Apoptotic gene expression in Paget's disease: a possible role for Bcl-2

Paget's disease of bone is characterized by an increase in both the size and the number of bone-resorbing osteoclasts. An important regulator of osteoclast activity is the process of apoptosis, and any aberration in this process could lead to increased osteoclasis. Analysis using human apoptosis cDNA expression arrays revealed that the apoptotic suppressor, Bcl-2, showed a marked increase in expression in Pagetic bone. In situ hybridization (ISH) and computer-assisted image analysis confirmed that the levels of Bcl-2 transcripts were significantly (p<0.0001) increased in Pagetic osteoclasts. The Bcl-2:Bax transcript ratios were similarly elevated. These findings were confirmed by immunohistochemistry. The Bcl-2 gene promoter sequence from 20 Pagetic patients and controls was analysed. Single nucleotide mutations were identified in three of the Paget's patients and one of the controls. Luciferase reporter analysis showed that the mutations induced a basal 12-fold increase and hydrogen peroxide-induced 19-fold increase in luciferase expression, compared with the normal construct. It is concluded that in Paget's disease, there is an increase in the expression of genes that are involved in the inhibition of apoptosis, notably Bcl-2. The increase in Bcl-2 may be explained in some patients by mutations in the Bcl-2 gene promoter. These results provide a potential explanation for the dramatic increase in osteoclasis seen in patients with Paget's disease.