New potential targets for treating myeloma bone disease

Purpose: Myeloma bone disease results, in severe pain and pathologic fractures in >80% of patients. Myeloma bone disease is characterized, by both increased osteoclast activity and suppressed new bone formation. The basis for both, the increased bone destruction and decreased bone formation has been a topic of extensive investigation during the last several years. Experimental Design: Marrow samples for patients with myeloma were screened by both molecular biological and gene expression profiling techniques to identify factors that may be responsible for the enhanced bone destruction and suppressed bone formation in patients with the disease. Results: Several novel factors have been identified that directly stimulate osteoclastic bone destruction in myeloma. These include receptor activation NF-kappa B ligand, macrophage inflammatory peptide 1 alpha and interleukin (IL)-3. All of these factors are increased in most patients with myeloma. Furthermore osteoprotegerin levels are markedly suppressed, further driving osteoclast formation. In addition, four novel inhibitors of osteoblast differentiation or activity have been identified. These include two inhibitors of the Wnt signaling pathway. DKK1 and soluble frizzled protein 2. The Wnt signaling pathway is critical for osteoblast differentiation. Two cytokines IL-3 and IL-7, have also been reported that directly or indirectly inhibit osteoblast differentiation in patients with myeloma. Interestingly, increased macrophage inflammatory peptide 1 alpha, IL-3 and IL-7 result from abnormal transcriptional regulation of these genes by increased levels of acute myelogenous leukemia-1 to acute myelogenous leukemia-1B transcription factors. Conclusions: The recent identification of novel stimulators of osteoclast activity and inhibitors of osteoblast differentiation provide new therapeutic targets for treating this devastating bone disease in patients with myeloma.