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G el-Hajj Fuleihan

Publications and source records attributed to G el-Hajj Fuleihan.

9 recordsLinked to original sources
PubMed1998

Calcium-regulated renal calcium handling in healthy men: relationship to sodium handling.

Several studies have shown an increase in urinary calcium excretion in response to a calcium load. However, because of the inverse changes in PTH levels with a calcium load, the effect of changes in serum calcium per se on its own excretion is unclear in humans. In this study we used a PTH clamp protocol to further characterize calcium-regulated renal calcium and magnesium handling and the relationship of the former to sodium excretion. Eight normal male subjects were evaluated using a calcium clearance protocol with graded calcium infusions under a PTH clamp while in balance during a high and then during a low sodium diet. The curves describing calcium and magnesium excretion as a function of serum ionized calcium on the high sodium diet were best fitted by sigmoidal functions, with midpoints (the levels of calcium resulting in half-maximal increases in urinary cation excretion) of 1.51 and 1.49 mmol/L, respectively. The curve describing urinary sodium as a function of serum calcium was also sigmoidal on the high sodium diet, with a midpoint of 1.55 mmol/L. Our data taken in conjunction with those of previous studies evaluating sodium and calcium excretion in diseases characterized by inactivating or activating mutations in the calcium receptor, are consistent with the hypothesis that PTH-independent, calcium-dependent changes in renal calcium, magnesium, and sodium handling may be mediated at least in part by this receptor, which is known to be located in the loop of Henle.

Adult↗
PubMed1997

The parathyroid hormone circadian rhythm is truly endogenous--a general clinical research center study.

While circulating levels of PTH follow a diurnal pattern, it has been unclear whether these changes are truly endogenous or are dictated by external factors that themselves follow a diurnal pattern, such as sleep-wake cycles, light-dark cycles, meals, or posture. We evaluated the diurnal rhythm of PTH in 11 normal healthy male volunteers in our Intensive Physiologic Monitoring Unit. The first 36 h spent under baseline conditions were followed by 28-40 h of constant routine conditions (CR; enforced wakefulness in the strict semirecumbent position, with the consumption of hourly snacks). During baseline conditions, PTH levels followed a bimodal diurnal rhythm with an average amplitude of 4.2 pg/mL. A primary peak (t1max) occurred at 0314 h, and the secondary peak (t2max) occurred at 1726 h, whereas the primary and secondary nadirs (t1min and t2min) took place, on the average, at 1041 and 2103 h, respectively. This rhythm was preserved under CR conditions, albeit with different characteristics, thus confirming its endogenous nature. The serum ionized calcium (Cai) demonstrated a rhythm in 3 of the 5 subjects studied that varied widely between individuals and did not have any apparent relation to PTH. Urinary calcium/creatinine (UCa/Cr), phosphate/Cr (UPO4/Cr), and sodium/Cr (UNa/Cr) ratios all followed a diurnal rhythm during the baseline day. These rhythms persisted during the CR, although with different characteristics for the first two parameters, whereas that of UNa/Cr was unchanged. In general, the temporal pattern for the UCa/Cr curve was a mirror image of the PTH curve, whereas the UPO4/Cr pattern moved in parallel with the PTH curve. In conclusion, PTH levels exhibit a diurnal rhythm that persists during a CR, thereby confirming that a large component of this rhythm is an endogenous circadian rhythm. The clinical relevance of this rhythm is reflected in the associated rhythms of biological markers of PTH effect at the kidney, namely UCa/Cr and UPO4/Cr.

Adult↗
PubMed1992

Effect of sequential and daily continuous hormone replacement therapy on indexes of mineral metabolism.

BACKGROUND: Continuous regimens of estrogen-progesterone have recently been favored over sequential regimens because of a lower incidence of withdrawal bleeding. To determine whether the beneficial effects of sequential hormonal therapy on bone metabolism are preserved with the newer continuous regimens, we studied indexes of skeletal metabolism and changes in bone mineral density during a 1-year prospective trial. METHODS: Our subjects were randomized to one of three treatment groups: those in group C-2.5 were treated with 0.625 mg of conjugated estrogen with 2.5 mg of micronized medroxyprogesterone acetate daily continuously; group C-5 received 0.625 mg of conjugated estrogen and 5.0 mg of micronized medroxyprogesterone acetate daily continuously; and group S-5 received 0.625 mg of conjugated estrogen on days 1 through 25 and 5 mg of micronized medroxyprogesterone acetate on days 14 through 25. RESULTS: At 1 year, all groups demonstrated a significant decrease in indexes of bone formation turnover, including decrements in alkaline phosphatase levels of 11% to 30% and in osteocalcin levels of 45% to 60%. Intact parathyroid hormone levels rose 10% to 20%, with a concomitant near-significant decrement in ionized calcium levels at 12 months. In addition, there were significant decrements in the 24-hour urinary calcium-creatinine ratios and hydroxyproline-creatinine ratios of 13% to 28%, measures of bone resorption. Linear regression analyses showed that the subjects with the high bone resorption achieved the greatest increment in bone mineral density in response to hormone therapy. CONCLUSION: The daily continuous estrogen-progesterone regimens are as efficacious as sequential hormonal therapy in decreasing indexes of bone turnover and stabilizing bone mineral density of the spine and proximal femur.

Bone Density↗
PubMed1991

Effects of the lectin concanavalin-A on the regulation of second messengers and parathyroid hormone release by extracellular Ca2+ in bovine parathyroid cells.

The lectin Concanavalin-A (Con-A) binds to cell surface carbohydrate-containing moieties and modulates the function of a variety of glycoprotein receptors. Since extracellular calcium (Ca2+) may regulate parathyroid function by a receptor-like process, we examined the effects of Con-A on various aspects of Ca(2+)-regulated parathyroid function. We recently showed that Con-A significantly reduces the inhibitory effects of high Ca2+ on dopamine as well as isoproterenol- and forskolin-stimulated cAMP accumulation. In our present studies Con-A similarly reduced the inhibitory effect of 2.0 mM Ca2+ on PTH release from 60 +/- 6% to 40 +/- 6% and increased the set-point for Ca(2+)-regulated PTH release from 1.25 to 1.8 mM. This effect was dose dependent. Con-A also inhibited the Ca(2+)-stimulated accumulation of inositol phosphates by 50-60% in association with a marked reduction in the high Mg(2+)-evoked spike in cytosolic Ca2+ as well as a significant decrease in the sustained rise in cytosolic Ca2+ at 2-3 mM extracellular Ca2+. These data provide further evidence for a key role for cell surface carbohydrate-containing moieties in the mechanism through which parathyroid cells "sense" Ca2+ and, in turn, regulate PTH release, phosphoinositide turnover, and the release of intracellular Ca2+ stores. It is possible that the putative Ca2+ receptor is a glycoprotein or is closely associated with glycoproteins or other moieties containing alpha-methyl-D-glucoside or alpha-methyl-D-mannoside residues.

Animals↗
PubMed1991

Low dose prednisone does not affect calcium homeostasis or bone density in postmenopausal women with rheumatoid arthritis.

To assess whether low doses of prednisone produce generalized alterations in skeletal homeostasis in rheumatoid arthritis (RA), indices of calcium metabolism and bone mineral density (BMD) were measured in 22 women with RA treated without or with prednisone (6.6 mg daily). Ionized and total calcium concentrations, intact parathyroid hormone (PTH) and osteocalcin levels were comparable in the 2 groups. BMD measurements in the lumbar spine, and proximal femur sites including the femoral neck, Ward's triangle, and trochanteric region were not significantly different in patients with RA treated without or with prednisone. In our experience low dose prednisone did not adversely affect indices of mineral metabolism, or bone density in RA.

Adult↗
PubMed1990

Effect of the lectin concanavalin-A on calcium-regulated adenosine 3',5'-monophosphate accumulation in bovine parathyroid cells.

Extracellular calcium (Ca2+) is the major physiological regulator of parathyroid function; high Ca2+ decreases PTH secretion as well as reduces cAMP accumulation. There is an increasing body of evidence suggesting the presence of a receptor-like mechanism at the surface of the parathyroid cell which mediates these and other actions of Ca2+. In the present studies we used the lectin Concanavalin-A (Con-A) to investigate the possible role of carbohydrate moieties in the regulation of cAMP metabolism by Ca2+ in bovine parathyroid cells, which is thought to involve inhibition of adenylate cyclase via activation of the guanine nucleotide regulatory protein Gi. Pretreatment of parathyroid cells with Con-A for 15-60 min significantly reversed the inhibitory effect of high Ca2+ on dopamine-stimulated cAMP accumulation, reducing the inhibition at 3 mM Ca2+ from 70 +/- 3% to 30 +/- 3%. This effect was also observed in the absence of preincubation and with concentrations of Con-A as low as 40 micrograms/ml and was reversed by alpha-methyl-D-glucoside, a specific antagonist of the lectin. The lectin also reversed the inhibitory effects of Ca2+ (2-3 mM) on cAMP accumulation stimulated by isoproterenol and forskolin to a comparable extent. Prostaglandin F2 alpha-induced inhibition of cAMP accumulation (likewise mediated by Gi) was, however, not reversed by Con-A, suggesting that the lectin did not have a generalized effect on the cell surface or on receptors inhibiting adenylate cyclase. Moreover, fluoride-induced inhibition of cAMP accumulation was not reversed by Con-A, providing additional evidence that the lectin did not act at or distal to Gi (i.e. modulate Gi, adenylate cyclase, and/or phosphodiesterase). The present study suggests that Con-A may modulate the actions of extracellular Ca2+ on parathyroid secretion, possibly modifying the interaction of Ca2+ with the cell surface by affecting carbohydrate moieties that seem to be important in the Ca2(+)-sensing process. The structural element involved in Ca2+ sensing in the parathyroid cell may be a glycoprotein or closely associated with glycoproteins with carbohydrate chains containing alpha-methyl-D-glycoside.

Animals↗
PubMed1989

Calcium-dependent release of N-terminal fragments and intact immunoreactive parathyroid hormone by human pathological parathyroid tissue in vitro.

The regulation of PTH secretion by extracellular calcium was studied in parathyroid tissue obtained from patients with hyperparathyroidism (adenoma or hyperplasia) using both an amino (N)-terminal RIA as well as an immunoradiometric assay (intact assay) specific for the intact hormone. The parathyroid glands separated into three major groups when examined in terms of absolute amounts of PTH secreted, degree of suppressibility, and set-point for calcium (the concentration of calcium causing half-maximal inhibition of PTH release). In cell preparations from group A (two different adenomas, two hyperplastic glands from a patient with renal failure, and a hyperplastic gland from a patient with hypophosphatemic rickets), both assays showed comparable PTH release (agreeing within 2-fold), similar degrees of suppressibility and similar, if not identical, set-points. In group B (two adenomas and one hyperplastic gland from a patient with renal failure), PTH secretion, as measured in the N-terminal assay, was 3- to 6-fold more than that measured in the intact assay. The set-points and maximal degrees of suppressibility were, however, still comparable. In group C [two adenomas and one gland from a patient with hypophosphatemic rickets (the sister of the patient in group A)], no suppressibility was observed when PTH release was measured using the intact assay (i.e. less than 50% suppression of PTH release at 2-3 mM Ca2+). In one of these three glands, the N-terminal assay was used in addition to the intact assay, and no suppressibility was present with either assay. Thus, in general, the effects of extracellular Ca2+ on PTH secretion from pathological parathyroid tissue were similar when assessed with both an N-terminal and an intact assay, at least with respect to setpoint and maximal suppressibility. In a few cases, maximal PTH release was greater when measured with the N-terminal assay, consistent with substantial release of N-terminal fragments in addition to intact PTH. In addition, nonsuppressible glands were not uncommon when PTH release was measured by the intact assay, confirming previous studies with less specific assays.

Adolescent↗
PubMedDate not supplied

Osteoporosis: an update.

Prevention is the therapy of choice for optimizing skeletal health and preventing osteoporosis. Attempts directed at increasing peak bone mass (e.g., good calcium intake during preadolescence, adolescence, and adulthood), reducing risk factors for bone loss such as menstrual abnormalities, thin body habitus, decreased physical activity or excessive alcohol intake, and slowing down bone loss and reversing any causes of secondary bone loss should be pursued vigorously. In practice, all patients should be encouraged to get regular exercise, as well as adequate vitamin D and calcium intake. In the absence of contraindications, estrogen is the mainstay therapy for the prevention and treatment of osteoporosis. Other antiresorptive agents are available as alternative therapies to estrogen. Of equal importance to elderly women with established osteoporosis is counseling on how to prevent falls. Therapies that increase bone formation (aside from fluoride), including growth factors, are not currently available. However, such interventions used in conjunction with an antiresorptive therapy, offer the potential to greatly enhance and therefore normalize bone mass and may hold a promise for the treatment of osteoporosis in the future.

Female↗