Most patients with chronic kidney disease develop secondary hyperparathyroidism with disabling systemic complications. Calcimimetic agents are effective tools in the management of secondary hyperparathyroidism, acting through allosteric modification of the calcium-sensing receptor (CaR) on the parathyroid gland (PT) to decrease parathyroid hormone (PTH) secretion and PT cell proliferation. This study showed that rats that were fed an adenine high-phosphorus diet had increased serum PTH and PTH mRNA levels at 7 and 21 d. For studying the effect of activation of the CaR by the calcimimetics R-568 on PTH gene expression, R-568 was given by gavage to uremic rats for the last 4 d of a 7-d adenine high-phosphorus diet. R-568 decreased both PTH mRNA and serum PTH levels. The effect of the calcimimetic on PTH gene expression was posttranscriptional and correlated with differences in protein-RNA binding and posttranslational modifications of the trans acting factor AUF1 in the PT. The AUF1 modifications as a result of uremia were reversed by treatment with R-568 to those of normal rats. Therefore, uremia and activation of the CaR mediated by calcimimetics modify AUF1 posttranslationally. These modifications in AUF1 correlate with changes in protein-PTH mRNA binding and PTH mRNA levels. T he elevated parathyroid hormone (PTH) and disordered mineral metabolism associated with secondary hyperparathyroidism (HPT) complicate the clinical course of most patients with late-stage chronic kidney disease (CKD) and, when advanced, are associated with markedly increased morbidity and mortality (1). The hallmark of secondary HPT is the high levels of circulating PTH, which result from increased PTH secretion, increased PTH gene expression and synthesis, and increased parathyroid gland (PT) cell proliferation (2). The elucidation of PTH gene regulation in CKD is central to the understanding and control of the pathogenesis of secondary HPT (2-4). A limited number of preformed secretory granules contain mature PTH in the PT, and the increased PTH secretion demands the synthesis of new hormone (5-7). Accordingly, treatments that are designed to regulate PTH gene expression and translation may be of substantial clinical benefit.Data from clinical trials have demonstrated that calcimimetic therapy can reduce PTH, serum calcium and phosphorus, and the calcium-phosphorus product (Ca ϫ P) (8,9) and lead to the achievement of Kidney Disease Outcomes Quality Initiative target levels for PTH and Ca ϫ P in many more patients (10). In addition, calcimimetics, which act through the allosteric modulation of the calcium-sensing receptor (CaR), have been shown effectively to decrease PT cell proliferation in a rat model of secondary HPT (11). Therefore, there is considerable interest in determining the mechanisms by which this novel therapeutic class regulates PTH. To date, there have been no reports on the effects of calcimimetics on PTH gene expression. In this study, we examined the effect of the calcimimetic R-568 on PTH mRNA levels, protein-RNA b...