Calcitonin effectiveness

Karachalios, X, Lyritis, G., Giannarakos, D., Papanicolaou, G., and Sotopoulos, K. 1992. Calcitonin effects on rabbit bone—Bending tests on ulnar osteotomies. Acta Orthop Scand 63 615-8. 

Several years ago, it was discovered that the thyroid gland was also the source of a hypocalcemic hormone having effects in general opposition to those of the parathyroid hormone. This hormone is produced in mammals by the parafollicular C-ceUs and in other vertebrates by the ultimobrachial bodies (45). Originally called thyrocalcitonin, it is now referred to as calcitonin (CT). 

FIGURE 3.11 Constitutive activity in melanophores expressing hCTR2 receptor, (a) Basal melanophore activity, (b) Effect of transfection with human cDNA for human calcitonin receptors (16 j-ig/ml). (c) Concentration response curve for cDNA for human calcitonin receptors (abscissae as log scale) and constitutive activity. Data redrawn from [27]. 

FIGURE 5.4 Microphysiometry responses of HEK 293 cells transfected with human calcitonin receptor, (a) Use of microphysiometry to detect receptor expression. Before transfection with human calcitonin receptor cDNA, HEK cells do not respond to human calcitonin. After transfection, calcitonin produces a metabolic response, thereby indicating successful membrane expression of receptors, (b) Cumulative concentration-response curve to human calcitonin shown in real time. Calcitonin added at the arrows in concentrations of 0.01, 0.1, 1.10, and lOOnM. Dose-response curve for the effects seen in panel B. 

In fact, a measure of the degree of confidence can be gained from the t calculation. Shown in Appendix A are columns for greater degrees of confidence. The value for df = 4 for a 98% confidence level is 3.747 and it can be seen that the experimentally calculated value is also greater than this value. Therefore, the level of confidence that these samples came from different populations is raised to 98%. However, the level of confidence in believing that these two samples came from separate populations does not extend to 99% (t = 4.604). Therefore, at the 98% confidence level this analysis indicates that the potency of human calcitonin is effectively increased by enrichment of G -protein in the cell. 

As can be seen from the analysis in Table 11.3, the paired t-test indicates that the effect of AC512 on the constitutive activity is significant at the 99% level of confidence (p<0.01 and AC512 is an inverse agonist and does decrease the constitutive receptor activity of calcitonin receptors). 

FIGURE 11.3 One-way ANOVA (analysis of variance). One-way analysis of variance of basal rates of metabolism in melanophores (as measured by spontaneous dispersion of pigment due to G,.-protein activation) for four experiments. Cells were transiently transfected with cDNA for human calcitonin receptor (8 j-ig/ml) on four separate occasions to induce constitutive receptor activity. The means of the four basal readings for the cells for each experiment (see Table 11.4) are shown in the histogram (with standard errors). The one-way analysis of variance is used to determine whether there is a significant effect of test occasion (any one of the four experiments is different with respect to level of constitutive activity). 

Due to its anti-resorptive effects, calcitonin has been widely used to treat a variety of metabolic bone diseases, including osteoporosis. However, the availability of more potent drugs has lead to a decline in the clinical use of calcitonin. 

A peptide hormone rapidly inhibiting osteoclast activity. The relevance of calcitonin in human calcium homeostasis is not well understood. Calcitonin has been used for the treatment of osteoporosis, although due to the availability of more potent drugs with less side effects, and the lack of clear data on the anti-fracture efficacy of calcitonin, its clinical use has been steadily declining. 

Perhaps the most benefit of calcitonin is in patients with or at risk for vertebral fractures. Nasal calcitonin increases vertebral bone mineral density by 1% to 3%.38-40 One 5-year study found a 30% decrease in the risk of vertebral fractures.38 Increases in hip bone mineral density and reductions in non-vertebral fractures have not been demonstrated.38-40 Calcitonin may have analgesic effects in women with back pain from vertebral fractures.41 However, enthusiasm for using calcitonin in this setting has waned in favor of managing fracture risk and pain separately.10... 

The absorption of drugs from the rectal [32] cavity has been studied in some detail. Muranishi et al. [34] have shown that a significant increase in the absorption and lymphatic uptake of soluble and colloidal macromolecules can be achieved by pretreating the rectal mucosal membrane with lipid-nonionic surfactant mixed micelles. They found no evidence of serious damage of the mucosal membrane. Davis [30] suggested that the vaginal cavity could be an effective delivery site for certain pharmaceuticals, such as calcitonin, used for the treatment of postmenopausal osteoporosis. 

Calcitonin. This hormone, which is also secreted from the thyroid gland, is synthesized by the parafollicular cells (C cells) located between the follicles. The primary effect of calcitonin is to decrease the blood levels of calcium and phosphate. The mechanism of action involves the direct inhibition of osteoclast activity, which decreases bone resorption. This results in less demineralization of the bone and therefore a decrease in the release of calcium and phosphate from the bone into the blood. Calcitonin has no direct effect on bone formation by osteoblasts. 

An alternative therapeutic approach to osteoporosis is through the use of calcitonin (798), a peptide hormone containing 32 amino acids (the sequence is species dependent) secreted by the thyroid gland, which stimulates the production of new bone. Synthetic calcitonins corresponding to human, eel, and salmon variants, and natural calcitonin extracted from pig thyroid, are all used in medicine - they have slightly different efficacies, side effects, and tolerance levels (799). 

The answer is c. (Hardman, p 15230 Administration of intravenous CaG would immediately correct the tetany that might occur in a patient in whom a thyroidectomy was recently performed. Parathyroid hormone would act more slowly but could be given for its future stabilizing effect. Long-term control of a patient after a thyroidectomy can be obtained with vitamin D and dietary therapy Calcitonin is a hypocalcemic antagonist of parathyroid hormone. Plicamycin (mithramycin) is used to treat Paget s disease and hypercalcemia. The dose employed is about one-tenth the amount used for plicamycin s cytotoxic action. 

Calcitonin is indicated for osteoporosis treatment for women at least 5 years past menopause. Although limited data suggest beneficial effects in men and concomitantly with glucocorticoids, these indications are not FDA approved. 

Calcitonin may provide pain relief to some patients with acute vertebral fractures. If used, it should be prescribed for short-term treatment (4 weeks) and should not be used in place of other more effective and less expensive analgesics, nor should it preclude the use of more appropriate osteoporosis therapy. 

Prevention of osteoporosis and fracture can be achieved through limiting the resorption-remodeling process. Four main families of products can be effective in controlling bone resorption estrogens, SERMs, bisphosphonates, and calcitonin. Large, prospective randomized trials have proven the effectiveness... 

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