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Concept: Alkaline phosphatase


BACKGROUND: Osteoinductive bone substitutes are defined by their ability to induce new bone formation even at heterotopic implantation sites. The present study was designed to analyze the potential osteoinductivity of two different bone substitute materials in caprine muscle tissue.Materials and methods: One gram each of either a porous beta-tricalcium phosphate (beta-TCP) or an hydroxyapatite/silicon dioxide (HA/SiO2)-based nanocrystalline bone substitute material was implanted in several muscle pouches of goats. The biomaterials were explanted at 29, 91 and 181 days after implantation. Conventional histology and special histochemical stains were performed to detect osteoblast precursor cells as well as mineralized and unmineralized bone matrix. RESULTS: Both materials underwent cellular degradation in which tartrate-resistant acid phosphatase (TRAP)-positive osteoclast-like cells and TRAP-negative multinucleated giant cells were involved. The Ss-TCP was completely resorbed within the observation period, whereas some granules of the HA-groups were still detectable after 180 days. Neither osteoblasts, osteoblast precursor cells nor extracellular bone matrix were found within the implantation bed of any of the analyzed biomaterials at any of the observed time points. CONCLUSIONS: This study showed that Ss-TCP underwent a faster degradation than the HA-based material. The lack of osteoinductivity for both materials might be due to their granular shape, as osteoinductivity in goat muscle has been mainly attributed to cylindrical or disc-shaped bone substitute materials. This hypothesis however requires further investigation to systematically analyze various materials with comparable characteristics in the same experimental setting.

Concepts: Extracellular matrix, Skeletal system, Alkaline phosphatase, Observation, Hypothesis, Materials science, Intramembranous ossification, Osteoblast


Vascular calcification, occurring during late-stage vascular and valvular disease, is highly associated with chronic kidney disease-mineral and bone disorders (CKD-MBD), representing a major risk factor for cardiovascular morbidity and mortality. The hallmark of vascular calcification, which involves both media and intima, is represented by the activation of cells committed to an osteogenic programme. Several studies have analysed the role of circulating calcifying cells (CCCs) in vascular calcification. CCCs are bone marrow (BM)-derived cells with an osteogenic phenotype, participating in intima calcification processes and defined by osteocalcin and bone alkaline phosphatase expression. The identification of CCCs in diabetes and atherosclerosis is the most recent, intriguing and yet uncharted chapter in the scenario of the bone-vascular axis. Whether osteogenic shift occurs in the BM, the bloodstream or both, is not known, and also the factors promoting CCC formation have not been identified. However, it is possible to recognize a common pathogenic commitment of inflammation in atherosclerosis and diabetes, in which metabolic control may also have a role. Currently available studies in patients without CKD did not find an association of CCCs with markers of bone metabolism. Preliminary data on CKD patients indicate an implication of mineral bone disease in vascular calcification, as a consequence of functional and anatomic integrity interruption of BM niches. Given the pivotal role that parathyroid hormone and osteoblasts play in regulating expansion, mobilization and homing of haematopoietic stem/progenitors cells, CKD-MBD could promote CCC formation.

Concepts: Immune system, Bone, Cancer, Metabolism, Bone marrow, Alkaline phosphatase, Organ, Calcification


Exercise has shown little success in mitigating bone loss from long-duration spaceflight. The first crews of the International Space Station (ISS) used the “interim resistive exercise device” (iRED), which allowed loads of up to 297 lb(f) (or 1337 N) but provided little protection of bone or no greater protection than aerobic exercise. In 2008, the Advanced Resistive Exercise Device (ARED), which allowed absolute loads of up to 600 lb(f) (1675 N), was launched to the ISS. We report dietary intake, bone densitometry, and biochemical markers in 13 crewmembers on ISS missions from 2006 to 2009. Of these 13, 8 had access to the iRED and 5 had access to the ARED. In both groups, bone-specific alkaline phosphatase tended to increase during flight toward the end of the mission (p = 0.06) and increased 30 days after landing (p < 0.001). Most markers of bone resorption were also increased in both groups during flight and 30 days after landing (p < 0.05). Bone densitometry revealed significant interactions (time and exercise device) for pelvis bone mineral density (BMD) and bone mineral content (p < 0.01), hip femoral neck BMD (p < 0.05), trochanter BMD (p < 0.05), and total hip BMD (p < 0.05). These variables were unchanged from preflight only for ARED crewmembers, who also returned from flight with higher percent lean mass and lower percent fat mass. Body mass was unchanged after flight in both groups. All crewmembers had nominal vitamin D status (75 ± 17 nmol/L) before and during flight. These data document that resistance exercise, coupled with adequate energy intake (shown by maintenance of body mass determined by dual-energy X-ray absorptiometry [DXA]) and vitamin D, can maintain bone in most regions during 4- to 6-month missions in microgravity. This is the first evidence that improving nutrition and resistance exercise during spaceflight can attenuate the expected BMD deficits previously observed after prolonged missions.

Concepts: Osteoporosis, Bone, Dual energy X-ray absorptiometry, Alkaline phosphatase, Peripheral quantitative computed tomography, Strength training, Osteopenia, International Space Station


Patients with neuroendocrine carcinomas grade 3 have a poor prognosis. Etoposide-platinum combination is the standard chemotherapy but the role of a second-line remains unknown. Irinotecan alone or in combination has shown some efficacy in patients treated for small cell lung cancer which had pathological similarities with neuroendocine tumors. To determine safety and efficacy of the FOLFIRI regimen in patients with neuroendocrine carcinomas grade 3 after failure of etoposide-platinum combination. Retrospective study of patients with neuroendocrine carcinomas grade 3 and treated with the FOLFIRI regimen after progression or toxicity of etoposide-platinum combination in first-line. Patients with ECOG performance status ≥ 3 and/or serum alkaline phosphatase ≥ 5 x ULN and/or bilirubin ≥ 1.5 x ULN were excluded. Among 39 patients who failed etoposide-platinum combination, 19 (49%) (12 women, median age 53 [29-78] years) received the FOLFIRI regimen with a median number of 6 [1-16] courses. Six patients (32 %) had at least one episode of grade 3-4 toxicity (neutropenia n=3, diarrhea n=3) without toxic death. Six patients (31%) had objective response, 6 (31%) stable disease and 7 (38%) tumor progression. Median progression-free survival under FOLFIRI was 4 months. Overall survival was 18 months versus 6.8 months in non eligible patients. FOLFIRI regimen is a safe and potentially efficient chemotherapy given as second-line in patients with neuroendocrine carcinomas grade 3 who remain in good condition and with correct liver tests after failure of etoposide-platinum combination. These results should be confirmed in a future prospective study.

Concepts: Cancer, Oncology, Lung cancer, Chemotherapy, Alkaline phosphatase, Small cell carcinoma, Performance status, FOLFIRI


Two clinical studies were conducted to assess the safety, tolerability, pharmacokinetics (PK), and pharmacodynamics (PD) of single and multiple doses (intravenous [i.v.] and subcutaneous [s.c.]) of blosozumab in postmenopausal women, including prior/current bisphosphonate (BP) users. In these phase 1, randomized, subject- and investigator-blind, placebo-controlled studies, subjects received escalating doses of blosozumab: single i.v. doses up to 750 mg, single s.c. dose of 150 mg, multiple i.v. doses up to 750 mg every 2 weeks (Q2W) for 8 weeks, multiple s.c. doses up to 270 mg Q2W for 8 weeks, or placebo. Six subjects were randomized to each dose in the single-dose study (12 to placebo) and up to 12 subjects to each arm in the multiple-dose study. Blosozumab was well tolerated with no safety concerns identified following single or multiple administrations up to 750 mg. Dose-dependent responses were observed in sclerostin, N-terminal propeptide of procollagen type 1, bone specific alkaline phosphatase, osteocalcin, C-terminal fragment of type 1 collagen, and bone mineral density (BMD) following single and multiple (up to 5) administrations of blosozumab. There was up to a 3.41% (p = 0.002) and up to a 7.71% (p < 0.001) change from baseline in lumbar spine BMD at day 85 following single or multiple administrations of blosozumab, respectively. Prior BP use did not appear to have a clear impact on the effects of single doses of blosozumab when considering bone biomarker and BMD responses. Antibodies to blosozumab were detected by a screening assay but no pattern with regards to dose or route of administration and no clear impact on blosozumab exposure or PD responses was identified. In summary, blosozumab was well tolerated and exhibited anabolic effects on bone. These findings support further investigation of blosozumab as a potential anabolic therapy for osteoporosis.

Concepts: Osteoporosis, Pharmacology, Bone, Clinical trial, Collagen, Alkaline phosphatase, Intravenous therapy, Placebo


Pentachloronitrobenzene (PCNB) is a fungicide belonging to the organochlorine family and used extensively in agriculture for crop production. Many studies have implied that PCNB has become an environmental concern due to its widespread contamination in eco-systems. However, whether PCNB is bioaccumulated, degraded and phytotoxic in plants is poorly understood. In this study, several alfalfa (Medicago sativa) cultivars were grown in soil with PCNB to investigate their absorption and catabolism, including PCNB residues in the soil and PCNB-induced toxic responses in plants. Alfalfa plants varied widely in their ability to accumulate and degrade PCNB. The degradation rate of PCNB was 66.26-77.68% after alfalfa growth in the soils for 20 d, while the rates in the control (soil without alfalfa) were only 48.42%. Moreover, concentrations of PCNB residues in the rhizosphere soil were significantly higher than those in the non-rhizosphere soils. Alfalfa exposed to 10 mg kg(-1) PCNB showed inhibited growth and oxidative damage, but the effects of PCNB on the cultivars differed significantly, indicating that the alfalfa cultivars have different tolerance to PCNB. Activities of invertase (INV), urease (URE), polyphenol oxidase (PPO), alkaline phosphatase (ALP) and acid phosphatase (ACP) were assayed in the treated soils and showed that the enzyme activities were altered after PCNB exposure. The URE, PPO, ALP and ACP activities were increased in soil following the planting of alfalfa. The objective of the study was to analyze the potential of different cultivars of alfalfa to accumulate and degrade PCNB from the contaminated soil.

Concepts: Agriculture, Enzyme, Alkaline phosphatase, Soil, Fabaceae, Land degradation, Alfalfa, Medicago


Mouse serum alkaline phosphatase (ALP) is frequently measured and interpreted in mammalian bone research, however; little is known about the circulating ALPs in mice and their relation to human ALP isozymes and isoforms. Mouse ALP was extracted from liver, kidney, intestine, and bone from vertebra, femur and calvaria tissues. Serum from mixed strains of wild-type (WT) mice and from individual ALP knockout strains were investigated, i.e., Alpl(-/-) (a.k.a. Akp2 encoding tissue-nonspecific ALP or TNALP), Akp3(-/-) (encoding duodenum-specific intestinal ALP or dIALP), and Alpi(-/-) (a.k.a. Akp6 encoding global intestinal ALP or gIALP). The ALP isozymes and isoforms were identified by various techniques and quantified by high-performance liquid chromatography. Results from the WT and knockout mouse models revealed identical bone-specific ALP isoforms (B/I, B1, and B2) as found in human serum, but in addition mouse serum contains the B1x isoform only detected earlier in patients with chronic kidney disease and in human bone tissue. The two murine intestinal isozymes, dIALP and gIALP, were also identified in mouse serum. All four bone-specific ALP isoforms (B/I, B1x, B1, and B2) were identified in bone tissues from mice, in good correspondence with those found in human bones. All mouse tissues, except liver and colon, contained significant ALP activities. This is a notable difference as human liver contains vast amounts of ALP. Histochemical staining, Northern and Western blot analysis confirmed undetectable ALP expression in liver tissue. ALP activity staining showed some positive staining in the bile canaliculi for BALB/c and FVB/N WT mice, but not in C57Bl/6 and ICR mice. Taken together, while the main source of ALP in human serum originates from bone and liver, and a small fraction from intestine (<5%), mouse serum consists mostly of bone ALP, including all four isoforms, B/I, B1x, B1, and B2, and two intestinal ALP isozymes dIALP and gIALP. We suggest that the genetic nomenclature for the Alpl gene in mice (i.e., ALP liver) should be reconsidered since murine liver has undetectable amounts of ALP activity. These findings should pave the way for the development of user-friendly assays measuring circulating bone-specific ALP in mice models used in bone and mineral research.

Concepts: Bone, Liver, Alkaline phosphatase, Liver function tests, Chromatography, Small intestine, Mice, Offal



The abnormal cartilage/bone metabolism in unilateral condyle may be a direct factor that contributes to developmental mandibular laterognathism. However, although many molecules have been demonstrated to play crucial roles in the development of temporomandibular joints, the exact molecular mechanisms that lead to the disrupted condylar cartilage/bone development were greatly unknown. In this retrospective study, our findings revealed that serum alkaline phosphatase (ALP) level in adult patients with developmental mandibular laterognathism was lower than that in control subjects, and the serum ALP levels continue to reduce in adult patients (>20 years old). Although the exact relationship between the lower serum ALP level and developmental mandibular laterognathism is unclear, the findings further support the opinion that the condylar growth may sustain for a long time in the affected condyle in patients with developmental mandibular laterognathism and offer an alternative choice to use total serum ALP activity as a possible biomarker to assess condylar growth activity in patients with developmental mandibular laterognathism.

Concepts: Chemistry, Mandible, Alkaline phosphatase, Joint, Joints, Temporomandibular joint, Masseteric nerve


Intestinal alkaline phosphatase (IAP) plays a pivotal role in maintaining gut health and well-being. Oral supplementation with IAP in mice improves gut barrier function and prevents luminal proinflammatory factors from gaining access to the circulation. In this study, we sought to explore the relationship between IAP and tight junction protein (TJP) expression and function.

Concepts: Gene, Enzyme, Function, Alkaline phosphatase, C-reactive protein, Tight junction protein 1