Pseudoxanthoma Elasticum (PXE) is a rare disease caused by loss of function of the gene Abcc6 and characterized by ectopic calcification of multiple tissues, but the physiological reasons underlying ectopic calcification in PXE remain unclear. In a murine model of Abcc6 deficient PXE where animals develop robust cardiac calcification after heart injury, we show the critical importance of the liver in mediating ectopic cardiac calcification. Tissue-specific deletion of Abcc6 in the liver, but not in the heart was sufficient to cause post-injury cardiac calcification. Metabolomics and gene expression demonstrated deficiencies in nucleotide metabolism, cellular energetics and defects in cellular respiration, underlying ectopic calcification in PXE. Functional abnormalities in cellular respiration in the injured heart were similar in globally or liver-specific Abcc6-deficient animals demonstrating that hepatic Abcc6 expression regulates cellular respiration in the injured heart. We show that ectopic calcification in PXE is primarily dystrophic and treatment with clodronate or etidronate, that prevent the growth of calcium hydroxyapatite mineralization, was sufficient to rescue the phenotype of ectopic cardiac calcification in Abcc6-deficient states. Taken together, these observations highlight the role of the liver in regulating target tissue metabolic and mitochondrial function in causing ectopic calcification in Abcc6-deficient states.
Wang et al. (2026) studied this question.