OPG/RANKL/RANK系统及其临床应用

人OPG，RANK和RANKL是3个肿瘤坏死因子家族新成员，主要存在于人的骨髓及其他少数组织中。2000年美国骨与矿物质研究协会对其给予了标准化命名，并统称为OPG/RANKL/RANK系统。作为破骨细胞形成、分化和骨吸收调节的关键调节物，OPG/RANKL/RANK系统在骨质疏松、骨硬化病、类风湿性关节炎、骨肿瘤、Paget’s病、牙周炎及正畸牙移动等临床疾病的发病机制及治疗方面均取得了较大进展。     

姜黄素对佐剂性关节炎大鼠滑膜OPG和RANKL蛋白表达的影响

目的:通过观察姜黄素对佐剂性关节炎(Adjuvant arthritis,AA)模型大鼠滑膜病理、滑膜骨保护素(Osteoprotegerin,OPG)、核因子κB受体活化因子配体(Receptor activator for nuclear factor-κB ligand,RANKL)表达的影响,探讨其防治类风湿关节炎(Rheumatoid arthritis,RA)可能作用机制。方法:雄性SD大鼠以弗氏完全佐剂造模,分为模型组与姜黄素组,另有正常组,d 28处死所有大鼠行滑膜常规病理HE染色,并用Western blot法来检测滑膜RANKL、OPG蛋白的表达。结果:模型组大鼠滑膜炎性细胞浸润、纤维细胞及滑膜细胞的增生较正常组均明显增加(P<0.01),而姜黄素组的大鼠滑膜组织病理较模型组显著改善(P<0.01);姜黄素组大鼠的滑膜RANKL表达显著低于模型组,滑膜OPG表达显著高于模型组,RANKL/OPG比值显著低于模型组(P<0.01)。结论:姜黄素不仅改善AA大鼠关节滑膜病理学损伤,还可调节滑膜RANKL/OPG的比值。因此姜黄素可能通过调节OPG/RANKL系统来发挥对AA大鼠的治疗作用。     

脊髓损伤大鼠骨组织微环境中RANKL/OPG表达的改变

目的研究脊髓损伤(SCI)大鼠骨组织微环境中RANKL/OPG表达的改变,探讨SCI对骨代谢的影响。方法 20只雄性6wSD大鼠,分为SCI组和Sham组。饲养3w后收集右侧胫骨测定骨密度,左侧胫骨切取后立刻液氮冷冻保存,一部分用于骨组织提取RNA,半定量RT-PCR分析RANKL、OPG、Col1α1、OCN基因的表达变化;另一部分用于酶免疫分析(EIA)方法测量骨组织中RANKL和OPG的含量。结果 3w时SCI组胫骨的骨密度明显低于Sham组,骨密度的下降既发生在胫骨近端干骺端(-26.3%,P0.05),又发生在胫骨干(-21.2%,P0.05)。RT-PCR检测表明,SCI后3w大鼠胫骨近端骨组织微环境中RANKL的表达显著上调(+122.2%,P0.01),OPG(-22.1%,P0.05)和OCN(-25.3%,P0.05)的表达显著下调。RANKL和OPG的表达改变也得到了EIA的证实。结论 SCI时RANKL过表达及OCN和OPG表达下调,提示SCI时易发生骨质疏松。     

RANKL/OPG系统与类风湿性关节炎

骨质重建是骨吸收和骨形成的动态平衡过程,破骨细胞是骨吸收的效应细胞。类风湿性关节炎(RA)致残的主要原因是关节软骨及骨的破坏,破骨细胞(OC)在RA骨破坏的病理过程中起关键作用。核因子-κB受体活化因子配体(RANKL)／护骨素(OPG)系统对破骨细胞生成起决定作用,也是治疗RA的新靶点。     

RANK/RANKL/OPG系统与肿瘤

胞核因子κB受体活化因子/细胞核因子κB受体活化因子配体/骨保护因子(RANK/RANKL/OPG)系统在破骨细胞的活化、发育、成熟过程中起关键性作用,近年研究发现该系统也广泛参与骨肿瘤发生、肿瘤骨转移、细胞凋亡,这些研究为相关疾病的治疗提供了新的思路和方法,如重组OPG和人类RANKL单克隆抗体AMG-162的应用。     

周期性和持续性流体剪切力对成骨细胞OPG、RANKL蛋白表达的影响

目的:观察两种不同加载模式的流体剪切力(周期性或持续性)对MC3T3-E1成骨细胞增殖以及骨保护素(OPG)、细胞核因子k B受体活化因子配体(RANKL)蛋白表达的影响,同时探讨影响成骨细胞功能的最佳流体剪切力加载模式。方法:对MC3T3-E1成骨细胞分别加载生理强度为12 dyn/cm2的周期性流体剪切力或持续性流体剪切力。其中,持续性模式采用12 dyn/cm2的流体剪切力,加载成骨细胞2 h,静息2 h;周期性流体剪切力采用12 dyn/cm2流体剪切力加载成骨细胞30 min,然后静息3 0min,如此往复循环4次,总的加力时间为2 h。最后,MTT法检测不同加载模式下成骨细胞的增殖情况,Westernblot检测两组成骨细胞OPG、RANKL蛋白的表达影响。结果:MTT结果显示,两种加载模式的流体剪切力均能够显著促进成骨细胞的增殖(P<0.05),与持续性流体剪切力相比,周期性流体剪切力更能有效的促进成骨细胞的增殖(P<0.05)。另外,两种模式的流体剪切力均能有效地调控MC3T3-E1成骨细胞OPG、RANKL的表达(P<0.05)。但与持续性流体剪切力相比,周期性流体剪切力对成骨细胞OPG蛋白的促进作用更为显著(41.34%±5.37%vs 80.42%±4.19%,P<0.05);对成骨细胞RANKL蛋白的抑制作用更为明显[(24.17±5.92)%vs(8.45±2.18)%,P<0.05]。结论:与持续流体剪切力相比,周期性流体剪切力对成骨细胞增殖以及OPG、RANKL蛋白有更显著的调节作用。     

高甘油三酯对去卵巢大鼠股骨RANKL/OPG mRNA表达的影响

目的:探讨高甘油三酯(TG)对去卵巢大鼠股骨核因子-κB受体活化因子配体/护骨素(RANKL/OPG)mRNA表达的影响及非诺贝特的作用。方法:将3月龄雌性SD大鼠40只,用果糖饲养复制高TG模型,大鼠分为4组:(1)去卵巢+果糖组;(2)去卵巢+果糖+非诺贝特(FF)组;(3)去卵巢+普食组;(4)假手术+果糖组。12周后取股骨检测RANKL/OPG mRNA表达水平。结果:(1)去卵巢+果糖组的TG水平高于去卵巢+普食组(P0.01),也高于去卵巢+果糖+FF组(P0.01);(2)去卵巢+果糖组RANKL/OPG mRNA水平,均高于去卵巢+果糖+FF组、去卵巢+普食组和假手术+果糖组(P0.01或P0.05)。结论:高果糖饮食可以诱导去卵巢大鼠形成高甘油三酯血症,后者使股骨组织中RANKL/OPG mRNA增加;非诺贝特可降低TG,保持RANKL/OPG mRNA的平衡。     

RANKL／OPG与人多发性骨髓瘤骨病的关系

多发性骨髓瘤(MM)是以骨髓微环境中浆细胞恶性增殖为特征的血液肿瘤。细胞核因子κB受体活化因子配基(RANKL) /护骨素(OPG)与MM发病关系密切。在MM中,存在RANKL表达上调、OPG表达下调;这种RANKL/OPG比率异常与MM骨病及骨病范围、MM的肿瘤负荷、分期和预后均有关。     

富血小板纤维蛋白对下颌骨牵引成骨区RANKL表达的影响

目的　通过动物实验,研究应用富血小板纤维蛋白（Platelet-rich Fibrin,PRF）对兔下颌骨牵引成骨区核因子KB受体活化因子配体（receptor activator for NF-KB ligand,RANKL）的影响, 为临床研究与应用提供参考依据。 方法　在20只成年大耳白兔的一侧下颌骨前部行骨切开术,用牵引器延长一侧下颌骨4 mm,牵引间隙放置PRF膜;另一侧下颌骨行骨切开并安置牵引器,作为对照组,稳定期第1、7、14、21、28天,分别处死各组动物,取牵引区新生骨痂行组织学及RANKL免疫组化染色。 结果　下颌牵引延长后牵引间隙均有新骨形成,免疫组织化学显色RANKL主要定位于骨髓基质细胞的胞浆中,其中以稳定期的第1,14天的表达最强。在稳定期第1、14天,实验组较对照组RANKL表达的阳性细胞率及阳性面积百分比差异有统计学意义（P＜0.05）,以后逐渐下降,第28 d仅有微弱表达。 结论　动物实验表明,PRF能促进兔下颌骨牵引成骨区新骨的生成,RANKL可能在牵引成骨过程中特别是调控组织细胞应力信号传递的早期发挥破骨作用。     

蓉黄颗粒对非透析肾虚湿热证慢性肾脏病矿物质和骨异常患者血清OPG、RANKL 水平的影响

目的:观察非透析慢性肾脏病矿物质和骨异常(CKD-MBD)肾虚湿热证患者血清骨保护素(OPG)、核因子-κB 受体活化因子配体(RANKL)水平的变化及蓉黄颗粒对其干预作用。方法:将70 例非透析CKD-MBD 肾虚湿热证患者随机分为治疗组和对照组各35 例,实际完成61 例,治疗组30 例,对照组31 例,并设正常组20 例。治疗组和对照组均给予对症治疗,治疗组加服蓉黄颗粒,每天3 次,每次1 袋,疗程均为8 周。观察两组患者临床疗效、治疗前后尿素氮(BUN)、血肌酐(Scr)、肾小球滤过率估算值(eGFR)、血钙(Ca)、血磷(P)、碱性磷酸酶(ALP)、全段甲状旁腺激素(iPTH)、OPG 及RANKL 水平的变化情况。结果:治疗组临床疗效显著优于对照组(P<0.01);两组中医证候积分值均随疗程的增加逐渐下降(P<0.01),而治疗组下降幅度均显著优于对照组(P<0.01)。治疗后,治疗组BUN、Scr、eGFR、Ca、P、iPTH 及ALP 水平均显著改善(P<0.05 或P<0.01);对照组除BUN、iPTH 改善显著(P<0.05 或P<0.01)外,其余各项指标均无明显改善(P>0.05);治疗后治疗组各项指标亦均显著优于对照组(P<0.05 或P<0.01)。治疗前两组患者血清OPG 及RANKL 水平均显著高于正常组(P<0.01);治疗后,治疗组血清OPG、RANKL 水平及OPG/ RANKL 比值均显著改善(P<0.05 或P<0.01),对照组仅OPG/ RANKL比值明显上升(P<0.01),且治疗组各项指标均显著优于对照组(P<0.05 或P<0.01)。结论:非透析CKD-MBD 肾虚湿热证患者OPG 及RANKL 水平均显著高于正常人群,OPG/ RANKL 比值低于正常人群;蓉黄颗粒具有改善非透析CKD-MBD 肾虚湿热证患者临床症状、有效纠正钙磷代谢紊乱、保护肾功能的作用,其机制可能与其降低血清OPG、RANKL 水平,升高OPG/RANKL 比值有关。     

Serum Levels of OPG,RANKL, and RANKL/OPG Ratio in Patients with Ankylosing Spondylitis: A Systematic Review and Meta-analysis

Objectives: To investigate the role of osteoprotegerin (OPG), receptor activator of nuclear factor-kB ligand (RANKL), and RANKL/OPG ratio in the pathogenesis of ankylosing spondylitis (AS).

Methods: Studies that compared serum levels of OPG, RANKL, and RANKL/OPG ratio between AS patients and healthy controls were gathered. Pooled standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated by the random-effects model.

Results: Twenty studies containing 1592 AS patients and 1064 healthy controls were included in this meta-analysis. Serum levels of OPG, RANKL, and RANKL/OPG ratio in AS patients were significantly higher than that in normal controls (OPG: SMD = 0.401, 95%CI = 0.026–0.777, p = 0.036; RANKL: SMD = 1.116, 95%CI = 0.510–1.723, p < 0.001; RANKL/OPG ratio: SMD = 0.691, 95%CI = 0.084–1.299, p = 0.026, respectively). Subgroup analysis suggested that Asian AS patients and patients with elevated ESR (ESR >20 mm/h) had higher serum OPG levels compared to normal controls. Asian patients, CRP >10 mg/L, ESR >20 mm/h, duration of disease ≤8 years, and BASDAI score >4 points subgroups showed increased RANKL levels compared to controls.

Conclusions: Serum levels of OPG, RANKL, and RANKL/OPG ratio may be used as potential susceptible biomarkers for AS, but they could be influenced by race, inflammatory factors, and disease activity of AS patients.     

Dehydroepiandrosterone inhibited the bone resorption through the upregulation of OPG/RANKL

The plasma level of dehydroepiandrosterone （DHEA） is decreases gradually along with aging. The beneficial effects of DHEA as an anti-aging steroid, such as the stimulatory effect on immune system, anti-diabetes mellitus, antl-atherosclerosis, anti.dementia, anti-obesity and anti-osteoporosis have been demonstrated in experiment both in vitro and in vivo. It is important to investigate the effective mechanism of DHEA in therapeutics for postmenopausal osteoporosis. Having isolated and cultured osteoblasts （OBs） and osteoclasts （OCs）, we analysed the effect of DHEA on osteoblastic viability, regulation of DHEA on the expression of osteoprotegerin （OPG）/receptor activator of NF-κB Ugand （RANKL） mRNA in OBs, and then observed the action of DHEA on bone resorption of OCs in the presence or absence of OBs. The results showed that DHEA improved viability of OBs within the concentration range of 10^-8-10^-6 M, especially at the concentration of 10^-7 M. DHEA could apparently increase the ratio of OPG/RANKL mRNA in OBs. In the presence of OBs, DHEA could decrease the number and area of absorption lacuna of specula. We concluded, therefore, only in the presence of OBs, DHEA could inhibit the bone resorption of OCs, which may be mediated by OPG/RANKL of OBs.     

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.     

OPG/RANKL/RANK信号通路在骨巨细胞瘤发病机制中的作用

文题释义：OPG/RANKL/RANK 信号通路：是骨代谢中至关重要的一条信号通路,它是成骨细胞与破骨细胞之间相互作用的信号通道,同时也是骨巨细胞瘤影响骨代谢的主要途径。 骨巨细胞瘤(Giant cell tumor of bone,GCTB)：是常见的原发性骨肿瘤之一,其发病率占所有原发性骨肿瘤的4%-10%,多发生于20-40岁的青壮年患者,好发于股骨远端、胫骨近端或桡骨远端。骨巨细胞瘤组织学来源尚不清楚,一般认为起始于骨髓内间叶组织。该肿瘤具有较强的侵袭性,对骨质有较大的破坏和侵蚀作用,但很少有患者出现反应性新骨生成或是自愈倾向。 背景：研究表明,骨保护素/核因子κB受体活化因子配体/核因子κB受体活化因子(OPG/RANKL/RANK)信号通路与骨巨细胞瘤发病机制之间有一定的相关性,通过控制OPG/RANKL/RANK信号通路影响成骨细胞与破骨细胞之间相互作用,对该病起到一定的治疗作用。 目的：介绍 OPG/RANKL/RANK信号通路与骨巨细胞瘤发病机制的关系,总结并讨论OPG/RANKL/RANK信号通路在骨巨细胞瘤发病机制中的最新研究进展。 方法：检索 PubMed 数据库、Web of science数据库及万方数据库中2001至2019年相关文献,检索词分别为“OPG/RANKL/RANK,giant cell tumor of bone,pathogenesis,signal pathway, bone metabolism,OPG/RANK/RANKL,骨巨细胞瘤,发病机制,信号通路,骨代谢”。排除较陈旧及重复的文献,通过整理,共纳入53篇文献进行分析探讨。 结果与结论：①骨保护素抑制破骨细胞增殖及分化,降低成熟破骨细胞活性,阻断核因子κB受体活化因子配体与核因子κB受体活化因子结合,减缓破骨;②核因子κB受体活化因子配体与破骨细胞前体细胞表面的核因子κB受体活化因子结合,促进破骨细胞前体细胞分化,增殖,进而加速破骨;③核因子κB受体活化因子配体与其受体结合后,激活核因子κB等信号因子促进破骨细胞的增殖、分化并激活破骨细胞,同时调节相关基因的转录及表达;④OPG/RANK/RANKL与骨巨细胞瘤发病机制相关。 ORCID: 0000-0002-2756-4848(梁晨亮) 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     

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.     

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。     

Effect of hypoxia on the expression of RANKL/OPG in human periodontal ligament cells in vitro

To investigate the impact of hypoxia on the expression of receptor activator of NF-kB ligand (RANKL) and osteoprotegerin (OPG) in human periodontal ligament cells (hPDLCs) in vitro. hPDLCs were incubated in a hypoxic atmosphere of 2% O₂, 5% CO₂, 94% N₂ at 37°C for 6, 12, 24 and 48 h. After that, cell proliferation assay was determined using CCK-8 technique. SP immunocytochemistry method was performed to trace the expression of hypoxia-inducible factor 1 alpha (HIF-1α) in hPDLCs. The expression levels of RANKL and OPG were investigated using real-time PCR and ELISA. As a control, the cells were incubated at normoxic conditions of 20% O₂, 5% CO₂, 75% N₂. All results were analyzed using one-way ANOVA at a significant level of P=0.05. OPG mRNA and protein levels were down-regulated meanwhile RANKL mRNA and soluble RANKL (sRANKL) protein levels were up-regulated after stimulated by hypoxia. The relative RANKL/OPG expression ratios were increased in both mRNA and protein levels. The expression of RANKL mRNA and sRANKL protein levels was enhanced significantly (P<0.05) under the hypoxia conditions at 12 h, 24 h and 48 h while OPG mRNA and protein were reduced significantly (P<0.05) at 12 h, 24 h and 48 h. Hypoxia can affect the expression of RANKL and OPG in hPDLCs, which constitute an important pathogenic event in the alveolar bone resorption. Lack of oxygen in periodontal tissue may accelerate the development of periodontitis.     

RANKL/OPG/TRAIL plasma levels and bone mass loss evaluation in antiretroviral naive HIV-1-positive men

Osteopenia and osteoporosis are common in HIV-1-infected individuals and represent a challenge in clinical and therapeutic management. This report investigated osteopenia/osteoporosis in a group of 31 antiretroviral naive HIV-1-positive men and the role of specific molecules belonging to TNF and the TNF-receptor family in HIV-1-related bone mass loss. Osteoprotegerin (OPG), the receptor activator of NF-kappab-ligand (RANKL), and the TNF-related apoptosis-inducing ligand (TRAIL) were significantly increased in the plasma of antiretroviral naive HIV-1-positive patients compared to a control group of healthy blood donors. In addition, TRAIL and RANKL plasma concentrations were positively correlated to HIV-1-RNA viral load. Measurement of bone mineral density in 20 out of 31 HIV-1-positive subjects disclosed osteopenia/osteoporosis in 40% of these patients. The antiretroviral naive HIV-1-positive subjects with low bone mineral density had a decreased plasma OPG/RANKL ratio and a plasma RANKL concentration >500 pg/ml. Together, these data indicate that plasma concentrations of specific factors involved in bone homeostasis were increased during HIV-1 infection and that RANKL and OPG/RANKL ratio deregulation may be involved in osteopenia/osteoporosis occurring in antiretroviral naive HIV-1 individuals.