PTH-stimulated adenylate cyclase activity and bone histomorphometry in iliac crest biopsies in the evaluation of uremic patients: a pilot study with the use of artificial intelligence.
Iliac crest biopsies of normals, uremic patients and subjects with primary hyperparathyroidism (pHPT) were investigated. It appeared that serum 1,25- and 24,25-(OH)2-D3 correlated inversely with basal adenylate cyclase (AC) activity and relative PTH-stimulated AC, respectively. Net PTH-elicited AC (dPTH-AC) activation hence reflected individual vitamin D status. The combination variable serum PTH (s-PTH) x dPTH-AC x [H+] correlated well with resorption surface (RS) in both normals, patients with pHPT or subjects with uremia, while s-PTH, dPTH-AC activity or pH as single variables were only marginally related to RS. For all subjects analyzed, osteoid volume (OV) correlated positively with serum alkaline phosphatase but negatively with serum 1,25-(OH)2-D3. OV showed no correlation with dPTH-AC, while the relationship between OV and s-PTH was strong, suggesting that PTH stimulates osteoid deposition via some signalling pathway other than cAMP. In normals, OV was inversely proportional to s-PTH, due to homologous desensitization of this signalling system. Furthermore, s-PTH was negatively correlated with urine cAMP due to homologous desensitization of the effect of PTH on the kidney 25-(OH)-D3 1 alpha-hydroxylase. This phenomenon was absent in uremic patients. Evaluation of variables by artificial intelligence showed that the prototype uremic patient exhibited serum creatinine > 900 microM, RS > 0.12, pH between 7.15 and 7.34 and s-PTH x dPTH-AC x [H+] between 0.5 and 3.7 units with the distinguishability index 'very good' (< 5% overlap) towards normals. Average similarity of uremic patients with the prototype for normal subjects was only 22%. Cluster analysis of all the variables was conducted for comparison and yielded less clinically relevant information. Hence, emulation done by the expert system was superior and clearly indicates that present treatment modalities restore normal bone turnover only to a minor degree or not at all.
Jablonski
G
G
Institute for Surgical Research, National Hospital, Rikshospitalet, Oslo, Norway.
Nordahl
K
K
Halse
J
J
Dahl
E
E
Aksnes
L
L
Gautvik
K M
KM
Gordeladze
J O
JO
D000262:Adenylyl Cyclases / Q000187:drug effects / Q000378:metabolism*; D000328:Adult; D001185:Artificial Intelligence; D001706:Biopsy; D001862:Bone Resorption / Q000201:enzymology / Q000473:pathology; D016000:Cluster Analysis; D004789:Enzyme Activation / Q000187:drug effects; D005069:Evaluation Studies as Topic; D005103:Expert Systems; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000188:drug therapy / Q000473:pathology; D007085:Ilium / Q000187:drug effects* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000494:pharmacology* / Q000627:therapeutic use; D010865:Pilot Projects; D012044:Regression Analysis; D014511:Uremia / Q000188:drug therapy / Q000201:enzymology / Q000473:pathology*
D010281:Parathyroid Hormone; D000262:Adenylyl Cyclases