Sequential treatment with zoledronic acid followed by teriparatide or vice versa increases bone mineral density and bone strength in ovariectomized rats.

Bisphosphonates (BPs) and teriparatide (TPTD) are both effective treatments for osteoporosis, but BP treatment prior to daily TPTD treatment has been shown to impair the effect of TPTD in some clinical studies. In contrast, the loss of bone mineral density (BMD) that occurs after withdrawal of TPTD can be prevented by BP treatment. Although various studies have investigated the combination and/or sequential use of BP and TPTD, there have been no clinical studies investigating sequential treatment with zoledronic acid (ZOL) and TPTD (or vice versa). In this study, we evaluated the effects of sequential treatment with TPTD followed by ZOL, and ZOL followed by TPTD, using ovariectomized (OVX) rats. Two months after OVX, osteopenic rats were treated with ZOL, TPTD, or vehicle for a period of 4 months (first treatment period), and then the treatments were switched and administered for another 4 months (second treatment period). The group treated with ZOL followed by TPTD showed an immediate increase in BMD of the proximal tibia and greater BMD and bone strength of the lumbar vertebral body, femoral diaphysis, and proximal femur than the group treated with ZOL followed by vehicle. Serum osteocalcin, a marker of bone formation, increased rapidly after switching to TPTD from ZOL. The group treated with TPTD followed by ZOL did not lose BMD in the proximal tibia after TPTD was stopped, while the group treated with TPTD followed by vehicle did lose BMD. The BMD and bone strength of the lumbar vertebral body, femoral diaphysis, and proximal femur were greater in the group treated with TPTD followed by ZOL than in the group treated with TPTD followed by vehicle. The increase in serum osteocalcin and urinary CTX after withdrawal of TPTD was prevented by the switch from TPTD to ZOL. In conclusion, our results demonstrate that switching from ZOL to TPTD resulted in a non-attenuated anabolic response in the lumbar spine and femur of OVX rats. In addition, switching from TPTD to ZOL caused BMD to be maintained or further increased. If these results can be reproduced in a clinical setting, the sequential use of ZOL followed by TPTD or vice versa in the treatment of osteoporosis patients would contribute to increases in BMD that, hopefully, would translate into a corresponding decrease in the incidence of vertebral and non-vertebral fractures.

Changes in osteoblast phenotype during differentiation of enzymatically isolated rat calvaria cells.

Osteoblasts enzymatically isolated from newborn rat calvariae show various phenotypes including formation of mineralized bone nodules in culture. We investigated the temporal changes in osteoblast phenotype in these cells up to day 20 in culture. These cells formed unmineralized nodules by day 5. Mineralization was observed at the center of nodules by day 10, and nodules became larger on day 15. The nodules were surrounded by numerous alkaline phosphatase (ALP)-positive cells. ALP activity gradually increased by day 20. Parathyroid hormone (PTH) responsiveness increased with time in culture. Osteoblasts produced no osteocalcin by day 10, but its synthesis was detected from day 15. These cells expressed substantial levels of ALP and PTH/PTHrP receptor mRNAs as early as day 5 in culture, but very weak expression of osteocalcin mRNA on day 5. The levels of expression of these transcripts increased with time in culture. In situ hybridization demonstrated that PTH/PTHrP receptor and osteocalcin mRNAs were strongly expressed in nodules, but the former appeared much earlier than the latter. BMP-2 and BMP-4 mRNAs also appeared in the cells forming nodules. Immunohistochemical analysis demonstrated that cells expressing either BMP-2/4 or their receptors (BMPR-IA, BMPR-IB, and BMPR-II) preferentially appeared in nodules. These observations suggested that BMPs play an important role in the formation of mineralized bone nodules in an autocrine and/or paracrine fashion in these cells. The present study confirmed that osteoblasts enzymatically isolated from newborn rat calvariae are a useful tool for studying the differentiation process of osteoblasts.

Parathyroid hormone exerts disparate effects on osteoblast differentiation depending on exposure time in rat osteoblastic cells.

It has been reported that PTH exerts bone-forming effects in vivo when administered intermittently. In the present study, the anabolic effects of PTH(1-34) on osteoblast differentiation were examined in vitro. Osteoblastic cells isolated from newborn rat calvaria were cyclically treated with PTH(1-34) for the first few hours of each 48-h incubation cycle. When osteoblastic cells were intermittently exposed to PTH only for the first hour of each 48-h incubation cycle and cultured for the remainder of the cycle without the hormone, osteoblast differentiation was inhibited by suppressing alkaline phosphatase activity, bone nodule formation, and mRNA expression of alkaline phosphatase, osteocalcin, and PTH/PTHrP receptor. Experiments using inhibitors and stimulators of cAMP/protein kinase A (PKA) and Ca2+/PKC demonstrated that cAMP/PKA was the major signal transduction system in the inhibitory action of PTH. In contrast, the intermittent exposure to PTH for the first 6 h of each 48-h cycle stimulated osteoblast differentiation. Both cAMP/ PKA and Ca2+/PKC systems appeared to be involved cooperatively in this anabolic effect. Continuous exposure to PTH during the 48-h incubation cycle strongly inhibited osteoblast differentiation. Although both cAMP/PKA and Ca2+/PKC were involved in the effect of continuous exposure to PTH, they appeared to act independently. A neutralizing antibody against IGF-I blocked the stimulatory effect on alkaline phosphatase activity and the expression of osteocalcin mRNA induced by the 6-h intermittent exposure. The inhibitory effect induced by the 1-h intermittent exposure was not affected by anti-IGF-I antibody. These results suggest that PTH has diverse effects on osteoblast differentiation depending on the exposure time in vitro mediated through different signal transduction systems. These in vitro findings explain at least in part the in vivo action of PTH that varies with the mode of administration.

Parathyroid hormone regulates osteoblast differentiation positively or negatively depending on the differentiation stages.

The effects of parathyroid hormone (1-34) (PTH (1-34) on osteoblast differentiation were investigated using primary osteoblast-like cells isolated from newborn mouse calvaria. The osteoblast-like cells cultured at low cell densities, in which the cells remained in a subconfluent state at the end of culture, were exposed for 7 days to PTH. This stimulated alkaline phosphatase (ALP) activity in a dose-dependent manner. In contrast, PTH dose-dependently inhibited both ALP activity and osteocalcin production in cells inoculated at high cell densities, in which they had reached a confluent state before the end of culture. The changes of ALP activity by PTH were accompanied with the expression of ALP messenger RNA. PTH induced no changes of the hydroxyproline content in the cell layer when the cells were exposed to the hormone at a subconfluent state, but reduced the content at a postconfluent state. The stimulation of ALP activity by PTH at a preconfluent state was retained even after the removal of PTH from the culture media. The opposite effect of PTH, observed between the preconfluent and the postconfluent state, was reproduced by adding dibutyryl cyclic adenosine monophosphate (cAMP) or forskolin, but not by adding phorbol myristate acetate. In a colony-forming unit fibroblastic (CFU-F) assay, using bone marrow cells isolated from tibiae of 10-week-old mice, PTH induced no changes in the total number of CFU-Fs, but increased the proportion of ALP-positive colonies. These results indicate that PTH exerts opposite effects on the phenotypic expression of osteoblasts, depending on their differentiation stages of osteoblasts. PTH may preferentially stimulate osteoblast differentiation in immature osteoblasts but inhibit it in more mature cells.

Effects of BMP-2, BMP-4, and BMP-6 on osteoblastic differentiation of bone marrow-derived stromal cell lines, ST2 and MC3T3-G2/PA6.

The effects of bone morphogenetic protein-2 (BMP-2) on osteoblastic differentiation of bone marrow stromal cells were investigated using two bone marrow stromal cell lines, ST2 and MC3T3-G2/PA6 (PA6). BMP-2 stimulated ALP activity and induced parathyroid hormone (PTH)-dependent production of cAMP in both ST2 and PA6 cells, but these effects were more apparent in ST2 cells than in PA6 cells. BMP-2 induced the production of osteocalcin in ST2 cells, but not in PA6 cells. BMP-4 and BMP-6 stimulated ALP activity in ST2 cells, but the effect of BMP-6 was less marked than that of BMP-2 and BMP-4. BMP-4 induced PTH-dependent cAMP production of cAMP in ST2 cells, but BMP-6 did not. When ST2 cells were transplanted into the peritoneal cavities of athymic mice with BMP-2 in diffusion chambers, these cells generated mineralized bone in the chambers. These results indicate that BMPs induce the differentiation of bone marrow stromal cells into osteoblasts. However, the effects differ among the BMPs and among the types of cell exposed to these proteins.

An estrogen deficiency caused by ovariectomy increases plasma levels of systemic factors that stimulate proliferation and differentiation of osteoblasts in rats.

To investigate the pathogenesis of accelerated bone formation in estrogen deficiency, diffusion chambers containing osteoblast-like cells isolated from newborn rat calvariae were transplanted into the peritoneal cavity of sham-operated (sham), ovariectomized (OVX) rats, and OVX rats with supplement of 17 beta-estradiol (OVX + E2). Bone formation in the diffusion chambers transplanted into OVX rats was more accelerated than that transplanted into sham rats and OVX + E2 rats. Osteoblast-like cells cultured with the sera isolated from OVX rats exhibited higher levels of the DNA content in the culture wells, alkaline phosphatase activity, messenger RNA expression for alkaline phosphatase and osteocalcin, calcium content in the cell layer, and formation of bone-like nodules than those exposed to the sera from sham rats and OVX + E2 rats. Antibody against IGF-I almost completely inhibited the increase in DNA contents induced by the sera isolated from OVX rats but partially inhibited alkaline phosphatase activity. Adding IGF-I to the sera isolated from sham rats increased the DNA content to the same extent as that induced by the supplement with the sera from OVX rats but did not increase alkaline phosphatase activity appreciably. Addition of various concentrations of 17 beta-estradiol, interleukin (IL)-1, and IL-6 to the sera isolated from sham rats did not increase the DNA content or alkaline phosphatase activity in the osteoblast-like cells. These results indicate that some systemic factor(s) other than IGF-I, IL-1, and IL-6 may be responsible for the stimulative effect on osteoblast differentiation in the pathogenesis of the accelerated bone formation induced by estrogen deficiency in rats.

Modification of D-galactosamine-induced liver damage in rats by intravenous injection of newly isolated intact splenic cells.

In rats of an inbred F344/DuCrj line, simultaneous injection of newly isolated intact splenic cells (derived from normal rats of the same strain) markedly modified and reduced the liver damage induced by treatment with D-galactosamine. When rats treated with D-galactosamine plus newly isolated intact splenic cells were compared with those treated with D-galactosamine alone, the former showed less atrophy of the liver, a smaller decrease in serum albumin, and lower serum levels of GOT, GPT, LDH, and total bilirubin, suggesting that the escape of these liver components into serum, which occurs when the liver is damaged, was suppressed in the former group. This effect was not observed when mitomycin C-treated splenic cells were injected. These results suggest that intact splenic cells injected intravenously play an important role in mediating the mechanisms responsible for repair of liver damage.

In-vitro preparation of experimental models of hepatitis with D-galactosamine and their modification by liver-repairing factors.

Hepatocytes, isolated from male F344/DuCrj rats by means of perfusion with collagenase, were incubated in Williams E medium containing newborn calf serum (PFCS), insulin, dexamethasone and D-galactosamine. The resulting liver-cell damage was confirmed by MTT assay to be dependent on the dose of D-galactosamine. This damage was clearly modified by the addition to the medium of the liver-repairing factors which appeared in serum in the initial stage of liver damage resulting from either partial hepatectomy or administration of D-galactosamine (Gal-N) in rats. When a massive number of splenocytes from normal rats was injected into the caudal vein of rats with liver damage caused by D-galactosamine, liver-damage-repairing factors were induced in the serum which were found to exert a particularly strong inhibition of the damage to hepatocytes caused by D-galactosamine when incubated in vitro.