The Wnt signaling pathway and bone metabolism

PURPOSE OF REVIEW: The Wnt signaling pathway has been a major focus of effort in the bone field for the past 5 years. This review will examine some of the seminal findings that have brought us to our current understanding of the role of this pathway in bone metabolism. RECENT FINDINGS: The Wnt/beta-catenin signaling pathway has been shown to play a major role in bone cell differentiation, proliferation and apoptosis. It is a critical component of bone mass regulation and required for bone to respond to mechanical loading. The pathway is tightly regulated by a number of modulator proteins. Mutations in pathway components that result in aberrant regulation are involved in a number of bone diseases. SUMMARY: Understanding the role that the Wnt signaling pathways play in the regulation of bone metabolism offers great promise for the developmental of new paradigms and pharmaceutical strategies for the treatment of various diseases such as osteoporosis, rheumatoid arthritis and osteoarthritis. Progress in this regard has already been made.     

Wnt Signaling: Role in Regulation of Haematopoiesis

Hematopoietic stem cells (HSCs) are a unique population of bone marrow cells which are responsible for the generation of various blood cell lineages. One of the significant characteristics of these HSCs is to self-renew, while producing differentiating cells for normal hematopoiesis. Deregulation of self-renewal and differentiation leads to the hematological malignancies. Several pathways are known to be involved in the maintenance of HSC fate among which Wnt signaling is a crucial pathway which controls development and cell fate determination. Wnt signaling also plays a major role in differentiation, self-renewal and maintenance of HSCs. Wnt ligands activate three major pathways including planar cell polarity, Wnt/β-catenin and Wnt/Ca²⁺. It has been shown that Wnt/β-catenin or canonical pathway regulates cell proliferation, survival and differentiation in HSCs, deregulation of this pathway leads to hematological malignancies. Wnt non-canonical pathway regulates calcium signaling and planar cell polarity. In this review, we discuss various signaling pathways induced by Wnt ligands and their potential role in hematopoiesis.     

Evolution of the parathyroid hormone family and skeletal formation pathways

Bone is considered to be a feature of higher vertebrates and one of the features that was required for the movement from water onto land. But there are a number of evolutionarily important species that have cartilaginous skeletons, including sharks. Both bony and cartilaginous fish are believed to have a common ancestor who had a bony skeleton. A number of factors and pathways have been shown to be involved in the development and maintenance of bony skeleton including the Wnt pathway and the parathyroid hormone gene family. The study of these pathways and factors in cartilaginous animals may shed light on the evolution of the vertebrate skeleton.     

非经典Wnt信号在骨稳态中的作用

Wnt信号通路是由经典及非经典两类通路组成的一个复杂的蛋白网络,其在骨代谢疾病和肿瘤疾病等研究中至关重要.对于骨代谢疾病早期报道多集中于经典信号通路,但随着研究的不断深入,非经典Wnt信号通路在调控骨稳态(骨形成和骨吸收)中的作用日益受到关注.本文对非经典Wnt配体及其在骨稳态中的作用进行阐述,了解非经典Wnt信号的靶向调控为治疗骨质疏松症等骨稳态失衡相关疾病提供潜在研究方法及新的靶点.     

Diseases of Wnt signaling

The Wnt signaling pathways play fundamental roles in the differentiation, proliferation, death and function of many cells and as a result are involved in critical developmental, growth and homeostatic processes in animals. There are four currently known pathways of Wnt signaling; the so-called canonical or Wnt/β-catenin pathway, the Wnt/Ca⁺² pathway involving Protein Kinase A, the planar cell polarity pathway and a pathway involving Protein Kinase C that functions in muscle myogenesis. The best studied of these is the Wnt/β-catenin pathway. The Wnts are an evolutionarily highly conserved family of genes/proteins. Control of the Wnt pathways is modulated by a number of the proteins that either interact with the Wnt ligands directly, or with the low density lipoprotein-receptor related proteins (LRP) 5 and 6 that along with one of several Frizzled proteins function as co-receptors for the Wnt ligands. Aberrant regulation resulting as a consequence of mutations in any of several components of the Wnt pathway and/or protein modulators of the pathway have been shown to cause a wide spectrum of diseases. This review will briefly touch on various diseases of Wnt signaling including cancer, aortic valve calcification and several bone related phenotypes. Our emerging understanding of Wnt signaling offers great hope that new molecular based screening tests and pharmaceutical agents that selectively target this pathway will be developed to diagnose and treat these diseases in the future. An erratum to this article can be found at     

Molecular genetics of adrenocortical tumor formation and potential pharmacologic targets

Abnormalities in the cAMP/PKA signaling pathway have been linked to the formation of benign adrenal tumors, as well as a possible predisposition to adrenocortical cancer. Mutations in the G-protein coupled receptor are associated with McCune-Albright syndrome and ACTH-independent macronodular adrenal hyperplasia, while defects in cAMP-dependent protein kinase A can lead to the development of Carney's complex, as well as primary pigmented nodular adrenocortical disease (PPNAD), and micronodular adrenocortical hyperplasia (MAH). Defects in phosphodiesterases, which regulate cAMP levels, have also been demonstrated in PPNAD and MAH. The Wnt signaling pathway, which is involved in oncogenesis in a variety of tumors, has also been implicated in adrenocortical tumorigenesis. MicroRNA profiling has added to our understanding of the signaling pathways involved in tumor formation in the adrenal cortex. Will this all lead to the development of specific targets for pharmacologic therapies? In this article, we review the molecular genetics of adrenocortical tumors and refer to potential targets for pharmacologic therapy.     

Lo que el clínico debe saber sobre los mecanismos de conexión entre la inflamación y la formación de hueso. ¿Es suficiente el bloqueo de la inflamación para prevenir la osificación?

In spondyloarthropathies, the distinctive evidence of skeletal damage is de novo bone formation in the form of an ossifying enthesopathy, be it axial or peripheral, and bony ankylosis. Biologic therapy that neutralize the tumor necrosis factor have shown to be effective controlling the inflammatory activity of these diseases. However, data from animal models, clinical imaging studies and ecographic data seem to indicate that inflammation and bone formation could be independent processes and that control of inflammation might not be enough to impede the development of ankylosis in these patients. In the osteoblasts’ differentiation and activation that leads to bone formation, the Wnt (wingless) pathway and the bone morphogenic proteins acquire a special role and might be determinant in the onset and progression of enthesopathic ossification, as well as become therapeutic targets. On the other hand, clinical and imaging findings as well as the determination of bone markers support the hypothesis that that ossification is initially related to inflammation as a repair process. These facts are reviewed and the latest theories are exposed, in an attempt to establish a link between inflammation and bone formation.     

What the clinician needs to know about the relationship between inflammation and bone formation. Is blocking inflammation enough to prevent ossification?

In spondyloarthropathies, the distinctive evidence of skeletal damage is de novo bone formation in the form of an ossifying enthesopathy, be it axial or peripheral, and bony ankylosis. Biologic therapy that neutralize the tumor necrosis factor have shown to be effective controlling the inflammatory activity of these diseases. However, data from animal models, clinical imaging studies and ecographic data seem to indicate that inflammation and bone formation could be independent processes and that control of inflammation might not be enough to impede the development of ankylosis in these patients. In the osteoblasts' differentiation and activation that leads to bone formation, the Wnt (wingless) pathway and the bone morphogenic proteins acquire a special role and might be determinant in the onset and progression of enthesopathic ossification, as well as become therapeutic targets. On the other hand, clinical and imaging findings as well as the determination of bone markers support the hypothesis that that ossification is initially related to inflammation as a repair process. These facts are reviewed and the latest theories are exposed, in an attempt to establish a link between inflammation and bone formation.     

An update on primary hip osteoarthritis including altered Wnt and TGF-β associated gene expression from the bony component of the disease

The study of primary hip OA is continuing to redefine what was once considered a stagnant pathology as one of dynamic change, occurring over a long period of time involving the many composite tissue types of the joint including the bone. Examination of the inverse relationships evident between OA and fracture cohorts, including individuals with osteoporosis (OP), indicates an imbalance in formation and resorption in the bony component of both pathologies. This review contains an overview of primary OA followed by an assessment of differential gene expression and altered cellular characteristics identified in the bony compartments of primary hip OA, with a focus on the wingless mouse mammary tumor virus integration (Wnt) and TGF-β signalling pathways. The studies reviewed here suggest that OA is a systemic disease involving the bone and validate the assessment of molecular changes to further investigate this complex disease.     

Genetic aspects of susceptibility,severity, and clinical expression in ankylosing spondylitis

While twin studies have previously demonstrated high heritability of susceptibility to ankylosing spondylitis (AS), it is only recently that the involvement of genetic factors in determining the severity of the disease has been demonstrated. The genes involved in determining the rate of ankylosis in AS are likely to be different from those involved in the underlying immunologic events, and represent important potential targets for treatment of AS. This article will describe the progress that has been made in the genetic epidemiology of AS, and in identifying the genes involved.     

Evidence that Dkk‐1 is dysfunctional in ankylosing spondylitis

Objective

Dkk‐1 is an inhibitory molecule that regulates the Wnt pathway, which controls osteoblastogenesis. This study was undertaken to explore the potential role of Dkk‐1 in ankylosing spondylitis (AS), a prototypical bone‐forming disease.

Methods

Serum Dkk‐1 levels were measured in 45 patients with AS, 45 patients with rheumatoid arthritis (RA), 15 patients with psoriatic arthritis (PsA), and 50 healthy subjects by sandwich enzyme‐linked immunosorbent assay (ELISA). A functional ELISA was used to assess the binding of Dkk‐1 to its receptor (low‐density lipoprotein receptor–related protein 6). Furthermore, we studied the effect of sera from patients with AS and healthy subjects on the activity of the Wnt pathway in the Jurkat T cell model, with and without a neutralizing anti–Dkk‐1 monoclonal antibody, by Western immunoblotting.

Results

Serum Dkk‐1 levels were significantly increased in patients with AS (mean ± SEM 2,730 ± 135.1 pg/ml) as compared with normal subjects (P = 0.040), patients with RA (P = 0.020), and patients with PsA (P = 0.049). Patients with AS receiving anti–tumor necrosis factor α (anti‐TNFα) treatment had significantly higher serum Dkk‐1 levels than patients with AS not receiving such treatment (P = 0.007). Patients with AS studied serially prior to and following anti‐TNFα administration exhibited a significant increase in serum Dkk‐1 levels (P = 0.020), in contrast to patients with RA, who exhibited a dramatic decrease (P < 0.001). Jurkat cells treated with serum from AS patients exhibited increased Wnt signaling compared with cells treated with control serum. In that system, Dkk‐1 blockade significantly enhanced Wnt signaling in control serum–treated, but not AS serum–treated, Jurkat T cells.

Conclusion

Our findings indicate that in patients with AS, circulating bone formation–promoting factors functionally prevail. This can be at least partially attributed to decreased Dkk‐1–mediated inhibition.

     

Targeting the Wnt/beta-catenin pathway to regulate bone formation in the adult skeleton

The recent identification of a link between bone mass in humans and gain- or loss-of-function mutations in the Wnt coreceptor low-density lipoprotein receptor-related protein 5 (osteoporosis pseudoglioma syndrome, high bone mass trait) or in the Wnt antagonist sclerostin (sclerosteosis, van Buchem syndrome) has called the attention of academic and industry scientists and clinicians to the importance of this signaling pathway in skeletal biology and disease. Multiple genetic and pharmacological manipulations of Wnt signaling in mice have since then confirmed the central role of this pathway in regulating bone formation.     

关于sFRP-1在心血管疾病中的研究进展

sFRP-1基因，其实质为一种分泌型糖蛋白，主要与Wnt信号通路具有同源结构的卷曲蛋白受体竞争性结合，通过对Wnt信号通路的负调控，广泛介入到调控细胞增殖、分化、凋亡、癌变以及调节机体的生长发育、疾病等病理生理的复杂过程。抑制wnt信号通路可以阻止心肌细胞缺血坏死面积的进一步扩大，延缓心肌重塑的过程，进而改善预后。作为Wnt信号通路的抑制因子，sFRP-1的作用不可忽视，相关实验研究结果有理由使我们相信sFRP-1基因很有可能成为未来心血管疾病治疗的靶向基因。     

Wnt-beta-catenin signaling in the pathogenesis of osteoarthritis

Osteoarthritis (OA) is a progressively degenerative joint condition that is influenced by various metabolic and structural factors. The canonical Wnt-frizzled-beta-catenin pathway has been implicated in the pathogenesis of OA. Products of the Wnt, frizzled, secreted frizzled-related protein (sFRP), Dickkopf and LDL-receptor-related protein gene families have crucial roles in the development and maintenance of bone, cartilage and joints. Increased levels of beta-catenin have been observed in degenerative cartilage, suggesting that a diminished capacity to limit Wnt signaling might contribute to cartilage loss. Polymorphisms in genes involved in Wnt signaling-particularly in the gene encoding sFRP-3-are associated with an increased susceptibility to the development of OA. At least one of these polymorphisms in the gene encoding sFPR-3 is associated with a reduced ability to limit beta-catenin signaling. In addition, the canonical Wnt signaling pathway is influenced by local factors, including alterations in glycosaminoglycan sulfation, cartilage matrix content, transforming growth factor beta and vitamin D. A higher circulating level of the Wnt inhibitor Dickkopf-1, for instance, is associated with slowed progression of hip OA. Hence, the sum of local and systemic factors contributes to the outcome of the Wnt-frizzled pathways. Further investigation is needed to fully define the role of Wnt signaling in OA.     

Wnt信号通路在动脉粥样硬化及血管钙化中的研究进展

Wnt信号调控胚胎发育过程的多种生物学行为,包括细胞增殖、凋亡、细胞极性和器官发生,在胚胎发育过程起着重要作用。而在成人中,该信号处于沉默状态。最近证据表明,Wnt信号通路在许多生物学过程和疾病中被重新激活,参与代谢、炎症、肿瘤等疾病的发生,调节骨稳态,促进成骨细胞分化,诱导骨生成,并与动脉粥样硬化和血管钙化的发展进程密切相关。本文重点就Wnt信号通路的激活在内皮功能障碍、炎症反应、平滑肌细胞增殖及促进动脉粥样硬化和血管钙化等方面的作用进行综述。     

Histopathologic evidence that sacroiliitis in ankylosing spondylitis is not merely enthesitis

OBJECTIVE: To systematically study the histopathology of sacroiliitis in ankylosing spondylitis (AS) at 5 different stages of the disease. METHODS: Two independent observers assessed 75 microscopic features in the sacroiliac (SI) joints in 12 cases of AS (5 biopsies, 7 autopsies) and in 22 control cases (all autopsies). RESULTS: In AS, synovitis, pannus formation, myxoid marrow, superficial cartilage destruction, enthesitis, intraarticular fibrous strands, new bone formation, and bony ankylosis were significantly more frequent than in control cases, in which there was more endochondral bone within deep-zone articular cartilage. Cartilaginous fusion occurred in both groups, but much earlier in AS. There was no residual synovium when the joint lumen was totally occluded. Mild but destructive synovitis and myxoid subchondral bone marrow were the earliest changes identified in AS. These lesions destroyed the adjacent articular tissues, a loss that was followed to varying degrees by fibrous scarring, woven bone, and new cartilage. The original cartilages also fused, and chondral fusion was the predominant mode of ankylosis. Both the original and the reparative cartilaginous tissues were replaced by bone. Active enthesitis occurred in 2 advanced and 3 late cases; fibrous scar tissue, presumed to represent previous enthesitis, was observed in all stages except the earliest. Paraarticular bone was at first dense, and later porotic. CONCLUSION: In the sacroiliitis of AS, two findings predominate: 1) synovitis and subchondral bone marrow changes offer a more rational explanation for widespread joint destruction than does enthesitis; and 2) an unusual form of chondroid metaplasia contributes to ankylosis.     

Clinical review 165: Markers of bone remodeling in metastatic bone disease

Many cancers have a strong propensity to spread to bone. The processes involved in cancer dissemination to bone are complex and variable, and the changes in bone metabolism, once bony metastases have occurred, are usually profound. This review surveys the usefulness of bone markers in the diagnosis and follow-up of patients with malignant bone disease. In patients with established bone metastases, most markers of bone remodeling are abnormal compared with healthy controls or cancer patients without bone lesions. Although bone markers may have a potential as diagnostic tools in cancer patients, the available data do not allow final conclusions regarding the accuracy and validity of any of the presently used markers in the diagnosis of bone metastases. As regards monitoring of anticancer therapy, most markers of bone remodeling respond to active treatments. These indices therefore may have the potential to be used in the monitoring of antitumor therapies. However, most if not all of the available evidence on the use of bone markers in monitoring anticancer therapy is observational, and it remains unclear whether they have any beneficial effects on overall outcome. The same is true for their prognostic value, although evidence suggests that suppressed levels of bone formation or high rates of bone resorption are independent predictors of poor survival.     

Wnt signaling and osteoblastogenesis

Wnts are a large family of growth factors that mediate fundamental biological processes like embryogenesis, organogenesis and tumorigenesis. These proteins bind to a membrane receptor complex comprised of a frizzled (FZD) G-protein-coupled receptor (GPCRs) and a low-density lipoprotein (LDL) receptor-related protein (LRP). The formation of this ligand-receptor complex initiates a number of intracellular signaling cascades that includes the canonical/β-catenin pathway, as well as several GPCR-mediated noncanonical pathways. In recent years, canonical Wnt signaling has been shown to play a substantial role in the control of bone formation. Clinical investigations have found that mutations in LRP-5 are associated with bone mineral density and fractures. For example, loss-of-function mutations in LRP-5 cause osteoporosis pseudoglioma syndrome, while gain-of-function mutations lead to high bone mass phenotypes. Studies of knockout and transgenic mouse models for Wnt pathway components like Wnt-10b, LRP-5/6, secreted frizzled-related protein-1, dickkopf-2, Axin-2 and β-catenin have demonstrated that canonical signaling modulates most aspects of osteoblast physiology including proliferation, differentiation, bone matrix formation/mineralization and apoptosis as well as coupling to osteoclastogenesis and bone resorption. Future studies in this rapidly growing area of research should focus on elucidating Wnt/FZD specificity in the control of bone cell function, the role of noncanonical pathways in skeletal remodeling, and direct effects of Wnts on cells of the osteoclast lineage.