4.7 Review

High-Resolution Mass Spectrometry for the Measurement of PTH and PTH Fragments: Insights into PTH Physiology and Bioactivity

Journal

JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY
Volume 33, Issue 8, Pages 1448-1458

Publisher

AMER SOC NEPHROLOGY
DOI: 10.1681/ASN.2022010036

Keywords

parathyroid hormone; mineral metabolism; mass spectrometry

Funding

  1. Fred C. and Katherine B. Andersen Foundation [21]
  2. US Department of Health and Human Services NIH [DK 125252]

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This review discusses the importance of measuring both PTH 1-84 and PTH fragments in order to obtain a true biologic representation of total PTH bioactivity. It highlights current advances in methods for PTH measurement and emphasizes the usefulness of mass spectrometry as a potential reference method.
Full-length parathyroid hormone (PTH 1?84) is crucial for the regulation of calcium and phosphate homeostasis and bone remodeling. PTH 1?84 is metabolized into various PTH fragments, which are measured with varying levels of efficiency by PTH immunoassays. These PTH fragments, which increase in serum as CKD progresses, could potentially modulate the effects of PTH 1?84 and contribute to CKD-associated bone disorders. To obtain a true biologic representation of total PTH bioactivity, it is necessary to measure not only PTH 1?84 but also PTH fragments that are present in circulation. Traditional second-generation PTH immunoassays collectively measure PTH 1?84, PTH fragments, and post-translationally modified PTH 1?84, making it difficult to accurately predict the character of underlying renal osteodystrophy. This review highlights current advances in methods available for PTH measurement and the clinical relevance of PTH fragments in CKD. We emphasize the usefulness of mass spectrometry as a potential reference method for PTH measurement.

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