作者:Pirow J. Bekker、Donna Holloway、Arline Nakanishi、Michael Arrighi、Philip T. Leese、Colin R. Dunstan
DOI:10.1359/jbmr.2001.16.2.348
日期:——
Osteoprotegerin (OPG), a tumor necrosis factor (TNF) receptor family member, is a critical regulator of bone resorption. It is an important inhibitor of the terminal differentiation and activation of osteoclasts. This randomized, double‐blind, placebo‐controlled, sequential dose escalation study was conducted in postmenopausal women to determine the effect of a single subcutaneous (sc) dose of OPG on bone resorption as indicated by the biochemical markers, urinary N‐telopeptide (NTX) and deoxypyridinoline (DPD), which are stable collagen degradation products. NTX levels decreased within 12 h after OPG administration. At the highest dose administered (3.0 mg/kg), a mean percent decrease in NTX of approximately 80% was observed 4 days after dosing. Six weeks after dosing a mean decrease of 14% in NTX was observed. The levels of bone‐specific alkaline phosphatase (BSAP), a marker of bone formation, did not change for approximately 3 weeks after dosing. Thereafter, a modest decrease, reaching approximately 30% at 6 weeks, was observed in the 3.0‐mg/kg dose group. The rapid decrease from baseline in NTX and delayed decrease in BSAP indicated that OPG acted primarily on osteoclasts to decrease bone resorption. OPG injections are well tolerated. This study, for the first time, indicates that a single sc injection of OPG is effective in rapidly and profoundly reducing bone turnover for a sustained period and that OPG therefore may be effective in treatment of bone diseases characterized by increased bone resorption such as osteoporosis.
护骨素(OPG)是一种肿瘤坏死因子(TNF)受体家族成员,是骨吸收的关键调节因子,对破骨细胞的终末分化和激活具有重要的抑制作用。该项随机、双盲、安慰剂对照的序贯剂量递增研究是在绝经后妇女中进行,以通过生物标志物——尿N-端肽(NTX)和脱氧吡啶啉(DPD,稳定的胶原蛋白降解产物)来确定单次皮下注射OPG对骨吸收的影响。OPG给药后12小时内NTX水平降低。最高剂量组(3.0 mg/kg)给药4天后,NTX的平均下降百分比约为80%。给药6周后,NTX的平均下降百分比为14%。骨特异性碱性磷酸酶(BSAP)是骨形成的标志物,约3周内未发现变化;此后,3.0 mg/kg剂量组BSAP略有下降,6周时约为30%。NTX从基线的快速下降及BSAP的延迟下降表明OPG主要作用于破骨细胞以减少骨吸收。OPG注射耐受良好。本研究首次表明单次皮下注射OPG可有效地在持续相当长的时间内迅速大幅减少骨转换,因此OPG对以骨吸收增加为特征的骨病(例如骨质疏松症)可能具有良好的治疗效果。