A.M. ZOOLOGIST, 7:K2.">-833 (1967). Aspects of Parathyroid Physiology in Mammals Roy V. Talmage Department of Biology, Rice University, Houston, Texas 77001 SYNorsts. This report summarizes the parameters of parathyroid physiology in the mammal. Emphasis is given to the part played by this hormone in the processes of growth and remodelling in bone as well as to its function in the maintenance of a relatively constant level of ionic calcium in the extracellular fluid. The importance of phosphate ions has been shown, particularly with respect to their role in the rate of Ca-transport through the extracellular fluid compartments, and their influence on the rate of parathyroid secretion. In addition, the inter-relationship of the newly discovered hormone, thyrocalcitonin, is considered. The latter hormone, by suppressing resorption of bone, may have an influence in stabilizing plasma levels of calcium; it also has a moderate, but long range effect on the rate of bone remodelling. Finally, an attempt has been made to relate the vast amount of work done with these two hormones in mammals to their phylogenetic development in vertebrates. It is suggested that the parathyroids developed at the time when the specialization of bone in vertebrates produced a solid structure which was incompatible with the fluid calcium concentration needed for the maintenance of many physiological functions. The parathyroid hormone, by its action to increase the transfer of calcium from bone against a concentration gradient, permitted these vertebrates to maintain the higher fluid calcium ion concentration needed for the normal functioning of the animal. Since this report is part of a series of papers dealing with the comparative physiology of the parathyroids, only those aspects of parathyroid function in mammals will be covered which the author feels are pertinent in relating parathyroid action in mammals to the possible phylogenetic development of these glands. Although these papers deal primarily with parathyroid physiology, some discussion of the possible role of thyrocalcitonin, the recently discovered hypocalcemic hormone of the thyroid, will be included. Several years ago, a review of parathyroid physiology started with the statement that "the primary function of the hormone of the parathyroid glands is the maintenance of a constant Ca++ concentration in circulating fluids by the addition of Ca, and that, at the physiological level, most actions of the hormone are directed toward this goal" (Talmage, et al., 1965). This point may well be taken; however, one can not look only at plasma calcium levels in studying parathyroid physiology in vertebrates. The work reported here was aided in part by a research contract from the Atomic Energy Commission. Therefore, in the review that follows, emphasis will be placed not only on problems related to calcium in extracellular fluid, but also on the importance of the concurrent consideration of phosphate turnover and the role of parathyroid hormone in growth and remodelling of bone. The Need for Parathyroid Hormone: If one takes plasma from any mammal, even from the rat which has unusually high phosphate values, and adds to it small increments of calcium and biphosphate ions, while maintaining the pH, it is readily demonstrable that mammalian blood is undersaturated with these ions. In fact, the blood of man is only about 50% saturated. However, if one shakes tertiary calcium phosphate with plasma, it is possible to remove all the calcium and phosphate from the blood. The next step is to substitute chips of either dead or live bone for the calcium phosphate salt and incubate these in plasma from the same species. Results of this type of experiment for the rat are summarized in Figure 1 (Talmage, I967«). If the calrium and phosphate content of the 825 826 ROY V. TALMACE BONE SERUM INCUBATION - 4 HOURS (RAT) lo- TOTAL CALCIUM gPHOSPHOROUS 08 P04 s' 7- I o o 6- N 5" O O I 4. 32I- FIG. 1. Bone Serum Incubation—4 Hours. The with bone chips of the femur of the rat. From bars represent the calcium values of the plasma usedTalmage (1967a). as incubation medium before and after incubation plasma used as the incubation medium is normal, both these ions are withdrawn by bone. If, however, the content of these ions in blood is subnormal, the bone will provide them for the plasma. Because of the excellent circulation of blood through the bones of mammals, the same type of withdrawal process is assumed to be occurring continuously in vivo. In fact, the rapid drop in blood calcium levels, after parathyroidectomy in mammals with no calcium source from the gut, is considered evidence for this. Neuman and Neuman (1958) referred to this as the phenomenon of undersaturation of plasma with respect to itself and the supersaturation of plasma with respect to bone. As the result of such data, the author suggests that the need for parathyroid hormone in any vertebrate species can be established by incubating bone chips from the animal in plasma taken from normal members of the same species. If during the incubation, calcium and phosphate are withdrawn from the plasma medium, it is suggested that the species normally requires a secretion of parathyroid hormone to maintain its levels of plasma calcium. However, such a postulate requires experimental confirmation. Preliminary tests have been run using frogs, turtles, a skate, and trout. Of this group, the frog was the only vertebrate in which the response was similar to that depicted in Figure 1. The turtle is unusual because the large carapace provides an extra source of contact for these salts between the fluid and solid phases. In fact, Clark (1965) has suggested that the parathyroids are nonfunctional in this species. No investigator has yet identified functional parathyroids in any of the fishes, some of which do have bony skeletons PARATHYROID PHYSIOLOGY IN MAMMALS containing hydroxyapatite. However, the physico-chemical relationship between these more primitive bones and the circulating fluids is also unknown. One might even suggest that in these vertebrates the problem facing the animal may be the prevention of hypercalcemia instead of hypocalcemia, and that probably one should look for thyrocalcitonin activity as preceding that of parathyroid hormone in the evolutionary scheme. Parathyroid Function: A Calcium Replacement Mechanism The McLean feedback mechanism of parathyroid action (McLean and Urist, 1955) visualized parathyroid hormone as being released from the gland in response to a drop in the level of ionized calcium in the plasma circulating through it. In re- 827 sponse, this hormone acted on bone to raise the level of calcium back to normal. In 1962 we expanded this mechanism, postulating that the parathyroids function to replace continuously the calcium lost from plasma due to the concentration gradient toward bone (Talmage, 1962), and presented a diagram of a model system describing our postulate. We are now presenting a modification (Fig. 2) which has been corrected to include the possible role of thyrocalcitonin in the overall maintenance of plasma calcium levels. The basic concepts of the postulate remained unchanged, and the reader is referred to the 1962 report for details. The above statements concerning the need for parathyroid hormone are in accord with our postulated model. Parathyroid hormone is needed by the vertebrate whenever the physico-chemical relationships be- CALCIUM REPLACEMENT MECHANISM THYROIDS PARATHYROIDS KIDNEY THRESHOLD (NORMAL ANIMAL) KIDNEY THRESHOLD (PTX ANIMAL) PLASMA FIG. 2. The diagrammatic presentation of the interrelationship of parathyroid hormone and thyro- BONE calcitonin in the maintenance of serum calcium levels. Revised from Talmage (1962). 828 ROY V. TALMAGE twecn bone and the circulating fluids are such that a concentration gradient toward bone exists, which must be the case if the plasma calcium level is in the range of 10 mg/100 ml. The extent of the need for parathyroid hormone would depend not only on the slope of the concentration gradient curve, but also on the ease of contact between the solid phase represented by bone and the fluid phase represented by blood and extracellular fluid. Therefore, vascularization of bone and hemodynamic considerations would be important factors. The concentration of phosphate in the plasma, which will be discussed in the next section, would be another important factor. At the present time these relationships are easily demonstrable in the rat. In an earlier report (Yoshida and Talmage, 1962), sufficient experimental evidence was collected to allow the authors to postulate that a similar replacement mechanism was operative in the bullfrog, Rana catesbeiana. While work in this area with lower vertebrates has been minimal, the similarity between the frog and the rat encourages us to postulate that the parathyroid glands appeared phylogenetically when a calcium replacement mechanism became necessary to prevent levels of blood calcium from falling below the physiological optimum. It must be emphasized that, while the basic equilibration level illustrated in Figure 2 is affected and possibly controlled primarily by physico-chemical considerations, metabolic activity and therefore the involvement of bone cells is required. This has been well demonstrated recently by the dramatic effect of thyrocalcitonin in parathyroidectomized rats (Hirsch, 1967, and Klein, et ah, 1967). The Influence of Phosphate in Parathyroid Physiology Some years ago, parathyroid hormone was considered to control the level of calcium entirely through its ability to increase renal excretion of phosphate. While parathyroid hormone does increase the excretion of phosphate, it does not control calcium levels in this manner. It has been shown that the hormone functions equally well in nephrectomized animals, and the plasma of vertebrates is not saturated with calcium and phosphate as would be required by such a theory of action (Albright and Reifenstein, 1948). However, phosphate has an important influence on the rate of secretion of parathyroid hormone and, therefore, on the degree of participation of those glands in the physiology of the animal. If an animal is placed on an extremely low phosphate diet containing normal or subnormal calcium, the parathyroids become inactive and often atrophy from disuse (Copp, et al., 1965). On the other hand, if the phosphate content of the plasma is elevated, either experimentally by nephrectomy (Talmage, et al., 1960), or by a high phosphate-tocalcium ratio in the diet, the gland becomes overactive (Clark, 1967). In either case, the calcium level of plasma may remain normal. This does not imply that the phosphate ion in any way directly controls the rate of secretion of parathyroid hormone, for this has been proven not to be the case (Talmage and Toft, 1961). The influence of phosphate must be explained by its effect on the dynamics of calcium transport through the blood and not on the calcium level itself. In Figure 2, phosphate is indicated by the arrow to be acting on the normal gradient of movement of calcium from the fluid to solid phase. If the amount of phosphate is increased under constant concentrations of blood calcium, the rate of deposition of calcium as well as phosphate in bone is increased. This decreases the ionic calcium concentration of the fluid phase causing an immediate increase in secretion of parathyroid hormone. If the concentration of phosphate ions is decreased markedly, it is possible to reduce the normal gradient of calcium movement almost to zero and thereby negate the need for parathyroid hormone. It is not surprising, then, that parathyroid activity can be related to high phosphate-to-calcium ratios, even if the total calcium in the diet is far above normal (Clark, 1967). It is unfortunate that in many studies of parathyroid function, both in mammals and in lower vertebrates, levels of phos- PARATHYROID PHVSIOI.OCY IN MAMMALS phate in plasma have been completely ignored. Indeed, if the plasma calcium is controlled and maintained by parathyroid secretion, it is the fluctuating phosphate levels that actually control parathyroid activity. It must be emphasized that this concept is not connected in any way to the effect of parathyroid hormone on renal phosphate excretion which will be taken up in the next section. It is of interest to note that in many cases of normal increased rates of bone growth, such as in the growing child, the plasma phosphate levels are elevated while the calcium levels remain constant. Extraosseous Effects of Parathyroid Hormone 829 What is important is that the hormone affects the transport of both calcium and phosphate ions between blood and the renal tubule, but in opposite directions (Talmage and Kraintz, 1954). The hormone increases the tubular reabsorption of calcium and decreases it for phosphate. The net result of these reverse effects is to permit the bone to economize on its release of calcium, thereby conserving it for the animal. (Note: There may still be investigators who believe the action of the hormone is on the secretion of phosphate by the distal tubule. This concept has not yet been disproven.) The sequence of action appears to be as follows: Increased parathyroid secretion is produced by a drop in the level of ionic calcium in plasma flowing through the gland. The action of the hormone is to increase the release of both calcium and phosphate from bone. Simultaneously, additional phosphate is excreted by the kidney, and more calcium is reabsorbed. The increased excretion of phosphate in many mammals, including man, over-compensates for the additional release of phosphate from bone, and, if continued, may be effective in decreasing the concentration gradient for calcium and phosphate toward bone. The increased rate for tubular reabsorption of calcium returns calcium to the plasma and aids in raising plasma calcium toward normal, reducing the amount of calcium needed from bone. Cortelyou (1962) has presented data indicating that a somewhat similar renal response to parathyroid hormone occurs in the frog. It is well recognized that the primary actions of parathyroid hormone are mediated through bone cells. However, there are two extraosseous sites where marked gradients for calcium and/or phosphate ions occur, and the influence of parathyroid hormone has been implicated at both. One of these is related to absorption of these ions from the gut, and the other concerns their excretion through the kidney. We are not prepared to draw any conclusions concerning stimulation of absorption of calcium in the gut by parathyroid hormone. Reports can be found supporting the concept of this action of the hormone, including an earlier one from our own laboratory (Talmage and Elliott, 1958, and Cramer, et al, 1962). Other reports either suggest a negative effect (Clark and Smith, 1964), namely increased absorption in the absence of the parathyroid, or no effect (Wasserman and The Dual Role of Parathyroid Hormone in Comar, 1961). Possibly there is an effect of Bone the hormone here, but the variables effectUp to this point, we have been concerned ing absorption in the gut are so numerous with the various metabolic activities surand so complex that the influence of the rounding the control of plasma levels of hormone can not be clearly delineated. calcium and the rate of its transport Whether or not there is an effect, it is through blood. Bone plays a major part in hard to see how it could play an important this, as it is not only the cause of the conrole in the overall calcium homeostasis of centration gradient removing calcium from the animal. the fluid compartments, but also the source While the effect of the hormone on the of calcium returned to fluid by the action kidney may also be secondary to its role in of parathyroid hormone. Many studies bone, it is nonetheless easily demonstrable. have demonstrated that the calcium sup- 830 ROY V. TALMACE plied due to hormonal action is not that which has been deposited recently (labile bone) but, rather, that from older, deep, stable bone (Talmage and Elliott, 1958b), as indicated in Figure 2. One of the current problems in parathyroid physiology is concerned with which cells respond to the hormone and what is the nature of their response. Two lines of research have been emphasized: (1) In our laboratory (Talmage, 1967a), we have concentrated on demonstrating the non-necessity of the osteoclast for the transfer of calcium from bone to fluid under the influence of parathyroid hormone, and (2) others (Belanger, et al., 1966) have demonstrated the influence of the hormone on the osteocyte. We have emphasized that the hormone appears to act directly on the mesenchyme or progenitor cell to form additional osteoclasts. We have noted that the osteoclast is the only bone cell which has not been proven to have a cause-and-effect relationship to parathyroid activity. Therefore, we have recently postulated a dual action of parathyroid hormone in bone (Talmage, 1967b). The first action is through individual cells, probably osteocytes, to increase the transfer of calcium from bone to fluid. The second action is through mesenchymal cells to increase the rate of formation of osteoclasts, and thereby the rate of bone remodelling. This suggests that breakdown of bone by osteoclasts is only an indirect result of parathyroid action and plays only a passive role in providing calcium for the maintenance of plasma levels. If this postulate of dual action proves to be correct, it is interesting to speculate as to the phylogenetic importance of each. Osteoclasts have been identified in vertebrates as far down the scale as amphibians, but in frogs their numbers are markedly reduced as compared to their mammalian counterparts. Osteocytes, located in their lacunae, are relatively abundant. However, in our own earlier report, we noted not only the existence of the replacement mechanism in the frog, but also that endogenous parathyroid hormone increased the number of osteoclasts in the shaft of the femur of this amphibian (Yoshida and Talmage, 1962). The Relationship of Thyrocalcitonin to Parathyroid Function The recently discovered hypocalcemic factor of the thyroid, thyrocalcitonin (Hirsch, et al., 1964), has excited considerable interest among investigators interested in calcium metabolism. We observed that endogenous secretion could be demonstrated in the rat in the presence of high calcium levels induced by intravenous infusion (Talmage, et al., 1965). Also, recent studies (Care, 1967) have demonstrated the presence of thyrocalcitonin in the blood of several mammals following artificial production of hypercalcemia. This peptide hormone (Munson, et al., 1966) is believed to be secreted by the parafollicular cells of the thyroid (Foster, et al., 1964) in the response to a rise in the ionic calcium, of plasma above normal levels. Care (1967) has suggested that the hormone may act as a fine control of the plasma calcium level working in opposition to parathyroid hormone whose function he relegates to that of a coarse control. Examination of the calcium replacement mechanism pictured in Figure 2 suggests that, according to our postulates, in those animals having functional parathyroids and an active concentration gradient for calcium toward bone, the problem facing the animal is the prevention of hypocalcemia and not hypercalcemia. Therefore, we can not visualize an important role for this new hormone in the physiology of the animal if it is only secreted in response to hypercalcemia. Recently we have reported evidence, however, that endogenous secretion occurs at normal, or even slightly subnormal, calcium levels in the rat (Klein and Talmage, 1967). This evidence was based on the suppression of removal of radioactive calcium and phosphate, which had been administered a week prior to a peritoneal lavage procedure, in animals whose thyroids were intact and functional but which were hypocalcemic due to the removal of the parathyroids. We concluded from this study PARATHYROID PHYSIOLOGY IN MAMMALS that this newly discovered hormone was active in the normal animal and could, therefore, play a part not only in the control of levels of calcium in the plasma but also in remodelling processes of bone. It seems clear from the results obtained with thyrocalcitonin that a low rate of bone resorption occurs continuously, unrelated to parathyroid function. In Figure 2, this is indicated as a contribution of "deep" bone to the basic levels. Both that contribution induced by parathyroid hormone and this resorption are suppressed by thyrocalcitonin. The role of thyrocalcitonin in lower vertebrates is yet unknown, though its existence has been demonstrated at least in birds (Urist, 1967). Earlier in this report we suggested that, in vertebrate groups lower phylogenetically than the amphibians, the problems of hypercalcemia may be more acute than those of hypocalcemia. Such a condition could result from the fact that the development of bone had not progressed to the point where a calcium concentration gradient toward bone existed. These animals might, therefore, be subject to surges in calcium absorption due to dietary conditions which could result in elevated levels of plasma calcium. For example, Urist (1963) has reported that the calcium levels in the blood of some lower vertebrates may run as high as 20 mg/100 ml. We will follow with interest any attempts that are made to establish the existence of thyrocalcitonin in these vertebrates. The Problem of the Mechanism of Action of Parathyroid Hormone At the present time there is no agreement among investigators as to which biochemical pathways are stimulated by parathyroid hormone in producing its physiological effects. It is our opinion that this is due primarily to the difficulties of determining the physico-chemical properties at the surface of bone and therefore the relationship of cellular activity to the movement of calcium and phosphate in either direction. The two most recent theories, that of organic acid production (Neuman, et al., 831 1956) and mitochondrial transport (De Luca, et al., 1962), have both been proven inadequate or nonspecific. One of die problems that is still to be settled concerns the concurrent dissolution of bone crystal and the breakdown of the organic matrix upon which it is deposited. As yet no experiment has been devised which clearly demonstrates that one component of bone is resorbed first. Therefore, despite the fact that the end result, physiologically, is the release of calcium from bone, there are those (Belanger, et al., 1966) who are convinced that enzymatic degradation of the organic matrix proceeds first, permitting the dissolution of bone crystals. Every investigator has his favorite theory, and ours is that the action of parathyroid hormone and possibly even thyrocalcitonin will be proven to be concerned with movement of calcium across cell membranes. The major proponent of this is Borle (1967), but unfortunately his test system, the HeLa cells, is certainly not physiological. Briefly, his theory is that every cell has a calcium pump, similar to the sodium pump. Utilizing the expenditure of energy, through systems not yet determined, intracellular calcium levels are kept minimal by the active translocation of calcium to the exterior of the cell. While there may be metabolic agents which affect the rate of the pumping action, Borle feels that parathyroid hormone acts on the cell membrane, permitting a more active entry of calcium into the cell. The stimulus to the pump would result from increased intracellular calcium. There are major problems in explaining the transport of calcium at sites in bone, kidney, and gut by this mechanism. In bone, the first problem is the delineation of the types of bone cell directly affected by the hormone. Enzymatic studies of homogenates of bone have of necessity been carried out utilizing a variety of types of bone cell with markedly different metabolic functions. It is not surprising that many contradictory results have been obtained by such experiments. How much progress can be expected in the next few years is uncertain. However, now that the 832 Rov V. 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