Chattopadhyay, Naibedya. Effects of calcium-sensing receptor on the secretion of parathyroid hormone-related peptide and its impact on humoral hypercalcemia of malignancy. Am J Physiol Endocrinol Metab 290: E761-E770, 2006; doi:10.1152/ajpendo.00350.2005.-The extracellular calcium-sensing receptor (CaR) plays a key role in the defense against hypercalcemia by "sensing" extracellular calcium (Ca 2ϩ o) levels in the parathyroid and kidney, the key organs maintaining systemic calcium homeostasis. However, CaR function can be aberrant in certain pathophysiological states, e.g., in some types of cancers known to produce humoral hypercalcemia of malignancy (HHM) in humans and animal models in which high Ca 2ϩ o, via the CaR, produces a homeostatically inappropriate stimulation of parathyroid hormone-related peptide (PTHrP) secretion from these tumors. Increased levels of PTHrP set a cycle in motion whereby elevated systemic levels of Ca 2ϩ o resulting from its increased bone-resorptive and positive renal calcium-reabsorbing effects give rise to hypercalcemia, which in turn begets worsening hypercalcemia by stimulating further release of PTHrP by the cancer cells. I review the relationship between CaR activation and PTHrP release in normal and tumor cells giving rise to HHM and/or malignant osteolysis and the actions of the receptor on key cellular events such as proliferation, angiogenesis, and apoptosis of cancer cells that will favor tumor growth and osseous metastasis. I also illustrate diverse signaling mechanisms underlying CaR-stimulated PTHrP secretion and other cellular events in tumor cells. Finally, I raise several necessary questions to demonstrate the roles of the receptor in promoting tumors and metastases that will enable consideration of the CaR as a potential antagonizing/ neutralizing target for the treatment of HHM.G protein-coupled receptor; osteolysis; metastasis; cytokine; receptor tyrosine kinase
HUMORAL HYPERCALCEMIA OF MALIGNANCY AND THE ROLE OF PTHRPHYPERCALCEMIA IS USUALLY DEFINED as a state in which serum calcium concentrations are greater than 12 mg/dl, corrected for serum albumin concentration. Hypercalcemia frequently arises from primary hyperparathyroidism or in the context of various malignancies including, most frequently, breast, prostate, lung, and renal carcinomas (for review see Ref. 41). Many factors, including vascular endothelial growth factor (VEGF) and interleukin-8 and -11, have been implicated in promoting hypercalcemia of malignancy (41). However, parathyroid hormonerelated peptide (PTHrP) has now been shown to be the major pathogenic factor (31, 98 -100). This is because the tumor burden and bone lesions have been shown to be decreased significantly by treatment with PTHrP-neutralizing antibody in mice inoculated with a human breast cancer cell line ] or lung squamous cell carcinoma-derived cells [HARA (44)]. When produced in excess by extraskeletal tumor cells, i.e., in humoral hypercalcemia of malignancy (HHM), PTHrP spills into the systemic circulation and acts on the s...