Effect of Arginine Infusion on Ghrelin Secretion in Growth Hormone Sufficient and GH Deficient Children

BACKGROUND

The physiological link between ghrelin and growth hormone (GH) has not yet been fully clarified. Furthermore, the existence of a negative feedback mechanism between growth hormone-insulin-like growth factor (GH-IGF)-I axis and ghrelin and the influence of amino acids on ghrelin secretion in children remain matters of debate.

OBJECTIVES

To understand the regulation of ghrelin secretion and clarify the relationship between ghrelin and GH secretion in GH-deficient (GHD) and GH-sufficient (GHS) children.

PATIENTS AND METHODS

Ten GHD (male/female [M/F], 6/4; age [mean ± SEM], 10.7 ± 0.9 years) and 10 GHS prepubertal children (M/F, 6/4; age [mean ± SEM], 10.3 ± 0.6 years), underwent an arginine (ARG) test (infusion, 0.5 g/kg, iv). Levels of GH, total ghrelin, and acylated ghrelin (AG) were assayed every 30 min from 0 to +120 min.

RESULTS

Peak GH values were lower in GHD subjects than in GHS subjects (P < 0.0001). The baseline levels, peak levels, or area under the curves (AUC) for total ghrelin and AG were similar between GHD and GHS children. ARG infusion was followed by a slight to significant decrease in total ghrelin levels, but not AG levels, both in GHD and GHS subjects with a nadir at +30 min. No correlation was seen between GH, total ghrelin, or AG response and ARG infusion.

CONCLUSIONS

Total ghrelin and AG levels seemed unaffected by GH status in prepubertal children. ARG infusion was unable to blunt ghrelin secretion irrespective of GH status in childhood. Moreover, since ARG influences GH secretion via modulation of somatostatin release, ghrelin secretion seems to be partially refractory to somatostatin action.

Additive effects of intra-articular injection of growth hormone and hyaluronic acid in rabbit model of collagenase-induced osteoarthritis

In a rabbit model of collagenase-induced osteoarthritis, the additive effects of intra-articular recombinant human growth hormone (GH) administration to hyaluronic acid (HA) were evaluated. After intra-articular collagenase injection, mature New Zealand white rabbits (n=30) were divided into 3 groups. Group 1 (control rabbits) received once weekly intra-articular saline injections for 4 weeks. Group 2 rabbits received 6 mg HA injections, and group 3 rabbits were injected with 6 mg HA and 3 mg recombinant human GH. These injections were initiated 4 weeks after collagenase injections. Lameness was observed for 9 weeks after collagenase injections. Macroscopic and histopathological knee joint findings were also evaluated at the end of 9 weeks after collagenase injections. Although all animals had lameness after collagenase injections, the duration and severity of lameness were significantly shorter and less severe in group 3 than group 1 and 2 (P<0.01). Macroscopic scores showed that femoral condyles of group 3 rabbits received significantly less cartilage damage than those of groups 1 and 2 rabbits (P<0.01). Histopathological score was also the lowest in group 3 (P<0.01). These results suggest that co-injection of intra-articular HA and recombinant human GH is more effective than HA injections alone in an osteoarthritis model.

Comparative study of the effects of different growth hormone doses on growth and spatial performance of hypophysectomized rats

This study was designed to examine the effects of recombinant human growth hormone replacement on somatic growth and cognitive function in hypophysectomized (HYPOX) female Sprague-Dawley rats. Rats (5 per group) were randomized by weight to 3 experimental groups: group 1, administered 200 microg/kg of GH once daily for 9 days; group 2, administered 200 microg/kg of GH twice daily; and group 3, administered saline daily. Somatic growth was evaluated by measurement of body weight daily and of the width of the proximal tibial growth plate of the HYPOX rats. Cognitive function was evaluated using the Morris water maze (MWM) test. The results indicated that GH replacement therapy in HYPOX rats promoted an increase in the body weight and the width of the tibial growth plate in a dose-dependent manner. On the third day of the MWM test, the escape latency in the GH-treated groups 1 and 2 was significantly shorter than that in the control rats (P<0.001 and P=0.032, respectively), suggesting that rhGH improved spatial memory acquisition in the MWM test. Therefore it is concluded that rhGH replacement therapy in HYPOX rats stimulates an increase in somatic growth in a dose-dependent manner and also has beneficial effects on cognitive functions.

Cytokeratin distribution and functional properties of growth hormone-producing pituitary adenomas

In addition to its structural function, cytokeratin may have other important roles within cells. We have reported that in growth hormone-producing adenomas (GH cell adenomas), two distinct types can be recognized by their cytokeratin distribution patterns (dot-like or perinuclear pattern) and that each type has different clinicopathological and endocrinological properties. To confirm these phenomena in a larger series and to clarify the significance of different cytokeratin distribution patterns, we studied cytokeratin localization in 70 GH cell adenomas from acromegalic patients. Type I adenomas ( 15) almost exclusively (>98%) composed of cells with a prominent, dot-like distribution; type 2 adenomas (36) comprised of cells with perinuclear cytokeratin; and type 3 adenomas (11) comprised of both cell types were separated. The remaining 8 did not exhibit a distinct distribution pattern. By electron microscopic immunocytochemistry for cytokeratin, dot-like distribution corresponded to fibrous bodies, whereas perinuclear distribution represented immune deposition in the perinuclear zone. Immunohistochemistry for GH, prolactin, β-thyrotropin, and α-subunit of glycoprotein hormones revealed a reduced expression of these hormones in type 1 adenomas, compared with types 2 and 3 adenomas. In normal pituitary glands, almost all GH cells showed a perinuclear cytokeratin distribution, and only a few GH cells exhibited a dot-like pattern. These findings suggest that a dot-like cytokeratin distribution in GH cells may be pathological (a change from physiological perinuclear distribution) and that adenomas with such a distribution may reduce endocrine activities as a result of unknown factors.

Immunohistological localization of TGFα, EGF, IGF-I, and TGFβ in the normal human pituitary gland

In previous studies, we demonstrated several growth factors, including epidermal growth factor (EGF), transforming growth factorβ (TGFβ), insulin-like growth factor-I (IGF-I, somatomedin C), and TGFe in extracts of the human pituitary. Using immunohistochemistry, reactivity for TGFα, EGF, and TGFβ was localized in sections of 12 of 12 autopsy-derived human pituitary glands. IGF-I reactivity was demonstrated in 5 of 5 pituitary glands. Sections staining for TGFα and IGF-I were double-stained for the full spectrum of anterior pituitary hormones (i.e., GH, PRL, ACTH, LH, FSH, TSH, and a-subunit). Intracellular EGF immunostaining was demonstrated within the posterior pituitary and in some squamous cell nests of the pars tuberalis. Occasional extracellular EGF reactivity was also noted within connective tissue of the anterior pituitary. Polyclonal antibody to TGFβ showed extracellular reactivity within connective tissue surrounding the gland as well as that separating cords of secretory cells. TGFβ staining was also noted in the mediae of small vessels. Monoclonal anti-TGFα antibody labeled scattered secretory cells throughout the anterior pituitary, including ones engaged in follicle formation, and some cells lining Rathke's cleft remnants. TGFα reactivity in secretory cells was expressed in cells also staining for PRL, α-subunit, LH, FSH, and TSH. No TGFα reactivity was noticed in cells staining for either GH or ACTH. IGF-I reactivity was observed in occasional secretory cells within the anterior pituitary and in neuronal processes of the posterior pituitary. Anterior pituitary cells reactive for hormones were nonreactive for IGF-I. The presence of EGF and TGFβ reactivity within extracellular matrix suggests that it represents a possible storage site of these growth factors within the anterior pituitary. The presence of EGF and IGF-I within the axons and terminations of posterior pituitary implies either local or possibly hypothalamic production of EGF. Finally, our results indicate that TGFα and IGF-I, as well as perhaps EGF, are manufactured by specific pituitary cells and that they may have a role in the endocrine function of the anterior and posterior pituitary, respectively.

Pit-1/ghf-1 transcription factor expression in rodent pituitaries

The Pit-1/GHF-1 (Pit-1) transcription factor is important for the development of anterior pituitary cells that produce GH and PRL. We examined the expression of Pit-1 mRNA in pituitary tissues from rats and mice. Analysis of pituitaries from normal and GHRH transgenic mice showed that Pit-1 transcripts were readily detected in normal, hyperplastic, and neoplastic pituitaries. A cell line (GHRH-CL1) established from a GhRH transgenic mouse pituitary tumor in our laboratory also expressed Pit-1 mRNA. Normal rat pituitaries and those with estrogen-induced PRL cell hyperplasia expressed Pit-1 mRNA. There was a decrease in Pit-1 mRNA in hyperplastic rat pituitaries concomitant with a decrease In GH mRNA amounts and an increase in PRL mRNA amounts after estrogen treatment. Similarly, analysis of GH₃ cells in vitro showed that estrogen and bFGF modulated PRL but not Pit-1 mRNA levels. Pit-1 mRNA was localized by combined in situ hybridization and immunohistochemistry to predominantly GH and PRL cells, although some TSH and LH cells in the rat pituitary also expressed Pit-1 mRNA, indicating wide distribution of the mRNA for this transcription factor in various anterior pituitary cell types. Analysis of cell proliferation in normal rat pituitary and GH₃ cells revealed that estrogen and bFGF stimulated cell proliferation in normal pituitaries but inhibited proliferation in GH₃ cells, whereas Pit-1 transcripts remained unchanged in both groups of cultured cells. These results indicate that Pit-1 mRNA is readily detected in normal, hyperplastic, and neoplastic rodent pituitaries. Changes in Pit-1 mRNA amounts appear to correlate more closely with changes in GH than PRL mRNA levels in cultured pituitary cells.Endocr Pathol 4:146-154, 1993.

Effect of intravenous infusion of growth hormone-releasing hormone on the morphology of rat pituitary somatotrophs

The effect of GRH infusion on rat adenohypophysial morphology was studied by light microscopy, immunocytochemistry, in situ hybridization, and electron microscopy. Synthetic rat GRH was intravenously administered by osmotic minipumps at 14.4, 72, 360 and 720 μg/ day/rat for 1 week. In one group treated for 1 week with a daily dose of 720 μg GRH, the rats were killed 7 days after withdrawal of GRH. Control rats in which GRH was replaced by excipient, or those that received no treatment, were included as well. GRH infusion with daily doses of 360 and 720 μg resulted in a significant increase in pituitary weight and weaker GH immunoreactivity compared with other groups. Ultrastructurally, the somatotrophs were increased in size and became sparsely granulated, and the organelles involved in hormone sythesis were very prominent. The intensity of the GH mRNA signal did not differ from control animals, suggesting the desensitization of somatotrophs to GRH. The highest GRH dose induced an increased number of nuclei immunoreactive for proliferation cell nuclear antigen (PCNA). One week after GRH withdrawal, shrinkage of cytoplasm, involution of RER and Golgi complex, and a decrease of cell attachment sites indicated the reversibility of changes induced by GRH. In conclusion, GRH infusion induced, within days, hypertrophy and proliferation of somatotrophs with ultrastructural features of highly stimulated, sparsely granulated cells. Morphological changes were reversible.Endocr Pathol 4:131-139, 1993.

Bromocriptine-induced reversible lysosomal change and reduction of prolactin and growth hormone messenger RNA in cultured GH3 cell lines

We examined the effects of bromocriptine on the ultrastructure and on the levelsof messenger RNA (mRNA) of prolactin and growth hormone (GH) in a cultured GH₃ cell line. Prolactin and GH concentrations measured by radioimmunoassay in the incubation medium as well as the cell number of the GH₃ cells were significantly decreased by treatment with 10^-4M bromocriptine for 24 hours. Electron microscopy of bromocriptine-treated GH₃ cells demonstrated accumulation of cytoplasmic vacuoles containing cytoplasmic components including secretory granules (crinophagy) which were positive for acid phosphatase staining. The remarkable morphological changes in GH₃ cells, induced by treatment with 10^-4M bromocriptine for 24 hours, disappeared 48 hours after substitution with bromocriptine-free medium. An immunoelectron-microscopic study demonstrated gold particles binding with antiprolactin antibodies not only In the cytoplasm but also inside vacuoles of GH₃ cells after incubation with bromocriptine for 24 hours. Treatment with 10^-4M bromocriptine for 24 hours caused the reduction both of mRNAs of prolactin measured by dot-blot hybridization and the Northern-blotting method and of GH measured by the Northern-blotting method. In conclusion, bromocriptine induces a reversible lysosomal change and could inhibit gene transcription of prolactin and GH in GH₃ cells.Endocr Pathol 4:28-33, 1993.

Mixed growth hormone cell- prolactin cell pituitary adenoma with acromegaly: α-subunit most growth hormone cells

A 51 -year-old woman with mixed growth hormone (GH) cell-prolactin (PRL) cell pituitary adenoma is presented. She had clinical signs due to hypersecretion of GH and PRL. Resected tissue was studied immunohistochemically and morphologically. The serial sections revealed that GH and α-subunit were co-localized in most cells, while GH and PRL were localized in different cells.

Absence of somatotrophs, lactotrophs, and thyrotrophs in the pituitary of two dwarfs with hypothyroidism: Deficiency of pituitary transcription factor-1?

Most patients with dwarfism due to growth hormone (GH) deficiency have normal pituitary somatotroph morphology and GH response to GH-releasing hormone (GRH), consistent with decreased GRH synthesis, release, or delivery. Primary pituitary hyposecretion of GH may result from adenohypophysial tissue destruction caused by tumors, such as craniopharyngioma. We report a hitherto undescribed form of primary pituitary dwarfism associated with absence of adenohypophysial GH, prolactin (PRL), and thyrotropin (TSH). Two sisters had dwarfism, hypothyroidism, and hypoglycemia. The first child had craniofacial abnormalities and died at age 11/2 months of fluid overload. The second sibling died at age 4 years of pulmonary congestion. At autopsy, both pituitaries were small and acidophils were conspicuously absent. They contained a normal number of corticotrophs with intense adrenocorticotropin (ACTH) immunoreactivity, and gonadotrophs with normal content of α-subunit and β-subunits of follicle-stimulating hormone (FSH) and luteinizing hormone (LH). No GH, PRL, or β-TSH immunoreactivity was identified. The thyroid glandswere atrophic. Both children had marked pancreatic nesidioblastosis, with an increased number of insulin-containing cells. This clinicopathologic entity appears to represent a familial disorder in which there is defective development of three adenohypophysial cell types: somatotrophs, lactotrophs, and thyrotrophs. A common pituitary transcription factor, Pit-1, has been implicated in the differentiation of these three cell types. The pituitary changes in these two children resemble those described in Snell, Jackson, and Ames dwarf mice, which have recently been shown to be due to abnormalities of the Pit-1 gene. We suggest that this novel human disease is due to deficient or abnormal pituitary transcription factor Pit-1.

Folliculostellate cells in pituitary adenomas: Studies of hormonal profile and tumor vascularity

The hormonal immunoreactivity and vascularity of pituitary adenomas containing folliculostellate (FS) cells have been compared with those of tumors in which such cells were not identified. FS cells were present in variable numbers in 36 of 92 tumors. Adenomas immunoreactive for growth hormone (GH), adrenocorticotropic hormone (ACTH), or prolactin (PRL) contained FS cells in 40-50% of cases. Those immunoreactive for glycoprotein hormones and alphasubunit contained FS cells in 67-85% of cases, a statistically significant correlation. When alpha-subunit was also present in GH-, GH/PRL-, and ACTH-immunoreactive tumors, a higher proportion contained FS cells (57-91%). These data suggest a correlation between the presence of FS cells and glycoprotein immunoreactivity in pituitary adenomas. Vascular channels identified by the binding of the lectinUlex europaeus were quantified in the two types of tumors. Those containing FS cells were not more vascular than those without FS cells, which suggests that FS cells do not play a significant role in the regulation of intratumoraf vascularization in human pituitary adenomas.

Silent mixed growth hormone cell-prolactin cell pituitary adenoma

The case of a 51 -year-old man with recurrent nonfunctioning pituitary adenoma is presented. Despite clinically and endocrinologically normal pituitary function in regard to growth hormone and prolactin, many growth hormone- and prolactin-positive cells were immunohis-tochemically detected in adenoma tissue. Furthermore, a quite rare tumor of silent mixed growth hormone cell-prolactin cell pituitary adenoma was confirmed by the double-labeling immunoelectron-microscopical study.

Effects of somatostatin on somatotroph adenomas of the human pituitary: An in vitro functional and morphological study

The effects of somatostatin or the somatostatin analog SMS 201-995 were studied on 4 densely granulated somatotroph adenomas and 4 sparsely granulated somatotroph adenomas in vitro. Release of growth hormone (GH) into culture media during incubation with somatostatin or SMS 201 -995 were measured by radioimmunoassay, and light-microscopical and ultrastructural morphometric parameters were compared with those of cultured control somatotroph adenoma cells of the same tumor. In all tumors except for 1 densely granulated somatotroph adenoma, somatostatin or SMS 201-995 decreased GH release into culture media in 24- and 2-hour incubations. After 48-hour incubation with somatostatin or SMS 201-995, there was no change in cell size or secretory granule diameter. One densely granulated adenoma showed decreased cytoplasmic volume density (CVD) of Golgi apparatus and secretory granules, and a sparsely granulated adenoma had reduced CVD of endoplasmic reticulum. All the tumors that responded with decreased GH release exhibited increased CVD of lysosomes after incubation with somatostatin or SMS 201-995. These results indicate that both densely and sparsely granulated somatotroph adenomas respond to somatostatin inhibition and, furthermore, that inhibition of hormone release is associated with accumulation of lysosomes, suggesting lysosomal degradation of stored hormone.

Hypothalamic hormonal regulation of human growth hormone gene expression in somatotroph adenoma cell cultures

Pituitary growth hormone (GH) secretion is stimulated by hypothalamic growth hormonereleasing hormone (GRH) and inhibited by somatotropin release-inhibiting hormone (so-matostatin, SRIH). The effect of GRH and SRIH was therefore tested on human GH gene expression in nine somatotroph tumor cell cultures. SMS 201-995, a long-acting somatostatin analog, was also tested in these long-term pituitary cultures. Cells were grown in serum-free defined medium and treated with GRH, SMS 201-995, or SRIH for up to 72 hours. After 72 hours, total cellular RNA was extracted and subjected to an RNAse protection assay, using a radiolabeled 210 base human GH cRNA probe. This sensitive technique allowed detection of small amounts of GH messenger RNA (mRNA). Nonstimulated somatotroph tumor cells expressed human GH mRNA detected by protection of double-stranded hybrid bands. SMS 201-995 had no effect on GH mRNA levels. GRH induced GH mRNA transcripts four- to sixfold. These results indicate that GRH stimulates both long-term in vitro GH secretion and GH mRNA levels in human GH cell cultures. SMS 201-995 has a potent and sustained long-term inhibitory effect on GH secretion but does not appear to alter human GH mRNA levels. Although 15 nM SMS 201-995 attenuated GH secretion to 30% of controls during 72-hour incubation, the peptide did not alter GH mRNA levels. SMS 201 -995 may therefore act as an inhibitor of GH secretion without altering expression of the human GH gene in somatotroph adenomas.

Neurohormonal immunoregulation

The immune system may be divided into primary lymphoid organs (bone marrow, bursa of Fabricius, and thymus), which produce mature leukocytes and secondary organs (spleen, lymph nodes, tonsils, Peyer's patches, etc.), which are concerned with specific immune responses. In the primary organs, stem cells proliferate and differentiate into various subsets of polymorphonuclear and mononuclear cells. Evidence is increasing that cell proliferation in the primary lymphoid organs is dependent on pituitary growth hormone (GH) and prolactin (PRL), which control the expression of growth regulatory genes (protooncogenes) such as c-myc and also induce essential growth factors (insulinlike growth factor, thymic and bursal hormones, etc.) and, possibly, their receptors. The adrenocorticotropic hormone-adrenal axis serves as an inhibitory pathway, antagonizing the action of PRL and GH on primary lymphoid tissue. The effect of glucocorticoids is especially forceful on thymocytes through the activation of the genetically programmed suicide pathway. Sex hormones also regulate the primary lymphoid organs, but their mechanism of action remains to be clarified. Thymus-derived feedback signals toward the pituitary gland have already been described. The pituitary gland exerts a similar regulatory influence on mature lymphocytes during their antigen-driven differentiation. PRL or GH is required for primary immune reactions; however, the secondary immune response may be less dependent on these hormones. Once the immune system is primed, antigen itself becomes a primary regulator. Exposure of memory cells to antigen leads to the production of growth factors (interleukins) and to the expression of their receptors. Therefore, antigen appears to fulfill, at this stage, a role that is originally played by GH or PRL in the primary lymphoid organs and, to some extent, also during antigen-driven differentiation. During immune reactions, interleukin-1 and tumor necrosis factor activate the adrenocorticotropic hormoneadrenal axis, which plays an important role in setting upper limits to and terminating responses. Lymphocytes have receptors for and react to numerous hormones, neurotransmitters, and mediators derived from a number of organs and tissues. Therefore, ultimately the reaction of a lymphocyte will be the vector of all positive and negative signals received. A hierarchy and sequential system of signals exists. Primary regulatory signals (competence signals) represent the most powerful regulators (e.g., PRL, GH or antigen) of lymphoid cells. The delivery of a competence signal is the prerequisite for subsequent lymphoproliferation, which is regulated by growth factors that are specific for a certain developmental stage of the lymphoid cell and act sequentially. Hormonal factors that promote growth and differentiation deliver the second regulatory signals. Competence factors and growth and differentiation hormones regulate gene expression in lymphocytes. The third class of signals modulate the function of mature effector cells (e.g., locomotion, secretion, phagocytosis, cytotoxicity). Neuro-transmitters appear to function as secondary signal modulators and tertiary functional regulators.