Níveis sustentáveis de hormônio de crescimento humano (hGH) circulante e aumento de peso altamente significativo, avaliados também em comparação a repetidas injeções de hormônio, foram observados em trabalhos anteriores, baseados na eletrotransferência de DNA plasmidial no músculo de camundongos anões imunodeficientes (lit/scid). No presente trabalho, um modelo animal homólogo de terapia gênica para GH foi estudado mediante clonagem da sequência genômica do DNA de GH de camundongo (mGH-gDNA), a qual substituiu o hGH-gDNA no vetor que havia sido utilizado em camundongos anões imunodeficientes. O novo vetor, agora nomeado UBI-mGH-gDNA, foi utilizado em camundongos anões imunocompetentes (lit/lit). Foi primeiramente realizado um teste in vitro, transfectando-se células humanas HEK 293 com este plasmídeo e obtendo-se uma expressão de 3,0 &mu;g mGH/106 células/dia, contra 3,7 &mu;g mGH/106 células/dia, para o UBI-hGH-gDNA. Estes dois plasmídeos foram então injetados (50 &mu;g/animal) no músculo quadríceps de camundongos, seguido de eletroporação, realizando um ensaio de 94 dias. Enquanto após 15 dias, as inclinações das curvas de variação de peso relacionadas ao mGH, hGH e salina foram 0,130, 0,112 e 0,027 g/camundongo/dia, respectivamente, após 94 dias, as inclinações correspondentes foram 0,041, 0,028 e 0,033 g/camundongo/dia. As análises estatísticas mostraram que após 15 dias, as inclinações das duas curvas com o GH foram significativamente maiores que a inclinação do controle (P<0,001), enquanto que após 94 dias, somente a inclinação da curva do mGH foi maior que a do controle (P<0,005). A porcentagem de aumento de peso nos animais tratados com o gene do mGH, após 94 dias, foi de 34,3%, enquanto que o comprimento nariz-cauda e o comprimento do fêmur, dois parâmetros que medem diretamente o crescimento longitudinal, foram de 9,5% e 26%, respectivamente, quando comparados aos valores iniciais. A interrupção do crescimento progressivo do grupo tratado com hGH não foi inesperada, considerando a óbvia reação imunogênica dos animais imunocompetentes contra o GH humano e não contra o de camundongo (título do anticorpo anti-hGH 1:100 a 1:3200). A inclinação altamente positiva do grupo controle, já observada em camundongos lit/lit mas não em lit/scid, é provavelmente devida ao ganho de peso natural desta linhagem, não suportada, contudo, por um proporcional crescimento longitudinal. Níveis circulatórios de mGH da ordem de 4 ng/mL foram detectados após 15 dias para o grupo tratado com o mGH, enquanto o grupo controle apresentou níveis em torno de 0,7 ng mGH/mL (P<0,001). Níveis circulatórios de mIGF-I foram também determinados nos dias 15, 45 e 94 nos animais tratados com mGH, sempre mostrando valores 1,5 - 3,0 vezes maiores que o grupo controle, e valores 1,2-1,6 vezes maiores que o grupo tratado com hGH. Este modelo de tratamento homólogo pode ser considerado uma primeira abordagem e um importante suporte para futuros ensaios pré-clínicos baseados na administração de DNA plasmidial para o tratamento da deficiência de GH humano. / Sustained levels of circulating human growth hormone (hGH) and highly significant weight increases, also found comparable to repeated hormone injections, were observed in previous works, after electrotransfer of naked plasmid DNA into the muscle of immunodeficient dwarf mice (lit/scid). In the present work an homologous animal model for GH gene therapy was studied by cloning the genomic sequence of mouse GH-DNA (mGH-gDNA), which substituted hGH-gDNA in the plasmid that had been used in immunodeficient dwarf mice, now named UBI-mGH-gDNA and used in immunocompetent dwarf mice (lit/lit). An in vitro test was first carried out by transfecting HEK 293 human cells with this plasmid and obtaining an expression of 3.0 &mu;g mGH/106 cells/day, against 3.7 &mu;g /106 cells/day obtained with UBI-hGH-gDNA. The same two plasmids DNA (50 &mu;g/mouse) were then injected into the quadriceps muscle of lit/lit, followed by electroporation, carrying out a 94-day assay. While after 15 days the slopes of the weight variation curves related to mGH, hGH and saline were 0.130, 0.112 and 0.027 g/mouse/day respectively, after 94 days the corresponding slopes were 0.041, 0.028 and 0.033 g/mouse/day. Statistical tests showed that after 15 days the slopes of both GH curves were significantly higher than the control (P<0.001), while after 94 days only the slope of the mGH curve was significantly higher than the control (P<0.005). Weight increase for mGH-treated mice, after 94 days, was 34.3%, while nose-to-tail and femur length, both directly measuring longitudinal growth, increased 9.5% and 26.0%, respectively, when compared to the initial values. The progressive growth arrest of the hGH-treated mice was not unexpected, considering the obvious immunogenic reaction of the immunocompetent animals against human and not against mouse GH ( anti-hGH antibody title 1:100 to 1:3200). The highly positive slope of the control group, already observed in lit/lit but never in lit/scid, is probably due to the natural weight gain of this strain, not supported, however, by a proportional longitudinal growth. mGH circulating levels of the order of 4 ng/mL were detected after 15 days for mGH-treated mice, while the control presented levels around 0.7 ng mGH/mL (P<0.001). Mouse IGF-I serum levels were also determined on day 15, 45 and 94 in mGH-treated mice, always showing 1.5-3.0 fold higher values than the control and 1.2-1.6 fold higher values than hGH-treated mice. This homologous treatment model can be considered a first approach and an important support to the preclinical testing of naked DNA administration for the treatment of human GH deficiency.

In a HEK 293 cell line stably expressing seabream GHS-R1a (sbGHS-R1a), we found that a synthetic growth hormone secretagogue (GHS) increased [ 3H]-inositol phosphate production, clearly indicating coupling of this receptor to Gq/11-proteins. Using Western blotting, we found that GHS could also stimulate extracellular signal-regulated kinases 1 and 2 (ERK1/2), and that this response was inhibited by the MEK inhibitor U0126. For both the [3H]-inositol phosphate and ERK1/2 assays, the presence of the GHS-R antagonist D-Lys(3)-GHRP-6 significantly inhibited the GHS-stimulated activities, and in addition inhibited basal activities by 50% and 40%, respectively. These results showed that sbGHS-R1a is a constitutively active receptor and the antagonist D-Lys(3)-GHRP-6 is an inverse agonist. We also proposed that the expression of sbGHS-Rs was involved in the regulation of cell apoptosis. / Oligomerization of the human GHS-Rs (hGHS-Rs) was explored by transient transfection of the hGHS-Rs in HEK 293 cells followed by co-immunoprecipitation of differentially epitope-tagged forms of the receptors and bioluminescence resonance energy transfer 2 (BRET2) studies. (Abstract shortened by UMI.) / The concept that G protein-coupled receptors (GPCRs) exist and potentially function as dimers and/or higher oligomers has progressed from hypothesis to being widely accepted recently. Oligomerization of GPCRs has been increasingly noted in the regulation of the biological activity of the receptors. The growth hormone secretagogue receptor 1a (GHS-R1a) is a GPCR which principally regulates the pulsatile release of growth hormone from the pituitary gland. The GHS-R exists in two forms: GHS-R1a being a constitutively-active GPCR with 7 transmembrane (TM) domains, and GHS-R1b being a truncated version of type 1a but having only 5 TM domains. The endogenous agonist for GHS-R1a is ghrelin which exerts a wide range of physiological actions, but the function of GHS-R1b is still unclear. Since the tissue distribution patterns of the two isoforms of GHS-R are different, the objective of the present study is to explore the mechanisms of cell signalling of GHS-R1a and to determine the extent and importance of interactions between these two receptor isoforms. / Leung Po Ki. / "July 2005." / Adviser: Helen Wise. / Source: Dissertation Abstracts International, Volume: 67-07, Section: B, page: 3728. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2005. / Includes bibliographical references (p. 189-210). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / School code: 1307.

Níveis sustentáveis de hormônio de crescimento humano (hGH) circulante e aumento de peso altamente significativo, avaliados também em comparação a repetidas injeções de hormônio, foram observados em trabalhos anteriores, baseados na eletrotransferência de DNA plasmidial no músculo de camundongos anões imunodeficientes (lit/scid). No presente trabalho, um modelo animal homólogo de terapia gênica para GH foi estudado mediante clonagem da sequência genômica do DNA de GH de camundongo (mGH-gDNA), a qual substituiu o hGH-gDNA no vetor que havia sido utilizado em camundongos anões imunodeficientes. O novo vetor, agora nomeado UBI-mGH-gDNA, foi utilizado em camundongos anões imunocompetentes (lit/lit). Foi primeiramente realizado um teste in vitro, transfectando-se células humanas HEK 293 com este plasmídeo e obtendo-se uma expressão de 3,0 &mu;g mGH/106 células/dia, contra 3,7 &mu;g mGH/106 células/dia, para o UBI-hGH-gDNA. Estes dois plasmídeos foram então injetados (50 &mu;g/animal) no músculo quadríceps de camundongos, seguido de eletroporação, realizando um ensaio de 94 dias. Enquanto após 15 dias, as inclinações das curvas de variação de peso relacionadas ao mGH, hGH e salina foram 0,130, 0,112 e 0,027 g/camundongo/dia, respectivamente, após 94 dias, as inclinações correspondentes foram 0,041, 0,028 e 0,033 g/camundongo/dia. As análises estatísticas mostraram que após 15 dias, as inclinações das duas curvas com o GH foram significativamente maiores que a inclinação do controle (P<0,001), enquanto que após 94 dias, somente a inclinação da curva do mGH foi maior que a do controle (P<0,005). A porcentagem de aumento de peso nos animais tratados com o gene do mGH, após 94 dias, foi de 34,3%, enquanto que o comprimento nariz-cauda e o comprimento do fêmur, dois parâmetros que medem diretamente o crescimento longitudinal, foram de 9,5% e 26%, respectivamente, quando comparados aos valores iniciais. A interrupção do crescimento progressivo do grupo tratado com hGH não foi inesperada, considerando a óbvia reação imunogênica dos animais imunocompetentes contra o GH humano e não contra o de camundongo (título do anticorpo anti-hGH 1:100 a 1:3200). A inclinação altamente positiva do grupo controle, já observada em camundongos lit/lit mas não em lit/scid, é provavelmente devida ao ganho de peso natural desta linhagem, não suportada, contudo, por um proporcional crescimento longitudinal. Níveis circulatórios de mGH da ordem de 4 ng/mL foram detectados após 15 dias para o grupo tratado com o mGH, enquanto o grupo controle apresentou níveis em torno de 0,7 ng mGH/mL (P<0,001). Níveis circulatórios de mIGF-I foram também determinados nos dias 15, 45 e 94 nos animais tratados com mGH, sempre mostrando valores 1,5 - 3,0 vezes maiores que o grupo controle, e valores 1,2-1,6 vezes maiores que o grupo tratado com hGH. Este modelo de tratamento homólogo pode ser considerado uma primeira abordagem e um importante suporte para futuros ensaios pré-clínicos baseados na administração de DNA plasmidial para o tratamento da deficiência de GH humano. / Sustained levels of circulating human growth hormone (hGH) and highly significant weight increases, also found comparable to repeated hormone injections, were observed in previous works, after electrotransfer of naked plasmid DNA into the muscle of immunodeficient dwarf mice (lit/scid). In the present work an homologous animal model for GH gene therapy was studied by cloning the genomic sequence of mouse GH-DNA (mGH-gDNA), which substituted hGH-gDNA in the plasmid that had been used in immunodeficient dwarf mice, now named UBI-mGH-gDNA and used in immunocompetent dwarf mice (lit/lit). An in vitro test was first carried out by transfecting HEK 293 human cells with this plasmid and obtaining an expression of 3.0 &mu;g mGH/106 cells/day, against 3.7 &mu;g /106 cells/day obtained with UBI-hGH-gDNA. The same two plasmids DNA (50 &mu;g/mouse) were then injected into the quadriceps muscle of lit/lit, followed by electroporation, carrying out a 94-day assay. While after 15 days the slopes of the weight variation curves related to mGH, hGH and saline were 0.130, 0.112 and 0.027 g/mouse/day respectively, after 94 days the corresponding slopes were 0.041, 0.028 and 0.033 g/mouse/day. Statistical tests showed that after 15 days the slopes of both GH curves were significantly higher than the control (P<0.001), while after 94 days only the slope of the mGH curve was significantly higher than the control (P<0.005). Weight increase for mGH-treated mice, after 94 days, was 34.3%, while nose-to-tail and femur length, both directly measuring longitudinal growth, increased 9.5% and 26.0%, respectively, when compared to the initial values. The progressive growth arrest of the hGH-treated mice was not unexpected, considering the obvious immunogenic reaction of the immunocompetent animals against human and not against mouse GH ( anti-hGH antibody title 1:100 to 1:3200). The highly positive slope of the control group, already observed in lit/lit but never in lit/scid, is probably due to the natural weight gain of this strain, not supported, however, by a proportional longitudinal growth. mGH circulating levels of the order of 4 ng/mL were detected after 15 days for mGH-treated mice, while the control presented levels around 0.7 ng mGH/mL (P<0.001). Mouse IGF-I serum levels were also determined on day 15, 45 and 94 in mGH-treated mice, always showing 1.5-3.0 fold higher values than the control and 1.2-1.6 fold higher values than hGH-treated mice. This homologous treatment model can be considered a first approach and an important support to the preclinical testing of naked DNA administration for the treatment of human GH deficiency.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 6 uppsatser.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Reduction in the quality of life (QOL) is commonly described in the growth hormone (GH) deficiency, with reports of benefits of GH replacement therapy in QOL. In most of the descriptions, GH deficiency is not isolated, of adult onset type and has multiple causes with its respective treatments that by themselves can influence QOL. In the present work we evaluated (QOL) by the questionnaire Questions on Life Satisfaction Hypopituitarism Module (QLS-H) in 20 adult with isolated deficiency of GH (IGHD) due to a mutation in the GH releasing hormone receptor gene (IGHD, 10 men) comparing with 20 controls (CO, 10 men). Additionally IGHD group was evaluated after 6 months of treatment with long acting GH (Nutropin Depot®, Genentech ) given subcutaneously every 15 days ( pGH) and after 12 months of its interruption (12M). There was not difference in the total score of QOL (TSQOL) among the groups IGHD and CO, 90(50,25) and 93 (79,25) respectively, median (interquartile range) and nor in any of the nine categories that composes the TSQOL. Similar results were obtained when data were analyzed by sex. Despite modest but significant trough serum insulin like growth factor I (IGF-I) increase GH treatment didn't influence TSQOL in pGH 100(51) and 12M 93(38). Only the score of perception of the satisfaction with the physical resistance increased (p=0,01) in the time pGH. In conclusion, genetic and lifelong DIGH doesn't reduce the QOL and the treatment with long-acting GH for 6 months didn't also influence it, in spite of the improvement of the perception of the satisfaction with the physical resistance, obtained with the treatment. / Redução na qualidade de vida (QV) é comumente descrita na deficiência do hormônio do crescimento (GH) com relatos de benefícios de terapia de reposição com o GH sobre a mesma. Na maioria das descrições, a deficiência do GH não é isolada, tem início na idade adulta e comporta múltiplas etiologias com seus respectivos tratamentos, os quais por si próprios podem influenciar a QV. No presente trabalho avaliamos a QV através do questionário Questions on Life Satisfaction Hypopituitarism Module (QLS-H) de 20 indivíduos adultos com deficiência isolada do GH devido a uma mutação no gene do receptor do hormônio liberador do GH (DIGH, 10 homens) comparando com 20 controles (CO, 10 homens). Adicionalmente o grupo DIGH foi avaliado após 6 meses de tratamento com GH de depósito ministrado subcutâneo a cada 15 dias (após GH) e após 12 meses da sua interrupção (12M). Não houve diferença no escore total de qualidade de vida (ETQV) entre os grupos DIGH e CO, 90(50,25) e 93 (79,25), respectivamente, mediana (distância interquartilica) e nem em alguma das nove categorias que compõem o ETQV. Resultado semelhante foi obtido quando analisado por sexo. Apesar de modesto, mas significante aumento dos níveis de vale do fator de crescimento semelhante a insulina tipo I (IGF-I), o tratamento com GH não influenciou o ETQV após GH 100(51) e 12M 93(38). Apenas o escore de percepção da satisfação com a resistência física aumentou (p=0,01) no tempo após GH. Em conclusão, DIGH genética e vitalícia não reduz a qualidade de vida e o tratamento com GH de depósito durante 6 meses também não a influenciou, apesar da melhora na percepção da satisfação com a resistência física obtida com o tratamento.

No description available.

No description available.

No description available.

Η προκλητή δοκιμασία με GHRH + GHRP-6 είναι ένα από τα πιο ισχυρά ερεθίσματα για την έκκριση της GH. Προκειμένου να εκτιμηθεί η διαγνωστική της ικανότητα σε παιδιά με κλασσική ανεπάρκεια GH (Growth Hormone Deficiency, GHD) αλλά και με νευροεκκριτική δυσλειτουργία της GH (GH Neurosecretory Dysfunction, GHND), 35 παιδιά με μέγιστη απάντηση της GH < 10 μg/L μετά από πρόκληση με levo-dopa/κλονιδίνη (GHD), 15 με φυσιολογική απάντηση στις προκλητές εξετάσεις αλλά παθολογική αυτόνομη 24ωρη έκκριση της GH (GHND) και 20 φυσιολογικοί μάρτυρες έλαβαν 1 μg/kg GHRH και GHRP-6 i.v. και η GH μετρήθηκε στο χρόνο -15΄, 0΄, 5΄, 10΄, 15΄, 30΄, 45΄, 60΄. Έξι ασθενείς δεν απάντησαν στην συνδυασμένη προκλητή εξέταση με GHRH και GHRP-6 (μη αποκριτές), με σημαντικά χαμηλότερη μέγιστη τιμή GH: 20.7 μg/L (7.8-31.8) από τους μάρτυρες και τους υπόλοιπους ασθενείς (αποκριτές). Η απάντηση της GH (μg/L) ήταν παρόμοια μεταξύ των προεφηβικών μαρτύρων: 167±88, των προεφηβικών παιδιών με κλασσική ανεπάρκεια: 202±110 και των προεφηβικών παιδιών με νευροεκκριτική δυσλειτουργία της GH: 155±83. Οι εφηβικοί μάρτυρες είχαν υψηλότερη απάντηση: 328±149 από τους εφηβικούς ασθενείς με GHD: 203±105 και GHND: 186±105. Ενώ οι εφηβικοί μάρτυρες είχαν υψηλότερη απάντηση GH από τους προεφηβικούς, οι εφηβικοί και προεφηβικοί ασθενείς και των δύο ομάδων (GHD και GHND) είχαν παρόμοια μέγιστη απάντηση GH. Tα δεδομένα της μελέτης επιβεβαιώνουν ότι ο συνδυασμός GHRH και GHRP-6 είναι ένα ισχυρό ερέθισμα για την έκκριση της GH που μπορεί να κινητοποιήσει τα υποφυσιακά αποθέματα αυξητικής ορμόνης σε παιδιά που παρουσιάζουν τόσο κλινικά, όσο και βιοχημικά χαρακτηριστικά ανεπάρκειας αυξητικής ορμόνης. Πρόκειται για μία ασφαλή και σύντομη δοκιμασία χωρίς ανεπιθύμητες ενέργειες για τα παιδιά, η οποία μπορεί να διακρίνει τους ασθενείς με σημαντική έκπτωση των υποφυσιακών αποθεμάτων αλλά και εκκριτικής ικανότητας της GH, που παρουσιάζουν και την πιο σημαντική ανεπάρκεια στην αύξηση. Είναι πιθανό οι ασθενείς «αποκριτές» να παρουσιάζουν υποθαλαμική δυσλειτουργία στη νευρορύθμιση της έκκρισης της GH και να μπορούν να απαντήσουν θεραπευτικά σε συνθετικά εκλυταγωγά της GH.Κατά συνέπεια, η εξέταση με GHRH+GHRP-6 μπορεί να χρησιμεύσει στην επιλογή ασθενών όχι μόνο με ανεπάρκεια GH αλλά και με άλλες διαταραχές της αύξησης με θεραπευτική ένδειξη τη χορήγηση GH, οι οποίοι θα μπορούσαν να απαντήσουν στη χορήγηση συνθετικών εκλυταγωγών της GH. Περαιτέρω μελέτες χρειάζονται για να απαντήσουν στα πολύ σημαντικά αυτά κλινικά ερωτήματα. / The combined growth hormone-releasing hormone and growth hormone-releasing peptide-6 (GHRH + GHRP-6) test is most potent in evaluating GH secretion. The aim of this research was to assess its capability in children with GH deficiency and low spontaneous GH secretion (GH neurosecretory dysfunction). Thirty-five children with GH <10 ng/ml after levo-dopa/clonidine (GHD), 15 with normal provocative tests but abnormal 24-hour spontaneous GH secretion (GHND), and 20 controls (C) were given 1 μg/kg of GHRH and GHRP-6 i.v. and GH (ng/ml) was measured at -15, 0, 5, 10, 15, 30, 45 and 60 min. Six were non-responders to the combined test, with significantly lower peak GH 20.7 (7.8-31.8) than C and the rest of the patients (responders). Peak GH was similar between prepubertal (PP) controls 167 +/- 88, GHD 202 +/- 110 and GHND 155 +/- 83. Pubertal (P) controls had higher peak GH 328 +/- 149 than P-GHD 203 +/- 105 and P-GHND 186 +/- 105. While P-C had higher peak GH than PP-C, PP and P children had similar responses within the GHD and GHND groups. The GHRH + GHRP-6 test detects children with severe GH insufficiency. Patients with GHD respond similarly to those with GHND, indicating a possible hypothalamic GH neuroregulatory dysfunction in GHD. Responders to the combined test may be eligible for treatment with a synthetic GH secretagogue.

Atualmente, a maioria dos endocrinologistas pediátricos usa uma dose fixa de GH, calculada por quilo de peso ou área de superfície corporal, para todos os pacientes. Algumas crianças com DGH, tratadas com as doses atuais, não atingem uma estatura normal e outras não atingem a estatura-alvo geneticamente prevista pela altura dos pais. Além disso, algumas crianças com DGH desenvolvem características acromegalóides após o uso por longo prazo da medicação. A existência de um marcador preciso e eficiente seria útil para a individualização da dose de rGH. Esse marcador deveria ser mensurado em um período de tempo menor que a velocidade de crescimento (VC). Neste estudo usamos as concentrações de IGF-I como esse marcador. Durante 12 meses, acompanhamos trinta crianças portadoras de DGH grave, em tratamento prévio por cerca de quatro anos, divididas em dois grupos de 15, para comparar o tratamento com a dose de rGH baseada no peso versus o tratamento com a dose de rGH ajustada pelas concentrações de IGF-I para mantê-las em uma faixa alvo (entre 0 a +2 DP). Foi possível manter concentrações de IGF-I dentro de valores predeterminados pelo ajuste da dose de rGH em 13 dos 15 pacientes, mas a VC não foi diferente entre os grupos (6,8±2,6 vs. 6,9±2,7 cm/ano; p=NS); porém, quando considerados apenas os pacientes prépúberes que mantiveram concentrações de IGF-I entre 0 e +2DP em pelo menos 75% das dosagens, sua velocidade de crescimento foi maior em comparação com as crianças que mantiveram concentrações de IGF-I abaixo de 0DP em 50% ou mais das dosagens (8,8±1,8 vs. 6,3±2,9 cm/ano; p<0,05). Em paralelo, comparamos as concentrações de IGF-I de diferentes genótipos do exon 3 do receptor de GH (GHR), nessas trinta crianças, durante o tratamento. Duas das mais comuns isoformas em seres humanos são geradas pela retenção (full length GHR - GHRfl) e exclusão do exon 3 (exon 3 deleted GHR - GHRd3). A influência desse polimorfismo na resposta ao tratamento com rGH em pacientes com DGH tem sido alvo de controvérsia. No presente estudo, apesar de receberem a mesma dose de rGH (41±10 vs. 41±8 ug/kg d; p=NS), pacientes carreando ao menos um alelo-d3 GHR, como grupo, tiveram maiores níveis de IGF-I que aqueles homozigotos para o alelo GHR full-length (0,9±0,9 vs. -0,3±1,2 DP; p<0,05) , indicando uma melhor sensibilidade ao GH para o primeiro genótipo. A VC não foi diferente entre os grupos GHRd3 vs. GHRfl (7,3±1,9 vs. 6,4±3,1cm/ano; p=NS). / Currently, most pediatric endocrinologists use a fixed rGH dose calculated according to the weight or body surface area for all patients. Some children with GHD, treated with the present doses, do not achieve normal height, and some, even reaching normal height, do not achieve the genetic target height determined by their parents\' heights. At the same time, some children with GHD develop acromegalic characteristics after long-term treatment with rGH. The existence of a specific and effective marker to individualize rGH dose would be useful to control therapy of children with GHD. This marker ideally should be obtained in a shorter time interval than the growth velocity (GV). In the present study, we measured insulin-like growth factor (IGF-I) as this marker. During one year, we followed 30 children with severe GHD, treated previously with rGH for an average of 4yrs, divided in two groups of 15, to compare weight-based versus IGF-I-based rGH dosing to reach IGF-I levels between a target range (0 and +2 SDS). It was feasible to maintain IGF-I levels in this predetermined range by adjusting the rGH dose in 13 of 15 patients, but growth velocity was not different in groups with weight-based or IGF-I based rGH dose (6.8±2.6 vs. 6.9±2.7cm/y; p=NS); however, in prepubertal children who reached predetermined target IGF-I levels in 75% of the measurements GV was higher than in those who did not (8.8±1.8 vs. 6.3±2.9 cm/y; p<0.05). In parallel, we compared IGF-I levels of different GH receptor (GHR) exon 3 genotypes in these 30 children during treatment. Two of the more common GHR isoforms in humans are generated by retention (full length GHR - GHRfl) and by exclusion of exon 3 (exon 3 deleted GHR - GHRd3). The influence of this polymorphism on the response to rGH treatment in patients with GH deficiency has been controversial. In the present study, despite receiving similar rGH doses (41±10 vs. 41±8 ug/kg d; p=NS), patients carrying at least one GHR d3-allele, as a group, had higher IGF-I levels than those homozygous for the GHR full-length allele (0.9±0.9 vs. -0.3±1.2 SDS; p<0.05), indicating a greater GH sensitivity with the former genotype. GV was not different between groups GHRd3 vs. GHRfl (7.3±1.9 vs. 6.4±3.1cm/y; p=NS).