Calcimimetic agents: review and perspectives.

Abstract

BACKGROUND:

Recognition of the role of the extracellular calcium-sensing receptor (CaR) in mineral metabolism has greatly improved our understanding of calcium homeostasis. The activation of this receptor by small changes in the extracellular ionized calcium (ec(Ca2+)) regulates PTH, calcitonin secretion, urinary calcium excretion, and, ultimately, bone turnover.

METHODS:

The cloning of the CaR and the discovery of mutations that make the receptor less or more sensitive to calcium have allowed a better understanding of several hereditary disorders characterized by either hyperparathyroidism or hypoparathyroidism. The CaR, able to amplify the sensitivity of the CaR to Ca++ and suppress PTH levels with a resulting decrease in blood Ca++, became an ideal target for the development of compounds, the calcimimetics. Experience with the calcimimetic R-568 in patients with primary and secondary hyperparathyroidism and parathyroid carcinoma are summarized.

RESULTS:

The first clinical studies with the first-generation calcimimetic agents have demonstrated their efficacy in lowering plasma intact PTH concentration in uremic patients with secondary hyperparathyroidism. However, the low bioavailability of these first calcimimetics predicts a difficult clinical utilization. The second-generation calcimimetic, AMG 073, having a better pharmacokinetic profile, appears to be effective and safe for the treatment of secondary hyperparathyroidism, suppressing PTH levels while simultaneously reducing serum phosphorus levels and the calcium x phosphorus product.

CONCLUSION:

The advantage of controlling PTH secretion without the complications related to hypercalcemia, hyperphosphatemia, and increased calcium x phosphorus product is very promising.

• Authors: Pablo Ureña, João M Frazão
• Journal: Kidney international. Supplement (Kidney Int Suppl) Issue 85 Pg. S91-6 (Jun 2003) ISSN: 0098-6577 [Print] United States
• PMID: 12753275 (Publication Type: Journal Article, Review)

Chemical References

• Aniline Compounds
• N-(2-chlorophenylpropyl)-1-(3-methoxyphenyl)ethylamine
• Parathyroid Hormone
• Phenethylamines
• Propylamines
• Receptors, Calcium-Sensing
• Calcium

Topics

• Aniline Compounds (pharmacokinetics, therapeutic use)
• Animals
• Calcium (physiology)
• Clinical Trials as Topic
• Humans
• Hyperparathyroidism, Secondary (drug therapy)
• Kidney Failure, Chronic (complications)
• Parathyroid Hormone (metabolism)
• Phenethylamines
• Propylamines
• Receptors, Calcium-Sensing (drug effects, physiology)