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West C, Federspiel J, Rogers K, Khatri A, Rao-Dayton S, Fernandez Ocana M, Lim S, D'Antona AM, Casinghino S, Somanathan S. Complement activation by AAV-neutralizing antibody complexes. Hum Gene Ther 2023. [PMID: 37082966 DOI: 10.1089/hum.2023.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023] Open
Abstract
Treatment of monogenetic disorders using adeno-associated viral vectors (AAV) is an area of intense interest. AAV is a human pathogen and pre-existing capsid antibodies are prevalent in the population posing a challenge to safety and efficacy of AAV-mediated gene therapies. Here we investigated the risk of AAV-mediated complement activation when sera from a cohort of human donors was exposed to AAV9 capsid. Seropositive donor sera carrying neutralizing antibodies from a previous environmental exposure activated complement when admixed with AAV9 capsids and complement-activation was associated with donors who had higher levels of ant-AAV IgG1 antibodies. These findings were consistent with Mass spectrometry analysis that identified increased binding of immunoglobulins and complement factors when AAV9 capsids were admixed with seropositive sera. Finally, complement activation was abrogated after IgG-depletion using affinity columns or serum pre-treatment with an IgG degrading enzyme. Overall, these results demonstrate an important role of pre-existing neutralizing antibodies in activating complement; a risk that can be mitigated by employing adequate immunosuppression strategies when dosing seropositive patients with vector.
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Affiliation(s)
- Cara West
- Pfizer Inc, 2253, Rare Diseases Research Unit, Cambridge, Massachusetts, United States;
| | - Joel Federspiel
- Pfizer Inc, 2253, Drug Safety Research and Development, Andover, Massachusetts, United States;
| | - Kara Rogers
- Pfizer Inc, 2253, Drug Safety Research & Development, Groton, Connecticut, United States;
| | - Arpana Khatri
- Pfizer Inc, 2253, Rare Disease Research Unit, Cambridge, Massachusetts, United States;
| | - Sheila Rao-Dayton
- Pfizer Inc, 2253, Biomedicine Design, Morrisville, North Carolina, United States;
| | - Mireia Fernandez Ocana
- Pfizer Inc, 2253, Drug Safety Research and Development, Andover, Massachusetts, United States;
| | - Sean Lim
- Pfizer Inc, 2253, Biomedicine design, Cambridge, Massachusetts, United States;
| | | | - Sandra Casinghino
- Pfizer Inc, 2253, Drug Safety Research & Development, Groton, Connecticut, United States;
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PALAZZI X, Pardo I, Sirivelu M, Newman L, Kumpf S, Qian J, Franks T, Lopes S, Liu J, Monarski L, Casinghino S, Ritenour C, Ritenour H, Dubois C, Olson J, Graves J, Alexander K, Coskran T, Lanz TA, Brady J, McCarty D, Somanathan S, Whiteley L. Biodistribution and Tolerability of AAV-PHP.B-CBh-SMN1 in Wistar Han Rats and Cynomolgus Macaques Reveal Different Toxicologic Profiles. Hum Gene Ther 2021; 33:175-187. [PMID: 34931542 PMCID: PMC8885435 DOI: 10.1089/hum.2021.116] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Recombinant adeno-associated viruses (AAVs) have emerged as promising vectors for human gene therapy, but some variants have induced severe toxicity in Rhesus monkeys and piglets following high-dose intravenous (IV) administration. To characterize biodistribution, transduction, and toxicity among common preclinical species, an AAV9 neurotropic variant expressing the survival motor neuron 1 (SMN1) transgene (AAV-PHP.B-CBh-SMN1) was administered by IV bolus injection to Wistar Han rats and cynomolgus monkeys at doses of 2 × 1013, 5 × 1013, or 1 × 1014 vg/kg. A dose-dependent degeneration/necrosis of neurons without clinical manifestations occurred in dorsal root ganglia (DRGs) and sympathetic thoracic ganglia in rats, while liver injury was not observed in rats. In monkeys, one male at 5 × 1013 vg/kg was found dead on day 4. Clinical pathology data on days 3 and/or 4 at all doses suggested liver dysfunction and coagulation disorders, which led to study termination. Histologic evaluation of the liver in monkeys showed hepatocyte degeneration and necrosis without inflammatory cell infiltrates or intravascular thrombi, suggesting that hepatocyte injury is a direct effect of the vector following hepatocyte transduction. In situ hybridization demonstrated a dose-dependent expression of SMN1 transgene mRNA in the cytoplasm and DNA in the nucleus of periportal to panlobular hepatocytes, while quantitative polymerase chain reaction confirmed the dose-dependent presence of SMN1 transgene mRNA and DNA in monkeys. Monkeys produced a much greater amount of transgene mRNA compared with rats. In DRGs, neuronal degeneration/necrosis and accompanying findings were observed in monkeys as early as 4 days after test article administration. The present results show sensory neuron toxicity following IV delivery of AAV vectors at high doses with an early onset in Macaca fascicularis and after 1 month in rats, and suggest adding the autonomic system in the watch list for preclinical and clinical studies. Our data also suggest that the rat may be useful for evaluating the potential DRG toxicity of AAV vectors, while acute hepatic toxicity associated with coagulation disorders appears to be highly species-dependent.
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Affiliation(s)
- Xavier PALAZZI
- Pfizer Global Research and Development, 105623, 1, Eastern Point Road, Groton, Connecticut, United States, 06340
| | - Ingrid Pardo
- Pfizer Global Research and Development, 105623, Groton, Connecticut, United States
| | - Madhu Sirivelu
- Pfizer Worldwide Research Development and Medicine, Drug Safety Research and Development, Cambridge, Massachusetts, United States
| | - Leah Newman
- Pfizer Global Research and Development, 105623, Groton, Connecticut, United States
| | - Steven Kumpf
- Pfizer Global Research and Development, 105623, Groton, Connecticut, United States
| | - Jessie Qian
- Pfizer Global Research and Development, 105623, Groton, Connecticut, United States
| | - Tania Franks
- Pfizer Global Research and Development, 105623, Groton, Connecticut, United States
| | - Sarah Lopes
- Pfizer Global Research and Development, 105623, Groton, Connecticut, United States
| | - June Liu
- Pfizer Global Research and Development, 105623, Groton, Connecticut, United States
| | - Laura Monarski
- Pfizer Global Research and Development, 105623, Groton, Connecticut, United States
| | - Sandra Casinghino
- Pfizer Global Research and Development, 105623, Groton, Connecticut, United States
| | - Casey Ritenour
- Pfizer Global Research and Development, 105623, Groton, Connecticut, United States
| | - Hayley Ritenour
- Pfizer Global Research and Development, 105623, Groton, Connecticut, United States
| | - Christopher Dubois
- Pfizer Global Research and Development, 105623, Groton, Connecticut, United States
| | - Jennifer Olson
- Pfizer Global Research and Development, 105623, Groton, Connecticut, United States
| | - John Graves
- Pfizer Global Research and Development, 105623, Groton, Connecticut, United States
| | - Kristin Alexander
- Pfizer Global Research and Development, 105623, Groton, Connecticut, United States
| | - Timothy Coskran
- Pfizer Global Research and Development, 105623, Groton, Connecticut, United States
| | - Thomas A Lanz
- Pfizer Global Research and Development, 105623, Groton, Connecticut, United States
| | - Joseph Brady
- Pfizer Worldwide Research Development and Medicine, Drug Safety Research and Development, Cambridge, Massachusetts, United States
| | - Douglas McCarty
- Pfizer Worldwide Research Development and Medicine, Drug Safety Research and Development, Cambridge, Massachusetts, United States
| | - Suryanarayan Somanathan
- Pfizer Worldwide Research Development and Medicine, Drug Safety Research and Development, Cambridge, Massachusetts, United States
| | - Laurence Whiteley
- Pfizer Worldwide Research Development and Medicine, Drug Safety Research and Development, Cambridge, Massachusetts, United States
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Affiliation(s)
- J. Whritenour
- Pfizer Inc., Drug Safety Research and Development, Groton, Connecticut 06340;
| | - S. Casinghino
- Pfizer Inc., Drug Safety Research and Development, Groton, Connecticut 06340;
| | - M. Collinge
- Pfizer Inc., Drug Safety Research and Development, Groton, Connecticut 06340;
| | - X. Zhu
- Pfizer Inc., Drug Safety Research and Development, Groton, Connecticut 06340;
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Casinghino S, Cole S, Bono C, Al-Derzi M. FcγR3A genotype influences the inhibition of activated T cell proliferation by infliximab and adalimumab (HUM1P.313). The Journal of Immunology 2015. [DOI: 10.4049/jimmunol.194.supp.52.38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Abstract
The anti-tumor necrosis factor (TNF) antibodies, infliximab and adalimumab are efficacious in Crohn’s disease (CD) patients but their relevant mechanism(s) of action (MOA) are not fully elucidated. Neutralization of TNF activity is a key efficacy mechanism, but may not be the only relevant MOA for efficacy in CD. Fc receptor-mediated dampening of the immune response has been proposed as one of the alternative hypotheses. Two FcγR3A-158 polymorphisms (158V and 158F) have been shown to influence binding affinity of IgG1 antibodies, and CD patients with V/V genotypes have increased biological responses to infliximab. Previous work by others showed that in a mixed lymphocyte reaction (MLR), infliximab and adalimumab induced formation of immunosuppressive macrophages in an Fc region-dependent manner and that these macrophages inhibited proliferation of activated T cells. We ran MLRs with FcγR3A genotype-matched donor pairs to determine if Fc receptor genotype influenced the anti-inflammatory response by infliximab and adalimumab. Our results showed that regulatory macrophages were induced regardless of FcγR3A genotype but that decreases in T cell proliferation were more pronounced with V/V donor pairs than with V/F or F/F genotypes. In conclusion, our work suggests that infliximab and adalimumab may be more effective at inducing an anti-inflammatory state in individuals with the 158V polymorphism of FcγR3A.
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Tartaro K, VanVolkenburg M, Wilkie D, Coskran TM, Kreeger JM, Kawabata TT, Casinghino S. Development of a fluorescence-basedin vivophagocytosis assay to measure mononuclear phagocyte system function in the rat. J Immunotoxicol 2014; 12:239-46. [DOI: 10.3109/1547691x.2014.934976] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Meegan J, Field C, Sidor I, Romano T, Casinghino S, Smith CR, Kashinsky L, Fair PA, Bossart G, Wells R, Dunn JL. Development, validation, and utilization of a competitive enzyme-linked immunosorbent assay for the detection of antibodies against Brucella species in marine mammals. J Vet Diagn Invest 2011; 22:856-62. [PMID: 21088168 DOI: 10.1177/104063871002200603] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
A competitive enzyme-linked immunosorbent assay (cELISA) was developed by using a whole-cell antigen from a marine Brucella sp. isolated from a harbor seal (Phoca vitulina). The assay was designed to screen sera from multiple marine mammal species for the presence of antibodies against marine-origin Brucella. Based on comparisons with culture-confirmed cases, specificity and sensitivity for cetacean samples tested were 73% and 100%, respectively. For pinniped samples, specificity and sensitivity values were 77% and 67%, respectively. Hawaiian monk seal (Monachus schauinslandi; n = 28) and bottlenose dolphin (Tursiops truncatus; n = 48) serum samples were tested, and the results were compared with several other assays designed to detect Brucella abortus antibodies. The comparison testing revealed the marine-origin cELISA to be more sensitive than the B. abortus tests by the detection of additional positive serum samples. The newly developed cELISA is an effective serologic method for detection of the presence of antibodies against marine-origin Brucella sp. in marine mammals.
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Affiliation(s)
- Jenny Meegan
- Aquatic Animal Health Department, College of Veterinary Medicine, University of Florida, Gainesville, FL 32610-0136, USA.
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Su L, Du F, Sung L, Yang S, Jeong B, Casinghino S, Nedambale T, Xu J, Tian C, Yang X, Ji W. 66 IN VITRO DEVELOPMENT OF YAK (POEPHAGUS MUTUS) CLONED EMBRYOS BY INTERSPECIES SOMATIC NUCLEAR TRANSFER. Reprod Fertil Dev 2005. [DOI: 10.1071/rdv17n2ab66] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Interspecies nuclear transfer (NT) is an important tool for preservation of endangered animal species. This study was carried out to clone Yak (Poephagus mutus) embryos by using Yak skin fibroblasts and bovine (Bos taurus) recipient cytoplasts, and to compare the efficiency of YAK interspecies NT (bovine cytoplast-Yak donor cell) and bovine somatic NT (bovine cytoplast-bovine donor cell). Recipient oocytes were extracted from antral follicles of bovine ovaries, and subsequently cultured in maturation medium for 18–20 h in 5% CO2 and 95% humidified air at 39°C. Cumulus cells were removed from the oocytes by vortexing also facilitated further enucleation. Yak skin fibroblast cells were prepared from cultured ear explants of an adult 5-year-old female. Fibroblasts were cultured at passage 6–9 in 10% FBS DMEM at 37°C in 5% CO2 humidified air. The donor cell at a diameter of 19–20 μm was inserted into the perivitelline space of an enucleated oocyte. A bovine female cell line at similar passage number was used for bovine somatic NT as control. Somatic cell-cytoplast pairs were then fused by applying two direct current pulses at 2.0 kV/cm for a duration of 6–10 μs/pulse. Fused embryos were activated in 10 μg/mL cycloheximide and 2.5 μg/mL cytochalasin D in M199 plus 7.5% FBS for 5 h. Reconstructed Yak embryos were cultured in CR1aa plus 6 mg/mL BSA for 2 days (initiation of activation = Day 0) at 39°C, 5% CO2, 5% O2, and 90% N2, and then in 7.5% FBS CR1aa medium for 5 successive days on bovine cumulus monolayers. Expanding and hatching blastocysts on Day 7 were recorded and cryopreserved for further embryo transfer trials. The percentage of cleavage and the development to morulae and blastocysts were statistically analyzed using a General Linear Model (GLM, Univariate, SPSS 9.0, SPSS Inc, Chicago, IL, USA). As indicated in Table 1, the results demonstrated that the efficiencies of fusion rate as well as developmental potential in vitro were significantly higher in the bovine somatic NT group compared to those of the Yak interspecies NT group. However, the morphology and cell number per embryo of interspecies Yak cloned embryos were indistinguishable from those of bovine NT embryos. Our data suggest that bovine oocytes possess the capability of reprogramming/reactivation of the genome from differentiated somatic Yak nuclei.
Table 1.
Comparison of yak interspecies and bovine somatic nuclear transfer
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Chen Y, Shu H, Ji C, Casinghino S, Kim K, Gundberg CM, Centrella M, McCarthy TL. Insulin-like growth factor binding proteins localize to discrete cell culture compartments in periosteal and osteoblast cultures from fetal rat bone. J Cell Biochem 1998. [DOI: 10.1002/(sici)1097-4644(19981201)71:3<351::aid-jcb4>3.0.co;2-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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9
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Chen Y, Shu H, Ji C, Casinghino S, Kim K, Gundberg CM, Centrella M, McCarthy TL. Insulin-like growth factor binding proteins localize to discrete cell culture compartments in periosteal and osteoblast cultures from fetal rat bone. J Cell Biochem 1998; 71:351-62. [PMID: 9831072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Insulin-like growth factor (IGF)-I and IGF-II are expressed at biologically effective levels by bone cells. Their stability and activity are modulated by coexpression of IGF binding proteins (IGFBPs). Secreted IGFBPs may partition to soluble, cell-associated, and matrix-bound compartments. Extracellular localization may sequester, store, or present IGFs to appropriate receptors. Of the six IGFBPs known, rat osteoblasts synthesize all but IGFBP-1. Of these, IGFBP-3, -4, and -5 mRNAs are induced by an increase in cAMP. Little is known about extracellular IGFBP localization in bone and nothing about IGFBP expression by nonosteoblastic periosteal bone cells. We compared basal IGFBP expression in periosteal and osteoblast bone cell cultures and assessed the effects of changes in cAMP-dependent protein kinase A or protein kinase C. Basal IGFBP gene expression differed principally in that more IGFBP-2 and -5 occurred in osteoblast cultures, and more IGFBP-3 and -6 occurred in periosteal cultures. An increase in cAMP enhanced IGFBP-3, -4, and -5 mRNAand accordingly increased soluble IGFBP-3, -4, and -5 and matrix-bound IGFBP-3 and -5 in both bone cell populations. In contrast, protein kinase C activators suppressed IGFBP-5 mRNA, and its basal protein levels remained very low. We also detected low Mr bands reactive with antisera to IGFBP-2, -3, and -5, suggesting proteolytic processing or degradation. Our studies reveal that various bone cell populations secrete and bind IGFBPs in selective ways. Importantly, inhibitory IGFBP-4 does not significantly accumulate in cell-associated compartments, even though its secretion is enhanced by cAMP. Because IGFBPs bind IGFs less tightly in cell-bound compartments, they may prolong anabolic effects by agents that increase bone cell cAMP.
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Affiliation(s)
- Y Chen
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut 06520, USA
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10
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Ji C, Casinghino S, Chang DJ, Chen Y, Javed A, Ito Y, Hiebert SW, Lian JB, Stein GS, McCarthy TL, Centrella M. CBFa(AML/PEBP2)-related elements in the TGF-β type I receptor promoter and expression with osteoblast differentiation. J Cell Biochem 1998. [DOI: 10.1002/(sici)1097-4644(19980601)69:3<353::aid-jcb12>3.0.co;2-d] [Citation(s) in RCA: 70] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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11
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Ji C, Casinghino S, Chang DJ, Chen Y, Javed A, Ito Y, Hiebert SW, Lian JB, Stein GS, McCarthy TL, Centrella M. CBFa(AML/PEBP2)-related elements in the TGF-beta type I receptor promoter and expression with osteoblast differentiation. J Cell Biochem 1998; 69:353-63. [PMID: 9581873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Organization of the transforming growth factor-beta (TGF-beta) type I receptor (TRI) promoter predicts constitutive transcription, although its activity increases with differentiation status in cultured osteoblasts. Several sequences in the rat TRI promoter comprise cis-acting elements for CBFa (AML/PEBP2alpha) transcription factors. By gel mobility shift and immunological analyses, a principal osteoblast-derived nuclear factor that binds to these sites is CBFa1 (AML-3/PEBP2alphaA). Rat CBFa1 levels parallel expression of the osteoblast phenotype and increase under conditions that promote mineralized bone nodule formation in vitro. Fusion of CBFa binding sequence from the TRI promoter to enhancer-free transfection vector increases reporter gene expression in cells that possess abundant CBFa1, and overexpression of CBFa increase the activity of transfected native TRI promoter/reporter plasmid. Consequently, phenotype-restricted use of cis-acting elements for CBFa transcription factors can contribute to the high levels of TRI that parallel osteoblast differentiation and to the potent effects of TGF-beta on osteoblast function.
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Affiliation(s)
- C Ji
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut 06520-8041, USA
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12
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McCarthy TL, Ji C, Casinghino S, Centrella M. Alternate signaling pathways selectively regulate binding of insulin-like growth factor I and II on fetal rat bone cells. J Cell Biochem 1998; 68:446-56. [PMID: 9493908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Bone cells synthesize and respond to IGF-I and IGF-II which contribute to bone remodeling and linear growth. In osteoblasts, prostaglandin (PG)E2 stimulates IGF-I but not IGF-II synthesis through a cAMP-dependent protein kinase A (PKA)-related event. However, protein kinase C (PKC) activation by PGE2 enhances replication and protein synthesis by less differentiated periosteal cells more so than in osteoblast-enriched cultures from fetal rat bone. Using various PGs and other PKA and PKC pathway activators, the importance of these aspects of PGE2 activity has now been examined on IGF receptors in these bone cell culture models. PGE2 and other agents that activate PKA enhanced 125I-IGF-II binding to type 2 IGF receptors on both cell populations. In contrast, agents that activate PKC enhanced 125I-IGF-I binding to type 1 receptors on less differentiated bone cells, and of these, only phorbol myristate acetate (PMA), which activates PKC in a receptor-independent way, was effective in osteoblast-enriched cultures. No stimulator increased total type 1 receptor protein in either cell population. Consequently, ligand binding to type 1 and type 2 IGF receptors is differentially modulated by specific intracellular pathways in bone cells. Importantly, changes in apparent type 1 receptor number occur rapidly and may do so at least in part through post-translational effects. These results may help to predict new ways to manipulate autocrine or paracrine actions by IGFs in skeletal tissue.
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Affiliation(s)
- T L McCarthy
- Yale University School of Medicine, Section of Plastic Surgery, New Haven, Connecticut 06520-8041, USA.
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Mccarthy TL, Ji C, Casinghino S, Centrella M. Alternate signaling pathways selectively regulate binding of insulin-like growth factor I and II on fetal rat bone cells. J Cell Biochem 1998. [DOI: 10.1002/(sici)1097-4644(19980315)68:4<446::aid-jcb5>3.0.co;2-q] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Chang DJ, Ji C, Kim KK, Casinghino S, McCarthy TL, Centrella M. Reduction in transforming growth factor beta receptor I expression and transcription factor CBFa1 on bone cells by glucocorticoid. J Biol Chem 1998; 273:4892-6. [PMID: 9478931 DOI: 10.1074/jbc.273.9.4892] [Citation(s) in RCA: 130] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Glucocorticoid in excess suppresses bone formation in vivo and disrupts bone matrix protein synthesis by osteoblasts in vitro. In contrast, transforming growth factor beta (TGF-beta) potently enhances bone matrix apposition. The rat TGF-beta type I receptor gene promoter contains cis-acting elements for transcription factor CBFa1, which increases in parallel with osteoblast differentiation. Here we present molecular data linking these events. We show that previously unexplained effects of glucocorticoid on bone loss may be mediated in part by suppression of CBFa1, with a resultant decrease in the expression and activity of the TGF-beta type I receptor on matrix-producing bone cells.
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Affiliation(s)
- D J Chang
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut 06520-8041, USA
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15
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Shin JH, Ji C, Casinghino S, McCarthy TL, Centrella M. Parathyroid hormone-related protein enhances insulin-like growth factor-I expression by fetal rat dermal fibroblasts. J Biol Chem 1997; 272:23498-502. [PMID: 9295284 DOI: 10.1074/jbc.272.38.23498] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Interactions between cells of differing embryonic origins comprise a common theme during tissue development and repair. Often, communication between them can be mediated by soluble growth mediators and in some cases is restricted in focus. That is, some cells respond to, but do not produce, mediators expressed by other cells within the tissue. Because keratinocytes respond to but do not express insulin-like growth factor I (IGF-I), another skin cell population, the dermal fibroblast, may supply this factor. However, keratinocytes express, but do not respond to parathyroid hormone related protein (PTHrp), which increases cAMP production by dermal fibroblasts. Based on earlier results where inducers of cAMP increase local IGF-I expression in skeletal tissue, we postulated that PTHrp might induce local IGF-I by dermal fibroblasts and provide a source of this factor for keratinocyte activity. Our studies reveal that IGF-I mRNA and protein levels increase in response to PTHrp in vitro, and that this effect is replicated by inducers of cAMP, but not by activators of protein kinase C. Consequently, these factors appear to comprise a paracrine loop within the skin, permitting focused but restricted IGF-I expression to support skin growth, remodeling, or repair.
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Affiliation(s)
- J H Shin
- Section of Plastic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut 06520-8041, USA
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16
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Ji C, Casinghino S, McCarthy TL, Centrella M. Multiple and essential Sp1 binding sites in the promoter for transforming growth factor-beta type I receptor. J Biol Chem 1997; 272:21260-7. [PMID: 9261136 DOI: 10.1074/jbc.272.34.21260] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Maximal gene expression driven by the promoter for the transforming growth factor beta type I receptor (TGF-betaRI) occurs with a 1. 0-kilobase pair fragment immediately upstream of exon 1. This region lacks a typical TATA box but contains CCAAT boxes, multiple Sp1, and PEBP2/CBFalpha binding sites among other possible cis-acting elements. Alterations within two CCAAT box sequences do not mitigate reporter gene expression driven by the basal promoter, and no nuclear factor binds to oligonucleotides encompassing these sites. In contrast, other deletions or site-specific mutations reveal an essential Sp1 site in the basal promoter and several dispersed upstream Sp1 sites that contribute to maximal reporter gene expression. The proportions of transcription factors Sp1 and Sp3, and their ratios of binding to consensus elements, are maintained in bone cells at different stages of differentiation. Finally, nuclear factor that binds to PEBP2/CBFalpha-related cis-acting elements in the basal promoter sequence also occurs in osteoblasts. Our studies reveal that constitutive expression of TGF-betaRI may be determined by constitutive nuclear factor binding to Sp1 sites, whereas other elements may account for the variations in TGF-betaRI levels that parallel changes in bone cell differentiation or activity.
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Affiliation(s)
- C Ji
- Section of Plastic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut 06520-8041, USA
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17
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McCarthy TL, Ji C, Shu H, Casinghino S, Crothers K, Rotwein P, Centrella M. 17beta-estradiol potently suppresses cAMP-induced insulin-like growth factor-I gene activation in primary rat osteoblast cultures. J Biol Chem 1997; 272:18132-9. [PMID: 9218447 DOI: 10.1074/jbc.272.29.18132] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Insulin-like growth factor-I (IGF-I) is a key factor in bone remodeling. In osteoblasts, IGF-I synthesis is enhanced by parathyroid hormone and prostaglandin E2 (PGE2) through cAMP-activated protein kinase. In rats, estrogen loss after ovariectomy leads to a rise in serum IGF-I and an increase in bone remodeling, both of which are reversed by estrogen treatment. To examine estrogen-dependent regulation of IGF-I expression at the molecular level, primary fetal rat osteoblasts were co-transfected with the estrogen receptor (hER, to ensure active ER expression), and luciferase reporter plasmids controlled by promoter 1 of the rat IGF-I gene (IGF-I P1), used exclusively in these cells. As reported, 1 microM PGE2 increased IGF-I P1 activity by 5-fold. 17beta-Estradiol alone had no effect, but dose-dependently suppressed the stimulatory effect of PGE2 by up to 90% (ED50 approximately 0.1 nM). This occurred within 3 h, persisted for at least 16 h, required ER, and appeared specific, since 17alpha-estradiol was 100-300-fold less effective. By contrast, 17beta-estradiol stimulated estrogen response element (ERE)-dependent reporter expression by up to 10-fold. 17beta-Estradiol also suppressed an IGF-I P1 construct retaining only minimal promoter sequence required for cAMP-dependent gene activation, but did not affect the 60-fold increase in cAMP induced by PGE2. There is no consensus ERE in rat IGF-I P1, suggesting novel downstream interactions in the cAMP pathway that normally enhances IGF-I expression in skeletal cells. To explore this, nuclear extract from osteoblasts expressing hER were examined by electrophoretic mobility shift assay using the atypical cAMP response element in IGF-I P1. Estrogen alone did not cause DNA-protein binding, while PGE2 induced a characteristic gel shift complex. Co-treatment with both hormones caused a gel shift greatly diminished in intensity, consistent with their combined effects on IGF-I promoter activity. Nonetheless, hER did not bind IGF-I cAMP response element or any adjacent sequences. These results provide new molecular evidence that estrogen may temper the biological effects of hormones acting through cAMP to regulate skeletal IGF-I expression and activity.
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Affiliation(s)
- T L McCarthy
- Yale University School of Medicine, Section of Plastic Surgery, New Haven, Connecticut 06520-8041, USA.
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Ji C, Casinghino S, McCarthy TL, Centrella M. Cloning, characterization, and expression of the transforming growth factor-β type I receptor promoter in fetal rat bone cells. J Cell Biochem 1996. [DOI: 10.1002/(sici)1097-4644(19961215)63:4<478::aid-jcb9>3.0.co;2-q] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Abstract
Transforming growth factor (TGF-beta) binds several discrete membrane proteins. Of these, a type 1 receptor appears indispensable for signal transduction. Previous examination of TGF-beta receptor expression has been limited to changes in cell surface protein, and more recently, mRNA abundance. In order to learn more about TGF-beta function and receptor expression during osteogenesis, we have now cloned a 4 kilobase (kb) DNA fragment 5' proximal to the coding region of the rat TGF-beta type I receptor gene. Sequence analysis revealed multiple elements compatible with transcription initiation, including a properly positioned and oriented CCAAT box, six Sp1 binding sites (three defining GC boxes), and two strong AP2 binding sites within a 0.7 kb span directly upstream of the coding region. The 3' terminal 0.3 kb span comprises a GC-enriched (77%) so-called CpG island that, like other similarly organized promoters, lacks a TATA box. Primer extension and RNase protection studies with cRNAs from this area show multiple initiation sites within 220 bp 5' proximal to the initial methionine codon. Transient transfections using nested, deleted, and inverted promoter sequences demonstrated maximal reporter expression by a 1 kb fragment encompassing all of these elements. Truncation of the 1 kb fragment from the 5' and 3' ends indicated the need for several elements for peak promoter activity. These results, and transfections in fetal rat bone and dermal cells, suggest that this promoter contains elements that specify basal and conditional expression of the TGF-beta type I receptor in bone.
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MESH Headings
- Amino Acid Sequence
- Animals
- Base Sequence
- Binding Sites/genetics
- Cells, Cultured
- Cloning, Molecular
- Codon, Initiator
- Electrophoresis, Polyacrylamide Gel
- Female
- Gene Expression Regulation
- Gene Library
- Genes, Reporter
- Methionine/genetics
- Molecular Sequence Data
- Parietal Bone/metabolism
- Promoter Regions, Genetic
- RNA, Complementary/genetics
- Rats
- Rats, Sprague-Dawley
- Receptors, Transforming Growth Factor beta/genetics
- Ribonucleases/metabolism
- Sequence Analysis, DNA
- Sequence Deletion
- Skin/metabolism
- Transcription, Genetic
- Transfection
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Affiliation(s)
- C Ji
- Department of Surgery, Yale University, School of Medicine, New Haven, Connecticut 06520-8041, USA
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20
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Abstract
The proportion of transforming growth factor-beta (TGF-beta) binding among conventional membrane receptors on bone cells can vary with hormone or growth factor treatment or with the state of osteoblast-like activity and appears to determine the nature of its biological effects. Therefore, functional TGF-beta receptor stability could be an important aspect of regulation. Suppression of protein synthesis reduced TGF-beta binding to types I and II receptors with t1/2 of 2 h and to betaglycan with t1/2 of 6 h. In contrast, suppression of mRNA transcription reduced TGF-beta binding at least 3-fold more slowly at each receptor site. Preexposure to TGF-beta decreased its binding at all three sites within 4 h in osteoblast-enriched cultures. This effect was transient with lower TGF-beta concentrations, where the receptor profile was nearly fully restored within 24-48 h. In contrast, less differentiated bone cells were less sensitive to ligand-dependent receptor down-regulation. Agents that alter protein kinase and phosphatase activity also modified the TGF-beta binding profile in specific ways. Together, these results indicate that cell surface TGF-beta receptors turn over rapidly by ligand-independent and ligand-dependent mechanisms, demonstrate that the binding capacity of TGF-beta receptors is less stable than their mRNAs, and that functional receptor levels may be determined in part by post-transcriptional events.
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Affiliation(s)
- M Centrella
- Section of Plastic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut 06520-8041, USA
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Centrella M, Casinghino S, Gundberg C, McCarthy TL, Wozney J, Rosen V. Changes in bone morphogenetic protein sensitivity relative to differentiation in fetal rat bone cell cultures. Ann N Y Acad Sci 1996; 785:224-6. [PMID: 8702135 DOI: 10.1111/j.1749-6632.1996.tb56267.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- M Centrella
- Yale University School of Medicine, New Haven, Connecticut 06520-8041, USA
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McCarthy TL, Casinghino S, Mittanck DW, Ji CH, Centrella M, Rotwein P. Promoter-dependent and -independent activation of insulin-like growth factor binding protein-5 gene expression by prostaglandin E2 in primary rat osteoblasts. J Biol Chem 1996; 271:6666-71. [PMID: 8636084 DOI: 10.1074/jbc.271.12.6666] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Insulin-like growth factor (IGF) action is mediated by high affinity cell surface IGF receptors and modulated by a family of secreted IGF binding proteins (IGFBPs). IGFBP-5, the most conserved of six IGFBPs characterized to date, uniquely potentiates the anabolic actions of IGF-I for skeletal cells. In osteoblasts, IGFBP-5 production is stimulated by prostaglandin E2 (PGE2), a local factor that mediates certain effects induced by parathyroid hormone, cytokines such as interleukin-1 and transforming growth factor-beta, and mechanical strain. In this study, we show that transcriptional and post-transcriptional events initiated by PGE2 collaborate to enhance IGFBP-5 gene expression in primary fetal rat osteoblast cultures. PGE2 treatment stimulated up to a 7-fold rise in steady-state levels of IGFBP-5 mRNA throughout 32 h of incubation. Analysis of nascent IGFBP-5 mRNA suggested that PGE2 had only a modest stimulatory effect on IGFBP-5 gene transcription, and transient transfection studies with IGFBP-5 promoter-reporter genes confirmed that PGE2 enhanced promoter activity by approximately 2-fold. Similar stimulatory effects were seen with forskolin. A DNA fragment with only 51 base pairs of the 5'-flanking sequence retained hormonal responsiveness, which may be mediated by a binding site for transcription factor AP-2 located at positions -44 to -36 in the proximal IGFBP-5 promoter. Incubation of osteoblasts with the mRNA transcriptional inhibitor 5,6-dichloro-1-beta-D-ribofuranosylbenzimidazole demonstrated that PGE2 enhanced IGFBP-5 mRNA stability by 2-fold, increasing the t1/2 from 9 to 18 h. The effects of PGE2 on steady-state IGFBP-5 transcripts were abrogated by preincubating cells with cycloheximide, indicating that the effects of PGE2 on both gene transcription and mRNA stability required ongoing protein synthesis. Therefore, both promoter-dependent and -independent pathways converge to enhance IGFBP-5 gene expression in response to PGE2 in osteoblasts.
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Affiliation(s)
- T L McCarthy
- Section of Plastic Surgery, Yale University School of Medicine, New Haven, Connecticut 06520-8041, USA
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Centrella M, Casinghino S, Kim J, Pham T, Rosen V, Wozney J, McCarthy TL. Independent changes in type I and type II receptors for transforming growth factor beta induced by bone morphogenetic protein 2 parallel expression of the osteoblast phenotype. Mol Cell Biol 1995; 15:3273-81. [PMID: 7760823 PMCID: PMC230560 DOI: 10.1128/mcb.15.6.3273] [Citation(s) in RCA: 111] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Transforming growth factor beta (TGF-beta), a potent regulator of bone formation, has bifunctional effects on osteoblast replication and biochemical activity that appear differentiation dependent. We now show that cell surface binding sites for TGF-beta vary markedly among fibroblasts, bone-derived cells, and highly differentiated osteosarcoma cultures from fetal rats. Expression of betaglycan and type II receptors decline relative to type I receptor expression in parallel with an increase in osteoblast-like activity, predicting that the ratio among various TGF-beta binding sites could influence how its signals are perceived. Bone morphogenetic protein 2 (BMP-2), which induces osteoblast function, does not alter TGF-beta binding or biochemical activity in fibroblasts and has only small effects in less differentiated bone cells. In contrast, BMP-2 rapidly reduces TGF-beta binding to betaglycan and type II receptors in osteoblast-enriched primary cell cultures and increases its relative binding to type I receptors in these cells and in ROS 17/2.8 cultures. Pretreatment with BMP-2 diminishes TGF-beta-induced DNA synthesis in osteoblast-enriched cultures but synergistically enhances its stimulatory effects on either collagen synthesis or alkaline phosphatase activity, depending on the present state of bone cell differentiation. Therefore, BMP-2 shifts the TGF-beta binding profile on bone cells in ways that are consistent with progressive expression of osteoblast phenotype, and these changes distinguish the biochemical effects mediated by each receptor. Our observations indicate specific stepwise actions by TGF-beta family members during osteoblast differentiation, developing in part from changes imprinted by BMP-2 on TGF-beta receptor stoichiometry.
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Affiliation(s)
- M Centrella
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut 06520, USA
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Abstract
Prostaglandins (PGs) may stimulate or inhibit bone cell replication and protein synthesis. These disparities may be concentration or time dependent, or occur in discrete cell types or by different second signals. Cell populations that express progressive degrees of osteoblast-like activity can be obtained by serial collagenase digestion of fetal rat parietal bone. The first (population 1) appears less differentiated, whereas the later (populations 3-5) exhibit biochemical features characteristic of osteoblasts. Within 24 h of treatment, three separate PGs increased DNA synthesis in population 1 with relative potencies of PGE1 < PGE2 < PGF2 alpha. By contrast, PGE1 and PGE2 (both strong cAMP inducers) inhibited basal DNA synthesis in population 3-5. These differences were paralleled by analogous changes in collagen and noncollagen synthesis in each population. The mitogenic effect in population 1 persisted for 72 h, and at later times was sensitive to indomethacin. These changes were unlikely to be cAMP dependent, as PGF2 alpha did not induce cAMP production, and the cAMP inducer forskolin was inhibitory. Moreover, phorbol ester treatment enhanced DNA synthesis to a greater extent in population 1 than in populations 3-5, and cotreatment with H-8 (at Km, approximately 10 microM) and staurosporine (at Km, approximately 0.01 microM) decreased the mitogenic effect of PGs in population 1, consistent with a reduction in protein kinase-C activation. These studies suggest that PGs activate less differentiated bone cells by a protein kinase-dependent event, whereas cAMP (induced by PGE1 and PGE2) decreases DNA and protein synthesis in more differentiated bone cells and tempers the increase in cellular activation found in population 1. Consequently, agents or events that increase the synthesis of specific PGs could differentially regulate, in positive and negative ways, biochemical activities in discrete bone cell populations.
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Affiliation(s)
- M Centrella
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut 06520
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McCarthy TL, Casinghino S, Centrella M, Canalis E. Complex pattern of insulin-like growth factor binding protein expression in primary rat osteoblast enriched cultures: regulation by prostaglandin E2, growth hormone, and the insulin-like growth factors. J Cell Physiol 1994; 160:163-75. [PMID: 7517403 DOI: 10.1002/jcp.1041600119] [Citation(s) in RCA: 90] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Primary osteoblast-enriched (Ob) cultures from fetal rat bone synthesize insulin-like growth factor (IGF) I and IGF-II, which each enhance Ob function. While a number of agents modulate IGF-I production, IGF-II is constitutively expressed in this culture model. Independent of their expression, however, the activity of the IGFs can be modified by a small group of proteins termed IGF binding proteins (IGFBPs), but little is known about the regulation of individual IGFBPs that are synthesized by Ob cells. Northern blot analysis revealed that serum-deprived primary rat Ob cells express transcripts encoding IGFBP-2, IGFBP-3, IGFBP-4, IGFBP-5, and IGFBP-6, but undetectable levels of IGFBP-1 transcripts. Western ligand blots of Ob culture medium probed with 125I-IGF-I or 125I-IGF-II showed predominant IGFBPs migrating at 30/32 kDa, with minor bands at 24 and 38-47 kDa. Western antibody analysis identified IGFBP-2 and IGFBP-5 within the 30/32 kDa complex, while gel mobility shift on SDS-PAGE following deglycosylation determined that IGFBP-3 comprised the 38-47 kDa complex. By Northern analysis, 6 h treatment with prostaglandin E2 (PGE2), growth hormone (hGH), IGF-I, or IGF-II revealed a complex pattern of regulatory effects on steady-state IGFBP transcript expression. PGE2 increased the transcript levels of IGFBP-3, IGFBP-4, and IGFBP-5, (approximately 22-, approximately 2- and approximately 4-fold respectively), but had no effect on IGFBP-2 or IGFBP-6 transcripts. hGH enhanced IGFBP-3 and IGFBP-5 transcripts (each approximately twofold). IGF-I and IGF-II had no effect on IGFBP-2 steady-state transcript levels but enhanced the level of IGFBP-5 transcripts (approximately fourfold). By Western ligand blot analysis, 24 h treatment with PGE2 elevated the 24 and 38-47 kDa IGFBPs and to a lesser extent the 30/32 kDa complex, hGH elevated the 38-47 kDa IGFBPs, and IGF-I and IGF-II each increased the 30/32 kDa IGFBP complex. Therefore, a comparison of results obtained from Northern, Western ligand, and Western antibody studies indicates that multiple IGFBPs are expressed by primary rat Ob cultures. While IGFBP-2 and IGFBP-6 synthesis in Ob cultures is relatively unaffected by short-term treatment with PGE2, hGH, or the IGFs, these agents modify IGFBP-3, IGFBP-4, and IGFBP-5 expression with individual patterns of effects. In addition, some changes in IGFBP polypeptide levels that are independent of alterations in transcript expression may result from the formation of complexes between IGFs and certain IGFBPs, which could serve to store IGFs for future utilization in the formation phase of bone remodeling.
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Affiliation(s)
- T L McCarthy
- Section of Plastic and Reconstructive Surgery, Yale University School of Medicine, New Haven, Connecticut 06520
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Centrella M, Casinghino S, Ignotz R, McCarthy TL. Multiple regulatory effects by transforming growth factor-beta on type I collagen levels in osteoblast-enriched cultures from fetal rat bone. Endocrinology 1992; 131:2863-72. [PMID: 1446624 DOI: 10.1210/endo.131.6.1446624] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Transforming growth factor-beta (TGF beta) stimulates bone formation in vivo and in vitro, related in part to an increase in type I collagen production. In osteoblast-enriched cultures from fetal rat bone, 24- to 48-h TGF beta 1 treatment enhanced collagen synthesis rates by 2.5- to 6-fold, while it increased collagen accumulation by 5- to 10-fold. These effects were not accounted for by similar changes in acid-soluble radioisotope, cell number, or steady state type I procollagen transcripts. Basal collagen synthesis and accumulation were markedly reduced when mRNA transcription was blocked with alpha-amanitin, but the relative stimulatory effects of TGF beta 1 persisted in toxin-treated cultures. Newly synthesized collagen was rapidly secreted into the culture medium. While pulse-chase studies demonstrated that total (medium plus cell-associated) collagen levels were stable throughout the 48-h period, TGF beta 1 increased the fraction of cell-associated collagen between 24-48 h, and this was partially blocked by alpha-amanitin, but not by antibody to fibronectin or beta 1-integrin subunit. TGF beta 1, therefore, has multiple effects on type I collagen in fetal bone-derived cell cultures, including small increases in mRNA, large increases in polypeptide synthesis, and enhanced association of secreted collagen to the cell layer, which may require synthesis of extracellular components unrelated to fibronectin or the beta 1-integrin subunit.
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Affiliation(s)
- M Centrella
- Department of Research, Saint Francis Hospital and Medical Center, Hartford, Connecticut 06105
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