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  1. Article ; Online: Male Lrp5A214V mice maintain high bone mass during dietary calcium restriction by altering the Vitamin D endocrine system.

    Ozgurel, Serra Ucer / Reyes Fernandez, Perla C / Chanpaisaeng, Krittikan / Fleet, James C

    Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research

    2024  

    Abstract: Environmental factors and genetic variation individually impact bone. However, it is not clear how these factors interact to influence peak bone mass accrual. Here we tested whether genetically programmed high bone formation driven by missense mutations ... ...

    Abstract Environmental factors and genetic variation individually impact bone. However, it is not clear how these factors interact to influence peak bone mass accrual. Here we tested whether genetically programmed high bone formation driven by missense mutations in the Lrp5 gene (Lrp5A214V) altered the sensitivity of mice to an environment of inadequate dietary calcium (Ca) intake. Weanling male Lrp5A214V mice and wildtype littermates (control) were fed AIN-93G diets with 0.125%, 0.25%, 0.5% (reference, basal), or 1% Ca from weaning until 12 wks of age (i.e. during bone growth). Urinary Ca, serum Ca, and Ca regulatory hormones (PTH, 1,25 dihydroxyvitamin D3 (1,25(OH)2D3), bone parameters (μCT, ash), and renal/intestinal gene expression were analyzed. As expected, low dietary Ca intake negatively impacted bones and Lrp5A214V mice had higher bone mass and ash content. Although bones of Lrp5A214V mice have more matrix to mineralize, their bones were not more susceptible to low dietary Ca intake. In control mice, low dietary Ca intake exerted expected effects on serum Ca (decreased), PTH (increased), and 1,25(OH)2D3 (increased) as well as their downstream actions (i.e. reducing urinary Ca, increasing markers of intestinal Ca absorption). In contrast, Lrp5A214V mice had elevated serum Ca with a normal PTH response but a blunted 1,25(OH)2D3 response to low dietary Ca that was reflected in the renal 1,25(OH)2D3 producing/degrading enzymes, Cyp27b1 and Cyp24a1. Despite elevated serum Ca in Lrp5A214V mice, urinary Ca was not elevated. Despite an abnormal serum 1,25(OH)2D3 response to low dietary Ca, intestinal markers of Ca absorption (Trpv6, S100g mRNA) were elevated in Lrp5A214V mice and responded to low Ca intake. Collectively, our data indicate that the Lrp5A214V mutation induces changes in Ca homeostasis that permit mice to retain more Ca and support their high bone mass phenotype.
    Language English
    Publishing date 2024-01-31
    Publishing country England
    Document type Journal Article
    ZDB-ID 632783-7
    ISSN 1523-4681 ; 0884-0431
    ISSN (online) 1523-4681
    ISSN 0884-0431
    DOI 10.1093/jbmr/zjae011
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Diet X Gene Interactions Control Femoral Bone Adaptation to Low Dietary Calcium.

    Chanpaisaeng, Krittikan / Reyes-Fernandez, Perla C / Dilkes, Brian / Fleet, James C

    JBMR plus

    2022  Volume 6, Issue 9, Page(s) e10668

    Abstract: Genetics and dietary calcium (Ca) are each critical regulators of peak bone mass but it is unclear how genetics alters the physiologic response of bone to dietary Ca restriction (RCR). Here, we conducted genetic mapping in C57BL/6J × DBA/2J (BXD) ... ...

    Abstract Genetics and dietary calcium (Ca) are each critical regulators of peak bone mass but it is unclear how genetics alters the physiologic response of bone to dietary Ca restriction (RCR). Here, we conducted genetic mapping in C57BL/6J × DBA/2J (BXD) recombinant inbred mouse lines to identify environmentally sensitive loci controlling whole-bone mass (bone mineral density [BMD], bone mineral content [BMC]), distal trabecular bone, and cortical bone midshaft of the femur. Mice were fed adequate (basal) or low Ca diets from 4-12 weeks of age. Femurs were then examined by dual-energy X-ray absorptiometry (DXA) and micro-computed tomography (μCT). Body size-corrected residuals were used for statistical analysis, genetic mapping, and to estimate narrow sense heritability (h
    Language English
    Publishing date 2022-08-19
    Publishing country England
    Document type Journal Article
    ISSN 2473-4039
    ISSN (online) 2473-4039
    DOI 10.1002/jbm4.10668
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  3. Article ; Online: Examining Mechanisms for Voltage-Sensitive Calcium Channel-Mediated Secretion Events in Bone Cells.

    Reyes Fernandez, Perla C / Wright, Christian S / Farach-Carson, Mary C / Thompson, William R

    Calcified tissue international

    2023  Volume 113, Issue 1, Page(s) 126–142

    Abstract: In addition to their well-described functions in cell excitability, voltage-sensitive calcium channels (VSCCs) serve a critical role in calcium ( ... ...

    Abstract In addition to their well-described functions in cell excitability, voltage-sensitive calcium channels (VSCCs) serve a critical role in calcium (Ca
    MeSH term(s) Calcium/metabolism ; Signal Transduction ; Calcium Channels/metabolism ; Osteocytes/metabolism ; Biological Transport
    Chemical Substances Calcium (SY7Q814VUP) ; Calcium Channels
    Language English
    Publishing date 2023-06-01
    Publishing country United States
    Document type Journal Article ; Review ; Research Support, N.I.H., Extramural
    ZDB-ID 304266-2
    ISSN 1432-0827 ; 0944-0747 ; 0008-0594 ; 0171-967X
    ISSN (online) 1432-0827
    ISSN 0944-0747 ; 0008-0594 ; 0171-967X
    DOI 10.1007/s00223-023-01097-w
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Dietary calcium intake and genetics have site-specific effects on peak trabecular bone mass and microarchitecture in male mice.

    Chanpaisaeng, Krittikan / Reyes Fernandez, Perla C / Fleet, James C

    Bone

    2019  Volume 125, Page(s) 46–53

    Abstract: Trabecular bone (Tb) is used for rapid exchange of calcium (Ca) in times of physiologic need and the site-specific characteristics of Tb may explain why certain sites are more vulnerable to osteoporosis. We hypothesized that peak trabecular bone mass ( ... ...

    Abstract Trabecular bone (Tb) is used for rapid exchange of calcium (Ca) in times of physiologic need and the site-specific characteristics of Tb may explain why certain sites are more vulnerable to osteoporosis. We hypothesized that peak trabecular bone mass (PTBM) and Tb microarchitecture are differentially regulated by dietary Ca intake, genetics, or Gene-by-Diet (GxD) interactions at the distal femur and the fifth lumbar (L5) vertebra. Male mice from 62 genetically distinct lines were fed basal (0.5%) or low (0.25%) Ca diets from 4 to 12 wks of age. Afterwards, the right femur and L5 vertebra were removed and trabecular bone was analyzed by μCT. In mice fed the basal diet, bone volume fraction (BV/TV), trabecular number (Tb.N), and connectivity density (Conn.D) were significantly higher in the L5 vertebra than femur. Femur Tb had a weaker, more rod-like structure than the L5 vertebrae while mice fed the low Ca diet developed rod-like structures at both sites. Dietary Ca restriction also caused a greater relative reduction of Tb.N and Conn.D in the femur than L5 vertebra, i.e. it was more harmful to the integrity of Tb microarchitecture in femur. Genetics was a major determinant of Tb at both sites, e.g. heritability of BV/TV on the basal diet = 0.65 (femur) and 0.68 (L5 vertebra). However, while GxD interactions altered the impact of dietary Ca restriction on Tb parameters at both sites, the effect was not uniform, e.g. some lines had site-specific responses to Ca restriction. The significance of our work is that there are site-specific effects of dietary Ca restriction and genetics that work independently and interactively to influence the attainment of PTBM and Tb microarchitecture.
    MeSH term(s) Animals ; Bone Density/drug effects ; Bone Density/genetics ; Calcium, Dietary/administration & dosage ; Calcium, Dietary/pharmacology ; Cancellous Bone/drug effects ; Cancellous Bone/metabolism ; Femur/drug effects ; Femur/metabolism ; Male ; Mice ; Spine/drug effects ; Spine/metabolism
    Chemical Substances Calcium, Dietary
    Language English
    Publishing date 2019-05-09
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
    ZDB-ID 632515-4
    ISSN 1873-2763 ; 8756-3282
    ISSN (online) 1873-2763
    ISSN 8756-3282
    DOI 10.1016/j.bone.2019.05.011
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Effects of Gabapentin and Pregabalin on Calcium Homeostasis: Implications for Physical Rehabilitation of Musculoskeletal Tissues.

    Reyes Fernandez, Perla C / Wright, Christian S / Warden, Stuart J / Hum, Julia / Farach-Carson, Mary C / Thompson, William R

    Current osteoporosis reports

    2022  Volume 20, Issue 6, Page(s) 365–378

    Abstract: Purpose of review: In this review, we discuss the mechanism of action of gabapentinoids and the potential consequences of long-term treatment with these drugs on the musculoskeletal system.: Recent findings: Gabapentinoids, such as gabapentin (GBP) ... ...

    Abstract Purpose of review: In this review, we discuss the mechanism of action of gabapentinoids and the potential consequences of long-term treatment with these drugs on the musculoskeletal system.
    Recent findings: Gabapentinoids, such as gabapentin (GBP) and pregabalin (PGB) were designed as antiepileptic reagents and are now commonly used as first-line treatment for neuropathic pain and increasingly prescribed off-label for other pain disorders such as migraines and back pain. GBP and PGB exert their analgesic actions by selectively binding the α
    MeSH term(s) Humans ; Calcium ; Gabapentin/pharmacology ; gamma-Aminobutyric Acid/therapeutic use ; gamma-Aminobutyric Acid/pharmacology ; Homeostasis ; Pregabalin/therapeutic use ; Pregabalin/pharmacology
    Chemical Substances Calcium (SY7Q814VUP) ; Gabapentin (6CW7F3G59X) ; gamma-Aminobutyric Acid (56-12-2) ; Pregabalin (55JG375S6M)
    Language English
    Publishing date 2022-09-23
    Publishing country United States
    Document type Journal Article ; Review ; Research Support, Non-U.S. Gov't ; Research Support, N.I.H., Extramural
    ZDB-ID 2186581-4
    ISSN 1544-2241 ; 1544-1873
    ISSN (online) 1544-2241
    ISSN 1544-1873
    DOI 10.1007/s11914-022-00750-x
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Effects of Dietary Protein Source and Quantity on Bone Morphology and Body Composition Following a High-Protein Weight-Loss Diet in a Rat Model for Postmenopausal Obesity.

    Wright, Christian S / Hill, Erica R / Reyes Fernandez, Perla C / Thompson, William R / Gallant, Maxime A / Campbell, Wayne W / Main, Russell P

    Nutrients

    2022  Volume 14, Issue 11

    Abstract: Higher protein (>30% of total energy, HP)-energy restriction (HP-ER) diets are an effective means to improve body composition and metabolic health. However, weight loss (WL) is associated with bone loss, and the impact of HP-ER diets on bone is mixed and ...

    Abstract Higher protein (>30% of total energy, HP)-energy restriction (HP-ER) diets are an effective means to improve body composition and metabolic health. However, weight loss (WL) is associated with bone loss, and the impact of HP-ER diets on bone is mixed and controversial. Recent evidence suggests conflicting outcomes may stem from differences in age, hormonal status, and the predominant source of dietary protein consumed. Therefore, this study investigated the effect of four 12-week energy restriction (ER) diets varying in predominate protein source (beef, milk, soy, casein) and protein quantity (normal protein, NP 15% vs. high, 35%) on bone and body composition outcomes in 32-week-old obese, ovariectomized female rats. Overall, ER decreased body weight, bone quantity (aBMD, aBMC), bone microarchitecture, and body composition parameters. WL was greater with the NP vs. HP-beef and HP-soy diets, and muscle area decreased only with the NP diet. The HP-beef diet exacerbated WL-induced bone loss (increased trabecular separation and endocortical bone formation rates, lower bone retention and trabecular BMC, and more rod-like trabeculae) compared to the HP-soy diet. The HP-milk diet did not augment WL-induced bone loss. Results suggest that specific protein source recommendations may be needed to attenuate the adverse alterations in bone quality following an HP-ER diet in a model of postmenopausal obesity.
    MeSH term(s) Animals ; Body Composition ; Cattle ; Diet, Reducing ; Dietary Proteins/pharmacology ; Female ; Obesity/metabolism ; Postmenopause ; Rats ; Weight Loss/physiology
    Chemical Substances Dietary Proteins
    Language English
    Publishing date 2022-05-28
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2518386-2
    ISSN 2072-6643 ; 2072-6643
    ISSN (online) 2072-6643
    ISSN 2072-6643
    DOI 10.3390/nu14112262
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  7. Article ; Online: Deletion of the auxiliary α2δ1 voltage sensitive calcium channel subunit in osteocytes and late-stage osteoblasts impairs femur strength and load-induced bone formation in male mice.

    Wright, Christian S / Lewis, Karl J / Semon, Katelyn / Yi, Xin / Reyes Fernandez, Perla C / Rust, Katie / Prideaux, Matthew / Schneider, Artur / Pederson, Molly / Deosthale, Padmini / Plotkin, Lilian I / Hum, Julia M / Sankar, Uma / Farach-Carson, Mary C / Robling, Alexander G / Thompson, William R

    Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research

    2024  Volume 39, Issue 3, Page(s) 298–314

    Abstract: Osteocytes sense and respond to mechanical force by controlling the activity of other bone cells. However, the mechanisms by which osteocytes sense mechanical input and transmit biological signals remain unclear. Voltage-sensitive calcium channels (VSCCs) ...

    Abstract Osteocytes sense and respond to mechanical force by controlling the activity of other bone cells. However, the mechanisms by which osteocytes sense mechanical input and transmit biological signals remain unclear. Voltage-sensitive calcium channels (VSCCs) regulate calcium (Ca2+) influx in response to external stimuli. Inhibition or deletion of VSCCs impairs osteogenesis and skeletal responses to mechanical loading. VSCC activity is influenced by its auxiliary subunits, which bind the channel's α1 pore-forming subunit to alter intracellular Ca2+ concentrations. The α2δ1 auxiliary subunit associates with the pore-forming subunit via a glycosylphosphatidylinositol anchor and regulates the channel's calcium-gating kinetics. Knockdown of α2δ1 in osteocytes impairs responses to membrane stretch, and global deletion of α2δ1 in mice results in osteopenia and impaired skeletal responses to loading in vivo. Therefore, we hypothesized that the α2δ1 subunit functions as a mechanotransducer, and its deletion in osteocytes would impair skeletal development and load-induced bone formation. Mice (C57BL/6) with LoxP sequences flanking Cacna2d1, the gene encoding α2δ1, were crossed with mice expressing Cre under the control of the Dmp1 promoter (10 kb). Deletion of α2δ1 in osteocytes and late-stage osteoblasts decreased femoral bone quantity (P < .05) by DXA, reduced relative osteoid surface (P < .05), and altered osteoblast and osteocyte regulatory gene expression (P < .01). Cacna2d1f/f, Cre + male mice displayed decreased femoral strength and lower 10-wk cancellous bone in vivo micro-computed tomography measurements at the proximal tibia (P < .01) compared to controls, whereas Cacna2d1f/f, Cre + female mice showed impaired 20-wk cancellous and cortical bone ex vivo micro-computed tomography measurements (P < .05) vs controls. Deletion of α2δ1 in osteocytes and late-stage osteoblasts suppressed load-induced calcium signaling in vivo and decreased anabolic responses to mechanical loading in male mice, demonstrating decreased mechanosensitivity. Collectively, the α2δ1 auxiliary subunit is essential for the regulation of osteoid-formation, femur strength, and load-induced bone formation in male mice.
    MeSH term(s) Mice ; Male ; Female ; Animals ; Osteocytes/metabolism ; Osteogenesis/genetics ; Calcium/metabolism ; X-Ray Microtomography ; Mice, Inbred C57BL ; Osteoblasts/metabolism ; Femur/diagnostic imaging ; Femur/metabolism ; Calcium Channels/genetics ; Calcium Channels/metabolism
    Chemical Substances Calcium (SY7Q814VUP) ; Calcium Channels
    Language English
    Publishing date 2024-03-18
    Publishing country England
    Document type Journal Article
    ZDB-ID 632783-7
    ISSN 1523-4681 ; 0884-0431
    ISSN (online) 1523-4681
    ISSN 0884-0431
    DOI 10.1093/jbmr/zjae010
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article ; Online: Compensatory Changes in Calcium Metabolism Accompany the Loss of Vitamin D Receptor (VDR) From the Distal Intestine and Kidney of Mice.

    Reyes-Fernandez, Perla C / Fleet, James C

    Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research

    2016  Volume 31, Issue 1, Page(s) 143–151

    Abstract: 1,25 Dihydroxyvitamin D3 (1,25(OH)2 D) increases intestinal Ca absorption when dietary Ca intake is low by inducing gene expression through the vitamin D receptor (VDR). 1,25(OH)2 D-regulated Ca absorption has been studied extensively in the small ... ...

    Abstract 1,25 Dihydroxyvitamin D3 (1,25(OH)2 D) increases intestinal Ca absorption when dietary Ca intake is low by inducing gene expression through the vitamin D receptor (VDR). 1,25(OH)2 D-regulated Ca absorption has been studied extensively in the small intestine, but VDR is also present in the large intestine. Our goal was to determine the impact of large intestinal VDR deletion on Ca and bone metabolism. We used transgenic mice expressing Cre-recombinase driven by the 9.5-kb human caudal type homeobox 2 (CDX2) promoter to delete floxed VDR alleles from the caudal region of the mouse (CDX2-KO). Weanling CDX2-KO mice and control littermates were fed low (0.25%) or normal (0.5%) Ca diets for 7 weeks. Serum and urinary Ca, vitamin D metabolites, bone parameters, and gene expression were analyzed. Loss of the VDR in CDX2-KO was confirmed in colon and kidney. Unexpectedly, CDX2-KO had lower serum PTH (-65% of controls, p < 0.001) but normal serum 1,25(OH)2 D and Ca levels. Despite elevated urinary Ca loss (eightfold higher in CDX2-KO) and reduced colonic target genes TRPV6 (-90%) and CaBPD9k (-80%) mRNA levels, CDX2-KO mice had only modestly lower femoral bone density. Interestingly, duodenal TRPV6 and CaBPD9k mRNA expression was fourfold and threefold higher, respectively, and there was a trend toward increased duodenal Ca absorption (+19%, p = 0.076) in the CDX2-KO mice. The major finding of this study is that large intestine VDR significantly contributes to whole-body Ca metabolism but that duodenal compensation may prevent the consequences of VDR deletion from large intestine and kidney in growing mice.
    MeSH term(s) Animals ; Calcitriol/metabolism ; Calcium/metabolism ; Humans ; Intestinal Absorption/physiology ; Intestine, Large/metabolism ; Kidney/metabolism ; Mice ; Mice, Knockout ; Receptors, Calcitriol/genetics ; Receptors, Calcitriol/metabolism
    Chemical Substances Receptors, Calcitriol ; Calcitriol (FXC9231JVH) ; Calcium (SY7Q814VUP)
    Language English
    Publishing date 2016-01
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 632783-7
    ISSN 1523-4681 ; 0884-0431
    ISSN (online) 1523-4681
    ISSN 0884-0431
    DOI 10.1002/jbmr.2600
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  9. Article ; Online: Automated image-analysis method for the quantification of fiber morphometry and fiber type population in human skeletal muscle.

    Reyes-Fernandez, Perla C / Periou, Baptiste / Decrouy, Xavier / Relaix, Fréderic / Authier, François Jérôme

    Skeletal muscle

    2019  Volume 9, Issue 1, Page(s) 15

    Abstract: Background: The quantitative analysis of muscle histomorphometry has been growing in importance in both research and clinical settings. Accurate and stringent assessment of myofibers' changes in size and number, and alterations in the proportion of ... ...

    Abstract Background: The quantitative analysis of muscle histomorphometry has been growing in importance in both research and clinical settings. Accurate and stringent assessment of myofibers' changes in size and number, and alterations in the proportion of oxidative (type I) and glycolytic (type II) fibers is essential for the appropriate study of aging and pathological muscle, as well as for diagnosis and follow-up of muscle diseases. Manual and semi-automated methods to assess muscle morphometry in sections are time-consuming, limited to a small field of analysis, and susceptible to bias, while most automated methods have been only tested in rodent muscle.
    Methods: We developed a new macro script for Fiji-ImageJ to automatically assess human fiber morphometry in digital images of the entire muscle. We tested the functionality of our method in deltoid muscle biopsies from a heterogeneous population of subjects with histologically normal muscle (male, female, old, young, lean, obese) and patients with dermatomyositis, necrotizing autoimmune myopathy, and anti-synthetase syndrome myopathy.
    Results: Our macro is fully automated, requires no user intervention, and demonstrated improved fiber segmentation by running a series of image pre-processing steps before the analysis. Likewise, our tool showed high accuracy, as compared with manual methods, for identifying the total number of fibers (r = 0.97, p < 0.001), fiber I and fiber II proportion (r = 0.92, p < 0.001), and minor diameter (r = 0.86, p < 0.001) while conducting analysis in ~ 5 min/sample. The performance of the macro analysis was maintained in pectoral and deltoid samples from subjects of different age, gender, body weight, and muscle status. The output of the analyses includes excel files with the quantification of fibers' morphometry and color-coded maps based on the fiber's size, which proved to be an advantageous feature for the fast and easy visual identification of location-specific atrophy and a potential tool for medical diagnosis.
    Conclusion: Our macro is reliable and suitable for the study of human skeletal muscle for research and for diagnosis in clinical settings providing reproducible and consistent analysis when the time is of the utmost importance.
    MeSH term(s) Adolescent ; Adult ; Aged ; Aged, 80 and over ; Aging/pathology ; Autoimmune Diseases/diagnostic imaging ; Autoimmune Diseases/pathology ; Dermatomyositis/diagnostic imaging ; Dermatomyositis/pathology ; Female ; Fluorescent Antibody Technique ; Healthy Volunteers ; Humans ; Image Interpretation, Computer-Assisted/methods ; Male ; Middle Aged ; Muscle Fibers, Skeletal/classification ; Muscle Fibers, Skeletal/ultrastructure ; Muscle, Skeletal/diagnostic imaging ; Muscle, Skeletal/ultrastructure ; Muscular Diseases/diagnostic imaging ; Muscular Diseases/pathology ; Myositis/diagnostic imaging ; Myositis/pathology ; Obesity/diagnostic imaging ; Obesity/pathology ; Software ; Young Adult
    Language English
    Publishing date 2019-05-27
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2595637-1
    ISSN 2044-5040 ; 2044-5040
    ISSN (online) 2044-5040
    ISSN 2044-5040
    DOI 10.1186/s13395-019-0200-7
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  10. Article ; Online: Loss of the auxiliary α

    Kelly, Madison M / Sharma, Karan / Wright, Christian S / Yi, Xin / Reyes Fernandez, Perla C / Gegg, Aaron T / Gorrell, Taylor A / Noonan, Megan L / Baghdady, Ahmed / Sieger, Jacob A / Dolphin, Annette C / Warden, Stuart J / Deosthale, Padmini / Plotkin, Lilian I / Sankar, Uma / Hum, Julia M / Robling, Alexander G / Farach-Carson, Mary C / Thompson, William R

    JBMR plus

    2024  Volume 8, Issue 2, Page(s) ziad008

    Abstract: Voltage-sensitive calcium channels (VSCCs) influence bone structure and function, including anabolic responses to mechanical loading. While the pore-forming ( ... ...

    Abstract Voltage-sensitive calcium channels (VSCCs) influence bone structure and function, including anabolic responses to mechanical loading. While the pore-forming (α
    Language English
    Publishing date 2024-01-10
    Publishing country England
    Document type Journal Article
    ISSN 2473-4039
    ISSN (online) 2473-4039
    DOI 10.1093/jbmrpl/ziad008
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