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Blood, 15 January 2009, Vol. 113, No. 3, pp. 517-525.
Prepublished online as a Blood First Edition Paper on October 3, 2008; DOI 10.1182/blood-2008-03-145169.


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REVIEW ARTICLE

The role of Dickkopf-1 in bone development, homeostasis, and disease

Joseph J. Pinzone1,2, Brett M. Hall3,4, Nanda K. Thudi5, Martin Vonau1, Ya-Wei Qiang6, Thomas J. Rosol2,5, and John D. Shaughnessy, Jr6

1 Department of Internal Medicine, 2 Comprehensive Cancer Center, and 3 Department of Pediatrics, The Ohio State University, Columbus; 4 Center for Childhood Cancer, Columbus Children's Research Institute, OH; 5 Department of Veterinary Sciences, The Ohio State University, Columbus; and 6 Myeloma Institute for Research and Therapy, University of Arkansas for Medical Sciences, Little Rock

Wnt/β-catenin signaling is central to bone development and homeostasis in adulthood and its deregulation is associated with bone pathologies. Dickkopf-1 (DKK1), a soluble inhibitor of Wnt/β-catenin signaling required for embryonic head development, regulates Wnt signaling by binding to the Wnt coreceptor lipoprotein-related protein-5 (LRP5)/Arrow. LRP5 mutations causing high bone mass syndromes disrupt DKK1-mediated regulation of LRP5. Forced overexpression of Dkk1 in osteoblasts causes osteopenia, disruption of the hematopoietic stem cell (HSC) niche, and defects in HSC function. Dkk1 also inhibits fracture repair. Studies suggest that DKK1 activation in osteoblasts is the underlying cause of glucocorticoid- and estrogen deficiency–mediated osteoporosis, and at least partially underlies the teratogenic effects of thalidomide on limb development. DKK1 induces proliferation of mesenchymal stem cells (MSC) in vitro and may play a role in the development of high-grade undifferentiated pleomorphic sarcomas derived from MSC and osteosarcomas. DKK1 has been implicated in causing erosive arthritis, the osteolytic phenotypes of multiple myeloma and metastatic breast cancer, and osteoblastic metastases of prostate cancer. Preclinical studies have shown that neutralizing DKK1/Dkk1 and/or enhancing Wnt/β-catenin signaling may prove effective in treating bone pathologies. Here, we review the rapidly growing body of literature defining a pivotal role for DKK1 in bone health and disease.


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