Physiological mineralization of skeletal tissues is a complex and highly regulated process. Uncontrolled or pathological mineralization can have severe consequences and can lead to morbidity and mortality. Recently, Ank was shown to be a transmembrane protein, which transports intracellular PP
i to the extracellular milieu (
11,
30). Recent studies have demonstrated that mutations in human Ank lead to abnormal mineralization in articular cartilage and bone (
11,
30,
34). Furthermore, other studies have shown that
ank mRNA is highly expressed by hypertrophic chondrocytes in the murine growth plate and that Ank expression is upregulated in osteoarthritic cartilage, where mineralization also occurs (
10,
17,
41). However, little is known about the regulatory functions of Ank during physiological and pathological mineralization. The results of this study show that Ank is a crucial regulator of PP
i-P
i homeostasis and BCP mineral formation in growth plate cartilage. Ank expression is markedly upregulated in terminally differentiated growth plate chondrocytes undergoing mineralization. Suppression of
ank gene expression by using siRNA or inhibition of Ank PP
i transport activities in terminally differentiated growth plate chondrocytes notably reduced their rate of mineralization. In contrast, overexpression of Ank in hypertrophic nonmineralizing growth plate chondrocytes accelerates their terminal differentiation and mineralization. These findings seem to be contradictory to the notion that PP
i is an inhibitor of BCP mineral formation (
5,
44). However, our study also demonstrates that enhanced Ank PP
i transport activities lead to an upregulation of APase expression and activity, resulting in the rapid hydrolysis of the mineralization inhibitor PP
i and the generation of P
i, which is required as a signaling molecule and for BCP mineral formation. Consequently, inhibition of APase activity in growth plate chondrocytes expressing high levels of Ank leads to an increase of extracellular PP
i concentration and inhibition of BCP mineralization, consistent with previous findings showing that PP
i is an inhibitor of BCP mineralization (
5,
24,
31,
36,
44).
Our findings that Ank is highly expressed in hypertrophic and mineralizing growth plate chondrocytes in vitro and in vivo are consistent with previous findings showing
ank mRNA localization in hypertrophic chondrocytes during endochondral bone formation in the mouse (
41). In addition, our sequence analysis between the chicken
ank sequence and
ank sequences from a variety of other species reveals a high sequence similarity, suggesting that the function of Ank within different species is highly conserved and important. Interestingly, increased expression of Ank, APase, and other terminal differentiation markers was also detected in human osteoarthritic cartilage (
10,
17,
20,
33 (see also Fig. ), suggesting that Ank may play a similar regulatory role in pathological BCP mineral formation and terminal differentiation in articular cartilage during osteoarthritis.
How does Ank upregulate APase gene expression and activity? Our findings demonstrating (i) that chondrocytes expressing large amounts of Ank show a lower extracellular PP
i concentration than chondrocytes expressing less Ank; (ii) that the intracellular P
i concentration in growth plate chondrocytes treated with RA and GP is higher than the concentration in cells treated with GP only, and this increase of intracellular P
i concentration is inhibited by the type III Na
+/P
i cotransport inhibitor PFA; (iii) that type III Na
+/P
i cotransporter Pit-1 and Pit-2 gene expression is increased in Ank-overexpressing growth plate chondrocytes, and this increase is inhibited by APase activity inhibitor levamisole or by PFA; and (iv) that APase expression and activity in Ank-overexpressing hypertrophic growth plate chondrocytes is inhibited by either levamisole or PFA suggest that APase-mediated hydrolysis of PP
i to P
i acts as feedback loop to further stimulate APase expression and activity. Furthermore, these findings suggest that extracellular P
i being transported through the type III Na
+/P
i cotransporters, Pit-1 and Pit-2, into chondrocytes acts as an intracellular signaling molecule, which further stimulates APase and other mineralization-related gene expression (Fig. ). Other studies have also demonstrated that extracellular P
i not only is required for the formation of BCP crystals but also acts as a signaling molecule and affects cell differentiation (
2,
23). Microarray analysis of osteoblasts cultured in the presence of different concentrations of P
i or β-glycerophosphate revealed up- and downregulation of a variety of genes, including transcriptional regulators, membrane transport proteins (including Pit-1), signaling molecules, and extracellular matrix proteins (
3). Other studies have shown that high concentrations of extracellular P
i stimulate apoptosis of osteoblasts and chondrocytes (
23). These studies have also demonstrated that osteoblasts and growth plate chondrocytes mainly express type III Na
+/P
i cotransporters and that blocking these transporters by PFA or other agents inhibited P
i-mediated events, including alterations of gene expression and apoptosis (
2,
3,
23). These findings are consistent with our results demonstrating that interfering with type III Na
+/P
i cotransport systems in terminally differentiated or Ank-overexpressing growth plate chondrocytes inhibits upregulation of APase expression and activity. However, our results also demonstrate that besides the transport of P
i into growth plate chondrocytes, other mechanisms which regulate APase gene expression and activity exist. We and others have shown that RA increases Cbfa1 expression and activity in growth plate chondrocytes (
14,
46). Cbfa1 is a transcription factor which has been shown to stimulate hypertrophic and terminal differentiation events and which activates the expression of mineralization-related genes, including the APase gene (
43). Another activator of mineralization-related gene expression, including that of APase, is annexin-mediated Ca
2+ influx into growth plate chondrocytes. We have previously shown that annexins II, V, and VI mediate Ca
2+ influx into terminally differentiated growth plate chondrocytes, leading to increased cytoplasmic Ca
2+ concentration and upregulation of Cbfa1, APase, type I collagen, and osteocalcin gene expression. Chelation of intracellular Ca
2+ with 1,2-bis(2-amino phenoxy)ethane-
N,
N,
N′
,N′-tetraacetic acid acetoxy methylester (BAPTA-AM) or a specific annexin channel activity blocker inhibited this upregulation (
46,
47). In addition, it might be possible that APase gene expression is also regulated by nuclear RA receptors. Therefore, PP
i/P
i homeostasis regulated by Ank likely acts as a feedback loop, which further stimulates APase expression and activity and allows sufficient P
i to be generated during the initiation of mineralization.
Interestingly, even higher concentrations of APase are found on the outer membrane surface of matrix vesicles than on the plasma membrane of growth plate chondrocytes (
19). These vesicles are released from the plasma membrane of mineralization-competent growth plate chondrocytes, and they have the critical role of initiating the mineralization process (
1,
19). We and others have shown that the first mineral forms within the vesicles and that annexins also form Ca
2+ channels in matrix vesicles, allowing influx of Ca
2+ into the vesicle lumen (
1,
19). Other studies have demonstrated that these vesicles also contain type III Na
+/P
i cotransporters allowing the influx of P
i into the vesicles (
27). Therefore, high APase expression and activities are required for the initiation of mineralization, and Ank-regulated PP
i/P
i homeostasis seems to play a critical role in providing sufficient APase activity required for this process.
A recent study has shown that increased APase expression leads to an enhanced production of plasma cell membrane glycoprotein-1, a member of the nucleoside triphosphate pyrophosphohydrolases, which is expressed by osteoblasts, hypertrophic growth plate chondrocytes, and articular chondrocytes and which generates PP
i by hydrolysis of its major substrate ATP (
16). Therefore, it is possible that an interrelated series of upregulations of extracellular PP
i-generating and hydrolyzing protein expression and activities is required for effective and controlled mineralization of growth plate cartilage and other skeletal tissues. Any disturbance to this well-regulated system leads to uncontrolled or defective mineralization. For example, hypophosphatasia as a consequence of deactivating mutations in the APase gene is characterized by poorly mineralized growth plate cartilage (rickets) and bones (osteomalacia) and by elevated levels of PP
i, which probably causes poor mineralization (
4,
29,
48). CPPD crystal deposits in articular cartilage due to elevated levels of extracellular PP
i are eminent in patients with adult hypophosphatasia. Tiptoe-walking mice have a nonsense mutation in plasma cell membrane glycoprotein-1, leading to excessive BCP mineralization in ligaments, tendon, and articular cartilage because of a lack of extracellular PP
i (
28,
38). A nonsense mutation in
ank mice leads to a similar phenotype, again because of the lack of extracellular PP
i (
11). On the other hand, mutations in human
ank that activate Ank PP
i transport activity lead to CPPD crystal deposits in articular cartilage and subsequent osteoarthritis (because of supersaturation of PP
i), whereas other mutations in human
ank, which were also suggested to be Ank PP
i transport-stimulating mutations, result in overgrowth and overmineralization (BCP crystals) of craniofacial bones (likely because of the antagonistic effects of APase and Ank) (
30,
31).
As discussed above, excessive extracellular PP
i can lead to either CPPD or BCP crystal formation. As shown in this study, increased levels of extracellular PP
i in hypertrophic and terminally differentiated growth plate chondrocytes lead to increased APase activity, subsequent hydrolysis of PP
i to P
i, and BCP mineralization. In contrast, patients with CPPD deposition disease resulting from either upregulated expression of
ank or Ank PP
i transport-activating mutations have CPPD crystal deposits in articular cartilage because of a supersaturation of extracellular PP
i (
10,
31). In the case of growth plate chondrocytes, these cells respond to the increased extracellular PP
i concentration by hydrolysis of PP
i to P
i followed by further upregulation of APase expression and activity. In contrast, in articular chondrocytes, which do not express APase and seem not to upregulate APase by increased levels of extracellular PP
i, supersaturation with PP
i leads to CPPD crystal formation. The fact that articular chondrocytes, in contrast to growth plate chondrocytes, do not upregulate APase expression and activity in response to increased Ank activities further confirms our earlier notion that P
i (resulting from the hydrolysis of PP
i) and not PP
i is the signaling molecule that leads to the upregulation of expression of the APase gene and other genes and possibly to apoptosis. However, results from this study and others have shown that articular chondrocytes can undergo hypertrophic and terminal differentiation events similarly to growth plate chondrocytes, including upregulation of Ank and APase expression (
10,
17,
20,
33). In this case, the Ank-mediated increase of extracellular PP
i and initial hydrolysis of PP
i to P
i by APase may lead to a further stimulation of APase and other mineralization-related gene expression and subsequent BCP mineral formation in osteoarthritic cartilage, similar to the events occurring in growth plate cartilage. BCP crystals will then further accelerate cartilage destruction.
In conclusion, our study demonstrates that upregulated expression and activities of Ank during growth plate chondrocyte hypertrophy and terminal differentiation, and possibly in articular osteoarthritic cartilage, play a crucial regulatory element in BCP mineralization in these tissues. Upregulated Ank expression and activity result in elevated levels of extracellular PPi. The initial APase activity present in growth plate chondrocytes and osteoarthritic chondrocytes then hydrolyzes PPi, thereby removing an inhibitor of mineralization and providing Pi required for further upregulation of APase and other mineralization-related gene expression. Therefore, the coordinated regulation of expression and activities of Ank and other proteins involved in PPi and Pi generation and the control of a precise extracellular PPi level are absolutely crucial for normal skeletal development and mineralization.