Iron deficiency and high-intensity running interval training do not impact femoral or tibial bone in young female rats

2021 ◽  
pp. 1-22
Author(s):  
Jonathan M. Scott ◽  
Elizabeth A. Swallow ◽  
Corinne E. Metzger ◽  
Rachel Kohler ◽  
Joseph M. Wallace ◽  
...  

Abstract In the US, as many as 20% of recruits sustain stress fractures during basic training. In addition, approximately one-third of female recruits develop iron deficiency upon completion of training. Iron is a cofactor in bone collagen formation and vitamin D activation, thus we hypothesized iron deficiency may be contributing to altered bone microarchitecture and mechanics during 12-weeks of increased mechanical loading. Three-week old female Sprague Dawley rats were assigned to one of four groups: iron adequate sedentary, iron deficient sedentary, iron adequate exercise, and iron deficient exercise. Exercise consisted of high-intensity treadmill running (54 min 3×/week). After 12-weeks, serum bone turnover markers, femoral geometry and microarchitecture, mechanical properties and fracture toughness, and tibiae mineral composition and morphometry were measured. Iron deficiency increased the bone resorption markers C-terminal telopeptide type I collagen and tartate-resistant acid phosphatase 5b (TRAcP 5b). In exercised rats, iron deficiency further increased bone TRAcP 5b, while in iron adequate rats, exercise increased the bone formation marker procollagen type I N-terminal propeptide. In the femur, exercise increased cortical thickness and maximum load. In the tibia, iron deficiency increased the rate of bone formation, mineral apposition, and zinc content. These data show that the femur and tibia structure and mechanical properties are not negatively impacted by iron deficiency despite a decrease in tibiae iron content and increase in serum bone resorption markers during 12-weeks of high-intensity running in young growing female rats.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 506-506
Author(s):  
Evangelos Terpos ◽  
Deborah Heath ◽  
Amin Rahemtulla ◽  
Kostas Zervas ◽  
Andrew Chantry ◽  
...  

Abstract Bortezomib is a proteasome inhibitor, which is currently indicated for the treatment of relapsed/refractory myeloma (MM). Although the anti-myeloma effect of bortezomib has been clearly demonstrated, its effect on bone metabolism is still unclear. There are recent reports that bortezomib increases serum alkaline phosphatase (ALP) activity, which is consistent with enhanced osteoblast function. The aim of this study was to evaluate the effect of bortezomib on bone turnover in 34 patients with relapsed MM. Bortezomib was given alone at a dose of 1.3 mg/m2 on days 1, 4, 8, and 11 of a 3-week cycle for 4 cycles. Responders could continue for 4 more cycles, while non-responders could continue therapy with the addition of dexamethasone. The following serum indices were measured on day 1 of cycle 1, and then on day 21 of cycles 4 and 8: osteoblast inhibitor dickkopf-1 (DKK-1); osteoclast regulators: soluble RANKL (sRANKL) and osteoprotegerin (OPG); bone resorption markers: C-telopeptide of collagen type-I (CTX) and tartrate-resistant acid phosphatase type-5b (TRACP-5b); and bone formation markers: bone-specific ALP (bALP) and osteocalcin (OC). We also studied 33 healthy controls of similar gender and age. The objective response rate after 4 cycles of therapy was 66%: CR 8% and PR 58%. Sixteen responders and 3 non-responders continued on therapy for 4 more cycles. Myeloma patients at baseline had increased values of DKK-1 (p=0.007), sRANKL, sRANKL/OPG ratio, and both markers of bone resorption (p<0.0001) when compared to controls. In contrast, bone formation as assessed by serum bALP and OC was significantly reduced (p<0.001). There was a strong correlation between bone lytic disease and serum CTX (r=0.59, p<0.01), and sRANKL (r=0.4, p=0.03). Patients with severe bone disease (>9 lytic lesions, n=7) had elevated values of DKK-1 compared with all others (mean±SD: 223.4±264.4 ng/mL vs. 84±62.4 ng/mL; p=0.01). Moreover, serum levels of DKK-1 correlated with CTX levels (r=0.39, p=0.04), and weakly with bALP concentrations (r=−0.32, p=0.09). The administration of bortezomib produced a significant reduction of DKK-1 (p=0.035), sRANKL (p=0.01), CTX and TRACP-5b (p<0.001) after 4 cycles, which was still seen after 8 cycles of treatment (p<0.01). Bortezomib also produced a dramatic increase in both markers of bone formation, bALP and OC, after 4 and 8 cycles of therapy (p<0.01). Responders tended to have lower initial levels of DKK-1 compared with non-responders. Patients who achieved a CR or vgPR after 4 cycles of bortezomib had greater elevation of bALP than all others: mean±SD of increase: 306.3%±556.9% vs. 45.8%±56.5%; p=0.02. It is of interest that 3/4 non responders also had an increase in bALP (mean: 39.6%) after 4 cycles of bortezomib. There was no other correlation between response to therapy and alteration of bone markers. No healing of the lytic lesions was observed even in CR patients. This study suggests that bortezomib reduces serum levels of DKK-1 and RANKL, irrespective of response to therapy, in patients with relapsed myeloma and thus leads to normalization of abnormal bone remodeling through the increase of bone formation and reduction of bone resorption.


Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 4745-4745
Author(s):  
Evangelos Terpos ◽  
Dimitrios Christoulas ◽  
Efstathios Kastritis ◽  
Eirini Katodritou ◽  
Xenophon Papanikolaou ◽  
...  

Abstract Lenalidomide in combination with dexamethasone is very effective for the management of refractory/relapsed multiple myeloma (MM). However, there is very little information for the effect of lenalidomide on bone metabolism in MM. We evaluated bone remodeling in 36 patients (22M/14F; median age 64 years) with refractory/relapsed MM who received lenalidomide-based regimens: 27 received the combination of lenalidomide at the standard dose of 25mg/day x 21 days, every 28 days, with either high (n=18) or low (n=9) dose dexamethasone, while 9 patients received the combination of lenalidomide/low dose dexamethasone plus bortezomib (BDR) at a dose of 1 mg/m2, iv, on days 1, 4, 8, 11 every 28 days. The following serum indices of bone turnover were measured on day 1 of cycle 1, and then on day 28 of cycle 3: osteoblast inhibitor dickkopf-1 (Dkk-1); osteoclast regulators: soluble RANKL (sRANKL) and osteoprotegerin (OPG); bone resorption markers: C-telopeptide of collagen type-I (CTX) and tartrate-resistant acid phosphatase type-5b (TRACP-5b); and bone formation markers: bone-specific ALP (bALP) and osteocalcin (OC). We also studied 20 healthy controls of similar gender and age. The median number of previous therapies was 3 (range: 2–7). At baseline, 9 patients had no lytic lesions (group A), while 3 patients had 1–3 lytic lesions (group B) and 24 patients had more than 3 lytic lesions and/or a pathological fracture (group C) in plain radiography of the skeleton. After 3 cycles of therapy the objective response (CR+PR) rate was 77% (21/27) in lenalidomide/dexamethasone patients and 55% (5/9) in BDR patients. MM patients at baseline had increased levels of Dkk-1 (p=0.002), sRANKL (p=0.04), and both markers of bone resorption (p<0.01) compared to controls. In contrast, bone formation as assessed by serum bALP and OC was significantly reduced (p<0.01). Patients with advanced bone disease (group C) had increased levels of CTX (p<0.001), TRACP-5b (p<0.01), Dkk-1 (p=0.04) and reduced levels of OC (p=0.04) compared with all others. Moreover, serum levels of DKK-1 correlated with TRACP-5b (r=0.614, p<0.0001), CTX (r=0.29, p=0.03), sRANKL (r=0.423, p=0.001) and OPG (r=0.572, p<0.0001). The administration of lenalidomide-based regimens produced only a reduction of Dkk-1 (p=0.04) and TRACP-5b (p=0.03) after 3 cycles of therapy. Interestingly, patients who received BDR showed a dramatic reduction of sRANKL (p=0.02), sRANKL/OPG ratio (p=0.03) and Dkk-1 (p=0.02), which associated with an increase in both markers of bone formation (p=0.04). The % reduction of sRANKL and TRACP-5b and the % increase of bALP and OC was higher in BDR patients compared with others. There was no correlation between response to therapy and bone markers’ changes. In conclusion, the combination of lenalidomide plus dexamethasone seems not to have a clear effect on bone metabolism after 3 cycles of therapy, possibly due to administration of high dose dexamethasone in the majority of patients. BDR patients had a beneficial effect mainly on bone formation, reflecting the bone anabolic effect of bortezomib and/or the lower dose of dexamethasone given in these patients. Longer follow-up is needed to exact final conclusions for the effect of lenalidomide on bone metabolism in relapsed/refractory MM.


1998 ◽  
Vol 83 (2) ◽  
pp. 333-338 ◽  
Author(s):  
Ernest A. Amama ◽  
Michiyoshi Taga ◽  
Hiroshi Minaguchi

To evaluate the clinical utility of recently developed biochemical markers in the assessment of bone metabolism during GnRH agonist (GnRHa) treatment, we compared five bone resorption markers[ C-telopeptide (CTX) and N-telopeptide (NTX) of type I collagen, hydroxyproline (Hpr), pyridinoline (Pyr), and deoxypyridinoline (Dpyr)] and two bone formation markers [total alkaline phosphatase (Alp) and osteocalcin (OC)]. Sixty-eight normally menstruating women were injected with a long-acting GnRHa once a month for 24 weeks for the treatment of endometriosis or leiomyoma. The mean percentage bone loss at the lumbar spine was 3.79% at the end of treatment. Although levels of all markers increased significantly as the treatment progressed, CTX and NTX exhibited the highest correlation coefficients between bone loss at 24 weeks and the seven markers measured at 0, 4, 12, 16, and 24 weeks of treatment. Serum estradiol levels were similarly suppressed during the treatment in both fast losers (whose bone loss was more than the mean) and slow losers (whose bone loss was less than the mean). However, significantly higher z-scores of bone resorption markers, but not of bone formation markers, were observed in the fast losers at 24 weeks of treatment, suggesting a more accelerated bone resorption in this group. Whereas the three highest z-scores at 24 weeks of treatment were CTX, NTX, and Dpyr (in that order), the highest z-score (P &lt; 0.05) was observed for CTX in the fast losers. The subjects in the highest quartile of CTX, the highest, and second highest quartiles of NTX at 24 weeks of treatment experienced 2.1, 2.2, and 1.7 times more bone loss (P &lt; 0.001), respectively, than those in the lowest quartiles. Furthermore, the subjects in the highest quartile of both CTX and NTX experienced 3.6 times more bone loss (P &lt; 0.001) than those in the lowest quartile of both markers. These results indicate that both CTX and NTX are useful and sensitive markers for bone resorption in a hypoestrogenic state induced by GnRHa.


Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 1815-1815 ◽  
Author(s):  
Evangelos Terpos ◽  
Dimitrios Christoulas ◽  
Efstathios Kastritis ◽  
Maria Roussou ◽  
Maria Gavriatopoulou ◽  
...  

Abstract Abstract 1815 Poster Board I-841 Bortezomib is the first-in-class proteasome inhibitor with established activity in multiple myeloma (MM), which also increases osteoblast function both in vitro and in vivo. The addition of bortezomib to the combination of lenalidomide and dexamethasone (RD) regimen seems to increase the RD efficacy. There are very limited data in the literature for the effect of RD on bone metabolism while there are no reports for the effect of BRD on myeloma bone disease. The aim of this study was to evaluate the effect of BRD and RD on bone remodeling of patients with relapsed/refractory MM. We studied 91 patients who participated in a prospective study in which patients with pre-existing peripheral neuropathy (PN) grade <2 received BRD, while patients with PN of grade 2 or more received RD, regardless of their performance status and renal function. In BRD arm, patients received bortezomib at a dose of 1 mg/m2 on days 1, 4, 8 and 11; lenalidomide 15 mg on days 1-14 (or at a lower dose if creatinine clearance (CrCl) was <30 ml/min) and dexamethasone 40 mg, PO, on days 1-4, in a 21-day cycle. In RD arm, patients received lenalidomide on days 1-21 at a dose based on their CrCl, according to guidelines, and dexamethasone 40 mg, PO, on days 1-4 and 15-18 for the first 4 cycles and only on days 1-4 thereafter, every 28 days. All patients also received 4 mg zoledronic acid, iv, monthly. Bone remodeling was studied by the measurement of a series of serum indices, on day 1 of cycles 1, 4 & 7, in patients and in 31 healthy controls of similar age and gender: i) osteoclast regulators [sRANKL and osteoprotegerin (OPG)], ii) osteoblast inhibitor dickkopf-1 (Dkk-1), iii) bone resorption markers [C-telopeptide of collagen type-I (CTX) and 5b-isoenzyme of tartrate resistant acid phosphatase (TRACP-5b)], and iv) bone formation markers [bone-specific alkaline phosphatase (bALP) and osteocalcin (OC)]. Radiological skeletal survey was performed at baseline, after 6 cycles of therapy and then as needed, while patients were assessed for skeletal-related events (SREs) throughout the period of the study. As of July 2009, 80 patients (43M/37F, median age 67 years) have received 6 cycles of therapy (40 in each treatment arm) and the bone markers measurements have been completed and analyzed. Myeloma patients at baseline had increased serum levels of Dkk-1 (p<0.001), sRANKL (p=0.006), and bone resorption markers (p<0.01) compared to control group. On the contrary, both markers of bone formation were significantly reduced compared to controls (p<0.001). Strong correlation was observed between Dkk-1 and sRANKL/OPG ratio (r=0.639, p<0.001). Objective response was 60% (24/40 patients) in RD and 62.5% (25/40 patients) in BRD. BRD administration resulted in a significant reduction of Dkk-1 (p=0.031) and increase of OC (p=0.002) after 3 cycles of therapy which was continued after 6 cycles of therapy. Furthermore, BRD led to a reduction of sRANKL (p=0.023) and sRANKL/OPG ratio (p=0.027) and a significant increase of bALP (p=0.01) after 6 cycles of treatment. These changes were irrespective of treatment response. In BRD patients, percentage reduction of Dkk-1 strongly correlated with percentage increase of bALP after 6 cycles of therapy (r=-0.682, p=0.004). In patients who received RD no significant alterations in markers of bone remodeling were observed. However, patients who responded to RD showed a reduction in CTX (p=0.039) compared with those who did not respond after 6 cycles of therapy. Patients who received 6 cycles of RD showed an increase of Dkk-1 levels: responders had a median increase of 9% while non-responders had a median increase of 91% compared to baseline values (p<0.01). The percentage change of sRANKL (p=0.007) and Dkk-1 (p=0.009) was significantly different between patients who received BRD and those who received RD: both molecules were reduced after 6 cycles of BRD while both were increased after six cycles of RD. No SREs were observed in the BRD arm while two patients treated with RD who had not responded to therapy developed a vertebral pathological fracture. Our study suggests that RD regimen does not seem to have any effect on bone formation even in responding patients with relapsed/refractory MM, possibly due to the presence of high dose dexamethasone and to the enhancement of Dkk-1 expression by lenalidomide. On the contrary, patients who received BRD had an increased bone formation, at least partially due to a significant reduction of Dkk-1, reflecting the strong anabolic effect of bortezomib in MM patients. Disclosures Terpos: Janssen-Cilag: Consultancy, Honoraria.


PRILOZI ◽  
2016 ◽  
Vol 37 (2-3) ◽  
pp. 15-21 ◽  
Author(s):  
Suzy Y Honisett ◽  
David Pagliaro ◽  
Kathy Tangalakis ◽  
Bronwyn Kingwell ◽  
Peter Ebeling ◽  
...  

Abstract Introduction: Independently, hormone therapy and exercise have well-established protective effects on bone parameters. The combined effects of hormone therapy and exercise, however, are less clear. We, therefore, examined the effects of hormone therapy on bone turnover markers in postmenopausal women undergoing regular high intensity exercise. Methods: In a randomised, double blind study, postmenopausal athletes competing at Masters level, received either hormone therapy (50 μg transdermal oestradiol, 5 mg MPA, n = 8) or placebo (n = 7) for 20 weeks. Women were tested before and after treatment for plasma concentrations of oestradiol, FSH, LH, and serum bone formation marker -osteocalcin (OC); and urine bone resorption markers-pyridinoline (PYD) and deoxypyridinoline (DPD). Results: As a result of treatment with hormone therapy there were significant reductions in levels of FSH (73.3 ± 13.7 to 48.6 ± 10.5 mmol/L, p = 0.01) and bone resorption markers (PYD, 81.9 ± 7.7 to 57.8 ± 3.7 nmol/mmol Cr, p = 0.001, and DPD, 18.5 ± 3.1 to 11.8 ± 2.1 nmol/mmol Cr, p = 0.01). Oestradiol and bone formation markers were not significantly altered as a result of hormone therapy. There were no changes to any variables with placebo treatment. Conclusion: Hormone therapy reduced bone resorption, but not bone formation, in postmenopausal athletes. These favorable reductions in bone turnover; therefore, provide an effective treatment in combination with high intensity exercise to further reduce the subsequent risk of osteoporosis and associated fractures.


2019 ◽  
Vol 11 (3) ◽  
pp. 264-272 ◽  
Author(s):  
William D. Rees ◽  
Susan M. Hay ◽  
Helen E. Hayes ◽  
Valerie J. Stevens ◽  
Lorraine Gambling ◽  
...  

AbstractIron deficiency is common in pregnant and lactating women and is associated with reduced cognitive development of the offspring. Since iron affects lipid metabolism, the availability of fatty acids, particularly the polyunsaturated fatty acids required for early neural development, was investigated in the offspring of female rats fed iron-deficient diets during gestation and lactation. Subsequent to the dams giving birth, one group of iron-deficient dams was recuperated by feeding an iron-replete diet. Dams and neonates were killed on postnatal days 1, 3 and 10, and the fatty acid composition of brain and stomach contents was assessed by gas chromatography. Changes in the fatty acid profile on day 3 became more pronounced on day 10 with a decrease in the proportion of saturated fatty acids and a compensatory increase in monounsaturated fatty acids. Long-chain polyunsaturated fatty acids in the n-6 family were reduced, but there was no change in the n-3 family. The fatty acid profiles of neonatal brain and stomach contents were similar, suggesting that the change in milk composition may be related to the changes in the neonatal brain. When the dams were fed an iron-sufficient diet at birth, the effects of iron deficiency on the fatty acid composition of lipids in both dam’s milk and neonates’ brains were reduced. This study showed an interaction between maternal iron status and fatty acid composition of the offspring’s brain and suggests that these effects can be reduced by iron repletion of the dam’s diet at birth.


2020 ◽  
Vol 2020 ◽  
pp. 1-21
Author(s):  
Aleksandra Janas ◽  
Ewa Kruczek ◽  
Piotr Londzin ◽  
Sławomir Borymski ◽  
Zenon P. Czuba ◽  
...  

Although postmenopausal osteoporosis often occurs concurrently with diabetes, little is known about interactions between estrogen deficiency and hyperglycemia in the skeletal system. In the present study, the effects of estrogen deficiency on the development of biochemical, microstructural, and mechanical changes induced by streptozotocin-induced diabetes mellitus (DM) in the rat skeletal system were investigated. The experiments were carried out on nonovariectomized (NOVX) and ovariectomized (OVX) control and diabetic mature female Wistar rats. Serum levels of bone turnover markers (CTX-I and osteocalcin) and 23 cytokines, bone mass and mineralization, histomorphometric parameters, and mechanical properties of cancellous and compact bone were determined. The results were subjected to two-way ANOVA and principal component analysis (PCA). Estrogen deficiency induced osteoporotic changes, with increased bone resorption and formation, and worsening of microstructure (femoral metaphyseal BV/TV decreased by 13.0%) and mechanical properties of cancellous bone (the maximum load in the proximal tibial metaphysis decreased by 34.2%). DM in both the NOVX and OVX rats decreased bone mass, increased bone resorption and decreased bone formation, and worsened cancellous bone microarchitecture (for example, the femoral metaphyseal BV/TV decreased by 17.3% and 18.1%, respectively, in relation to the NOVX controls) and strength (the maximum load in the proximal tibial metaphysis decreased by 35.4% and 48.1%, respectively, in relation to the NOVX controls). Only in the diabetic rats, profound increases in some cytokine levels were noted. In conclusion, the changes induced by DM in female rats were only slightly intensified by estrogen deficiency. Despite similar effects on bone microstructure and strength, the influence of DM on the skeletal system was based on more profound systemic homeostasis changes than those induced by estrogen deficiency.


2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 71-71
Author(s):  
Joseph Roberts ◽  
Moriah Bellissimo ◽  
Kaitlin Taibl ◽  
Karan Uppal ◽  
Dean Jones ◽  
...  

Abstract Objectives Optimal bone health is maintained through a remodeling cycle consisting of resorption followed by formation. Procollagen type I N-terminal propeptide (P1NP) and C-terminal telopeptides of type I collagen (CTX) are biomarkers of bone metabolism that capture changes in bone formation and bone resorption, respectively. This study aimed to identify unique metabolic pathways related to bone turnover markers (BTMs) in healthy young adults. Methods This cross-sectional study included 34 healthy, young adults (19 females, average age 27.8 years). Bone mineral density (BMD) was assessed by dual-energy x-ray absorptiometry. Fasting plasma was analyzed using dual column liquid chromatography and ultra-high-resolution mass spectrometry for metabolomics. Serum levels of P1NP and CTX were measured with ELISA. Linear regression and pathway enrichment analyses were used to identify metabolic pathways related to the BTMs. Results All participants had a normal whole-body BMD T-score. Metabolites significantly associated with P1NP (at P &lt; 0.05) were significantly enriched in pathways linked to the TCA cycle, pyruvate metabolism, and metabolism of B-vitamins important for energy production (e.g., niacin, thiamin). Other nutrition-related metabolic pathways associated with P1NP were amino acid (proline, arginine, glutamate) and vitamin C metabolism, which are important for collagen formation. Metabolites were associated with CTX levels (at P &lt; 0.05), which were enriched within lipid and fatty acid beta-oxidation metabolic pathways, as well as fat soluble micronutrients pathways including, vitamin D metabolism, vitamin E metabolism, and bile acid biosynthesis. Conclusions High-resolution metabolomics identified several distinct plasma metabolic pathways, including energy-yielding metabolic pathways and pathways related to fatty acid, amino acid, and micronutrient metabolism that were associated with markers of bone formation and bone resorption. Characterizing these metabolism-related pathways associated with BTMs in healthy adults is an important step towards understanding the metabolic perturbations that lead to low bone mass in older and clinical populations. Funding Sources National Institutes of Health and Emory University.


Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 5018-5018
Author(s):  
Evangelos Terpos ◽  
Lia A. Moulopoulos ◽  
Athanasios Anagnostopoulos ◽  
Efstathios Kastritis ◽  
Maria Roussou ◽  
...  

Abstract Bone lytic disease is a major feature of multiple myeloma (MM) and is characterized by an increased osteoclast activity which is accompanied by a suppressed osteoblast function. Furthermore, increased angiogenesis is implicated in the pathogenesis of both bone disease and myeloma cell growth and survival. Magnetic resonance imaging (MRI) pattern of bone marrow involvement correlate with prognosis in MM. The aim of this study was to evaluate the MRI pattern of marrow infiltration in correlation with markers of bone remodeling and angiogenesis in 44 newly diagnosed, untreated, MM patients (42 with symptomatic and 2 with asymptomatic MM). MRI of the spine was performed at the same time with measurement of a series of biochemical serum indices of bone metabolism and angiogenesis: osteoclast stimulators [soluble receptor activator of nuclear factor-κB ligand (sRANKL), osteoprotegerin (OPG), and osteopontin], bone resorption markers [C- and N-telopeptide of collagen type-I (CTX, and NTX, respectively), and tartrate-resistant acid phosphatase isoform 5b (TRACP-5b)], bone formation markers [bone alkaline phosphatase (bALP), and osteocalcin (OC)], and angiogenic cytokines [vascular endothelial growth factor (VEGF), VEGF-A, angiogenin (ANG), angiopoietin-2 (ANGP-2), and basic fibroblast growth factor (bFGF)]. Myeloma patients had increased values of sRANKL (p&lt;0.0001), OPG (p=0.01), sRANKL/OPG ratio (p&lt;0.0001), NTX (p&lt;0.0001), CTX (p=0.04), TRACP-5b (p&lt;0.0001), VEGF (p=0.03), VEGF-A (p&lt;0.0001), ANG (p&lt;0.001), ANGP-2 (p=0.001), and bFGF (p=0.007) compared with respective values of 33, gender and age matched, controls. MRI revealed that 19 patients had focal pattern of marrow involvement, 11 diffuse, 10 normal, and 4 had a variegated pattern. Patients with diffuse MRI pattern also had reduced values of bALP (p&lt;0.0001) compared to controls, while patients with normal pattern had reduced levels of both formation markers (OC and bALP; p=0.04 and &lt;0.0001, respectively) and normal levels of OPG. On the contrary, patients with focal and variegated patterns had normal values of bALP and OC. Bone formation as assessed by bALP was more suppressed in patients with diffuse or normal MRI patterns compared to patients of focal or variegated patterns (mean±SD: 15.9±7.3 U/L vs. 29.3±24.5 U/L; p=0.02), while there was no difference between these groups in terms of resorption markers or osteoclast stimulators’ levels. In addition, patients with diffuse and normal MRI pattern also had increased levels of VEGF-A compared to patients of focal or variegated patterns (mean±SD: 83±68.4 pg/mL vs. 38.4±55 pg/mL; p=0.04). All but two patients of diffuse pattern (81%) had at least one vertebral fracture on radiographic evaluation of the axial skeleton compared to ten patients with focal pattern (52%). These results suggest that patients with diffuse MRI pattern have suppressed bone formation, increased levels of the major angiogenic cytokine VEGF-A, and increased incidence of vertebral fractures compared to patients who showed a focal pattern of myeloma infiltration.


Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 5143-5143
Author(s):  
Evangelos Terpos ◽  
Meletios A. Dimopoulos ◽  
Vikas Shrivastava ◽  
Kim Leitzel ◽  
Dimitrios Christoulas ◽  
...  

Abstract Tissue inhibitor of metalloproteinase-1 (TIMP-1) is a natural metalloproteinase (MMP) inhibitor that binds to and inactivates mainly MMP-9. TIMP-1 has multifunctional roles in tumorigenesis: inhibition of the catalytic activity of metalloproteinases, growth promotion, inhibition of apoptosis, and regulation of angiogenesis. Increased TIMP-1 has been associated with an unfavorable prognosis in many cancers including breast, colorectal, gastric, head and neck, lung cancer, and lymphomas. In vitro studies have revealed that TIMP-1 is overexpressed in myeloma cell lines. Furthermore, TIMP-1 promotes myeloma cell invasion across basement membranes. The aim of this study was to evaluate the serum levels of TIMP-1 in newly-diagnosed, previous untreated myeloma patients and explore possible correlations with clinical and laboratory data, including survival. Fifty-five patients with newly-diagnosed myeloma (25M/30F, median age: 69 years) were evaluated. Eleven patients had stage 1 disease according to ISS, while 27 had stage 2 and 17 stage 3 myeloma. Serum TIMP-1 was determined before the administration of any therapy, including bisphosphonates, using ELISA methodology (Oncogene Science/Siemens HealthCare Diagnostics, Cambridge, MA, USA) along with a series of serum markers of bone metabolism: osteoclast regulators [soluble receptor activator of nuclear factor-κB ligand (sRANKL), and osteoprotegerin (OPG)], osteoblast inhibitor dickkopf-1 (Dkk-1), bone resorption markers (N- & C-telopeptide of collagen type-I: NTX, CTX and ICTP; and tartrate-resistant acid phosphatase-isoform 5b, TRACP-5b), and bone formation markers (bone-specific alkaline phosphatase, bALP; and osteocalcin, OC). The above bone markers were also evaluated in 27 healthy controls of similar age and gender. The mean serum TIMP-1 level of all patients was 431.9 ng/ml (SD 198.1 ng/ml). Twenty-six patients (17M/9F; 47%) had elevated values of TIMP-1 (upper normal limit 324 ng/ml for males and 454 ng/ml for post-menopausal women). Patients had also increased levels of Dkk-1, sRANKL, sRANKL/OPG ratio and bone resorption markers (NTX, CTX, ICTP and TRACP-5b) (p&lt;0.01 compared with healthy controls). TIMP-1 serum levels correlated with ICTP (r=0.514, p&lt;0.001), beta2-microglobulin (r=0.414, p&lt;0.01), albumin (r=-0.416, p&lt;0.01), osteocalcin (r=0.325, p=0.01), CTX (r=0.314, p=0.01), NTX (r=0.306, p=0.02), and LDH (r=0.295, p=0.03). More importantly, TIMP-1 correlated with ISS (ANOVA p=0.005). Patients with ISS 3 disease had higher levels of TIMP-1 (mean±SD 557.8±234 ng/ml) compared with those who had ISS 1 (311±90.6 ng/ml; p=0.001) or ISS 2 disease (405.5±165.6 ng/ml; p=0.021). Furthermore, patients with lytic disease (n=43) had increased levels of TIMP-1 (457.7±205 ng/ml) compared with all others (313.6±107.6 ng/ml; p=0.05). The median follow-up was 31 months and 16/55 patients have died. The median survival has not been reached yet. Patients who had TIMP-1 level of above the mean value had a median survival of 37 months, while in all others the median survival has not been reached yet (p=0.04). Our study provides evidence for the first time that increased serum levels of TIMP-1 correlate with advanced myeloma, with increased bone resorption and with increased number of osteolytic lesions. Furthermore, elevated TIMP-1 was associated with inferior survival of MM patients. These results suggest that TIMP-1 may participate in myeloma pathogenesis and support that serum TIMP-1 deserves further study to determine its predictive and prognostic potential in a larger cohort of myeloma patients.


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