Postprandial insulin lispro. A new therapeutic option for type 1 diabetic patients.

OBJECTIVE: For intensified insulin therapy of type 1 diabetes, bolus injection of regular human insulin 30-15 min before a meal is currently recommended. This randomized study is aimed to determine whether insulin lispro (LIS), a new insulin analog with a rapid onset of action, can provide comparable blood glucose (BG) control by injection after the meal. RESEARCH DESIGN AND METHODS: Eighteen type 1 diabetic subjects injected regular insulin (REG) at 40, 20, or 0 min before or LIS at 20 or 0 min before or 15 min after the start of a standardized test meal. BG excursions and area under the curve of BG excursions (AUC) at the six visits were compared by analysis of variance. Hypoglycemic events (BG < or = 2.78 mmol/l) were evaluated in relation to the achieved postprandial BG control. RESULTS: Mean AUC values were 2.00, 2.55, and 3.33 mmol.h.l-1 for REG given 40, 20, and 0 min before the test meal, respectively, and -2.19, -2.15, and 1.98 mmol.h.l-1 for LIS given 20 and 0 min before and 15 min after the start of the test meal, respectively. LIS injected 20 min (-20) or immediately (0) before the meal was significantly more effective in controlling postprandial BG excursion (P < 0.001) than any REG treatment. Postprandial injection of LIS (15) did not compromise postprandial BG control and resulted in less hypoglycemia. REG -40 and LIS -20 were associated with early hypoglycemia, but other hypoglycemic events were equally distributed among groups. CONCLUSIONS: The optimal time for bolus insulin injection was 20 min before the meal for REG and immediately before the meal for LIS. LIS injected immediately after a standard meal provided postprandial BG control at least as good as REG injected from 40 to 0 min before the meal. Postprandial injection of LIS is an attractive new therapeutic option.

Differential actions of growth hormone and insulin-like growth factor-I on tissue protein metabolism in dwarf mice.

The actions and interactions of exogenous insulin-like growth factor-I (IGF-I) and bovine GH (bGH) on protein metabolism were investigated in vivo using Snell dwarf mice. Mice were administered a daily dose of 1.5 or 20 micrograms bGH in the presence or absence of 20 micrograms IGF-I. IGF-I and GH stimulated significant increases in whole body weight gain. Serum IGF-I concentrations increased dramatically in mice administered IGF-I, but more modestly in GH-treated mice. However, greater increases in tissue IGF-I content were observed for GH- than for IGF-treated mice, implying that GH exerted its anabolic actions by local IGF-I synthesis. Skeletal muscle (combined gastrocnemius plus plantaris) weight was significantly increased in GH-treated mice and tended to increase in IGF-treated mice. Muscle protein synthesis was stimulated by about 50% in mice treated with IGF-I alone and the lower dose of GH and by over 100% in the group treated with 20 micrograms/day GH compared with that in saline-treated mice; further additive increases in synthesis rates were observed for mice administered both IGF-I and GH. In all cases, this stimulation was due to both increased RNA content and efficiency of protein synthesis, expressed as grams of protein synthesized per g RNA/day. Liver weight and protein synthetic rate were increased by as much as 25% and 34%, respectively, in GH-treated mice, but IGF-I inhibited hepatic protein metabolism, tending to decrease synthesis rates and inducing a decrease in the efficiency of protein synthesis. Thus, IGF-I and GH have specific and differential effects on tissue protein metabolism in this model.

Potentiation of insulin-like growth factor-I (IGF-I) activity by an antibody: supportive evidence for enhancement of IGF-I bioavailability in vivo by IGF binding proteins.

The effects of ovine polyclonal antibodies raised against human recombinant IGF-I were investigated in GH-deficient rodents in vivo both in the presence and absence of exogenous IGF-I. Dwarf mice (negligible endogenous serum IGF-I) treated with anti-IGF-I serum which had been pre-incubated with IGF-I exhibited a significantly greater rate of daily weight gain than did mice treated with the same dose of IGF-I alone (P < 0.001) or even a 2.5-fold higher dose (P < 0.001). Similar increases in whole body weight gain were observed in dwarf rats, with a concomitant increase in dissected muscle weight. Serum IGF-I concentrations were greater in all animals treated with the complex of anti-IGF-I antibodies and IGF-I than in those administered only IGF-I. Size exclusion chromatography of dwarf rat serum indicated the presence of high mol wt material (> 160 kDa) capable of binding 125I-IGF-I in the anti-IGF-I treated rats. We suggest that this particular polyclonal antibody is behaving in a similar manner to an enhancing IGF binding protein, maintaining a reservoir of bioactive IGF-I. Since the antibody has a slightly lower affinity (2 x 10(8) liters/M) than that of the type 1 receptor, these data provide tentative indirect evidence to support the hypothesis that the recently discovered mechanisms which apparently decrease the affinities of several IGFBPs may indeed result in increased IGF-I bioavailability.

Adult growth hormone (GH)-deficient patients demonstrate heterogeneity between childhood onset and adult onset before and during human GH treatment. Adult Growth Hormone Deficiency Study Group.

The onset of adult GH deficiency may be during either adulthood (AO) or childhood (CO), but potential differences have not previously been examined. In this study the baseline and GH therapy (12.5 micrograms/kg per day) data from CO (n = 74; mean age 29 yr) and AO (n = 99; mean age 44 yr) GH-deficient adult patients have been compared. The first 6 months comprised randomized, double-blind treatment with GH or placebo, then all patients were GH-treated for a further 12 months. At baseline the height, body weight, body mass index, lean body mass, and waist/hip ratio of AO patients were significantly (P < 0.001) greater than in CO patients. Serum insulin-like growth factor-I (IGF-I) levels were below normal but were lower in CO than AO patients (P < 0.001), and the correlation with IGF binding protein-3 was stronger in CO than in AO patients. Osteocalcin concentration in CO patients was above the normal range and significantly greater than in AO patients. Both groups had significant psychosocial distress, but the deviation from normality was greater in AO patients. Throughout GH therapy there was a significant increase in lean body mass and significant decrease in percent body fat and sum of skinfolds in each group. Wais/hip ratio was decreased by long-term therapy in AO but not CO patients. Total and low density lipoprotein cholesterol levels were decreased from baseline at 6 months in AO but not CO patients and high density lipoprotein cholesterol was increased in both groups throughout therapy. IGF-I and IGF binding protein-3 were increased into the normal range by GH therapy in both groups. Mean osteocalcin level in AO patients was increased at 6 months with no further change with GH therapy, whereas in CO patients there was a steep increase up to 12 months but then a sharp decrease. Nottingham Health Profile scores showed significant improvements in physical mobility and energy at 18 months of therapy in AO patients but no consistent effects in CO patients. GH-induced side effects were mainly reported by AO patients; very few CO patients reported treatment-emergent adverse events. These results demonstrate significant differences in clinical and biochemical presentation and responses to therapy of the adult GH deficiency syndrome. This is consistent with the existence of two entities, developmental (CO) and metabolic (AO), and the different functions of GH at different periods of life.

The anabolic actions of growth hormone and thyroxine on protein metabolism in Snell dwarf and normal mice.

The individual effects of GH and thyroxine (T4) on protein metabolism were determined in dwarf and normal mice in vivo. The hormone deficiencies of dwarf mice (low serum concentrations of GH and T4) resulted in decreased protein synthesis rates in skeletal muscle and liver, but no difference in synthesis rates in heart. The efficiency of synthesis (g protein/g RNA per day; KRNA) was lower in all three tissues in dwarf compared with normal mice, but effects on RNA concentration were not consistent; there was no change in muscle, a decrease in liver and an increase in heart. Treatment of dwarf mice for 9 days with either human GH or T4 caused increases in body weight and length. Protein synthesis rates were increased in muscle, liver and heart by either hormone, though much more so with T4 than GH. In muscle and liver both GH and T4 treatment resulted in an increased RNA concentration, but T4 treatment also increased KRNA. In heart, both GH and T4 increased KRNA with no change in RNA concentration. GH caused no significant changes in protein degradation rates so that growth rates were increased. T4 increased degradation rates so that there was no increased net growth in muscle or liver; in heart, T4 did induce increased growth despite the large increase in degradation rate. Tibial length was increased by both hormones; GH treatment of dwarf mice also increased cartilage sulphate incorporation on day 9, but T4 treatment did not, suggesting that bone growth is transient with T4 treatment. Normal mice showed no changes in growth or tissue protein metabolism in response to GH, but following T4 treatment there was increased protein turnover due to higher tissue RNA concentrations, although only heart growth was increased. Thus normal mice showed almost no net response to GH or T4, but dwarf mice showed a large response to both hormones. The response was different, however, in that GH caused concomitant increases in growth rates whereas T4 altered body tissue proportions.

Collagen and non-collagen protein turnover in skeletal muscle of growth hormone-treated lambs.

Long-term administration of GH to normal, well-fed lambs caused a significant increase in net muscle growth. This could be accounted for by increased rates of muscle protein synthesis, although red and white muscles responded differently. The increased rate of protein synthesis was due to an increased protein synthetic capacity (increased muscle RNA content) but efficiency per unit of RNA also tended to increase in red muscle. For similar increases in net growth protein turnover was increased to a much greater extent in red than in white muscle. The ratio of collagen to non-collagen protein was unaffected in both muscle types by GH treatment, even though collagen synthesis rates were significantly increased in red muscle. To date, GH is the only anabolic agent in ruminants which acts via increased rates of protein synthesis rather than by decreased rates of protein degradation.

Growth hormone control of tissue protein metabolism in dwarf mice: enhancement by a monoclonal antibody.

Monoclonal antibody (MAb) to GH has been shown to increase the anabolic response induced by the hormone in individual tissues of dwarf mice. Dwarf mice were treated with GH at a low and a high dose (2.5 and 50 mU/day respectively), with and without complexing to an MAb. Treatment was for 7 and 14 days, at which times protein synthesis rates in skeletal muscle, liver and heart were determined from incorporation of labelled phenylalanine following injection of a flooding dose. The MAb potentiated the actions of GH and produced increases in the rates of protein synthesis in each of the tissues to a significantly greater extent than did GH alone. The increase in protein synthesis rate induced by MAb appears to be mechanistically distinct from that observed by increasing the dose of GH. In skeletal muscle and liver there was a dose-response to the GH alone in terms of the RNA concentration, i.e. the capacity for protein synthesis, whereas in each tissue examined the MAb caused very little further response in the RNA concentration. The MAb-induced enhancement of protein synthesis rate was almost entirely due to an increase in the RNA activity, i.e. the efficiency of the synthesizing system. Complexing GH to a particular MAb, or to antisera of restricted epitope specificity, has previously been shown to enhance the in-vivo effects of GH on whole body protein content; the mechanism for this enhancement has not been adequately determined.(ABSTRACT TRUNCATED AT 250 WORDS)

Monoclonal antibody enhancement of the effects of human growth hormone on growth and body composition in mice.

Dwarf mice were treated for 10 days with phosphate-buffered saline (PBS), human growth hormone (hGH) or hGH with monoclonal antibody EB1 (hGH/MAB-EB1); for each treatment there were three groups which received 50, 75 or 100% of the amount of food eaten when available ad libitum. The PBS control groups lost more or gained less weight than equivalent groups receiving hGH alone, and mice given hGH/MAB-EB1 showed a greater weight gain than those in comparable groups receiving hGH alone. When weight gain or loss was expressed as g/g food eaten, groups treated with hGH gained more or lost less than the PBS groups. Similarly, weight gain/g food was significantly greater in hGH/MAB-EB1 animals than in the comparable groups given hGH alone. A similar pattern of response was observed for increases in tail length and uptake of 35SO42- into costal cartilage in vivo. For mice given hGH alone, fat content was decreased compared with that in the equivalent group given PBS, and mice treated with hGH/MAB-EB1 had less fat than the equivalent group given hGH alone. Administration of hGH alone caused a concomitant increase in protein content and body weight such that, compared with mice given PBS, there was no significant increase in protein as a proportion of body weight. However, hGH/MAB-EB1 caused an increase in whole body protein which was significantly greater than that for the equivalent group given hGH alone, when expressed as per cent body weight. Monoclonal antibody EB1 has been shown to enhance the actions of hGH on growth and body composition in Snell dwarf mice and to increase food conversion efficiency.

Effects of the anabolic steroid stanozolol on growth and protein metabolism in the rat.

The effects of the anabolic steroid stanozolol on whole body and muscle growth and protein metabolism in the rat have been examined. No responses could be found in normal well-fed male rats. Female rats responded to 1 mg/kg per day with an increased body and skeletal muscle growth rate and an increase in muscle protein synthesis. The anabolic action on muscle protein synthesis was due to increased RNA concentration with no change in the rate of protein synthesis per unit RNA (KRNA). Investigation of any anticatabolic effects of stanozolol treatment in male rats deprived of food for 24 h indicated no response of protein balance and turnover. However, rats treated with catabolic doses of corticosterone (50 mg/kg per day) did respond to stanozolol with decreased muscle growth inhibition due to better-maintained muscle protein synthesis. The latter response was due to a reversal of the corticosterone-induced reduction of KRNA, but with no effect on RNA concentration. Thus there appear to be at least two effects of stanozolol; an anabolic action evident only in female rats, involving increased muscle RNA concentrations, and an anticatabolic action involving inhibition of the corticosterone-induced fall in muscle RNA activity. In both cases, stanozolol influenced muscle protein synthesis with no evident effects on protein degradation.

Responses to protein deficiency of plasma and tissue insulin-like growth factor-I levels and proteoglycan synthesis rates in rat skeletal muscle and bone.

The relative biological importance of plasma levels of insulin-like growth factors (IGFs) is uncertain since the IGFs may act through endocrine mechanisms involving circulating IGFs secreted by the liver, or by autocrine/paracrine mechanisms with IGF production in or close to their target cells. We report here studies in rats designed to examine this problem with an investigation of the changes in plasma and tissue concentrations of IGF-I in relation to the inhibition of bone and muscle growth and proteoglycan synthesis, a putative IGF-I-sensitive process, by protein deficiency. Over a 3-week period in young well-fed growing rats, there were marked increases in plasma IGF-I, whereas in the protein-deficient animals in which growth was inhibited concentrations fell markedly. In bone, concentrations of IGF-I were initially 20% of plasma, did not increase with age and were minimally influenced by protein deficiency. In skeletal muscle, concentrations of IGF-I were initially 3% of plasma, did not increase with age, but did fall with protein deficiency. In bone, the inhibition of proteoglycan synthesis by the protein deficiency was not correlated with changes in tissue IGF-I concentrations and was poorly correlated with changes in plasma hormone concentrations, although in the latter case an exponential relationship could be fitted to the data from the initial control and subsequent protein-deficient animals. In muscle, the changes in proteoglycan synthesis were significantly linearly correlated with changes in tissue IGF-I compared with an exponential relationship with plasma concentrations from the initial control and subsequent protein-deficient animals.(ABSTRACT TRUNCATED AT 250 WORDS)

Interactions between growth hormone and nutrition in hypophysectomized rats: body composition and production of insulin-like growth factor-I.

Hypophysectomy of adult rats results in a loss of body growth which can be reversed by treatment with GH. The increased growth caused by administration of GH is accompanied by an increase in food consumption. The effects of GH and interactions with nutrition were investigated by treating hypophysectomized rats with GH and either providing unrestricted food or preventing the increased food consumption by pair-feeding with the same intake as that of the hypophysectomized animals. Over the 7-day experimental period, the GH-treated animals grew significantly when food was available ad libitum but did not gain body weight when an increase in food intake was prevented. However, there was a significant interaction between GH and nutrition on body composition; GH significantly decreased body fat and increased the protein: fat ratio only in the animals with the restricted intake. Gastrocnemius muscle weight was increased by GH regardless of food intake, but heart weight did not increase and liver weight was actually decreased by GH treatment when food intake was restricted. Serum concentrations of insulin and insulin-like growth factor-I (IGF-I) were increased by GH in the rats with food available ad libitum but not in the pair-fed rats. However, the liver concentration of IGF-I and its mRNA were increased by GH although the increase in IGF-I mRNA was modulated by the restricted food intake. The decreased weight of the liver in the pair-fed GH-treated rats, despite the increase in IGF-I mRNA, suggests that IGF-I does not influence liver growth. In the gastrocnemius muscle, however, GH increased IGF-I mRNA concentration similarly in both rats with food available ad libitum and in pair-fed rats. Decreased nutrition therefore modulated the action of GH but emphasized its nutrient partitioning effect, thus increasing the anabolic drive towards skeletal muscle growth; this appeared to be mediated by the local production of IGF-I within the muscle.

Use of human GH in elderly patients with accidental hip fracture.

OBJECTIVE: To investigate whether early intervention with recombinant human growth hormone (hGH) after hip fracture improves functional recovery and long-term outcome. SUBJECTS AND METHODS: Functional recovery after hip fracture is often incomplete. The catabolic situation that develops after the hip fracture accident, and a state of malnutrition either pre-existing or developing after surgery, are main contributing factors for the poor clinical outcome. hGH has been used to promote anabolism in a variety of clinical catabolic situations. The study design was randomized, double-blind and placebo-controlled. A total of 111 patients older than 60 years with an accidental hip fracture (mean age 78.5+/-9.1 (s.d.) years) were randomized to receive either hGH (20 microg/kg per day) or placebo for a period of 6 weeks, starting within 24 h after the hip fracture accident. Thereafter patients were followed up for an additional period of 18 weeks. Efficacy was assessed by comparing the changes in the Barthel Index score of activities of daily living and in a patient's living situation between the hGH- and the placebo-treated subjects. RESULTS: Eighty-five (78.5%) patients completed the first 8 weeks of the study and 76 (68.5%) the entire study period of 24 weeks. When split according to age, a trend was found that for patients older than 75 years the changes in Barthel Index score from baseline were less in the hGH group than in the placebo group (-18.6+/-18 vs -28.1+/-26) at 6 weeks after surgery (P<0.075). There was an overall trend to a higher rate of return to the pre-fracture independent living situation in the hGH group than in the placebo group. Analysis by age revealed a significantly higher proportion of hGH- than placebo-treated patients returning to the pre-fracture living situation for subjects older than 75 years (93.8 vs 75.0%, P=0.034). hGH treatment increased IGF-I values to levels in the range of those of normal subjects of 50-60 years of age. CONCLUSIONS: A 6 week treatment with hGH (20 microg/kg per day) of otherwise healthy patients after an accidental hip fracture may be of benefit if given to subjects older than 75 years of age. The rate of return to the pre-fracture living situation in subjects of this age treated with hGH was significantly increased when compared with the placebo-treated group. The treatment intervention was well tolerated and no safety issues were recorded.

Asymmetry of facial expression in spontaneous emotion.

The observation that emotional expressions are more intense on the left side of the face is consistent with other evidence of the importance of the right hemisphere in emotional communication. However, the question has been raised whether it is truly spontaneous emotional expressions or only posed facial displays that show a left-sided asymmetry. We surreptitiously examined facial asymmetry during spontaneous emotional expressions as subjects remembered happy or sad experiences. These were contrasted with the subjects' posed expressions of happy or sad emotions. Both of these procedures resulted in more intense expressions on the left side of the face. The left-sided advantage was stronger during the spontaneous than the posed displays, and was observed for both happy and sad emotions.

Coefficient of beta-cell failure in patients with type 2 diabetes treated with pioglitazone or acarbose.

AIM: A new method of assessing the coefficient of failure of pancreatic beta-cells from any index of glycaemia has been proposed. This method of analysis has been used to assess data on HbA1c and fasting glucose concentrations from a randomised study comparing pioglitazone with acarbose. METHODS: Patients were treated for 26 weeks with either pioglitazone 45 mg once daily or acarbose 300 mg/day as 3 equal doses. Plasma HbA1c concentration was measured every two months and fasting glucose was measured monthly. The coefficient of failure was determined for each patient from the slope of the least squares regression line over time. RESULTS: The coefficient of failure from HbA1c was - 2.65 +/- 2.13 %/year with pioglitazone and - 1.25 +/- 3.11 %/year with acarbose, indicating improved beta-cell function in each case. The coefficient of failure was improved to a significantly greater extent with pioglitazone ( P < 0.001). Coefficient of failure from fasting blood glucose also showed a greater improvement with pioglitazone (- 53.1 +/- 95.0 mg/dl/year) than with acarbose (- 29.9 +/- 142.5 mg/dl/year; p = 0.049). CONCLUSION: The coefficient of failure showed a significantly greater improvement of beta-cell function with pioglitazone than with acarbose during 26 weeks of treatment.

Characteristics of skeletal muscle growth and protein turnover in a fast-growing rat strain.

1. Protein turnover and muscle composition has been studied in rat skeletal muscle throughout development in a relatively-fast-growing rat strain. 2. Muscle growth involved an increase in the total DNA and in the DNA-unit size as indicated by proteins: DNA. As a result of the latter increase together with no change in RNA: DNA, the RNA concentration fell throughout development. 3. Rates of protein synthesis measured in vivo by the continuous intravenous infusion method fell throughout development from 15.6%/d at 25 d to 4.46%/d at 320 d, and these changes reflected mainly the fall in RNA concentration, since there was no marked change in the rate of protein synthesis per unit RNA. 4. The rate of protein degradation, measured as the difference between rates of protein synthesis and growth, fell from 9.82%/d at 25 d to 4.46%/d at 320 d. 5. When these changes in protein turnover throughout development are compared with measurements made previously in a slow-growing strain it would appear that the faster growth was achieved as a result of increased efficiency of protein synthesis (defined as net synthesis: over-all synthesis) and this occurred mainly because of lower rates of protein degradation.

Protein degradation in skeletal muscle: implications of a first order reaction for the degradative process.

The rate of protein degradation is usually thought to be first order, i.e. determined by the nature of the protein as a substrate. It is not immediately apparent if this is the case for the overall process in the cell since rates of turnover of individual proteins may vary between tissues. In muscle the characteristics of protein turnover in relation to DNA-unit size have led to the development of a model for protein turnover in which degradation rates are determined by the rate of dissociation of protein subunits from the myofibrillar matrix. This is a necessary step if heterogeneous turnover occurs and if degradation and resynthesis of myofibrillar proteins occurs peripherally to the myofibril. As a result a first order rate can be envisaged so that during muscle growth the protein mass per unit DNA increases to a characteristic amount thus determining the specific activity of the degrading system. Such a mechanism may apply to all cells.

Interactions between growth hormone and nutrition in hypophysectomised rats: skeletal muscle myosin heavy chain mRNA levels.

The aim of this study was to examine the role of growth hormone (GH) in regulating muscle phenotype and to determine how this is modulated by altered nutrition. Total RNA was extracted from gastrocnemius muscles of hypophysectomised rats treated with saline, GH or GH but fed a restricted intake. Type 1, 2A, 2B, embryonic and neonatal myosin heavy chain mRNA levels were estimated by slot blot hybridization. Hypophysectomy reduced the concentrations of types 1, 2A and embryonic mRNAs and dramatically elevated types 2B and neonatal compared to control levels, but this was time-dependent. All MHC mRNA levels were partially restored to control levels in the GH-treated rats except for type 1; the level of this transcript was only elevated by GH in the restricted intake group. Restricted food intake modulated the effects of GH administration for all other MHC mRNA concentrations.

Action and interaction of growth hormone and the beta-agonist, clenbuterol, on growth, body composition and protein turnover in dwarf mice.

The responses of dwarf mice to dietary administration of clenbuterol (3 mg/kg diet), daily injections of growth hormone (15 micrograms/mouse per d) or both treatments combined were investigated and their actions, and any interactions, on whole-body growth, composition and protein metabolism, and muscle, liver and heart growth and protein metabolism, were studied at days 0, 4 and 8 of treatment. Growth hormone, with or without clenbuterol, induced an increase in body-weight growth and tail length growth; clenbuterol alone did not affect body-weight or tail length. Both growth hormone and clenbuterol reduced the percentage of whole-body fat and increased the protein:fat ratio. They also increased protein synthesis rates of whole body and muscle, although the magnitude of the increase was greater in response to growth hormone than to clenbuterol. Clenbuterol specifically induced growth of muscle, with a decrease in liver protein content, whereas growth hormone exhibited more general anabolic effects on tissue protein. Previous reports have suggested that effects of clenbuterol on skeletal muscle are mediated, at least in part, via decreased rates of protein degradation; we could find little evidence of any decrease in whole-body or tissue protein degradation and anabolic effects were largely due to increases in protein synthesis rates. However, small increases in muscle protein degradation rate were observed in response to growth hormone. Growth hormone induced a progressive increase in serum insulin-like growth factor-1 concentration, whereas there was no change with clenbuterol administration. Anabolic effects on whole-body and skeletal muscle protein metabolism, therefore, appear to be initially via independent mechanisms but are finally mediated by a common response (increased protein synthesis) in dwarf mice.