IMR Press / FBL / Volume 28 / Issue 8 / DOI: 10.31083/j.fbl2808167
Open Access Review
Role of Parathyroid Hormone and Parathyroid Hormone-Related Protein in Protein-Energy Malnutrition
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1 Division of Nephrology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Ratchathewi, 10400 Bangkok, Thailand
*Correspondence: sinee.dis@mahidol.edu; sineemd@hotmail.com (Sinee Disthabanchong)
Front. Biosci. (Landmark Ed) 2023, 28(8), 167; https://doi.org/10.31083/j.fbl2808167
Submitted: 15 May 2023 | Revised: 10 July 2023 | Accepted: 14 July 2023 | Published: 15 August 2023
Copyright: © 2023 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license.
Abstract

Parathyroid hormone (PTH) is an endocrine peptide found exclusively in the parathyroid glands, whereas parathyroid hormone-related protein (PTHrP) is expressed in a wide range of tissues and organs and exerts endocrine, paracrine, and autocrine actions. PTH and PTHrP have a similar homology, sharing the initial 13 amino acid residues at the N-terminus and binding to the same type 1 PTH receptor (PTH1R), which regulates calcium homeostasis. An abnormal increase in PTH production can occur in primary and secondary hyperparathyroidism, whereas PTHrP can be produced in large quantities by malignant cancer cells from solid organs. In addition to increased bone resorption and hypercalcemia, recent evidence suggests that excess PTH and PTHrP can result in protein-energy wasting, malnutrition, and cachexia. Through binding to PTH1R and activation of cyclic adenosine monophosphate (cAMP)-dependent protein kinase A in white adipose tissue, PTH and PTHrP can stimulate the expression of thermogenic genes causing adipose tissue browning. This change results in an increase in resting energy expenditure, loss of muscle and fat mass, and weight loss. These findings provide a mechanistic link for the long-established relationship between hyperparathyroidism and myopathy, as well as cancer and cachexia. The purpose of this review is to provide a summary of the emerging evidence from both experimental and clinical studies on the role of PTH and PTHrP in protein-energy malnutrition.

Keywords
protein-energy wasting
malignancy
solid tumor
muscle wasting
catabolism
parathyroid
sarcopenia
hypoalbuminemia
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