Recent data indicate that energy, fat, bone, and glucose metabolism are interrelated through novel hormonal regulatory pathways
[20]. We observed a complex phenotype in
GPRC6A−/− mice consisting of defective mineralization of bone and impaired osteoblast function in male and female mice, a decrease in lean body mass, an increase in fat mass, hyperphosphatemia and hypercalciuria, hyperglycemia and feminization of male mice associated with altered ratio of estradiol and testosterone, suggesting that
GPRC6A participates in hormonal control of energy metabolism. Multiple organs and metabolic functions were affected by ablation of
GPRC6A in mice.
Obesity-dependent metabolic syndrome is associated with impaired glucose tolerance and hepatic steatosis
[27]. Similarly,
GPRC6A−/− mice had elevated serum glucose levels () glucose intolerance, insulin resistance and hepatic steatosis, as evidence by histological presence of fat and biochemical evidence of increase triglyceride content in livers of knockout mice (). The presence of a metabolic-like syndrome in
GPRC6A−/− mice suggests that this receptor regulates metabolic pathways involved in glucose and fat metabolism, although these studies do not define the exact target organ of GPCR6A effects or whether this is a direct effect of GPRC6A or an indirect effect related to insulin resistance in
GPRC6A−/− mice. Recently, osteocalcin produced by bone has been shown to be a circulating hormone that targets the pancreas to increase insulin secretion and adipocytes to increase adiponectin production
[28]. Osteocalcin (Oc) has also been shown to target an unknown Gαi coupled GPCR
[29] and can activate GPRC6A in the presence of extracellular calcium
[3]. These observations raise the possibility that GPRC6A, might mediate some of the actions of Oc in vivo and provide a molecular pathway linking bone and energy metabolism. Future studies will be needed to determine if this receptor mediates the effects of osteocalcin on energy metabolism and to clarify the mechanisms underlying insulin resistance and hepatic steatosis in
GPRC6A−/− mice.
Another phenotype was feminization of male
GPRC6A−/− mice. Low testosterone levels acting observed in
GPRC6A null mice, through classical genomic mechanisms, could explain the feminization of
GPRC6A null mice. The phenotype of
GPRC6A null mouse resembles, but is less severe than, the
AR null and
Tfm (Testicular feminized) mouse models
[21],
[23].
GPRC6A null mice, however, have inappropriately normal LH and FSH levels and increased estrogen, whereas the disruption of the genomic actions of AR is associated with increased LH and FSH and low estradiol levels
[30]. Our studies do not define the mechanism of the altered testosterone/estrogen ratio. The alterations in circulating sex steroid levels in
GPRC6A null mice might result from direct actions of the receptor to regulate testosterone biosynthesis or conversion to estrogens in the testis or other tissue, and/or to an indirect effect through potential GPRC6A regulation of the hypothalamus or pituitary gland. The observation that
GPRC6A is expressed in the hypothalamus (GEO accession GDS565), gonadotrope cells of the anterior pituitary (GEO accession GDS2167), sertoli cells (GEO accession GDS222) and testes (GEO accession GDS2098) as well as the slight increase in level of aromatase protein expression in testis support both possibilities
[2],
[3],
[14]. Testosterone replacement in
GPRC6A−/− mice, measurement of aromatase activity and steroid biosynthesis, and assessment of GPRC6A function in other tissues will all be needed to establish the biological significance and mechanism of the observed reduction in testosterone levels in these mice.
The predominant effect of
GPRC6A deficiency in bone was to impair bone mineralization. It is not clear whether these bone abnormalities represent a direct effect of
GPRC6A loss from osteoblasts or secondary effects due to potential actions of the concomitant sex steroid hormone abnormalities on bone remodeling. But testosterone deficiency typically leads to increased osteoclast-mediated bone resorption
[31], which was not observed in these animals. Further studies will be needed to determine the relative contribution of secondary alterations in sex hormones and primary loss of calcium-sensing receptor responses to the observed bone phenotype in
GPRC6A null mice. Regardless, the expression of
GPRC6A in bone and osteoblasts and the resulting bone phenotype raises the possibility that GPRC6A is a candidate for the novel osteoblastic calcium-sensing receptor
[3],
[15]. that is distinct from CASR
[15].
With regard to the kidney, we observed that
GPRC6A is expressed in both proximal and distal tubules and the ablation of this receptor resulted in increased renal excretion of calcium, phosphate, and β2-microglobulin. The effects of GPRC6A loss of function on urinary calcium excretion is opposite to the hypocalcuria caused by inactivating mutations of the related calcium sensing receptor CASR
[32]. It is not clear from our studies if these renal abnormalities associated with disruption of GPRC6A function are direct or indirect. We failed to observe in
GRPC6A null mice evidence of secondary increase PTH or increased bone turnover that would be expected if
GPRC6A ablation resulted in a renal calcium leak. Theoretically, a primary decrease in bone formation and decreased buffering capacity for calcium, with consequent increased urinary expression of dietary calcium could account for the relationship between osteopenia and hypercalciuria in
GPRC6A−/− mice. Alternatively, a primary effect of GPRC6A to regulate gastrointestinal phosphate transport would be another possible explanation for increased serum and urinary phosphate. There are some enigmatic clinical disorders with features similar to the
GPRC6A−/− mice that support the possibility of coordinated effects between bone formation and renal conservation of calcium. In this regard, a subset of male patients with idiopathic osteoporosis and nephrolithiasis have the combined features of decreased osteoblast-mediated bone formation and hypercalciuria, without evidence of hypogonadism, secondary hyperparathyroidism, or abnormal vitamin D levels
[33] [34]. It will be interesting to determine if gene polymorphisms of GPRC6A are associated with osteopenic and hypercalciuric clinical disorders. The observed reduction of NaPi IIa in
GPRC6A−/− mice and the low molecular weight proteinuria is consistent with a primary proximal tubular defect. The increase in serum phosphate in
GPRC6A−/− is unexplained.
In summary, we have shown that GPRC6A has multiple functions as evidenced by abnormalities in
GPRC6A null mice that include alterations in circulating testosterone and estrogen levels and feminization of male mice, defects of bone density and bone cell function and abnormalities in the renal handling of calcium and phosphate, hyperglycemia and liver steatosis. The ligand profile of GPRC6A, which includes extracellular calcium, calcimimetics, amino acids, and osteocalcin
[2],
[3],
[14],
[20], along with the complex phenotype of
GPRC6A null mice suggests that GPRC6A may represent an anabolic receptor that responds to a variety of nutritional and hormonal signals and may serve to coordinate the functions of multiple organs in response to changes of these ligands.