If both rapid and genomic pathways may co-exist in the same cell, the involvement of the nuclear vitamin D receptor (VDR) in the rapid effects of 1,25-dihydroxyvitamin D 3 (1,25-(OH) 2 D 3 ) remains unclear. We therefore studied rapid and long term effects of 1,25-(OH) 2 D 3 in cultured skin fibroblasts from three patients with severe vitamin D-resistant rickets and one age-matched control. Patients bear homozygous missense VDR mutations that abolished either VDR binding to DNA (patient 1, mutation K45E) or its stable ligand binding (patients 2 and 3, mutation W286R). In patient 1 cells, 1,25-(OH) 2 D 3 (1 pM-10 nM) had no effect on either intracellular calcium or 24-hydroxylase (enzyme activity and mRNA expression). In contrast, cells bearing the W286R mutation had calcium responses to 1,25-(OH) 2 D 3 (profile and magnitude) and 24-hydroxylase responses to low (1 pM-100 pM) 1,25-(OH) 2 D 3 concentrations (activity, CYP24, and ferredoxin mRNAs) similar to those of controls. The blocker of Ca 2؉ channels, verapamil, impeded both rapid (calcium) and long term (24-hydroxylase activity, CYP24, and ferredoxin mRNAs) responses in patient and control fibroblasts. The MEK 1/2 kinase inhibitor PD98059 also blocked the CYP24 mRNA response. Taken together, these results suggest that 1,25-(OH) 2 D 3 rapid effects require the presence of VDR and control, in part, the first step of 1,25-(OH) 2 D 3 catabolism via increased mRNA expression of the CYP24 and ferredoxin genes in the 24-hydroxylase complex.The general and severe end organ resistance to vitamin D observed in patients with mutations in the gene encoding the nuclear vitamin D receptor (VDR) 1 bring forth strong evidence that most cellular actions of 1,25-(OH) 2 D 3 , the hormonal form of vitamin D, are mediated through interactions of the hormone with its nuclear receptor (1). The VDR, which belongs to the steroid/thyroid nuclear receptor family, is composed of two principal domains, one domain for hormone binding (exons 6 -9) and one domain for DNA binding (exons 2 and 3, coding for two zinc fingers) (2). Although most classical effects of 1,25-(OH) 2 D 3 involve this genomic pathway, several other effects may be observed very rapidly, within seconds to minutes, and are not blocked by inhibitors of transcription or translation, suggesting a more direct action of the hormone at the membrane level (3-7). These effects include activation of the phospholipase C pathway via G␣ q/11 (8, 9), activation of the adenylate cyclase pathway (10), opening of voltage-gated Ca 2ϩ channels (L-type) in the plasma membrane (11, 12), Ca 2ϩ mobilization from the endoplasmic reticulum (5), and an increase in cyclic guanosine monophosphate levels (13). The rapid effects of 1,25-(OH) 2 D 3 also include the activation of the mitogenactivated protein kinase (MAPK) pathway (14 -16), which induces a cross-talk with the cell nucleus via phosphorylation of cytoplasmic kinases and nuclear transcription factors (7,16,17).Attempts have been made to identify the receptor mediating the non-classical r...