Evolution of the parathyroid hormone (PTH) assay--importance of circulating PTH immunoheterogeneity and of its regulation.

Most of what we know on PTH bioactivity has been associated with the first 34 amino acids of the PTH structure acting on the type I PTH/PTHrP receptor, leaving little place to the carboxyl-terminal structure. This reality has dictated the evolution of the PTH assay. The first generation of PTH assays has permitted the description of circulating PTH immunoreactivity and of its acute regulation by calcium concentration. Most assays reacted with the dominant forms of circulating PTH, PTH fragments devoid of bioactivity. This was believed to limit their clinical performance, particularly in the diagnosis of hypercalcemic disorders and the evaluation of secondary hyperparathyroidism and/or bone diseases associated with chronic renal failure. This brought up the development of a 2nd generation of PTH assays, the Intact (I) PTH assay. These assays were initially demonstrated to react only with hPTH(1-84), the bioactive form of the hormone. They greatly improved the differential diagnosis of hypercalcemic disorders, facilitated studies of parathyroid function in renal failure patients but were still limited in their capacity to dissociate the various bone diseases associated with chronic renal failure. Eventually, it was demonstrated that these assays, which used 13-34 epitopes, reacted with large C-PTH fragments having a partially preserved amino-terminal (N) structure, also called non-(1-84) PTH. These fragments accounted for up to 50% of I-PTH immunoreactivity in renal failure patients. hPTH(7-84), a surrogate of non-(1-84) PTH fragments, was demonstrated to cause hypocalcemia and to antagonize hPTH(1-34) and hPTH(1-84) calcemic effect in vivo and to inhibit bone resorption in vitro via a C-PTH receptor, different from the type I PTH/PTHrP receptor. This suggested a dual control of calcium concentration via N- and C-PTH molecular forms. This also explained why the ratio of C-PTH fragments/I-PTH was so well regulated both acutely and chronically in various experimental conditions. The fact that I-PTH assays detected circulating PTH molecular forms with biological effects opposite to those of hPTH(1-84) was believed to explain their limitations, particularly in renal failure, and prompted the evolution of a third generation of PTH assays. The last is based on a 1-4 epitope to reveal PTH(1-84) and not hPTH(7-84). It also permits an indirect evaluation of non-(1-84) PTH fragments by subtracting a 3rd generation PTH value from a 2nd generation PTH value and the calculation of a PTH(1-84)/non-(1-84) PTH ratio. The combination of a third generation PTH value with the PTH(1-84)/non-(1-84) PTH ratio value has in some studies improved the differential diagnosis of bone diseases associated with renal failure. But more studies are required to see whether PTH(1-84)/PTH fragment ratios will improve the clinical performance of PTH concentrations used alone.

New insights into interactions between the human PTH/PTHrP receptor and agonist/antagonist binding.

We prepared a polyclonal antiserum [Ab-(88-97)] against residues 8-97 of the NH2-terminal tail of the human (h) parathyroid hormone (PTH)/PTH-related protein (PTHrP) receptor. Ab-(88-97) bound specifically to the receptor, as assessed by fluorescence-activated cell sorter analysis of HEK C21 cells, which stably express approximately 400,000 hPTH/PTHrP receptors per cell. Unlike PTH, Ab-(88-97) binding did not elicit either adenosine 3',5'-cyclic monophosphate or intracellular calcium concentration signaling responses in these cells. Incubation of C21 cells for 90 min at 4 degrees C with hPTH-(1-34) plus antiserum reduced the Ab-(88-97) binding to the cells by up to 40-50% of control values in a PTH concentration-dependent fashion with a half-maximal effective concentration of approximately 5 nM. The decrease in Ab-(88-97) binding caused by hPTH-(1-34) was completely reversed by coincubation with hPTHrP-(7-34). We conclude that residues 88-97 of the hPTH/PTHrPR are involved, either directly or indirectly, in agonist but not antagonist binding to the receptor.

Constitutive activation of the cyclic adenosine 3',5'-monophosphate signaling pathway by parathyroid hormone (PTH)/PTH-related peptide receptors mutated at the two loci for Jansen's metaphyseal chondrodysplasia.

Two different activating PTH/PTH-related peptide (PTHrP) receptor mutations, H223R and T410P, were recently identified as the most likely cause of Jansen's metaphyseal chondrodysplasia. To assess the functional importance of either amino acid position in the human PTH/PTHrP receptor, H223 and T410 were individually replaced by all other amino acids. At position 223, only arginine and lysine led to agonist-independent cAMP accumulation; all other amino acid substitutions resulted in receptor mutants that lacked constitutive activity or were uninformative due to poor cell surface expression. In contrast, most amino acid substitutions at position 410 conferred constitutive cAMP accumulation and affected PTH/PTHrP receptor expression not at all or only mildly. Mutations corresponding to the H223R or T410P exchange in the human PTH/PTHrP receptor also led to constitutive activity when introduced into the opossum receptor homolog, but showed little or no change in basal cAMP accumulation when introduced into the rat PTH/PTHrP receptor. The PTH/PTHrP receptor residues mutated in Jansen's disease are conserved in all mammalian members of this family of G protein-coupled receptors. However, when the equivalent of either the H223R or the T410P mutation was introduced into several other related receptors, including the PTH2 receptor and the receptors for calcitonin, secretin, GH-releasing hormone, glucagon-like peptide I, and CRH, the resulting mutants failed to induce constitutive activity. These studies suggest that two residues in the human PTH/PTHrP receptor, 223 and 410, have critical roles in signal transduction, but with different sequence constrains.

Expression of alternatively spliced isoforms of the parathyroid hormone (PTH)/PTH-related peptide receptor messenger RNA in human kidney and bone cells.

Using a PCR-based strategy, two variants of the PTH/PTH-related peptide (PTH-rp) receptor mRNA were identified in human kidney, SaOS-2 human osteoblast cells, and rat bone that are produced by alternative splicing of exons coding for the N-terminal portion of the receptor. In the S-N3-E2 isoform, the exon coding the signal peptide (S) is spliced to an alternative 3'-acceptor site, producing a product respecting the reading frame, but in which the E1 exon is replaced by 12 amino acids derived from the N3 intron. In the S-E2 isoform, in which the E1 exon is deleted by cassette exclusion, the reading frame is changed, but a truncated receptor may be produced by reinitiation of translation at an overlapping stop/start codon. After transfection of COS and Chinese hamster ovary cells with the originally described S-E1-E2 isoform and the two splice variants, active transcription of PTH/PTH-rp receptor mRNA was detected by RT-PCR in all cases. Cell lines transfected with the S-E1-E2 and S-N3-E2 isoforms displayed a 15- to 25-fold and 2- to 3-fold increase, respectively, in cAMP content after stimulation with 2.4 x 10(-7) M human PTH(1-34), whereas cells transfected with the S-E2 isoform did not respond. PTH elicited an increase in intracellular calcium only in cells transfected with the S-E1-E2 isoform. Studies evaluating the surface expression of receptors using anti-human PTH/PTH-rp receptor antibodies and the ability of transfected cells to bind [125I]PTH-rp indicated that the low or absent responses to PTH stimulation resulted, at least in part, from low surface expression of the S-N3-E2 and S-E2 isoforms. These studies support the conclusion that exon E1 is extremely important in promoting surface expression of the PTH/PTH-rp receptor but indicate that isoforms lacking this exon can retain the ability to recognize PTH. The possible intracellular expression of these splice variants, which account for 15-20% of total PTH/PTH-rp receptor mRNA, needs to be evaluated.