Robert C. Baxter

Binding proteins for the insulin-like growth factors: Structure, regulation and function

Binding proteins for the insulin-like growth factors (IGF-I and IGF-II) are increasingly being recognized as modulators of IGF actions in both inhibitory and stimulatory ways. At least three distinct classes of binding protein are thought to exist, differing in their primary structures and binding characteristics, although all are able to bind both IGF-I and IGF-II. This review outlines the purification and characterization of the binding proteins that have been identified to date, and describes the regulation of their production and of their levels in the circulation. Current views on their potential biological roles are also discussed.

Radioimmunoassay of growth hormone-dependent insulinlike growth factor binding protein in human plasma.

A specific radioimmunoassay has been established for a growth hormone-dependent insulinlike growth factor (IGF) binding protein (BP) from human plasma. Although the assay was directed against a 53-kD, acid-stable BP subunit, the main immunoreactive BP in the circulation had an apparent molecular mass of approximately 125 kD. Only higher primate species showed cross-reactivity, and IGF-I, IGF-II, and other peptides were without effect. Circulating BP levels in healthy subjects rose threefold from early childhood to puberty. In 65 adults aged 18 to 65, the mean level (+/- SD) was 6.12 +/- 1.43 micrograms/ml, and declined with age. Strong growth hormone-dependence of BP was also seen; there was a 2.2-fold increase in active acromegaly and a 50-80% reduction in growth hormone deficiency. Poorly controlled diabetic subjects had BP levels 40% below normal, whereas in renal failure and third-term pregnancy a mild elevation was seen. Measurement of BP may provide a useful adjunct to IGF assays in growth disorders.

Diagnosis of growth hormone deficiency in adults

There is no consensus as to the most appropriate method of diagnosing growth-hormone (GH) deficiency in adults. We have evaluated the relative diagnostic merits of measuring peak GH response to insulin-induced hypoglycaemia (insulin tolerance test), mean 24 h GH concentration derived from 20 min sampling, serum insulin-like growth factor I (IGF-I) concentrations, and serum IGF binding protein 3 (IGFBP-3) concentrations. These tests were undertaken in 23 patients considered GH deficient from extensive organic pituitary disease, and in 35 sex-matched normal subjects of similar age and body-mass index. Hypopituitary subjects had significantly lower stimulated peak GH, mean 24 h GH, IGF-I, and IGFBP-3 concentrations than normal subjects. The ranges of stimulated peak GH responses were clearly separated between the hypopituitary (< 0.2-3.1 ng/mL) and normal (5.3-42.5 ng/mL) groups, but mean 24 h GH, IGF-I, and IGFBP-3 concentrations overlapped. Mean 24 h GH concentrations were below assay sensitivity in 80% of hypopituitary subjects and 16% of normal subjects. 70% and 72%, respectively, of the IGF-I and IGFBP-3 values in hypopituitary subjects were within the range for normal subjects. We conclude that GH deficiency in adults is most reliably identified by stimulatory testing, and that IGF-I and IGFBP-3 are poor diagnostic tests of adult GH deficiency.

Growth hormone-dependent insulin-like growth factor (IGF) binding protein both inhibits and potentiates IGF-I-stimulated DNA synthesis in human skin fibroblasts

This study investigates the effects of BP-53, the acid-stable IGF-binding subunit of the circulating 150 kDa IGF-binding protein complex, on IGF-I-stimulated thymidine incorporation by neonatal human skin fibroblasts. When cells were incubated for 24 h with IGF-I in serum-free medium, and thymidine incorporation studied over the final 4-h period, maximal stimulation (4- to 7-fold) was seen with 30 ng/ml IGF-I, with a half-maximal effect at 6.8 +/- 1.2 ng/ml (SD, n = 4). Co-incubation of IGF-I with increasing concentrations of pure BP-53 caused dose-dependent inhibition of IGF-I-stimulated thymidine incorporation, which was complete when IGF-I and BP-53 were equimolar. In contrast, preincubation of cells with BP-53 for 8-48 h before adding IGF-I resulted in a potentiation of the subsequent IGF-I effect. The potentiation was maximal (2-fold) at a BP-53 concentration of 150 ng/ml, and appeared to act by increasing the maximal rate of thymidine incorporation rather than the sensitivity of this process to IGF-I. Since neonatal fibroblasts produce a protein which is identical to BP-53 in size and immunoreactivity, these results suggest an autocrine role for BP-53 in regulating fibroblast responsiveness to IGF-I.

Enhancement of the anabolic effects of growth hormone and insulin-like growth factor I by use of both agents simultaneously.

The use of growth hormone (GH) as an anabolic agent is limited by its tendency to cause hyperglycemia and by its inability to reverse nitrogen wasting in some catabolic conditions. In a previous study comparing the anabolic actions of GH and IGF-I (insulin-like growth factor I), we observed that intravenous infusions of IGF-I (12 micrograms/kg ideal body wt [IBW]/h) attenuated nitrogen wasting to a degree comparable to GH given subcutaneously at a standard dose of 0.05 mg/kg IBW per d. IGF-I, however, had a tendency to cause hypoglycemia. In the present study, we treated seven calorically restricted (20 kcal/kg IBW per d) normal volunteers with a combination of GH and IGF-I (using the same doses as in the previous study) and compared its effects on anabolism and carbohydrate metabolism to treatment with IGF-I alone. The GH/IGF-I combination caused significantly greater nitrogen retention (262 +/- 43 mmol/d, mean +/- SD) compared to IGF-I alone (108 +/- 29 mmol/d; P < 0.001). GH/IGF-I treatment resulted in substantial urinary potassium conservation (34 +/- 3 mmol/d, mean +/- SE; P < 0.001), suggesting that most protein accretion occurred in muscle and connective tissue. GH attenuated the hypoglycemia induced by IGF-I as indicated by fewer hypoglycemic episodes and higher capillary blood glucose concentrations on GH/IGF-I (4.3 +/- 1.0 mmol/liter, mean +/- SD) compared to IGF-I alone (3.8 +/- 0.8 mmol/liter; P < 0.001). IGF-I caused a marked decline in C-peptide (1,165 +/- 341 pmol/liter; mean +/- SD) compared to the GH/IGF-I combination (2,280 +/- 612 pmol/liter; P < 0.001), suggesting maintenance of normal carbohydrate metabolism with the latter regimen. GH/IGF-I produced higher serum IGF-I concentrations (1,854 +/- 708 micrograms/liter; mean +/- SD) compared to IGF-I only treatment (1,092 +/- 503 micrograms/liter; P < 0.001). This observation was associated with increased concentrations of IGF binding protein 3 and acid-labile subunit on GH/IGF-I treatment and decreased concentrations on IGF-I alone. These results suggest that the combination of GH and IGF-I treatment is substantially more anabolic than either IGF-I or GH alone. GH/IGF-I treatment also attenuates the hypoglycemia caused by IGF-I alone. GH/IGF-I treatment could have important applications in diseases associated with catabolism.

Nuclear import of insulin-like growth factor-binding protein-3 and -5 is mediated by the importin beta subunit

Although insulin-like growth factor-binding protein (IGFBP)-3 and IGFBP-5 are known to modulate cell growth by reversibly sequestering extracellular insulin-like growth factors, several reports have suggested that IGFBP-3, and possibly also IGFBP-5, have important insulin-like growth factor-independent effects on cell growth. These effects may be related to the putative nuclear actions of IGFBP-3 and IGFBP-5, which we have recently shown are transported to the nuclei of T47D breast cancer cells. We now describe the mechanism for nuclear import of IGFBP-3 and IGFBP-5. In digitonin-permeabilized cells, where the nuclear envelope remained intact, nuclear translocation of wild-type IGFBP-3 appears to occur by a nuclear localization sequence (NLS)-dependent pathway mediated principally by the importin β nuclear transport factor and requiring both ATP and GTP hydrolysis. Under identical conditions, an NLS mutant form of IGFBP-3, IGFBP-3[228KGRKR → MDGEA], was unable to translocate to the nucleus. In cells where both the plasma membrane and nuclear envelope were permeabilized, wild-type IGFBP-3, but not the mutant form, accumulated in the nucleus, implying that the NLS was also involved in mediating binding to nuclear components. By fusing wild-type and mutant forms of NLS sequences (IGFBP-3 [215–232] and IGFBP-5 [201–218]) to the green fluorescent protein, we identified the critical residues of the NLS necessary and sufficient for nuclear accumulation. Using a Western ligand binding assay, wild-type IGFBP-3 and IGFBP-5, but not an NLS mutant form of IGFBP-3, were shown to be recognized by importin β and the α/β heterodimer but only poorly by importin α. Together these results suggest that the NLSs within the C-terminal domain of IGFBP-3 and IGFBP-5 are required for importin-β-dependent nuclear uptake and probably also accumulation through mediating binding to nuclear components.

The somatomedins: insulin-like growth factors

Publisher Summary This chapter presents an account of the recent advances in the understanding of the origins, functions, and clinical significance of insulin-like growth factors. The term “somatomedin” was coined over a decade ago to describe partly characterized plasma factors that (1) stimulated sulfate incorporation into chondroitin sulfate of cartilage, (2) has insulin-like activity (not neutralized by anti-insulin serum) in adipose tissue and diaphragm, and (3) caused increased thymidine incorporation into DNA in various tissues. The chapter describes where and how somatomedins are produced and transported in the circulation, how somatomedins interact with their target tissues and those concerned with the measurement of somatomedins, and the physiological and clinical significance of their levels in the circulation. The past few years have seen major advances in the understanding of insulin-like growth factor action, culminating in direct demonstrations of growth effects in laboratory animals. Thus, it seems probable that an exciting and fruitful period of research into the somatomedins is expected to follow over the next few years.

Insulin-like growth factor-binding protein-3 modulates expression of Bax and Bcl-2 and potentiates p53-independent radiation-induced apoptosis in human breast cancer cells.

We report that transfection of insulin-like growth factor-binding protein-3 (IGFBP-3) cDNA in human breast cancer cell lines expressing either mutant p53 (T47D) or wild-type p53 (MCF-7) induces apoptosis. IGFBP-3 also increases the ratio of pro-apoptotic to anti-apoptotic members of the Bcl-2 family. In MCF-7, an increase in Bad and Bax protein expression and a decrease in Bcl-xL protein and Bcl-2 protein and mRNA were observed. In T47D, Bax and Bad proteins were up-regulated; Bcl-2 protein is undetectable in these cells. As T47D expresses mutant p53 protein, these modulations of pro-apoptotic proteins and induction of apoptosis are independent of p53. The effect of IGFBP-3 on the response of T47D to ionizing radiation (IR) was examined. These cells do not G1 arrest in response to IR and are relatively radioresistant. Transfection of IGFBP-3 increased the radiosensitivity of T47D and increased IR-induced apoptosis but did not effect a rapid G1 arrest. IR also caused a much greater increase in Bax protein in IGFBP-3 transfectants compared with vector controls. Thus, IGFBP-3 increases the expression of pro-apoptotic proteins and apoptosis both basally and in response to IR, suggesting it may be a p53-independent effector of apoptosis in breast cancer cells via its modulation of the Bax:Bcl-2 protein ratio.

The IGF axis and programmed cell death.

Insulin‐like growth factors (IGF) are mitogenic peptides that have been implicated as positive regulators of cellular proliferation. In recent years, several studies have suggested an additional role for the IGF axis in the regulation of apoptosis. Signalling through the IGF receptor has been shown to have a potent survival function and protect cells from a variety of apoptotic stimuli. The actions of IGF are regulated by a family of high‐affinity IGF binding proteins (IGFBP), which sequester the IGF from the IGF receptor. However, there is some evidence that one of these binding proteins, IGFBP‐3, may have its own pro‐apoptotic effects that are independent of its ability to modulate IGF bioavailability. In addition, it has been suggested that the tumour suppressor p53, a crucial mediator of apoptosis in response to cellular stress, may elicit several of its apoptotic effects through manipulation of components of the IGF axis. This review summarizes what is currently known about the role of the IGF system in the regulation of apoptosis, highlighting its implications in the context of tumorigenesis.

IGF binding proteins in cancer: mechanistic and clinical insights

The six members of the family of insulin-like growth factor (IGF) binding proteins (IGFBPs) were originally characterized as passive reservoirs of circulating IGFs, but they are now understood to have many actions beyond their endocrine role in IGF transport. IGFBPs also function in the pericellular and intracellular compartments to regulate cell growth and survival — they interact with many proteins, in addition to their canonical ligands IGF-I and IGF-II. Intranuclear roles of IGFBPs in transcriptional regulation, induction of apoptosis and DNA damage repair point to their intimate involvement in tumour development, progression and resistance to treatment. Tissue or circulating IGFBPs might also be useful as prognostic biomarkers.