Bone-forming cells are highly coupled by gap junctions formed
primarily by connexin43 (Cx43) and, to a lesser degree,
connexin45 (Cx45) proteins (Civitelli et al., 1993; Donahue et
al., 1995; Steinberg et al., 1994). Several in vitro studies have
demonstrated that Cx43 is involved in modulating the
differentiation and function of bone-forming cells as well as
osteocytes (Cheng et al., 2001; Lecanda et al., 1998; Schiller
et al., 2001a; Schiller et al., 2001c); and work from our group
indicates that Cx43 controls osteoblast gene transcription via
modulation of specific signaling systems required for
osteoblast gene expression (Stains et al., 2003; Stains and
Although this work has laid the foundation for
understanding the biology of gap junction proteins in bone,
only recent studies in human and mouse genetics have brought
to the fore the biologic role of Cx43 in the skeleton. We had
reported that targeted ablation of the Cx43 gene in the mouse
leads to a skeletal phenotype characterized by retarded
intramembranous and endochondral ossification, craniofacial
abnormalities and osteoblast dysfunction (Lecanda et al.,
2000), providing in vivo evidence that this gap junction protein
is required for normal bone development and osteoblastic
differentiation (Lecanda et al., 1998; Stains et al., 2003). This
notion is now further supported by findings of Cx43 mutations
in patients with oculodentodigital dysplasia (ODDD), a rare
congenital disease whose phenotypic features include
craniofacial malformations and syndactyly (Paznekas et al.,
2003; Richardson et al., 2004). A similar, though not identical
phenotype has been recently reported in a mouse with a
dominant negative Cx43 mutant allele, Gja1Jrt(Flenniken et
al., 2005). Interestingly, these animals have also generalized
osteopenia, thus reinforcing the notion that functional Cx43 is
important for bone mass accrual and maintenance. Such a
premise could be tested in a full gene-deletion model, but
unfortunately homozygous Cx43 null mice die shortly after
birth because of severe cardiovascular malformations (Reaume
et al., 1995), thus precluding the use of this model to study the
consequences of complete lack of Cx43 in the adult skeleton.
In vitro studies have also shown that Cx43 is critical for bone
cell response to a variety of stimuli and pharmacologic agents.
For example, inhibition of gap junctional communication or
Connexin43 (Cx43) is involved in bone development, but its
role in adult bone homeostasis remains unknown. To
overcome the postnatal lethality of Cx43 null mutation, we
generated mice with selective osteoblast ablation of Cx43,
obtained using a Cx43flallele and a 2.3-kb fragment of the
? ?1(I) collagen promoter to drive Cre in osteoblasts (ColCre).
Conditionally osteoblast-deleted ColCre;Cx43–/flmice show
no malformations at birth, but develop low peak bone mass
and remain osteopenic with age, exhibiting reduced bone
formation and defective osteoblast function. By both
radiodensitometry and histology, bone mineral content
increased rapidly and progressively in adult Cx43+/flmice
after subcutaneous injection of parathyroid hormone
(PTH), an effect significantly attenuated in ColCre;Cx43–/fl
mice, with Cx43–/flexhibiting an intermediate response.
Attenuation of PTH anabolic action was associated with
failure to increase mineral apposition rate in response to
PTH in ColCre;Cx43–/fl, despite an increased osteoblast
number, suggesting a functional defect in Cx43-deficient
bone-forming cells. In conclusion, lack of Cx43 in
osteoblasts leads to suboptimal acquisition of peak bone
mass, and hinders the bone anabolic effect of PTH. Cx43
represents a potential target for modulation of bone
Key words: Gap junctions, Connexin43, Teriparatide, Bone anabolic
agents, Conditional gene deletion
Low peak bone mass and attenuated anabolic
response to parathyroid hormone in mice with an
osteoblast-specific deletion of connexin43
Dong Jin Chung1,2,*, Charlles H. M. Castro1,3,*, Marcus Watkins1, Joseph P. Stains1,‡, Min Young Chung2,
Vera Lucia Szejnfeld3, Klaus Willecke4, Martin Theis§and Roberto Civitelli1,¶
1Division of Bone and Mineral Diseases, Washington University School of Medicine, 660 S. Euclid Avenue, St Louis, MO 63110, USA
2Department of Internal Medicine, Chonnam University Research Institute of Medical Sciences, Chonnam National University Medical School,
Gwangju, Republic of Korea
3Universidade Federal de São Paulo-Escola Paulista de Medicina, São Paulo, Brasil
4Institut für Genetik, Universität Bonn, Germany
*These two authors contributed equally to this work
‡Present address: Department of Orthopaedics, University of Maryland, Baltimore, MD, USA
§Present address: Institute of Cellular Neurosciences, University of Bonn, Germany
¶Author for correspondence (e-mail: email@example.com)
Accepted 6 July 2006
Journal of Cell Science 119, 4187-4198 Published by The Company of Biologists 2006
Journal of Cell Science
JCS ePress online publication date 19 September 2006
Cx43 expression hinders osteoblast responses to fluid flow
(Cherian et al., 2005; Saunders et al., 2001), or to mechanically
induced calcium waves (Jørgensen et al., 2000). Further, the
action of parathyroid hormone (PTH), an important regulator
of bone remodeling also seems to be dependent on gap
junctional communication. PTH increases gap junctional
communication between osteoblasts by modulating Cx43
expression or function (Civitelli et al., 1998; Donahue et al.,
1995), and interference with Cx43-mediated gap junctional
communication using antisense oligonucleotides or chemical
inhibitors disrupts both PTH-induced cAMP accumulation
(Van der Molen et al., 1996) and osteoblast differentiation
(Schiller et al., 2001b). Based on these findings, and
considering the osteoblast dysfunction of Cx43 null osteoblasts
(Lecanda et al., 2000), we hypothesized that lack of Cx43
would negatively affect skeletal responsiveness to anabolic
stimuli, such as that produced by intermittent PTH
administration, the only currently available modality for
inducing new bone formation (bone anabolism) in patients with
osteoporosis and fractures (Neer et al., 2001).
To determine the biologic importance of Cx43 in the adult
skeleton, we generated a conditional Cx43 gene ablated mouse
model based on the Cre/loxP system (Nagy, 2000). In this
model, which overcomes the lethality of the germline Cx43
null mutation, Cre expression is driven by a 2.3-kb fragment
of the ?1(I) collagen promoter, resulting in replacement of the
entire Cx43 reading frame with the lacZ reporter cassette
selectively in bone-forming cells (Castro et al., 2003). With this
model, Cre is expressed just before birth and in cells that are
already partially differentiated into osteoblasts, thus providing
an osteoblast-specific and postnatal gene ablation model
(Dacquin et al., 2002). We find that these animals are viable,
but develop a low peak bone mass and remain osteopenic
throughout their adult life, the result of a reduced ability of
bone-forming cells to fully differentiate. They also exhibit a
dramatically attenuated response to the anabolic effect of
intermittent PTH administration. Thus, Cx43 is important not
only for normal skeletal development, but also for peak bone
mass accrual and adult bone homeostasis. Pharmacologic
stimulation of gap junctional communication may enhance the
effect of osteoanabolic agents, such as PTH.
Cre-mediated Cx43 gene deletion in osteoblasts
Specific osteoblast Cx43 gene deletion was demonstrated in
ColCre;Cx43–/flmice by different approaches. PCR of genomic
DNA extracted from bone revealed the expected 670-kb band
corresponding to the Cx43 deleted allele, a band that was
absent from extracts of tail soft tissue (Fig. 1A). Accordingly,
Cx43 immunoreactive bands were barely detectable in Western
blots of bone tissue extracts from conditionally deleted mice,
contrasting with strong bands in wild-type equivalent
littermates and fainter bands in heterozygous equivalent mice
(Fig. 1B), the latter reflecting both the loss of one Cx43 allele
and haploinsufficiency of the ‘floxed’ allele (Theis et al.,
2001). Substantial amounts of mRNA transcripts for the Cre
transgene were detected only in bone extracts from
ColCre;Cx43–/flmice but not in either Cx43–/flor Cx43+/fl
extracts (Fig. 1C). Whole-mount preparations of newborn
animals revealed strong X-gal stain in areas corresponding to
mineralized skeleton of ColCre;Cx43–/flmice, whereas very
Journal of Cell Science 119 (20)
faint stain was observed in Cx43–/flmice, which may reflect
endogenous ?-galactosidase expression (Kim et al., 2004), as
it is observed in animals lacking the lacZ reporter (Fig. 1D).
In conditional Cx43-deleted mice, X-gal blue staining was
intense in areas of more advanced ossification, such as the
diaphyses of long bones, vertebral bodies, ribs, distal mandible
and facial bones, whereas staining was not observed in the
epiphyses of long bones, corresponding to cartilaginous growth
plates, nor in the skin or internal organs (Fig. 1D). Confirming
osteoblast-specific Cx43 gene deletion, X-gal stain was
selectively observed in cells lining the bone surfaces of tibial
cortical endosteum and trabecular surfaces of both tibia and
vertebra. As expected, most osteocytes were also X-gal
positive, whereas no stain was observed in bone marrow cells
Osteopenia and reduced osteoblast number in Cx43
conditional knockout mice
All genotypes were obtained at the expected Mendelian
frequency and were viable. Whole-mount alizarin red/alcian
blue staining of newborn mice did not reveal any major skeletal
abnormalities in Cx43 conditional knockout mice compared
with their control littermates (Fig. 2A), consistent with post-
developmental deletion of Cx43. However, body weight at 1
month was significantly lower in ColCre;Cx43–/flmice relative
to the other genotypes in both males and females, a difference
that persisted until at least 6 months of age (Fig. 2B).
Importantly, conditional Cx43-deficient mice exhibited
significantly lower whole-body bone density by dual-energy X-
ray absorptiometry (DEXA) compared with Cx43+/flor Cx43–/fl
littermates by two-way ANOVA (Fig. 2C). This relative
osteopenia was significant as early as 1 month of age and
persisted with age at least up to 6 months (P<0.05 and P<0.01,
respectively). Bone mineral content (BMC) very closely
resembled the bone density data, with approximately 5% lower
bone mass in ColCre;Cx43–/flmice relative to the wild-type and
heterozygous equivalent mice.
Histomorphometric analysis evidenced a markedly more
reduced trabecular bone mass in ColCre;Cx43–/flmice, with
approximately 40% reduction in bone volume/total volume and
more than 50% reduction in osteoblast number relative to wild-
type littermates (Fig. 3A-C). Trabecular thickness in the
conditional Cx43 ablated mice was likewise reduced by ~30%,
without differences in trabecular number (Fig. 3D,E). Mineral
apposition rate was reduced by ~17%, although not statistically
significantly, relative to wild-type and heterozygous equivalent
littermates (Fig. 3F). By contrast, there were no statistical
differences in osteoclast number among the different genotypes
(Fig. 3G). The apparent discrepancy in the degree of osteopenia
between DEXA and histomorphometric measurement is not
uncommon (Castro et al., 2004), and reflects both a lower
sensitivity of DEXA and different skeletal sites measured.
Delayed differentiation of Cx43-deficient osteoblasts
To gain further insights into the pathobiologic mechanism of
this osteopenic phenotype, we studied calvaria cells isolated
from genetically modified animals. Demonstrating osteoblast-
specific and differentiation-dependent Cx43 gene replacement,
X-gal staining was negative in ColCre;Cx43–/flcalvaria cells
upon reaching confluence, but it became progressively stronger
1 week post-confluence onward (Fig. 4A). Progressively
Journal of Cell Science
Connexin43 and PTH in vivo
Fig. 1. Cre-mediated Cx43 gene deletion in osteoblasts. (A) PCR of genomic DNA extracted from bone (b) or tail (t) tissue revealed the
presence of a 670-kb band corresponding to the Cx43-deleted allele selectively in the bone tissue extract. (B) Western blot of bone tissue
extracts from mice of the different genotypes showing barely detectable Cx43 immunoreactive bands in Western blots of ColCre;Cx43–/fltissue,
contrasting with strong expression of Cx43 protein in wild-type equivalent littermates, and lower but detectable expression in heterozygous
equivalent mice. (C) Quantitation of mRNA for Cre by real-time PCR, showing the presence of the transgene only in extracts of ColCre;Cx43–/fl
bone (one femur). (D) Whole mounts of newborn mice revealing strong X-gal stain in areas corresponding to mineralized skeleton of
ColCre;Cx43–/flmice, whereas only very faint stain was observed in Cx43–/flmice. (E) X-gal stained sections of the mid-shaft (upper left) and
metaphysis (lower left) of the tibia, and of one lumbar vertebra (right) of ColCre;Cx43–/flmice, showing blue stain in cells lining the bone
surface in both skeletal sites, but not in bone marrow cells. Non-stained surfaces correspond to areas where the cell layer was artifactually
detached from bone. F, female; M, male; Ob, osteoblasts; Ocy, osteocytes.
Fig. 2. Low bone mass phenotype in conditionally Cx43 deleted mice. (A) Whole mount of alizarin red and alcian blue staining of newborn
mice did not reveal any major skeletal abnormalities in ColCre;Cx43–/flmice compared with their control littermates. (B) Lower body weight in
ColCre;Cx43–/fl(n=46) relative to Cx43+/fl(n=69) and Cx43–/flgroups (n=42) at 6 months of age. (C) Whole-body BMD measured by DEXA
monitored in vivo revealed significantly lower bone mass in ColCre;Cx43–/flrelative to wild-type littermates (P<0.05, for genotype effect; two-
way ANOVA for repeated measures).
Journal of Cell Science
increased X-gal stain during osteoblast differentiation is
entirely consistent with the expression pattern of the promoter
used to drive Cre (Dacquin et al., 2002). Accordingly, barely
detectable Cx43 immunoreactive bands were detected in
lysates of conditionally deleted cells, with reduced abundance
of Cx43 in heterozygous equivalent cells (Fig. 4B). Likewise,
Cx43 mRNA abundance, assessed by real-time PCR, was
reduced by ~90% and ~50% in conditionally Cx43-deleted and
heterozygous equivalent calvaria cells after 3 weeks in culture
Development of alkaline phosphatase activity, a marker of
osteogenic differentiation, was significantly reduced in
calvarial cells derived from ColCre;Cx43–/flmice 2 weeks post-
confluence, when it usually reaches a peak, as it occurred in
the other two genotypes (Fig. 4D). Furthermore, after 2 weeks
in culture the abundance of mRNA transcripts for other
osteoblast-specific genes, namely osteocalcin, ?1(I) collagen,
osteopontin and Cbfa1/Runx2 was reduced by more than 50%,
measured by real-time PCR, relative to wild-type equivalent
cells (Fig. 4E). By contrast, neither Cx45 nor N-cadherin
mRNA were significantly different among the three genotypes
(Fig. 4E). Importantly, ColCre;Cx43–/flcalvaria cells were not
able to produce mineralized matrix until 3 weeks in culture,
whereas Cx43+/fland Cx43–/flcells were able to start
mineralization after 2 weeks (Fig. 4F,G). These in vitro data
strengthen the notion that Cx43 expression is necessary for full
elaboration of the osteoblast phenotype.
Attenuated bone anabolic response to intermittent PTH
in osteoblast Cx43-deficient mice
We next tested the ability of conditional Cx43-deficient mice to
respond to the anabolic stimulus provided by intermittent PTH
injections. In a first study, we tested 4 doses of PTH in 5- to 6-
month-old mice treated 5 days a week for 4 weeks. Because of
the lower bone mass in the conditionally deleted mice relative
to the other genotypes (Figs 2, 3), in these studies we monitored
whole-BMC rather than bone density, to assess the absolute
amount of bone gained in each group. In the wild-type equivalent
Cx43+/flgroup, PTH treatment induced rapid and dose-related
increments in whole-body BMC, with significant increases over
baseline at 4 weeks with all doses, except the lowest one.
Maximal increases were 13.1% and 13.4% in Cx43+/fland
Cx43–/flmice, respectively, with significant bone gain as early as
after 2 weeks of treatment (Fig. 5A,B). However, in the
conditionally Cx43-deleted ColCre;Cx43–/flmice, only two
doses of PTH resulted in statistically significant increments in
bone mass, and the maximal effect obtained (9.8%) was ~30%
lower than that observed in the other two genotypes (Fig. 5C).
Journal of Cell Science 119 (20)
Fig. 3. Histomorphometric characterization of osteopenia in conditionally osteoblast Cx43-deleted mice. (A) Trichrome Masson stain of 4 ?m
undecalcified sections of proximal tibiae from mice of the three different genotypes at 6 months. (B-G) Quantitative histomorphometry showing
significantly lower bone volume/total volume, osteoblast number and trabecular thickness in the ColCre;Cx43–/fl, with non-statistically different
trabecular number, mineral apposition rate and osteoclast number among the three genotype groups. *P<0.05 versus Cx43+/fl(one-way
ANOVA); n=6 per genotype group.
Journal of Cell Science
Connexin43 and PTH in vivo
However, taking into account the increase occurring in untreated
wild-type animals (4.8%), the difference in response amplitude
would be more than 40%.
Rather surprisingly, even in vehicle-treated groups we
detected a basal increase in BMC, presumably reflecting
continuous bone growth in these 5-6-month-old animals.
Because this may confound the extent of bone gain obtained
with PTH, we repeated a similar study in older mice (7.4- to
9.6-months-old), whose bone mass should be stable. In this
case, we used 40 ?g/kg PTH, a dose that induced maximal
effects in all genotypes in the younger animals. Again, 4-week
treatment with 40 ?g/kg PTH induced significant changes of
whole-body bone mass in Cx43+/fl(12.5±4.7% from baseline;
n=15) and Cx43–/fl(9.3±4.6%; n=11) mice, whereas the
anabolic effect of PTH was reduced by 47% in the
ColCre;Cx43–/flgroup (6.7±5.3%; n=10). The changes in bone
mass induced by PTH in the conditionally deleted animals
were just slightly higher but not statistically different than the
changes observed in a group of wild-type equivalent mice
treated with vehicle (3.4±3.9%; n=9) (Fig. 6A). Region-
specific analysis on BMC changes by DEXA also revealed that
PTH significantly increased bone mass (>12%) at the lumbar
spine only in the wild-type equivalent group, whereas no
changes occurred at this site in the conditionally Cx43-deleted
mice (Fig. 6B). Conversely, the anabolic effect of PTH on
femur BMC was not affected by genotype, exhibiting an
anabolic response of almost equal magnitude for each group
Attenuated stimulation of bone formation after PTH
treatment in osteoblast Cx43-deficient mice
Bone histomorphometric analysis was fully consistent with the
DEXA results. After a 4-week treatment with 40 ?g/kg PTH,
bone volume (BV)/total volume (TV) was increased almost
Fig. 4. Delayed differentiation of Cx43-deficient osteoblasts. (A) X-gal staining of post-confluent ColCre;Cx43–/flcalvaria cells grown in
mineralizing medium, showing blue staining becoming stronger with time in culture. (B) Western analysis demonstrated barely detectable
Cx43-specific bands in lysates of conditionally deleted cells, and reduced abundance of Cx43 in heterozygous equivalent cells. (C) Abundance
of Cx43 mRNA, assessed by real-time PCR, was reduced in ColCre;Cx43–/flcalvarial cells relative to wild-type equivalent cells after 3 weeks in
culture (n=3). (D) Development of alkaline phosphatase activity was significantly reduced in calvarial cells derived from ColCre;Cx43–/flmice 2
weeks post-confluence (n=4). (E) The abundance of mRNA transcripts for other osteoblast-specific genes was reduced by more than 50%, as
measured by real-time PCR, relative to wild-type equivalent cells (*P<0.05 versus Cx43+/fl; one-way ANOVA; n=3). (F) Representative results
of von Kossa stain of post-confluent calvaria cells and (G) quantitative data on three different preparations showing delayed in vitro matrix
mineralization by ColCre;Cx43–/flcalvaria cell cultures (*P<0.05 versus Cx43+/fl; Tukey test; n=3).
Journal of Cell Science
threefold in Cx43+/flmice compared with mice of the same
genotype treated with vehicle. A significant increase of lesser
magnitude was also observed in the heterozygous equivalent
group, Cx43–/fl, whereas BV/TV was not different in the
ColCre;Cx43–/flgroup relative to the vehicle-treated group
(Fig. 7A-D). Osteoblast number was increased in all genotypes
with no statistical differences among groups, even though this
parameter was ~30% lower in conditionally Cx43-deleted mice
relative to Cx43+/fllittermates (Fig. 7E). Conversely, other
static histomorphometric parameters of bone formation,
trabecular number and thickness were significantly increased
(~20 and ~40%, respectively) but not in
ColCre;Cx43–/flor Cx43–/flmice (Fig. 7F,G). Cortical thickness
was also highest in Cx43+/flmice, but the changes were not
statistically significant (Fig. 7H). By contrast, osteoclast
perimeter was higher in the Cx43–/fland ColCre;Cx43–/fl
groups, but even in this case the differences were not
statistically significant (Fig. 7I).
Dynamic histomorphometric parameters of bone formation
were assessed at two skeletal sites, to further investigate
differences in PTH responses at the spine and femur. Abundant
double-calcein labels were observed in wild-type mice after
PTH treatment at both the spine and at the endosteal surface
of the tibia. Double labelling was also present in the
heterozygous equivalent mice, whereas in the majority of
conditional knockout mice only single labels were detected
Journal of Cell Science 119 (20)
Fig. 5. Attenuated BMC response to PTH in osteoblast Cx43-deficient mice. Percent change from baseline of whole body BMC after a 4-week
treatment with different doses of teriparatide (PTH), showing a dose-related increase of bone mass in wild-type Cx43+/flmice (A). Effects of
lesser magnitude were observed in heterozygous equivalent Cx43–/flmice at the intermediate doses (B), whereas the effect of PTH treatment
was uniformly attenuated at all doses in ColCre;Cx43–/flmice (C). *P<0.05, **P<0.01 versus vehicle (one-way ANOVA); n=6-8 per each data
point. Data are mean ± s.e.m.; n=12 (vehicle) and 6-8 (PTH-treated groups).
Fig. 6. Region-specific changes in BMC in osteoblast Cx43-deficient mice. (A) Percent change from baseline of whole body BMC after a 4-
week treatment with 40 ?g/kg PTH in a group of 7.4-9.6-month-old mice, showing an attenuated response in conditionally deleted
ColCre;Cx43–/flmice (n=10) relative to wild-type animals (n=15), whereas response in Cx43–/flmice (n=11) was intermediate. (B) Response
was absent at the lumbar spine in both ColCre;Cx43–/fland heterozygous equivalent Cx43–/fl. (C) Significant increases in bone mass were
instead detected in all genotypes on the total femoral area. **P<0.01, *P<0.05 versus vehicle (n=9); #P<0.05 versus ColCre;Cx43–/fl; one-way
Journal of Cell Science
Connexin43 and PTH in vivo
(Fig. 8A,C). Consequently, mineral apposition rate (calculated
in the trabecular and endosteal surfaces) was significantly
lower in ColCre;Cx43–/flmice than in the Cx43+/flgroup in both
sites (Fig. 8B,D). However, periosteal mineral apposition rate
in the tibia was not significantly different among groups, even
though the average was lower in ColCre;Cx43–/flmice
(0.423±0.246 ?m/day) relative to Cx43+/fl(0.614±0.629
?m/day) and Cx43–/flmice (0.710±0.497 ?m/day), a result
very consistent with the cortical thickness data. Finally, 5-
bromo-2?-deoxy-uridine (BrdU)-positive cells were observed
on the bone surface in all genotypes after PTH treatment (Fig.
8E), and the osteoblast mitotic index was not different among
groups (Fig. 8F).
The present study demonstrates that selective deletion of Cx43
in osteoblasts leads to a marked decrease in peak bone mass
and osteopenia; it also severely attenuates the bone anabolic
response to intermittent administration of PTH. These
abnormalities are caused by a functional defect in bone-
forming cells, which fail to increase their activity in response
to the hormonal stimulus. Thus, functional Cx43 is required for
normal bone mass acquisition and maintenance and it is
involved in the mechanism of action of PTH-induced
An important role for Cx43 in bone homeostasis and for the
function of bone-forming cells was postulated by several in
vitro studies (Civitelli et al., 1993; Donahue et al., 2000;
Schiller et al., 2001a), and it was established by analysis of
mice with a germline null mutation of the Cx43 gene, which
exhibit delayed ossification of both endochondral and
differentiation (Lecanda et
malformations are not present in ColCre;Cx43–/flmice, most
likely because in these animals Cx43 is deleted at around birth
(Dacquin et al., 2002), and thus embryonic development would
be expected to be normal. However, the osteoblast defect is
reproduced in ColCre;Cx43–/flmice, a defect that leads to
significant osteopenia throughout
generalized osteopenia is also present in Gja1Jrt/+mice, which
carry a point mutation of the Cx43 gene (Flenniken et al.,
2005), and whose phenotype resembles that of human ODDD,
a rare autosomal dominant condition characterized by
craniofacial (ocular, nasal and dental) malformations, limb
dysmorphisms, spastic paraplegia and neurodegeneration
(Loddenkemper et al., 2002; Schrander-Stumpel et al., 1993).
Human ODDD has been linked to mutations of the Cx43 gene
(Kjaer et al., 2004; Paznekas et al., 2003; Richardson et al.,
2004), however both Cx43 null and Gja1Jrt/+mice exhibit
impaired skull ossification (Flenniken et al., 2005; Lecanda et
Fig. 7. Static bone histomorphometric analysis after a 4-week treatment with 40 ?g/kg PTH. (A-C) Trichrome Masson stain of the proximal
tibia showing less abundant trabecular bone mass in the conditional knockout (cKO) ColCre;Cx43–/flrelative to heterozygous equivalent (Het)
Cx43–/fland wild-type (WT) Cx43+/flmice. (D) Robust anabolic response occurred in the WT group, and an attenuated response was observed
in Het mice. By contrast, no significant increases in bone volume/total volume were detected in the conditionally deleted ColCre;Cx43–/flmice
relative to the other genotype groups. (E) Osteoblast number was significantly increased by PTH treatment in all groups. (F) Trabecular number
was significantly increased in the wild-type groups only. (G) The same result was observed for trabecular thickness. (H) No significant changes
were detected for cortical thickness. (I) Osteoclast number was not different among the different groups. *P<0.05 versus vehicle (ANOVA);
Journal of Cell Science
al., 2000), whereas osteosclerotic changes are described in
patients with ODDD (Paznekas et al., 2003; Schrander-
Stumpel et al., 1993). Such a discrepancy may be related to
species differences, or to mechanisms by which different
ODDD mutations affect connexin function. Nevertheless, there
is now evidence from different mouse genetic models
consistently demonstrating that interference with Cx43 in the
postnatal skeleton leads to a low bone mass phenotype.
As noted, the cellular bases of the phenotype observed in
conditionally Cx43-deleted mice suggest a defect in osteoblast
differentiation and function, previously observed in the
germline Cx43 null mutants (Lecanda et al., 2000), and very
likely present also in the Gja1Jrt/+mouse (Flenniken et al.,
2005). Accordingly, ColCre;Cx43–/fl
osteoblast number, modestly decreased mineral apposition
rate, delayed in vitro osteoblast differentiation, and profound
deficit in osteoblast-specific gene expression. These results
mice have a low
confirm that Cx43 is required for full osteoblast differentiation
and functional activity, although in vivo interference with gap
junctional communication between osteoblasts and other cells
on the bone microenvironment may also contribute to the
phenotype. Because the 2.3-kb fragment of the ?1(I) collagen
promoter we used to delete Cx43 is expressed in committed
osteoblasts (Dacquin et al., 2002), it is likely that the decreased
osteoblast number in bone of conditionally deleted mice
reflects a delayed differentiation rather than a decreased
recruitment of new osteoblasts, a conclusion also supported by
similar proliferation rates of bone cells in wild-type and deleted
mice. Of course, this conclusion does not exclude other
functions of Cx43 at earlier stages of osteoblast differentiation
as postulated by studies in the Gja1Jrt/+mouse (Flenniken et
Although low bone mass is present in both ColCre;Cx43–/fl
and Gja1Jrt/+(Flenniken et al., 2005) mutants, the molecular
Journal of Cell Science 119 (20)
Fig. 8. Dynamic bone histomorphometric analysis and osteoblast proliferation after a 4-week treatment with 40 ?g/kg PTH. (A) Fluorescent
micrographs (200?) of undecalcified sections of lumbar spine trabecular bone showing double calcein labels in both wild-type Cx43+/fl(WT)
and heterozygous equivalent Cx43–/fl(Het) mice, but only single labels in conditional knockout ColCre;Cx43–/fl(cKO) mice. (B) Mineral
apposition rate (MAR) in the lumbar spine was significantly lower in cKO ColCre;Cx43–/flmice than in either HT or WT Cx43+/flgroup (n=5-
6). (C) Calcein labeling and (D) mineral apposition rate in the endosteal surface of the tibia showing attenuated response to PTH in cKO mice
(n=5-6). (E) BrdU stain of endosteal tibial surface, showing positively stained cells equally in mice of all genotypes (n=3-4). (F) Osteoblast
mitotic index, expressed as percentage of BrdU-labeled cells per total number of cells on the bone surface. *P<0.05 versus Cx43+/fl, one-way
Journal of Cell Science
Connexin43 and PTH in vivo
mechanisms leading to osteopenia may be different. In the
Gja1Jrt/+mice the mutation is germline and acts as dominant
negative (Roscoe et al., 2005; Shibayama et al., 2005), whereas
in our model the mutation is recessive and it occurs only in
committed osteoblasts. Furthermore, osteoblasts also express
Cx45 (Civitelli et al., 1993) and although this connexin forms
gap junction channels of different biophysical properties than
those formed by Cx43 (Steinberg et al., 1994; Veenstra et al.,
1994), Cx45 might be sufficient to support some degree of gap
junctional communication in the absence of Cx43. This may
provide a partial compensatory mechanism for the lack of
Cx43, even though Cx45 expression is not upregulated in
conditionally deleted cells. By contrast, the Gja1Jrt/+variant
may interfere with both connexins, or other interacting
proteins, thus inhibiting the function of both Cx43 and Cx45
(Giepmans, 2004; Saez et al., 2003). These concepts are not at
odds with the established notion that Cx45 overexpression
reduces Cx43 function (Koval et al., 1995; Lecanda et al.,
1998), because while in a mixed Cx43/Cx45 environment the
biophysical properties of Cx45 prevail, in a Cx43 null
background, as it occurs in our mouse model, the presence of
Cx45 would allow a certain degree of cell-cell communication
that may partially compensate for lack of Cx43.
The consequences of osteoblast-specific ablation of Cx43
are more severe under the stimulatory action of intermittent
administration of PTH, reflected by the dramatic attenuation of
the anabolic effect of PTH in ColCre;Cx43–/fl
Interestingly, although responses of lesser magnitude were also
observed at intermediate doses of PTH in Cx43–/flmice, in
which the abundance of Cx43 in osteoblasts is reduced, the
highest dose of PTH used (80 ?g/kg) elicited a response
similar to wild-type mice. By contrast, effects on bone mass
that were maximal in wild-type and heterozygous equivalent
animals were never achieved in the conditionally deleted mice,
and no further gains were obtained with doses above 20 ?g/kg.
Thus, the gains in bone mass that can be induced by PTH are
minimal, though not totally absent, when osteoblasts are
deprived of Cx43 in vivo, a conclusion consistent with the
notion that the anabolic response to PTH requires functional
Cx43. Instead, reduced Cx43 abundance in Cx43–/flmice may
be sufficient to support some osteoblast functions but not
others. In particular, PTH upregulation of Cx43 expression
(Civitelli et al., 1998) is likely to be attenuated when Cx43 is
decreased, and this may contribute to attenuation of PTH
anabolic effect we have seen in Cx43–/flmice. Similar
observations have been made in the study of Cx43 function in
astroglia, where the Cx43flallele shows haploinsufficiency for
some phenotypical parameters but not for others (Theis et al.,
2003). We also observed skeletal site-specific differences in
Cx43 sensitivity to PTH anabolic effect in the conditionally
deleted animals by regional DEXA analysis. It is possible that
lack of Cx43 attenuates PTH response on trabecular bone to a
greater extent than it does on cortical bone, thus potentially
explaining the normal response in femur observed by DEXA
in conditionally Cx43-deleted mice. Envelope- or site-specific
effects of PTH have been reported, with more pronounced bone
mass increments observed in the trabecular than in the cortical
component (Calvi et al., 2001; Gunness-Hey and Hock, 1984;
Iida-klein et al., 2002).
The attenuated osteoanabolic response to PTH is the
consequence of a failure of Cx43-deficient bone-forming cells
to produce new bone under the hormonal stimulus, as
demonstrated by ~70% lower mineral apposition rate in
ColCre;Cx43–/flthan in wild-type mice after a 4-week
treatment with PTH, despite a significant increase in osteoblast
number. Considering that osteoblast number is decreased in
untreated ColCre;Cx43–/flmice, the results seem to indicate
that the hormone is still able to stimulate osteoblast recruitment
to the bone surface in conditional Cx43-deficient mice,
although these cells are obviously impaired in their ability to
synthesize new bone in response to PTH. Because Cx43
deletion occurs in cells that are already fully committed to the
osteogenic lineage, it is likely that some of PTH effects, for
example recruitment or proliferation of osteoprogenitors, occur
at a stage when Cx43 deletion has not yet taken place, or are
Cx43 independent. Although earlier studies indicated that
intermittent PTH administration activates existing bone lining
cells without affecting cell proliferation (Dobnig and Turner,
1995), an increase in bone marrow osteoprogenitor cells has
been reported in response to PTH in rats (Kostenuik et al.,
1999) and mice (Tanaka et al., 2004), and osteoblast number
is consistently increased in mice (Iida-klein et al., 2002; Knopp
et al., 2005). Furthermore, because osteoblast number was
increased and osteoblast proliferation was not altered in the
conditionally deleted animals, it is unlikely that our gene
manipulation may have affected the anti-apoptotic action of
PTH to a substantial degree (Jilka et al., 1999).
Although the molecular aspects of the interaction between
Cx43- and PTH-induced bone anabolism remain to be
elucidated, we had previously observed that PTH upregulates
Cx43 expression and function in osteoblasts (Civitelli et al.,
1998), and more recently, we demonstrated that interference
with Cx43 alters transcriptional regulation of specific gene
promoter elements, via MAP kinase- and protein kinase C-
dependent pathways (Stains et al., 2003; Stains and Civitelli,
2005b). Because PTH signal transduction involves both of
these pathways, it is possible that Cx43 is required to
appropriately integrate PTH-activated signals and/or to
equalize hormonal responses throughout the osteoblast
network (Stains and Civitelli, 2005a). Consistent with this
hypothesis, in preliminary results we find that interference with
Cx43 function reduces the capacity of osteoblastic cells to
increase osteocalcin gene transcription under stimulation by
PTH (De Marzo et al., 2005). It is worth mentioning that the
distribution of PTH receptors is not uniform throughout the
bone tissue, and even within cell lines, certain signal responses
are not homogeneous (Civitelli et al., 1992). The present results
have interesting ramifications for development of therapeutic
strategies for bone anabolism. The nature of the defect in
response to intermittent PTH in our animal model makes it
likely that similar attenuations of bone mass responses may
occur for other anabolic agents or stimuli, i.e. mechanical load,
because activation of bone-forming cell function is the ultimate
requirement for manufacturing new bone. It is also reasonable
to believe that the osteoanabolic response to PTH could be
enhanced by increasing gap junctional communication using
pharmacologic agents, thus allowing lesser doses or less
frequent parenteral administration of PTH. Furthermore, the
requirement of osteoblast/osteocyte Cx43 for the anti-apoptotic
action of bisphosphonates (Plotkin et al., 2005), which are also
widely used in the therapy of osteoporosis, can now be tested
Journal of Cell Science
In summary, we have demonstrated that selective Cx43 gene
deletion in osteoblasts results in adult osteopenia, delayed
osteoblast differentiation, and greatly attenuated osteoanabolic
response to PTH, the consequence of a failure of Cx43-
deficient bone-forming cells to mount a full response to the
hormone. Cx43-mediated gap junctional communication
represents a potential target for modulation of bone anabolic
Materials and Methods
Development of the mouse model used in these studies has already been reported
in some detail (Castro et al., 2003). Briefly, a mouse strain harboring a mutant
‘floxed’ Cx43 allele (Cx43fl) (Theis et al., 2001) was mated to mice expressing Cre
under control of a 2.3 kb ?1(I) collagen promoter fragment (abbreviated as ColCre)
(Dacquin et al., 2002), so that Cre-mediated recombination replaces the entire Cx43
reading frame with the lacZ reporter cassette. Homozygous Cx43fl/flmice were
generated first and crossed with ColCre mice also carrying a Cx43 null allele
(ColCre;Cx43+/–). This strategy avoids potential effects of activation of Cre in the
parental germ line. These crosses generate, in approximately equal numbers, the
Cx43 conditionally deleted mice, ColCre;Cx43–/fl, as well as three additional
genotypes, Cx43+/fl(wild-type equivalent), Cx43–/fl(heterozygous equivalent), and
ColCre;Cx43+/fl(conditional heterozygous). All the mouse lines used in this project
were developed in a mixed C57BL/6-C129/J background and littermate were used
as controls. Mice were fed regular chow ad libitum and housed in a room maintained
at constant temperature (25°C) on a 12 hours of light and 12 hours of dark schedule.
Genotyping was performed by PCR on genomic DNA extracted from mouse tails,
after digestion with proteinase K, as described (Lecanda et al., 2000). The Cx43
null allele was detected using primers Cx43-5?: 5? GGT CAA CGT GGA GAT GCA
CCT GAA GCA GAT 3?; Cx43-3?: 5? AAT CGA TTG GCA GCT TGA TGT TCA
AGC C 3? and Neor-5?: 5?GGA TCG GCC ATT GAA CAA GAT GGA TTG CAC
3?. Primers Cx43-5? and Cx43-3? amplify a 900-bp product within the Cx43 coding
region. Primer Neor-5? hybridizes to the neomycin resistance cassette present only
in the null allele, and when used with primer Cx43-3?, it amplifies a 1.4-kb band,
spanning the Neo cassette and part of the adjacent Cx43 gene (Houghton et al.,
1999). PCR was performed in a final volume of 25 ?L reaction; 2 mM MgCl2, 1?
PCR buffer, 0.08 mM of each dATP, dCTP, dGTP, dTTP, 1 ?M primers, 2.5 U Taq
DNA polymerase, 1-5 ?g genomic DNA. The DNA was denatured at 94°C for 3
minutes and amplified for 35 cycles (94°C for 30 seconds, 70°C for 45 seconds and
72°C for 120 seconds) followed by a final extension at 70°C for 20 minutes.
Primers UMP (5? TCA TGC CCG GCA CAA GTG AGA C 3?) and UMPR (5?
TCA CCC CAA GCT GAC TCA ACC G 3?) were used for the simultaneous
detection of the ‘floxed’ (Cx43fl) and wild-type (Cx43+) alleles, as described (Theis
et al., 2001). These primers generate a 1 kb amplicon corresponding to the Cx43fl
allele, and a 900 bp band, corresponding to the wild-type allele. In some
experiments, the deleted Cx43 allele was directly identified in whole bone extracts,
after homogenization and phenol/chloroform extraction. This was accomplished
using primers Cx43delforw (5? GGC ATA CAG ACC CTT GGA CTC C 3?) and
Cx43delrev (5? TGC GGG CCT CTT CGC TAT TAC G 3?), which encompass the
junction between the Cx43 gene intron and the ?-galactosidase coding region, thus
generating a 670 bp amplicon, corresponding to the Cx43-deleted allele (Theis et
al., 2001). The ColCre transgene was detected by using the primers Cre 1123-1104:
5?-AAG TGC CTT CTC TAC ACC TG-3?, Cre 982-1002: 5?-TGC TTA TAA CAC
CCT GTT ACG-3?, MS1: 5?-GCT CAG CAA GCT CAC AGC AA-3?, and LM6:
5?-GAG CTT ACA CAT TTC GTC-3?. These primers generate 141 bp Cre-specific
amplicon and a 448 bp Cre-negative amplicon.
A total of 157 mice were used for basal phenotypic characterization. For the PTH
studies, 90 (45 males and 45 females) 5- to 6-month-old animals of three genotypes,
Cx43+/fl, Cx43–/fland ColCre;Cx43–/fl, were subcutaneously injected (5 days a week
for 4 weeks) with either vehicle (0.9% saline containing 0.1% BSA and 0.001N
HCl; n=12) or human recombinant PTH (1-34) (Teriparatide®, Eli-Lilly,
Indianapolis, IN) at doses of 10 ?g/kg (n=19), 20 ?g/kg (n=18), 40 ?g/kg (n=18),
and 80 (n=23) ?g/kg of body weight. Mice were weighed on the second week of
treatment, and the amount of PTH injected was adjusted for any change in weight.
A second group of older mice (7.4- to 9.6-month-old; n=45) was also treated with
40 ?g/kg PTH with the same modalities as just detailed.
Whole-body mounts and X-gal staining
After sacrifice, newborn mice were skinned, eviscerated and maintained for 24 hours
in ethanol 100%. After fixation in acetone for 24 hours, the carcasses were stained
in a solution containing alizarin red 0.1%, alcian blue 0.3%, acetic acid and 70%
ethanol (1:1:1:17). They were then transferred to a 1% KOH solution in 20%
glycerol until they were cleared and then stored in glycerol for analysis of cartilage
and bone, as described (Lecanda et al., 2000; McLeod, 1980). For whole-mount X-
gal staining, carcasses of newborn mice were fixed for 2 hours in 2% formaldehyde,
0.02% paraformaldehyde, 5 mM EGTA, 0.1 mM MgCl2and 0.1 M NaPO4, pH 7.3,
then washed in a solution containing NP-40 and stained for 3 hours in X-gal
substrate (5-bromo-4-chloro-3-indolyl-D-galactopyranoside) 1 mg/ml, as described
(Frendo et al., 1998). They were then transferred to a 1% KOH solution in 20%
glycerol until they were cleared and then stored in glycerol. For X-gal staining of
bone sections, tibiae or lumbar spine were fixed in 2% paraformaldehyde and 0.02%
glutaraldehyde for 1 hour, and then decalcified in 4% EDTA for 17 days. Decalcified
bones were incubated in 0.1% (v/v) X-gal substrate (see above) for 12 hours, post-
fixed in 4% paraformaldehyde and embedded for paraffin sectioning (Hens et al.,
2005). Sections were counterstained with eosin.
Bone mineral density (BMD) measurements
Total body BMC and BMD were monitored by DEXA using a PIXImus scanner
(GE/Lunar, Madison, WI), under anesthesia with 100 mg/kg ketamine and 10 mg/kg
xylazine i.p., as described (Castro et al., 2004). Heads were excluded from the
analysis by masking. Region-specific BMD was also measured at the spine and
femur, by identifying regions of interest corresponding to the L1-L6 area or the
entire femur, respectively. In the latter case, animals were positioned with the femur
at a 45° angle with the tibia, and values for both femurs averaged. Calibration was
performed daily with a standard phantom as suggested by the manufacturer. The
precision of whole-body BMD, assessed by the root mean square method is 1.34%
(coefficient of variation) (Castro et al., 2004).
Mice were labeled twice by injection of calcein (15 mg/kg i.p., Sigma-Aldrich) on
days 7 and 2 before euthanasia, and bone samples were prepared according to
previously described methods, with some modifications (Castro et al., 2004).
Briefly, dissected tibiae or lumbar spine were fixed in 70% ethanol and either
decalcified in 14% EDTA for 14 days and embedded in paraffin, or left undecalcified
and embedded in methyl methacrylate. Plastic sections were stained using the
Masson trichrome technique, and tartrate-resistant acid phosphatase activity stain
was used for paraffin sections, which were counterstained with methyl green and
thionin for identification of osteoclasts and osteoblasts (Liu and Kalu, 1990). Eight
?m sections were left unstained for dynamic bone histomorphometry. Quantitative
histomorphometry was performed in an area 175-875 ?m distal to the growth plate
using the OsteoMeasure software program (Osteometrix, Atlanta, GA) in an
epifluorescence microscopic system, as detailed elsewhere (Castro et al., 2004). The
following parameters of bone remodeling were estimated (Parfitt et al., 1987):
trabecular bone volume as a percentage of total tissue volume, trabecular thickness
(in ?m), trabecular number (per ?m), trabecular separation (in ?m), osteoblast
perimeter per bone perimeter (in percent) or osteoblast number per trabecular area
(in number/mm2), osteoclast perimeter per bone perimeter (in percent), and mineral
apposition rate (in ?m/day), calculated as the mean distance between two
fluorescent labels divided by the number of days between the labels.
Cell culture and phenotypic characterization
Osteoblast-enriched calvaria cultures were prepared from newborn mice by
sequential collagenase digestion as described (Castro et al., 2004; Lecanda et al.,
2000), and grown in ?-modified essential medium (?MEM; Mediatech, Herndon,
VA), supplemented with 10% fetal bovine serum (FBS; Atlanta Biologicals,
Norcross, GA) and 100 IU/ml penicillin and 100 ?g/ml streptomycin (Sigma
Chemicals, St Louis, MO). Approximately 3-5 calvariae were pooled to prepare the
cell cultures used in each experiment. Cx43 gene deletion was assessed in
differentiating osteoblasts by ?-galactosidase activity after fixation in 2%
paraformaldehyde, and incubation in a solution containing 1 mg/ml X-gal substrate
(see above), as described (Castro et al., 2003). Osteogenic differentiation was
assessed by monitoring alkaline phosphatase activity and in vitro mineralization by
von Kossa staining in the presence of 50 ?g/ml ascorbic acid and 10 mM ?-
glycerophosphate, using standard techniques (Castro et al., 2004; Lecanda et al.,
2000; Shin et al., 2000). Enzymatic activity was normalized for total protein content
(Bio-Rad protein assay kit) and expressed as nmol of p-nitrophenol produced from
p-nitrophenyl phosphate per minute per mg of protein. Mineralization was
quantitated by calculating the surface area covered by dark stain per well, using
digital image-processing software (IPLab v.3.5; Scanalytics, Rockville, MD), as
previously described (Lecanda et al., 2000).
In vivo cell proliferation was assessed by BrdU incorporation, determined by
immunoassay, according to the manufacturer’s instructions (5-Bromo-2?-deoxy-
uridine labeling and detection Kit III, Roche Molecular Biochemicals). For in vivo
labeling, 100 ?g BrdU (Sigma, St Louis, MO, USA) per gram of body weight in
PBS was injected i.p. 2 hours before sacrifice. Longitudinal, 5 ?m sections of
paraffin-embedded tibiae, prepared as described above, were rehydrated and
incubated for 10 minutes with 30% H2O2in absolute methanol (1:9) and processed
in denaturing and blocking solutions following the manufacturer’s protocol. BrdU
incorporated into nuclei was detected by immunostaining (Zymed Laboratories,
Journal of Cell Science 119 (20)
Journal of Cell Science
Connexin43 and PTH in vivo
South San Francisco, CA). Slides were counterstained with hematoxylin and high-
power field images of the cancellous bone were examined by optical microscopy.
All BrdU-positive (dark-brown) nuclei in the secondary spongiosa were counted.
The percentage of BrdU-positive nuclei versus total nuclei was calculated as mitotic
For whole cell lysates, calvaria cells were grown on 100 cm2Petri dishes and were
extracted in a buffer containing 50 mM Tris-HCl, pH 7.4, 150 mM NaCl, 20 mM
EDTA, 1% Triton X-100, 1% sodium deoxycholate, 0.1% SDS and protease
inhibitors. For whole bone extracts, one femur was homogenized in TRIzol (Gibco)
and incubated for 5 minutes at room temperature. After precipitation of DNA with
ethanol, proteins were extracted from the phenol-ethanol supernatant by adding 1.5
ml of isopropanol per 1 ml of TRIzol reagent. The protein pellet was washed three
times in 0.3 M guanidine hydrochloride in 95% ethanol, and dissolved in 1% SDS.
Proteins were separated by SDS-PAGE and transferred onto nitrocellulose
membranes (Invitrogen, Carlsbad, CA). Western blots were processed at room
temperature as described (Castro et al., 2003; Lecanda et al., 2000) using an anti-
Cx43 antibody (Sigma, St Louis, MO) at 1:8000 dilution or anti-GAPDH antibody,
and visualized by enhanced chemiluminescence (ECL) detection.
As already reported (Stains et al., 2003; Stains and Civitelli, 2005b), confluent
calvaria cells or bone tissue were extracted using TRIzol (Gibco) and total RNA (1
?g) was reverse transcribed using Superscript II reverse transcriptase and
oligo(dT)15primers. Real-time PCR analysis was performed using the SYBR green
PCR method according to manufacturer’s instruction (PE Biosystems, Foster City,
CA). The primers used in this study have all been reported (Mbalaviele et al., 2005;
Stains et al., 2003). GAPDH (PE Biosystems) was used as internal control. The
cycle number at which the fluorescence exceeded the threshold of detection (CT)
for GAPDH was subtracted from that of the target gene product for each well (?CT).
Transcription levels relative to Cx43+/flcontrols was defined as (2–??CT), where
??CT equals the genotype ?CT minus the ?CT of Cx43+/flcells. All real-time PCR
experiments were performed at least three times.
Group means were analyzed by ANOVA after establishing normal distribution of
data and homogeneity of variances. Where significant overall differences were
observed by one-way ANOVA, the Tukey Kramer test or other post-hoc analyses
were applied for multiple group comparisons. For repeated measures (PTH studies),
a two-way ANOVA was applied, keeping treatment or genotype and time as
independent variables. Analyses were performed using SPSS v.12.0.0 (SPSS,
Chicago, IL), with the level of significance for comparison set at P<0.05. All data
are expressed as the mean ± s.d. (unless otherwise indicated).
Supported by NIH grant R01 AR041255 (R.C.) and by funds from
Barnes-Jewish Hospital Foundation (R.C.). Work in Bonn was
supported by grants of the German Research Association (SFB
400/E3 and Wi270/22-3.4) and the Funds of the Chemical Industry
(to K.W.). D.J.C. was partially supported by a grant from the Sung-
Am Cultural Foundation. C.H.M.C. was a post-doctoral Fellow of
CAPES Foundation, Ministry of Education, Brazil. M.T. received a
stipend of the Graduierten Kolleg: Pathogenese von Krankheiten des
Nervensystems. Part of this work has been presented at the 2005
International Gap Junction Conference, Whistler, BC, Canada, 13-18
August 2005, and at the 27th annual meeting of the American Society
for Bone and Mineral Research, Nashville, TN, 23-27 September
Calvi, L. M., Sims, N. A., Hunzelman, J. L., Knight, M. C., Giovannetti, A., Saxton,
J. M., Kronenberg, H. M., Baron, R. and Schipani, E. (2001). Activated parathyroid
hormone/parathyroid hormone-related protein receptor in osteoblastic cells
differentially affects cortical and trabecular bone. J. Clin. Invest. 107, 277-286.
Castro, C. H., Stains, J. P., Sheikh, S., Szejnfeld, V. L., Willecke, K., Theis, M. and
Civitelli, R. (2003). Development of mice with osteoblast-specific connexin43 gene
deletion. Cell Commun. Adhes. 10, 445-450.
Castro, C. H., Shin, C. S., Stains, J. P., Cheng, S. L., Sheikh, S., Mbalaviele, G.,
Szejnfeld, V. L. and Civitelli, R. (2004). Targeted expression of a dominant-negative
N-cadherin in vivo delays peak bone mass and increases adipogenesis. J. Cell Sci. 117,
Cheng, B., Zhao, S., Luo, J., Sprague, E., Bonewald, L. F. and Jiang, J. X. (2001).
Expression of functional gap junctions and regulation by fluid flow in osteocyte-like
MLO-Y4 cells. J. Bone Miner. Res. 16, 249-259.
Cherian, P. P., Siller-Jackson, A. J., Gu, S., Wang, X., Bonewald, L. F., Sprague, E.
and Jiang, J. X. (2005). Mechanical strain opens connexin 43 hemichannels in
osteocytes: a novel mechanism for the release of prostaglandin. Mol. Biol. Cell 16,
Civitelli, R., Fujimori, A., Bernier, S., Warlow, P. M., Goltzman, D., Hruska, K. A.
and Avioli, L. V. (1992). Heterogeneous [Ca2+]iresponse to parathyroid hormone
correlates with morphology and receptor distribution in osteoblastic cells.
Endocrinology 130, 2392-2400.
Civitelli, R., Beyer, E. C., Warlow, P. M., Robertson, A. J., Geist, S. T. and Steinberg,
T. H. (1993). Connexin43 mediates direct intercellular communication in human
osteoblastic cell networks. J. Clin. Invest. 91, 1888-1896.
Civitelli, R., Ziambaras, K., Warlow, P. M., Lecanda, F., Nelson Harley, J., Atal, N.,
Beyer, E. C. and Steinberg, T. H. (1998). Regulation of connexin43 expression and
function by prostaglandin E2 (PGE2) and parathyroid hormone (PTH) in osteoblastic
cells. J. Cell. Biochem. 68, 8-21.
Dacquin, R., Starbuck, M., Schinke, T. and Karsenty, G. (2002). Mouse alpha1(I)-
collagen promoter is the best known promoter to drive efficient Cre recombinase
expression in osteoblast. Dev. Dyn. 224, 245-251.
De Marzo, A., Stains, J. P. and Civitelli, R. (2005). Interference with connexin43
function attenuates parathyroid hormone regulation of the rat osteocalcin promoter. J.
Bone Miner. Res. 20, S430.
Dobnig, H. and Turner, R. T. (1995). Evidence that intermittent treatment with
parathyroid hormone increases bone formation in adult rats by activation of bone lining
cells. Endocrinology 136, 3632-3638.
Donahue, H. J., McLeod, K. J., Rubin, C. T., Andersen, J., Grine, E. A., Hertzberg,
E. L. and Brink, P. R. (1995). Cell-to-cell communication in osteoblastic networks:
Cell line-dependent hormonal regulation of gap junction function. J. Bone Miner. Res.
Donahue, H. J., Li, Z., Zhou, Z. and Yellowley, C. E. (2000). Differentiation of human
fetal osteoblastic cells and gap junctional intercellular communication. Am. J. Physiol.
Cell Physiol. 278, C315-C322.
Flenniken, A. M., Osborne, L. R., Anderson, N., Ciliberti, N., Fleming, C., Gittens,
J. E., Gong, X. Q., Kelsey, L. B., Lounsbury, C., Moreno, L. et al. (2005). A Gja1
missense mutation in a mouse model of oculodentodigital dysplasia. Development 132,
Frendo, J. L., Xiao, G., Fuchs, S., Franceschi, R. T., Karsenty, G. and Ducy, P. (1998).
Functional hierarchy between two OSE2 elements in the control of osteocalcin gene
expression in vivo. J. Biol. Chem. 273, 30509-30516.
Giepmans, B. N. (2004). Gap junctions and connexin-interacting proteins. Cardiovasc.
Res. 62, 233-245.
Gunness-Hey, M. and Hock, J. M. (1984). Increased trabecular bone mass in rats
treated with human synthetic parathyroid hormone. Metab. Bone Dis. Relat. Res. 5,
Hens, J. R., Wilson, K. M., Dann, P., Chen, X., Horowitz, M. C. and Wysolmerski,
J. J. (2005). TOPGAL mice show that the canonical Wnt signaling pathway is active
during bone development and growth and is activated by mechanical loading in vitro.
J. Bone Miner. Res. 20, 1103-1113.
Houghton, F. D., Thonnissen, E., Kidder, G. M., Naus, C. C., Willecke, K. and
Winterhager, E. (1999). Doubly mutant mice, deficient in connexin32 and -43, show
normal prenatal development of organs where the two gap junction proteins are
expressed in the same cells. Dev. Genet. 24, 5-12.
Iida-klein, A., Zhou, H., Lu, S. S., Levine, L. R., Ducayen-Knowles, M., Dempster,
D. W., Nieves, J. and Lindsay, R. (2002). Anabolic action of parathyroid hormone is
skeletal site specific at the tissue and cellular levels in mice. J. Bone Miner. Res. 17,
Jilka, R. L., Weinstein, R. S., Bellido, T., Roberson, P., Parfitt, A. M. and Manolagas,
S. C. (1999). Increased bone formation by prevention of osteoblast apoptosis with
parathyroid hormone. J. Clin. Invest. 104, 439-446.
Jørgensen, N. R., Henriksen, Z., Brot, C., Eriksen, E. F., Sorensen, O. H.,
Civitelli, R. and Steinberg, T. H. (2000). Human osteoblastic cells propagate
intercellular calcium signals by two different mechanisms. J. Bone Miner. Res. 15,
Kim, J. E., Nakashima, K. and De Crombrugghe, B. (2004). Transgenic mice
expressing a ligand-inducible cre recombinase in osteoblasts and odontoblasts: a new
tool to examine physiology and disease of postnatal bone and tooth. Am. J. Pathol. 165,
Kjaer, K. W., Hansen, L., Eiberg, H., Leicht, P., Opitz, J. M. and Tommerup, N.
(2004). Novel Connexin 43 (GJA1) mutation causes oculo-dento-digital dysplasia with
curly hair. Am. J. Med. Genet. A 127, 152-157.
Knopp, E., Troiano, N., Bouxsein, M., Sun, B. H., Lostritto, K., Gundberg, C.,
Dziura, J. and Insogna, K. (2005). The effect of aging on the skeletal response to
intermittent treatment with parathyroid hormone. Endocrinology 146, 1983-1990.
Kostenuik, P. J., Harris, J., Halloran, B. P., Turner, R. T., Morey-Holton, E. R. and
Bikle, D. D. (1999). Skeletal unloading causes resistance of osteoprogenitor cells to
parathyroid hormone and to insulin-like growth factor-I. J. Bone Miner. Res. 14, 21-
Koval, M., Geist, S. T., Westphale, E. M., Kemendy, A. E., Civitelli, R., Beyer, E. C.
and Steinberg, T. H. (1995). Transfected connexin45 alters gap junction permeability
in cells expressing endogenous connexin43. J. Cell Biol. 130, 987-995.
Lecanda, F., Towler, D. A., Ziambaras, K., Cheng, S.-L., Koval, M., Steinberg, T. H.
and Civitelli, R. (1998). Gap junctional communication modulates gene expression in
osteoblastic cells. Mol. Biol. Cell 9, 2249-2258.
Lecanda, F., Warlow, P. M., Sheikh, S., Furlan, F., Steinberg, T. H. and Civitelli, R.
(2000). Connexin43 deficiency causes delayed ossification, craniofacial abnormalities,
and osteoblast dysfunction. J. Cell Biol. 151, 931-944.
Journal of Cell Science
4198 Download full-text
Liu, C. C. and Kalu, D. N. (1990). Human parathyroid hormone-(1-34) prevents bone
loss and augments bone formation in sexually mature ovariectomized rats. J. Bone
Miner. Res. 5, 973-982.
Loddenkemper, T., Grote, K., Evers, S., Oelerich, M. and Stogbauer, F. (2002).
Neurological manifestations of the oculodentodigital dysplasia syndrome. J. Neurol.
Mbalaviele, G., Sheikh, S., Stains, J. P., Salazar, V. S., Cheng, S. L., Chen, D. and
Civitelli, R. (2005). ?-catenin and BMP-2 synergize to promote osteoblast
differentiation and new bone formation. J. Cell Biochem. 94, 403-418.
McLeod, M. J. (1980). Differential staining of cartilage and bone: Whole mount fetuses
by alcian blue and alizarin red S. Teratology 22, 299-301.
Nagy, A. (2000). Cre recombinase: the universal reagent for genome tailoring. Genesis
Neer, R. M., Arnaud, C. D., Zanchetta, J. R., Prince, R., Gaich, G. A., Reginster,
J. Y., Hodsman, A. B., Eriksen, E. F., Ish-Shalom, S., Genant, H. K. et al.
(2001). Effect of parathyroid hormone (1-34) on fractures and bone mineral
density in postmenopausal women with osteoporosis. N. Engl. J. Med. 344, 1434-
Parfitt, A. M., Drezner, M. K., Glorieux, F. H., Kanis, J. A., Malluche, H., Meunier,
P. J., Ott, S. M. and Recker, R. R. (1987). Bone histomorphometry: standardization
of nomenclature, symbols, and units. Report of the ASBMR Histomorphometry
Nomenclature Committee. J. Bone Miner. Res. 2, 595-610.
Paznekas, W. A., Boyadjiev, S. A., Shapiro, R. E., Daniels, O., Wollnik, B., Keegan,
C. E., Innis, J. W., Dinulos, M. B., Christian, C., Hannibal, M. C. et al. (2003).
Connexin 43 (GJA1) mutations cause the pleiotropic phenotype of oculodentodigital
dysplasia. Am. J. Hum. Genet. 72, 408-418.
Plotkin, L. I., Aguirre, J. I., Kousteni, S., Manolagas, S. C. and Bellido, T. (2005).
Bisphosphonates and estrogens inhibit osteocyte apoptosis via distinct molecular
mechanisms downstream of extracellular signal-regulated kinase activation. J. Biol.
Chem. 280, 7317-7325.
Reaume, A. G., De Sousa, P. A., Kulkarmi, S., Langille, B. L., Zhu, D., Davies, T. C.,
Juneja, S. C., Kidder, G. M. and Rossant, J. (1995). Cardiac malformation in
neonatal mice lacking connexin43. Science 267, 1831-1834.
Richardson, R., Donnai, D., Meire, F. and Dixon, M. J. (2004). Expression of Gja1
correlates with the phenotype observed in oculodentodigital syndrome/type III
syndactyly. J. Med. Genet. 41, 60-67.
Roscoe, W., Veitch, G. I., Gong, X. Q., Pellegrino, E., Bai, D., McLachlan, E., Shao,
Q., Kidder, G. M. and Laird, D. W. (2005). Oculodentodigital dysplasia-causing
connexin43 mutants are non-functional and exhibit dominant effects on wild-type
connexin43. J. Biol. Chem. 280, 11458-11466.
Saez, J. C., Berthoud, V. M., Branes, M. C., Martinez, A. D. and Beyer, E. C. (2003).
Plasma membrane channels formed by connexins: their regulation and functions.
Physiol. Rev. 83, 1359-1400.
Saunders, M. M., You, J., Trosko, J. E., Yamasaki, H., Li, Z., Donahue, H. J. and
Jacobs, C. R. (2001). Gap junctions and fluid flow response in MC3T3-E1 cells. Am.
J. Physiol. Cell Physiol. 281, C1917-C1925.
Schiller, P. C., D’Ippolito, G., Balkan, W., Roos, B. A. and Howard, G. A. (2001a).
Gap-junctional communication is required for the maturation process of osteoblastic
cells in culture. Bone 28, 362-369.
Schiller, P. C., D’Ippolito, G., Balkan, W., Roos, B. A. and Howard, G. A. (2001b).
Gap-junctional communication mediates parathyroid hormone stimulation of
mineralization in osteoblastic cultures. Bone 28, 38-44.
Schiller, P. C., D’Ippolito, G., Brambilla, R., Roos, B. A. and Howard, G. A. (2001c).
Inhibition of gap-junctional communication induces the trans-differentiation of
osteoblasts to an adipocytic phenotype in vitro. J. Biol. Chem. 276, 14133-14138.
Schrander-Stumpel, C. T., Groot-Wijnands, J. B., Die-Smulders, C. and Fryns, J. P.
(1993). Type III syndactyly and oculodentodigital dysplasia: a clinical spectrum. Genet.
Couns. 4, 271-276.
Shibayama, J., Paznekas, W., Seki, A., Taffet, S., Jabs, E. W., Delmar, M. and Musa,
H. (2005). Functional characterization of connexin43 mutations found in patients with
oculodentodigital dysplasia. Circ. Res. 96, e83-e91.
Shin, C. S., Lecanda, F., Sheikh, S., Weitzmann, L., Cheng, S. L. and Civitelli, R.
(2000). Relative abundance of different cadherins defines differentiation of
mesenchymal precursors into osteogenic, myogenic, or adipogenic pathways. J. Cell.
Biochem. 78, 566-577.
Stains, J. P. and Civitelli, R. (2005a). Cell-cell interactions in regulating osteogenesis
and osteoblast function. Birth Defects Res. C Embryo Today 75, 72-80.
Stains, J. P. and Civitelli, R. (2005b). Gap junctions regulate extracellular signal-
regulated kinase signaling to affect gene transcription. Mol. Biol. Cell 16, 64-72.
Stains, J. P., Lecanda, F., Screen, J., Towler, D. A. and Civitelli, R. (2003). Gap
junctional communication modulates gene transcription by altering the recruitment of
Sp1 and Sp3 to connexin-response elements in osteoblast promoters. J. Biol. Chem.
Steinberg, T. H., Civitelli, R., Geist, S. T., Robertson, A. J., Hick, E., Veenstra, R. D.,
Wang, H.-Z., Warlow, P. M., Westphale, E. M., Laing, J. G. et al. (1994).
Connexin43 and connexin45 form gap junctions with different molecular
permeabilities in osteoblastic cells. EMBO J. 13, 744-750.
Tanaka, S., Sakai, A., Tanaka, M., Otomo, H., Okimoto, N., Sakata, T. and
Nakamura, T. (2004). Skeletal unloading alleviates the anabolic action of intermittent
PTH(1-34) in mouse tibia in association with inhibition of PTH-induced increase in c-
fos mRNA in bone marrow cells. J. Bone Miner. Res. 19, 1813-1820.
Theis, M., de Wit, C., Schlaeger, T. M., Eckardt, D., Kruger, O., Doring, B., Risau,
W., Deutsch, U., Pohl, U. and Willecke, K. (2001). Endothelium-specific replacement
of the connexin43 coding region by a lacZ reporter gene. Genesis 29, 1-13.
Theis, M., Jauch, R., Zhuo, L., Speidel, D., Wallraff, A., Doring, B., Frisch, C., Sohl,
G., Teubner, B., Euwens, C. et al. (2003). Accelerated hippocampal spreading
depression and enhanced locomotory activity in mice with astrocyte-directed
inactivation of connexin43. J. Neurosci. 23, 766-776.
Van der Molen, M. A., Rubin, C. T., McLeod, K. J., McCauley, L. K. and Donahue,
H. J. (1996). Gap junctional intercellular communication contributes to hormonal
responsiveness in osteoblastic networks. J. Biol. Chem. 271, 12165-12171.
Veenstra, R. D., Wang, H.-Z., Beyer, E. C. and Brink, P. R. (1994). Selective dye and
ionic permeability of gap junction channels formed by connexin45. Circ. Res. 75, 483-
Journal of Cell Science 119 (20)
Journal of Cell Science