator of nuclear factor-κB ligand,RANKL) mRNA及蛋白表达量。结果与结论：①去势6周后,去势组骨体积分数降低,证明骨质疏松建模成功;②拔牙4周后,与对照组相比,柚皮苷组、雌二醇组骨小梁间距小、骨小梁数量多,牙槽骨高度丢失更少,说明柚皮苷可促进拔牙窝骨愈合;③与对照组相比,柚皮苷组、雌二醇组拔牙创周围骨组织骨保护素表达升高、RANKL表达降低,说明柚皮苷可以通过上调骨保护素和下调RANKL的表达水平,促进骨质疏松大鼠拔牙创骨愈合。https://orcid.org/0000-0002-6871-7273(黄浩哲)中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程     

Screening for osteoporosis after breast cancer: For whom,why and when

Osteoporosis and breast cancer are common diseases in postmenopausal women. Bone and the breast are both estrogenic dependent tissues and different surrogate markers for osteoporosis are opposite of those for the risk of breast cancer. In particular, numerous studies have reported a positive relationship between high bone mineral density (BMD) and a greater risk of breast cancer. On the other hand, most treatments in early breast cancer women including ovarian suppression treatments (chemotherapy, surgery or GnRH agonists) and aromatase inhibitor (AI) therapy induce a profound and rapid suppression of estrogen levels thereby increasing the rate of bone loss. Nevertheless, their impact on the risk of fracture is still questionable, especially in postmenopausal women with no osteoporosis at baseline. The purpose of this minireview is to examine the relationship between breast cancer and the risk of fracture and to discuss a screening strategy for osteoporosis after breast cancer.