Why Current PTH Assays Mislead Clinical Decision Making in Patients with Secondary Hyperparathyroidism

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Abstract

Preclinical studies in cell culture systems as well as in whole animal chronic kidney disease (CKD) models showed that parathyroid hormone (PTH), oxidized at the 2 methionine residues (positions 8 and 18), caused a loss of function. This was so far not considered in the development of PTH assays used in current clinical practice. Patients with advanced CKD are subject to oxidative stress, and plasma proteins (including PTH) are targets for oxidants. In patients with CKD, a considerable but variable fraction (about 70 to 90%) of measured PTH appears to be oxidized. Oxidized PTH (oxPTH) does not interact with the PTH receptor resulting in loss of biological activity. Currently used intact PTH (iPTH) assays detect both oxidized and non-oxPTH (n-oxPTH). Clinical studies demonstrated that bioactive, n-oxPTH, but not iPTH nor oxPTH, is associated with mortality in CKD patients.

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Author and article information

Journal

Journal ID (publisher-id): NEF

Journal ID (nlm-ta): Nephron

Journal ID (doi): 10.1159/issn.1660-8151

Title: Nephron

Publisher: S. Karger AG

ISSN (Print): 1660-8151

ISSN (Electronic): 2235-3186

Publication date Subscription-year: 2017

Publication date (Print): May 2017

Publication date (Electronic): 10 February 2017

Volume: 136

Issue: 2

Pages: 137-142

Affiliations

^aInstitute of Nutritional Science, University of Potsdam, Potsdam, ^bIFLb, Institut für Labormedizin Berlin, Berlin, Germany; ^cDepartment of Embryology, Medical School, and ^dDepartment of Nephrology, Guangzhou Overseas Chinese Hospital, The First Affiliated Hospital, Jinan University, Guangzhou, China

Author notes

*Prof. Dr. Berthold Hocher, Institute of Nutritional Science, University of Potsdam, DE-14558 Nuthetal, Potsdam (Germany), E-Mail hocher@uni-potsdam.de

Article

Publisher ID: 455289 Other ID: Nephron 2017;136:137-142

DOI: 10.1159/000455289

PubMed ID: 28183082

SO-VID: cc8ff14b-4b85-4f23-bc67-a9e9427e51fa

License:

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

History

Date received : 25 November 2016

Date accepted : 17 December 2016

Page count

Figures: 3, References: 62, Pages: 6

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