Developments in the Management of Growth Hormone Deficiency: Clinical Utility of Somapacitan

Growth hormone (GH) replacement therapy for growth hormone deficiency (GHD) in children and adults has for over 25 years, until recently, been administered as daily injections. This daily treatment regimen often incurs a burden to patients and caregivers, leading to high rates of non-adherence and, consequently, decreased treatment efficacy outcomes. To address this shortcoming, long-acting growth hormones (LAGHs) have been developed with the aim of reducing the burden of daily injections, thereby potentially improving treatment adherence and outcomes. Somapacitan (Sogroya®) (Novo Nordisk, Bagsværd, Denmark) is a LAGH currently approved for the treatment of adult and childhood GHD (AGHD and CGHD, respectively) in several countries. Other LAGHs, such as somatrogon (Ngenla®) (Pfizer, New York, United States) and lonapegsomatropin/TransCon GH (Skytrofa®) (Ascendis Pharma, Copenhagen, Denmark), are also currently approved and available for the treatment of CGHD in several countries. In this review, we will consider the method of protraction, pharmacokinetics (PK) and pharmacodynamics (PD), efficacy, and safety results of somapacitan in adult and pediatric trials and how these characteristics differ from those of the other aforementioned LAGHs. Additionally, the administration of somapacitan and timing of measurement of serum insulin-like growth factor-I (IGF-I) levels are summarized. Information on administration, advice on missed doses, and clinical guidelines are discussed, as well as identifying which patients are suitable for somapacitan therapy, and how to monitor and adjust dosing whilst on therapy.

Somapacitan, a once-weekly reversible albumin-binding GH derivative, in children with GH deficiency: A randomized dose-escalation trial

OBJECTIVE

To evaluate the safety, local tolerability, pharmacodynamics and pharmacokinetics of escalating single doses of once-weekly somapacitan, a reversible, albumin-binding GH derivative, vs once-daily GH in children with GH deficiency (GHD).

DESIGN

Phase 1, randomized, open-label, active-controlled, dose-escalation trial (NCT01973244).

PATIENTS

Thirty-two prepubertal GH-treated children with GHD were sequentially randomized 3:1 within each of four cohorts to a single dose of somapacitan (0.02, 0.04, 0.08 and 0.16 mg/kg; n=6 each), or once-daily Norditropin^® SimpleXx^® (0.03 mg/kg; n=2 each) for 7 days.

MEASUREMENTS

Pharmacokinetic and pharmacodynamic profiles were assessed.

RESULTS

Adverse events were all mild, and there were no apparent treatment-dependent patterns in type or frequency. Four mild transient injection site reactions were reported in three of 24 children treated with somapacitan. No antisomapacitan/anti-human growth hormone (hGH) antibodies were detected. Mean serum concentrations of somapacitan increased in a dose-dependent but nonlinear manner: maximum concentration ranged from 21.8 ng/mL (0.02 mg/kg dose) to 458.4 ng/mL (0.16 mg/kg dose). IGF-I and IGFBP-3, and change from baseline in IGF-I standard deviation score (SDS) and IGFBP-3 SDS, increased dose dependently; greatest changes in SDS values were seen for 0.16 mg/kg. IGF-I SDS values were between -2 and +2 SDS, except for peak IGF-I SDS with 0.08 mg/kg somapacitan. Postdosing, IGF-I SDS remained above baseline levels for at least 1 week.

CONCLUSIONS

Single doses of once-weekly somapacitan (0.02-0.16 mg/kg) were well tolerated in children with GHD, with IGF-I profiles supporting a once-weekly treatment profile. No clinically significant safety/tolerability signals or immunogenicity concerns were identified.

Long-acting pegylated human GH in children with GH deficiency: a single-dose, dose-escalation trial investigating safety, tolerability, pharmacokinetics and pharmacodynamics

OBJECTIVE

GH replacement therapy currently requires daily injections, which may be inconvenient and distressing for young patients. This study determined the safety, tolerability, pharmacokinetics and pharmacodynamics of escalating single doses of a pegylated GH (NNC126-0083) developed for once-weekly administration, in children with GH deficiency (GHD).

DESIGN AND METHODS

Thirty children (age ≥6 and ≤12 years, weight ≥16 kg) were randomised to NNC126-0083 or daily GH treatment. The subjects discontinued their daily GH treatment 7-9 days before receiving NNC126-0083 at 0.01, 0.02, 0.04 or 0.06 mg protein/kg (n=22) or seven once-daily doses of GH at 0.035 mg protein/kg (n=8).

RESULTS

NNC126-0083 was well tolerated, and no short-term safety or local tolerability issues were identified. After NNC126-0083 treatment, dose-dependent IGF1 increases were evident for maximum concentration (C(max)), but not area under the curve (AUC(0)(-)(168 h)). Mean values for IGF1 AUC(0)(-)(168 h)/168 h and C(max) were higher for GH than for NNC126-0083, although the difference was not statistically significant for cohort's 0.06 mg protein/kg. At 0.06 mg protein/kg, the resulting IGF1 response began subsiding at ∼3 days post-dose.

CONCLUSION

Single doses of long-acting NNC126-0083 were safe and well tolerated in children with GHD. Increased IGF1 levels were observed in all NNC126-0083 dose groups; however, a satisfactory once-weekly IGF1 profile was not reached within the NNC126-0083 dose levels administered.

Differential effects of insufflated, subcutaneous, and intravenous growth hormone on bone growth, cognitive function, and NMDA receptor subunit expression

The objective of this study was to characterize the effect of inhalable growth hormone (GH) delivered by an insufflator to the lungs of hypophysectomized Sprague Dawley rats. In the first cohort, the safety and efficacy of the insufflated GH were evaluated. Three experimental groups (n = 7 per group) were treated with GH for 15 d: One group received sc injection of GH daily at 200 microg/kg (SC200). Two other groups received GH by insufflation daily: 200 microg/kg (INS 200) and 600 microg/kg (INS 600). In the second set of experiments, GH was administered in three routes [SC200, INS200, intravenous (IV200)] (n=10) for 5 d, and escape latency and N-methyl D-aspartate (NMDA) receptor expression were evaluated. In the first cohort, INS200 showed similar bioactivity as SC200 in growth promotion, tibial growth, as well as escape latency on the 12th day of treatment. Insufflated GH was well tolerated without significant inflammatory responses. In the second cohort, expression of the NMDA receptor 1 and 2B in hippocampus measured after 3 or 6 d of daily treatments were significantly higher in INS200 as compared to IV200, consistent with the improvement of the escape latency. In summary, the inhalable form of GH delivered by intratracheal insufflation was safe, and its bioactivity was comparable to sc injection both in promotion of growth and acquisition of learning ability. If applied properly to human, inhalable GH would be effective for growth promotion and possibly for several disorders caused by underexpression of NMDA receptors.

Improving the pharmacokinetics/pharmacodynamics of prolactin, GH, and their antagonists by fusion to a synthetic albumin-binding peptide

To prolong the circulation half-life of human prolactin (hPRL), human GH (hGH), and their competitive antagonists, hPRL-G129R and hGH-G120R, we examined the effects of fusing a serum albumin-binding peptide (SA20) to their amino- or carboxyl-terminus. Fusion of the SA20 peptide to the amino-terminus of the ligands was less detrimental upon their ability to induce or inhibit signal transduction and cell proliferation in vitro than fusion to the carboxyl-terminus. Pharmacokinetic (PK) studies in mice revealed that the half-life of SA20-hPRL and SA20-hGH was prolonged and their clearance was reduced in comparison with hPRL and hGH. Pharmacodynamic (PD) studies in 8-week-old female mice revealed that lobuloalveolar development in mammary glands was greater in all three groups (daily, every 2 days, or every third day over a 12-day period) of mice treated with SA20-hPRL (4 mg/kg) compared with hPRL (3.59 mg/kg). Similarly, daily administration (i.p.) of SA20-hGH (8 mg/kg) or hGH (7.15 mg/kg) to 23-day-old female mice over a 40-day period revealed the superiority of SA20-hGH over hGH as measured by weight gain, body length, and lobuloalveolar development in the mammary glands. These findings indicate that SA20 modification of hPRL, hGH, and their respective antagonists improves their PK/PD properties.

Treatment of systemic diseases by inhalation of biomolecule aerosols

Clinical experience since many years has shown that aerosol inhalation is an established route for the treatment of pulmonary diseases. In contrast, treatment of systemic diseases by means of aerosol inhalation is a novel therapeutic approach. This was caused for a long time by a lack of accuracy, efficiency, and reproducibility of the administered drug doses due to a poor knowledge of the physiological background of aerosol inhalation, an insufficient inhaler technology as well as a suboptimal breathing procedure. However, these problems have been solved in the last years and nowadays modern aerosol delivery systems allow the production of an aerosol with a defined and optimised particle size combined with an optimized breathing maneuver and optimization of the efficacy of the technology. Clinical studies demonstrated that only a small number of morphological factors (e.g., exogen allergic alveolitis, active sarcoidosis, active smoking) influence alveolar drug deposition and the inhaled systematically active compounds caused no relevant allergic reactions even after inhalation for longer time periods. Up to now, most data are available for the inhalation of insulin which has been introduced in clinical treatment for a short time. However, a lot of other molecules have been tested in aerosol inhalation studies. This review describes some examples other than insulin in the field of inhalant treatment of systemic diseases.

Advantages and disadvantages of GH/IGF-I combination treatment

Growth hormone (GH) is the primary regulator of insulin-like growth factor-I (IGF-I) production in a wide variety of tissues. There is much overlap in the endocrine, metabolic and anabolic effects of GH and IGF-I but both hormones have divergent effects on glucose metabolism, insulin sensitivity and differentiation of prechondrocytes. Theoretically combined administration of GH and IGF-I may be more effective than GH alone or IGF-I alone. Arguments in favor for this are: 1] Clearance of IGF-I may be markedly altered by the co-administration of GH and this will provide sustained actions of IGF-I. 2] Higher serum IGF-I levels are achieved with a combination treatment of GH and IGF-I than with GH treatment alone or IGF-I alone. In addition, combination therapy may have additive or synergistic effects. 3] The combination GH and IGF-I counteracts disadvantageous effects on glucose metabolism of either GH alone or IGF-I alone. 4] GH may exert direct actions on tissues independently from IGF-I. 5] Combination of GH and IGF-I may be more effective in improving tissue IGF-I levels. The combination therapy of GH and IGF-I might be beneficial in growth retardation, in certain specific subgroups of critically ill or catabolic patients and in the treatment of GH-deficient subjects with the metabolic syndrome and/or manifest diabetes. It is at present unknown whether an optimal balance between safety and efficacy can be achieved with the combination therapy of GH and IGF-I, since this combination has been evaluated in only a small number of patient populations and in studies of a relatively short duration. In addition, a disadvantage may be the financial costs of combination therapy of GH and IGF-I. In conclusion, there are many reasons for believing that administration of the combination therapy of GH and IGF-I could have advantages above GH alone or IGF-I alone. However, determination of whether co-administration of GH and IGF-I indeed is superior to either agent alone awaits further study.

Elimination kinetic of recombinant somatotropin in bovine

Bovine somatotropin (bST), also called growth hormone is a protein hormone produced by the pituitary gland and responsible directly or indirectly for various effects on growth, development and reproductive functions. Its recombinant bovine somatotropin form (rbST) is used in dairy cattle to enhance milk production. Even if the effects of treatment with rbST have been largely studied, until now analytical methods able to detect rbST were limited to immunoassays, which suffer from the impossibility to distinguish between the endogenous and the recombinant form. In this study, a sample preparation procedure based on different precipitation steps, extraction on solid phase and enzymatic digestion was used to purify rbST from serum. The detection was performed by liquid chromatography coupled to tandem mass spectrometry in positive electrospray ionization mode (LC-ESI(+)-MS/MS) allowing the unambiguous identification and quantification of rbST in serum. Samples collected from a cow treated with recombinant bovine somatotropin were analysed and for the first time, the elimination kinetic specific to recombinant somatotropin has been characterized in serum. Detection of rbST was possible from 4h 30min to 4 days after administration and concentration was found up to 10ngmL(-1) during the kinetic.

Pharmacodynamics of growth hormone abuse biomarkers and the influence of gender and testosterone: a randomized double-blind placebo-controlled study in young recreational athletes

CONTEXT

IGF axis proteins and collagen peptides are promising markers of GH abuse.

OBJECTIVE

Our objective was to investigate whether responses of serum IGF axis and collagen markers to GH differ between men and women, and are influenced by testosterone (T).

DESIGN

This was a randomized, double-blind, placebo-controlled study of 8-wk treatment followed by 6-wk washout.

SETTING

The study was performed at a clinical research facility.

PARTICIPANTS

A total of 96 recreationally trained healthy athletes (63 men, 33 women), aged 18-40 yr, were studied.

INTERVENTION

All subjects received GH (2 mg/d sc) or placebo for 8 wk; men also received T (250 mg/wk im) or placebo for 5 wk.

MAIN OUTCOME MEASURES

Serum IGF axis proteins (IGF-I, IGF binding protein-3, and acid labile subunit) and collagen peptides (N-terminal propeptide of type I procollagen, C-terminal telopeptide of type I collagen, and N-terminal propeptide of type III procollagen) were measured.

RESULTS

GH induced significant increases in IGF axis and collagen markers that were greater in men than women (P < 0.001). Of the IGF axis markers, IGF-I showed the greatest increase. The relative incremental responses of the collagen markers in general were greater than the IGF markers, especially for PIIINP. The collagen markers increased and decreased more slowly with most remaining elevated (P < 0.01) after 6 wk, in comparison to IGF markers, which returned to baseline within 1 wk. Addition of T to GH amplified the response of PIIINP by more than 1.5-fold but did not affect any other marker. T alone did not affect IGF axis markers but modestly increased collagen markers.

CONCLUSIONS

These markers of GH abuse are less responsive in women. The increases in collagen markers have a different time course to the IGF markers and extend the window of detection in both sexes. The response of PIIINP is increased by coadministration of T.

Spatio-temporal kinetics of growth hormone receptor signaling in single cells using FRET microscopy

The growth hormone (GH) receptor (R)-mediated JAK2 (Janus kinase-2)-STAT5 (signaling transducer and activator of transcription-5) pathway involves a cascade of protein-protein interactions and tyrosine phosphorylations that occur in a spatially and temporally sensitive manner in cells. To study GHR dimerization or GH-induced conformational change of predimerized GHRs and STAT5 activation kinetics in intact cells, fluorescence resonance energy transfer (FRET) and live-cell imaging methods were employed. FRET measurements at the membrane of HEK-293T cells co-expressing GHRs tagged at the C-terminus with cyan (C) and yellow (Y) fluorescent proteins (FPs) revealed transient GHR dimerization lasting 2-3 min, with a maximum at 3 min after GH stimulation, which was sufficient to induce STAT5 activation. The transient nature of the dimerization or GH-induced conformational change of predimerized GHRs kinetics was not a result of GHR internalization, as neither potassium- nor cholesterol-depletion treatments prolonged the FRET signal. YFP-tagged STAT5 recruitment to the membrane, binding to GHR-CFP, and phosphorylation, occurred within minutes of GH stimulation. Activated STAT5a-YFP did not show nuclear accumulation, despite nuclear pSTAT5 increase, suggesting high turnover of STAT5 nuclear shuttling. Although GHR dimerization and STAT5 activation have been reported previously, this is the first spatially resolved demonstration of GHR-signaling kinetics in intact cells.

Comparative pharmacokinetics and pharmacodynamics of a new sustained-release growth hormone (GH), LB03002, versus daily GH in adults with GH deficiency

CONTEXT

LB03002 is a novel sustained-release GH preparation administered once weekly.

OBJECTIVE

Our objective was to examine the pharmacokinetics, pharmacodynamics, and safety of LB03002 vs. daily GH.

DESIGN AND SETTING

This open-label, crossover study compared the pharmacokinetics and pharmacodynamics of LB03002 and daily GH.

PATIENTS AND OTHER PARTICIPANTS

Six male and three female patients with adult GH deficiency participated in the single-center study.

INTERVENTION

Subjects were on stable daily GH treatment before the study. After a 4-wk washout with no GH, five weekly doses of LB03002 were given.

MAIN OUTCOME MEASURE

GH and IGF-I concentrations were measured during the last dose of daily GH and during the first and fifth weekly doses of LB03002.

RESULTS

The observed maximal serum GH concentration was approximately doubled after LB03002 (6.1 +/- 3.2 and 4.5 +/- 2.2 microg/liter at first and fifth doses) compared with daily GH (2.7 +/- 2.2 microg/liter). A sustained increase in GH concentration for more than 48 h was observed with LB03002, such that dose-normalized area under the curve (AUC) was not significantly different between daily GH and LB03002. Mean maximal serum IGF-I concentration was 34-41% greater with LB03002 than with daily GH, and AUC was 7-fold greater. However, normalized to GH dose, AUC for IGF-I was comparable. Adverse events and local reactions were acceptable, and there were no evident safety concerns with LB03002.

CONCLUSIONS

Multiple weekly doses of LB03002 appeared safe and well tolerated. Comparable GH bioavailability and sustained IGF-I elevations support the use of once-weekly LB03002 to replace daily GH therapy.

Ghrelin stimulates food intake and growth hormone release in rats with thermal injury: synthesis of ghrelin

Ghrelin, a 28-residue octanoylated peptide recently isolated from the stomach, exhibits anti-cachectic properties through regulating food intake, energy expenditure, adiposity, growth hormone secretion and immune response. Burn injury induces persistent hypermetabolism and muscle wasting. We therefore hypothesized that ghrelin may also play a role in the pathophysiology of burn-induced cachexia. Overall ghrelin expression in the stomach over 10 days after burn was significantly decreased (p = 0.0003). Total plasma ghrelin was reduced 1 day after burn. Thus, changes in ghrelin synthesis and release may contribute to burn-induced dysfunctions. Ghrelin (30 nmol/rat, i.p.) greatly stimulated 2 h food intake in rats on five separate days after burn and in control rats. On post-burn day 15, plasma growth hormone levels were significantly lower than in controls, and this was restored to normal levels by ghrelin (10 nmol/rat, i.p.). These observations suggest that ghrelin retains its ability to favorably modulate both the peripheral anabolic and the central orexigenic signals, even after thermal injury despite ongoing changes due to prolonged and profound hypermetabolism, suggesting that long-term treatment with ghrelin may attenuate burn-induced dysfunctions.

Permeation of growth hormone across the blood-brain barrier

Exogenous GH can affect central nervous system function when given peripherally to animals and as a supplemental therapy to humans. This study tested whether GH crosses the blood-brain barrier (BBB) by a specific transport system and found that both mice and rats have small but significant uptake of GH into the brain without a species difference. Determined by multiple-time regression analysis, the blood-to-brain influx transfer constants of 125I-labeled rat GH in mice (0.23+/-0.07 microl/g.min) and rats (0.32+/-0.04 microl/g.min) were comparable to those of some cytokines of similar size, with a half-time disappearance of 125I-GH of 3.8-7.6 min in blood. Intact 125I-GH was present in both serum and brain homogenate 20 min after iv injection. At this time, about 26.8% of GH in brain entered the parenchyma, whereas 10% was entrapped in endothelial cells. Neither excess GH nor insulin showed acute modulation of the influx, indicating lack of a saturable transport system for GH at the BBB. Binding and cellular uptake studies in cultured cerebral microvessel endothelial cells (RBE4) further ruled out the presence of high-capacity adsorptive endocytosis. The brain influx of GH by simple diffusion adds definitive value to the long-disputed question of whether and how GH crosses the BBB. The central nervous system effects of peripheral GH can be attributed to permeation of the BBB despite the absence of a specific transport system.

Are the metabolic effects of GH and IGF-I separable?

IGF-I mediates some, but not all of the metabolic actions of GH and it has both GH-like and insulin-like actions in vivo. GH and IGF-I both have a net anabolic effect in man enhancing whole body protein synthesis over a period of weeks and perhaps months. Both hormones favorably improve body composition in GH deficient subjects with an increase in lean body mass and decreased adiposity. This is also observed when IGF-I is given to patients with GH-receptor mutations. These compounds, however, have divergent effects on carbohydrate metabolism. A potent glucose lowering effect is typically observed after IGF-I administration, with improved insulin sensitivity with marked lowering of circulating insulin concentrations, whereas GH therapy is associated with mild compensatory hyperinsulinemia, a reflection of relative insulin resistance. The latter observation makes IGF-I a potentially more convenient anabolic agent to use in conditions where carbohydrate metabolism is more likely to be impaired. GH increases lipolysis as a direct effect of GH on the adipocyte, as well as lipid oxidation by increasing substrate availability. However IGF-I increases lipid oxidation only when given chronically, most likely as a result of chronic insulinopenia. These compounds have been tried in a variety of catabolic conditions in man and both hormones have been effective in reducing the protein wasting effects of glucocorticosteroids and mitigate some of the catabolic effects of severe hypogonadism in males. A comparison of these and other effects of these hormones is provided in this brief review. Subsequent studies are still needed to fully elucidate the safety and efficacy of IGF-I for use in humans.

Fat metabolism in exercise - with special reference to training and growth hormone administration

Despite abundance of fat, exclusive dependency on fat oxidation can only sustain a metabolic rate corresponding to 50-60% of VO(2max) in humans. This puzzling finding has been subject to intense research for many years. Lately, it has gained renewed interest as a consequence of increased obesity and physical inactivity imposed by Western lifestyle. Why are humans so poor at metabolizing fat? Can fat metabolism be manipulated by exercise, training, diet and hormones? And why is fat stored in specialized adipose tissue and not just as lipid droplets inside muscle cells? In the present review, human fat metabolism is discussed in relation to how human fat metabolism is designed. Limitations in this design are explored and examples of different designs for fat metabolism from animal physiology are included to illustrate these limitations. Various means of manipulating fat metabolism are discussed with special emphasis on exercise, training, growth hormone (GH) physiology and GH administration. It is concluded that fat stores, non-esterified fatty acids (NEFAs) availability and enzymes for fat oxidation can be increased substantially. However, it is almost impossible to increase fat oxidation during endurance exercise at higher intensities. It seems that, for some reason, the human being is far from optimally designed for fat oxidation during exercise. Acute GH administration has several unexpected effects on fat and carbohydrate metabolism during aerobic exercise, and future research in this area is likely to provide valuable information with respect to GH physiology and the regulation of fat and carbohydrate metabolism during aerobic exercise.

Growth hormone in the nervous system: autocrine or paracrine roles in retinal function?

Growth hormone (GH) is primarily produced in the pituitary gland, although GH gene expression also occurs in the central and autonomic nervous systems. GH-immunoreactive proteins are abundant in the brain, spinal cord, and peripheral nerves. The appearance of GH in these tissues occurs prior to the ontogenic differentiation of the pituitary gland and prior to the presence of GH in systemic circulation. Neural GH is also present in neonates, juveniles, and adults and is independent of changes in pituitary GH secretion. Neural GH is therefore likely to have local roles in neural development or neural function, especially as GH receptors (GHRs) are widespread in the nervous system. In recent studies, GH mRNA and GH immunoreactive proteins have been identified in the neural retina of embryonic chicks. GH immunoreactivity is present in the optic cup of chick embryos at embryonic day (ED) 3 of the 21-d incubation period. It is widespread in the neural retina by ED 7 but also present in the nonpigmented retina, choroid, sclera, and cornea. This immunoreactivity is associated with proteins in the neural retina comparable in size with those in the adult pituitary gland, although it is primarily associated with 15-16 kDa moieties rather than with the full-length molecule of approximately 22 kDa. These small GH moieties may reflect proteolytic fragments of "monomer" GH and (or) the presence of different GH gene transcripts, since full-length and truncated GH cDNAs are present in retinal tissue extracts. The GH immunoreactivity in the retina persists throughout embryonic development but is not present in juvenile birds (after 6 weeks of age). This immunoreactivity is also associated with the presence of GH receptor (GHR) immunoreactivity and GHR mRNA in ocular tissues of chick embryos. The retina is thus an extrapituitary site of GH gene expression during early development and is probably an autocrine or paracrine site of GH action. The marked ontogenic pattern of GH immunoreactivity in the retina suggests hitherto unsuspected roles for GH in neurogenesis or ocular development.

Sustained release of human growth hormone from microcapsules prepared by a solvent evaporation technique

Biodegradable microcapsules for sustained release of recombinant human growth hormone (rhGH) were prepared by a solid-in-oil-in-water (S/O/W) emulsion solvent evaporation technique using lyophilized protein microparticles. The minimum mean particle size of rhGH in S/O dispersions was 2.8-3.0 microm when ammonium acetate was added at molar ratios of 10-20 times against rhGH. High entrapment of rhGH in microcapsules was achieved by incorporating rhGH powder with a smaller particle size obtained by lyophilizing with ammonium acetate. As the particle size of rhGH decreased, the in vivo initial release decreased, while subsequent serum levels of rhGH in sustained release phase were higher. Addition of zinc oxide to microcapsules resulted in higher serum levels than those prepared without zinc oxide, suggesting a stabilizing effect of zinc oxide after subcutaneous injection into rats. The release profile of rhGH from microcapsules was controllable by selecting the proper copoly(DL-lactic/glycolic)acid (PLGA) with L/G ratio and molecular weight. Utilization of rhGH powder with a smaller particle size obtained by lyophilizing with ammonium acetate is essential for preparation of microcapsules with high entrapment and well-controlled sustained release profile with small initial release.

Impact of GHBP interference on estimates of GH and GH pharmacokinetics

OBJECTIVE

Circulating GH-binding protein (GHBP) may interfere with GH measurements in immunoassays by competing with the antibodies for ligands. The concentrations of circulating GHBP in humans are closely related to the amount of body fat, and subject to large interindividual differences.

SUBJECTS AND METHODS

To assess the influence of GHBP in a widely used commercial immunometric GH kit (DELFIA, Wallac, Finland) we systematically tested the effects of varying GHBP concentrations and assay incubation times on GH estimates over a broad range of GH concentrations. We subsequently investigated the impact of 24-h vs. 2-h incubation on estimates of GH pharmacokinetics obtained from two-step primed-constant infusions of GH in a group of 26 healthy nonobese men [mean age 37.3 years (range 22-55); body mass index (BMI) = 24.6 +/- 0.4 kg/m2].

RESULTS

GHBP at physiological concentrations of 0.2, 0.5, 1.0, 2.0 nm reduced the GH estimates by as much as 40% at low GH concentrations. By increasing the incubation time from the recommended 2 h to 24 h the interference from GHBP was almost completely eliminated. The increase in measured GH using 24-h vs. 2-h incubation showed a strong positive correlation to the subjects' GHBP levels (r = 0.66, P < 0.001). Consequently, the estimates of metabolic clearance rate (MCR) of GH at constant infusion rates of 1.5 micro g/kg/h and 3.0 micro g/kg/h were significantly reduced when using 24 h as opposed to 2 h incubation, and the changes were negatively correlated to the GHBP levels (r = -0.62, P < 0.001 and r =-0.54, P < 0.01, respectively). Furthermore, by reducing the interference of GHBP through 24-h incubation, the previously observed positive correlations between MCR and not only the subjects' GHBP levels but also with total body fat were reduced, while the positive correlation between baseline insulin concentrations and GH clearance was strengthened.

CONCLUSIONS

We conclude that differences in GHBP concentrations significantly influence GH measurements in this commercial immunoassay, and that interindividual differences in GHBP concentrations may interfere with the results in studies involving between-subject comparisons of GH concentrations and pharmacokinetics. We believe the extended incubation time allows for better 'extraction' of GH bound to serum GHBP, and that this effect should be investigated, and if relevant, be exploited in other GH immunoassays.

Computational stabilization of human growth hormone

Recombinant human growth hormone (hGH) is used worldwide for the treatment of pediatric hypopituitary dwarfism and in children suffering from low levels of hGH. It has limited stability in solution, and because of poor oral absorption, is administered by injection, typically several times a week. Development has therefore focused on more stable or sustained-release formulations and alternatives to injectable delivery that would increase bioavailability and make it easier for patients to use. We redesigned hGH computationally to improve its thermostability. A more stable variant of hGH could have improved pharmacokinetics or enhanced shelf-life, or be more amenable to use in alternate delivery systems and formulations. The computational design was performed using a previously developed combinatorial optimization algorithm based on the dead-end elimination theorem. The algorithm uses an empirical free energy function for scoring designed sequences. This function was augmented with a term that accounts for the loss of backbone and side-chain conformational entropy. The weighting factors for this term, the electrostatic interaction term, and the polar hydrogen burial term were optimized by minimizing the number of mutations designed by the algorithm relative to wild-type. Forty-five residues in the core of the protein were selected for optimization with the modified potential function. The proteins designed using the developed scoring function contained six to 10 mutations, showed enhancement in the melting temperature of up to 16 degrees C, and were biologically active in cell proliferation studies. These results show the utility of our free energy function in automated protein design.

Body composition and circulating levels of insulin, insulin-like growth factor-binding protein-1 and growth hormone (GH)-binding protein affect the pharmacokinetics of GH in adults independently of age

The aim of our study was to scrutinize the association among age, body composition, and GH status in healthy adults. Using two-step, primed constant infusions of GH during suppression of endogenous GH secretion with octreotide in a group of 26 healthy nonobese men [mean age, 37.3 yr (range, 22-55 yr); body mass index, 24.6 +/- 0.4 kg/m(-2)] we investigated the contributions of age, body composition, insulin, and binding proteins to the variability in the pharmacokinetics and acute actions of GH. All subjects were investigated twice, with the infusion rates of GH calculated according to either total body weight or intraabdominal fat mass. Body composition was determined using computed tomography and bioimpedance measurements. There was no correlation between age and body weight, yet strong positive correlations were observed between age and intraabdominal fat area (r = 0.78; P < 0.0001) and waist to hip ratio (r = 0.71; P < 0.0001) and to a lesser degree to sc fat area (r = 0.42; P < 0.03). The between-subject variability in steady state GH levels was significantly larger when GH was administered per cm(2) intraabdominal fat area than per kg BW (P < 0.001). During primed constant infusions of GH at rates of 1.5 and 3.0 microg/kg x h, the corresponding MCRs of GH were 148.8 +/- 5.4 and 89.8 +/- 2.4 ml/min x m(-2), respectively, and the MCRs were inversely related to the achieved steady state GH levels (P < 0.0001). The MCR was unrelated to age, but was negatively correlated to baseline concentrations of IGF-binding protein-1 (IGFBP-1; r = -0.53, P < 0.01) and positively correlated to basal levels of insulin (r = 0.46; P < 0.05), GH-binding protein (GHBP; r = 0.52; P < 0.01), IGFBP-3 (r = 0.47; P < 0.05), and total body fat (r = 0.44; P < 0.05). GH infusion caused significant changes in the concentrations of IGF-I, free fatty acids, GHBP, IGFBP-1, and insulin, but none of these effects was correlated to age. Based on our results we conclude that 1) the clearance of GH is concentration dependent; 2) the pharmacokinetics and acute effects of GH are not affected by age per se; and 3) basal levels of insulin, IGFBP-1, and GHBP as well as age-related changes in body composition are important predictors of GH pharmacokinetics.

Pharmacokinetics of human growth hormone administered subcutaneously with two different injection systems

The bioavailability of recombinant human growth hormone (somatropin, CAS 12629-01-5) was compared between a transcutaneous jet injection device and subcutaneous cannula injection. Thirteen healthy male subjects received 8.64 IU somatropin once with jet and once with cannula injection in a randomized cross-over study. Baseline-corrected somatropin serum concentrations were evaluated with non-compartmental and compartmental methods. The 90% confidence intervals with two one-sided t-tests around the ratios of injection devices were 91-120% for maximum concentration, 94-110% for area-under-curve until 14 h, and 92-103% for area-under-curve to infinity. Somatropin has a known metabolic half-life of ca. 20-30 min while the observed terminal half-lives were 2-4 h. Absorption and elimination rate constants were similar. Times of maximum concentrations, terminal half-lives and lag times to start of absorption appeared to be shorter and the absorption rate constant appeared to be larger for jet than for cannula injection. In conclusion, the kinetics of somatropin from subcutaneous tissue had a "flip-flop" characteristic. Bioavailability of somatropin after jet injection was equivalent to cannula injection.

New radiolabeled CCK-8 analogues [Tc-99m-GH-CCK-8 and Tc-99m-DTPA-CCK-8]: preparation and biodistribution studies in rats and rabbits

The aim of this study is to label CCK-8 with Tc-99m and to investigate its radiopharmaceutical potential. CCK-8 was labeled with Tc-99m using GH and DTPA as bifunctional chelating agents. Labeling efficiency was higher than 99%. Complex was stable more than 5 hours at room temperature. 37 MBq Tc-99m-GH-CCK-8 or Tc-99m-DTPA-CCK-8 was administered intravenously to rabbits for biodistribution experiments. Dynamic and static images were obtained from anterior projection using a Camstar XC/T gamma camera. For quantitative evaluation, regions of interest were drawn on organs and time-activity curves were generated. The highest accumulation occurred in brain within 10 and 30 minutes after injection. Renal and hepatobiliary excretion were observed. Brain distribution studies in rats showed the highest activity was in hypothalamus. Results demonstrated that Tc-99m-GH-CCK-8 and Tc-99m-DTPA-CCK-8 analogs may be a useful new class of receptor-binding peptides for diagnosis and therapy of brain diseases related with CCK-B receptor-expressing tumors.

Pharmacokinetics of lactosaminated recombinant human growth hormone in mice

AIM

To study the pharmacokinetic characteristics of lactosaminated recombinant human growth hormone (hGH-L) in mice.

METHODS

The biodistribution was studied with in vivo radioactive tracer technique. The pharmacokinetics was investigated by radioimmunoassay (RIA) method of hGH-L. The results were compared with that of recombinant human growth hormone (hGH).

RESULTS

125I-hGH-L has remarkable livertaxis. The area under drug concentration-time curve (32686.9 microg . min . L-1) in blood and serum mean residence time (21.4 min) of hGH-L are less than that of hGH (36913.1 microg . min . L-1 and 24.9 min) (P < 0.05). In target organ liver, hGH-L distribution half life (1.8 min) and elimination half life (11.1 min) are shorter than that of hGH (2.1 min and 27.7 min) (P < 0.05). The area under drug concentration-time curve (17621.9 microg . min . L-1) of hGH-L is bigger than that of hGH(12148.2 microg . min . L-1) (P < 0.05) in liver.

CONCLUSION

The pharmacokinetic parameters of hGH-L has obvious advantage over that of hGH.

Adsorption of erythropoietin and growth hormone to peritoneal dialysis bags and tubing

OBJECTIVE

To study the adsorption of erythropoietin and growth hormone to dialysis bags and tubing.

DESIGN

In vitro study in which radiolabeled erythropoietin and recombinant human growth hormone were added to small-volume (50- and 250-mL) dialysis bags. Recovery was measured after 15-minute dwells. Experiments were performed in triplicate.

SETTING

University hospital.

RESULTS

Adsorption of erythropoietin and growth hormone was less than 7%.

CONCLUSION

Adsorption of erythropoietin and recombinant human growth hormone to dialysis bags and tubing is minimal. This finding provides another argument in favor of intraperitoneal therapy in pediatric peritoneal dialysis.

Effects of oral administration of a synthetic fragment of human growth hormone on lipid metabolism

A small synthetic peptide sequence of human growth hormone (hGH), AOD-9401, has lipolytic and antilipogenic activity similar to that of the intact hormone. Here we report its effect on lipid metabolism in rodent models of obesity and in human adipose tissue to assess its potential as a pharmacological agent for the treatment of human obesity. C57BL/6J (ob/ob) mice were orally treated with either saline (n = 8) or AOD-9401 (n = 10) for 30 days. From day 16 onward, body weight gain in AOD-9401-treated animals was significantly lower than that of saline-treated controls. Food consumption did not differ between the two groups. Analyses of adipose tissue ex vivo revealed that AOD-9401 significantly reduced lipogenic activity and increased lipolytic activity in this tissue. Increased catabolism was also reflected in an acute increase in energy expenditure and glucose and fat oxidation in ob/ob mice treated with AOD-9401. In addition, AOD-9401 increased in vitro lipolytic activity and decreased lipogenic activity in isolated adipose tissue from obese rodents and humans. Together, these findings indicate that oral administration of AOD-9401 alters lipid metabolism in adipose tissue, resulting in a reduction of weight gain in obese animals. The marked lipolytic and antilipogenic actions of AOD-9401 in human adipose tissues suggest that this small synthetic hGH peptide has potential in the treatment of human obesity.

[Does the growth hormone pharmacokinetic profile help to predict the treatment response?]

Pharmacokinetics of subcutaneously administered recombinant growth hormone (rGH) were studied in nine GH deficient children at the time of the first rGH injection at the beginning of treatment. Serum GH levels were determined by four different methods: immunofunctional assay, immunofluorometric assay and two bioassays on Nb2 cells. The results showed similar profiles whatever the type of assay with a concentration peak reached 2 to 6 hours after subcutaneous injection; however, large individual variations in peak amplitude were observed. They were related to individual variations in the growth velocity during the first year of rGH treatment. These variations are possibly related to individual differences in rGH degradation at the site of injection. Study of rGH absorption profiles appears useful in the evaluation of rGH treatment in GH deficient patients.

Carrier-enhanced human growth hormone absorption across isolated rabbit intestinal tissue

Small molecular weight alpha acid derivatives are able to enhance the intestinal absorption of human growth hormone through isolated rabbit intestinal tissue. The enhancement is not through the usual tissue modification associated with traditional penetration enhancers nor is it through an active transport process. Rather these small molecules associate with human growth hormone in solution to make it more transportable through intestinal tissue. It is shown that the enhancer has specificity for a particular protein and the enhancer and human growth hormone must be in solution together to be effective, i.e. pretreating the tissue with enhancer and then adding the protein does not increase tissue permeability. Moreover, the enhancer does not increase the permeability of mannitol or progesterone, thus providing additional evidence of specificity and establishing that these agents are not classical penetration enhancers.

[Pharmacokinetic analysis of lactosaminated human growth hormone and human growth hormone]

This study was undertaken to explore and compare the pharmacokinetic features of lactosaminated human growth hormone(hGH-L) and human growth hormone (hGH). Radioimmunoassay (RIA) technique was used. After mice were intravenously injected with hGH-L, their blood and liver samples were collected and handled. The blood drug concentration and liver drug concentration were determined using RIA technique. Then the pharmacokinetic parameters were obtained by analysing the curves of blood drug concentration-time and liver drug concentration-time. hGH was determinated with the same methods. The results showed that the area under curve (AUC) of blood drug concentration-time curve of hGH-L was 32,686.90, the mean remain time (MRT) of hGH-L in blood was 21.37 minutes, but the AUC of blood drug concentration-time curve of hGH was 36,913.08 and the MRT of hGH in blood was 24.98 minutes. Therefore, in blood, the uptake of hGH-L was less than that of hGH, the removal of hGH-L was faster than the removal of hGH. In liver, for hGH-L, the half-time of distribution (t1/2 alpha) was 1.84 minutes, the half-time of removal(t1/2 beta) was 11.09 minutes, the AUC of liver drug concentration-time curve was 17,621.9; for hGH, the t1/2 alpha was 2.11 minutes, the t1/2 beta was 75.65 minutes, the AUC of liver drug concentration-time curve was 12,148.2. Therefore, in liver, the uptake of hGH-L was more than that of hGH, the distribution and removal of hGH-L were faster than those of hGH. Therefore, the pharmacokinetic features of hGH-L was better than the feature of hGH.

The effect of intake level on whole body kinetics and hepatic removal of somatotropin in growing beef steers

The effect of level of intake of a high concentrate diet (0.6, 1.0 and 1.6 x maintenance requirements, M) on whole body somatotropin (St) kinetics was evaluated in six growing, multicatheterized beef steers (398+/-27 kg), using a double 3x3 Latin Square design with 21 d-periods. Simultaneously to St kinetics, net hepatic removal of St was measured in 4 of the 6 steers. On the last day of each period, concentrations and net fluxes of St were determined, first in basal conditions for 5 hr, and then, during a primed (0.5 mg of St) infusion of bovine St (1.5 mg/hr) administered for 3 hr. The following results are LSM +/- SEM for 0.6, 1.0, and 1.6 x M, respectively. Increasing feed intake linearly decreased (P<0.01) basal St concentrations (5.6, 4.6, 3.1+/-0.62 ng/ml), mainly through a linear increment (P<0.01) in the metabolic clearance rate (32.7, 37.1, 43.4+/-2.60 l/hr), although secretion rate also tended to decrease (P = 0.09; 189, 185, 135+/-27.2 microg/hr). During the infusion period, net liver removal of immunoreactive ST averaged 60% of the total inflow of St. This confirms the liver is capable of removing large amounts of St, suggesting it has an important role in metabolic clearance of the hormone. Net liver removal of St, however, was not affected by intake. There was a strong correlation between the metabolic clearance rate of St with either whole body protein synthesis (r = 0.75, P<0.01) or protein retention (r = 0.68, P<0.01). Together these results indicate the importance of postsecretory metabolism of St in determining both arterial plasma concentrations of St and whole body protein anabolism.

Endocytosis and degradation of the growth hormone receptor are proteasome-dependent

The ubiquitin conjugation system is involved in ligand-induced endocytosis of the growth hormone receptor (GHR) via a cytosolic 10-amino acid ubiquitin-dependent endocytosis motif. Herein, we demonstrate that the proteasome is also involved in growth hormone receptor down-regulation. Ligand-induced degradation was blocked in the presence of specific proteasomal inhibitors. In addition, growth hormone (GH) internalization was inhibited, whereas the transferrin receptor cycle remained unaffected. A truncated GHR entered the cells independent of proteasome action. In addition, we show that GH internalization is independent of the presence of lysine residues in the cytosolic domain of the receptor, whereas its internalization can still be inhibited by proteasomal inhibitors. Thus, GHR internalization requires proteasome action in addition to an active ubiquitin conjugation system, but ubiquitination of the GHR itself seems not to be required.

Sustained release of human growth hormone from PLGA solution depots

PURPOSE

The effects of altering the dynamics of phase inversion of a polylactic glycolic acid (PLGA) solution depot on the sustained-release delivery profile of human growth hormone (hGH) were evaluated. The impact of adjusting the protein particle composition was also studied in a slow phase-inverting formulation.

METHODS

Protein release profiles of depots prepared from four model solvents were generated by injecting formulations into the subcutaneous space of normal rats and monitoring hGH serum levels over the course of 1 month. Scanning electron microscopy, Coulometric Karl Fischer titration, size-exclusion liquid chromatography, and reversed-phase liquid chromatography were used to observe depot morphologies, bulk water absorption, PLGA degradation, and protein particle dissolution rates, respectively.

RESULTS

An extended-release profile and significantly reduced burst effect resulted when the aqueous affinity of the depot solvent was reduced. As seen earlier in in vitro experiments, lowering the solvent's aqueous affinity slows the phase inversion rate, which in turn produces depot morphologies favorable to prolonged release. Protein burst on injection was entirely eliminated in a slow phase-inverting formulation by densifying the lyophilized protein particles. Unlike the use of metal cations to prolong release of some proteins in PLGA microsphere depots, this technique is more universal, and thus is potentially usable with any protein or highly soluble drug agent. The onset of biodegradation was observed to occur at 14 days for all depot formulations, however the bulk biodegradation rate slowed as the aqueous affinity of the depot solvent decreased. This result supports the hypothesis that, in a slow phase-inverting system, drug release over the first few weeks is governed by the diffusion rate of drug through the polymer solution.

CONCLUSIONS

By taking advantage of the effects of low aqueous affinity and protein particle densification, a PLGA solution depot was produced with the capability of sustaining hGH levels in normal rats at a serum level of 10 to 200 ng/ml for 28 days.

Influence of obesity and body fat distribution on growth hormone kinetics in humans

We studied the kinetics of exogenous recombinant 22-kDa human growth hormone (rhGH) in premenopausal women with upper body obesity (UBO), lower body obesity (LBO), or normal body weight. A bolus of 100 mU rhGH was administered during a continuous infusion of somatostatin to suppress endogenous GH secretion. GH kinetics were investigated with noncompartmental analysis of plasma GH curves. GH peak values in response to GH infusion and plasma half-life of GH were not significantly different between normal weight and obese subjects. In contrast, GH clearance was 33% higher in LBO women and 51% higher in UBO women compared with clearance in normal weight controls. The difference in clearance between LBO and UBO was not statistically significant. Altered GH clearance characteristics contribute to low circulating GH levels in obese humans. Body fat distribution does not appear to affect GH kinetics.

Pharmacokinetics and metabolic effects of high-dose growth hormone administration in healthy adult men

To evaluate pharmacokinetics of growth hormone (GH) and its effects on IGF-I, glucose, insulin, nonesterified fatty acid (NEFA) and triglyceride (TG), fifteen Japanese healthy adult male volunteers (20-27 years old) were studied. The subjects were divided into three groups, and received with a single s.c. injection of 0.075, 0.15 and 0.30 IU/kg of GH, respectively. The subjects assigned to receive 0.30 IU/kg were administered for additional 6 days. After a single administration of GH, Cmax and AUC of GH were increased in a dose-dependent manner. There was a significant positive correlation between the AUC and the T1/2 (r=0.516, P<0.05). Total body clearance was significantly greater in 0.075 IU/kg group than the other groups and showed a significant negative correlation with Cmax (r=-0.694, P<0.005) and AUC (r=-0.723, P<0.005). After a single administration of each dose, serum IGF-I concentrations were increased gradually. In the repeated administered group (0.30 IU/kg), IGF-I concentrations almost reached a plateau at a significantly high level four days after the start of administration and remained at a high level (786-405.4 ng/ml) until day 8. There was no significant difference in diurnal change of blood glucose and serum insulin after a single administration of GH among three groups. In the 0.3 U/kg group, there was no significant difference in diurnal change of blood glucose between day 1 and day 7, but serum insulin level was significantly higher in day 7 than in day 1 (P<0.01). Serum concentrations of NEFA were increased over time after administration in all subjects administered once or repeatedly. TG concentrations showed no changes after single administration of each dose level, but were significantly increased on day 7 in the subjects repeatedly treated with 0.30 IU/kg/day. This effect is speculated to be caused by high dose GH treatment. The above findings demonstrated that higher GH dose significantly influences on carbohydrate and lipid metabolism. It remains necessary to elucidate what kinds of effects of the long-lasting increased levels of insulin and triglyceride, even if reversible, would have on glucose and lipid metabolism.

Evaluation of certain veterinary drug residues in food. Fiftieth report of the joint FAO/WHO Expert Committee on Food Additives

This report presents the conclusions of a Joint FAO/WHO Expert Committee convened to evaluate the safety of residues of certain veterinary drugs in food and to recommend maximum levels for such residues. The first part of the report considers the neurotoxicity of anthelminthics belonging to the avermectin and milbemycin classes of compounds and the evaluation policy of the Committee in establishing Maximum Residue Levels (MRLs) for veterinary drugs in food. A summary follows of the Committee's evaluations of toxicological and residue data on a variety of veterinary drugs: five anthelminthic agents (eprinomectin, febantel, fenbendazole, oxfendazole and moxidectin), seven antimicrobial agents (gentamicin, procaine benzylpenicillin, sarafloxacin, spectinomycin, chlortetracycline, oxytetracycline and tetracycline), three antiprotozoal agents (diclazuril, imidocarb and nicarbazin), one glucocorticosteroid (dexamethasone), one production aid (recombinant bovine somatotropins) and one tranquilizing agent (azaperone). Annexed to the report are a summary of the Committee's recommendations on these drugs, including Acceptable Daily Intakes and MRLs, and further toxicological studies and other information required.

A pharmacokinetic/pharmacodynamic model for recombinant human growth hormone effects on induction of insulin-like growth factor I in monkeys

The pharmacokinetics of recombinant human growth hormone (rhGH) and its effects on the induction of insulin-like growth factor I (IGF-I) were studied in juvenile rhesus monkeys. Disposition profiles of rhGH from two short-term i.v. infusion studies were described by a two-compartment model yielding a clearance of 16.1 ml/min and T1/2 of 2.0 h. Four rhGH treatment groups were included in this study: group A, ProLease rhGH (24 mg), a sustained-release microsphere formulation; group B, a single s.c. injection plus an implanted osmotic pump (24.4 mg); group C, a single s.c. injection (25.9 mg); group D, daily 0.86-mg s.c. injection for 28 days. Their rhGH input profiles were analyzed by a numerical deconvolution method. ProLease and osmotic pump provided zero-order inputs of rhGH and maintained the serum rhGH concentrations around 9 to 13 ng/ml for 16 (group A) and 30 days (group B). For s.c. injections, rhGH underwent first-order absorption. An indirect response model was applied based on use of a Hill function for stimulation of IGF-I production. Parameter values obtained included Smax = 2.2, SC50 = 6.5 ng/ml, and gamma (slope coefficient) = 6.8, which were applicable to all treatments. The area under effect curve showed group B to be most effective for IGF-I induction, whereas group A produced the highest peak level in 16 days. Group C had the lowest induction among the four groups, despite being given the highest dose. Group D had modest IGF-I induction, but the pulsatile rhGH input is less effective than continuous input provided by ProLease. Our pharmacokinetic/pharmacodynamic model demonstrates that ProLease and osmotic pump delivery were best able to maintain rhGH level above the s.c.50 value, which provided more effective IGF-I induction compared with the single or daily subcutaneous injections in solution.

Pharmacokinetics of radioiodinated growth hormones in the turtle Chrysemys dorbigni

Growth hormone binding proteins (GHBP) have been identified in the blood of many species. The aim of the present work is to study the physiological role of the GHBP in the turtle serum which we recently described. Binding studies were carried out using in vivo pharmacokinetic and chromatographic techniques as well as in vitro methods. When (125)I-GH was injected in physiological concentration into Chrysemys dorbigni turtles, the first step of pharmacokinetics was the binding of a significant fraction of the labeled GH by the GHBPs present in serum. The decay curve followed a three compartments model and gave the equation: Ae(-alphat) + Be(-betat) + Ce(-gammat). The fast compartment with t(1/2) of 14.4 min or 25.2 min, for hGH and bGH represents 30.3% and 18.9% of total radioactivity, respectively, at hypothetical time zero (not experi mental). Chromatographic studies reveal that this rapid compartment represents free GH. The second and third compartments represent complex forms between GH and GHBPs present in the turtle serum, and represent 70% and 80% of total radioactivity for hGH and bGH, respectively. In vitro chromatographic studies showed direct evidence of the presence of GHBPs in the turtle serum. The presence of these GHBPs changed the pharmacokinetics of labeled GH in plasma and the subsequent liver uptake of GH. The labeled hGH or bGH binds to turtle serum in similar proportion, but maximal liver uptake of these hormones are completely different (L/B ratio of 9.2 +/- 0.6 (n = 5) for ( 125)I-hGH and 4.8 +/- 0.3 (n = 7) for (125)I-bGH). The reasons for these differences could be that human GH binds to lactogenic and somatotropic receptors and bovine GH binds only to somatotropic receptors.

The absorption profile and availability of a physiological subcutaneously administered dose of recombinant human growth hormone (GH) in adults with GH deficiency

AIMS

To investigate the absorption profile and estimate the bioavailability of three doses of recombinant human growth hormone (rhGH) smaller than 2 IU in females with GH deficiency (GHD). A second aim of the study was to compare the mean 24 h GH concentrations after s.c. injection of rhGH with the physiological mean 24 h GH concentration of healthy females of comparable age, height, and BMI.

METHODS

Fourteen female patients with substituted GHD, and 14 healthy females of comparable age, height, and BMI were studied. All GHD patients underwent 24 h GH sampling after s.c. injection of rhGH in doses of 0.6, 1.2, or 1.8 IU. In addition, these patients underwent a 4 h GH sampling after i.v. injection of rhGH (1 IU). In healthy subjects, blood was withdrawn every 10 min for 24 h to determine the physiological GH profile.

RESULTS

A s.c. dose of 0.6 IU resulted in a mean and maximum GH concentration of 0.95+/-0.04 mU l(-1) and 2.62+/-0.09 mU l(-1). A doubling (or tripling) of the rhGH dose resulted in a doubling (or tripling) of the mean and maximum GH concentration. The time of maximum GH concentration was reached on average after 261+/-27 min. Mean GH concentration in healthy females was comparable with the mean GH concentration after a s.c. dose of 1.2 IU. Mean availability of the s.c. injected dose was 63%+/-4%.

CONCLUSIONS

A dose of 1.2 IU resulted in a mean GH concentration comparable with the mean physiological GH concentration in healthy females of comparable age, height, and BMI.

Insulin-like growth factor-1 and growth hormone (GH) levels in canine cerebrospinal fluid are unaffected by GH or GH secretagogue (MK-0677) administration

Elevation in circulating GH levels results in a dose-related increase in serum insulin-like growth factor-1 (IGF-1) levels in dogs. However, it is not known whether elevations in systemic IGF-1 and GH levels contribute to the cerebrospinal fluid (CSF) levels of these hormones. Therefore, a study was designed in dogs to determine if elevated circulating GH levels was a result of a GH secretagogue (MK-0677) or if exogenous GH administration resulted in increased IGF-1 and GH levels in the CSF of dogs. A total of 12 normal, young adult male dogs were randomized to three treatment groups (4 dogs/group) based on body weight. There were 4 vehicle control dogs. A group of 4 dogs were dosed orally with MK-0677 (5 mg/kg/day) dissolved in deionized water. A third group of 4 dogs received subcutaneous injections of porcine GH (pGH) at a dose of 0.1 IU/kg/day. From all dogs, blood and CSF samples were collected prior to the initiation of treatment and on days 7 and 15 of treatment. All samples were assayed using a validated radioimmunoassay. Administration of MK-0677 or pGH resulted in a statistically significant (P < or = 0.05) increased body weight gain and increased serum IGF-1 and GH levels. In contrast, administration of MK-0677 resulted in no significant (P > 0.05) increase in CSF IGF-1 or GH levels on days 7 or 15 of the study. The CSF IGF-1 values ranged from 1.2 to 2.0 ng/ml with minimal variation among three separate samples taken during the course of the study from each dog. Similarly, the CSF GH levels were very low (< 0.98 ng/ml to 2.4 ng/ml) in all dogs irrespective of treatment group. This study has demonstrated that there is no correlation between the circulating levels of IGF-1 or GH and the levels of these hormones in the CSF of normal dogs. An approximately 100-fold difference between serum and CSF IGF-1 levels in vehicle control dogs suggest that there is a blood-brain barrier for the circulating IGF-1. Similarly, failure to see an elevation in CSF GH levels despite increases in serum GH levels shows that there is a blood-brain barrier for GH in normal dogs. These results suggest that the likely source of GH and IGF-1 in the CSF of dogs is from the CNS.

Spontaneous pulsatility and pharmacokinetics of growth hormone in liver cirrhotic patients

BACKGROUND/AIMS

Liver cirrhosis is characterized by high serum growth hormone levels and low serum insulin-like growth factor I and growth hormone-binding protein levels. The present study was designed to characterize the serum profile of growth hormone and growth hormone pharmacokinetics in postnecrotic liver cirrhosis, correlating it with liver function and nutritional states.

METHODS

Fifteen patients were grouped by the Child-Pugh score (group 1, score of 5 to 8; group 2, score of 9 to 12). Five healthy subjects served as controls. Nutritional status was assessed by the creatinine-height index. Baseline growth hormone, insulin-like growth factor, and growth hormone binding protein were measured, and growth hormone pharmacokinetics was followed for 48 h after administration of subcutaneous recombinant human growth hormone (0.06 mg/kg).

RESULTS

Trough serum growth hormone (microg/l) was higher in both patient groups (5.3+/-3.6) than in controls (1.0+/-0.3; p<0.01). More pulses were recorded in cirrhotic patients, and mean pulse amplitude (microg/l) was higher in cirrhotic patients than in controls (p<0.01). After subcutaneous recombinant human growth hormone injection, maximal growth hormone was higher in cirrhotic patients and the area under the curve over 24 h was greater (626+/-120) than in controls (330+/-54; p<0.01). Single regression analysis showed a weak correlation of both the Child-Pugh score and the creatinine-height index with the pharmacokinetic parameters.

CONCLUSIONS

Due to decreased growth hormone clearance, patients with liver cirrhosis have increased trough and peak serum growth hormone levels, as well as lower serum growth hormone binding protein and insulin-like growth factor. Recombinant human growth hormone pharmacokinetics are typical of a high hepatic extraction substance administered to patients with liver disease and portal hypertension, and this may be relevant to the further use of growth hormone therapy.

Somatopause and adiposity

Mobilization of lipids is the pivotal action of growth hormone (GH) in both children and adults. The temporal association between declining GH levels and accumulation of body fat with ageing is, therefore, interesting although the cause-effect relationship remains unknown. Recent cross-sectional data suggest that both stimulated and spontaneous GH release is predominantly predicted by the amount of abdominal fat in both men and women. The same study also shows that ageing is associated with an increased metabolic clearance rate and apparent distribution volume, both of which correlate positively with fat mass and negatively with age. Furthermore, the acute lipolytic response to a GH bolus is somewhat lower in older adults (and in women). It is, therefore, proposed that changes in life style and dietary habits, perhaps together with an age-determined reduced lipolytic responsiveness to GH, initiates fat accumulation. The increased fat mass, in turn, inhibits the release and promotes the clearance of GH thus establishing a vicious circle.

Fat distribution in children and adolescents--the influence of sex and hormones

A significant proportion of the morbidity related to obesity is now recognized to be related to the regional distribution of fat. The advent of dual energy X-ray absorptiometry has facilitated the assessment of body composition in a number of investigations on body fat. From current data, including the authors' own study of trunk and leg fat in 335 children and young adults, it is evident that gender differences for total body fat, percentage of body fat and distribution of fat occur after the pubertal years. Males develop a distribution of fat which favours central deposition of fat irrespective of their total body fat--a distribution that is, unfortunately, associated with a number of adverse implications on health. Furthermore, this tendency to increasing abdominal fat is independent of adipose tissue mass. Hormonal regulators of adipose tissue, including growth hormone which is already known to increase free fatty acids and decrease fat cell mass, need to be studied to account for these gender differences.

Growth hormone-binding protein enhances growth hormone activity in vivo

The decay curve of labeled growth hormone (GH) in the plasma followed a three-compartment model and could be described by the equation: concentration = Ae-alpha t + Be-beta t + Ce-gamma t, where A, B, and C are y-intercepts and alpha, beta, and gamma are compartments. When 125I-labeled ovine prolactin (oPRL) was injected, the decay curve could be described by the equation: concentration = Ae-alpha t + Ce-gamma t. Formation of 125I-labeled bovine-GH-binding protein (GHBP) complexes with somatogenic characteristics was demonstrated in the serum of both normal and GH transgenic mice. In contrast, 125I-oPRL was unable to form complexes of this type in any of the mice studied. Receptor-mediated liver uptake was found to be faster for PRL than for GH (5-6 min vs. 15-20 min). Liver uptake of radioactivity was significantly lower for PRL than for GH [liver to blood ratio (L/B) of 1.7 +/- 0.3 at 6 min vs. L/B of 3.7 +/- 0.6 at 20 min, respectively]. The presence of binding proteins for GH substantially reduces the clearance of this hormone and consequently increases the liver uptake of GH (mediated by GH receptors). This suggests that GHBPs act to increase the biological activity of GH in vivo.

Investigation into the release of bioactive recombinant human growth hormone from normal and low-viscosity poly(methylmethacrylate) bone cements

Previous studies showed that recombinant human growth hormone (hGH) released from hormone-loaded poly(methylmethacrylate) (PMMA) cement stimulated osteoid formation in a rabbit model. Local delivery of hGH from cemented hip arthroplasties may thereby provide a means of reducing the problem of aseptic loosening. We have investigated two different formulations of PMMA as delivery systems for bioactive hGH. The bioactivity of the hormone release in vitro was monitored with an eluted stain assay (ESTA). The hGH was also measured by an immunoassay, which provides an alternative assessment of structural integrity of the hormone released. In addition, we adapted the ESTA bioassay to assess the in vitro cytotoxicity of the cements. Using unloaded cements, the undiluted eluates from both types of PMMA proved cytotoxic. This cytotoxicity could be diluted out, and the procedure allowed us to measure the bioactivity of hGH in the eluates from hormone-loaded cements independent of their cytotoxicity. The major fraction of the bioactivity was released from both of the PMMA cements during the first 24 h, but the hormone remained detectable in eluates collected after 36 days of elution. Comparison of the bio- and immunoactivity of the hGH released showed that the ratio of these two activities (i.e., the B:I ratio) was constant over this time period. However in parallel studies in which hormone-loaded discs were stored under dry conditions prior to elution, we found that the B:I ratio then declined markedly. This suggests that fully hydrated conditions, such as when the discs are bathed in assay medium, are necessary to maintain the bioactivity of the hGH. Both cements released only approximately 1% of the hormone originally incorporated, but the hGH concentration which accumulated in the eluates were high in physiologic terms (approximately 1000 mU/L).

Inhibition of GH release of rats by new potent antagonists of growth hormone-releasing hormone (GH-RH)

Biological activity of a new series of potent GH-RH antagonists containing formyl or phenylacetyl group at the N-terminus of the sequence [D-Arg2,Phe(4-Cl)6,Nle27]hGH-RH(1-29)NH2, as well as various substitutions in positions 8, 15, or 28, and in some cases Agm in position 29, was evaluated in vivo. All five antagonists, administered at a 27-fold molar excess to rats, suppressed the GH-releasing effect of exogenous GH-RH(1-29)-NH2 by 64-75%. The inhibitory effects lasted for more than 15 min. The most potent analogue, PhAc-[D-Arg2,Phe(4-Cl)6,Abu15,Nle27]hGH-RH(1-28)Agm (MZ-5-156), showed an in vivo potency 7-16 times higher than the early antagonist [Ac-Tyr1,D-Arg2]hGH-RH(1-29)-NH2, which was used as standard. MZ-5-156 was capable of decreasing serum GH levels after intravenous, intraperitoneal, or intramuscular administration. In vitro, in the superfused rat pituitary cell system, MZ-5-156 induced a prolonged inhibition of GH release after continuous long-term administration and showed a potency more than 100 times greater than the standard antagonist. These results show that N-terminal acylation with phenylacetic acid of the sequence [D-Arg2,Phe(4-Cl)6,Nle27]hGH-RH(1-29)-NH2, containing modifications in positions 8, 15, 28, or 29, results in antagonists with high and protracted potency both in vivo and in vitro. In view of high antagonistic activity and prolonged duration of action, some of these antagonists of GH-RH may find clinical application for the treatment of IGF-dependent cancers.

Bioavailability and bioactivity of intravenous vs subcutaneous infusion of growth hormone in GH-deficient patients

OBJECTIVE

The bioavailability of GH immunoreactive serum concentrations is reduced following subcutaneous (s.c.) as compared with intravenous (i.v.) administration. Whether this difference also translates into a different biological activity remains to be investigated. The aim of the present study was to evaluate the short-term metabolic effects of GH following i.v. and s.c. delivery.

DESIGN AND MEASUREMENTS

In a cross-over design 10 GH-deficient patients were randomized to receive GH (0.03 microgram (0.1 mU/kg/min) as a continuous i.v. or s.c. infusion for 39 hours on two different occasions. Preceding each study GH therapy was discontinued for 5 days. Serum profiles of GH, IGF-I, IGF-II, IGF binding protein 3 (IGFBP-3), insulin, glucose and non-esterified fatty acids (NEFA) were recorded during the studies. Serum GH was measured by a polyclonal radio-immunoassay (RIA) and by a double monoclonal immunofluorimetric assay (DELFIA).

RESULTS

Higher mean integrated values (AUC) of serum GH (mU/l) were obtained with i.v. GH delivery [47.4 +/- 5.1 (i.v.), 33.3 +/- 3.0 (s.c.), P < 0.05]. The two GH assays showed qualitatively similar results, but higher mean GH concentrations were measured by RIA following both s.c. (P < 0.001) and i.v. infusion (P < 0.001). Serum IGF-I levels displayed different patterns following i.v. and s.c. GH infusion (P < 0.05 by ANOVA) and mean IGF-I levels (micrograms/l) were lower following s.c. GH infusion [159.5 +/- 21.8 (s.c.), 185.2 +/- 27.7 (i.v.), P = 0.002]. Serum IGF-II levels were unaffected by short-term GH treatment and by the route of GH administration. Serum IGFBP-3 levels increased in response to GH administration (P < 0.001), irrespective of route (P = 0.76). The IGF-I/IGFBP-3 molar ratio increased significantly following GH administration (P < 0.001), and a higher ratio was obtained following i.v. infusion (P < 0.005). Subcutaneous GH infusion resulted in significantly lower mean levels of serum NEFA (P < 0.02), whereas similar mean levels of serum insulin (P = 0.54), blood glucose (P = 0.24), energy expenditure (P = 0.13), and respiratory exchange ratio (P = 0.09) were observed on the two occasions.

CONCLUSIONS

A reduced bioavailability of s.c. as compared with i.v. administered GH has been recorded with two independent GH assays, and this was also accompanied by a significant, albeit modest, reduction in biological activity.

A month-long effect from a single injection of microencapsulated human growth hormone

An injectable sustained-release form of human growth hormone (hGH) was developed by stabilizing and encapsulating the protein, without altering its integrity, into biodegradable microspheres using a novel cryogenic process. A single injection of microspheres in monkeys resulted in elevated serum levels of recombinant hGH (rhGH) for more than one month. Insulin-like growth factor-I (IGF-I) and its binding protein IGFBP-3, both of which are induced by hGH, were also elevated for four weeks by the rhGH containing microspheres to a level greater than that induced by the same amount of rhGH administered by daily injections. These results show that, by using appropriate methods of stabilization and encapsulation, the advantages of sustained-release formulations previously demonstrated for low-molecular-weight drugs can now be extended to protein therapeutics.

4-[4-[(2-Hydroxybenzoyl)amino]phenyl]butyric acid as a novel oral delivery agent for recombinant human growth hormone

A series of N-acetylated, non-alpha, aromatic amino acids was prepared and shown to promote the absorption of recombinant human growth hormone (rhGH) from the gastrointestinal tract. Seventy compounds in this family were tested in vivo in rats. Of the compounds tested, 4-[4-[(2-hydroxybenzoyl)amino]phenyl]butyric acid was identified as a preclinical candidate and was used to demonstrate the oral delivery of rhGH in primates. A significant positive correlation was found between the relative log k' of the delivery agents, as determined by HPLC on an immobilized artificial membrane (IAM) column, and serum rhGH concentrations following oral or colonic dosing in rats. Structure-activity relationships have also been developed on the basis of electronic effects and hydrogen-bonding characteristics of the aromatic amide substituents.

Pharmacokinetics and pharmacodynamics of a single dose of recombinant human growth hormone after subcutaneous administration by jet-injection: comparison with conventional needle-injection

The pharmacokinetics and pharmacodynamics of recombinant human growth hormone (rhGH) were studied after a single subcutaneous dose given by jet-injection, and have been compared with the results obtained after conventional needle-injection. Twelve healthy male volunteers completed an open label, randomised, two-way crossover study, with a 7-day washout period between the two single sc doses. Pharmacokinetic parameters were derived from rhGH concentrations in blood samples collected regularly over 24 h after dosing on Day 1 of each period. To investigate the pharmacodynamics, additional samples were taken for the analysis of somatomedin C (IGF-I) and free fatty acids (FFA). A higher and earlier Cmax was found after jet-injection (ratio (%) jet-injected/needle-injected 124; 90%-confidence interval 108-142). The AUC0-infinity for rhGH were similar (ratio (%) jet-injected/needle-injected 98; 90%-confidence interval 93-103). Both treatments were associated with a significant and similar rise in IGF-I. Both administrations of rhGH were associated with identical rhythmical changes in FFA. The study indicates that jet-injected and needle-injected rhGH are bioequivalent with respect to the amount absorbed. The criterion for bioequivalence is not met for the rate of absorption. It is unlikely that the latter finding will influence the pharmacodynamics of rhGH, since bioequipotency was established for the effect on IGF-I generation. Jet-injection was safe in use and was generally well tolerated.