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<p>There is a prevalent belief that acute hormone responses to resistance exercise mediate adaptations in skeletal muscle hypertrophy; however, there is little supporting evidence. We conducted studies to examine the relationship between acute hormonal increases after resistance exercises and subsequent changes in muscle anabolism.</p> <p>We tested the hypothesis that exercise-induced responses of anabolic hormones—growth hormone (GH) and testosterone—would enhance rates of myofibrillar protein synthesis (MPS) after an acute bout of resistance exercise, and would augment muscle hypertrophy after training. We concluded, however, that resistance exercise-induced increases in putative anabolic hormones do not enhance MPS or hypertrophy.</p> <p>We also examined whether rates of MPS would be attenuated in women (compared with men) after resistance exercise, due to their lack of post-exercise testosteronemia. We reported similar increases in MPS in men and women; post-exercise testosterone responses in women, which were 45-fold lower than men, did not attenuate elevations in MPS.</p> <p>Collectively, our work leads to the conclusion that the acute rise in hormones such as testosterone and GH has very little bearing on MPS and hypertrophy responses to resistance exercise. Instead, the rise in these hormones appears to be a non-specific response to exercise stress rather than a response that is important for muscle anabolism. Contrary to widely used principles, our data suggests that exercise programs should not be designed based on nuances in the post-exercise hormonal milieu. Alternatively, understanding local mechanotransduction, which is directly linked to muscle fibre loading, will reveal the processes that drive human exercise-mediated muscle hypertrophy.</p> / Doctor of Philosophy (PhD)

The objectives of this research were to characterize insulin-like growth factor-I (IGF-I) gene expression in cattle, to determine how IGF-I gene expression is affected by nutritional intake and growth hormone (GH) in cattle, and to identify the regulatory DNA region that mediates GH stimulation of IGF-I gene expression. It was found that transcription of the IGF-I gene in cattle was initiated from both exon 1 and exon 2, generating class 1 and class 2 IGF-I mRNA, respectively. Both classes of IGF-I mRNA appeared to be ubiquitously expressed, with the highest level in liver and with class 1 being more abundant than class 2 in all tissues examined. Class 1 IGF-I mRNA may be also translated more efficiently than class 2 IGF-I mRNA. Liver expression of IGF-I mRNA was decreased (P < 0.01) by food deprivation in cattle, and this decrease was due to an equivalent decrease in both classes of IGF-I mRNA. Liver expression of IGF-I mRNA was increased (P < 0.01) by GH, and this increase resulted mainly from increased expression of class 2 IGF-I mRNA. Using cotransfection analyses, a ~700 bp chromosomal region ~75 kb 5' from the first exon of the human IGF-I gene was found to enhance reporter gene expression in the presence of constitutively active signal transducer and activator of transcription 5 (STAT5) proteins, transcription factors that are known to be essential for GH-increased IGF-I gene expression. This 700 bp DNA region contains two STAT5-binding sites that appear to be conserved in mammals including cattle. Electrophoretic mobility shift assays and cotransfection analyses confirmed their ability to bind to STAT5 proteins and to mediate STAT5 activation of gene expression, respectively. Chromatin immunoprecipitation assays indicated that overexpressed constitutively active STAT5b protein bound to the chromosomal region containing these two STAT5-binding sites in Hep G2 cells, and this binding was associated with increased expression of IGF-I mRNA. These two STAT5-binding sites were also able to mediate GH-induced STAT5 activation of gene expression in reconstituted GH-responsive cells. These results together suggest that the distal DNA region that contains two STAT5-binding sites may mediate GH-induced STAT5 activation of IGF-I gene transcription in vivo. / Ph. D.

The overall objective of this dissertation research was to understand the mechanisms by which serum insulin-like growth factor-I (IGF-I) is regulated by nutritional intake in cattle. Two studies were conducted to achieve this objective. In the first study, effects of feeding levels on basal and growth hormone (GH)-stimulated serum concentrations of IGF-I, IGF binding protein-3 (IGFBP-3) and acid-labile subunit (ALS), and their mRNA expression in the liver were determined in beef cows. It was found that increased nutritional intake did not alter basal concentrations of serum IGF-I, IGFBP-3 or ALS, or their mRNA expression in the liver. However, under increased nutritional intake, GH administration stimulated a greater increase in serum IGF-I concentration, and this greater increase was not due to reduced degradation of IGF-I in serum. Increased nutritional intake did not enhance GH-stimulated IGF-I mRNA expression in the liver, but it increased the amount of IGF-I mRNA associated with polysomes, suggesting that liver translation of IGF-I mRNA is enhanced under increased nutritional intake. Under increased nutritional intake, GH also stimulated greater increases in serum IGFBP-3 and ALS concentrations, but these greater increases were not due to greater expression or translation of their mRNAs in the liver. Taken together, these results suggest that translation of GH-stimulated IGF-I mRNA in the liver is enhanced under increased nutritional intake and this enhancement may be partially responsible for the greater GH-stimulated increase in serum IGF-I concentration. These results also suggest that the greater GH-stimulated increases in serum IGFBP-3 and ALS may be secondary to the greater increase in serum IGF-I because increased IGF-I may increase the formation of IGF-I/IGFBP-3/ALS complexes, thereby increasing the retention of IGFBP-3 and ALS in the blood. In the second study, the effects of food deprivation on serum IGF-I concentration in steers and the underlying mechanism were determined. It was found that food deprivation decreased serum IGF-I concentration and that this decrease was not due to increased IGF-I degradation in serum. Food deprivation decreased liver IGF-I mRNA expression, and this decrease was associated with decreased expression of GH receptor (GHR) mRNA and protein in the liver. Food deprivation was also associated with increased mRNA expression of two inhibitors of the GHR signaling pathway, suppressor of cytokine signaling-2 (SOCS2) and cytokine-inducible SH2 protein (CIS). These results suggest that decreased IGF-I gene expression in the liver may be at least partially responsible for the decrease in circulating IGF-I concentration during food deprivation, and that the former decrease may be due to increased expression of SOCS2 and CIS, and decreased expression of GHR in the liver. Overall, this dissertation research indicates that multiple mechanisms are involved in nutritional regulation of circulating IGF-I concentration in cattle. / Ph. D.

The overall objective of this research was to further understand the mechanism by which growth hormone (GH) stimulates milk production in cattle. Three studies were conducted toward this objective. In the first study, the effects of GH and insulin-like growth factor-I (IGF-I), a major mediator of GH action in vivo, on cell proliferation, nutrient transport, and milk protein gene expression in bovine mammary epithelial cell line MAC-T cells were determined. GH increased (P < 0.01) expression of four major milk protein genes in MAC-T cells transfected with GHR expression plasmid. Cotransfection analyses indicated that GH also stimulated (P < 0.01) luciferase reporter gene expression from the promoters of the four milk protein genes in MAC-T cells. These findings together with the fact that GHR mRNA and protein are expressed in the epithelial cells of the bovine mammary gland suggest that GH may directly stimulate milk protein gene expression in the mammary gland. This study also showed that IGF-I increased the proliferation (P < 0.01) and amino acid transport (P < 0.05) in MAC-T cells. Because GH is known to stimulate IGF-I production in animals, IGF-I-mediated mammary epithelial cell proliferation and amino acid uptake may be additional mechanisms by which GH increases milk production in cattle. In the second study, the role of connective tissue growth factor (CTGF) on IGF-I-stimulated proliferation of MAC-T cells was investigated. A microarray analysis revealed that IGF-I decreased CTGF mRNA expression in MAC-T cells (P < 0.01). This effect of IGF-I was further found to be mediated through the PI-3 kinase/Akt signaling pathway from the IGF-I receptor (IGF-IR). CTGF alone stimulated MAC-T cell proliferation (P < 0.01). However, together with IGF-I, CTGF attenuated the proliferating effect of IGF-I on MAC-T cells, and this attenuation was reversed by additional IGF-I. Therefore, IGF-I inhibition of CTGF expression may benefit IGF-I stimulation of MAC-T cell proliferation. CTGF had no effect on IGF-I-induced phosphorylation of IGF-IR or total IGF-IR expression in MAC-T cells, suggesting that CTGF may attenuate IGF-I stimulation of MAC-T cell proliferation through a postreceptor inhibition of the IGF-IR signaling pathway. In the third study, whether a milk yield-associated T/A polymorphism in exon 8 of the bovine GHR gene affected GHR signaling was determined. It was found that the two corresponding GHR variants did not differ in mediating GH induction of gene expression, suggesting that the two GHR variants are not functionally different and hence are unlikely to mediate different effects of GH on milk production. In summary, the results of this dissertation research suggest that GH may directly stimulate milk protein gene expression and indirectly stimulate mammary epithelial cell proliferation and amino acid uptake through IGF-I, thereby stimulating milk production in cattle. The results also suggest that IGF-I stimulation of mammary epithelia cell proliferation may involve an inhibition of CTGF expression in the cells. / Ph. D.

The objective of part one of this study was to determine if the presence of porcine growth hormone (pGH) during oocycte in vitro maturation (IVM) affected subsequent embryo development. Pig cumulus-oocyte complexes (COC) (n=987) were aspirated from slaughterhouse derived ovaries and cultured in BSA-free NCSU 23 medium containing porcine follicular fluid (10% v/v), cysteine (0.1 mg/ml) and hormonal supplements (eCG and hCG, 10 IU/ml each), 10 ng/ml EGF, and with or without pGH (100 ng/ml) for 22 h. The COC were then cultured in the same medium with or without 100 ng/ml pGH, but without hormonal supplements for an additional 22 h. After the completion of maturation culture, cumulus cells were removed and oocytes were co-incubated with frozen-thawed spermatozoa for 8 h. Putative embryos were transferred to NCSU 23 containing 0.4% BSA and cultured for 144 h. Embryo development was assessed on d 6 of culture. The treatment groups were as follows: treatment 1 = control group cultured in IVM medium alone; treatment 2 = 100 ng/ml pGH present of the first 22 h of maturation culture and absent for the second 22 h of maturation culture; treatment 3 = 100 ng/ml pGH absent for the first 22 h of maturation culture, but present for the second 22 h of maturation culture; and treatment 4 = 100 ng/ml pGH present throughout the entire IVM period. Embryos were visually scored for developmental stage at 144 h following fertilization. Each oocyte in the study received a developmental score, based on a scale of 1 = uncleaved, 2 = 2-cell embryo, 3 = 4- to 8-cell embryo, 4 = 9- to 16-cell embryo, 5 = morula, and 6 = blastocyst. The addition of pGH did not affect porcine embryo development as compared to the control (1.57 ± .08, 1.67 ± .08, 1.47 ± .08, and 1.60 ± .08, respectively; P > .10). Replicates within the study differed significantly from each other (P < .01) primarily because the development in replicate 6 was greater than for all others. There was a significant treatment by replicate interaction (P < .05); pGH added during the first 22 h of IVM and pGH added during the second 22 h of IVM in replicate 6 resulted in higher development scores than for controls and continuous pGH addition. However, in replicate 2, continuous pGH resulted in the greatest development. These results suggest that pGH may exert a stimulatory effect on embryo development when present in the IVM media; however, further studies using pGH in IVM culture are necessary. The objectives of the second part of the study were to examine aspects of intracytoplasmic sperm injection (ICSI) using membrane-disrupted spermatozoa, in vitro fertilization (IVF), and sperm-mediated gene transfer in the pig. Porcine oocytes were shipped overnight in maturation media at 39°C in a portable incubator. After 22 h of maturation culture, oocytes were washed in maturation medium without gonadotropins and cultured for an additional 22 h. Cumulus cells were removed and oocytes were divided into four treatment groups: treatment 1 = ICSI using membrane-damaged spermatozoa coincubated with linear green fluorescent protein (GFP) DNA; treatment 2 = ICSI using membrane damaged spermatozoa; treatment 3 = IVF with frozen-thawed spermatozoa coincubated with linear GFP DNA prior to IVF; treatment 4 = IVF with frozen-thawed spermatozoa with no DNA coincubation. Embryos were scored for developmental stage at 144 h following fertilization. Each oocyte in the study received a developmental score, based on a scale of 1 = uncleaved, 2 = 2-cell embryo, 3 = 4-cell embryo, 4 = 5- to 8-cell embryo, 5 = 9- to 16-cell embryo, 6 = morula, and 7 = blastocyst. Although no overall difference in development score was observed following the four different treatments, a treatment difference among cleaved oocytes was observed when comparing only the two ICSI treatments (P < .05); development scores were greater in the ICSI treatment in which sperm were not coincubated with linear GFP DNA prior to injection than when the coincubation was performed (3.76 ± .21 vs. 3.13 ± .17, respectively). No differences in development score were observed in the two IVF treatments. The percentage of embryos expressing the GFP transgene on d 6 of culture following fertilization was 7.3% in the ICSI+GFP group and 0% in all other treatment groups. Thus, sperm-mediated gene transfer using ICSI in the pig has been demonstrated, although success rates were low. / Master of Science

Diets rich in hydrolyzable carbohydrates induce a hyperglycemic/insulinemic response and may increase the incidence of metabolic disorders associated with some types of laminitis, exertional rhabdomyolysis and osteochondrosis in horses. This study applied the minimal model of glucose and insulin dynamics to determine the effect of diet on metabolites and hormones that regulate glucose metabolism in young horses. Twelve Thoroughbred foals were raised on pasture and supplemented twice daily with a feed high in either sugar and starch (SS) or fat and fiber (FF). As weanlings (age 199 ± 19 d, weight 274 ± 18 kg), the subjects underwent a modified frequent sampling intravenous glucose tolerance test during which they remained in stalls and had access to grass hay and water ad libitum. Samples were colleted at -60, -45, 1, 2, 3, 4, 5, 6, 7, 8, 10, 12, 14, 16, 19, 22, 23, 24, 25, 27, 30, 35, 40, 50, 60 , 70 , 80, 90, 100, 120, 150, 180, 210, 240, 270, 300, 330 and 360 min with a glucose bolus of 300 mg/kg BW at 0 min and an insulin bolus of 1.5 mU/kg BW at 20 min. Plasma was analyzed for glucose, insulin, growth hormone (GH) and insulin-like growth factor-I (IGF-I) concentrations. Insulin sensitivity, glucose effectiveness, acute insulin response to glucose and disposition index were derived using Minmod Millennium and WinSAAM software. Diet groups were compared using the non-parametric Kruskal-Wallis test or the sign test. Time interactions were compared using a mixed model with repeated effects. Rank-ordered linear regression was used for correlations. Basal glucose did not differ between groups (P = 0.75). There was nearly a trend towards higher basal (P = 0.11), and median insulin was higher in the sugar and starch foals at all 36 sample points (P = 0.030). The basal glucose:basal insulin ratio for the sugar and starch supplemented foals was lower than for fat and fiber foals (P = 0.025). Insulin sensitivity (SI) was lower in foals fed sugar and starch than foals fed fat and fiber (P = 0.007). Acute insulin response to glucose was directly correlated to weight (r = 0.78; P = 0.003) and inversely correlated with SI (r = -0.55; P = 0.067). The glucose:insulin ratio was directly correlated to SI (r = 0.92; P < 0.001). Growth hormone concentrations were increased from basal from 19 to 180 min after the glucose dose (P < 0.05). Basal IGF-I was higher (P = 0.006) in the SS group compared to the FF group. Concentrations of total IGF-I increased with time (P = 0.002) in the SS group. The change in IGF-I concentration from baseline to the end of the study was positively correlated (r = 0.72; P = 0.008) to the area under the insulin curve from 0 to 80 min. Basal IGF-I was inversely correlated to SI (r = 0.71; P = 0.015). These results show that the metabolic response to a diet high in hydrolyzable carbohydrates differs from the response to a fat and fiber meal resembling forage. Weanlings adapted to meals high in glucose equivalents have higher insulin and IGF-I secretion as compared to foals adapted to a fat and fiber feed, possibly contributing to lower insulin sensitivity observed in these foals. Such deviations may contribute to metabolic dysfunction and osteochondrosis in horses fed grain diets. / Master of Science

Many of the presently approved somatic gene therapy protocols involve reimplantation of genetically engineered autologous cells into a patient. A potentially more cost-effective approach to the delivery of therapeutic gene products is the use of a universal recombinant cell line that can be implanted into a number of patients with the same product requirements. Enclosure of these non-autologous cells inside a permselective microcapsule membrane would permit the diffusion of the recombinant product but prevent entry of the host’s immune mediators. The clinical efficacy of this approach has been demonstrated by the implantation of recombinant fibroblasts and myoblasts to correct mutant phenotypes in murine models of diseases such as dwarfism (Al-Hendy et al., 1995) and lysosomal storage disease (Bastedo, 1994). In the first part of this thesis, a new microcapsule type was created that incorporated a combination of traits from both alginate-poly-L-lysine-alginate and barium-alginate microcapsules. The new, barium-poly-L-lysine-alginate microcapsule was cross-linked with BaCl2 and received a poly-L-lysine, and a second alginate coat. The three different types of microcapsules were compared with respect to encapsulated cell viability, proliferation and secretion in vitro. Results of these analyses demonstrated that cells inside alginate-poly-L-lysinealginate microcapsules had higher viability and a greater proliferation rate than did cells inside either barium-alginate or barium-poly-L-lysine alginate microcapsules. However, secretion from the alginate-poly-L-lysine alginate microcapsules was lower than from either of the barium-alginate types, and the two types of barium-alginate microcapsules, formulated with a higher alginate concentration, were more resistant to well-defined fluid shearing forces, than was the calcium alginate microcapsule. No significant difference in any of the parameters measured was observed between the barium-alginate and bariumpoly-L-lysine alginate microcapsule types. In the second part of this thesis the three different types of microcapsules, each containing canine MDCK cells secreting ~20 ng/106 cells/hr of human growth hormone (hGH) were implanted into the peritoneal cavities of a large animal model. The microencapsulated cells were able to deliver recombinant human growth hormone to the circulation of dogs at levels nearly 100 % higher than human physiological levels. In contrast, implantation of unencapsulated recombinant cells resulted only in short-term delivery of hGH to the dogs. The level of titre of anti-hGH antibodies was monitored in the experimental and control animals, and its increase was determined to be associated with the disappearance of the human growth hormone from the circulation of the dogs. The BaCl2 cross-linked capsules with the higher alginate concentration lasted longer in vivo, confirming their superior mechanical integrity relative to the alginate-poly-L-lysine alginate type. The presence of the microcapsules in the peritoneum of the dogs was associated with localized inflammation of the omentum, and mild lymphadenitis. This pathology, combined with varying degrees of fibrotic overgrowth of the microcapsules with increasing time in vivo, suggests that modifications must be made in order to improve the biocompatibility of alginate microcapsules. In conclusion, modifications of alginate microcapsules, such as the cross-linking with barium cations, the use of higher alginate concentrations and lamination with polyL-lysine alginate have contributed to the mechanical stability of the capsules and permitted the long-term delivery of recombinant gene products using non-autologous cells. This study has highlighted some of the issues to be addressed during pre-clinical studies in large animal models, in order to determine the efficacy of this new technology for humans. / Thesis / Master of Science (MS)

Introdução: A incidência de baixa estatura devido a deficiência do hormônio do crescimento (DGH) ocorre em 1:4.000-10.000 nascidos vivos. Diversos fatores de transcrição são necessários para a diferenciação dos cinco tipos de células produtoras de 6 hormônios hipofisários. Mutações nos fatores de transcrição HESX1, GLI2, LHX3, LHX4, SOX2, SOX3, PROP1 e POU1F1 foram descritas em pacientes com deficiência hormonal hipofisária isolada ou múltipla associada ou não a outras malformações. Mutações no gene OTX2, um fator de transcrição responsável pela formação da vesicula ocular e pela hipófise, podem causar malformações oculares tais como anoftalmia e microftalmia, isoladamente ou em associação com DGH isolado (DGHI) ou deficiência hipofisária hormonal múltipla (DHHM). Recentemente, dois pacientes não relacionados com DHHM e neuroipófise ectópica, sem anormalidades oculares foram descritos com mutações em heterozigose no OTX2 sugerindo um papel deste gene na etiologia do hipopituitarismo sem outras características sindrômicas. Objetivo: O objetivo desse trabalho foi o de analisar o gene OTX2 em pacientes com DGHI ou DHHM e correlacionar os achados moleculares com o fenótipo. Pacientes: Foram estudados 125 pacientes com DHHM (6 filhos de pais consangüíneos e 33 com parentes com baixa estatura) e 33 com DGHI (7 filhos de pais consangüíneos e 8 com parentes com baixa estatura). Materiais e métodos: Amostras de DNA dos pacientes foram submetidas à reação de polimerização em cadeia utilizando-se primers intrônicos desenhados para amplificar os 3 exons e as regiões flanqueadoras do gene OTX2. Os produtos de PCR foram purificados e sequenciados pelo método de Sanger. Resultados: Uma nova variante alélica c.689A>T, p.H230L em heterozigose no exon 5 foi encontrado em um único paciente com deficiência de GH, TSH, LH/FSH e ACTH associada a neuroipófise ectópica, sem malformação ocular. A histidina na posição 230 é altamente conservada em todas as espécies de vertebrados, e a análise in silico prediz um efeito prejudicial à estrutura da proteína. A análise da variante na família revelou 8 parentes não afetados como portadores heterozigotos, sugerindo uma doença autossômica dominante com padrão de penetrância incompleta. Esta variante não foi encontrada em 400 alelos de 200 controles brasileiros, porém foi descrito como polimorfismo no banco de dados de SNP em uma população européia americana, com incidência de 1 alelo T, entre 8600 alelos, sendo assim considerado raro. Encontramos também outras quatro variantes alélicas na casuística (c.98-70C> A; c.420G> C, p.P148P; c.435C> T, p.S145S; C * 10G> A), não conservadas entre as espécies. Duas delas levando a troca silenciosa de amino ácidos, sem efeito deletério no sítio exonic splice enhancer. Conclusão A nossa coorte de 158 pacientes é a maior população rastreada para mutações no OTX2 e a detecção de uma variante suspeita em heterozigose em um único paciente portador de hipopituitarismo e neuroipófise ectópica sugere que mutações no OTX2 são uma causa rara de DHHM ou DGHI sem malformação ocular na população estudada. O achado molecular da variante c.689A>T, p.H230L em heterozigose, com padrão de penetrância incompleta é consistente com a observação de que as características fenotípicas de camundongos heterozigotos com perda de função do Otx2 são fortemente influenciados pela background genético, não podendo dessa forma, descartar que outros moduladores genéticos possam ser responsáveis pela penetrância incompleta nessa família. Essa hipótese deverá ser investigada pela análise do exoma do paciente e seus familiares. O fato de a variante estar localizada numa região altamente conservada entre as espécies, sugere que a mesma seja causadora do fenótipo em questão, porém serão necessários os estudos funcionais de transfecção transitória para determinar se se trata de perda de função ou efeito negativo dominante de genes alvos expressos no ectoderme oral ou neural / Introduction: The incidence of short stature due to growth hormone deficiency (GHD) occurs in 1:4.000-10.000 live births. Several transcription factors are required for differentiation of five types of cells producing 6 pituitary hormones. Mutations in the transcription factors HESX1, GLI2, LHX3, LHX4, SOX2, SOX3, PROP1 and POU1F1 have been described in patients with isolated pituitary hormone deficiency or multiple associated or not with other malformations. Mutations in OTX2, a transcription factor responsible for the formation of the eye vesicle and the pituitary gland, can cause ocular malformations such as anophthalmia and microphthalmia, alone or in association with isolated GHD (IGHD) or combined pituitary hormone deficiency (CPHD). Recently, two unrelated patients with CPHD and ectopic neurohypophysis without ocular abnormalities were described with heterozygous mutations in OTX2 suggesting a role of this gene in the etiology of hypopituitarism without other syndromic features. Objective: The aim of this study was to analyze the OTX2 gene in patients with GHD or CPHD and correlate the molecular findings with the phenotype. Patients: We studied 125 patients with CPHD (6 children of consanguineous parents and 33 relatives with short stature) and 33 with IGHD (7 children of consanguineous parents and 8 relatives with short stature). Materials and methods: DNA samples from the patients were subjected to polymerase chain reaction using intronic primers designed to amplify the 3 exons and flanking regions of the gene OTX2. The PCR products were purified and sequenced by the Sanger method. Results: A new heterozygous allelic variant c.689A> T, p.H230L in exon 5 was found in one patient with deficiencies of GH, TSH, LH / FSH and ACTH associated with ectopic neurohypophysis without ocular malformation. The histidine at position 230 is strongly conserved in all vertebrate species, and in silico analysis predicts a detrimental effect on protein structure. The analysis of the variant in the family revealed eight unaffected relatives as heterozygous carriers, suggesting an autosomal dominant pattern with incomplete penetrance. This variant was not found in 400 alleles of 200 Brazilian controls, but it was described as a polymorphism in the SNP database in a European American population, with an incidence of 1 T allele among 8600 alleles, and therefore considered rare. We also found four other allelic variants in the samples (c.98-70C> A; c.420G> C, p.P148P; c.435C> T, p.S145S; C * 10G> A), not conserved between species. Two of them leading to a silent amino acid exchange, without deleterious effect in the exonic splice enhancer site. Conclusion Our cohort of 158 patients is the largest population screened for mutations in OTX2 and the detection of a suspected heterozygous variant in one patient with hypopituitarism and ectopic neurohypophysis suggests that OTX2 mutations are a rare cause of CPHD/IGHD without ocular malformation in the studied population. The molecular finding of a heterozygous variant c.689A> T, p.H230L, with incomplete penetrance pattern is consistent with the observation that the phenotypic characteristics of mice with heterozygous loss of function of Otx2 are strongly influenced by genetic background, suggesting that other genetic modulators may be responsible for the incomplete penetrance in this family. This hypothesis should be investigated by analysis of exoma in the patient and their family. The fact that the variant is located in a region highly conserved among species suggests that it is causing the phenotype in question, but it will require the functional studies with transient transfections to determine whether it is the loss of function or effect of dominant negative target genes expressed in neural or oral ectoderm