Dose-response study of the effect of growth hormone on mechanical properties of skin graft wounds

Local Growth Hormone Therapy for Pressure Ulcer Healing on a Human Skin Mouse Model

The growth hormone is involved in skin homeostasis and wound healing. We hypothesize whether it is possible to improve pressure ulcer (PU) healing by locally applying the recombinant human growth hormone (rhGH) in a human skin mouse model. Non-obese diabetic/severe combined immunodeficient mice (n = 10) were engrafted with a full-thickness human skin graft. After 60 days with stable grafts, human skin underwent three cycles of ischemia-reperfusion with a compression device to create a PU. Mice were classified into two groups: rhGH treatment group (n = 5) and control group (n = 5). In the rhGH group for local intradermal injections, each had 0.15 mg (0.5IU) applied to the PU edges, once per week for four weeks. Evaluation of the wound healing was conducted with photographic and visual assessments, and histological analysis was performed after complete wound healing. The results showed a healing rate twice as fast in the rhGH group compared to the control group (1.25 ± 0.33 mm2/day versus 0.61 ± 0.27 mm2/day; p-value < 0.05), with a faster healing rate during the first 30 days. The rhGH group showed thicker skin (1953 ± 457 µm versus 1060 ± 208 µm; p-value < 0.05) in the repaired area, with a significant decrease in collagen type I/III ratio at wound closure (62 days, range 60-70). Local administration of the rhGH accelerates PU healing in our model. The rhGH may have a clinical use in pressure ulcer treatment.

Therapeutic augmentation of the growth hormone axis to improve outcomes following peripheral nerve injury

INTRODUCTION

Peripheral nerve injuries often result in debilitating motor and sensory deficits. There are currently no therapeutic agents that are clinically available to enhance the regenerative process. Following surgical repair, axons often must regenerate long distances to reach and reinnervate distal targets. Progressive atrophy of denervated muscle and Schwann cells (SCs) prior to reinnervation contributes to poor outcomes. Growth hormone (GH)-based therapies have the potential to accelerate axonal regeneration while at the same time limiting atrophy of muscle and the distal regenerative pathway prior to reinnervation.

AREAS COVERED

In this review, we discuss the potential mechanisms by which GH-based therapies act on the multiple tissue types involved in peripheral nerve regeneration to ultimately enhance outcomes, and review the pertinent mechanistic and translational studies that have been performed. We also address potential secondary benefits of GH-based therapies pertaining to improved bone, tendon and wound healing in the setting of peripheral nerve injury.

EXPERT OPINION

GH-based therapies carry great promise for the treatment of peripheral nerve injuries, given the multi-modal mechanism of action not seen with other experimental therapies. A number of FDA-approved drugs that augment the GH axis are currently available, which may facilitate clinical translation.

Human growth hormone may be detrimental when used to accelerate recovery from acute tendon-bone interface injuries

BACKGROUND

There have been few scientific studies that have examined usage of human growth hormone to accelerate recovery from injury. The hypothesis of this study was that human growth hormone would accelerate tendon-to-bone healing compared with control animals treated with placebo in a rat model of acute rotator cuff injury repair.

METHODS

Seventy-two rats underwent repair of acute rotator cuff injuries and were randomized into the following postoperative dosing regimens: placebo, and human growth hormone at 0.1, 1, 2, 5, and 10 mg/kg/day, administered subcutaneously once per day for fourteen days (Protocol 1). An additional twenty-four rats were randomized to receive either (1) placebo or (2) human growth hormone at 5 mg/kg, administered subcutaneously twice per day for seven days preoperatively and twenty-eight days postoperatively (Protocol 2). All rats were killed twenty-eight days postoperatively. Mechanical testing was performed. Ultimate stress, ultimate force, stiffness, energy to failure, and ultimate distension were determined.

RESULTS

For Protocol 1, analysis of variance testing showed no significant difference between the groups with regard to ultimate stress, ultimate force, stiffness, energy to failure, or ultimate distension. In Protocol 2, ultimate force to failure was significantly worse in the human growth hormone group compared with the placebo group (21.1 ± 5.85 versus 26.3 ± 5.47 N; p = 0.035). Failure was more likely to occur through the bone than the tendon-bone interface in the human growth hormone group compared with the placebo group (p = 0.001). No significant difference was found for ultimate stress, ultimate force, stiffness, energy to failure, or ultimate distension between the groups in Protocol 2.

CONCLUSIONS

In this rat model of acute tendon-bone injury repair, daily subcutaneous postoperative human growth hormone treatment for fourteen days failed to demonstrate a significant difference in any biomechanical parameter compared with placebo. Furthermore, subcutaneous administration of 5 mg/kg of human growth hormone twice daily from seven days preoperatively until twenty-eight days postoperatively demonstrated lower loads to ultimate failure and a higher risk of bone fracture failure compared with placebo.

Growth hormone system: skin interactions

This paper describes the growth hormone system, emphasizing its possible effects on epidermal cells, dermal structures and wound healing. A review of the literature was conducted on studies concerning the growth hormone molecule, its receptor and carrier proteins and the other proteins involved in the mechanisms of its manifestation in dermal tissue.

Acute and chronic effects of growth hormone on renal regulation of electrolyte and water homeostasis

For decades, growth hormone (GH) has been known to influence electrolyte and water handling in humans and animals. However, the molecular mechanisms underlying the GH-induced anti-natriuretic and anti-diuretic effects have remained elusive. This review will examine the existing literature on renal electrolyte and water handling following acute and chronic GH-exposure. Renal responses to GH differ in acute and chronic models. Acute application of GH results in a reduced urinary electrolyte and water excretion, whereas the chronic effects of GH are more diverse, as this state likely represents a complex mixture of primary and secondary actions of GH as well as compensatory mechanisms. During chronic GH-exposure an initial sodium retaining state often occurs, followed by a normalization of the urinary sodium excretion, although extracellular volume expansion still persists. We recently described a possible mechanism by which GH acutely increases renal electrolyte and water reabsorption, by modulation of the kidney specific Na(+), K(+), 2Cl(-) co-transporter (NKCC2). The primary aim of this review is to investigate how GH-induced regulation of NKCC2 may be involved in the complex renal changes previously described during acute and chronic GH. We propose, that the GH-induced increase in NKCC2 activity may explain the initial water and sodium retention seen in a number of studies. Moreover, renal changes seen during prolonged GH-exposure may now be seen on the background of the acute stimulation of NKCC2. Additionally, GH also promotes renal acidification, thus influencing renal acid/base handling. The GH-induced renal acidification is partly compatible with changes in NKCC2 activity. Finally, we review the available data on changes in hormonal systems affecting tubular transport during acute and chronic GH-exposure.

Acute growth hormone administration induces antidiuretic and antinatriuretic effects and increases phosphorylation of NKCC2

Growth hormone (GH) has antidiuretic and antinatriuretic effects in rats and humans, but the molecular mechanisms responsible for these effects are unknown. The aim of this study was to investigate the mechanisms behind the acute renal effects of GH in rats. Female rats received rat (r)GH (2.8 mg/kg sc) or saline and were placed in metabolic cages for 5 h. Urinary excretion of electrolytes and urinary volume were reduced after rGH injection, while urine osmolality was increased. Creatinine and lithium clearance remained unchanged, suggesting that rGH increases reabsorption in segments distal to the proximal tubule. Total plasma insulin-like growth factor I (IGF-I) levels did not change, while cortical IGF-I mRNA abundance was increased. The relative abundance of total and Ser(256)-phosphorylated aquaporin 2 was found to be unchanged by immunoblotting, whereas a significant increase of Thr(96) and Thr(101)-phosphorylated NKCC2 (renal Na(+), K(+), 2Cl(-) cotransporter) was found in the inner stripe of outer medulla thick ascending limbs (mTAL). Additionally, an increased NKCC2 expression was observed in the cortical region. Immunohistochemistry confirmed these findings. The density of NKCC2 molecules in the apical membrane of mTAL cells appeared to be unchanged after rGH injection evaluated by immunoelectron microscopy. Basolateral addition of rGH or IGF-I to microperfused rat mTAL segments did not change transepithelial voltage. In conclusion, GH appears to exert its acute antinatriuretic and antidiuretic effects through indirect activation of NKCC2 in the mTAL.

The total length of myocytes and capillaries, and total number of myocyte nuclei in the rat heart are time-dependently increased by growth hormone

Growth hormone (GH) can increase size and dimensions of rat hearts. The aim was to study how GH administration influences the growth of cardiac myocytes and capillaries in relation to time. Three-month-old female rats were divided into 10 groups (n=3), and injected with either GH (5mg/kg/day) or vehicle for 5, 10, 20, 40, or 80 days. From the left ventricle (LV) histological sections were made and stereological methods applied. Linear regression showed that GH time-dependently increased: LV volume (r=0.96, P<0.001), total volume of myocytes (r=0.96, P<0.001) and capillaries (r=0.64, P<0.05), total length of myocytes (r=0.90, P<0.001) and capillaries (r=0.78, P<0.001), and total number of myocyte nuclei (r=0.85, P<0.001). In conclusion, during 80 days of GH treatment the total volume and length of myocytes and capillaries, and total number of myocyte nuclei increased in a linear way. The results indicate that GH is a potent mediator of myocardial growth.

Epidermal homeostasis: the role of the growth hormone and insulin-like growth factor systems

GH and IGF-I and -II were first identified by their endocrine activity. Specifically, IGF-I was found to mediate the linear growth-promoting actions of GH. It is now evident that these two growth factor systems also exert widespread activity throughout the body and that their actions are not always interconnected. The literature highlights the importance of the GH and IGF systems in normal skin homeostasis, including dermal/epidermal cross-talk. GH activity, sometimes mediated via IGF-I, is primarily evident in the dermis, particularly affecting collagen synthesis. In contrast, IGF action is an important feature of the dermal and epidermal compartments, predominantly enhancing cell proliferation, survival, and migration. The locally expressed IGF binding proteins play significant and complex roles, primarily via modulation of IGF actions. Disturbances in GH and IGF signaling pathways are implicated in the pathophysiology of several skin perturbations, particularly those exhibiting epidermal hyperplasia (e.g., psoriasis, carcinomas). Additionally, many studies emphasize the potential use of both growth factors in the treatment of skin wounds; for example, burn patients. This overview concerns the role and mechanisms of action of the GH and IGF systems in skin and maintenance of epidermal integrity in both health and disease.

Contribution of circulating IGF-I to wound repair in GH-treated rats

Systemic administration of growth hormone (GH) stimulates granulation tissue formation, increases collagen deposition, improves the breaking strength of incisional wounds, and decreases donor-site healing times in burn patients. The possible role for circulating IGF-I in mediating this effect of growth hormone has not been investigated. To assess the relative effects of systemic IGF-I and GH on dermal repair, incisional wounds were created on the backs of male Sprague-Dawley rats treated with GH, or IGF-I or a combination of GH and IGF-I. After 7 days of treatment, wound strips were taken for wound strength and immunohistochemical analysis. Uninjured skin and liver samples were collected for mRNA analysis and plasma samples were taken at the completion of the experiment to determine circulating IGF-I levels. Increased circulating IGF-I levels and increased weight gain were observed only in the IGF-I and IGF-I+GH treatment groups, although steady-state igf-I levels were not altered in liver and uninjured skin after 7 days in any treatment group. IGF-I treatment had no positive effects on wound repair. Wound strength was increased with GH treatment only and associated with an increase in the intensity of IGF-I immunostaining in the granulation tissue of GH-treated animals. In line with the wound strength data, co-administration of IGF-I resulted in the decreased intensity of IGF-I immunostaining. We conclude that the GH-stimulated increase in wound strength is not mediated via endocrine-derived IGF-I and that only locally produced IGF-I acting in an autocrine or paracrine fashion contributes to the regulation of the wound repair process.

Dorsal skin responses to topical application with hydrogen peroxide in Mini and Wistar rats

Mini rats (Jcl: WistarTGN(ARGHGEN) 1Nts) (MRs) are Wistar rat (WR)-derived transgenic rats in which the expression of growth hormone (GH) gene is suppressed under the presence of antisense RNA transgene. In order to evaluate the effects of GH-deficiency on the acute injury by external stimuli, the dorsal skin responses to a single topical application with 20% hydrogen peroxide (HPO), one of the environmental oxidative stressors, were histologically compared between male MRs and WRs of 8 weeks old, whose hair cycle was under the telogen phase. As a result, formation of granulation tissues, reepithelialization and regrowth of hair follicles were delayed in MRs compared with WRs. While hair follicles of MRs of this age are under a long-lasting telogen phase after their 2nd cycle, a new hair cycle started not only in the HPO-applied area but also in the solvent-applied area with a little time lag. These findings suggest that GH-deficiency may influence the skin responses to the external chemical stimuli.

Efeito da somatotropina sobre a cicatrização de feridas cutâneas, em ratos

A somatotropina, além do efeito anabolizante, age no processo de cicatrização acelerando a formação local de tecido de granulação, síntese e deposição de colágeno, quando administrada por via subcutânea. Objetivo: Avaliar o efeito da somatotropina sobre a cicatrização de feridas cutâneas, em ratos. Métodos: Utilizaram-se 53 ratos Wistar, machos, com idade média de 145,19 dias e peso inicial médio de 287,72 g, divididos em dois grupos: controle (n=26) que recebeu 1,2 ml/dia de água destilada pela via subcutânea e experimento (n=27) que recebeu 0,2 UI/kg/dia de somatotropina humana pela mesma via. Fez-se uma ferida cutânea no dorso do animal, que diariamente era medida, procedendo-se ao final do experimento o cálculo de contração da ferida. Os tempos de aferição foram 3, 7 e 14 dias, quando de 9 animais de cada grupo, coletou-se sangue para dosagem bioquímica de proteínas plasmáticas e ressecou-se a ferida para estudo histológico. À microscopia avaliou-se: epitelização, reação inflamatória local, tecido de granulação, neovascularização e fibrose. Resultados: O cálculo de contração da ferida, nos 3 tempos de aferição, não demonstrou diferenças entre os grupos controle e experimento. Na dosagem bioquímica encontrou-se diminuição das proteínas totais (p=0,007) e aumento da relação albumina/globulina (p=0,03) no 14º dia no grupo controle, enquanto o grupo experimento manteve-as constantes. Na avaliação histológica observou-se significante aumento da fibrose no 7º dia no grupo experimento (p<0,0001). Conclusões: A somatotropina mantém constantes a relação albumina/globulina e as proteínas totais plasmáticas no 14º dia, além de intensificar a fibrose cicatricial quando utilizada durante 7 dias.

Growth hormone influences the content and composition of collagen in the aorta from old rats

Collagen and elastin are major components of the aortic extracellular matrix and crucial in determining the stiffness of the aorta. We recently showed that growth hormone (GH) changes the mechanical properties, content and composition of aortic collagen from young rats. In the present study, the effect of GH on aorta from old rats was investigated. Old female rats (18(1/2)-20(1/2) months) were injected with either GH (5 mg/kg per day; n=15) or vehicle (n=14) for 80 days. Mechanical and biochemical properties of the thoracic aorta were investigated. Long-term GH injections increased the body weight of female rats by 47% accompanied by a threefold increase in serum IGF-I. The diameter of the aorta was increased by 5%, resulting in a 10% increase in the cross-section of the aortic lumen. Growth hormone increased the content of collagen per sample by 6% and increased the amount of type I collagen relative to type III collagen. No changes in the mechanical properties or elastin content per sample were found. In conclusion, GH induced a substantial growth of old rats. However, although the diameter and the collagen content were increased, the mechanical properties of the aorta were preserved in the GH-injected rats.

Safety issues in children and adolescents during growth hormone therapy--a review

The action of growth hormone (GH) via its receptor involves many organ systems and metabolic pathways. These diverse actions are reviewed in this paper in the context that they may represent unwanted side-effects of GH therapy for growth promotion. The monitoring of GH therapy in large multicentre international databases has demonstrated a low frequency of adverse events. Tumour recurrence or new malignancy are not increased. Headaches, especially in the first few months of therapy, require close evaluation as benign intracranial hypertension is found infrequently, especially in children with GH deficiency and chronic renal failure (CRF). Children at risk for slipped capital femoral epiphysis and scoliosis require close monitoring during therapy. Decreased insulin sensitivity that is dose-dependent is observed during GH therapy. Glucose homeostasis, however, is not affected, but a recent report of increased incidence of Type 2 diabetes mellitus in children undergoing GH therapy requires prospective surveillance.

Role of cytokines in healing chronic skin wounds

In the chronic wound, the normal cascade of inflammation, granulation and reconstruction phases of healing is interrupted. Cytokines are now known to orchestrate different biochemical mediators resulting in the restoration of the healing phases. Growth factors may play a significant role in stimulating wound repair by stimulating growth and proliferation. Since growth factors stimulate a variety of functions depending on cell type and wound stage and since wound-healing defects may occur at any phase of healing, a mixed combination of growth factors would be predicted to be more effective than a single factor. Factors that may modulate the action of growth factors include electrical stimulation, weight bearing, debriding and ischemia.

Growth hormone does not attenuate the inhibitory effects of sepsis on wound healing

Chronic abdominal sepsis is associated with impaired tissue repair. Treatment of burn patients with growth hormone results in improved healing of skin graft donor sites. The goal of this study was to determine whether administration of growth hormone could attenuate the inhibitory effects of sepsis on cutaneous wound healing. Four groups of male Sprague Dawley rats were studied: control, control + growth hormone, sepsis, and sepsis + growth hormone. Sepsis was caused by implantation of a bacterial focus in the peritoneal cavity. Control animals underwent sham laparotomy, and polyvinyl alcohol sponge implants were placed in subdermal pockets in all animals. Saline or growth hormone (400 microg) was injected subcutaneously every 12 hours. On day 5, the incisional wounds and polyvinyl alcohol sponge implants were harvested. The breaking strength of abdominal incisions was measured. Granulation tissue penetration and quality were determined by scoring polyvinyl alcohol sponge implant histology from 1 to 4 in a blinded fashion. Collagen deposition in polyvinyl alcohol sponge implants was quantitated by hydroxyproline assay. Septic mortality was not altered by growth hormone administration. Septic animals showed a reduction in food consumption for 2 days after surgery (p < 0.05 vs. controls), which was not affected by growth hormone administration. The breaking strength of incisional wounds and hydroxyproline content of polyvinyl alcohol sponge implants was reduced in septic rats (p < 0.001 vs. controls) but administration of growth hormone for 5 days did not improve breaking strength or collagen deposition in either group. We conclude that the administration of growth hormone for 5 days did not improve collagen deposition or breaking strength in cutaneous wounds from control or septic animals. The results suggest that growth hormone treatment is unlikely to improve tissue repair in sepsis-induced catabolic illness.

Growth hormone and the expression of mRNAs for matrix proteins and oncogenes in bone

To examine the effects of growth hormone (GH) on the expression of the mRNAs of bone matrix proteins, three experiments were carried out with 3-month-old female Sprague-Dawley rats. In the first experiment rats were given a single subcutaneous injection of recombinant human GH (8 mg rhGH/kg b. wt.), sacrificed 15 min, 1 h, 2 h, 4 h, 8 h, 16 h and 24 h later, and RNA isolated from cancellous bone from the distal femoral metaphysis. Growth hormone increased the level of type I collagen mRNA by 187, 417, and 509% over the control level at 15 min, 1 h and 2 h, respectively; the mRNA levels declined to 119 and 99% at 4 and 8 h, respectively, and then rose again to 351 and 423% over the control level at 16 and 24 h, respectively. Osteocalcin mRNA transcript increased by 89, 90, 325, 342, 361, and 407% over the control level at 15 min, 1 h, 2 h, 4 h, 8 h and 16 h, respectively, and fell to 66% at 24 h. The level of IGF-I mRNA increased by 45, 83, 120, 140, and 175% over the control level at 2, 4, 8, 16, and 24 h, respectively. In the second experiment, following the administration of rhGH (8 mg/kg b. wt.) bone osteocalcin mRNA increased by 127, 177, 361, and 413% over the control level at 30 min, 1 h, 2 h and 4 h, respectively; IGF-I mRNAs increased by 38, 33, 87, and 437 at 30 min, 1 h, 2 h and 4 h, respectively, but the levels did not become significant until 2 h; c-fos mRNA increased significantly at 30 min, and c-jun and c-myc mRNAs did not increase until 4 h. In the third experiment, animals were given a single injection of rhGH (8 mg/kg b. wt.) and the animals were bled at timed intervals and acid ethanol-extractable serum IGF-I determined. Serum IGF-I increased significantly only at 12 h following rhGH administration. Our data indicate that GH stimulates a rapid increase in the expression of mRNAs for the bone matrix proteins, type I collagen and osteocalcin, by a mechanism that appears to be independent of IGF-I, the early response oncogenes or an increase in osteoblast number.

Modulation of intestinal vitamin D receptor by ovariectomy, estrogen and growth hormone

Age-related decline in intestinal calcium (Ca) absorption often occur in postmenopausal osteoporotic women. The impaired Ca absorption can be corrected by estrogen (E2) therapy. Growth hormone (GH) therapy has also been reported to increase intestinal absorption of calcium. Since 1,25-dyhydroxyvitamin D (1,25(OH)2D) is the primary regulator of calcium absorption, we explored whether the mechanisms by which E2 and GH enhance Ca absorption involves the vitamin D endocrine system. We measured serum 1,25(OH)2D concentrations and determined the binding characteristics of intestinal vitamin D receptors (VDRs) in four groups of female rats: sham operated (sham), ovariectomized (ovx), ovx + E2, and ovx + GH. Serum 1,25(OH)2D levels were 42.4 +/- 3.4 and 42.5 +/- 3.2 pg/ml in sham and ovx rats, respectively, and decreased by 63 and 34% (P < 0.001) in ovx + E2 and ovx + GH-treated rats, respectively. The numbers of total, unoccupied and occupied VDRs were 116.9 +/- 2.0, 72.1 +/- 1.1 and 44.8 +/- 1.9 fmol/mg protein, respectively, in sham operated rats, and decreased significantly following ovariectomy by 24, 27 and 19% (P < 0.01), respectively. E2 therapy not only significantly increased total, unoccupied and occupied VDRs above those of ovx rats by 55, 58 and 49% respectively, but it increased the levels above those of sham operated controls as well (P < 0.01). In contrast, GH administration prevented the decrease that occurred in ovx rats in the number of total and unoccupied VDRs (111.2 +/- 3.3; 72.6 +/- 1.4 fmol/mg protein, respectively), but it had no significant effect on the number of occupied VDRs. The dissociation constant (Kd) of intestinal VDRs was unaltered by ovariectomy, E2 and GH. We conclude that down regulation of intestinal VDRs may contribute to the Ca malabsorption that occurs in ovarian hormone deficient states such as postmenopausal osteoporosis, and that the stimulation of Ca absorption by E2 and GH may result, in part, from up regulation of intestinal VDRs.

Histologic evidence: growth hormone completely prevents reduction in cortical bone gain and partially prevents cancellous osteopenia in the tibia of hypophysectomized rats

BACKGROUND

In previous studies we found that the cause of bone loss in young hypophysectomized (HX) animals was due primarily to an inhibition in growth-dependent bone gain and a decrease in bone turnover. The aim of this study was to determine whether growth hormone, which has stimulatory effects on bone growth and turnover, can prevent HX-induced skeletal alterations in rats.

METHODS

Female Sprague-Dawley rats were divided into baseline control (BASAL), age-matched control (CON), HX, HX plus low-dose GH (1.5 mg/kg/d, subcutaneously), and HX plus high-dose GH (4.5 mg/kg/d) groups. The BASAL group was sacrificed at 2 months of age and the remaining groups were sacrificed after 6 weeks of treatment. Cancellous and cortical bone histomorphometry was performed on double-fluorescent-labeled 40 microm-thick sections of the proximal tibia and tibial shaft.

RESULTS

Both low- and high-dose GH prevented the HX-induced decrease of IGF-I serum levels. High-dose GH also significantly increased the body weight and the wet weight of the gastrocnemius muscle when compared to the CON groups. In the tibial shaft, the periosteal labeled surface, mineral apposition rate and bone formation rate were higher in both of the GH-treated groups than in the HX group (P < 0.05). The tissue area and cortical bone area of the high-dose GH-treated rats were greater than those of the HX rats, but did not differ from those of the CON rats. In the proximal tibia, both low- and high-dose GH prevented an HX-induced decrease in the longitudinal growth rate and growth plate width, and increased surface-based bone formation compared to the HX and CON. Cancellous bone volume, tissue-based bone formation rate, and eroded surface in both of the GH-treated groups were higher than those of the HX group, but lower than those of the BASAL and CON groups (P < 0.05). Bone architecture of the HX rats was also improved after GH treatment.

CONCLUSIONS

This study clearly demonstrates that GH replacement at the dosage of 4.5 mg/kg/d can completely prevent the HX-induced reduction in cortical bone gain in the tibial shaft, but can only partially prevent cancellous osteopenia in the proximal tibia after six weeks.

Growth hormone stimulates bone formation and strength of cortical bone in aged rats

The influence of growth hormone on bone formation, mechanical strength, and composition has been investigated in femur middiaphyseal cortical bone from 2-year-old male rats. The rats were given biosynthetic human growth hormone (bhGH) at 2.7 mg/kg/day in two daily injections for 20, 40, or 80 days, and all animals were killed 80 days after the start of bhGH administration. Control animals were given saline. All animals were labeled with tetracycline on days 41 and 69. Only in the bhGH-80-day group was subperiosteal tetracycline double labeling seen all around the femur diaphysis, and this pattern was found in all animals of the group. Double labeling subperiosteally at the posteromedial aspect was found in all animals of the experiment, but compared with the control group, a 400% and an 800% increase in mineral apposition rate was seen in the bhGH-40-day and bhGH-80-day groups, respectively. Light microscopy and polarization microscopy showed that this newly deposited bone was organized in the same concentric lammellae and had the same direction of the collagen fibers when compared with the surrounding bone formed before the start of bhGH injections. The cortical bone cross-sectional area was increased in the bhGH-40-day and bhGH-80-day groups. At the endosteum, scattered labeling was found in animals from all groups, and no differences in medullary cross-sectional areas were seen. The mechanical analysis revealed an increased mechanical strength of the whole diaphyseal bone after bhGH administration. When the data were corrected for dimensions of the diaphyseal bone, no differences in intrinsic mechanical properties of the bone tissue were found. No differences in apparent density of dry defatted bone, ash, and collagen were seen, whereas apparent density of dry defatted bone minus ash was decreased in all groups given bhGH. Correspondingly, a slight increase in ash concentrations of the bhGH-injected animals was seen. bhGH administration also increased the body weight, muscle mass, and total serum IGF-I and thyroxine concentrations.