Growth hormone deficiency in adulthood and the effects of growth hormone replacement: a review. Growth Hormone Research Society Scientific Committee.
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Adult↗
Biomedical subjects
L Carlsson
Publications and source records attributed to L Carlsson.
Leptin levels in protracted critical illness: effects of growth hormone-secretagogues and thyrotropin-releasing hormone.
Prolonged critical illness is characterized by feeding-resistant wasting of protein, whereas reesterification, instead of oxidation of fatty acids, allows fat stores to accrue and associate with a low-activity status of the somatotropic and thyrotropic axis, which seems to be partly of hypothalamic origin. To further unravel this paradoxical metabolic condition, and in search of potential therapeutic strategies, we measured serum concentrations of leptin; studied the relationship with body mass index, insulin, cortisol, thyroid hormones, and somatomedins; and documented the effects of hypothalamic releasing factors, in particular, GH-secretagogues and TRH. Twenty adults, critically ill for several weeks and supported with normocaloric, continuously administered parenteral and/or enteral feeding, were studied for 45 h. They had been randomized to receive one of three combinations of peptide infusions, in random order: TRH (one day) and placebo (other day); TRH + GH-releasing peptide (GHRP)-2 and GHRP-2; TRH + GHRH + GHRP-2 and GHRH + GHRP-2. Peptide infusions were started after a 1-microgram/kg bolus at 0900 h and infused (1 microgram/kg.h) until 0600 h the next morning. Serum concentrations of leptin, insulin, cortisol, T4, T3, insulin-like growth factor (IGF)-I, IGF-binding protein-3 and the acid-labile subunit (ALS) were measured at 0900 h, 2100 h, and 0600 h on each of the 2 study days. Baseline leptin levels (mean +/- SEM: 12.4 +/- 2.1 micrograms/L) were independent of body mass index (25 +/- 1 kg/m2), insulin (18.6 +/- 2.9 microIU/mL), cortisol (504 +/- 43 mmol/L), and thyroid hormones (T4: 63 +/- 5 nmol/L, T3: 0.72 +/- 0.08 nmol/L) but correlated positively with circulating levels of IGF-I [86 +/- 6 micrograms/L, determination coefficient (R2) = 0.25] and ALS (7.2 +/- 0.6 mg/L, R2 = 0.32). Infusion of placebo or TRH had no effect on leptin. In contrast, GH-secretagogues elevated leptin levels within 12 h. Infusion of GHRP-2 alone induced a maximal leptin increase of +87% after 24 h, whereas GHRH + GHRP-2 elevated leptin by up to +157% after 24 h. The increase in leptin within 12 h was related (R2 = 0.58) to the substantial rise in insulin. After 45 h, and having reached a plateau, leptin was related to the increased IGF-I (R2 = 0.37). In conclusion, circulating leptin levels during protracted critical illness were linked to the activity state of the GH/IGF-I axis. Stimulating the GH/IGF-I axis with GH-secretagogues increased leptin levels within 12 h. Because leptin may stimulate oxidation of fatty acids, and because GH, IGF-I, and insulin have a protein-sparing effect, GH-secretagogue administration may be expected to result in increased utilization of fat as preferential substrate and to restore protein content in vital tissues and, consequently, has potential as a strategy to reverse the paradoxical metabolic condition of protracted critical illness.
Adult↗
Low growth hormone secretion in patients with fibromyalgia--a preliminary report on 10 patients and 10 controls.
OBJECTIVE: To evaluate the secretion of growth hormone in patients with fibromyalgia (FM). METHODS: Serum concentrations of growth hormone (24 h profiles), insulin-like growth factor I (IGF), and IGF binding protein-3 were determined in 10 women with FM and in 10 healthy controls. Quality of sleep was assessed by means of a visual analog scale. RESULTS: Sleep was significantly more disturbed in the patients than in controls. A significantly lower secretion of growth hormone was found in the patients in comparison with healthy controls. CONCLUSION: These results suggest that growth hormone secretion is decreased in patients with FM. Substitution therapy with low doses of growth hormone may be worth evaluating in the treatment of FM.
Adult↗
Desmin is essential for the tensile strength and integrity of myofibrils but not for myogenic commitment, differentiation, and fusion of skeletal muscle.
A null mutation was introduced into the mouse desmin gene by homologous recombination. The desmin knockout mice (Des -/-) develop normally and are fertile. However, defects were observed after birth in skeletal, smooth, and cardiac muscles (Li, Z., E. Colucci-Guyon, M. Pincon-Raymond, M. Mericskay, S. Pournin, D. Paulin, and C. Babinet. 1996. Dev. Biol. 175:362-366; Milner, D.J., G. Weitzer, D. Tran, A. Bradley, and Y. Capetanaki. 1996. J. Cell Biol. 134:1255- 1270). In the present study we have carried out a detailed analysis of somitogenesis, muscle formation, maturation, degeneration, and regeneration in Des -/- mice. Our results demonstrate that all early stages of muscle differentiation and cell fusion occur normally. However, after birth, modifications were observed essentially in weight-bearing muscles such as the soleus or continually used muscles such as the diaphragm and the heart. In the absence of desmin, mice were weaker and fatigued more easily. The lack of desmin renders these fibers more susceptible to damage during contraction. We observed a process of degeneration of myofibers, accompanied by macrophage infiltration, and followed by a process of regeneration. These cycles of degeneration and regeneration resulted in a relative increase in slow myosin heavy chain (MHC) and decrease in fast MHC. Interestingly, this second wave of myofibrillogenesis during regeneration was often aberrant and showed signs of disorganization. Subsarcolemmal accumulation of mitochondria were also observed in these muscles. The lack of desmin was not compensated by an upregulation of vimentin in these mice either during development or regeneration. Absence of desmin filaments within the sarcomere does not interfere with primary muscle formation or regeneration. However, myofibrillogenesis in regenerating fibers is often abortive, indicating that desmin may be implicated in this repair process. The results presented here show that desmin is essential to maintain the structural integrity of highly solicited skeletal muscle.
Adenosine Triphosphatases↗
A potential role of R-cadherin in striated muscle formation.
We have examined the murine embryonic expression pattern of the cell adhesion molecule R-cadherin in muscle, kidney, thymus, and lung. In developing muscle, R-cadherin was first seen at 10.5-11.5 days postcoitum in the somitic myotome. Consistently, we found R-cadherin expressed at the highest levels in the myotome, early skeletal muscle, and smooth muscle (both vascular and visceral), while very low levels of R-cadherin were detected in the heart. The expression pattern and subcellular localization of R-cadherin in developing skeletal muscle indicate a possible role in myoblast cell-cell interactions during both primary and secondary myogenesis. In the developing kidney, R-cadherin was first detected at 10.5 days postcoitum in the mesonephric epithelial tubule cells. In the metanephric kidney, it was specifically expressed in the pretubular aggregates, comma- and S-shaped bodies, proximal tubules, and collecting ducts. Thus, in the kidney, R-cadherin was associated with the mesenchymal-epithelial transition. R-cadherin was also found in other developing epithelia, for example in the thymic epithelial cells. In the lung, R-cadherin was expressed at the highest levels in the smooth muscle surrounding the lung epithelial tubules. To test whether R-cadherin can direct formation of tissues, we constitutively expressed R-cadherin in E-cadherin-/- ES cells and examined histogenesis in teratomas derived from these cells. R-cadherin exclusively rescued formation of striated muscle and epithelia in the teratomas. R-cadherin's ability to form epithelia in vivo was substantiated by its ability to rescue formation of cystic embryoid bodies in vitro. By comparing our data with the previously reported embryonic expression patterns and histogenetic activities of E- and N-cadherin, we suggest that R-cadherin plays an important role in the formation of striated muscle and possibly also of epithelia.
Animals↗
[Care in ambulances should be utilized better].
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Ambulances↗
Targeted disruption of the V(H) 81X gene: influence on the B cell repertoire.
We have generated a mutant mouse in which the most D-proximal V(H) gene (V(H)81X) has been disrupted by introducing a neomycin-resistance gene into the V(H)81X exon by means of gene targeting in embryonic stem cells. The mutant mice generated are unable to express the V(H)81X gene but appear to display a normal pattern of B cell differentiation as well as normal numbers of bone marrow and peripheral B cells from fetal life all through ontogeny. They mount normal immune responses to several different antigens tested. In contrast, the distribution of V(H) gene rearrangements in the V(H)7183 family is altered in homozygous mutant mice. Thus, the antibody repertoire of the targeted mice is modified, at least as far as the expression of V(H)7183 genes is concerned.
Animals↗
Null mutation in the desmin gene gives rise to a cardiomyopathy.
A null mutation in the desmin gene has been introduced into the germ line of mice. Such mice develop and reproduce normally proving that desmin is not needed either for the formation of the heart or the alignment of functioning myofibrils. However, cardiovascular lesions and a skeletal myopathy were observed in growing and adult mice. In the present study we have carried out a detailed analysis of these cardiac lesions. Homozygous mutant mice, which were confirmed to lack expression of desmin mRNA and desmin protein in the heart, were revealed by electron microscopy to contain degenerating cardiomyocytes as early as 5 days post-partum. At 10 days post-partum and onwards the degeneration of cardiomyocytes gave rise to areas with an accumulation of macrophages, fibrosis and calcification preferentially in the inter-ventricular septum and the free wall of the right ventricle. The localization of the lesions mainly to these sites suggested that it is not the work load and contractions per se which were the pathogenic events leading to the cardiomyopathy. It might be that stress related to lengthening of the myocytes occur more in the right ventricle than in the left. At the ultrastructural level changes in the intercalated discs, disruption of the sarcolemma and supercontraction of myofibrils seemed to be the key events leading to cardiomyocyte death. Thus, the intermediate filaments are required to maintain the basic integrity of cardiomyocytes and especially the link between the intermediate filaments and the sarcolemma appear more important than previously realized.
Animals↗
Clinical and radiologic survivorship of cementless tibial components fixed with finned polyethylene pegs.
One hundred twenty patients (22 men, 98 women; 144 knees) with uncemented Freeman-Samuelson total knee arthroplasty were followed prospectively. Eighty-one patients had rheumatoid arthritis and 39 patients had osteoarthrosis. The mean follow-up period was 6.8 years. Three different types of tibial components were used: a high-density polyethylene component without stem, a metal-backed tibial component without stem, and a metal-backed tibial component with stem. Progressive varus tilting turned out to be an early sign of failure and occurred in 22% of the tibial components. Revision of the tibial component was done in 17 knees. Survival analysis with revision as endpoint revealed a survival rate of 79% at a follow-up period of 10 years. Cementless fixation of this design using macrointerlocking pegs and no other stabilization resulted in poor fixation and a high revision rate and cannot be recommended.
Adult↗
Postoperative inflammatory response after autologous and allogeneic blood transfusion.
BACKGROUND: Allogeneic blood transfusions cause immunosuppression. The aim of this study was to determine whether complement anaphylatoxins, cytokines, or both are released in the recipient, after blood transfusions in general, and after autologous blood transfusions in particular. METHODS: Thirty-one patients having total hip joint replacement surgery were randomized to receive either allogeneic red blood cells (n = 15) or predeposited autologous whole blood transfusion (n = 16). Plasma concentrations of the anaphylatoxins C3a and C5a, the terminal C5b-9 complement complex, and cytokines IL-6 and IL-8 in the recipients were repeatedly analyzed before, during, and after surgery. RESULTS: Significantly increased concentrations of IL-6 and IL-8 appeared in both groups, with a significantly greater increase in the autologous blood group. Patients in both groups developed a moderate but significant increase of C3a without a significant difference between them. C5a and terminal C5b-9 complement complex were not greatly changed. CONCLUSIONS: The study showed a greater increase in cytokine concentration after autologous blood transfusion than after allogeneic blood transfusion. The lower response in the latter may result from transfusion-induced suppression of cellular immunity.
Adult↗
Myringotomized mice develop myringosclerosis in the pars flaccida and not in the pars tensa.
The development of myringosclerosis has been correlated with increased production of oxygen-derived free radicals. For the present study, we used a null mutant mouse lacking extracellular superoxide dismutase to test the hypothesis that increased production of free radicals can cause the development of myringosclerosis. Null mutant mice and wild-type, control mice were myringotomized and kept in ambient air for 3 weeks. Both groups developed myringosclerosis in the pars flaccida, but not in the pars tensa. The sclerotic lesions were visible in both the light and the electron microscope but not in the otomicroscope. In particular, the localization of the sclerotic deposits was found beneath both the inner and outer epidermal epithelium. No difference concerning the extent or number of sclerotic lesions between the null mutant and the wild-type mice could be distinguished.
Animals↗
A bone-anchored percutaneous connector system for neural prosthetic applications.
A percutaneous connector system has been developed for use in neural prosthetic applications. It is based on a skin-penetrating, bone-anchored titanium pedestal, housing an II-channel electrode array. Initial applications for the system are in audiology and as such, the proposed fixture site is in the temporal bone. The titanium pedestal is based on existing design features of the EPI Bioglass implant, developed by University College London (UCL), and the Brånemark System, employed by Nobel Biocare AB. The electrode array, consisting of platinum wires in a silicone carrier, can be custom designed to suit the application. The design features of the connector system are reviewed. Animal studies have been used to assess soft tissue reactions and the osseointegration of the pedestal. The histological data are presented. The pedestal, electrode array and the mating external connector are currently undergoing mechanical and electrical testing. The percutaneous connector system will undergo clinical trials, initially in the study of tinnitus (employing stimulation via an extracochlear electrode), and as part of a cochlear implant system (using a multichannel intracochlear electrode array and digital signal processing techniques.
Animals↗
Growth hormone (GH) assays: influence of standard preparations, GH isoforms, assay characteristics, and GH-binding protein.
The impact of the adoption of the new biosynthetic growth hormone (GH) WHO International Reference Preparation (IRP 88/624), and the recommendation to report results in microgram/L instead of mU/L, is described. Conversion factors were determined by comparing both the linear and nonlinear relations of the GH values. The Pharmacia polyclonal IRMA (p-IRMA) and the DELFIA monoclonal time-resolved immunofluorometric assay (trIFMA) with kit calibrators calibrated either against the pituitary-derived WHO IRP 80/505 or the new 88/624 were evaluated. Conversion factors of 4.17 mU/L = 1 microgram/L for the p-IRMA and 4.31 mU/L = 1 microgram/L for the trIFMA were necessary. Different cross-reactivity patterns for the deaminated and dimer 22-kDa, 20-kDa, and 17-kDa GH isoforms were found. Expected GH recovery was similar when the measured values were adjusted according to the results of the cross-reactivity study.
Adolescent↗
Electrophysiological characterization of the prokinetic agents cisapride and mosapride in vivo and in vitro: implications for proarrhythmic potential?
In the present study the electrophysiological characteristics and the proarrhythmic potential of cisapride and a structurally related drug, mosapride, were compared. In the anesthetized guinea pig, cisapride and d-sotalol (0.01-10 micromol/kg i.v., n = 6) dose-dependently prolonged the duration of the monophasic action potential recorded from the left ventricle. The maximal lengthening was 18 +/- 3.2% at 1.0 micromol/kg (mean +/- S.E.M., P < .01 vs. base line) and 19 +/- 2.5% at 10 micromol/kg (P < .001) for cisapride and d-sotalol, respectively. In contrast, mosapride did not increase this variable. In a rabbit model of the acquired long QT syndrome, infusion of cisapride (0.3 micromol/kg/min for 10 min maximum, n = 6), but not mosapride or vehicle, was associated with a significant lengthening of the QTU interval (43 +/- 3.8 ms, P < .01). Furthermore, torsades de pointes appeared in two of the six rabbits given cisapride. In isolated rabbit Purkinje fibers (PF), cisapride increased the action potential duration (48 +/- 5.6% at 0.1 micromol/l, P < .01 vs. control, n = 4). Mosapride did not significantly influence the action potential duration (3 +/- 2.0% increase at 1.0 micromol/l, n = 6). However, after mosapride was washed out, the addition of cisapride (0.1 micromol/l) caused a 46 +/- 3.2% lengthening of the action potential duration (P < .01 vs. 1.0 micromol/l mosapride). Early afterdepolarizations and triggered activity appeared in four of eight cisapride-superfused PF stimulated at a very low frequency (0.1 Hz). In isolated rabbit cardiomyocytes, cisapride concentration-dependently blocked (IC50 = 9 nmol/l) the rapid component of the delayed rectifying K+ current (I(Kr)). Mosapride was approximately 1000-fold less potent in blocking I(Kr) (IC50 = 4 micromol/l). It is concluded that the electrophysiological characteristics of cisapride may explain the recently reported propensity to prolong the QT interval and to induce torsades de pointes in susceptible patients, although a structurally related benzamide, mosapride, did not appear to have electrophysiological features of relevance for induction of torsades de pointes in common with cisapride.
Action Potentials↗
Accuracy of machine milling and spark erosion with a CAD/CAM system.
A method for manufacturing crowns and fixed partial dentures based on CAD/CAM has been developed as an alternative to the lost wax technique and the casting of an alloy. In this process two steps are included: milling and spark erosion. The computer-assisted design (CAD) relies heavily on the accuracy of the milling and spark erosion processes to achieve a clinically acceptable restoration. These two processes must be able to produce the crown data generated in the CAD files. This study evaluated the accuracy of the Procera CAD/CAM system in creating specific geometric bodies that were compared with the known dimensions in the CAD files for these bodies. The manufacturing errors of milling (ellipse +/- 6.5 microm, square +/- 3.4 microm, and cylinder +/- 5.8 microm) and spark erosion (ellipse +/- 8.6 microm and square +/- 10.4 microm) were determined. The accuracy of this manufacturing process demonstrated that this system was capable of producing a crown with a clinically accepted range for marginal opening gap dimension of less than 100 microm.
Analysis of Variance↗
Measuring fit at the implant prosthodontic interface.
Four centers in the United States and Sweden have been working for 2 years to develop systems and methods for measuring fit at the prosthodontic interface. Two systems are based on stylus contact techniques, one system uses a laser as its reader source, and one system is photogrammetric. All the systems are capable of providing data as three-dimensional x, y, and z axes coordinate values that can be transformed into linear and angular data that characterize the bearing surfaces of abutments or abutment replicas and their mating components in the prosthesis framework. The centroid, a single point computed from the collected data, was the measurement unit, derived for these bearing surfaces, that was used to compare the systems. All four methods can most likely detect misfits that are relevant in the clinical setting; however, only one system can be used intraorally. When any measurement system is assessed, the data should always be examined for repeatability to establish the reliability of the system. This investigation made comparisons among the measurement methods used at the four centers. It was apparent from this study that comparisons of data from measurement systems should be rounded to the nearest 10 microns. The SDs determined in the comparisons were larger than 5 microns and therefore misfits should be calculated in terms smaller than 10 microns. This final point is important to the clinician who relies on research reports about precision of fit when selecting treatment approaches in caring for the implant prosthodontic needs of their patients.
Calibration↗
Characterisation of the effects of cadmium on the release of calcium and on the activity of some enzymes from neonatal mouse calvaria in culture.
Exposure to cadmium (Cd) causes skeletal impairments, such as osteoporosis and osteomalacia, in many mammalian species, including humans. There is, however, some controversy about the mechanism of action of these Cd-induced skeletal effects, although both a direct influence on bone cells and effects that are secondary to renal damage caused by the metal have been demonstrated. In the present study, we cultured calvarial bones from neonatal mice and exposed them to Cd to study the effects of the metal on calcium release and on the activity of some enzymes of importance for bone resorption and bone formation. Cd dose-dependently stimulated calcium release from the bones. Maximal release was noted at Cd concentrations of 0.4-0.8 microM, which was similar to the level of release in the presence of maximal stimulatory concentrations of parathyroid hormone (10 nM) and prostaglandin E2 (10 microM). Cykloheximide (1 microM) inhibited calcium release elicited by Cd, prostaglandin E2 and parathyroid hormone. Cd-induced calcium release was linearly increased from 24 to 72 hr of culture. Production of prostaglandin E2 by the bone specimens was dose-dependently stimulated by Cd and inhibited by 1 microM indomethacin. Cd-induced calcium release was inhibited by acetazolamide (100 microM), indomethacin (1 microM) and ibuprofen (10 microM). Prostaglandin E2-stimulated calcium release was not inhibited by indomethacin. Exposure to 32 microM Cd, present during a 48-hr incubation period, significantly decreased prostaglandin E2-stimulated calcium release from 38.9% to 29.8%. Calcium release induced by parathyroid hormone was more sensitive to inhibition by the metal (i.e., Cd concentrations of 0.2 and 32 microM decreased the release from 37.7% to 31% and 19%, respectively). Cd present in the culture medium during a 48-hr incubation dose-dependently inhibited the activity of alkaline phosphatase and tartrate-resistant acid phosphatase in the bones but did not influence the activity of carbonic anhydrase. We conclude that Cd has a direct stimulatory effect on bone resorption, and this effect is dependent on prostaglandin production and also on protein synthesis. On the other hand, Cd also has an inhibitory effect on bone resorption (i.e., resorption is inhibited by higher concentrations of the metal). Moreover, Cd may impair bone formation by impeding the activity of alkaline phosphatase.
Acid Phosphatase↗
Electrophysiological and inotropic characterization of a novel class III antiarrhythmic agent, GLG-V-13, in the mammalian heart.
GLG-V-13, a novel 3,7-diheterabicyclo(3.3.1)nonane, was examined both in vivo and in vitro to characterize its electrophysiological, hemodynamic, and inotropic properties. In anesthetized guinea pigs, GLG-V-13 [0.5-500 micrograms/kg intravenously (i.v.), n = 6] lengthened the epicardial monophasic action potential (MAP) duration, the atrioventricular (AV) conduction time and the RR interval in a dose-dependent manner. At the highest dose, these variables were increased by 30, 13, and 23%, respectively. No significant effects were noted on QRS duration or blood pressure (BP). In rabbit atrial and papillary muscle preparations, GLG-V-13 (0.32-3.2 mg/L) did not exert a negative inotropic action and in isolated rabbit cardiomyocytes the agent blocked the rapidly activating delayed rectifier K+ current (IKr, EC50 = 48 micrograms/L). In 10 intact anesthetized mongrel dogs, the left ventricular (LV) endocardial MAP was measured during atrial pacing before and after administration of GLG-V-13 (3 and 6 mg/kg i.v.). As compared with the drug-free state, the agent induced a significant prolongation of the MAP at all pacing frequencies (2.0-4.5 Hz). In 15 anesthetized dogs studied 1-4 days after two-stage ligation of the left anterior descending coronary artery (LAD), the antiarrhythmic/proarrhythmic potential of GLG-V-13 was compared with that of lidocaine. ECG, His bundle, LV (IZepi), and composite and normal zone composite electrograms were recorded. Programmed electrical stimulation (PES) and burst pacing (4.0-7.0 Hz) were delivered to the right ventricular outflow tract. In the drug-free state, sustained monomorphic ventricular tachycardia (SMVT) was inducible in 6 dogs (6 of 15). After lidocaine, SMVT was induced in 7 other dogs (13 of 15). GLG-V-13 prevented induction of SMVT in 5 of 6 dogs; a proarrhythmic action was noted in 1 dog only. GLG-V-13 slowed the heart rate (HR), increased the AH and the HV intervals, prolonged the paced (2.5 Hz) QT interval, and increased the ventricular effective refractory period (VERP). These effects were associated with 2:1 block of late potentials in the IZepi electrograms, a phenomenon also observed during rapid atrial pacing (2.5-3.5 Hz), suggestive of a marked prolongation of refractoriness in the ischemically damaged myocardium. In light of the recent Cardiac Arrhythmia Suppression Trial (CAST) study, the antiarrhythmic efficacy, together with the low proarrhythmic potential and lack of cardiodepressant properties of GLG-V-13, may merit further investigation of this novel class III antiarrhythmic agent.
Animals↗