• Clinical and Experimental Pediatrics
• /
• 제51권8호
• /
• pp.812-819
• /
• 2008

목 적 : 비타민 D는 뼈의 무기질화에 필수적인 역할을 하는 호르몬으로 부족하게 되면 구루병이 생길 수 있다. 본 연구는 비타민 D 결핍증이 잘 발생하는 위험군을 알아보고 그 예방 대책에 대한 관심을 고지하고자 계획하게 되었다. 방 법 : 2003년 3월부터 2007년 7월까지 노원을지병원 소아과에 내원한 환아들중에서 검사 상 우연히 알칼리성인산분해효소가 증가해 있으면서 방사선사진으로 무증상 구루병으로 진단받은 환아들에 대하여 후향적으로 그 특징과 치료 경과를 조사하였다. 결 과 : 남아 6명과 여아 2명의 총 8명이 무증상 구루병으로 진단되었다. 이들의 진단 시 연령은 $12.6{\pm}5.8$개월이었으며, 1월부터 7월 사이에 진단되었고 동반질환으로 폐렴, 요로감염, 장염, 철결핍성 빈혈이 있었다. 이들은 모두 모유 수유를 위주로 하고 있었고, 진단당시 2명의 환아가 몸무게가 3백분위수 미만으로 성장 장애를 보이고 있었다. 진단 시 평균 혈중 알칼리성인산분해효소는 $1,995.8{\pm}739.5IU/L$로 증가되어 있었고, 평균 혈중 칼슘은 $9.5{\pm}0.6mg/dL$, 평균 혈중 인은 $3.6{\pm}1.5mg/dL$였다. 평균 intact-PTH는 $214.8{\pm}155.9pg/mL$로 증가되어 있었고 25-hydroxyvitamin D는 2명을 제외한 6명의 환아에서 30 ng/mL 미만으로 감소되어 있었다. 모든 환자들은 손목 방사선 촬영에서 구루병양 변화를 보이고 있었으나 외관상 골기형이나 발달 장애는 없었다. 이들 중 6명은 3개월간 calcitriol을 투여한 후 생화학적인 검사와 손목 방사선 사진 상의 변화는 호전되었고 정상적으로 성장하였다. 2명은 치료하지 않은 채 저절로 호전되었으며 역시 외관상 성장장애를 보이지는 않았으나 2년간의 추적 관찰 후 현재 1명은 무릎 관절면의 골간단 이형성을 보이고 있으며 다른 1명은 일시적인 척추 측만증을 보였다가 호전되고 있다. 결 론 :무증상 구루병으로 진단된 환아들이 비타민 D 결핍이나 부족으로 인한 것으로 생각되며 모유 수유아에서 비타민 D 결핍증의 빈도가 높으므로 알칼리성인산분해효소가 높은 환자에서는 이를 의심하여 25-hydroxyvitamin D와 손목 방사선 사진을 검사하여 확인하여야 하며 이들 중 일부는 비타민 D 결핍성 구루병으로 진행할 수 있으므로, 모유 수유아에서 비타민 D 보충에 대한 교육이 필요하리라 생각된다.

• The Korean journal of internal medicine
• /
• 제34권1호
• /
• pp.146-155
• /
• 2019

Background/Aims: Indoxyl sulfate (IS) is a uremic toxin and an important causative factor in the progression of chronic kidney disease. Recently, paricalcitol (19-nor-1,25-dihydroxyvitamin D2) was shown to exhibit protective effects in kidney injury. Here, we investigated the effects of paricalcitol treatment on IS-induced renal tubular injury. Methods: The fluorescent dye 2',7'-dichlorofluorescein diacetate was used to measure intracellular reactive oxygen species (ROS) following IS administration in human renal proximal tubular epithelial (HK-2) cells. The effects of IS on cell viability were determined using MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) assays and levels of apoptosis-related proteins (Bcl-2-associated protein X [Bax] and B-cell lymphoma 2 [Bcl-2]), nuclear $factor-{\kappa}B$ ($NF-{\kappa}B$) p65, and phosphorylation of mitogen-activated protein kinase (MAPK) and protein kinase B (Akt) were determined by semiquantitative immunoblotting. The promoter activity of $NF-{\kappa}B$ was measured by luciferase assays and apoptosis was determined by f low cytometry of cells stained with f luorescein isothiocyanate-conjugated Annexin V protein. Results: IS treatment increased ROS production, decreased cell viability and induced apoptosis in HK-2 cells. IS treatment increased the expression of apoptosis-related protein Bax, decreased Bcl-2 expression, and activated phosphorylation of MAPK, $NF-{\kappa}B$ p65, and Akt. In contrast, paricalcitol treatment decreased Bax expression, increased Bcl-2 expression, and inhibited phosphorylation of MAPK, $NF-{\kappa}B$ p65, and Akt in HK-2 cells. $NF-{\kappa}B$ promoter activity was increased following IS, administration and was counteracted by pretreatment with paricalcitol. Additionally, flow cytometry analysis revealed that IS-induced apoptosis was attenuated by paricalcitol treatment, which resulted in decreased numbers of fluorescein isothiocyanate-conjugated Annexin V positive cells. Conclusions: Treatment with paricalcitol inhibited IS-induced apoptosis by regulating MAPK, $NF-{\kappa}B$, and Akt signaling pathway in HK-2 cells.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• 제27권1호
• /
• pp.16-23
• /
• 2005

It is commonly acknowledged that bone morphogenic protein (BMP-2) functions as a potential osteogenic inducer in bone formation. Recently, several papers reported that bone marrow-derived stem cell (BMSC) from human is not responsive to BMP-2 in comparison to high capacity of BMP-2 in the osteoinduction of stromal cell derived from bone marrow of rodent animals such as rat or mouse. In this study, we characterized BMSC derived from 11 years old donor for the responsiveness to rhBMP-2, dexamethasone (Dex) and 1,25-dihydroxyvitamin D (vitamin D), in order to analyze their function in the early osteogenesis. The effect of over mentioned agents was evaluated by means of assessing alkaline phosphatase (ALP) activity/staining, RT-PCR analysis and von Kossa staining. In addition, we analyzed the meaning of expressed several osteoblastic markers such as alkaline phosphatase, collagen typeI, osteopontin, bone sialoprotein and osteocalcin with relation to either differentiation or mineralization. Only in the presence of Dex, human BMSC could commit osteoblastic differentiation and matrix mineralization, and either BMP-2 or vitamin D treatment was not able to induce. But BMP-2 or Vitamin D showed potential synergy effect with Dex. ALP and bone sialoprotein were clearly expressed in response of Dex treatment compared to weak expression of osteopontin in early osteogenesis. Therefore, we expect that this study will contribute partly to elucidiating early osteogenesis mechanism in human, but variations among bone marrow donors must be considered through further study.