Percutaneous maxacalcitol injection therapy regresses hyperplasia of parathyroid and induces apoptosis in uremia.

Abstract

BACKGROUND:

A high level of parathyroid hormone (PTH) is considered to be an indicator of poor prognosis and a poor quality of life of dialysis patients; therefore, an effective and safe therapy for secondary hyperparathyroidism (SHPT) has been developed.

METHODS:

In 20 patients with SHPT resistant to maxacalcitol (OCT) intravenously administered, all detectably enlarged parathyroid glands were treated by percutaneous maxacalcitol injection therapy (PMIT) under ultrasonographic guidance consecutively 6 times, which was followed by OCT that was intravenously administered. The clinical effects of PMIT were evaluated based on the changes in the serum intact-PTH, adjusted Ca, phosphorus, and bone marker levels, and the parathyroid gland volume determined by ultrasonography. Morphologic examination, apoptosis analysis, and PTH mRNA expression level determination by reverse transcription-polymerase chain reaction (RT-PCR) using parathyroid tissues obtained by a biopsy technique were performed.

RESULTS:

PMIT and subsequent intravenous OCT administrations significantly decreased the serum intact-PTH level and parathyroid gland volume for at least 12 weeks after PMIT without major complications. Parathyroid tissues obtained after PMIT exhibited some partial defects of parathyroid cells, a marked increase in the number of the terminal deoxynucleotidyl transferase-mediated dUTP nick end-labeling (TUNEL)-positive cells, the ladder formation determined by DNA electrophoresis, and the decrease in the PTH mRNA expression level.

CONCLUSION:

PMIT is effective and safe for the treatment of refractory SHPT, and a locally high level of OCT suppresses PTH secretion and regresses parathyroid hyperplasia, which is involved in the induction of apoptosis of parathyroid cells.

• Authors: Kazuhiro Shiizaki, Ikuji Hatamura, Shigeo Negi, Nobuhiko Narukawa, Masahide Mizobuchi, Toshifumi Sakaguchi, Akira Ooshima, Tadao Akizawa
• Journal: Kidney international (Kidney Int) Vol. 64 Issue 3 Pg. 992-1003 (Sep 2003) ISSN: 0085-2538 [Print] United States
• PMID: 12911549 (Publication Type: Clinical Trial, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Parathyroid Hormone
• RNA, Messenger
• Calcitriol
• maxacalcitol

Topics

• Administration, Cutaneous
• Adult
• Aged
• Apoptosis (drug effects)
• Calcitriol (administration & dosage, analogs & derivatives)
• Female
• Humans
• Hyperparathyroidism, Secondary (drug therapy, pathology)
• Hyperplasia
• Injections, Intralesional
• Male
• Middle Aged
• Parathyroid Glands (drug effects, pathology)
• Parathyroid Hormone (genetics)
• RNA, Messenger (metabolism)
• Reverse Transcriptase Polymerase Chain Reaction
• Uremia (drug therapy, pathology, physiopathology)