William H. Daughaday and the foundations of modern research into growth hormone and the insulin-like growth factors.

This vignette summarizes some of the scientific accomplishments of Dr. William H. Daughaday, a founder of modern research into the biological effects of growth hormone and the insulin-like growth factors, and formulator of the somatomedin hypothesis of GH actions on growth.

Historical perspectives of prolactin and growth hormone as mammogens, lactogens and galactagogues--agog for the future!

Around 80 years ago researchers first established that the pituitary gland regulates mammary gland function as demonstrated by the ability of its extracts to promote both mammogenesis and lactogenesis in animal models. Little did they realize that in fact two hormones, prolactin (PRL) and growth hormone (GH), were contributing to these effects. By the mid 1930s PRL had been purified as a distinct lactogen, while the galactopoietic effect of GH was confirmed after its purification in the 1940s. Interest in these hormones initially centered about their potential for increasing milk production, while in the latter half of the twentieth century it became obvious that these hormones also had the potential to influence mammary cancer development. During the past 50 years large strides have been made into understanding how these hormones signal to, and within, cells of the mammary gland, paralleling rapid developments in the fields of cellular and molecular biology. In compiling this review we have summarized the progress that has been made to date regarding roles for these hormones in the mammary gland, with a goal of ensuring that some of the seminal literature is not diluted or forgotten. In doing so it is clear that there are lessons to be learned from past experiences, where new methods and technologies will continue to present exciting new opportunities to revisit lingering questions regarding these fascinating hormones and this fascinating organ.

A century of GH research revisited: from linear models to network complexity.

The history of GH started with the pioneer clinical and anatomical observations of Pierre Marie, who described the symptoms of acromegaly in 1886. Progressively, histochemical and histophysiological methods made it possible to characterize most cell types responsible for normal or pathological pituitary hormone secretion. Although the methods applied were indirect, and hormonal function assigned to each cell type could only be inferred from correlations, the quality of the corresponding studies was such that most of their results proved correct. In the second half of the XXth century, biochemical methods and bioassays led, between 1943 and 1956, to the production from pituitary extracts of highly purified fractions containing somatotropin activity. The subsequent demonstration that hypothalamo-hypophyseal interactions are of a neurohumoral nature permitted isolation of neuropeptides, a new class of neurotransmitters, many of which turned into major therapeutic agents. Subsequent purification of hundreds of neuropeptides, many with hypophysiotropic activity, and mapping of neurons producing them permitted to shift from relatively simple theories, postulating that stimulatory and inhibitory peptides are sufficient to account for the physiological control of pituitary secretion to more complex models. These permitted to understand how complex neuronal networks can produce a fine tuning of multiple combinations of neuropeptides and neurotransmitters, which interact with each other to adapt hormonal secretion to discrete physiological and pathological conditions.

Somatotropic function: the somatomedin hypothesis revisited.

The discovery in 1922 that an alkaline extract of the anterior pituitary can increase growth and change carcass composition of rats led to the discovery of growth hormone (somatotropin, ST). Since the early studies, much has been learned about the biological effects of ST. The advent of recombinant DNA technology has led to the commercial development of ST-based products for animal agriculture. Administration of porcine ST (pST) at maximally effective doses (approximately 100 microg x kg BW(-1) x d(-1)) to growing pigs for 30 to 77 d increases average daily gain approximately 10 to 20%, improves productive efficiency (i.e., the ratio of body weight gain to feed consumed) 13 to 33%, decreases lipid accretion rates by as much as approximately 80%, and stimulates protein deposition (muscle growth) by as much as 70%. These responses are associated with a decrease in feed intake of approximately 10 to 15%. The effects of ST are mediated directly and indirectly. The indirect effects of ST are mediated by the somatomedin (insulin-like growth factor-I). The discovery of somatomedin led to the introduction of the somatomedin hypothesis, which explained the basis of ST action. Since the discovery of the somatomedins, there have been several modifications of the hypothesis developed to accommodate the evolution in understanding of how ST and IGF-I affect a diverse array of biological events. This review will summarize the history of ST and the evolution of the somatomedin hypothesis.

Laron syndrome (primary growth hormone resistance or insensitivity): the personal experience 1958-2003.

Clinical and laboratory investigations starting in 1958 of a group of dwarfed children resembling isolated GH deficiency but who had very high serum levels of GH led to the description of the syndrome of primary GH resistance or insensitivity (Laron syndrome) and subsequently to the discovery of its molecular defects residing in the GH receptor and leading to an inability of IGF-I generation. With the biosynthesis of IGF-I in 1986, therapeutic trials started. Continuously more and more patients are being diagnosed in many parts of the world with a variety of molecular defects. This syndrome proved to be a unique model that enables the study of the consequences of GH receptor defects, the physiopathology of GH-IGF-I disruption, and comparison of the GH-independent IGF-I effects. This review presents the personal experience gained from the study follow-up and treatment of the 60 patients followed up for many years in the Israeli cohort.

A history of growth hormone injection devices.

In the early 1960s, growth hormone (GH) deficiency was treated by intramuscular injection of GH extracted from human pituitary glands. Since then, there have been many advances in treatment encompassing the route of administration, the injection product and the injection device. This review considers the advances in injection device that have already taken place and how they have benefited the patient, particularly in terms of reduced pain and improved convenience. In the future, needle-free injection techniques and depot formulations of GH are likely to offer alternatives to daily subcutaneous injections.

Hormones, mammary growth, and lactation: a 41-year perspective.

When I was a beginning graduate student 41 yr ago it had been established that estrogen caused mammary duct growth; a combination of estrogen and progesterone was required for lobule-alveolar development of the mammary glands; and prolactin and growth hormone were essential for mammary growth. In laboratory species exogenous prolactin, glucocorticoids, and estrogen would initiate secretion of milk provided the mammary glands had a well-developed lobule-alveolar system. It was not known with certainty that progesterone inhibited the process. For some species, prolactin and thyroxine had been shown to stimulate lactation, while glucocorticoids suppressed lactation. Definitive roles for growth hormone and insulin during lactation had not been established. Studies of hormonal control of mammary growth and function in cattle were few. In vitro methods to study hormonal regulation of the mammary glands were in their infancy. Quantitative measures of changes in mammary cell numbers and specific components of milk in response to hormones were rare. The concepts for quantification of hormone concentrations, hormone receptors, growth factors, and binding proteins in blood; hormonal regulation of nutrient partitioning; and hormonally induced mechanisms of action within mammary cells were waiting to be discovered. And eventually they were. However, lest we become too enamored with our current understanding of the hormones that control mammary growth and lactation, it remains a fact that the greatest physiological stimulus for milk yield is pregnancy, not some cocktail of exogenous hormones, growth factors, receptor agonists/antagonists, or gene therapies. Viva la mom!

The growth hormone cascade: progress and long-term results of growth hormone treatment in growth hormone deficiency.

The growth hormone (GH) cascade and the remarkable advances over the past four decades in our knowledge of its components are considered. It is now over 40 years since human pituitary GH (pit-hGH) was purified and the first GH-deficient patient, a 17-year-old male, was successfully treated with pit-hGH. However, the shortage of pit-hGH limited its use and the dose, the biopotency of preparations varied, strict criteria of GH deficiency (GHD) were used for patient selection including peak plasma immunoreactive GH levels after provocative stimuli of <3.5-5 ng/ml, treatment was not infrequently interrupted, the mean age for initiating treatment was often late in childhood (12-13 years) and the growth deficiency severe (height -4 to -6 SDS), and finally pit-hGH therapy was often discontinued when girls attained a height of 5' and boys 5'5". Nonetheless, the effects of pit-hGH were dramatic; the final height SDS increased in isolated GHD to about -2 SDS in boys and -2.5 to -3.0 SDS in girls, and in multiple pituitary hormone deficiencies to between -1 and -2 SDS. Between 1962 and 1985 when the Creutzfeldt-Jakob disease crisis struck, the number of GH-deficient patients treated with pit-hGH increased from about 150 to over 3,000. The advent of biosynthetic GH (rhGH) and its availability to treat large numbers of idiopathic GH-deficient children (the minimum prevalence rate of which in the USA and UK is between 1 in 3,400 and 4,000) dramatically changed this picture in 1985. It is estimated that more than 60,000 patients have been or are now on treatment. With rhGH treatment the attained mean adult height SDS is now about -1.0, and in our experience with the treatment of patients under 4 years of age, final height may exceed the target height. It is now recognized that (a) the replacement dose of rhGH ranges from 0.175 to 0.35 mg/kg/week and should be individualized; (b) dividing this dose into 6 or 7 daily subcutaneous injections is more effective than giving the same total dose in three weekly portions, and (c) final height correlates significantly with pretreatment chronologic age, height SDS and predicted adult height, duration of therapy, birth length, in some studies height SDS and age at start of puberty, weight, and serum GHBP (an indicator of GH receptor mass). Early recognition of GHD is essential for an optimal height outcome. rhGH treatment should not be delayed in children with documented GHD; the greater the height deficit, the lower the probability that target height will be reached. GHD needs to be detected earlier in children with organic hypopituitarism whether due to a developmental defect, neoplasm, radiation, head trauma, or a CNS infection. Early rhGH therapy in neonatal hypopituitarism has resulted in excellent growth responses. As the height prognosis in isolated GHD is not as good (especially in girls) as in GHD associated with gonadotropin deficiency, the use of LHRH agonists to delay puberty or potent aromatase inhibitors to delay skeletal maturation should be considered in selected patients with isolated GHD. When the growth response to rhGH is less than predicted, one must consider: (a) poor compliance; (b) improper preparation of rhGH for administration or faulty injection techniques; (c) the timing of administration; (d) the dose of glucocorticoid in the ACTH-deficient patient; (e) occult hypothyroidism; (f) inadequate nutrition; (g) a chronic illness; (h) neutralizing antibodies to rhGH, and (i) the wrong diagnosis. The major cause of mortality (unrelated to Creutzfeldt-Jakob disease or a CNS neoplasm) is adrenal crisis and hypoglycemia in children with both GH and ACTH deficiency. Major adverse effects of rhGH treatment in children are uncommon and include idiopathic intracranial hypertension, slipped capital femoral epiphysis, and acute pancreatitis. The rhGH is not an added risk for leukemia in the US and Europe in the absence of coexisting risk factors, nor is there a higher risk of recurrence of b

A history of growth hormone.

After the debacle of Brown-Séquard testicular extracts, hormone replacement therapy proper began in 1891 with the use of sheep thyroid extract to treat myxoedema. The second success in the field was "bovine' insulin to treat human diabetes in 1992. In contrast, the first successful use of growth hormone in a human pituitary dwarf did not come until 1958. Growth hormone preparations of reasonable purity had been made in the 1920s and were shown to be effective in rats and dogs, but the need for primate growth hormone in primates was not recognised until the late 1940s.

A question of rhythm: recent advances in growth hormone research.

Research by Dr. Gloria Shaffer Tannenbaum at the McGill University-Montreal Children's Hospital Research Institute has led to the development of a new test to differentiate children who are deficient in growth hormone from those who are short but growing normally. This clinical application is the fruit of Tannenbaum's discovery that growth hormone secretion occurs in a rhythmic pattern regulated by intricate interactions between two neurohormones: growth hormone-releasing hormone (GHRH) and somatotropin release-inhibiting factor (SRIF). In the test an analogue of SRIF is used to allow stores of growth hormone to build up. A subsequent challenge with GHRH is then used to identify children with a genuine deficiency. Tannenbaum's research also indicates that there are sexual differences in the pattern of growth hormone release and that growth hormone regulates its own secretion by means of a negative feedback system.

[Historical perspective on growth hormone treatment in children]. / Groeihormoonbehandeling bij kinderen in historisch perspectief.

The history of growth hormone treatment can be divided into two episodes. Between 1958 and 1985 growth hormone was extracted from human pituitaries. Because of the scarcity little scientific research was carried out and efficacy was not optimal. In 1985 biosynthetic growth hormone became available, which facilitated research on the use of growth hormone for various indications. In the future further research is needed on the pathophysiology of growth disturbances, on methods to improve efficacy, and on possible side-effects of pharmacological dosages.

Nutrition science from vitamins to molecular biology.

Nutrition is a science of great importance. Indeed, unless one studies it, one might be afraid to eat anything, in view of all the scare stories about food. Today is the age of molecular biology and above all of DNA. The human genome project will bring new understanding of genetic diseases, and many of these will be "inborn errors of metabolism," in which nutrition has an important role. The challenge of nutrition is to help provide a healthy diet for all the world.