Ann R Coll Surg Engl 2008; 90: 271-277 271The parathyroid glands were first described at autopsy in 1862 in an Indian rhinoceros by Sir Richard Owen from the Hunterian Museum of the Royal College of Surgeons of England, 1 but their role in calcium homeostasis was only recognised decades later. Calcium is an essential element throughout the phylogenetic tree and the free extracellular calcium concentration ([Ca 2+ ] ext ) is maintained within a narrow range (1.0-1.3 mM). A central role in the rapid control of calcium homeostasis is played by the parathyroid hormone (PTH), whose co-ordinated actions on bone, kidney and intestine increase the flow of calcium into the extracellular fluid. There is an inverse sigmoidal relationship between PTH secretion and [Ca 2+ ] ext . The initial changes in the secretory rate of PTH in response to low [Ca 2+ ] ext take place within seconds through the release of preformed hormones from storage granules. Within 15-30 min, there is also an increase in the net rate of PTH synthesis. Prolonged hypocalcaemia promotes parathyroid cellular hypertrophy and proliferation within days to weeks. ] ext ) via a receptor-type mechanism. This lead to the hypothesis that abnormalities in the expression and/or function of the CaR could explain the biochemical abnormalities in primary hyperparathyroidism (PHPT).
HUNTERIAN LECTURE
Ann R Coll Surg EnglCultured cells from parathyroid adenomas of patients operated for PHPT were used to monitor real-time changes in intracellular calcium concentration ([Ca 2+ ] i ) as measured by fluorescent microscopy using the Fura-2/AM dye. We found that CaR agonists trigger release of intracellular calcium pools and such responses are amplified by increasing the affinity of IP 3 receptors. Using confocal microscopy to monitor membrane trafficking in living parathyroid cells labelled with the fluorescent dye FM1-43, we found that a decrease in [Ca 2+ ] i rather than an absolute change in [Ca 2+ ] ext is the main stimulus for exocytosis from human parathyroid cells. These data suggest that, in PHPT, a defective signalling mechanism from the CaR allows cells from parathyroid adenomas to maintain low [Ca 2+ ] i with uninhibited PTH secretion in the face of hypercalcaemia. Over longer periods of time, CaR controls parathyroid proliferation via changes in tyrosine phosphorylation. We found that multiple proteins of molecular weight 20-65 kDa are phosphorylated within 10-60 min in response to CaR agonists.Further work demonstrated that high [Ca 2+ ] i stimulates the expression of bcl-2 oncoprotein in cultured human parathyroid cells and that, in parathyroid adenomas, predominant expression of bcl-2 rather than bax oncoprotein might prevent apoptosis and explain the slow growth rate of these tumours.More recently, it became apparent that CaR stimulates cell proliferation in several cell types not involved in calcium homeostasis. Using archived histological material from 65 patients who died with metastatic breast cancer, we identified ...