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Yuan J, Wang Y, Huang Y, Li S, Zhang X, Wu Z, Zhao W, Zhu J, Zhang J, Huang G, Yu P, Cheng X, Wang X, Liu X, Jia J. Investigating Novel Therapeutic Approaches for Idiopathic Short Stature: Targeting siRNA and Growth Hormone Delivery to the Growth Plate Using Exosome Nanoparticles. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2024; 11:e2309559. [PMID: 38639394 DOI: 10.1002/advs.202309559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 03/26/2024] [Indexed: 04/20/2024]
Abstract
Idiopathic short stature (ISS) is a common childhood condition with largely unknown underlying causes. Recent research highlights the role of circulating exosomes in the pathogenesis of various disorders, but their connection to ISS remains unexplored. In the experiments, human chondrocytes are cocultured with plasma exosomes from ISS patients, leading to impaired chondrocyte growth and bone formation. Elevated levels of a specific long non-coding RNA (lncRNA), ISSRL, are identified as a distinguishing factor in ISS, boasting high specificity and sensitivity. Silencing ISSRL in ISS plasma exosomes reverses the inhibition of chondrocyte proliferation and bone formation. Conversely, overexpression of ISSRL in chondrocytes impedes their growth and bone formation, revealing its mechanism of action through the miR-877-3p/GZMB axis. Subsequently, exosomes (CT-Exo-siISSRL-oeGH) with precise cartilage-targeting abilities are engineered, loaded with customized siRNA for ISSRL and growth hormone. This innovative approach offers a therapeutic strategy to address ISS by rectifying abnormal non-coding RNA expression in growth plate cartilage and delivering growth hormone with precision to promote bone growth. This research provides valuable insights into ISS diagnosis and treatment, highlighting the potential of engineered exosomes.
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Affiliation(s)
- Jinghong Yuan
- Department of Orthopaedics, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, P. R. China
- Institute of Orthopaedics of Jiangxi Province, Nanchang, 330006, P. R. China
| | - Yameng Wang
- Department of Orthopaedics, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, P. R. China
- Institute of Orthopaedics of Jiangxi Province, Nanchang, 330006, P. R. China
| | - Yanzhe Huang
- Department of Orthopaedics, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, P. R. China
- Institute of Orthopaedics of Jiangxi Province, Nanchang, 330006, P. R. China
| | - Shengqin Li
- Department of Orthopaedics, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, P. R. China
- Institute of Orthopaedics of Jiangxi Province, Nanchang, 330006, P. R. China
| | - Xiaowen Zhang
- Department of Pediatrics, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, P. R. China
| | - Zhiwen Wu
- Department of Orthopaedics, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, P. R. China
- Institute of Orthopaedics of Jiangxi Province, Nanchang, 330006, P. R. China
| | - Wenrui Zhao
- Department of Orthopaedics, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, P. R. China
- Institute of Orthopaedics of Jiangxi Province, Nanchang, 330006, P. R. China
| | - Junchao Zhu
- Department of Orthopaedics, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, P. R. China
- Institute of Orthopaedics of Jiangxi Province, Nanchang, 330006, P. R. China
| | - Junqiu Zhang
- Department of Pediatrics, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, P. R. China
| | - Guowen Huang
- Department of Orthopaedics, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, P. R. China
- Institute of Orthopaedics of Jiangxi Province, Nanchang, 330006, P. R. China
| | - Peng Yu
- Department of Endocrinology and Metabolism, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, P. R. China
| | - Xigao Cheng
- Department of Orthopaedics, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, P. R. China
- Institute of Orthopaedics of Jiangxi Province, Nanchang, 330006, P. R. China
| | - Xinhui Wang
- Division of Gastrointestinal and Oncologic Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Xijuan Liu
- Department of Pediatrics, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, P. R. China
| | - Jingyu Jia
- Department of Orthopaedics, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, P. R. China
- Institute of Orthopaedics of Jiangxi Province, Nanchang, 330006, P. R. China
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Cohen LE, Rogol AD. Invited Review-Children With Idiopathic Short Stature: An Expanding Role for Genetic Investigation in Their Medical Evaluation. Endocr Pract 2024:S1530-891X(24)00499-3. [PMID: 38679385 DOI: 10.1016/j.eprac.2024.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 04/02/2024] [Accepted: 04/02/2024] [Indexed: 05/01/2024]
Abstract
Short stature in children is a common reason for referral to a pediatric endocrinologist. Many genetic, nutritional, psychological, illness-related, and hormonal causes must be excluded before labeling as idiopathic. Idiopathic short stature is not a diagnosis, but rather describes a large, heterogeneous group of children, who are short and often slowly growing. As new testing paradigms become available, the pool of patients labeled as idiopathic will shrink, although most will have a polygenic cause. Given that many of the new diagnoses are involved in growth plate biology, physical examination should assess for subtle dysmorphology or disproportion of the skeleton that may indicate a heterozygous mutation that in its homozygous state would be apparent. When laboratory evaluations are negative, one may consider genetic testing, such as targeted gene or gene panel, comparative genomic hybridization, or whole exome or whole genome sequencing (respectively). With a known genetic diagnosis, targeted therapy may be possible rather than recombinant human growth hormone, where response is generally poorer than that for children with growth hormone deficiency, because the variety of diagnoses may have varying growth hormone sensitivity. A firm diagnosis has heuristic value: to truncate further diagnostic evaluation, alert the clinician to other possible comorbidities, inform the family for genetic counseling, and direct appropriate targeted therapy, if available.
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Affiliation(s)
- Laurie E Cohen
- Division of Endocrinology and Diabetes, Department of Pediatrics, Albert Einstein College of Medicine, New York, New York
| | - Alan D Rogol
- Division of Diabetes and Endocrinology, Department of Pediatrics, University of Virginia, Charlottesville Virginia.
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Hong H, Hu J, Xu H, Xia D, Pan X, Chen X, Guo Q, Zhang S, Chen J, Wu Y, Leng H, Zhang X, Wang X, Huang C. Beyond Growth Hormone: Association of Short Stature Types and Growth Hormones With Scoliosis. Spine (Phila Pa 1976) 2024; 49:221-231. [PMID: 37871182 DOI: 10.1097/brs.0000000000004853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 10/10/2023] [Indexed: 10/25/2023]
Abstract
STUDY DESIGN Cross-sectional and retrospective cohort study. OBJECTIVE We investigated the effect of 3 types of short stature [partial growth hormone deficiency (GHD), GHD, and idiopathic short stature (ISS)] and recombinant human growth hormone (rhGH) therapy on scoliosis. SUMMARY OF BACKGROUND DATA In short stature, rhGH is widely used and the concentration of growth hormone varies among types. The epidemiologic characteristics of scoliosis and the role of rhGH in scoliosis remain unclear. PATIENTS AND METHODS A cross-sectional study was conducted among 3896 patients with short stature (partial GHD, GHD, and ISS), and a 1:1 age and sex-matched control group with preexisting whole-spine radiographs. The cohort study included 2605 subjects who underwent radiography more than twice to assess scoliosis development, progression, and the need for bracing and surgery. Adjusted logistic regression was used to assess differences in the prevalence of scoliosis among patients with partial GHD, GHD, ISS, and controls. The Kaplan-Meier method was used to analyze the time course of scoliosis development and progression. Cox regression was applied to assess the independent factors related to scoliosis development and progression. Mendelian randomization analyses were also performed. RESULTS Compared with controls, patients with short stature had a higher incidence of scoliosis (34.47% in partial GHD, 31.85% in GHD, 32.94% in ISS vs . 8.83% in control, P < 0.001), a higher risk of scoliosis development [hazard ratio (HR) = 1.964 in partial GHD, P < 0.001; HR = 1.881 in GHD, P = 0.001; HR = 1.706 in ISS, P = 0.001), but not a higher risk of progression, brace, or surgery. Among the 3 types of short stature, there were no differences in the incidence, development, and progression of scoliosis or the need for bracing or surgery. RhGH treatment increased the risk of scoliosis development in each short-stature group (HR = 2.673 in partial GHD, P < 0.001; HR = 1.924 in GHD, P = 0.049; HR = 1.564 in ISS, P = 0.004). Vitamin D supplementation was protective against scoliosis development (HR = 0.456 in partial GHD, P = 0.003; HR = 0.42 in GHD, P = 0.013; HR = 0.838 in ISS, P = 0.257). CONCLUSIONS More attention should be paid to the spinal curve in patients with partial GHD, GHD, or ISS. For short stature treated with rhGH, the risk of scoliosis development was increased. Vitamin D supplementation may be beneficial for prevention. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Haofeng Hong
- Department of Orthopedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou Medical University, Wenzhou, Zhejiang, China
- Department of Orthopedics, Peking University Third Hospital, Beijing, China
| | - Jiasheng Hu
- Alberta Institute, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Honghao Xu
- School of Second Clinical Medicine, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Dongdong Xia
- Department of Orthopedics, Ningbo First Hospital, Ningbo, Zhejiang, China
| | - Xiangxiang Pan
- Department of Orthopedics, Ruian People's Hospital, Wenzhou, Zhejiang, China
| | - Xibang Chen
- Department of Orthopedics, Ruian People's Hospital, Wenzhou, Zhejiang, China
| | - Quanquan Guo
- Department of Orthopedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Shuhao Zhang
- Department of Orthopedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jiaoxiang Chen
- Department of Orthopedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yaosen Wu
- Department of Orthopedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Huijie Leng
- Department of Orthopedics, Peking University Third Hospital, Beijing, China
| | - Xiaolei Zhang
- Zhejiang Provincial Key Laboratory of Orthopedics, Wenzhou, Zhejiang, China
| | - Xiangyang Wang
- Department of Orthopedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Chongan Huang
- Department of Orthopedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou Medical University, Wenzhou, Zhejiang, China
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He M, Zhang Y, Zhao Q, He D, Li Y, Zhang M, Ban B. Letrozole combined with rhGH treatment increases the adult height of short pubertal boys. J Pediatr Endocrinol Metab 2024; 37:74-79. [PMID: 38018388 DOI: 10.1515/jpem-2023-0459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 11/13/2023] [Indexed: 11/30/2023]
Abstract
OBJECTIVES This study was performed to investigate the effectiveness of the combination of letrozole and recombinant human growth hormone (rhGH) to improve the predicted adult height (PAH) and final adult height (FAH) of Chinese short pubertal boys. METHODS In total, 171 Chinese short pubertal boys were recruited for this study. 96 of them received letrozole (2.5 mg/d) combined with rhGH (33.3-66.6 μg/kg.d), and the others received rhGH alone. Follow-up visits were conducted at 1, 3, 6, 9, and 12 months or regularly after the first treatment. During each visit, plasma samples were collected for clinical tests and biomedical analyses, all of which were performed according to standard protocols. This study was registered at www.chictr.org.cn under ID number ChiCTR1900026142. RESULTS After receiving treatment for at least 3 months, 68 boys (91 %) in the rhGH therapy group and 90 (94 %) in the letrozole combined with rhGH (letrozole+rhGH) therapy group achieved an increase in PAH, with the latter treatment leading to a more effective slowing of bone age (BA) advancement. Moreover, the increased PAH showed a significant positive correlation with treatment time in both groups, and letrozole+rhGH increased the PAH to a greater degree than rhGH alone (p=0.0023). And letrozole+rhGH not only slowed the increase in BA more efficiently than rhGH therapy alone (p=0.0025), but also achieved a higher FAH (p=0.0078). CONCLUSIONS Letrozole combined with rhGH treatment is a promising therapy to increase the PAH and FAH of Chinese short pubertal boys.
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Affiliation(s)
- Mingming He
- Department of Endocrinology, Affiliated Hospital of Jining Medical University, Jining Medical University, Jining, Shandong, P.R. China
- Chinese Research Center for Behavior Medicine in Growth and Development, Jining, Shandong, P.R. China
- National Human Genetic Resources Sharing Service Platform, Jining, Shandong, P.R. China
| | - Yanhong Zhang
- Department of Endocrinology, Affiliated Hospital of Jining Medical University, Jining Medical University, Jining, Shandong, P.R. China
- Chinese Research Center for Behavior Medicine in Growth and Development, Jining, Shandong, P.R. China
- National Human Genetic Resources Sharing Service Platform, Jining, Shandong, P.R. China
| | - Qianqian Zhao
- Department of Endocrinology, Affiliated Hospital of Jining Medical University, Jining Medical University, Jining, Shandong, P.R. China
- Chinese Research Center for Behavior Medicine in Growth and Development, Jining, Shandong, P.R. China
- National Human Genetic Resources Sharing Service Platform, Jining, Shandong, P.R. China
| | - Dongye He
- Department of Endocrinology, Affiliated Hospital of Jining Medical University, Jining Medical University, Jining, Shandong, P.R. China
- Chinese Research Center for Behavior Medicine in Growth and Development, Jining, Shandong, P.R. China
- National Human Genetic Resources Sharing Service Platform, Jining, Shandong, P.R. China
| | - Yanying Li
- Department of Endocrinology, Affiliated Hospital of Jining Medical University, Jining Medical University, Jining, Shandong, P.R. China
- Chinese Research Center for Behavior Medicine in Growth and Development, Jining, Shandong, P.R. China
- National Human Genetic Resources Sharing Service Platform, Jining, Shandong, P.R. China
| | - Mei Zhang
- Department of Endocrinology, Affiliated Hospital of Jining Medical University, Jining Medical University, Jining, Shandong, P.R. China
- Chinese Research Center for Behavior Medicine in Growth and Development, Jining, Shandong, P.R. China
- National Human Genetic Resources Sharing Service Platform, Jining, Shandong, P.R. China
| | - Bo Ban
- Department of Endocrinology, Affiliated Hospital of Jining Medical University, Jining Medical University, Jining, Shandong, P.R. China
- Chinese Research Center for Behavior Medicine in Growth and Development, Jining, Shandong, P.R. China
- National Human Genetic Resources Sharing Service Platform, Jining, Shandong, P.R. China
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Liu X, Zhang J, Yuan J, Ding R, Liu T, Jia J. LCN2 is a new diagnostic biomarker and potential therapeutic target in idiopathic short stature. J Cell Mol Med 2022; 26:3568-3581. [PMID: 35610759 PMCID: PMC9189333 DOI: 10.1111/jcmm.17408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 03/05/2022] [Accepted: 05/05/2022] [Indexed: 12/21/2022] Open
Abstract
Idiopathic short stature (ISS) is the most common paediatric endocrine disease. However, the underlying pathology of ISS remains unclear. Currently, there are no effective diagnostic markers or therapeutic strategies available for ISS. In this study, we aimed to identify differential plasma protein expression and novel biomarkers in patients with ISS, and elucidate the biological functions of candidate proteins in ISS pathogenesis. Four specimen pairs from four ISS children and age‐/sex‐matched control individuals were subjected to proteomics analysis, and 340 samples of children with a mean age 9.73 ± 0.24 years were utilized to further verify the differentially expressed proteins by enzyme‐linked immunosorbent assay (ELISA). The receiver‐operating characteristic (ROC) curve and the area under the ROC curve (AUC) were plotted. A total of 2040 proteins were identified, of which 84 were differentially expressed. In vitro and in vivo experiments confirmed the biological functions of these candidate proteins. LCN2 overexpression in ISS was verified using ELISA. Meanwhile, LCN2 showed high sensitivity and specificity in discriminating children with ISS from those with growth hormone deficiency, precocious puberty and normal control individuals. The upregulated expression of LCN2 not only suppressed food intake but also impaired chondrocyte proliferation and bone growth in chondrocytes and rats. As a result, the rats presented a short‐stature phenotype. Subsequently, we found that bone growth inhibition recovered after LCN2 overexpression was stopped in immature rats. To our knowledge, this is the first study to report that LCN2 may be a significant target for ISS diagnosis and treatment.
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Affiliation(s)
- Xijuan Liu
- Department of Pediatrics, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jian Zhang
- Department of Orthopedics, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jinghong Yuan
- Department of Orthopedics, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Rui Ding
- Department of Orthopedics, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Tao Liu
- Department of Pediatrics, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jingyu Jia
- Department of Orthopedics, The Second Affiliated Hospital of Nanchang University, Nanchang, China
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Tidblad A, Gustafsson J, Marcus C, Ritzén M, Ekström K. Metabolic Effects of Growth Hormone Treatment in Short Prepubertal Children: A Double-Blinded Randomized Clinical Trial. Horm Res Paediatr 2022; 93:519-528. [PMID: 33684919 DOI: 10.1159/000513518] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 12/01/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Growth hormone (GH) is a central hormone for regulating linear growth during childhood and also highly involved in the metabolism of lipids, carbohydrates, and protein. However, few studies report on how treatment with GH during childhood influences metabolic parameters. Our aim was to investigate metabolic effects of different doses of GH in short children with GH peak levels in the low to normal range. DESIGN Thirty-five prepubertal short children (<-2.5 SDS), aged 7-10 years, with peak levels of GH between 7 and 14 μg/L during an arginine-insulin tolerance test, were randomized to 3 different doses (11/33/100 μg/kg/day) of GH treatment for 2 years. Auxological and metabolic investigations were performed. These included metabolites in blood and interstitial microdialysis fluid, dual-energy X-ray absorptiometry, frequently sampled intravenous glucose tolerance test (FSIVGTT), and stable isotope examinations of rates of glucose production and lipolysis. RESULTS At 24 months, the high-dose group (HD) had higher fasting insulin compared with the standard-dose (SD) and low-dose (LD) groups (HD: 111.7 vs. SD: 61.2 and LD: 46.0 pmol/L [p < 0.001]) and showed signs of insulin resistance (HOMA-IR, HD: 4.20 vs. SD: 2.17 and LD: 1.71 (LD) [p < 0.001]). The FSIVGTT also demonstrated higher acute insulin response (p < 0.05). Few other metabolic differences were found at 24 months, but a decreased insulin sensitivity index (Si) could already be seen at 12 months for both SD and HD compared with the LD group (p < 0.05). CONCLUSION Treatment with GH resulted in a dose-dependent decrease in insulin sensitivity, demonstrated by higher levels of fasting insulin and signs of insulin resistance in both HOMA indices and FSIVGTT examinations.
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Affiliation(s)
- Anders Tidblad
- Department of Women's and Children's Health, Division of Pediatric Endocrinology, Karolinska Institutet, Stockholm, Sweden,
| | - Jan Gustafsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Claude Marcus
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Martin Ritzén
- Department of Women's and Children's Health, Division of Pediatric Endocrinology, Karolinska Institutet, Stockholm, Sweden
| | - Klas Ekström
- Department of Women's and Children's Health, Division of Pediatric Endocrinology, Karolinska Institutet, Stockholm, Sweden
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Taghizadeh B, Jaafari MR, Zarghami N. New insight into the importance of formulation variables on parenteral growth hormone preparations: potential effect on the injection-site pain. Front Endocrinol (Lausanne) 2022; 13:963336. [PMID: 36263321 PMCID: PMC9576007 DOI: 10.3389/fendo.2022.963336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 09/16/2022] [Indexed: 11/16/2022] Open
Abstract
Reducing injection-site pain (ISP) in patients with chronic conditions such as growth hormone deficiency is a valuable strategy to improve patient compliance and therapeutic efficiency. Thus understanding different aspects of pain induction following subcutaneous injection of biotherapeutics and identifying the responsible factors are vital. Here we have discussed the effects of formulation's viscosity, concentration, osmolality, buffering agents, pH, and temperature as well as injection volume, dosing frequency, and different excipients on ISP following subcutaneous injection of commercially available recombinant human growth hormone products. Our literature review found limited available data on the effects of different components of parenteral rhGH products on ISP. This may be due to high cost associated with conducting various clinical trials to assess each excipient in the formulation or to determine the complex interactions of different components and its impact on ISP. Recently, conducting molecular dynamics simulation studies before formulation design has been recommended as an alternative and less-expensive approach. On the other hand, the observed inconsistencies in the available data is mainly due to different pain measurement approaches used in each study. Moreover, it is difficult to translate data obtained from animal studies to human subjects. Despite all these limitations, our investigation showed that components of parenteral rhGH products can significantly contribute to ISP. We suggest further investigation is required for development of long acting, buffer-free, preservative-free formulations. Besides, various excipients are currently being investigated for reducing ISP which can be used as alternatives for common buffers, surfactants or preservatives in designing future rhGH formulations.
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Affiliation(s)
- Bita Taghizadeh
- Department of Medical Biotechnology, School of Advanced Medical Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mahmoud Reza Jaafari
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Pharmaceutical Nanotechnology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Nosratollah Zarghami
- Department of Medical Biotechnology, School of Advanced Medical Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Clinical Biochemistry and Laboratory Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
- *Correspondence: Nosratollah Zarghami,
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Ronchi SN, Mass EMSW, Bernardina NRD, de Melo Júnior AF, Dos Santos WC, de Andrade TU, Brasil GA, Bissoli NS. Low and high doses of oxandrolone promote pathological cardiac remodeling in young male rats. Steroids 2021; 170:108814. [PMID: 33727119 DOI: 10.1016/j.steroids.2021.108814] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 02/18/2021] [Accepted: 02/24/2021] [Indexed: 01/09/2023]
Abstract
UNLABELLED Oxandrolone (OXA) used in clinical practice, however, its misuse is frequent, including by adolescents pursuing an aesthetic goal. However, the impacts of noxious doses on the cardiovascular system remain unknown. AIM To investigate cardiac effects of OXA in low (LD) and high (HD) doses. METHODS Male Wistar prepubescent rats were separated into 3 experimental groups: control (CON), LD, and HD. Only the CON group received the carrier (carboxymethylcellulose, 0.5%), while the LD and HD groups received, respectively, 2.5 and 37.5 mg/kg/day of OXA via gavage for 4 weeks. The hemodynamic parameters (+dP/dtmax, -dP/dtmin, and Tau) and cardiac autonomic tonus were assessed. Hearts were retrieved for histological analyses and oxidative stress evaluation. Expression levels of calcium-handling proteins were measured by western blot. RESULTS The OXA treatment changed neither the cardiac contractility nor the cardiac autonomic tonus. However, cardiac hypertrophy, collagen deposition, and increased angiotensin-converting enzyme (ACE) expression were observed in a dose-dependent way. Also, the p-phospholamban (p-PLB)/PLB ratio was observed to decrease and increase, respectively, in the LD and HD groups; the sarcoplasmic/endoplasmic reticulum calcium ATPase 2a (SERCA2a)/PLB ratio being higher in both groups. OXA increased SOD1 expression and decreased catalase expression only in the LD group, and protein oxidation was increased in HD. CONCLUSION Both doses of OXA could promote pathological cardiac remodeling, probably via increased ACE, and these effects were exacerbated in the HD treatment, but cardiac contractility was not affected regardless of the dose.
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Affiliation(s)
- Silas Nascimento Ronchi
- Department of Physiological Sciences, Federal University of Espírito Santo, Vitória, ES, Brazil
| | | | | | | | | | | | | | - Nazaré Souza Bissoli
- Department of Physiological Sciences, Federal University of Espírito Santo, Vitória, ES, Brazil
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Roberts SA, Carswell JM. Growth, growth potential, and influences on adult height in the transgender and gender-diverse population. Andrology 2021; 9:1679-1688. [PMID: 33969625 PMCID: PMC9135059 DOI: 10.1111/andr.13034] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 05/03/2021] [Accepted: 05/03/2021] [Indexed: 12/30/2022]
Abstract
The sexually dimorphic trait of height is one aspect of the experience of transgender and gender‐diverse (TGD) individuals that may influence their gender dysphoria and satisfaction with their transition. In this article, we have reviewed the current knowledge of the factors that contribute to one's final adult height and how it might be affected in TGD youth who have not experienced their gonadal puberty in the setting of receiving gonadotropin‐releasing hormone analog (GnRHa) and gender‐affirming hormonal treatment. Additional research is needed to characterize the influence of growth and final adult height on the lived experience of TGD youth and adults and how to best assess their growth, predict their final adult height, and how medical transition can be potentially modified to help them meet their goals.
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Affiliation(s)
- Stephanie A Roberts
- Division of Endocrinology, Boston Children's Hospital, Boston, MA, USA.,Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Jeremi M Carswell
- Division of Endocrinology, Boston Children's Hospital, Boston, MA, USA.,Department of Pediatrics, Harvard Medical School, Boston, MA, USA
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Developmental Abnormalities of the Skull Base in Patients with Turner Syndrome. CURRENT HEALTH SCIENCES JOURNAL 2021; 46:329-335. [PMID: 33717506 PMCID: PMC7948014 DOI: 10.12865/chsj.46.04.02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 12/18/2020] [Indexed: 12/02/2022]
Abstract
The skull base is one of the most complex anatomic structures of the skeleton that is responsible for protecting and supporting the brain and is also involved in the development of the facial structures. The main objective of our study was to evaluate skull base abnormalities in a group of patients diagnosed with Turner syndrome by assessing lateral cephalometric radiographs. A total of 7 patients diagnosed with Turner syndrome in the Endocrinology Department of the Emergency Clinical County Hospital of Craiova were included in the study. The following cephalometric variables were measured in our study: total skull base (N-Ba): Nasion (N)-Basion (Ba); anterior skull base (N-S): Nasion (N)-Sella (S); posterior skull base (S-Ba): Sella (S)-Basion (Ba). Regarding the investigated cephalometric variables, the mean±standard deviation (SD) recorded values in our study were 86.34±4.26mm for the total skull base (N-Ba), 63.87±2.54mm for the anterior skull base (N-S) and 38.33±4.87mm for the posterior skull base (S-Ba). The results of our study were compared to the ones provided by one of the most representative studies described in the literature. A reduced size of the posterior base of the skull is considered pathognomonic in subjects diagnosed with Turner syndrome. Also, the posterior base of the skull directly influences the maxillomandibular skeletal relationships and it is therefore necessary to calculate this cephalometric variable, which is easily highlighted on a lateral cephalometric radiograph.
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Liu X, Du Z, Yi X, Sheng T, Yuan J, Jia J. Circular RNA circANAPC2 mediates the impairment of endochondral ossification by miR-874-3p/SMAD3 signalling pathway in idiopathic short stature. J Cell Mol Med 2021; 25:3408-3426. [PMID: 33713570 PMCID: PMC8034469 DOI: 10.1111/jcmm.16419] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 02/06/2021] [Accepted: 02/10/2021] [Indexed: 02/06/2023] Open
Abstract
Idiopathic short stature (ISS) is a main reason for low height among children. Its exact aetiology remains unclear. Recent findings have suggested that the aberrant expression of circRNAs in peripheral blood samples is associated with many diseases. However, to date, the role of aberrant circRNA expression in mediating ISS pathogenesis remains largely unknown. The up‐regulated circANAPC2 was identified by circRNA microarray analysis and RT‐qPCR. Overexpression of circANAPC2 inhibited the proliferation of human chondrocytes, and cell cycle was arrested in G1 phase. The expressions of collagen type X, RUNX2, OCN and OPN were significantly down‐regulated following circANAPC2 overexpression. Moreover, Von Kossa staining intensity and alkaline phosphatase activity were also decreased. Luciferase reporter assay results showed that circANAPC2 could be targeted by miR‐874‐3p. CircANAPC2 overexpression in human chondrocytes inhibits the expression of miR‐874‐3p. The co‐localization of circANAPC2 and miR‐874‐3p was confirmed in both human chondrocytes and murine femoral growth plates via in situ hybridization. The rescue experiment demonstrated that the high expression of miR‐874‐3p overexpression antagonized the suppression of endochondral ossification, hypertrophy and chondrocyte growth caused by circANAPC2 overexpression. A high‐throughput screening of mRNA expression and RT‐qPCR verified SMAD3 demonstrated the highest different expressions following overcircANAPC2. Luciferase reporter assay results indicated that miR‐874‐3p could be targeted by Smad3, thus down‐regulating the expression of Smad3. Subsequent rescue experiments of SMAD3 further confirmed that circANAPC2 suppresses endochondral ossification, hypertrophy and chondrocyte growth through miR‐874‐3p/Smad3 axis. The present study provides evidence that circANAPC2 can serve as a promising target for ISS treatment.
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Affiliation(s)
- Xijuan Liu
- Department of Pediatrics, The Second Affiliated Hospital of Nanchang University, Nanchang City, China
| | - Zhi Du
- Department of Orthopaedics, The Second Affiliated Hospital of Nanchang University, Nanchang City, China
| | - Xuan Yi
- Department of Orthopaedics, The Second Affiliated Hospital of Nanchang University, Nanchang City, China
| | - Tianle Sheng
- Department of Molecular laboratory, The Second Affiliated Hospital of Nanchang University, Nanchang City, China
| | - Jinghong Yuan
- Department of Orthopaedics, The Second Affiliated Hospital of Nanchang University, Nanchang City, China
| | - Jingyu Jia
- Department of Orthopaedics, The Second Affiliated Hospital of Nanchang University, Nanchang City, China
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Integrative bioinformatic analyses of genome-wide association studies for understanding the genetic bases of human height. Biologia (Bratisl) 2020. [DOI: 10.2478/s11756-020-00550-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Inzaghi E, Reiter E, Cianfarani S. The Challenge of Defining and Investigating the Causes of Idiopathic Short Stature and Finding an Effective Therapy. Horm Res Paediatr 2020; 92:71-83. [PMID: 31578025 DOI: 10.1159/000502901] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 08/26/2019] [Indexed: 11/19/2022] Open
Abstract
Idiopathic short stature (ISS) comprises a wide range of conditions associated with short stature that elude the conventional diagnostic work-up and are often caused by still largely unknown genetic variants. In the last decade, the improvement of diagnostic techniques has led to the discovery of causal mutations in genes involved in the function of the growth hormone (GH)/insulin-like growth factor-I (IGF-I) axis as well as in growth plate physiology. However, many cases of ISS remain idiopathic. In the future, the more frequent identification of the underlying causes will allow a better stratification of subjects and offer a tailored management. GH therapy has been proposed and approved in some countries for the treatment of children with ISS. To improve the efficacy of GH therapy, trials with GH combined with GnRH agonists, aromatase inhibitors, and even IGF-I have been conducted. This review aims to revise the current definition of ISS and discuss the management of children with ISS on the basis of the most recent evidence.
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Affiliation(s)
- Elena Inzaghi
- Dipartimento Pediatrico Universitario Ospedaliero Bambino Gesù Children's Hospital - Tor Vergata University, Rome, Italy
| | - Edward Reiter
- Baystate Children's Hosptal, University of Massachusetts Medical School-Baystate, Springfield, Massachusetts, USA
| | - Stefano Cianfarani
- Dipartimento Pediatrico Universitario Ospedaliero Bambino Gesù Children's Hospital - Tor Vergata University, Rome, Italy, .,Department of Women's and Children's Health, Karolinska Institutet and University Hospital, Stockholm, Sweden,
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Wit JM, Deeb A, Bin-Abbas B, Al Mutair A, Koledova E, Savage MO. Achieving Optimal Short- and Long-term Responses to Paediatric Growth Hormone Therapy. J Clin Res Pediatr Endocrinol 2019; 11:329-340. [PMID: 31284701 PMCID: PMC6878339 DOI: 10.4274/jcrpe.galenos.2019.2019.0088] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 07/05/2019] [Indexed: 02/07/2023] Open
Abstract
It is over sixty years since the first administration of human growth hormone (GH) to children with GH deficiency, and over thirty years since recombinant human GH has been available for treatment of GH deficiency and a wider range of non-GH deficiency disorders. From a diagnostic perspective, genetic analysis, using single gene or Sanger sequencing and more recently next generation or whole exome sequencing, has brought advances in the diagnosis of specific causes of short stature, which has enabled therapy to be targeted more accurately. Genetic discoveries have ranged from defects of pituitary development and GH action to abnormalities in intracellular mechanisms, paracrine regulation and cartilage matrix formation. The strategy of GH therapy using standard doses has evolved to individualised GH dosing, depending on diagnosis and predictors of growth response. Evidence of efficacy of GH in GH deficiency, Turner syndrome and short children born small for gestational age is reviewed. The importance of critical assessment of growth response is discussed, together with the recognition and management of a poor or unsatisfactory growth response and the organisational issues related to prevention, detection and intervention regarding suboptimal adherence to GH therapy.
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Affiliation(s)
- Jan M. Wit
- Leiden University Medical Centre, Department of Paediatrics, Leiden, Netherlands
| | - Asma Deeb
- Mafraq Hospital, Clinic of Paediatric Endocrinology, Abu Dhabi, United Arab Emirates
| | - Bassam Bin-Abbas
- King Faisal Specialist Hospital and Research Center, Department of Paediatrics, Riyadh, Saudi Arabia
| | - Angham Al Mutair
- King Abdullah Specialised Children’s Hospital, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research, Clinic of Paediatrics, Riyadh, Saudi Arabia
- King Saud bin Abdulaziz University for Health Science, Clinic of Paediatrics, Riyadh, Saudi Arabia
| | | | - Martin O. Savage
- William Harvey Research Institute, Barts and the London Faculty of Medicine and Dentistry, London, United Kingdom
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Derraik JGB, Miles HL, Chiavaroli V, Hofman PL, Cutfield WS. Idiopathic short stature and growth hormone sensitivity in prepubertal children. Clin Endocrinol (Oxf) 2019; 91:110-117. [PMID: 30908679 DOI: 10.1111/cen.13976] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 03/13/2019] [Accepted: 03/20/2019] [Indexed: 01/01/2023]
Abstract
OBJECTIVE We compared growth hormone sensitivity to an insulin-like growth factor I (IGF-I) generation test in children with idiopathic short stature (ISS) and of normal stature (NS) across the birthweight range. METHODS Forty-six prepubertal children (~7.1 years) born at term were studied: ISS (n = 23; 74% boys) and NS (n = 23; 57% boys). Children underwent a modified IGF-I generation test with recombinant human growth hormone (rhGH; 0.05 mg/kg/d) over four consecutive days. Hormonal concentrations were measured at baseline and day 5. RESULTS Children with idiopathic short stature were 1.90 SDS lighter (P < 0.0001) but had 4.5% more body fat (P = 0.0007) than NS children. Overall, decreasing birthweight SDS across the normal range (-1.9 to +1.5 SDS) was associated with lower percentage IGF-I response to rhGH stimulation in univariable (r = 0.45; P = 0.002) and multivariable models (β = 24.6; P = 0.006). Plasma IGF-I concentrations rose in both groups with rhGH stimulation (P < 0.0001). GHBP levels (P = 0.002) were suppressed in ISS children (-19%; P = 0.029) but increased among NS children (+18%; P = 0.028), with contrasting responses also observed for leptin and IGFBP-1. Further, the increase in insulin concentrations in response to rhGH stimulation was ~3-fold greater in NS children (142% vs 50%; P = 0.006). CONCLUSIONS A progressive decrease in birthweight SDS was associated with a reduction in GH sensitivity in both NS and ISS children. Thus, the lower IGF-I response to rhGH stimulation in association with decreasing birthweight indicates that the ISS children at the lower end of the birthweight spectrum may have partial GH resistance, which may contribute to their poorer growth.
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Affiliation(s)
- José G B Derraik
- Liggins Institute, University of Auckland, Auckland, New Zealand
- A Better Start - National Science Challenge, University of Auckland, Auckland, New Zealand
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Harriet L Miles
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | | | - Paul L Hofman
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Wayne S Cutfield
- Liggins Institute, University of Auckland, Auckland, New Zealand
- A Better Start - National Science Challenge, University of Auckland, Auckland, New Zealand
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16
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Murray PG, Clayton PE, Chernausek SD. A genetic approach to evaluation of short stature of undetermined cause. Lancet Diabetes Endocrinol 2018; 6:564-574. [PMID: 29397377 DOI: 10.1016/s2213-8587(18)30034-2] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 11/22/2017] [Accepted: 12/02/2017] [Indexed: 12/15/2022]
Abstract
Short stature is a common presentation to paediatric endocrinologists. After exclusion of major endocrine or systemic disease, most children with short stature are diagnosed based on a description of their growth pattern and the height of their parents (eg, familial short stature). Height is a polygenic trait and genome-wide association studies have identified many of the associated genetic loci. Here we review the application of genetic studies, including copy number variant analysis, targeted gene panels, and whole-exome sequencing in children with idiopathic short stature. We estimate 25-40% of children diagnosed with idiopathic short stature could receive a molecular diagnosis using these technologies. A molecular diagnosis for short stature is important for affected individuals and their families and might inform treatment decisions surrounding use of growth hormone or insulin-like growth factor 1 therapy.
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Affiliation(s)
- Philip G Murray
- Department of Paediatric Endocrinology, Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK; Division of Developmental Biology and Medicine, School of Medical Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester, UK
| | - Peter E Clayton
- Department of Paediatric Endocrinology, Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK; Division of Developmental Biology and Medicine, School of Medical Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester, UK
| | - Steven D Chernausek
- Diabetes and Endocrinology, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
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17
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Davidopoulou S, Chatzigianni A. Craniofacial morphology and dental maturity in children with reduced somatic growth of different aetiology and the effect of growth hormone treatment. Prog Orthod 2017; 18:10. [PMID: 28447324 PMCID: PMC5406315 DOI: 10.1186/s40510-017-0164-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 04/07/2017] [Indexed: 01/08/2023] Open
Abstract
Children with reduced somatic growth may present various endocrinal diseases, especially growth hormone deficiency (GHD), idiopathic short stature (ISS), chromosomal aberrations, or genetic disorders. In an attempt to normalize the short stature, growth hormone (GH) is administered to these children. The aim of this literature review was to collect information about the craniofacial morphology and dental maturity in these children and to present the existing knowledge on the effect of GH treatment on the above structures. This review demonstrated that regardless of the origin of the somatic growth retardation, these children show similar craniofacial features, such as short length of the cranial base and the mandible, increased lower facial height, retropositioned mandible, and obtuse gonion angle. On the other hand, dental maturation does not demonstrate a specific pattern. Except for the above findings, muscle alterations seem to be present in individuals with short stature, who present low body muscle mass and strength, while studies on their craniofacial muscles seem to be lacking. After GH administration, the exact amount and pattern of craniofacial growth is unpredictable; however, the facial convexity decreases, mandibular length increases, and posterior facial height increases, while tooth eruption remains unaffected. Thus, it is of great importance to gain more insight into the craniofacial growth of treated and untreated children with reduced somatic growth so that the influence of GH therapy on the various craniofacial structures could be ascertained and proper orthodontic treatment could be selected.
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Affiliation(s)
- Sotiria Davidopoulou
- Department of Preventive Dentistry, Periodontology and Implant Biology, School of Dentistry, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, 54124, Greece
| | - Athina Chatzigianni
- Department of Orthodontics, School of Dentistry, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, 54124, Greece.
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18
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Cheung LYM, Okano H, Camper SA. Sox21 deletion in mice causes postnatal growth deficiency without physiological disruption of hypothalamic-pituitary endocrine axes. Mol Cell Endocrinol 2017; 439:213-223. [PMID: 27616671 PMCID: PMC5123967 DOI: 10.1016/j.mce.2016.09.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 09/07/2016] [Accepted: 09/07/2016] [Indexed: 12/23/2022]
Abstract
The hypothalamic-pituitary axes are the coordinating centers for multiple endocrine gland functions and physiological processes. Defects in the hypothalamus or pituitary gland can cause reduced growth and severe short stature, affecting approximately 1 in 4000 children, and a large percentage of cases of pituitary hormone deficiencies do not have an identified genetic cause. SOX21 is a protein that regulates hair, neural, and trophoblast stem cell differentiation. Mice lacking Sox21 have reduced growth, but the etiology of this growth defect has not been described. We studied the expression of Sox21 in hypothalamic-pituitary development and examined multiple endocrine axes in these mice. We find no evidence of reduced intrauterine growth, food intake, or physical activity, but there is evidence for increased energy expenditure in mutants. In addition, despite changes in pituitary hormone expression, hypothalamic-pituitary axes appear to be functional. Therefore, SOX21 variants may be a cause of non-endocrine short stature in humans.
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Affiliation(s)
- Leonard Y M Cheung
- Department of Human Genetics, University of Michigan, Ann Arbor, MI, USA
| | - Hideyuki Okano
- Department of Physiology, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Sally A Camper
- Department of Human Genetics, University of Michigan, Ann Arbor, MI, USA.
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19
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Almeida M, Laurent MR, Dubois V, Claessens F, O'Brien CA, Bouillon R, Vanderschueren D, Manolagas SC. Estrogens and Androgens in Skeletal Physiology and Pathophysiology. Physiol Rev 2017; 97:135-187. [PMID: 27807202 PMCID: PMC5539371 DOI: 10.1152/physrev.00033.2015] [Citation(s) in RCA: 460] [Impact Index Per Article: 65.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Estrogens and androgens influence the growth and maintenance of the mammalian skeleton and are responsible for its sexual dimorphism. Estrogen deficiency at menopause or loss of both estrogens and androgens in elderly men contribute to the development of osteoporosis, one of the most common and impactful metabolic diseases of old age. In the last 20 years, basic and clinical research advances, genetic insights from humans and rodents, and newer imaging technologies have changed considerably the landscape of our understanding of bone biology as well as the relationship between sex steroids and the physiology and pathophysiology of bone metabolism. Together with the appreciation of the side effects of estrogen-related therapies on breast cancer and cardiovascular diseases, these advances have also drastically altered the treatment of osteoporosis. In this article, we provide a comprehensive review of the molecular and cellular mechanisms of action of estrogens and androgens on bone, their influences on skeletal homeostasis during growth and adulthood, the pathogenetic mechanisms of the adverse effects of their deficiency on the female and male skeleton, as well as the role of natural and synthetic estrogenic or androgenic compounds in the pharmacotherapy of osteoporosis. We highlight latest advances on the crosstalk between hormonal and mechanical signals, the relevance of the antioxidant properties of estrogens and androgens, the difference of their cellular targets in different bone envelopes, the role of estrogen deficiency in male osteoporosis, and the contribution of estrogen or androgen deficiency to the monomorphic effects of aging on skeletal involution.
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Affiliation(s)
- Maria Almeida
- Division of Endocrinology and Metabolism, Center for Osteoporosis and Metabolic Bone Diseases, University of Arkansas for Medical Sciences and the Central Arkansas Veterans Healthcare System, Little Rock, Arkansas; Departments of Cellular and Molecular Medicine and Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium; Center for Metabolic Bone Diseases, University Hospitals Leuven, Leuven, Belgium; and Institut National de la Santé et de la Recherche Médicale UMR1011, University of Lille and Institut Pasteur de Lille, Lille, France
| | - Michaël R Laurent
- Division of Endocrinology and Metabolism, Center for Osteoporosis and Metabolic Bone Diseases, University of Arkansas for Medical Sciences and the Central Arkansas Veterans Healthcare System, Little Rock, Arkansas; Departments of Cellular and Molecular Medicine and Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium; Center for Metabolic Bone Diseases, University Hospitals Leuven, Leuven, Belgium; and Institut National de la Santé et de la Recherche Médicale UMR1011, University of Lille and Institut Pasteur de Lille, Lille, France
| | - Vanessa Dubois
- Division of Endocrinology and Metabolism, Center for Osteoporosis and Metabolic Bone Diseases, University of Arkansas for Medical Sciences and the Central Arkansas Veterans Healthcare System, Little Rock, Arkansas; Departments of Cellular and Molecular Medicine and Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium; Center for Metabolic Bone Diseases, University Hospitals Leuven, Leuven, Belgium; and Institut National de la Santé et de la Recherche Médicale UMR1011, University of Lille and Institut Pasteur de Lille, Lille, France
| | - Frank Claessens
- Division of Endocrinology and Metabolism, Center for Osteoporosis and Metabolic Bone Diseases, University of Arkansas for Medical Sciences and the Central Arkansas Veterans Healthcare System, Little Rock, Arkansas; Departments of Cellular and Molecular Medicine and Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium; Center for Metabolic Bone Diseases, University Hospitals Leuven, Leuven, Belgium; and Institut National de la Santé et de la Recherche Médicale UMR1011, University of Lille and Institut Pasteur de Lille, Lille, France
| | - Charles A O'Brien
- Division of Endocrinology and Metabolism, Center for Osteoporosis and Metabolic Bone Diseases, University of Arkansas for Medical Sciences and the Central Arkansas Veterans Healthcare System, Little Rock, Arkansas; Departments of Cellular and Molecular Medicine and Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium; Center for Metabolic Bone Diseases, University Hospitals Leuven, Leuven, Belgium; and Institut National de la Santé et de la Recherche Médicale UMR1011, University of Lille and Institut Pasteur de Lille, Lille, France
| | - Roger Bouillon
- Division of Endocrinology and Metabolism, Center for Osteoporosis and Metabolic Bone Diseases, University of Arkansas for Medical Sciences and the Central Arkansas Veterans Healthcare System, Little Rock, Arkansas; Departments of Cellular and Molecular Medicine and Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium; Center for Metabolic Bone Diseases, University Hospitals Leuven, Leuven, Belgium; and Institut National de la Santé et de la Recherche Médicale UMR1011, University of Lille and Institut Pasteur de Lille, Lille, France
| | - Dirk Vanderschueren
- Division of Endocrinology and Metabolism, Center for Osteoporosis and Metabolic Bone Diseases, University of Arkansas for Medical Sciences and the Central Arkansas Veterans Healthcare System, Little Rock, Arkansas; Departments of Cellular and Molecular Medicine and Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium; Center for Metabolic Bone Diseases, University Hospitals Leuven, Leuven, Belgium; and Institut National de la Santé et de la Recherche Médicale UMR1011, University of Lille and Institut Pasteur de Lille, Lille, France
| | - Stavros C Manolagas
- Division of Endocrinology and Metabolism, Center for Osteoporosis and Metabolic Bone Diseases, University of Arkansas for Medical Sciences and the Central Arkansas Veterans Healthcare System, Little Rock, Arkansas; Departments of Cellular and Molecular Medicine and Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium; Center for Metabolic Bone Diseases, University Hospitals Leuven, Leuven, Belgium; and Institut National de la Santé et de la Recherche Médicale UMR1011, University of Lille and Institut Pasteur de Lille, Lille, France
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Al Herbish AS, Almutair A, Bin Abbas B, Alsagheir A, Alqahtani M, Kaplan W, Deeb A, El-Awwa A, Al Khawari M, Koledova E, Savage MO. Diagnosis and management of growth disorders in Gulf Cooperation Council (GCC) countries: Current procedures and key recommendations for best practice. Int J Pediatr Adolesc Med 2016; 3:91-102. [PMID: 30805477 PMCID: PMC6372455 DOI: 10.1016/j.ijpam.2016.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 07/04/2016] [Accepted: 07/04/2016] [Indexed: 11/26/2022]
Abstract
Diagnosis and management of growth disorders comprises an important area of pediatric practice. Current procedures in the different stages of the identification, referral, investigation, and treatment of growth disorders in the Gulf Cooperation Council (GCC) countries have been summarized. Evidence-based procedures, relating specifically to height screening for identification of short stature, auxological criteria for patient referral from primary to secondary pediatric care, and general and endocrine investigations and diagnosis have been discussed and outlined. The management issues related to key disorders that are licensed for growth hormone (hGH) therapy, namely GH deficiency, Turner syndrome, short stature related to birth size small for gestational age (SGA), and idiopathic short stature are discussed with recommendations described for best practice. Finally, two key components of short stature management, namely transitional care for the transfer of patients from pediatric to adult endocrinology services and adherence to recommended therapy with hGH, have been addressed with current practice outlines and recommendations presented.
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Affiliation(s)
| | - Angham Almutair
- King Abdullah Specialist Children's Hospital, King Saud bin Abdulaziz University for Health Science, Saudi Arabia
| | - Bassam Bin Abbas
- King Faisal Specialist Hospital and Research Centre, Saudi Arabia
| | - Afaf Alsagheir
- King Faisal Specialist Hospital and Research Centre, Saudi Arabia
| | | | | | - Asma Deeb
- Mafraq Hospital, Abu Dhabi, United Arab Emirates
| | - Ahmed El-Awwa
- Hamad Medical Corporation, Qatar and Alexandria Children's Hospital, Cairo, Egypt
| | | | | | - Martin O. Savage
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, UK
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21
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Marchini A, Ogata T, Rappold GA. A Track Record on SHOX: From Basic Research to Complex Models and Therapy. Endocr Rev 2016; 37:417-48. [PMID: 27355317 PMCID: PMC4971310 DOI: 10.1210/er.2016-1036] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
SHOX deficiency is the most frequent genetic growth disorder associated with isolated and syndromic forms of short stature. Caused by mutations in the homeobox gene SHOX, its varied clinical manifestations include isolated short stature, Léri-Weill dyschondrosteosis, and Langer mesomelic dysplasia. In addition, SHOX deficiency contributes to the skeletal features in Turner syndrome. Causative SHOX mutations have allowed downstream pathology to be linked to defined molecular lesions. Expression levels of SHOX are tightly regulated, and almost half of the pathogenic mutations have affected enhancers. Clinical severity of SHOX deficiency varies between genders and ranges from normal stature to profound mesomelic skeletal dysplasia. Treatment options for children with SHOX deficiency are available. Two decades of research support the concept of SHOX as a transcription factor that integrates diverse aspects of bone development, growth plate biology, and apoptosis. Due to its absence in mouse, the animal models of choice have become chicken and zebrafish. These models, therefore, together with micromass cultures and primary cell lines, have been used to address SHOX function. Pathway and network analyses have identified interactors, target genes, and regulators. Here, we summarize recent data and give insight into the critical molecular and cellular functions of SHOX in the etiopathogenesis of short stature and limb development.
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Affiliation(s)
- Antonio Marchini
- Tumour Virology Division F010 (A.M.), German Cancer Research Center, 69120 Heidelberg, Germany; Department of Oncology (A.M.), Luxembourg Institute of Health 84, rue Val Fleuri L-1526, Luxembourg; Department of Pediatrics (T.O.), Hamamatsu University School of Medicine, Higashi-ku, Hamamatsu 431-3192, Japan; and Department of Human Molecular Genetics (G.A.R.), Institute of Human Genetics, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Tsutomu Ogata
- Tumour Virology Division F010 (A.M.), German Cancer Research Center, 69120 Heidelberg, Germany; Department of Oncology (A.M.), Luxembourg Institute of Health 84, rue Val Fleuri L-1526, Luxembourg; Department of Pediatrics (T.O.), Hamamatsu University School of Medicine, Higashi-ku, Hamamatsu 431-3192, Japan; and Department of Human Molecular Genetics (G.A.R.), Institute of Human Genetics, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Gudrun A Rappold
- Tumour Virology Division F010 (A.M.), German Cancer Research Center, 69120 Heidelberg, Germany; Department of Oncology (A.M.), Luxembourg Institute of Health 84, rue Val Fleuri L-1526, Luxembourg; Department of Pediatrics (T.O.), Hamamatsu University School of Medicine, Higashi-ku, Hamamatsu 431-3192, Japan; and Department of Human Molecular Genetics (G.A.R.), Institute of Human Genetics, Heidelberg University Hospital, 69120 Heidelberg, Germany
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Choi SH, Fan D, Hwang MS, Lee HK, Hwang CJ. Effect of growth hormone treatment on craniofacial growth in children: Idiopathic short stature versus growth hormone deficiency. J Formos Med Assoc 2016; 116:313-321. [PMID: 27421175 DOI: 10.1016/j.jfma.2016.05.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 05/17/2016] [Accepted: 05/26/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND/PURPOSE Few studies have evaluated craniofacial growth in boys and girls with idiopathic short stature (ISS) during growth hormone (GH) treatment. The aim of this study was to evaluate the effect of GH treatment on craniofacial growth in children with ISS, compared with those with growth hormone deficiency (GHD). METHODS This study included 36 children (mean age, 11.3 ± 1.8 years) who were treated with GH consecutively. Lateral cephalograms were analyzed before and 2 years after start of GH treatment. RESULTS There were no significant differences in age and sex between ISS and GHD groups and the reference group from semilongitudinal study (10 boys and 8 girls from each group). Before treatment, girls with ISS showed a skeletal Class II facial profile compared with the GHD and reference groups (p = 0.003). During GH treatment, the amount of maxillary length increased beyond norm in the ISS and GHD groups in boys (p = 0.035) > 3 standard deviation score (SDS). Meanwhile, mandibular ramus height (p = 0.001), corpus length, and total mandibular length (p = 0.007 for both) increased more in girls with ISS than in girls with GHD. Lower and total anterior facial heights increased more in girls with ISS than in girls with GHD (p = 0.021 and p = 0.007, respectively), > 7-11 SDS. CONCLUSION GH should be administered carefully when treating girls with ISS, because GH treatment has great effects on vertical overgrowth of the mandible and can result in longer face.
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Affiliation(s)
- Sung-Hwan Choi
- Department of Orthodontics, The Institute of Cranial-Facial Deformity, College of Dentistry, Yonsei University, Seoul, South Korea
| | - Dong Fan
- Department of Dentistry, College of Medicine, Yeungnam University, Daegu, South Korea
| | - Mi-Soo Hwang
- Department of Radiology, College of Medicine, Yeungnam University, Daegu, South Korea
| | - Hee-Kyung Lee
- Department of Dentistry, College of Medicine, Yeungnam University, Daegu, South Korea.
| | - Chung-Ju Hwang
- Department of Orthodontics, The Institute of Cranial-Facial Deformity, College of Dentistry, Yonsei University, Seoul, South Korea.
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Counts DR, Silverman LA, Rajicic N, Geffner ME, Newfield RS, Thornton P, Carakushansky M, Escobar O, Rapaport R, Levitsky L, Rotenstein D, Hey-Hadavi J, Wajnrajch MP. A 4-Year, Open-Label, Multicenter, Randomized Trial of Genotropin® Growth Hormone in Patients with Idiopathic Short Stature: Analysis of 4-Year Data Comparing Efficacy, Efficiency, and Safety between an Individualized, Target-Driven Regimen and Standard Dosing. Horm Res Paediatr 2016; 84:79-87. [PMID: 25966824 DOI: 10.1159/000381642] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 03/12/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Growth hormone (GH) treatment regimens for children with non-GH-deficient, idiopathic short stature (ISS) have not been optimized. To compare the efficacy, efficiency, and safety of an individualized, target-driven GH regimen with standard weight-based dosing after 4 years of treatment. METHODS This is a 4-year, open-label, multicenter, randomized trial comparing individualized, formula-based dosing of Genotropin® versus a widely used ISS dose of Genotropin®. Subjects were prepubertal, had a bone age of 3-10 years for males and 3-9 years for females, were naive to GH treatment, and had a height standard deviation score (Ht SDS) of -3 to -2.25, a height velocity <25th percentile for their bone age, and peak stimulated GH >10 ng/ml. After the first 2 years, the individualized-dosing group was further randomized to either 0.18 or 0.24 mg/kg/week. RESULTS At 4 years, subjects in all treatment regimens achieved similar average height gains of +1.3 SDS; however, the individualized dosing regimen utilized less GH to achieve an equivalent height gain. CONCLUSION Individualized, formula-based GH dosing, followed by a dose reduction after 2 years, provides a more cost-effective growth improvement in patients with ISS than currently employed weight-based regimens.
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Affiliation(s)
- Debra R Counts
- University of Maryland School of Medicine, Baltimore, Md., USA
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24
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Wong SC, Dobie R, Altowati MA, Werther GA, Farquharson C, Ahmed SF. Growth and the Growth Hormone-Insulin Like Growth Factor 1 Axis in Children With Chronic Inflammation: Current Evidence, Gaps in Knowledge, and Future Directions. Endocr Rev 2016; 37:62-110. [PMID: 26720129 DOI: 10.1210/er.2015-1026] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Growth failure is frequently encountered in children with chronic inflammatory conditions like juvenile idiopathic arthritis, inflammatory bowel disease, and cystic fibrosis. Delayed puberty and attenuated pubertal growth spurt are often seen during adolescence. The underlying inflammatory state mediated by proinflammatory cytokines, prolonged use of glucocorticoid, and suboptimal nutrition contribute to growth failure and pubertal abnormalities. These factors can impair growth by their effects on the GH-IGF axis and also directly at the level of the growth plate via alterations in chondrogenesis and local growth factor signaling. Recent studies on the impact of cytokines and glucocorticoid on the growth plate further advanced our understanding of growth failure in chronic disease and provided a biological rationale of growth promotion. Targeting cytokines using biological therapy may lead to improvement of growth in some of these children, but approximately one-third continue to grow slowly. There is increasing evidence that the use of relatively high-dose recombinant human GH may lead to partial catch-up growth in chronic inflammatory conditions, although long-term follow-up data are currently limited. In this review, we comprehensively review the growth abnormalities in children with juvenile idiopathic arthritis, inflammatory bowel disease, and cystic fibrosis, systemic abnormalities of the GH-IGF axis, and growth plate perturbations. We also systematically reviewed all the current published studies of recombinant human GH in these conditions and discussed the role of recombinant human IGF-1.
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Affiliation(s)
- S C Wong
- Developmental Endocrinology Research Group (S.C.W., M.A.A., S.F.A.), University of Glasgow, Royal Hospital for Children, Glasgow G51 4TF, United Kingdom; Division of Developmental Biology (R.D., C.F.), Roslin Institute, University of Edinburgh, Midlothian EH25 9RG, United Kingdom; and Hormone Research (G.A.W.), Murdoch Children's Research Institute, Melbourne, VIC 3052, Australia
| | - R Dobie
- Developmental Endocrinology Research Group (S.C.W., M.A.A., S.F.A.), University of Glasgow, Royal Hospital for Children, Glasgow G51 4TF, United Kingdom; Division of Developmental Biology (R.D., C.F.), Roslin Institute, University of Edinburgh, Midlothian EH25 9RG, United Kingdom; and Hormone Research (G.A.W.), Murdoch Children's Research Institute, Melbourne, VIC 3052, Australia
| | - M A Altowati
- Developmental Endocrinology Research Group (S.C.W., M.A.A., S.F.A.), University of Glasgow, Royal Hospital for Children, Glasgow G51 4TF, United Kingdom; Division of Developmental Biology (R.D., C.F.), Roslin Institute, University of Edinburgh, Midlothian EH25 9RG, United Kingdom; and Hormone Research (G.A.W.), Murdoch Children's Research Institute, Melbourne, VIC 3052, Australia
| | - G A Werther
- Developmental Endocrinology Research Group (S.C.W., M.A.A., S.F.A.), University of Glasgow, Royal Hospital for Children, Glasgow G51 4TF, United Kingdom; Division of Developmental Biology (R.D., C.F.), Roslin Institute, University of Edinburgh, Midlothian EH25 9RG, United Kingdom; and Hormone Research (G.A.W.), Murdoch Children's Research Institute, Melbourne, VIC 3052, Australia
| | - C Farquharson
- Developmental Endocrinology Research Group (S.C.W., M.A.A., S.F.A.), University of Glasgow, Royal Hospital for Children, Glasgow G51 4TF, United Kingdom; Division of Developmental Biology (R.D., C.F.), Roslin Institute, University of Edinburgh, Midlothian EH25 9RG, United Kingdom; and Hormone Research (G.A.W.), Murdoch Children's Research Institute, Melbourne, VIC 3052, Australia
| | - S F Ahmed
- Developmental Endocrinology Research Group (S.C.W., M.A.A., S.F.A.), University of Glasgow, Royal Hospital for Children, Glasgow G51 4TF, United Kingdom; Division of Developmental Biology (R.D., C.F.), Roslin Institute, University of Edinburgh, Midlothian EH25 9RG, United Kingdom; and Hormone Research (G.A.W.), Murdoch Children's Research Institute, Melbourne, VIC 3052, Australia
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Abstract
INTRODUCTION Dwarfism is a challenge in arthroplasty. The anatomical features provide a lot of pitfalls. The aim of this study was to follow-up growth-restricted patients after endoprosthetic treatment. MATERIALS AND METHODS 138 knee arthroplasties in patients with a height ≤150 cm between January 1, 2000 and May 5, 2013 at our institution were enrolled in this study. 124 cases were available for 1-year follow-up. Out of these, 43 cases were available for 5-year follow-up so far. 14 patients were lost to follow-up. RESULTS IKS score increased from 35 ± 16 on admission to 67 ± 22 (p < 0.001) at 1-year follow-up and 65 ± 23 (p < 0.001) at 5-year follow-up. Function Score increased from 40 ± 29 on admission to 64 ± 21 (p < 0.001) at 1-year follow-up and 63 ± 23 (p < 0.001) at 5-year follow-up. Revision surgery was required in one case (0.8 %) after 1-year follow-up, and in an additional three cases (7 %) after 5-year follow-up. CONCLUSIONS Knee arthroplasty can be performed in patients suffering from dwarfism with good clinical benefits. However, survival rates are worse compared to the general population.
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Ouni M, Castell AL, Linglart A, Bougnères P. Genetic and Epigenetic Modulation of Growth Hormone Sensitivity Studied With the IGF-1 Generation Test. J Clin Endocrinol Metab 2015; 100:E919-25. [PMID: 25835289 PMCID: PMC4454803 DOI: 10.1210/jc.2015-1413] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
CONTEXT Like all hormones, GH has variable physiological effects across people. Many of these effects initiated by the binding of GH to its receptor (GHR) in target tissues are mediated by the expression of the IGF1 gene. Genetic as well as epigenetic variation is known to contribute to the individual diversity of GH-dependent phenotypes through two mechanisms. The first one is the genetic polymorphism of the GHR gene due to the common deletion of exon 3. The second, more recently reported, is the epigenetic variation in the methylation of a cluster of CGs dinucleotides located within the proximal part of the P2 promoter of the IGF-1 (IGF1) gene, notably CG-137. OBJECTIVE The current study evaluates the relative contribution of these two factors controlling individual GH sensitivity by measuring the response of serum IGF-1 to a GH injection (IGF-1 generation test) in a sample of 72 children with idiopathic short stature. RESULTS Although the d3 polymorphism of the GHR contributed 19% to the variance of the IGF-1 response, CG-137 methylation in the IGF-1 promoter contributed 30%, the combined contribution of the two factors totaling 43%. CONCLUSION Our observation indicates that genetic and epigenetic variation at the GHR and IGF-1 loci play a major role as independent modulators of individual GH sensitivity.
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Affiliation(s)
- Meriem Ouni
- Institut National de la Santé et de la Recherche Médicale Unité 986 (M.O., A.-L.C., A.L., P.B.) and Department of Pediatric Endocrinology and Diabetes (A.-L.C., A.L., P.B.), Paris Sud University, Bicêtre Hospital, 94275 Le Kremlin-Bicêtre, France
| | - Anne-Laure Castell
- Institut National de la Santé et de la Recherche Médicale Unité 986 (M.O., A.-L.C., A.L., P.B.) and Department of Pediatric Endocrinology and Diabetes (A.-L.C., A.L., P.B.), Paris Sud University, Bicêtre Hospital, 94275 Le Kremlin-Bicêtre, France
| | - Agnès Linglart
- Institut National de la Santé et de la Recherche Médicale Unité 986 (M.O., A.-L.C., A.L., P.B.) and Department of Pediatric Endocrinology and Diabetes (A.-L.C., A.L., P.B.), Paris Sud University, Bicêtre Hospital, 94275 Le Kremlin-Bicêtre, France
| | - Pierre Bougnères
- Institut National de la Santé et de la Recherche Médicale Unité 986 (M.O., A.-L.C., A.L., P.B.) and Department of Pediatric Endocrinology and Diabetes (A.-L.C., A.L., P.B.), Paris Sud University, Bicêtre Hospital, 94275 Le Kremlin-Bicêtre, France
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27
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Abstract
Besides growth hormone, several pharmaceutical products have been investigated for efficacy and safety in increasing short term growth or adult height. Short-term treatment with testosterone esters in boys with constitutional delay of growth and puberty is efficacious in generating secondary sex characteristics and growth acceleration. The addition of oxandrolone to growth hormone (GH) in Turner syndrome has an additive effect on adult height gain. Treatment with GnRH analogs is the established treatment of central precocious puberty, and its addition to GH therapy appears effective in increasing adult height in GH deficient children, and possibly short children born SGA or with SHOX deficiency, who are still short at pubertal onset. Aromatase inhibitors appear effective in several rare disorders, but their value in increasing adult height in early pubertal boys with GH deficiency or idiopathic short stature is uncertain. A trial with a C-natriuretic peptide analog offers hope for children with achondroplasia.
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Affiliation(s)
- Jan M Wit
- Department of Paediatrics, Leiden University Medical Center, Leiden, The Netherlands.
| | - Wilma Oostdijk
- Department of Paediatrics, Leiden University Medical Center, Leiden, The Netherlands.
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Rothenbuhler A, Ormières B, Kalifa G, Bougnères P. A pilot study of growth hormone administration in boys with predicted adult short stature and near-ending growth. Growth Horm IGF Res 2015; 25:96-102. [PMID: 25641639 DOI: 10.1016/j.ghir.2015.01.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Revised: 01/16/2015] [Accepted: 01/19/2015] [Indexed: 10/24/2022]
Abstract
CONTEXT The growth-promoting effect of starting recombinant human growth hormone (rhGH) at the time of near-ending growth has not been studied in sexually mature boys who will have idiopathic short stature (ISS) as adults because it is believed that such an advanced stage of puberty would preclude favorable results. OBJECTIVES 1) To explore the effects of starting rhGH administration at time of near-ending growth in boys with ISS. 2) To search for predictors of response to rhGH. SUBJECTS Fifteen boys aged 15.5 ± 1 years terminating puberty were growing at a rate < 2 cm/6 months towards a predicted adult height (PAH) <-2.5 SDS. METHODS Participants received 0.50 ± 0.06 mg/kg · wk of rhGH according to a target-to-treat protocol. When growth became less than 0.5 cm in 3 months or when height has reached 169 cm, rhGH was ceased. Testosterone, growth velocity (GV), height, serum IGF-1, bone age (BA) at hand-wrist and knee score were measured at onset; IGF-1 and height were monitored every 3 months. A formula for PAH was developed. Height increment (HI, adult height-starting height) and height gain (HG, adult height-PAH) were calculated. RESULTS Following rhGH administration for 11.1 ± 4.8 months, GV-SDS increased from -2.5 ± 1.7 to 3.5 ± 4.3 (P = 2 × 10(-4)), HI = 8.5 ± 3.7 cm, HG = 6.8 ± 4.8 cm and adult height was -1.8 ± 0.9 SDS, compared to a PAH of -2.9 ± 0.6 SDS (P = 4 × 10(-4)). Knee score (P = 2 × 10(-3)), GV at rhGH onset (P = 8 × 10(-3)) and rhGH dose (P = 8 × 10(-3)) were identified as predictors of HI and HG, but BA was not. CONCLUSIONS Our study suggests that 1) a short period of rhGH administration can increase true adult height significantly in boys with ISS at time of near-ending growth; and 2) knee score rather than BA should be used to identify rhGH responders. These preliminary observations await confirmation by larger randomized trials.
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Affiliation(s)
- Anya Rothenbuhler
- AP-HP, Department of Pediatric Endocrinology, Bicêtre Hospital, Paris Sud University, 94275 Le Kremlin Bicêtre, France
| | - Baptiste Ormières
- Biomathematics Team, InsermU986, Pincus Building, Bicêtre Hospital, Paris Sud University, 94275 Le Kremlin Bicêtre, France
| | - Gabriel Kalifa
- AP-HP, Department of Pediatric Endocrinology, Bicêtre Hospital, Paris Sud University, 94275 Le Kremlin Bicêtre, France
| | - Pierre Bougnères
- AP-HP, Department of Pediatric Endocrinology, Bicêtre Hospital, Paris Sud University, 94275 Le Kremlin Bicêtre, France; Biomathematics Team, InsermU986, Pincus Building, Bicêtre Hospital, Paris Sud University, 94275 Le Kremlin Bicêtre, France.
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29
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Rothenbuhler A, Linglart A, Bougnères P. A randomized pilot trial of growth hormone with anastrozole versus growth hormone alone, starting at the very end of puberty in adolescents with idiopathic short stature. INTERNATIONAL JOURNAL OF PEDIATRIC ENDOCRINOLOGY 2015; 2015:4. [PMID: 25972902 PMCID: PMC4429943 DOI: 10.1186/1687-9856-2015-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Accepted: 12/22/2014] [Indexed: 11/10/2022]
Abstract
BACKGROUND When given during the course of puberty, anastrozole (A), an aromatase inhibitor, has been shown to increase the predicted adult height (PAH) of GH-deficient (GHD) boys treated with recombinant human growth hormone (rhGH). Our study questioned whether this treatment could retain some of its effects in non-GHD adolescent boys if started only at the very end of puberty, a time when rhGH treatment is denied to short adolescents who have almost reached their final height. OBJECTIVE To explore the effect on adult height of a combination of rhGH and A, compared with rhGH alone, at the end of puberty in boys with idiopatic short stature (ISS). METHODS A prospective randomized study comparing rhGH + A and rhGH was conducted in 24 healthy adolescent boys aged 15.2 ± 1.2 yrs with serum testosterone at adult levels and a faltering growth velocity <3.5 cm/yr leading to a predicted adult height (PAH) <2.5 SDS. Treatments were stopped when growth velocity became <10 mm in 6 months or when height was close to 170 cm. A historical group of ISS adolescents (N = 17) matched for puberty and growth was used for comparison. RESULTS IGF1 levels remained within normal limits in all treated patients. Mean treatment duration was 19 months in the rhGH + A group and 11.5 months in the rhGH group (P = 6.10(-4)). Adult height reached 168.4 ± 2.6 cm in the rhGH + A group and 164.2 ± 5.6 cm in the rhGH group (P < 0.02). Adult height was 160.1 ± 2.8 cm in the historical controls. CONCLUSION A combination of rhGH and A, started at the very end of puberty, seems to allow boys with ISS to reach a greater adult height than rhGH alone. Larger trials are needed to confirm this preliminary observation.
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Affiliation(s)
- Anya Rothenbuhler
- Department of Pediatric Endocrinology, Bicêtre Hospital, Pôle I3E, AP-HP, Paris Sud University, 94275 Le Kremlin Bicêtre, France
| | - Agnès Linglart
- Department of Pediatric Endocrinology, Bicêtre Hospital, Pôle I3E, AP-HP, Paris Sud University, 94275 Le Kremlin Bicêtre, France
| | - Pierre Bougnères
- Department of Pediatric Endocrinology, Bicêtre Hospital, Pôle I3E, AP-HP, Paris Sud University, 94275 Le Kremlin Bicêtre, France
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30
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Silva N, Bullinger M, Quitmann J, Ravens-Sieberer U, Rohenkohl A. HRQoL of European children and adolescents with short stature as assessed with generic (KIDSCREEN) and chronic-generic (DISABKIDS) instruments. Expert Rev Pharmacoecon Outcomes Res 2014; 13:817-27. [PMID: 24219053 DOI: 10.1586/14737167.2013.847366] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
UNLABELLED Short stature may be associated with impairments in health-related quality of life (HRQoL). This study compared the HRQoL of children/adolescents diagnosed with short stature to population norms and examined the effects of height deviation and treatment status on HRQoL. METHOD We cross-sectionally assessed 110 children/adolescents aged 8-18, with current short stature (height deviation ≤-2 standard-deviation (SD)) or normal height achieved since diagnosis, and 98 parents, using the generic KIDSCREEN and the chronic-generic DISABKIDS instruments. RESULTS Generic HRQoL of patients was similar to population norms. Patients with achieved normal height reported better chronic-generic HRQoL when untreated, while patients with current short stature reported better HRQoL upon receiving treatment. Parents reported better HRQoL for treated patients, especially for girls. CONCLUSION Although their HRQoL is not significantly compromised, patients diagnosed with short stature may profit from growth-hormone treatment. Specific instruments are needed to adequately assess the effectiveness of treatment.
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Affiliation(s)
- Neuza Silva
- Department of Medical Psychology, University Medical Centre Hamburg-Eppendorf, Martinistraße 52 W26, 20246 Hamburg, Germany
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31
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Loche S, Carta L, Ibba A, Guzzetti C. Growth hormone treatment in non-growth hormone-deficient children. Ann Pediatr Endocrinol Metab 2014; 19:1-7. [PMID: 24926456 PMCID: PMC4049545 DOI: 10.6065/apem.2014.19.1.1] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 03/18/2014] [Indexed: 01/20/2023] Open
Abstract
Until 1985 growth hormone (GH) was obtained from pituitary extracts, and was available in limited amounts only to treat severe growth hormone deficiency (GHD). With the availability of unlimited quantities of GH obtained from recombinant DNA technology, researchers started to explore new modalities to treat GHD children, as well as to treat a number of other non-GHD conditions. Although with some differences between different countries, GH treatment is indicated in children with Turner syndrome, chronic renal insufficiency, Prader-Willi syndrome, deletions/mutations of the SHOX gene, as well as in short children born small for gestational age and with idiopathic short stature. Available data from controlled trials indicate that GH treatment increases adult height in patients with Turner syndrome, in patients with chronic renal insufficiency, and in short children born small for gestational age. Patients with SHOX deficiency seem to respond to treatment similarly to Turner syndrome. GH treatment in children with idiopathic short stature produces a modest mean increase in adult height but the response in the individual patient is unpredictable. Uncontrolled studies indicate that GH treatment may be beneficial also in children with Noonan syndrome. In patients with Prader-Willi syndrome GH treatment normalizes growth and improves body composition and cognitive function. In any indication the response to GH seems correlated to the dose and the duration of treatment. GH treatment is generally safe with no major adverse effects being recorded in any condition.
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Affiliation(s)
- Sandro Loche
- SSD Endocrinologia Pediatrica, Ospedale Microcitemico, ASL Cagliari, Cagliari, Italy
| | - Luisanna Carta
- SSD Endocrinologia Pediatrica, Ospedale Microcitemico, ASL Cagliari, Cagliari, Italy
| | - Anastasia Ibba
- SSD Endocrinologia Pediatrica, Ospedale Microcitemico, ASL Cagliari, Cagliari, Italy
| | - Chiara Guzzetti
- SSD Endocrinologia Pediatrica, Ospedale Microcitemico, ASL Cagliari, Cagliari, Italy
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Stevens A, De Leonibus C, Hanson D, Dowsey AW, Whatmore A, Meyer S, Donn RP, Chatelain P, Banerjee I, Cosgrove KE, Clayton PE, Dunne MJ. Network analysis: a new approach to study endocrine disorders. J Mol Endocrinol 2014; 52:R79-93. [PMID: 24085748 DOI: 10.1530/jme-13-0112] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Systems biology is the study of the interactions that occur between the components of individual cells - including genes, proteins, transcription factors, small molecules, and metabolites, and their relationships to complex physiological and pathological processes. The application of systems biology to medicine promises rapid advances in both our understanding of disease and the development of novel treatment options. Network biology has emerged as the primary tool for studying systems biology as it utilises the mathematical analysis of the relationships between connected objects in a biological system and allows the integration of varied 'omic' datasets (including genomics, metabolomics, proteomics, etc.). Analysis of network biology generates interactome models to infer and assess function; to understand mechanisms, and to prioritise candidates for further investigation. This review provides an overview of network methods used to support this research and an insight into current applications of network analysis applied to endocrinology. A wide spectrum of endocrine disorders are included ranging from congenital hyperinsulinism in infancy, through childhood developmental and growth disorders, to the development of metabolic diseases in early and late adulthood, such as obesity and obesity-related pathologies. In addition to providing a deeper understanding of diseases processes, network biology is also central to the development of personalised treatment strategies which will integrate pharmacogenomics with systems biology of the individual.
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Affiliation(s)
- A Stevens
- Faculty of Medical and Human Sciences, Institute of Human Development, University of Manchester, Manchester, UK Manchester Academic Health Science Centre, Royal Manchester Children's Hospital, Central Manchester University Hospitals NHS Foundation Trust, 5th Floor, Oxford Road, Manchester M13 9WL, UK Paediatric and Adolescent Oncology, The University of Manchester, Manchester M13 9WL, UK Stem Cell and Leukaemia Proteomics Laboratory, School of Cancer and Imaging Sciences, The University of Manchester, Manchester M20 4BX, UK Musculoskeletal Research Group, NIHR BRU, University of Manchester, Manchester M13 9PT, UK Department Pediatrie, Hôpital Mère-Enfant, Université Claude Bernard, 69677 Lyon, France Faculty of Life Sciences, University of Manchester, Manchester M13 9NT, UK
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