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Role of Matrix Extracellular Phosphoglycoprotein in the Pathogenesis of X-Linked Hypophosphatemia

Shiguang Liu^*, Thomas A. Brown, Jianping Zhou^*, Zhou-Sheng Xiao^*, Hani Awad, Farshid Guilak and L. Darryl Quarles^*

^* Department of Internal Medicine and the Kidney Institute, the University of Kansas Medical Center, Kansas City, Kansas; Groton Laboratories, Pfizer Global Research and Development, Groton, Connecticut; and Department of Surgery, Duke University Medical Center, Durham, North Carolina

Address correspondence to: Dr. L. Darryl Quarles, University of Kansas Medical Center, MS 3018, 3901 Rainbow Boulevard, Kansas City, KS 66160. Phone: 913-588-7607; Fax: 913-588-9251; E-mail: dquarles{at}kumc.edu

Received for publication December 8, 2004. Accepted for publication March 7, 2005.

X-linked hypophosphatemia (XLH), a disorder characterized by hypophosphatemia, impaired skeletal mineralization, and aberrant regulation of 1, 25(OH)₂D₃, is caused by inactivating mutations of Phex, which results in the accumulation of putative phosphaturic factors, called phosphatonins. Matrix extracellular phosphoglycoprotein (Mepe) is a proposed candidate for phosphatonin. The authors found that Hyp mice had increased expression of the MEPE and another phosphaturic factor, Fgf23. To establish MEPE’s role in the pathogenesis of the XLH, Mepe-deficient mice were back-crossed onto the Hyp mouse homologue of XLH and phenotypes of wild-type, Mepe^–/–, Hyp, and Mepe^–/–/Hyp mice were examined. Transfer of Mepe deficiency onto the Phex-deficient Hyp mouse background failed to correct hypophosphatemia and aberrant serum 1,25(OH)₂D₃ levels. Increased Fgf23 levels in Hyp mice were not affected by superimposed Mepe deficiency. In addition, Mepe-deficient Hyp mice retained bone mineralization defects in vivo, characterized by decreased bone mineral density, reduced mineralized trabecular bone volume, lower flexural strength, and histologic evidence of osteomalacia; however, cultures of Hyp-derived bone marrow stromal cells in the absence of Mepe showed improved mineralization and normalization of osteoblast gene expression profiles observed in cells derived from Mepe-null mice. These results demonstrate that MEPE elevation in Hyp mice does not contribute to the hypophosphatemia associated with inactivating Phex mutations and is therefore not phosphatonin.

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