骨钙素：一种重要的能量代谢调节激素

骨钙素是一种由成骨细胞合成的结构蛋白,经过翻译后加工生成羧化骨钙素而参与骨骼发育。然而,最新研究发现,未发生羧化修饰的骨钙素可促进胰腺β细胞增殖和胰岛素分泌,增加脂联素基因表达和减弱胰岛素抵抗,对糖尿病和肥胖的发生具有抑制作用。临床检测也发现骨钙素含量与空腹血糖和胰岛素浓度呈负相关,糖尿病患者体内含量明显较低。这些研究确立了骨钙素是一种能量代谢调节的重要激素,拓展了对骨骼功能理解的同时也为治疗代谢性紊乱疾病提供了新靶点。     

骨钙素对糖代谢影响的研究进展

骨钙素,亦称γ-羧基骨蛋白、骨谷氨酸蛋白和骨依赖维生素K蛋白,是一种由非增殖期成骨细胞合成的分泌蛋白,经过翻译后加工生成羧化骨钙素而参与骨骼发育。既往研究认为它是骨形成和骨转化的标志。然而最新研究发现,未发生羧化修饰的骨钙素对糖代谢有一定的影响作用,可促进胰腺β细胞增殖和胰岛素分泌,减弱胰岛素抵抗。多项研究证实高血糖可影响骨钙素合成,骨钙素在糖尿病患者中降低,糖尿病患者因胰岛素分泌和作用缺陷对胰岛素受体作用减弱,影响成骨细胞摄取核酸、氨基酸、胶原纤维合成,使其合成分泌骨钙素减少。这些研究确立了骨钙素为一种可以影响糖代谢的重要激素,拓展了对骨骼功能影响的同时也为新型降血糖药物的开发提供了新靶点。本文针对骨钙素对糖代谢的影响做一综述。     

胚胎干细胞磷酸酶的研究进展

胚胎干细胞磷酸酶(embryonic stem cell phosphatase,ESP)是在骨、性腺、胚胎等组织中高表达的一种跨膜受体样蛋白酪氨酸磷酸酶。研究表明ESP可能介导细胞分化以及细胞间相互作用的信号转导,参与成骨细胞以及生殖细胞的分化过程。ESP还能够抑止肿瘤细胞生长、抑制癌症发生。近年的研究发现ESP可通过在成骨细胞中的特异性表达影响骨钙素的活性从而调节胰岛素的分泌和敏感性,提示ESP在骨骼的内分泌功能中起重要作用,并参与骨骼对机体能量代谢稳态的调节。     

骨钙素——作用于能量代谢的新型调节激素

骨钙素(osteocalcin,OC)由成熟成骨细胞合成及分泌,是临床常用的骨形成标志物。其合成后大部分以羧化形式沉积在骨基质中参与骨骼矿化,少量未羧化或羧化不全直接分泌入血。未羧基化OC可作用于胰岛β细胞、脂肪细胞而促进胰岛素、脂联素的分泌,对能量代谢具调节作用,这使OC成为一种新型的能量代谢调节激素。     

骨骼的新认识——骨内分泌

骨骼被认为是一个动态结缔组织,具有重塑能力,以维持钙稳态和造血等功能。大量的研究显示,骨骼不仅作为结构支架,也作为内分泌器官调控代谢过程。除了传统的OPG、SOST、DKK等在骨形成、骨构成、骨重建以及骨稳态中扮演重要角色,骨骼还分泌特异性激素--骨钙素(osteocalcin, OCN)和成纤维细胞生长因子23(fibroblast growth factor 23, FGF23)。其中,骨钙素可促进β细胞增殖、胰岛素分泌、提高胰岛素敏感性,还可调节脂肪细胞、男性性腺内分泌活动和神经系统活性;成纤维细胞生长因子23通过对肾调节维持血磷内稳态。     

骨骼的内分泌功能

既往认为骨骼是支持机体基本结构和参与运动及钙磷代谢的主要器官。近年发现组成骨骼的成骨细胞和破骨细胞能合成和分泌多种骨调节蛋白、生长因子、脂肪因子、炎症因子和心血管活性肽等多种生物活性物质,以旁/自分泌方式调节骨骼系统功能,并能通过血液循环远距分泌的方式,调节机体能量代谢、炎症反应和内分泌稳态等。     

褪黑激素对体重调节

褪黑激素是松果体分泌的一种激素,其分泌受光周期影响。很多研究在褪黑激素对季节性繁殖、睡眠、昼夜节律和抗氧化等方面的作用已作过阐述。本综述介绍了褪黑激素的结构、合成及分解代谢、分泌和作用机制,及其通过对能量代谢调节及与其他激素相互作用来调节体重的机制,并分析在不同物种中褪黑激素对体重的影响,展望褪黑激素对治疗人类肥胖的应用前景。     

骨骼内分泌功能研究进展

既往研究认为骨骼的主要功能包括:机械支持、保护重要器官、提供造血微环境、参与钙磷代谢。近年越来越多的证据表明,骨骼不仅是接受神经和体液调节的"惰性器官",而且是具有生物活性的"内分泌器官"。骨骼分泌的生物活性物质,如骨调节蛋白、生长因子、脂肪因子、细胞因子、活性多肽和激素等,能通过自分泌、旁分泌的方式调节骨的代谢,也能以远距分泌的方式作用于胰腺、肝脏、肾脏、骨骼肌、大脑、睾丸等靶器官或组织,发挥相应的生物学作用。     

人骨钙素蛋白在毕赤酵母中表达条件的优化

目的:在已构建的人骨钙素蛋白p PIC9K-BGP表达载体的基础上,进行表达条件优化,提高其表达含量,为研究其对2型糖尿病的作用机制奠定研究基础。方法:将前期构建的p PIC9K-BGP载体转入毕赤酵母中,以人骨钙素试剂盒鉴定不同诱导剂浓度、不同诱导温度和不同诱导时间对蛋白表达量的影响。结果:在诱导温度28℃、加入0.5%的甲醇诱导、诱导时间为96h时获得较高的分泌性蛋白的表达量。结论:优化了骨钙素在毕赤酵母中的表达条件,提高了表达量。     

胃激素ghrelin和nesfatin-1与骨骼肌糖代谢

胃肠系统既是物质消化吸收和能量代谢调节的重要器官,其分泌的胃肠激素又可以整合中枢和外周对摄食及体重的调控,并且通过中枢间接地或者直接作用于外周胰岛素敏感器官,从而调节糖代谢。骨骼肌作为葡萄糖摄取的主要位点和胰岛素的主要靶器官之一,其糖代谢对2型糖尿病有着至关重要的作用。胃激素,尤其是ghrelin作为已知的唯一一种血液中促进摄食的激素,对糖代谢的影响已经成为目前的研究热点。探索胃激素与骨骼肌糖代谢之间的关系将会为胰岛素抵抗和2型糖尿病的治疗带来新的希望。     

Bone metabolism: a note on the significance of mouse models

This minireview briefly surveys the complexity of regulations governing the bone metabolism. The impact of clinical studies devoted to osteoporosis is briefly summarized and the emphasis is put on the significance of experimental mouse models based on an extensive use of genetically modified animals. Despite possible arising drawbacks, the studies in mice are of prime importance for expanding our knowledge on bone metabolism. With respect to human physiology and medicine, one should be always aware of possible limitations as the experimental results may not be, or may be only to some extent, transposed to humans. If applicable to humans, results obtained in mice provide new clues for assessing unforeseen treatment strategies for patients. A recent publication representing in our opinion the important breakthrough in the field of bone metabolism in mice is commented in detail. It provides an evidence that skeleton is endocrine organ that affects energy metabolism and osteocalcin, a protein specifically synthesized and secreted by osteoblasts, is a hormone involved. If confirmed by other groups and applicable to humans, this study provides the awaited connection of long duration between bone disorders on one hand and obesity and diabetes on the other.     

Bone As An Endocrine Organ

ObjectiveTo review the recent evidence that has emerged supporting the role of bone as an endocrine organ.MethodsThis review will detail how bone has emerged as a bona fide endocrine “gland,” and with that, the potential therapeutic implications that could be realized for this hormone-secreting tissue by detailing the evidence in the literature supporting this view.ResultsThe recent advances point to the skeleton as an endocrine organ that modulates glucose tolerance and testosterone production by secretion of the bone-specific protein osteocalcin.ConclusionsBone has classically been viewed as an inert structure that is necessary for mobility, calcium homeostasis, and maintenance of the hematopoietic niche. Recent advances in bone biology using complex genetic manipulations in mice have highlighted the importance of bone not only as a structural scaffold to support the human body, but also as a regulator of a number of metabolic processes that are independent of mineral metabolism. (Endocr Pract. 2012;18:758-762)     

Endocrine regulation of energy metabolism by the skeleton

The regulation of bone remodeling by an adipocyte-derived hormone implies that bone may exert a feedback control of energy homeostasis. To test this hypothesis we looked for genes expressed in osteoblasts, encoding signaling molecules and affecting energy metabolism. We show here that mice lacking the protein tyrosine phosphatase OST-PTP are hypoglycemic and are protected from obesity and glucose intolerance because of an increase in beta-cell proliferation, insulin secretion, and insulin sensitivity. In contrast, mice lacking the osteoblast-secreted molecule osteocalcin display decreased beta-cell proliferation, glucose intolerance, and insulin resistance. Removing one Osteocalcin allele from OST-PTP-deficient mice corrects their metabolic phenotype. Ex vivo, osteocalcin can stimulate CyclinD1 and Insulin expression in beta-cells and Adiponectin, an insulin-sensitizing adipokine, in adipocytes; in vivo osteocalcin can improve glucose tolerance. By revealing that the skeleton exerts an endocrine regulation of sugar homeostasis this study expands the biological importance of this organ and our understanding of energy metabolism.     

Diabetic Polyneuropathy Relates to Bone Metabolism and Markers of Bone Turnover in Elderly Patients With Type 2 Diabetes: Greater Effects in Male Patients

BackgroundThere is evidence that diabetic polyneuropathy (PNP) is associated with reduced bone mineral density (BMD) in type 1 diabetes but little is known about the impact of diabetic PNP on bone metabolism in type 2 diabetes.ObjectivesThe aim of this study was to evaluate differences in bone metabolism by measuring markers of bone turnover and BMD in men and postmenopausal women with type 2 diabetes and diabetic PNP compared with those without PNP. Gender differences were analyzed for both groups of patients.MethodsOne hundred twenty patients with type 2 diabetes, 68 without PNP (43 men, 25 women, mean age 62 [8] years) and 52 with PNP (28 men, 24 women, mean age 64 [8] years) were studied. Clinical parameters with bone turnover biomarkers such as osteocalcin, bone alkaline phosphatase, procollagen type 1 amino-terminal propeptide, and carboxy-terminal telopeptide of type 1 collagen were measured in all patients. Dual energy x-ray absorptiometry to evaluate BMD was performed in a subgroup of patients.ResultsAfter controlling for age, body mass index, duration of diabetes, smoking, glycosylated hemoglobin, homeostasis model assessment index for insulin resistance, serum C-reactive protein, creatinine, calcium, gamma-glutamyltransferase, parathyroid and sex hormones levels, presence of micro/macrovascular complications, statin- as well as diabetes-related therapies, levels of carboxy-terminal telopeptide of type 1 collagen and procollagen type 1 amino-terminal propeptide were significantly higher among patients with PNP when compared with patients without PNP (P = 0.01 and P = 0.03, respectively). Differences in bone biomarkers were more pronounced among men with diabetes. BMD did not differ significantly between patients with and without PNP, independent of gender.ConclusionsMale patients with PNP exhibit a higher rate of bone turnover than men without PNP. High rate of bone turnover increases the susceptibility for developing osteoporosis. Prevention of diabetic PNP might also reduce the incidence of osteoporosis and fractures in patients with type 2 diabetes.     

Osteocalcina: nexo de unión entre homeostasis ósea y metabolismo energético

Research in animal models has demonstrated the role of osteocalcin, a bone formation marker, in regulation of energy metabolism. Those studies have led to a new concept of the bone acting as an endocrine organ by secreting osteocalcin, which acts by increasing insulin secretion, lowering plasma glucose, and increasing insulin sensitivity and energy expenditure. Results in humans have been conflicting. On the other hand, antiresorptive drugs used against osteoporosis decrease osteocalcin levels, while anabolic drugs increase osteocalcin levels. However, the effects of these therapies on energy metabolism have not been investigated.     

Bone endocrine regulation of energy metabolism and male reproduction

Usually vertebrate physiology is studied within the confined limits of a given organ, if not cell type. This approach has progressively changed with the emergence of mouse genetics that has rejuvenated the concept of a whole body study of physiology. A vivid example of how mouse genetics has profoundly affected our understanding of physiology is skeleton physiology. A genetic approach to bone physiology revealed that bone via osteocalcin, an osteoblast-secreted molecule, is a true endocrine organ regulating energy metabolism and male reproduction. This ongoing body of work that takes bone out of its traditional roles is connecting it to a growing number of peripheral organs. These novel important hormonal connections between bone, energy metabolism and reproduction underscore the concept of functional dependence in physiology and the importance of genetic approaches to identify novel endocrine regulations.     

Bone and glucose metabolism: A two-way street

Evidence from rodent models indicates that undercarboxylated osteocalcin (ucOC), a product of osteoblasts, is a hormone affecting insulin production by the pancreas and insulin sensitivity in peripheral tissues, at least in part through enhanced secretion of adiponectin from adipocytes. Clinical research to test whether this relationship is found in humans is just beginning to emerge. Cross-sectional studies confirm associations between total osteocalcin (OC), ucOC and glucose metabolism but cannot distinguish causality. To date, longitudinal studies have not provided a consistent picture of the effects of ucOC or OC on fasting glucose and insulin sensitivity. Further exploration into the physiological and mechanistic effects of ucOC and OC, in rodent models and clinical studies, is necessary to determine to what extent the skeleton regulates energy metabolism in humans.     

The effect of pramlintide (amylin analogue) treatment on bone metabolism and bone density in patients with type 1 diabetes mellitus.

Amylin is a 37-amino-acid peptide related to CGRP and calcitonin. It is co-secreted with insulin from pancreatic beta-cells. Amylin is deficient with type 1 diabetes mellitus. To study the in vivo effects of amylin in humans, diabetic patients are an adequate model of chronic amylin deficiency. We investigated the effect of a 12 months pramlintide therapy (amylin analogue) on bone metabolism in patients with type 1 diabetes mellitus. 23 patients with type 1 diabetes mellitus (age 45.2 +/- 10.3 years, duration of diabetes mellitus 20.7 +/- 9.8 years, 13 male, 10 female) injected themselves 0.1 ml pramlintide, a human amylin analogue, four times per day for a period of 12 months. Bone mineral density measurements of the lumbar spine by dual-energy X-ray absorptiometry (DXA), and biochemical markers of bone metabolism (serum-calcium, PTH, osteocalcin, urinary pyridinium cross-links) were obtained before and one year after starting pramlintide therapy. None of the following parameters changed significantly: bone density, serum calcium, PTH, osteocalcin or pyridinium cross-links. Only osteocalcin decreased from 7.205 ng/ml to 5.825 ng/ml, but this change was not statistically significant. We conclude that a one-year pramlintide therapy does not affect bone density or bone metabolism in patients with type 1 diabetes mellitus without osteopenia (based on the markers used).     

Wnt-Lrp5 Signaling Regulates Fatty Acid Metabolism in the Osteoblast

The Wnt coreceptors Lrp5 and Lrp6 are essential for normal postnatal bone accrual and osteoblast function. In this study, we identify a previously unrecognized skeletal function unique to Lrp5 that enables osteoblasts to oxidize fatty acids. Mice lacking the Lrp5 coreceptor specifically in osteoblasts and osteocytes exhibit the expected reductions in postnatal bone mass but also exhibit an increase in body fat with corresponding reductions in energy expenditure. Conversely, mice expressing a high bone mass mutant Lrp5 allele are leaner with reduced plasma triglyceride and free fatty acid levels. In this context, Wnt-initiated signals downstream of Lrp5, but not the closely related Lrp6 coreceptor, regulate the activation of β-catenin and thereby induce the expression of key enzymes required for fatty acid β-oxidation. These results suggest that Wnt-Lrp5 signaling regulates basic cellular activities beyond those associated with fate specification and differentiation in bone and that the skeleton influences global energy homeostasis via mechanisms independent of osteocalcin and glucose metabolism.