Dickkopf-1 (DKK-1) and sclerostin are essential Wnt/β-catenin pathway inhibitors, playing an important role in multiple myeloma bone disease (MBD). We aimed to examine the serum DKK-1 and sclerostin variations in newly diagnosed multiple myeloma (NDMM) patients at diagnosis and in the course of therapy, including autologous stem cell transplantation (ASCT). This study included 41 NDMM-patients and 33 controls. MBD was assessed by whole-body low-dose computed tomography. DKK-1 and sclerostin were assayed by commercial ELISA kits. At diagnosis, NDMM-patients revealed significantly higher DKK-1 and sclerostin values (p < 0.0001), showing dependence on disease stage (lowest in ISS-I and highest in ISS-III: p < 0.0012 and p < 0.025, respectively, for both proteins). Bone lesions revealed significant positive correlation with both DKK-1 (p < 0.05) and sclerostin (p < 0.0001). In the course of therapy, significant reduction, more prominent after ASCT, was observed for both parameters in each treatment point compared to the baseline (p < 0.0001). Markedly lower sclerostin (p < 0.01) and DKK-1 (p < 0.05) values were observed in patients with complete and very good partial response compared to those with partial response, stable, or progressive disease. Sclerostin and DKK-1 in NDMM patients reflect the MBD severity and the effect of therapy. Both proteins could represent a novel tool for better disease monitoring and effectiveness of therapy.

The hallmark of multiple myeloma is myeloma related bone disease. Interactions between myeloma plasma cells (MPCs), stromal cells, and the bone marrow (BM) microenvironment play a critical role in the pathogenesis of MBD. Bone remodeling is severely dysregulated with the prevalence of osteoclast activity. We aimed to assess circulating levels of sRANKL, periostin, and osteopontin as osteoclast activators in NDMM patients at diagnosis and in the course of treatment, correlations with clinical and laboratory data, and to evaluate their potential as additional biomarkers for the assessment of MBD. The current study involved 74 subjects (41 NDMM patients, 33 controls). MBD was assessed by whole-body low-dose computed tomography. sRANKL, periostin, and osteopontin were assayed by commercial ELISA kits. At diagnosis, all tested parameters were significantly higher in NDMM patients compared to the controls (p < 0.0001), correlating with disease stage, MBD grade, and BM infiltration by MPCs. During therapy, the serum levels of all tested proteins decrease, most prominently after autologous stem cell transplantation (p < 0.0001). A significant reduction was established in patients achieving complete and very-good partial response compared to all others (p < 0.05). In conclusion, sRANKL, periostin, and osteopontin reflect MBD severity and could be promising markers for MBD monitoring and the effect of myeloma treatment.

Background: The disturbed pleiotropic functions of vitamin D are related to numerous chronic non-skeletal diseases. The role of vitamin D insufficiency/deficiency in cardiovascular diseases (CVD) is controversial. Therefore, the aim was to study the vitamin D status in CVD patients and to reveal possible relationships with CVD risk factors. Methods: This prospective study includes 93 individuals devided into two groups - patients with CVD (n = 49) and patients at risk for CVD (n = 44) served as controls. The CVD-patients were stratified into AF-group - with paroxysmal or persistent atrial fibrillation and HF-group - with heart failure with preserved ejection fraction, in sinus rhythm. Vitamin D status was assessed by measurement of serum 25-hydroxy-vitamin D (25OHD) using liquid chromatography with mass detection. Gene expression of the regulatory enzyme of vitamin D metabolism, 1-alfa-hydroxylase (CYP27B1), was evaluated by two-step real-time qPCR. Coronary artery calcium scans were performed and coronary artery calcium score (CACS) was calculated. Routine biochemical parameters were extracted from the medical documentation. Standard statistical methods (descriptive statistics, unpaired Student's t-test, one-way ANOVA, simple and multiple linear regression analyses) were applied. Statistical significance was considered at p < 0.05. Results: Serum 25OHD levels of the controls were higher than those of the CVD-patients (37.36 +/- 15.10 ng/mL vs. 27.70 +/- 11.80 ng/mL, p = 0.008). The vitamin D status worsened with the severity of CVD pathology: significant decrease of 25OHD levels was found in the AF-group (29.56 +/- 11.76 ng/mL, p = 0.044) and HF-group (24.47 +/- 11.61 ng/mL, p = 0.003) vs. controls (37.36 +/- 15.10 ng/mL). Significant reduction in circulating vitamin D levels with the increase of CACS (p = 0.007) was also observed. Linear regression analysis revealed significant negative association for serum 25OHD with CACS for both the entire studied group (p = 0.008) and for CVD patients (p = 0.049). The gene expression of CYP27B1 was down regulated with both the severity of CVD pathology (p = 0.05) and coronary calcium accumulation (p = 0.08). Moreover, we found a significant positive relationship (p = 0.041) between serum 25OHD levels and CYP27B1 gene expression. Conclusions: Vitamin D deficiency may be an independent cardiovascular risk factor associated with the severity of CVD pathology and increased coronary calcium deposition. The mechanism by which vitamin D itself can affect cardiovascular outcomes remains to be clarified.