Inhibition of phosphate transporters ameliorates the inflammatory and necrotic side effects of the nitrogen-containing bisphosphonate zoledronate in mice

Tohoku J Exp Med. 2013 Oct;231(2):145-58. doi: 10.1620/tjem.231.145.

Abstract

Bisphosphonates (BPs) are pyrophosphate analogs. They are widely used against enhanced bone-resorption in various diseases. Nitrogen-containing BPs (N-BPs) exhibit strong anti-bone-resorptive effects but have inflammatory and necrotic side effects. The non-nitrogen-containing BPs (non-N-BPs) etidronate and clodronate lack such side effects, but their anti-bone-resorptive effects are weak. In mice, etidronate and clodronate reduce the inflammatory/necrotic effects of N-BPs, even those of zoledronate, the N-BP with the strongest anti-bone-resorptive effect yet reported and the highest risk of inflammation/necrosis. Here, to explore the mechanisms underlying this protection, we used a mouse model in which a single reagent or a mixture of two reagents was injected subcutaneously into ear-pinnas. These reagents included zoledronate, four non-N-BPs, pyrophosphate, and inhibitors of various organic-anion-transporters. Pyrophosphate and two of the four non-N-BPs (not etidronate or clodronate) had inflammatory/necrotic effects. These effects were reduced by etidronate and clodronate, but not by phosphonoformate, an inhibitor of two of the three known phosphate-transporter families. Phosphonoformate reduced the inflammatory/necrotic effects of zoledronate, but not those of pyrophosphate or of non-N-BPs. Conversely, pyrophosphate, at non-inflammatory/necrotic concentrations, reduced the inflammatory/necrotic effects of non-N-BPs, but not those of zoledronate. The efficacies of the protective effects against the inflammatory/necrotic effects of zoledronate were clodronate > etidronate > phosphonoformate. These findings suggest that (i) the N-BP zoledronate may enter soft-tissue cells via phosphonoformate-inhibitable phosphate-transporters, (ii) other phosphate-transporters may carry pyrophosphate and inflammatory/necrotic non-N-BPs into such cells, and (iii) etidronate and clodronate inhibit all these transporters, and they ameliorate the side effects of zoledronate by inhibiting phosphonoformate-inhibitable phosphate-transporters.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Animals
  • Bone Resorption / prevention & control*
  • Clodronic Acid / chemistry
  • Clodronic Acid / pharmacology
  • Diphosphonates / adverse effects*
  • Diphosphonates / chemistry
  • Etidronic Acid / chemistry
  • Etidronic Acid / pharmacology
  • Female
  • Foscarnet / chemistry
  • Foscarnet / metabolism
  • Imidazoles / adverse effects*
  • Imidazoles / chemistry
  • Mice
  • Mice, Inbred BALB C
  • Molecular Structure
  • Necrosis / chemically induced*
  • Necrosis / drug therapy
  • Osteitis / chemically induced*
  • Osteitis / drug therapy
  • Phosphate Transport Proteins / antagonists & inhibitors*
  • Zoledronic Acid

Substances

  • Diphosphonates
  • Imidazoles
  • Phosphate Transport Proteins
  • Clodronic Acid
  • Foscarnet
  • Zoledronic Acid
  • Etidronic Acid