The Abnormal Phenotypes of Cartilage and Bone in Calcium-Sensing Receptor Deficient Mice Are Dependent on the Actions of Calcium, Phosphorus, and PTH

Abstract

Patients with neonatal severe hyperparathyroidism (NSHPT) are homozygous for the calcium-sensing receptor (CaR) mutation and have very high circulating PTH, abundant parathyroid hyperplasia, and severe life-threatening hypercalcemia. Mice with homozygous deletion of CaR mimic the syndrome of NSHPT. To determine effects of CaR deficiency on skeletal development and interactions between CaR and 1,25(OH) ₂D ₃ or PTH on calcium and skeletal homeostasis, we compared the skeletal phenotypes of homozygous CaR–deficient (CaR ^−/−) mice to those of double homozygous CaR– and 1α(OH)ase–deficient [CaR ^−/−1α(OH)ase ^−/−] mice or those of double homozygous CaR– and PTH–deficient [CaR ^−/−PTH ^−/−] mice at 2 weeks of age. Compared to wild-type littermates, CaR ^−/− mice had hypercalcemia, hypophosphatemia, hyperparathyroidism, and severe skeletal growth retardation. Chondrocyte proliferation and PTHrP expression in growth plates were reduced significantly, whereas trabecular volume, osteoblast number, osteocalcin-positive areas, expression of the ALP, type I collagen, osteocalcin genes, and serum ALP levels were increased significantly. Deletion of 1α(OH)ase in CaR ^−/− mice resulted in a longer lifespan, normocalcemia, lower serum phosphorus, greater elevation in PTH, slight improvement in skeletal growth with increased chondrocyte proliferation and PTHrP expression, and further increases in indices of osteoblastic bone formation. Deletion of PTH in CaR ^−/− mice resulted in rescue of early lethality, normocalcemia, increased serum phosphorus, undetectable serum PTH, normalization in skeletal growth with normal chondrocyte proliferation and enhanced PTHrP expression, and dramatic decreases in indices of osteoblastic bone formation. Our results indicate that reductions in hypercalcemia play a critical role in preventing the early lethality of CaR ^−/− mice and that defects in endochondral bone formation in CaR ^−/− mice result from effects of the marked elevation in serum calcium concentration and the decreases in serum phosphorus concentration and skeletal PTHrP levels, whereas the increased osteoblastic bone formation results from direct effects of PTH.

Author Summary

Mice with homozygous deletion of the calcium-sensing receptor (CaR) mimic the syndrome of neonatal severe hyperparathyroidism (NSHPT) in humans with very high circulating parathyroid hormone (PTH) and severe life-threatening hypercalcemia. To determine effects of CaR deficiency on skeletal development and interactions between CaR and 1,25(OH) ₂D ₃ or PTH on calcium and skeletal homeostasis, we compared the skeletal phenotypes of homozygous CaR–deficient mice to those of double homozygous CaR– and 1,25(OH) ₂D ₃–deficient mice or those of double homozygous CaR– and PTH–deficient mice. CaR–deficient mice had hypercalcemia, hypophosphatemia, hyperparathyroidism, severe skeletal growth retardation, and abnormalities; and most died within 2 weeks of age. Deletion of 1,25(OH) ₂D ₃ in CaR–deficient mice resulted in a longer lifespan, normocalcemia, lower serum phosphorus, greater elevation in PTH, and slight improvement in skeletal growth. Deletion of PTH in CaR–deficient mice resulted in rescue of early lethality, normocalcemia, increased serum phosphorus, and normalization in skeletal growth. Our results indicate that reductions in hypercalcemia reduce the early lethality of CaR–deficient mice and that deletion of PTH in patients with NSHPT may normalize skeletal growth and development.