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. 2024 Jan 14;8(2):ziae004.
doi: 10.1093/jbmrpl/ziae004. eCollection 2024 Feb.

Inhibition of RANKL improves the skeletal phenotype of adenine-induced chronic kidney disease in mice

Affiliations

Inhibition of RANKL improves the skeletal phenotype of adenine-induced chronic kidney disease in mice

Corinne E Metzger et al. JBMR Plus. .

Erratum in

Abstract

Skeletal fragility and high fracture rates are common in CKD. A key component of bone loss in CKD with secondary hyperparathyroidism is high bone turnover and cortical bone deterioration through both cortical porosity and cortical thinning. We hypothesized that RANKL drives high bone resorption within cortical bone leading to the development of cortical porosity in CKD (study 1) and that systemic inhibition of RANKL would mitigate the skeletal phenotype of CKD (study 2). In study 1, we assessed the skeletal properties of male and female Dmp1-cre RANKLfl/fl (cKO) and control genotype (Ranklfl/fl; Con) mice after 10 wk of adenine-induced CKD (AD; 0.2% dietary adenine). All AD mice regardless of sex or genotype had elevated blood urea nitrogen and high PTH. Con AD mice in both sexes had cortical porosity and lower cortical thickness as well as high osteoclast-covered trabecular surfaces and higher bone formation rate. cKO mice had preserved cortical bone microarchitecture despite high circulating PTH as well as no CKD-induced increases in osteoclasts. In study 2, male mice with established AD CKD were either given a single injection of an anti-RANKL antibody (5 mg/kg) 8 wk post-induction of CKD or subjected to 3×/wk dosing with risedronate (1.2 μg/kg) for 4 wk. Anti-RANKL treatment significantly reduced bone formation rate as well as osteoclast surfaces at both trabecular and cortical pore surfaces; risedronate treatment had little effect on these bone parameters. In conclusion, these studies demonstrate that bone-specific RANKL is critical for the development of high bone formation/high osteoclasts and cortical bone loss in CKD with high PTH. Additionally, systemic anti-RANKL ligand therapy in established CKD may help prevent the propagation of cortical bone loss via suppression of bone turnover.

Keywords: PTH; RANKL; chronic kidney disease; cortical porosity.

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Conflict of interest statement

M.R.A. consults for and receives financial support from MBX Biosciences as well as receiving book royalties from Elsevier. All other authors have nothing to disclose.

Figures

Graphical Abstract
Graphical Abstract
Figure 1
Figure 1
Serum markers from study 1—male and female mice, Ranklfl/fl (Con), and Dmp1-Cre/Ranklfl/fl (cKO) with dietary adenine-induced CKD (AD) and CD counterparts. (A) Serum BUN was higher in all AD mice. (B) Serum PTH was higher in all AD mice. (C) Serum TRAcP 5b trended higher in control genotype AD mice. Results of the 2×2 ANOVA or Kruskal–Wallis test are in the text box above the graph. Bars not sharing the same letters are statistically different (P < .05).
Figure 2
Figure 2
Distal femur bone microarchitecture from study 1—male and female mice, Ranklfl/fl (Con), and Dmp1-Cre/Ranklfl/fl (cKO) with dietary adenine-induced CKD (AD) and CD counterparts. (A) Both male and female cKO mice had higher trabecular bone volume than did Con mice. (B) Cortical bone area was lower due to AD in Con mice, but not different from CD in cKO mice. (C) Cortical thickness was lower in Con ADmice of both sexes, but cKO AD mice had preserved cortical thickness. (D) Cortical porosity was elevated in both male and female Con AD mice, but cKO AD mice had values not different from matched controls. Results of the 2×2 ANOVA or Kruskal–Wallis test are in the text box above the graph. Bars not sharing the same letters are statistically different (P < .05).
Figure 3
Figure 3
Representative images from distal femur micro-CT scans from male and female mice. The trabecular image (top panel within sex) is from the sample closest to the group mean for trabecular bone volume. The cortical image (bottom panel within sex) is the sample closest to the group mean for cortical porosity.
Figure 4
Figure 4
Histomorphometry of the distal femur trabecular bone in study 1—male and female mice, Ranklfl/fl (Con), and Dmp1-Cre/Ranklfl/fl (cKO) with dietary adenine-induced CKD (AD) and CD counterparts. (A) MS/BS higher in Con mice vs cKO mice. Male Con-AD mice had higher MS/BS than Con-CD. (B) MAR was elevated due to adenine in all groups of mice. (C) BFR was higher in Con-AD mice of both sexes. Female cKO-AD mice had higher BFR than matched cKO-CD mice.( D) Con AD mice of both sexes had elevated osteoclast-covered trabecular surfaces. cKO mice had no adenine effect on osteoclast surfaces. Results of the 2×2 ANOVA test are in the text box above the graph. Bars not sharing the same letters are statistically different (P < .05).
Figure 5
Figure 5
Histomorphometry of the distal femur in Study 2. (A) MS to BS was higher in AD and AD+Ris compared to CD and AD+Anti-R. (B) MAR was highest in untreated AD mice followed by AD+Ris then followed by AD+Anti-R with CD having the lowest MAR. (C) Untreated AD and AD+Ris had higher BFR than CD and AD+Anti-R. (D) Osteoid surface was higher in all AD groups compared to CD. (E) Osteoclast-covered trabecular surfaces were highest in AD and AD+Ris with AD+Anti-R statistically lower, but higher than CD. (F) Osteoclast numbers were highest in untreated AD with AD+Anti-R higher than CD, but lower than untreated AD. Bars not sharing the same letters are statistically different (P < .05).
Figure 6
Figure 6
Intracortical remodeling in the distal femur cortical shaft in adenine mice from study 2: (A) anti-R-treated AD mice had lower labeled pores/bone area than other AD groups. (B) There were not statistical differences in MAR between adenine groups. (C) Anti-R-treated AD mice had lower intracortical BFR than other AD groups. (D) Osteoclast-covered pore surfaces were lower in anti-R-treated AD mice compared to other untreated and risedronate-treated AD mice. Bars not sharing the same letters are statistically different (P < .05).

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