Frances Liu

Insulin-like growth factor system abnormalities in hepatitis C-associated osteosclerosis. Potential insights into increasing bone mass in adults.

Hepatitis C-associated osteosclerosis (HCAO) is a rare disorder characterized by a marked increase in bone mass during adult life. Despite the rarity of HCAO, understanding the mediator(s) of the skeletal disease is of great interest. The IGFs-I and -II have potent anabolic effects on bone, and alterations in the IGFs and/or IGF-binding proteins (IGFBPs) could be responsible for the increase in bone formation in this disorder. Thus, we assayed sera from seven cases of HCAO for IGF-I, IGF-II, IGF-IIE (an IGF-II precursor), and IGFBPs. The distribution of the serum IGFs and IGFBPs between their ternary ( approximately 150 kD) and binary (approximately 50 kD) complexes was also determined to assess IGF bioavailability. HCAO patients had normal serum levels of IGF-I and -II, but had markedly elevated levels of IGF-IIE. Of the IGFBPs, an increase in IGFBP-2 was unique to these patients and was not found in control hepatitis C or hepatitis B patients. IGF-I and -II in sera from patients with HCAO were carried, as in the case of sera from control subjects, bound to IGFBP-3 in the approximately 150-kD complex, which is retained in the circulation. However, IGF-IIE was predominantly in the approximately 50-kD complex in association with IGFBP-2; this complex can cross the capillary barrier and access target tissues. In vitro, we found that IGF-II enhanced by over threefold IGFBP-2 binding to extracellular matrix produced by human osteoblasts and that in an extracellular matrix-rich environment, the IGF-II/IGFBP-2 complex was as effective as IGF-II alone in stimulating human osteoblast proliferation. Thus, IGFBP-2 may facilitate the targeting of IGFs, and in particular IGF-IIE, to skeletal tissue in HCAO patients, with a subsequent stimulation by IGFs of osteoblast function. Our findings in HCAO suggest a possible means to increase bone mass in patients with osteoporosis.

Effect of chronic renal failure and growth hormone therapy on the insulin-like growth factors and their binding proteins.

Abstract Children with chronic renal failure (CRF) are often growth retarded, and abnormalities of the growth hormone (GH)/insulin-like growth factor (IGF) axis in CRF may contribute to this poor growth. Despite normal IGF levels in CRF serum, IGF bioactivity is low due to excess IGF-binding proteins (IGFBPs) in the 35-kDa serum fractions. Levels of IGFBP-1, -2, -4 and -6, and a 29-kDa IGFBP-3 fragment, are high in CRF serum, and levels of intact IGFBP-1 and -2 correlate negatively with height. IGFBP-1 levels may be high due to insulin resistance, suggesting that the FKHR family of transcription factors may play a role in the overexpression of IGFBP-1, and other growth inhibitors, in CRF. GH-treated CRF children show catch-up growth that correlates positively with a rise in each component of the 150-kDa serum ternary complex (IGF-I or -II/IGFBP-3 or -5/acid-labile subunit); IGFBP-1, -2 and -6 levels do not rise, but serum IGF bioactivity does. Thus, GH increases levels of IGFs and ternary complexes in CRF serum. It is likely that increased IGFs contribute to catch-up growth by overcoming the inhibitory effects of excess IGFBPs present in the CRF milieu.

Insulin-like growth factor-binding protein-6 levels are elevated in serum of children with chronic renal failure: a report of the Southwest Pediatric Nephrology Study Group.

Previous studies suggest that growth retardation in children with chronic renal failure (CRF) results in part from inhibition of insulin-like growth factor (IGF) action by excess serum IGF-binding proteins (IGFBPs). Excess IGFBPs in CRF serum include IGFBP-1, -2, and -3 and a diffuse approximately 24- to 28-kDa IGFBP band identified by [125I]IGF ligand blot. The present studies characterized this diffuse approximately 24- to 28-kDa band. Initial studies identified this band as IGFBP-6, because it was immunoprecipitated by antiserum raised against a synthetic peptide of human IGFBP-6 (hIGFBP-6). Additional [125I]IGF ligand blots found that the immunoprecipitated band was 1) recognized by [125I]IGF-II but not [125I]IGF-1, 2) more abundant in CRF than in normal serum, and 3) more abundant in serum from dialyzed than nondialyzed prepubertal CRF children. Using the hIGFBP-6 antiserum in a specific and sensitive RIA, we found that serum IGFBP-6 levels were 4.7 +/- 1.7 nmol/L in 10 normal prepubertal children, 21.4 +/- 6.1 nmol/L in 44 nondialyzed prepubertal CRF children, 73.5 +/- 14.4 nmol/L in 7 dialyzed prepubertal CRF children, and 94.6 +/- 26.2 nmol/L in 14 dialyzed pubertal CRF children. IGFBP-6 levels were also elevated in 71 nondialyzed European children with CRF. In nondialyzed CRF children, serum IGFBP-6 levels 1) correlated inversely with the glomerular filtration rate, 2) did not correlate with height SD score, and 3) were not altered by 12 months of daily recombinant hGH treatment. In summary, a specific antiserum and RIA were used to demonstrate elevated levels of intact IGF-II-binding IGFBP-6 in serum of CRF children. We postulate that the excess IGFBP-6 may modulate the action of IGF-II on target tissues.

Bioactivity of a 29-kilodalton insulin-like growth factor binding protein-3 fragment present in excess in chronic renal failure serum

Children with chronic renal failure (CRF) have normal or high serum levels of GH, IGF-I, and IGF-II. Despite this, the serum of CRF patients has low IGF bioactivity, which may contribute to CRF growth failure. Recent studies suggest that excess IGF binding proteins (IGFBPs) in the ≈35-kD fractions of CRF serum contribute to this low IGF bioactivity. This report characterizes a 29-kD form of IGFBP-3, IGFBP-329, which accumulates in the ≈35-kD fractions of CRF serum and peritoneal dialysate. Deglycosylation and[125I]IGF ligand blot studies show that IGFBP-329 is a glycosylated IGFBP-3 fragment with low affinity for IGF peptides. Using an IGFBP-3 antibody column, IGFBP-329 was purified to homogeneity from the≈35-kD fractions of peritoneal dialysate from children with CRF. Compared with native IGFBP-3, pure IGFBP-329 has a 4-10-fold lower affinity for IGF-II and a 200-fold lower affinity for IGF-I. Consistent with the binding data, IGFBP-329 inhibited IGF-II-stimulated thymidine incorporation in chondrosarcoma cells, but was a less potent inhibitor than native IGFBP-3; also, native IGFBP-3 clearly inhibited IGF-I-stimulated thymidine incorporation in chondrosarcoma cells and potentiated IGF-I-stimulated aminoisobutyric acid uptake in bovine fibroblasts, but higher concentrations of IGFBP-329 had no effect on these IGF-I actions. Thus, the 29-kD IGFBP-3 form that accumulates in CRF serum and extravascular spaces is an IGFBP-3 fragment that may modulate IGF-II, but not IGF-I, effects on target tissues. Whether IGFBP-329 plays any role in the growth failure of children with CRF remains to be determined.

Characterization of insulin-like growth factors and their binding proteins in peritoneal dialysate

Abstract.Serum insulin-like growth factors (IGFs), which circulate bound to specific IGF binding proteins (IGFBPs), must exit the intravascular space before acting on target tissues. Little is known about the nature of IGF/IGFBPs in extravascular fluids of patients with chronic renal failure (CRF). Peritoneal dialysate (PD) was studied since, after a short incubation, PD contains proteins which have entered an extravascular space; thus, IGF/IGFBP forms in PD are more likely than serum forms to interact with target tissues. IGF-I and IGF-II, and IGFBPs 1 – 4, were readily identified by specific immunoassays and/or 125iodine-IGF ligand blotting of simultaneously obtained PD and serum samples from seven CRF children; IGFBP-3 was a major IGFBP in PD as in serum. Where quantitated, IGF and IGFBP levels in PD were approximately 10% of serum concentrations. After separation of PD and serum by size-exclusion chromatography, serum had more IGFBP-3 in 150-kilodalton (kDa) than 35-kDa fractions, while PD had far less IGFBP-3 in 150-kDa than 35-kDa fractions. Immunoblot studies revealed a major 29-kDa IGFBP-3 fragment, in addition to intact 41- and 38-kDa IGFBP-3 forms, in PD and CRF serum; the 29-kDa form predominated in the 35-kDa PD fractions. These data suggest that the 29-kDa fragment is the IGFBP-3 form most likely to modulate IGF effects on target tissues of CRF individuals.

High molecular weight forms of insulin-like growth factor II and its binding protein identified by protein immunoblotting

Insulin-like growth factor (IGF)II is a mitogenic polypeptide which circulates in association with a binding protein(s). Immunoblotting studies were performed in human serum and indicate that:(1)a approximately 200 kDa covalently-linked IGF-II/binding protein complex is antigenically related to the 30 kDa binding protein, (2)IGF-II prohormone is associated with this complex, and (3)a major portion of the IGF-II prohormone immunoreactivity in human serum is present in fractions which would not be detected by standard radioimmunoassay methods. Our data provide insight regarding the inter-relationships of IGF-II and its binding protein, and direct evidence for the presence of IGF-II prohormone in human serum.

Disturbances of growth hormone-insulin-like growth factor axis and response to growth hormone in acidosis

Severe chronic metabolic acidosis (CMA) in rats is associated with poor food intake and downregulation of growth hormone (GH), insulin-like growth factors (IGFs), and liver receptors; the administration of recombinant GH (rGH) fails to improve the growth failure. In mice with carbonic anhydrase II deficiency (CAD), a model of moderate CMA with food intake close to normal, we studied serum levels of GH, IGFs, and IGF-binding proteins, and the growth response to rGH. CAD was associated with low serum levels of GH in males. Randomized administration of rGH from ∼5 to ∼12 wk to CAD mice improved food efficiency and increased serum IGF-I levels, final length, and weight compared with placebo without affecting blood pH. Although administration of rGH also increased linear growth in healthy animals, the effect was less than that in CAD mice and was only observed when started before 6 wk of life. Thus growth failure in CAD mice is associated with a decrease in GH secretion in males but not in females. Long-term administration of rGH increases linear growth in CAD mice despite persistent CMA.

HORMONAL MECHANISMS OF GROWTH FAILURE IN MODERATE CHRONIC METABOLIC ACIDOSIS(CMA) WITH NORMAL FOOD INTAKE. 392

Hormonal changes in rats subjected to high doses of NH4Cl are similar to those observed in non acidotic rats with similar degree of food deprivation. To assess the effect of CMA with normal food intake on the growth hormone (GH)-insulin-like growth factor (IGF) axis, we compared 3-6 month-old mice with congenital deficiency in carbonic anhydrase II (CAD) to B6AF1 controls (Con). Because of the differences in secretory pattern of GH in rats, genders were analyzed separately. We measured hourly serum GH concentrations(avg±sem) by ELISA using a species-specific antiserum (provided by Genentech), and assessed free serum levels of IGF-1 and IGF-2 by the ratio of the concentration of total IGF-1 or IGF-2 (measured by RIA) to that of high molecular weight IGF-binding protein (IGF-BP3, measured by densitometric analysis of western ligand blots). In male Con (n=6) the number of peak GH levels (defined as > 5 ng/ml) and the average daytime GH concentration were similar to nocturnal values. The average daytime GH concentration and the incidence of GH peaks (8%) in Con males were approximately twice as high as in the other groups. Table

416 SOMATOMEDIN BINDING PROTEIN IN GROWTH HORMONE DEFICIENCY

The somatomedin (SM) peptides are carried in plasma complexed to SM binding proteins (SMBP). The SM complexes have two major forms in plasma. The 150K dalton complex is made up of three subunits: an acid stable SMBP, SM peptide, and an acid labile component. The 40K complex is made up of a SMBP and SM peptide In addition, there is unsaturated SMBP found mainly in the 35-40K region. We have compared levels of unsaturated SMBP in 7 normal adults to 21 children with growth hormone deficiency before and during treatment with hGH 0.1U/Kg/day 4 days. The SM-C/IGF-I content of each plasma was measured by RIA. There was a significant (p< 0.01) difference in unsaturated SMBP between normal controls (17.8±0.8 %Bound/20ul) and untreated hypopituitary patients (27.8±2.2 %Bound/20ul). Thus a lower SM-C/IGF-I was associated with a higher unsaturated SMBP. Furthermore, there was a significant negative correlation between SM-C/IGF-I content and unsaturated SMBP in the untreated hypopituitary patients (r=0.73, p< 0.001). Treatment with hGH normalized the mean unsaturated SMBP in the hypopituitary patients within two days. Full displacement curves and Scatchard analysis showed that the increased unsaturated SMBP in hypopituitary plasma was entirely due to an increased affinity (8.4±0.9 × 10−10M) when compared to normal (2.3±0.2 × 10−9M). We conclude that a higher affinity form of unsaturated SMBP is uniquely present in hypopituitarism which disappears with GH treatment. This change is in contrast to the low levels of acid stable SMBP which increase after GH.