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Exogenous parathyroid hormone attenuates ovariectomy-induced skeletal muscle weakness in vivo.

藤巻 太郎 山梨大学 DOI:info:doi/10.34429/00005167

2022.03.18

概要

（目的）
超高齢社会により筋量・骨量の低下が誘因となる転倒や骨折の頻度は増加し、これにより引き起こされる健康寿命低下の予防が社会的喫緊の課題である。
テリパラチドはヒト副甲状腺ホルモン（ PTH） 1–34製剤であり、骨粗鬆症の治療で広く使用されている。また、閉経後骨粗鬆症モデルである卵巣摘出（ OVX）マウスの骨量喪失はPTHにより改善されることが報告されている。この骨形成作用は骨芽細胞のWnt /β-カテニン経路を抑制するスクレロスチンを阻害することにより作用する。しかしながら、PTHの筋肉量と力の維持の機能とメカニズムは未だ不明な点が多い。本研究では、OVXマウスを使用した骨格筋の萎縮および機能障害に対するPTHの影響を調査し、新たな治療法の開発の一歩とすることを目的とした。

（方法）
8週齢の雌C57BL/6Jマウスの卵巣を麻酔下に切除し、OVXマウスを作成した。OVX、対照群である偽手術群（ Sham） にそれぞれPTH（ 80μg/kg） もしくはPBSを週3回腹腔内投与した。投与開始から20週時点で、運動能力（ 握力、トレッドミルテスト、血中乳酸値） を測定し、深麻酔下に安楽死させ筋肉（ 前脛骨筋）・骨・子宮等のサンプルを採取し組織学的・分子生物学的に解析した。
In vitroでは、筋芽細胞であるC2C12のPTH受容体の発現をWBで確認した。薬剤（ MDI）刺激による脂肪分化モデルを使用し、PTHの脂肪化に対する抑制効果を分化マーカーのPCR、WBにより評価し、組織学的評価も行った。また、PTHの筋脂肪化抑制効果が、Wnt/β-catenin阻害剤（ XAV）、Wnt siRNAにより妨げられるかも検討した。

（結果）
20 週後の椎体骨は、OVX 群と比較して OVX + PTH 群で卵巣摘出による骨量減少が有意に抑制された。運動能力においては、PTH 投与は卵巣摘出によって誘発される運動能力低下と血中乳酸値上昇率が軽減した。前脛骨筋では、PTH は卵巣摘出によって誘発される筋肉の酸化線維率と筋線維径（CSA）の低下を抑制させ、さらに卵巣摘出による筋細胞内脂質含有量の増加を減少させた。
In vitroにおいてPTHはC2C12細胞増殖、遊走能を増強し、MDI脂肪分化誘導培地で培養された脂肪滴分泌を減少させた。さらに、PTHはC2C12細胞において筋分化を促進させることが示された。PTH投与がC2C12細胞のβ-カテニン発現を増加させ、これはXAVにより抑制された。さらに、PTHにより誘発された細胞増殖能と遊走能は、XAV、siRNAにより無効化された。マウスモデルでは、OVXの前脛骨筋内のβ-カテニン発現が減少し、PTH投与によって改善した。

（考察）
OVX群は運動パフォーマンスの低下を示し、PTH投与により握力、走行可能最高速度の低下を有意に改善し、血中乳酸値上昇を弱めた。乳酸はMCT4によって細胞外に排出され、MCT1を介して細胞外乳酸が取り込まれATPが生成される。筋肉内のMCT1/MCT4含有量が運動後の乳酸値と相関していることが報告されており、我々の結果ではOVXマウスへのPTH投与がMCTを増加させ、運動後の乳酸血中濃度を低下させたと推測される。
NADH-TR反応はミトコンドリアの分布と密度の指標であり、酸化（タイプIIA、IID / X）と解糖系（ タイプIIB） の骨格筋線維を区別するために使用される。PTH投与がOVXマウスに観察された酸化線維割合の低下を軽減した。これはPTHがエネルギー代謝と酸化線維割合を改善することにより運動機能改善に寄与することが示唆される。
筋内脂肪含有量と運動機能は逆相関することが知られており、本研究でも、PTH投与により酸化と解糖系ともに卵巣摘出により誘発された筋内脂質含有量が減少した。In vitroでは PTHが細胞増殖と遊走を促進し、脂質分泌量を減少させた。このことは、OVXマウスモデルでのPTH処理の結果と概ね一致していると考えられる。
OVX後のβ-カテニン発現低下はPTH投与により回復し、In vitroにおける細胞増殖、遊走能のPTHによる増強はWnt /β-カテニン阻害剤またはWnt siRNAにより無効化された。これらの結果は、Wnt /β-カテニンシグナル伝達が、骨格筋における細胞増殖、遊走、分化、および脂質分泌の調節に重要な役割を果たすことを示唆している。

（結論）
筋肉の機能障害の予防と筋細胞内脂質含有量の抑制におけるPTHの極めて重要な役割を示した。PTH受容体はマウス筋肉組織と筋芽細胞株に発現し、OVXマウスへのPTH投与は筋力低下を大幅に改善し、運動による乳酸値上昇が抑制された。筋肉内のPTH / Wntシグナルは、細胞増殖、細胞遊走、筋分化、および脂質分泌を調節していることが示された。したがって、 PTHは筋肉機能を調節する新しい因子である可能性がある。PTHはすでに骨粗鬆症治療に広く使用されており既存薬再開発として期待される。高齢者/筋力低下患者へのPTHの投与が、筋萎縮、機能障害の治療のための有望で新しい戦略であると言える。

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