[HTML][HTML] Phosphate acts directly on the calcium-sensing receptor to stimulate parathyroid hormone secretion

PP Centeno, A Herberger, HC Mun, C Tu… - Nature …, 2019 - nature.com
PP Centeno, A Herberger, HC Mun, C Tu, EF Nemeth, W Chang, AD Conigrave, DT Ward
Nature communications, 2019nature.com
Extracellular phosphate regulates its own renal excretion by eliciting concentration-
dependent secretion of parathyroid hormone (PTH). However, the phosphate-sensing
mechanism remains unknown and requires elucidation for understanding the aetiology of
secondary hyperparathyroidism in chronic kidney disease (CKD). The calcium-sensing
receptor (CaSR) is the main controller of PTH secretion and here we show that raising
phosphate concentration within the pathophysiologic range for CKD significantly inhibits …
Abstract
Extracellular phosphate regulates its own renal excretion by eliciting concentration-dependent secretion of parathyroid hormone (PTH). However, the phosphate-sensing mechanism remains unknown and requires elucidation for understanding the aetiology of secondary hyperparathyroidism in chronic kidney disease (CKD). The calcium-sensing receptor (CaSR) is the main controller of PTH secretion and here we show that raising phosphate concentration within the pathophysiologic range for CKD significantly inhibits CaSR activity via non-competitive antagonism. Mutation of residue R62 in anion binding site-1 abolishes phosphate-induced inhibition of CaSR. Further, pathophysiologic phosphate concentrations elicit rapid and reversible increases in PTH secretion from freshly-isolated human parathyroid cells consistent with a receptor-mediated action. The same effect is seen in wild-type murine parathyroid glands, but not in CaSR knockout glands. By sensing moderate changes in extracellular phosphate concentration, the CaSR represents a phosphate sensor in the parathyroid gland, explaining the stimulatory effect of phosphate on PTH secretion.
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