Regulation of parathyroid function by the amyloid precursor protein

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Primary hyperparathyroidism (PHPT) is a common endocrine neoplastic disorder that predominantly occurs in the elderly. PHPT affects 15 to 30 individuals per 100,000 in the U.S., an overall incidence that has been steadily rising as the nation’s mean population ages. The disease is biochemically defined by constitutively elevated secretion of parathyroid hormone (PTH) from neoplastic parathyroid tissue, leading to chronic hypercalcemia and a spectrum of clinical sequelae including bone mass attrition and increased fracture risk. While the central physiological deficit in PHPT – the failure to maintain calcium homeostasis – is well recognized, the underlying molecular mechanisms that drive this systemic dysfunction have not been fully characterized. A major limitation to studying calcium sensing in normal and neoplastic parathyroid tissue has been the lack of experimentally tractable model systems that can faithfully reproduce the dynamic calcium response behaviors of the intact organ. To address this, our group has developed a series of ex vivo intact tissue assays that allow interrogative assessment of parathyroid gland function in response to dynamic changes in ambient calcium concentration. Through comparative assessment of normal and neoplastic human parathyroid tissue, we found molecular and biochemical functional heterogeneity among parathyroid adenomas that correlated to phenotypic variations in clinical presentation. In parallel, using a series of murine genetic models our group has recently demonstrated that heterocomplex formation between the calcium sensing receptor (CaSR) and the metabotropic GABAB1 receptor (GABAB1R) can attenuate calcium responsiveness, uncoupling PTH secretion from ambient calcium sensing. The abundance of GABAB1R/CaSR complexes was found to be increased in parathyroid adenomas from patients with PHPT, suggesting that upregulation of GABAB1R/CaSR heterodimer formation could contribute to the attenuation of calcium sensing in neoplastic parathyroid tissue. Indeed, based on recently published work in neuronal systems reporting that various cleaved peptides of the amyloid precursor protein (APP) bind and activate GABAB1R, we have found that tonic secretion of PTH by murine parathyroid tissue is stimulated by co-incubation with b-amyloid (Ab), a peptide cleavage product of APP. We further showed robust expression of APP and all 3 key secretases involved in cleavage of APP-related peptides (sAPPa, sAPPb, and Ab) in human parathyroid adenomas and murine parathyroid glands, implicating a novel paracrine mechanism that may foster functional heterogeneity in parathyroid adenomas. We propose to delineate this mechanism by (1) quantitating the expression of the various APP-derived peptides and determining their impact on calcium signaling and PTH secretion in normal and PHPT adenoma human parathyroid tissue; and (2) investigating the effects of parathyroid-specific APP knockout on mineral, skeletal, and hormonal homeostasis in vivo. The discovery of this entirely novel signaling axis represents a provocative new conceptual pathway potentially linking age-dependent post-translational processing of APP to the increased incidence of PHPT in the elderly.