Serum Preptin Level and Its Relationship with Bone Mineral Disease in Chronic Kidney Disease Patients

Preptin is a 34-aminoacid peptide derived from the E-peptide of pro-insulin-like growth factor 2 (pro-IGF2) that is co-secreted with insulin and upregulates glucose-mediated insulin secretion. High serum preptin levels were described in conditions associated with insulin resistance, such as polycystic ovary syndrome and type 2 diabetes mellitus (T2M). Insulin and also IGF2 are known to be anabolic bone hormones .

Preptin stimulates osteoblastic proliferation and increases mineralization in a concentration-independent manner in osteoblast precursor cell , Despite being associated with insulin resistance, an increased fat mass has beneficial bone effects . While the increased mechanical loading favors bone formation, adipokines and also pancreatic and gut hormones were also proposed to mediate the relationship between fat and bone. The importance of nutritional hormones in maintaining bone mass was, thus, recognized. Insulin has anabolic bone effects, and hyperinsulinemia contributes to increased bone mineral density (BMD). Similar to insulin, insulin-like growth factor 1 (IGF1) and IGF2, preptin was recently proposed to have anabolic bone activity .

End-stage renal disease (ESRD) patients present with specific bone and mineral metabolism disturbances. Chronic kidney disease-associated mineral and bone disorder accounts for increased morbidity and mortality in those patients. Biochemical markers known thus far do not effectively predict the complex bone changes that are observed in ESRD patients .