Equivalent potency and pharmacokinetics of recombinant human growth hormones with or without an N-terminal methionine

Efficacy and safety of a new ready-to-use recombinant human growth hormone solution

We report 24-month interim results of two multicenter phase III studies in previously untreated children with growth failure secondary to GH deficiency (GHD) that were paramount to the development of a new recombinant human GH (rh- GH, somatropin), approved as the first 'biosimilar' in Europe. Study 1 consisted of 3 parts performed in 89 children. The objective was to compare efficacy and safety of the lyophilized formulation of the new somatropin [Somatropin Powder (Sandoz)] with a licensed reference rhGH preparation and the liquid formulation of the new somatropin [Somatropin Solution (Sandoz)] and to assess long-term efficacy and safety of this ready-to-use Somatropin Solution. Study 2 was performed in 51 children and designed to demonstrate efficacy and safety of Somatropin Powder and to confirm its low immunogenic potential; rhGH was given sc at a daily dose of 0.03 mg/kg. Primary [body height, height SD score (HSDS), height velocity, and height velocity (HV) SD score (HVSDS)] and secondary [IGF-I and IGF binding protein 3 (IGFBP-3)] efficacy endpoints and safety parameters were assessed regularly. In study 1, all treatments showed comparable increases in growth. The baseline-adjusted difference between Somatropin Powder and the reference rhGH product in mean HV was -0.20 cm/yr (95% confidence interval (CI) [-1.34;0.94]) and in mean HVSDS was 0.76 (95% CI [-0.57;2.10]) after 9 months. These very small differences demonstrate comparable therapeutic efficacy between the two treatments. The results of study 2 were consistent with those seen in study 1. Equivalent therapeutic efficacy and clinical comparability in terms of safety and immunogenicity between Somatropin Powder and the reference rhGH product and between Somatropin Powder and Somatropin Solution was demonstrated. The safety and immunogenicity profiles were similar and as expected from experience with rhGH preparations.

Methionine-free brain-derived neurotrophic factor in wobbler mouse motor neuron disease: dose-related effects and comparison with the methionyl form

We compared the clinical and pharmacodynamic effects of N-terminal methionine brain-derived neurotrophic factor (met-BDNF) and endogenous met-free BDNF in wobbler mouse motor neuron disease (MND). Met- or met-free BDNF at 5 or 20 mg/kg was subcutaneously injected daily, six times/week for 4 weeks. At 20 mg/kg, grip strength (P<0.05, met-free BDNF; P<0.01, met-BDNF) and running speed (P<0.01 for both groups) improved compared to vehicle. At 5 mg/kg, the beneficial effect was more modest. Plasma BDNF levels after the final injection were dose-dependent and did not differ between BDNF groups. Endogenous met-free BDNF exerts effects similar to met-BDNF in wobbler MND.

Optimizing gh therapy in adults and children

Until the advent of modern neuroradiological imaging techniques in 1989, a diagnosis of GH deficiency in adults carried little significance other than as a marker of hypothalamo-pituitary disease. The relatively recent recognition of a characteristic clinical syndrome associated with failure of spontaneous GH secretion and the potential reversal of many of its features with recombinant human GH has prompted a closer examination of the physiological role of GH after linear growth is complete. The safe clinical practice of GH replacement demands a method of judging overall GH status, but there is no biological marker in adults that is the equivalent of linear growth in a child by which to judge the efficacy of GH replacement. Assessment of optimal GH replacement is made difficult by the apparent diverse actions of GH in health, concern about the avoidance of iatrogenic acromegaly, and the growing realization that an individual's risk of developing certain cancers may, at least in part, be influenced by cumulative exposure to the chief mediator of GH action, IGF-I. As in all areas of clinical practice, strategies and protocols vary between centers, but most physicians experienced in the management of pituitary disease agree that GH is most appropriately begun at low doses, building up slowly to the final maintenance dose. This, in turn, is best determined by a combination of clinical response and measurement of serum IGF-I, avoiding supraphysiological levels of this GH-dependent peptide. Numerous studies have helped define the optimum management of GH replacement during childhood. The recent requirement to measure and monitor GH status in adult life has called into question the appropriateness of simplistic weight- and surface area-based dosing regimens for the management of GH deficiency in childhood, with reliance on linear growth as the sole marker of GH action. It is clear that the monitoring of parameters other than linear growth to help refine GH therapy should now be incorporated into childhood GH treatment protocols. Further research will be required to define the optimal management of the transition from pediatric to adult GH replacement; this transition will only be possible once the benefits of GH in mature adults are defined and accepted by pediatric and adult endocrinologists alike.

High-yield production of a human therapeutic protein in tobacco chloroplasts

Transgenic plants have become attractive systems for production of human therapeutic proteins because of the reduced risk of mammalian viral contaminants, the ability to do large scale-up at low cost, and the low maintenance requirements. Here we report a feasibility study for production of a human therapeutic protein through transplastomic transformation technology, which has the additional advantage of increased biological containment by apparent elimination of the transmission of transgenes through pollen. We show that chloroplasts can express a secretory protein, human somatotropin, in a soluble, biologically active, disulfide-bonded form. High concentrations of recombinant protein accumulation are observed (>7% total soluble protein), more than 300-fold higher than a similar gene expressed using a nuclear transgenic approach. The plastid-expressed somatotropin is nearly devoid of complex post-translational modifications, effectively increasing the amount of usable recombinant protein. We also describe approaches to obtain a somatotropin with a non-methionine N terminus, similar to the native human protein. The results indicate that chloroplasts are a highly efficient vehicle for the potential production of pharmaceutical proteins in plants.

The level of bioavailable growth hormone (GH) after the first GH injection predicts the first year's growth response in GH-deficient children

Serum GH levels were measured in 9 prepubertal children with growth hormone (GH) deficiency using an immunofluorometric assay (IFMA) and a Nb2 cell bioassay, prior to and 2, 4, 6 and 12 hours after the first hGH subcutaneous injection (sc) (0.1 IU/Kg). After this first acute phase, hGH treatment was continued regularly at a dose of 0.1 IU/kg per day at bedtime. The acute pharmacokinetic profile was similar in the patients irrespectively of the assay used: serum GH usually starts to rise after 2 hours, peaks by 4 or 6 hours and drops back to near baseline levels 12 hours after s.c. GH administration. A great variation in the amplitude of peak levels was observed among the patients. The assays significantly (p<0.0001) correlate with each other in all subjects. An increase in serum GH values as evaluated by the Nb2 bioassay was observed in most children after s.c. GH injection, suggesting that the administered hormone preserves its biological activity. The individual variations in GH bioactivity in our GH-deficient children could be due to different mechanisms of the drug's degradation at the site of injection or in circulation. Pre-treatment height velocity calculated as standard deviation scores (SDS) significantly increased (p<0.001) from -2.77+/-0.42 to 1.22+/-0.87 SDS after a 12-month period of GH treatment in 8 patients who had already completed the first year of therapy, although it varied considerably among subjects. A higher serum GH peak value evaluated by both assays corresponded to a higher growth response during the 1st year, but not in the 2nd year of GH therapy. In conclusion, the degree of GH bioactivity released into circulation after sc GH injection may vary considerably among GHD patients and correlates with the growth response observed during the 1st year of GH therapy.

Dairy products and breast cancer: the IGF-I, estrogen, and bGH hypothesis

Research on the role of dietary factors in breast cancer causation has focused predominantly on fat intake. While some studies have examined associations between breast cancer rates and consumption of whole milk, there has been less attention given to dairy products in general. Dairy products contain both hormones and growth factors, in addition to fat and various chemical contaminants, that have been implicated in the proliferation of human breast cancer cells. This literature review evaluates the epidemiological and mechanistic evidence linking dairy consumption with breast cancer risk.

Cardiovascular effects of insulin-like growth factor-1 and growth hormone in chronic left ventricular failure in the rat

BACKGROUND

Insulin-like growth factor-1 (IGF-1) appears to have favorable cardiac effects associated with left ventricular remodeling early after myocardial infarction in the rat. The present study was designed to determine whether IGF-1 combined with growth hormone would be beneficial later as well, when infarct healing and cardiac remodeling have occurred.

METHODS AND RESULTS

Four weeks after coronary occlusion, 36 rats were randomized to IGF-1 (3 mg.kg-1.d-1) plus growth hormone (0.1 mg BID) or to placebo for 4 weeks. Treated rats had significant increases in body weight (22%), while the ratio of heart weight to body weight was unchanged. Under anesthesia, cardiac output (fluorescent microspheres) increased 46%, and systemic vascular resistance decreased by 21% (P < .001) in the treated group; a significant (22%) increase of the cardiac index was limited to treated rats with large myocardial infarctions. Small increases in the reduced left ventricular ejection fractions and left ventricular dP/dt(max) values with treatment were not significant. Treated rats showed a borderline (16%) increase in left ventricular end-diastolic volume (angiography), whereas the ratio of left ventricular end-diastolic volume to body weight was reduced in the treated group.

CONCLUSIONS

IGF-1 plus growth hormone administered to rats with left ventricular failure starting 1 month after MI was associated with substantial body growth, decreased systemic vascular resistance, and increased cardiac output. The failing heart also underwent treatment-induced increases in left and right ventricular weights in proportion to body growth, but left ventricular remodeling was minor, and a decrease in the ratio of left ventricular end-diastolic volume to body weight reflected relatively less chamber dilation compared with controls. A significant interaction between size of the myocardial infarction and treatment was observed for several variables, and IGF-1 and growth hormone increased the cardia index (P < .035) in rats with a large myocardial infarction.

Insulin-like growth factor-1 and growth hormone (GH) have distinct and overlapping anabolic effects in GH-deficient rats

The anabolic activity of recombinant human growth hormone (rhGH) and insulin-like growth factor 1 (rhlGF-1) given either alone or together were studied in two models of GH deficiency, hypophysectomized and GH-deficient dwarf rats. A range of rhGH doses (0.08 to 50 mg/kg/day, seven daily sc injections) were given either alone or together with one dose of rhIGF-l (2.4 mg/kg/day, sc infusion). When given alone, or co-administered with rhlGF-1, rhGH produced dose dependent increases in weight gain, bone growth and organ weights. Weight gain in response to rhGH given with rhlGF-1 was comparable to that obtained by a 25-fold higher dose of rhGH given alone. In both animal models absolute weights of the kidneys, liver, spleen and thymus were increased by rhlGF-1 while kidney and liver weight were increased by rhGH. In the hypophysectomized rat, spleen and thymus weights were increased by rhGH but the relative potency of the combination was a 1000-fold that of rhGH alone. The effects of rhlGF-1 and rhGH were additive indicating that the effects of GH or IGF-1 can be greatly increased by their co-administration.

Pharmacokinetics of radioiodinated human and ovine growth hormones in transgenic mice expressing bovine growth hormone

Pharmacokinetics of radioiodinated human growth hormone (hGH) and ovine growth hormone (oGH) were studied in normal mice and in transgenic mice carrying the bovine growth hormone (bGH) gene fused to phosphoenolpyruvate carboxykinase promoter/regulator (PEPCK-bGH). Multiexponential plasma decay curves were obtained in both normal and transgenic mice after a 125I-oGH injection and pharmacokinetic parameters were estimated by fitting blood concentration data to a three compartment model. The half-life for the rapid compartment was shorter in transgenic than in normal mice (t1/2 gamma: 1.2 +/- 0.3 vs. 2.2 +/- 0.5 min). The slow compartment had a t1/2 alpha of 160 +/- 23 min for transgenic and 70 +/- 8 min for normal mice while the middle compartment had a t1/2 beta of approximately 10 min for both groups of mice. The mean residence times were 167 +/- 24 and 55 +/- 5 min for transgenic and normal mice, respectively. Specific liver uptake of radioactivity after injection of 125I-oGH or 125I-hGH was found in both groups of animals. Specificity studies indicated that, similarly to normal mice, livers of transgenic mice possess a mixed population of somatotropic and lactogenic receptors. Uptake of labelled hGH by the liver was dose-dependent and the doses that prevented 50% of liver uptake (ED50%) were 8 and 165 micrograms per 50 g body weight for normal and transgenic mice, respectively. These in vivo results confirm and extend previous in vitro findings that a life-long excess of bGH increases hepatic somatotropic and lactogenic receptors. Since elevation in growth hormone (GH) receptors was reported to be associated with an increase in GH binding protein (GHBP), we suspect that both the increase in the mean residence time and the reduction in specific uptake of GH in the livers of transgenic mice may be the result of an increase in GHBP levels.

Hormonal Ergogenic Aids

Most hormonal agents used for nonmedical purposes in athletes have legitimate medical uses. This review introduces each compound by its pharmacology, clinical pharmacology, and legitimate medical use and reviews information on its abuse. Human growth hormone is presently available in virtually unlimited quantities due to its production by recombinant DNA technology. Its use in athletes is considered for its muscle-building, fat-depleting properties. Erythropoietin is a kidney hormone that increases red cell mass. It is used for renal dialysis patients to avoid blood transfusions. Its use in athletes is to raise red blood cell mass in an attempt to augment maximal oxygen capacity and the ability to do endurance work. Human chorionic gonadotropin has the biological activity of luteinizing hormone to increase testosterone synthesis and to maintain (partially) testicular volume when exogenous androgens are taken. Clenbuterol is a beta2adrenergic agonist with muscle-building properties that are seemingly specific to striated muscle; clenbuterol may cause reduction in body fat.

Interspecies scaling of clearance and volume of distribution data for five therapeutic proteins

The clearance and volume of distribution of five human proteins (recombinant CD4, CD4 immunoglobulin G, growth hormone, tissue-plasminogen activator, and relaxin) in humans and laboratory animals were analyzed as a function of body weight using allometric scaling techniques. These proteins cover a 16-fold range of molecular weight (6 to 98 kD), are produced by recombinant or synthetic methods, and may be cleared by different mechanisms. The analyses revealed that the clearance and volume data for each protein were satisfactorily described by an allometric equation (Y = a Wb). The allometric exponent (b) for clearance (ml/min) ranged from 0.65 to 0.84, the allometric exponent for the initial volume of distribution (ml) ranged from 0.83 to 1.05, and the allometric exponent for the volume of distribution at steady state (ml) ranged from 0.84 to 1.02. Exponent values from 0.6 to 0.8 for clearance and 0.8 to 1.0 for volumes are frequently cited for small molecules and are expected based on empirical interspecies relationships. When the preclinical data were analyzed separately, the preclinical allometric relationships were usually predictive of the human results. These findings indicate that the clearance and volume of distribution of select biomacromolecules follow well-defined, size-related physiologic relationships, and preclinical pharmacokinetic studies provide reasonable estimates of human disposition. Employing this methodology during the early phases of drug development may provide a more rational basis for dose selection in the clinical environment.

Mechanism of deiodination of 125I-human growth hormone in vivo. Relevance to the study of protein disposition

Examination of the disposition of proteins employing 125I-labeled tracers can be complicated by the in vivo deiodination of the tracer. The purpose of this study was to characterize the mechanism by which 125I-labeled proteins are deiodinated in vivo using 125I-human growth hormone (hGH) as a model compound. Intravenous (i.v.) administration of 125I-hGH resulted in a biphasic plasma kinetic pattern, with the majority of radioactivity removed from the plasma during the first 15 min. The level of circulating radioactivity at 2 hr was similar to that 15 min after administration. Radioactivity was eliminated from the animals almost exclusively in the urine. The chemical form of radioactivity in the plasma and urine was analyzed by HPLC, and precipitation of radioactivity with silver nitrate or trichloroacetic acid. Fifteen minutes after administration of 125I-hGH, 30% of the circulating radioactivity was present in the form of iodide (125I-). By 2 hr, the majority of radioactivity in the plasma was in the form of 125I-. The radioactivity in the urine was present exclusively in the form of 125I-. In vivo deiodination of 125I-hGH was reflected by the accumulation of radioactivity in the thyroid glands. There was no evidence for the presence of 125I-peptide intermediates in the plasma or urine of treated animals. In vitro, 125I-hGH was degraded to 125I-peptide intermediates by thyroid gland but not liver or kidney homogenates. In the absence of cofactors, 125I- was not observed as an in vitro metabolic product. However, in the presence of dithiothreitol and NADPH as cofactors, the predominant metabolic product formed by thyroid gland homogenates was 125I-. The deiodination of 125I-hGH by thyroid gland homogenates was inhibited by the serine protease inhibitor phenylmethylsulfonyl fluoride (PMSF), indicating that proteolysis of 125I-hGH was required for deiodination to occur. This was supported by the observation that 125I-labeled proteolytic fragments of 125I-hGH, but not 125I-hGH, were deiodinated by liver or kidney homogenates in the presence of these cofactors. Deiodination by thyroid gland homogenates was inhibited by the sulfhydryl-group blocking reagent, iodoacetate, in a concentration-dependent manner. The characteristics of the in vitro deiodination reaction suggest that a form of thyronine 5'-monodeiodinase may be involved in the in vivo deiodination of 125I-hGH and possibly other 125I-proteins. These data suggest that the disposition of proteins may be determined more accurately with 3H-, 14C- or 35S-labeled molecules which better represent the characteristics of the native protein.

Bovine growth hormone: human food safety evaluation

Scientists in the Food and Drug Administration (FDA), after reviewing the scientific literature and evaluating studies conducted by pharmaceutical companies, have concluded that the use of recombinant bovine growth hormone (rbGH) in dairy cattle presents no increased health risk to consumers. Bovine GH is not biologically active in humans, and oral toxicity studies have demonstrated that rbGH is not orally active in rats, a species responsive to parenterally administered bGH. Recombinant bGH treatment produces an increase in the concentration of insulin-like growth factor-I (IGF-I) in cow's milk. However, oral toxicity studies have shown that bovine IGF-I lacks oral activity in rats. Additionally, the concentration of IGF-I in milk of rbGH-treated cows is within the normal physiological range found in human breast milk, and IGF-I is denatured under conditions used to process cow's milk for infant formula. On the basis of estimates of the amount of protein absorbed intact in humans and the concentration of IGF-I in cow's milk during rbGH treatment, biologically significant levels of intact IGF-I would not be absorbed.

Pharmacology of new hormonal therapies in the treatment of pediatric endocrine disorders

Advances in genetic engineering will make possible treatment of many pediatric endocrine disorders with replacement therapy. Some of these conditions include short stature, precocious puberty, and diabetes mellitus. Although the availability of such hormonal replacement offers new treatment modalities, an understanding of their mechanism of action and pharmacologic characteristics is crucial to maximize their effectiveness while minimizing possible untoward effects. The clinician must evaluate potential risks and benefits as these substances come to market without definitive answers being available as to their long-term effects.