Diss. (sammanfattning) Stockholm : Karol. inst., 2005. / Härtill 4 uppsatser.

Genetic and Hormonal Regulation of Children's Growth MUDr. Jan Vosáhlo Abstract Growth in childhood is a complex process of changing the body, which can be disrupted by various illnesses including endocrine disorders, particularly growth hormone deficiency. Tumors or other processes affecting hypothalamic-pituitary area can be a postnatal cause of GHD; prenatal causes include 1) developmental disorders of the pituitary as part of complex syndromes, 2) developmental disorders of the pituitary due to defects in regulatory genes and 3) defects in genes involved in the synthesis and secretion of GH. The first topic of the thesis was septo-optic dysplasia - a complex syndrome involving optic nerve hypoplasia, structural brain abnormalities and pituitary dysfunctions. We extensively described phenotype in 11 Czech patients; we observed both complete SOD and incomplete forms variously combining two of the three main components of the syndrome. The cohort then became a part of an international study of 68 patients, in which we studied the phenotype in dependence on the brain morphology. We found correlation between the severity of clinical symptoms and the degree of septum pellucidum abnormities and also a correlation between hippocampus and falx abnormities and neurological symptoms. As the second topic we studied...

INTRODUÇÃO: Pacientes com deficiência de GH e síndrome de Turner, associados a baixa estatura, são beneficiados com o tratamento com GH. Há controvérsias sobre a atuação deletéria do GH no crescimento craniofacial, porém a maioria dos trabalhos é retrospectiva. Nosso objetivo foi realizar estudo prospectivo para avaliar o crescimento craniofacial de pacientes em tratamento com GH e o possível desenvolvimento de traços acromegálicos. CASUÍSTICA: 30 pacientes com idade cronológica de 4,6 a 23 anos e idade óssea de 1,5 a 13 anos divididos em 3 grupos baseados no diagnóstico e uso de GH: grupo 1- pacientes virgem de tratamento com GH portadores de hipopituitarismo e deficiência isolada (n=6); grupo 2: pacientes já em tratamento com GH: portadores de hipopituitarismo e deficiência isolada (n=16); grupo 3: pacientes com síndrome de Turner em tratamento com GH (n=8). A dose do GH utilizada foi de 0.1 a 0.15 U/kg/dia, via subcutânea, à noite, por 2 a 11 anos. MÉTODOS: medidas antropométricas (altura, pés e mãos), radiografia panorâmica, telerradiografia seguida pela análise cefalométrica de Ricketts e medidas lineares da base do crânio, altura facial, terço inferior da face, mandíbula e maxila, e fotografia facial de frente e perfil anualmente, por no mínimo 3 anos. As medidas lineares citadas foram comparadas com a média da população brasileira e entre si para avaliar o desenvolvimento craniofacial individual. As medidas de mãos e pés foram comparadas com atlas de morfometria e consideradas alteradas quando >P97. Os níveis de IGF1 e IGFBP3 foram mensurados a cada 6 meses para adequação da dose de GH. Os resultados foram analisados estatisticamente tomando-se como significantes valores de p<0,05. RESULTADOS: grupos 1 e 2 (deficiência isolada de GH ou hipopituitarismo): 3 pacientes com perfil desarmonioso obtiveram harmonia, 2 pacientes devido ao crescimento mandibular e um paciente devido ao crescimento maxilar, nenhum paciente desenvolveu desarmonia facial; observamos aumento significante da base posterior do crânio, mandíbula e terço inferior da face (p<0,05). Grupo 3 (síndrome de Turner): 2 pacientes com face desarmoniosa obtiveram harmonia, devido ao crescimento mandibular e nenhuma paciente desenvolveu desarmonia facial. Todos os pacientes, quando comparadas a análise cefalométrica de Ricketts inicial e final, mantiveram o mesmo padrão de crescimento facial. Observamos aumento das mãos em 2 pacientes (1 do sexo masculino com deficiência de GH e outra com síndrome de Turner), enquanto que o aumento dos pés foi observado em 50% das pacientes com síndrome de Turner e em 32% dos pacientes com deficiência de GH. CONCLUSÕES: A comparação das medidas cefalométricas do grupo de pacientes com deficiência de GH, virgem de tratamento, demonstrou maior atuação do GH no crescimento da base posterior do crânio e mandíbula; todos os pacientes mantiveram o mesmo padrão de crescimento craniofacial durante o acompanhamento; não houve correlação estatisticamente significante entre as medidas cefalométricas e a harmonia da face, portanto a associação dos métodos de cefalometria e análise facial por fotografia é necessária para avaliar a atuação do GH no crescimento craniofacial, houve melhora da harmonia facial em 28% dos pacientes retrognatas, devido ao crescimento mandibular, portanto pacientes retrognatas podem ser beneficiados com o tratamento com GH; não observamos desenvolvimento de desproporções faciais e nenhum paciente desenvolveu desarmonia facial no decorrer do tratamento com doses padronizadas de GH. Observamos, no entanto, aumento das extremidades, principalmente dos pés. / INTRODUCTION: Patients with GH deficiency and Turner syndrome, associated to short stature can benefit from GH treatment. There are controversies on the deleterious effect of GH on craniofacial growth; however, most of the studies are retrospective. Our objective was to carry out a prospective study to evaluate the craniofacial growth of patients in treatment with GH and the possible development of acromegalic features. PATIENTS: 30 patients with chronological age of 4.6 to 23 years and bone age of 1.5 to 13 years divided in 3 groups based on the diagnosis and GH use: group 1- patients with hypopituitarism and isolated GH deficiency naïve to GH treatment (n=6); group 2: patients with hypopituitarism and isolated GH deficiency (n=16) and group 3: patients with Turner syndrome, both already on GH treatment (n=8). GH treatment (0.1 to 0.15 U/kg/day, subcutaneously) was carried out at the night for 2 to 11 years. METHODS: Anthropometrical (height, hands and feet) measurements, panoramic x-ray, teleradiography followed by cephalometric analysis according to Ricketts and linear measurements of the skull base, facial height, lower third of the face, lower jaw and maxilla, and frontal and profile analysis of face by photography were made annually, for at least 3 years. The mentioned linear measurements were compared with the average Brazilian population and among themselves to evaluate the individual craniofacial development. The hand and foot size measurements were compared with a morphometric atlas and were considered increased when >P97. The levels of IGF1 and IGFBP3 were measured each 6 months for GH dose adequacy. The results were analyzed statistically and p values < 0.05 were considered statistically significant. RESULTS: Group 1 and 2 with isolated GH deficiency or hypopituitarism: 3 patients with disharmonious profile attained harmony, 2 due to the mandibular growth and 1 patient due to maxillary growth; no patient developed facial disharmony; we observed a significant increase of the posterior skull base, inferior jaw and lower third of the face (P<0.05). Group 3 with Turner syndrome: 2 patients with facial disharmony obtained harmony due to the mandibular growth and no patient developed facial disharmony. All of the patients maintained the same pattern of facial growth when the initial and final cephalometric analyses according to Ricketts were compared. Hand size increase was observed in 2 patients (1 with GH deficiency and another with Turner syndrome); foot size increase was observed in 50% of the patients with Turner syndrome and in 32% of the patients with GH deficiency. CONCLUSIONS: The comparison of the cephalometric measurements of the group with GH deficiency naïve to GH treatment, demonstrated a greater GH effect on the growth of the posterior skull base and jaw; all of the patients had kept the same craniofacial growth pattern during the follow-up; there was no statistically significant correlation between the cephalometric measurements and facial harmony; therefore, the association of the methods of cephalometric and facial analysis through photography is mandatory to evaluate the effect of GH on craniofacial growth. There was an improvement in the facial harmony in 28% of the retrognathic patients due to mandibular growth; therefore, patients with mandibular retrognathism can benefit from GH treatment. None of the patients treated with standardized doses of GH developed facial disharmony during treatment. We observed however, an increase of the extremities, mainly of the feet.

The growth of vertebrates is primarily regulated by the growth hormone-insulin-like growth factor (GH-IGF) system, but not in isolation. The central question of this dissertation was how do other hormones peripheral to the GH-IGF system interact with the system, including feedbacks by GH and IGF themselves on various tissues in rainbow trout (Oncorhynchus mykiss)? The representative hormones selected were thyroxine, cortisol, and the sex steroids testosterone and estrogen, along with GH and IGF. These hormones were chosen because they are known to affect overall growth and development during specific life events, but exactly what target genes and what mechanisms are involved are only at the early stages of being delineated in fish. Liver and gill tissues were selected as representative tissues to assess the in vitro effects on growth-related genes of the GH-IGF system. A total of more than thirty experiments were conducted, including time- and concentration-response, inhibitory studies, hormone combination studies, and radio-receptor binding assays. Hormones were applied to whole tissue cultures and real-time quantitative-PCR was used to measure hormonal effects on GHR, IGF, and IGFR1 genes. Microsomal preparations were treated with selected hormones and radio-labeled GH or IGF. A gamma counter was used to measure receptor-ligand activity. GH and IGF were found to possess autocrine and/or paracrine actions in self-regulating target growth genes. Thyroxine had no direct effects on targeted growth genes but may interact with other molecules or hormones to elicit its effects on growth and development. Cortisol directly influenced target growth genes in a tissue-specific and isoform-specific manner. Finally, sex steroids differentially regulated the growth genes: estradiol inhibited growth genes while testosterone directly stimulated growth genes. These findings contribute to understanding how hormones peripheral to the GH-IGF system interact with the growth system. / National Science Foundation grant IOS 0920116 to Dr. Mark Sheridan

In the Czech Republic is born to 5 % of SGA / IUGR children, about 5, 000 children a year, and their incidence is increasing. In 10 - 15 % does not occur postnatal compensation growth acceleration and growth retardation is then further deepens. Since 2003, these children can be treated by recombinant growth hormone in supraphysiological doses. Master thesis brings informations about SGA / IUGR children and their growth parameters during the first 2 years from the beginning of treatment when the monitoring was carried out at three - month intervals. The results are compared with the group of patients treated with growth hormone for growth hormone deficiency. Growth data was processed by a group of 57 SGA / IUGR children, which was compared with data of 34 children with growth hormone deficiency treated between 2003-2015 with growth hormone. Treatment of both groups of patients was carried out by a suitable therapeutic protocol, with the dose of GH by the respective diagnosis. These parameters were monitored: body height and weight, growth rate, BMI and weight - height ratio of patients. SGA / IUGR and GHD patients showed different growth profile in the initial phase of treatment when GHD patients had higher acceleration peak after 3 months of starting treatment and steeper increase in growth rate....

The present study deals with the comparison and establishment of methods for the detection of antibodies against recombinant human growth hormone (rhGH). Therefore, different methods for the detection of hGH-Abs were evaluated and compared in order to establish a test system that can be used for the detection of neutralizing antibodies against hGH, which could be developed under rhGH treatment. This manuscript describes in detail the validation of a newly developed biological assay, the neutralizing hGH-antibody assay (NAb assay). Therefore, a cell line transfected with the growth hormone receptor, that proliferates in the presence of hGH, was used. This proliferation was quantified by an increase of the optical density (OD/ absorbance) after addition of a colorimetric reagent, whereas the presence of hGH-antibodies leads to an inhibition of cell proliferation. To validate the test system for the detection of hGH-antibodies, we tested serum samples of 4 patients suffering from neurosecretory dysfunction (NSD) and samples taken from 6 patients with growth hormone deficiency (GHD) which were treated with rhGH and were highly suspected for a-hGH antibodies. These samples were tested in two different immunological assays, capable to screen sera for anti-hGH immunreactivity in the case of hGH-insensitivity during GH treatment. Using the NAb assay the neutralizing activity of specific hGH-antibodies was proved in serum samples of NSD and GHD type 1A patients. In case of neutralizing hGH-antibody activity, a clinically based decision can be made whether rhGH therapy should be stopped or the rhGH dosis should be increased. By the use of our test system, we offer the measurement of anti-hGH-antibody activity to other laboratories in cases when secondary hGH-insensitivity is assumed or observed.

Genetic and Hormonal Regulation of Children's Growth MUDr. Jan Vosáhlo Abstract Growth in childhood is a complex process of changing the body, which can be disrupted by various illnesses including endocrine disorders, particularly growth hormone deficiency. Tumors or other processes affecting hypothalamic-pituitary area can be a postnatal cause of GHD; prenatal causes include 1) developmental disorders of the pituitary as part of complex syndromes, 2) developmental disorders of the pituitary due to defects in regulatory genes and 3) defects in genes involved in the synthesis and secretion of GH. The first topic of the thesis was septo-optic dysplasia - a complex syndrome involving optic nerve hypoplasia, structural brain abnormalities and pituitary dysfunctions. We extensively described phenotype in 11 Czech patients; we observed both complete SOD and incomplete forms variously combining two of the three main components of the syndrome. The cohort then became a part of an international study of 68 patients, in which we studied the phenotype in dependence on the brain morphology. We found correlation between the severity of clinical symptoms and the degree of septum pellucidum abnormities and also a correlation between hippocampus and falx abnormities and neurological symptoms. As the second topic we studied...

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published_or_final_version / abstract / Biological Sciences / Doctoral / Doctor of Philosophy