Hypercalcemia After Cosmetic Oil Injections: Unraveling Etiology, Pathogenesis, and Severity.

Intramuscular injections of paraffin oil can cause foreign body granuloma formation and hypercalcemia. Macrophages with the ability to produce high levels of 1,25(OH)2 D3 may induce the mineral disturbance, but no major series of patients have been published to date. Here, medical history, physical evaluation, biochemical, and urinary analysis for calcium homeostasis were obtained from 88 males, who 6 years previously had injected paraffin or synthol oil into skeletal muscle. Moreover, granuloma tissue from three men was cultured for 48 hours ex vivo to determine 1,25(OH)2 D3 production supported by qPCR and immunohistochemistry of vitamin D metabolism and immune cell populations after treatment with 14 different drugs. The 88 men were stratified into men with hypercalcemia (34%), whereas normocalcemic men were separated into men with either normal (42%) or suppressed parathyroid hormone (PTH) (24%). All men had high calcium excretion, and nephrolithiasis was found in 48% of hypercalcemic men, 22% of normocalcemic men with normal PTH, and 47% of normocalcemic men with suppressed PTH. Risk factors for developing hypercalcemia were oil volume injected, injection of heated oil, high serum interleukin-2 receptor levels, and high urine calcium. High 1,25(OH)2 D3 /25OHD ratio, calcium excretion, and low PTH was associated with nephrolithiasis. The vitamin D activating enzyme CYP27B1 was markedly expressed in granuloma tissue, and 1,25(OH)2 D3 was released in concentrations corresponding to 40% to 50% of the production by human kidney specimens. Dexamethasone, ketoconazole, and ciclosporin significantly suppressed granulomatous production of 1,25(OH)2 D3 . In conclusion, this study shows that injection of large oil volumes alters calcium homeostasis and increases the risk of nephrolithiasis. Hypercalciuria is an early sign of disease, and high granulomatous 1,25(OH)2 D3 production is part of the cause. Prospective clinical trials are needed to determine if ciclosporin, ketoconazole, or other drugs can be used as prednisolone-sparing treatment. © 2020 American Society for Bone and Mineral Research (ASBMR).

Physiological and molecular evidence for Pi uptake via the symbiotic pathway in a reduced mycorrhizal colonization mutant in tomato associated with a compatible fungus.

A Lycopersicon esculentum mutant (rmc) is resistant to colonization by most arbuscular mycorrhizal fungi (AMF), but one Glomus intraradices isolate (WFVAM 23) develops arbuscules and vesicles in the rmc cortex. It is unknown whether the symbiotic phosphate (Pi)-uptake pathway is operational in this interaction. Hyphal uptake of (32)Pi and expression of plant Pi transporter genes were investigated in the rmc mutant and its wild-type progenitor (76R) associated with three AMF. Hyphae transferred (32)Pi in all symbioses with 76R and in the rmc-G. intraradices WFVAM 23 symbiosis. The other AMF did not colonize rmc. The Pi transporter-encoding LePT1 and LePT2 were expressed constitutively or in P-starved roots, respectively. The mycorrhiza-inducible Pi transporters LePT3 and LePT4 were expressed only in plants with AMF colonization and symbiotic (32)Pi transfer. LePT3 and LePT4 transcripts were reliable markers for a functional mycorrhizal uptake pathway in rmc. Our novel approach to the physiology and molecular biology of P transport can be applied to other arbuscular-mycorrhizal symbioses, irrespective of the size of plant responses.