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Ammer LS, Pohl S, Breyer SR, Aries C, Denecke J, Perez A, Petzoldt M, Schrum J, Müller I, Muschol NM. Is hematopoietic stem cell transplantation a therapeutic option for mucolipidosis type II? Mol Genet Metab Rep 2021; 26:100704. [PMID: 33505859 PMCID: PMC7815485 DOI: 10.1016/j.ymgmr.2020.100704] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 12/30/2020] [Accepted: 12/30/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Mucolipidosis type II (MLII) is an ultra-rare lysosomal storage disorder caused by defective lysosomal enzyme trafficking. Clinical hallmarks are craniofacial dysmorphia, cardiorespiratory dysfunction, hepatosplenomegaly, skeletal deformities and neurocognitive retardation. Death usually occurs in the first decade of life and no cure exists. Hematopoietic stem cell transplantation (HSCT) has been performed in few MLII patients, but comprehensive follow-up data are extremely scarce. METHODS MLII diagnosis was confirmed in a female three-month-old patient with the mutations c.2213C > A and c.2220_2221dup in the GNPTAB gene. At nine months of age, the patient received HSCT from a 9/10 human leukocyte antigen (HLA)-matched unrelated donor. RESULTS HSCT resulted in a sustained reduction of lysosomal storage und bone metabolism markers. At six years of age, the patient showed normal cardiac function, partial respiratory insufficiency and moderate hepatomegaly, whereas skeletal manifestations had progressed. However, the patient could walk and maintained an overall good quality of life. Neurocognitive testing revealed a developmental quotient of 36%. The patient died at 6.6 years of age following a human metapneumovirus (hMPV) pneumonia. CONCLUSIONS The exact benefit remains unclear as current literature vastly lacks comparable data on MLII natural history patients. In order to evaluate experimental therapies, in-depth prospective studies and registries of untreated MLII patients are indispensable.
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Affiliation(s)
- Luise Sophie Ammer
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- International Center for Lysosomal Disorders (ICLD), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sandra Pohl
- International Center for Lysosomal Disorders (ICLD), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sandra Rafaela Breyer
- International Center for Lysosomal Disorders (ICLD), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Pediatric Orthopedics, Children's Hospital Altona, Hamburg, Germany
- Department of Orthopedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Charlotte Aries
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- International Center for Lysosomal Disorders (ICLD), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jonas Denecke
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anna Perez
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- International Center for Lysosomal Disorders (ICLD), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Petzoldt
- Department of Anesthesiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Johanna Schrum
- Division of Pediatric Stem Cell Transplantation and Immunology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ingo Müller
- Division of Pediatric Stem Cell Transplantation and Immunology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nicole Maria Muschol
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- International Center for Lysosomal Disorders (ICLD), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Serum Pyridinoline is Associated With Radiographic Joint Erosions in Rheumatoid Arthritis. Arch Rheumatol 2020; 34:387-394. [PMID: 32010887 DOI: 10.5606/archrheumatol.2019.7243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 02/07/2019] [Indexed: 11/21/2022] Open
Abstract
Objectives This study aims to compare the serum pyridinoline (Pyd) levels between rheumatoid arthritis (RA) patients and healthy controls and to determine the correlation of serum Pyd levels with radiographic joint erosions. Patients and methods Serum samples were obtained from 48 patients with RA (9 males, 39 females; mean age 60.5 years; range 54 to 64 years) and 48 healthy controls (9 males, 39 females; mean age 57.5 years; range, 47 to 65 years). The enzyme-linked immunosorbent assay method was used for quantitative analysis of serum Pyd. Besides, all RA patients were assessed for joint damage based on modified Sharp score, disease activity based on disease activity score in 28 joints and functional capacity based on health assessment questionnaire-disability index. Results The median serum Pyd levels were significantly higher among the RA patients (110.20 ng/mL [92.30-120.64]) compared to the controls (98.22 ng/mL [85.54-111.41]); p<0.05. RA patients with erosive disease had significantly higher serum Pyd levels (p=0.024). There was a significant positive correlation between serum Pyd levels and joint erosion score (r=0.285, p=0.049). The serum Pyd levels had no demonstrable association with disease activity or functional capacity. Steroid therapy did not appear to influence the levels of serum Pyd. Conclusion Rheumatoid arthritis patients had significantly higher levels of serum Pyd compared to healthy controls. The serum Pyd levels had significant correlation with radiographic joint erosions which reflected disease damage.
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Sørensen KU, Kruger MC, Hansen-Møller J, Poulsen HD. Bone biochemical markers for assessment of bone responses to differentiated phosphorus supply in growing-finishing pigs. J Anim Sci 2019; 96:4693-4703. [PMID: 30085053 DOI: 10.1093/jas/sky311] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 07/30/2018] [Indexed: 12/11/2022] Open
Abstract
Phosphorus (P) is essential for building and maintaining a healthy and strong skeleton. Moreover, dietary P supply may play a role for bone turnover, and the excretion of bone turnover metabolites may be useful as markers for sufficient dietary P supply. The objective was to study the long-term effects of low, medium, and high dietary P supply on bone metabolism in terms of serum concentration and urinary excretion of bone turnover components and metabolites in healthy growing-finishing pigs compared with bone mineral content (BMC) and bone mineral density (BMD) of humerus and femur. Pigs were fed diets containing low [LP; 4.1 g/kg dry matter (DM)], medium (MP; 6.2 g/kg DM), or high dietary P (HP; 8.9 g/kg DM) from 39.7 kg body weight (BW) until slaughter at 110 kg BW. Urine and blood were collected at 40, 70, and 110 kg BW while bones were collected at slaughter. Serum was analyzed for osteocalcin (OC), bone alkaline phosphatase (BAP), and C-terminal telopeptides of type I collagen (CTX-I), whereas urine was analyzed for pyridinoline (PYD), deoxypyridinoline (DPD), CTX-I, hydroxylysine (HYL), galactosyl-hydroxylysine (GAL-HYL), glycosyl-galactosyl-hydroxylysine (GLC-GAL-HYL), and hydroxyproline (HYP). Humerus and femur were analyzed for BMC and BMD. The LP diet caused reduced OC and increased BAP and CTX-I concentrations in serum. Furthermore, BAP was increased in response to the HP diet. Urine metabolites of bone resorption were all increased in pigs fed the LP diet, but only a few responses were obtained in response to the HP diet. Furthermore, age-related decreases were identified for BAP, HYL, GAL-HYL, and GLC-GAL-HYL. Bone mineral content and BMD were markedly lowered in pigs fed the LP diet but were not affected in pigs fed the HP diet. In conclusion, OC, BAP, and CTX-I in serum have proved useful for P adequacy in growing-finishing pigs. In addition, urine bone resorption metabolites have also proved useful for P adequacy and analysis of PYD, DPD, and CTX-I was considered to be the most relevant markers due to their specificity for bone and their negative correlation with BMD, BMC, ash, calcium (Ca), and P contents. Finally, DPD may be the preferred marker in long-term P feeding assessments.
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Affiliation(s)
| | - Marlena C Kruger
- School of Health Sciences, Massey University, Palmerston North, New Zealand
| | | | - Hanne D Poulsen
- Department of Animal Science, Aarhus University, Tjele, Denmark
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The effects of short-term use of granulocyte colony-stimulating factor on bone metabolism in child cancer patients. North Clin Istanb 2018; 5:277-281. [PMID: 30859156 PMCID: PMC6371986 DOI: 10.14744/nci.2017.59320] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 12/08/2017] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVE: The granulocyte colony-stimulating factor (G-CSF) is the most commonly used hematopoietic growth factor recombinant DNA technology. It affects bone metabolism by modulating both osteoclast and osteoblast functions. The aim of the present study was to investigate the effects of short-term use of G-CSF on bone metabolism in children with leukemia and solid tumors. METHODS: Thirty-six patients with a malignancy who received G-CSF therapy according to chemotherapy protocols and another 20 growth factor-free cancer patients who were enrolled as controls were included in the study. The serum osteocalcin and urinary free deoxypyridinoline levels were measured before the start of G-CSF therapy, on day 3 after treatment, and 7 days after G-CSF therapy was discontinued. In the control group, the measurements were made during corticosteroid and methotrexate-free chemotherapy. RESULTS: The mean osteocalcin level (8.6±2.3 ng/mL) from before the onset of treatment decreased significantly (7.7±2.3 ng/mL) on day 3 of G-CSF therapy and significantly increased after 7 days of G-CSF therapy (7.9±2.2 ng/mL) (p<0.001 and p<0.001, respectively), which was still significantly lower than the pre-G-CSF values (p<0.001). The urinary free deoxypyridinoline level significantly increased on day 3 of G-CSF treatment (25.6±6.5 nmol/mmol Cr) and significantly decreased after 7 days of G-CSF therapy (22.6±6.4 nmol/mmol Cr) (p<0.001 and p<0.001, respectively), which was still significantly higher than the values recorded before G-CSF therapy (p<0.001). CONCLUSION: The findings show that the short-term use of G-CSF in children with cancer can affect bone metabolism and can play a role in metabolic changes. Decreased osteoblastic activity and increased osteoclastic activity suggest that osteoporosis may be associated with bone pain in these patients.
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Kuehn SC, Koehne T, Cornils K, Markmann S, Riedel C, Pestka JM, Schweizer M, Baldauf C, Yorgan TA, Krause M, Keller J, Neven M, Breyer S, Stuecker R, Muschol N, Busse B, Braulke T, Fehse B, Amling M, Schinke T. Impaired bone remodeling and its correction by combination therapy in a mouse model of mucopolysaccharidosis-I. Hum Mol Genet 2015; 24:7075-86. [PMID: 26427607 DOI: 10.1093/hmg/ddv407] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 09/22/2015] [Indexed: 01/21/2023] Open
Abstract
Mucopolysaccharidosis-I (MPS-I) is a lysosomal storage disease (LSD) caused by inactivating mutations of IDUA, encoding the glycosaminoglycan-degrading enzyme α-l-iduronidase. Although MPS-I is associated with skeletal abnormalities, the impact of IDUA deficiency on bone remodeling is poorly defined. Here we report that Idua-deficient mice progressively develop a high bone mass phenotype with pathological lysosomal storage in cells of the osteoblast lineage. Histomorphometric quantification identified shortening of bone-forming units and reduced osteoclast numbers per bone surface. This phenotype was not transferable into wild-type mice by bone marrow transplantation (BMT). In contrast, the high bone mass phenotype of Idua-deficient mice was prevented by BMT from wild-type donors. At the cellular level, BMT did not only normalize defects of Idua-deficient osteoblasts and osteocytes but additionally caused increased osteoclastogenesis. Based on clinical observations in an individual with MPS-I, previously subjected to BMT and enzyme replacement therapy (ERT), we treated Idua-deficient mice accordingly and found that combining both treatments normalized all histomorphometric parameters of bone remodeling. Our results demonstrate that BMT and ERT profoundly affect skeletal remodeling of Idua-deficient mice, thereby suggesting that individuals with MPS-I should be monitored for their bone remodeling status, before and after treatment, to avoid long-term skeletal complications.
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Affiliation(s)
| | - Till Koehne
- Department of Osteology and Biomechanics, Department of Orthodontics
| | - Kerstin Cornils
- Department of Stem Cell Transplantation, Research Department Cell and Gene Therapy
| | | | | | | | - Michaela Schweizer
- Center of Molecular Neurobiology, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany and
| | | | | | | | | | - Mona Neven
- Department of Osteology and Biomechanics
| | - Sandra Breyer
- Children's Hospital Hamburg-Altona, Department of Orthopedics, University Clinic Hamburg, Hamburg 22763, Germany
| | - Ralf Stuecker
- Children's Hospital Hamburg-Altona, Department of Orthopedics, University Clinic Hamburg, Hamburg 22763, Germany
| | | | | | | | - Boris Fehse
- Department of Stem Cell Transplantation, Research Department Cell and Gene Therapy
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Shagina NB, Tolstykh EI, Degteva MO, Anspaugh LR, Napier BA. Age and gender specific biokinetic model for strontium in humans. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2015; 35:87-127. [PMID: 25574605 DOI: 10.1088/0952-4746/35/1/87] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
A biokinetic model for strontium in humans is necessary for quantification of internal doses due to strontium radioisotopes. The ICRP-recommended biokinetic model for strontium has limitations for use in a population study, because it is not gender specific and does not cover all age ranges. The extensive Techa River data set on (90)Sr in humans (tens of thousands of measurements) is a unique source of data on long-term strontium retention for men and women of all ages at intake. These, as well as published data, were used for evaluation of age- and gender-specific parameters for a new compartment biokinetic model for strontium (Sr-AGe model). The Sr-AGe model has a similar structure to the ICRP model for the alkaline earth elements. The following parameters were mainly re-evaluated: gastrointestinal absorption and parameters related to the processes of bone formation and resorption defining calcium and strontium transfers in skeletal compartments. The Sr-AGe model satisfactorily describes available data sets on strontium retention for different kinds of intake (dietary and intravenous) at different ages (0-80 years old) and demonstrates good agreement with data sets for different ethnic groups. The Sr-AGe model can be used for dose assessment in epidemiological studies of general populations exposed to ingested strontium radioisotopes.
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Affiliation(s)
- N B Shagina
- Urals Research Center for Radiation Medicine, Chelyabinsk 454076, Russia
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Kollmann K, Pestka JM, Kühn SC, Schöne E, Schweizer M, Karkmann K, Otomo T, Catala-Lehnen P, Failla AV, Marshall RP, Krause M, Santer R, Amling M, Braulke T, Schinke T. Decreased bone formation and increased osteoclastogenesis cause bone loss in mucolipidosis II. EMBO Mol Med 2013; 5:1871-86. [PMID: 24127423 PMCID: PMC3914524 DOI: 10.1002/emmm.201302979] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Revised: 09/06/2013] [Accepted: 09/09/2013] [Indexed: 01/03/2023] Open
Abstract
Mucolipidosis type II (MLII) is a severe multi-systemic genetic disorder caused by missorting of lysosomal proteins and the subsequent lysosomal storage of undegraded macromolecules. Although affected children develop disabling skeletal abnormalities, their pathogenesis is not understood. Here we report that MLII knock-in mice, recapitulating the human storage disease, are runted with accompanying growth plate widening, low trabecular bone mass and cortical porosity. Intralysosomal deficiency of numerous acid hydrolases results in accumulation of storage material in chondrocytes and osteoblasts, and impaired bone formation. In osteoclasts, no morphological or functional abnormalities are detected whereas osteoclastogenesis is dramatically increased in MLII mice. The high number of osteoclasts in MLII is associated with enhanced osteoblastic expression of the pro-osteoclastogenic cytokine interleukin-6, and pharmacological inhibition of bone resorption prevented the osteoporotic phenotype of MLII mice. Our findings show that progressive bone loss in MLII is due to the presence of dysfunctional osteoblasts combined with excessive osteoclastogenesis. They further underscore the importance of a deep skeletal phenotyping approach for other lysosomal diseases in which bone loss is a prominent feature.
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Affiliation(s)
- Katrin Kollmann
- Department of Biochemistry, Children's Hospital, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Hong H, Kim WJ, Yoo SH, Abanto OD, Kim TJ, Kim YJ, Jung BM, Yun SS, Hwang SG. Dietary ungerminated and germinated soybean supplementation improves bone mineralization and strength in growing male rats. J Med Food 2010; 13:640-9. [PMID: 20438320 DOI: 10.1089/jmf.2009.1092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
It has been thought that soybean products rich in phytoestrogenic isoflavones are effective in promoting bone metabolism in ovariectomized rats. However, it is not clear if such an effect can be changed by germination of soybean and can be observed in growing males. The present study was undertaken to determine the effects of different concentrations of dietary ungerminated and germinated soybean (UGS and GS, respectively) on bone metabolism in young male rats. Forty-nine 6-week-old male Sprague-Dawley rats were assigned to seven dietary treatment groups: AIN 93G (control); control with UGS powder at 3% (UGS-L), 15% (UGS-M), or 30% (UGS-H); and control with GS powder at 3% (GS-L), 15% (GS-M), or 30% (GS-H). The biomarkers of bone metabolism (plasma and urinary Ca and P) and the physical properties and mineral content of bones were measured. Plasma osteocalcin and urinary deoxypyridinoline levels were not affected by soybean diets. The plasma P level was significantly elevated by dietary soybeans (P < .001). However, there was a negative correlation (r = -0.555) between plasma P level and dietary UGS level (P < .01). Between the UGS and GS groups, the P level of the GS-M group was significantly higher than that of the UGS-M group (P < .001). The tibial weight was decreased with low to medium doses of soybeans, but not with higher levels. Femoral bone strength was improved in the UGS-H, GS-M, and GS-H groups. The P contents of femoral and tibial bones were increased in all UGS groups as well as in GS-M and GS-H groups. In conclusion, soybean supplementation in young growing male rats improved bone mineralization and bone strength.
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Affiliation(s)
- Heeok Hong
- Department of Food Service Management, Sangmyung University, Seoul, Republic of Korea
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Millet P, Vilaseca MA, Valls C, Pérez-Dueñas B, Artuch R, Gómez L, Lambruschini N, Campistol J. Is deoxypyridinoline a good resorption marker to detect osteopenia in phenylketonuria? Clin Biochem 2005; 38:1127-32. [PMID: 16256974 DOI: 10.1016/j.clinbiochem.2005.09.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2005] [Revised: 07/29/2005] [Accepted: 09/17/2005] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To evaluate deoxypyridinoline as a resorption marker in phenylketonuria (PKU) and to search for a relationship between deoxypyridinoline, calcium/creatinine index (Ca/Cr I), osteocalcin and bone alkaline phosphatase (BAP). METHODS This was a transversal analytical study of 46 PKU patients [17.5 (4-38) years]. Deoxypyridinoline and osteocalcin were measured with a chemiluminescent assay and BAP was measured with an immunoradiometric assay. RESULTS Deoxypyridinoline was significantly increased in patients aged 7-14 and >18 years old, being associated with age (r=-0.724, P<0.001). Adult patients showed significantly higher Ca/Cr I, which correlates with Phe values for the year prior to the study (P=0.014). Serum BAP was significantly increased in pediatric patients (9-13 years), while it was decreased in adult patients (P=0.003). Decreased osteocalcin levels were found in patients>15 years (P=0.028). Altered deoxypyridinoline and BAP values were related (P=0.042). CONCLUSION PKU patients excreted increased D-Pyr, suggesting high bone resorption. Bone formation seems active in childhood but deteriorates in adult PKU patients. Periodic measurement of D-Pyr and BAP may be useful in the prevention of osteopenia in PKU patients.
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Affiliation(s)
- Pablo Millet
- PKU-follow-up Unit: Department of Biochemistry, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
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Nagasaki K, Shimomura Y, Suyama T, Magara S, Ogawa Y, Hiura M, Kikuchi T, Uchiyama M. Two cases of pseudohypoparathyroidism type ia in duozygotic twins with different phenotypes. Clin Pediatr Endocrinol 2005; 14:39-44. [PMID: 24790309 PMCID: PMC4004832 DOI: 10.1297/cpe.14.39] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2005] [Accepted: 05/16/2005] [Indexed: 11/28/2022] Open
Abstract
Pseudohypoparathyroidism (PHP) type Ia is characterized by hypocalcemia due to
PTH resistance and by features of Albright’s hereditary osteodystrophy, including short
stature, obesity, subcutaneous calcification and brachydactyly. A wide variety of clinical
and biochemical manifestations have been reported. We report two cases of PHP type Ia in
duozygotic twins with different phenotypes. The proband was a 10-yr-old girl. She showed
subcutaneous ossification, shortening of the metacarpal bone, short stature, obesity and
round face. She had normocalcemia (8.9 mg/dl), high-normal phosphate (5.0 mg/dl) and
increased levels of serum intact PTH (152 pg/ml) and TSH (9.17 μIU/ml)
levels. Her twin younger brother had atypical Albright’s hereditary osteodystrophy with
only mild obesity and subcutaneous calcifications, but he showed a low level of serum
calcium (7.0 mg/dl) and high levels of serum phosphate (7.6 mg/dl), intact PTH (377 pg/ml)
and TSH (6.9 μIU/ml). We diagnosed them as having PHP type Ia on the
basis of clinical and biochemical findings, Ellsworth-Howard test and family history.
There is considerable variability in clinical and biochemical features of PHP type Ia even
among affected duozygotic twins. The differences of intrauterine environment and growth
history cannot account for the variable phenotypes of PHP type Ia. Even if a patient shows
no AHO features, examination of all family members should be undertaken.
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Affiliation(s)
- Keisuke Nagasaki
- Division of Pediatrics, Department of Homeostatic Regulation and Development, Niigata University Graduate School of Medicine and Dental Sciences, Niigata, Japan
| | - Yutaka Shimomura
- Department of Dermatology, Niigata University Graduate School of Medicine and Dental Sciences, Niigata, Japan
| | - Takayuki Suyama
- Department of Dermatology, Niigata University Graduate School of Medicine and Dental Sciences, Niigata, Japan
| | - Shinichi Magara
- Division of Pediatrics, Department of Homeostatic Regulation and Development, Niigata University Graduate School of Medicine and Dental Sciences, Niigata, Japan
| | - Yohei Ogawa
- Division of Pediatrics, Department of Homeostatic Regulation and Development, Niigata University Graduate School of Medicine and Dental Sciences, Niigata, Japan
| | - Makoto Hiura
- Division of Pediatrics, Department of Homeostatic Regulation and Development, Niigata University Graduate School of Medicine and Dental Sciences, Niigata, Japan
| | - Toru Kikuchi
- Division of Pediatrics, Department of Homeostatic Regulation and Development, Niigata University Graduate School of Medicine and Dental Sciences, Niigata, Japan
| | - Makoto Uchiyama
- Division of Pediatrics, Department of Homeostatic Regulation and Development, Niigata University Graduate School of Medicine and Dental Sciences, Niigata, Japan
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Rodríguez-Soriano J, Vallo A, Aguirre M. Bone mineral density and bone turnover in patients with Bartter syndrome. Pediatr Nephrol 2005; 20:1120-5. [PMID: 15942790 DOI: 10.1007/s00467-005-1901-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2004] [Revised: 02/08/2005] [Accepted: 02/08/2005] [Indexed: 11/26/2022]
Abstract
The aim of this investigation was to evaluate bone mineral density (BMD), by use of DXA, and bone turnover, in patients with Bartter syndrome (BS). Ten patients (2 with BS type II and 8 with BS type III) were included in the procedure. Age at study varied between 2 and 30 years. During the studies usual treatment with indomethacin, spironolactone, and potassium chloride was maintained. Results were compared with those obtained in the 20 asymptomatic parents. Height of the patients at the time of the study did not differ from reference values (Z-score -1.2 to +0.8). Three patients (1 with BS type II and 2 with BS type III) presented reduced lumbar spine BMD or overt osteopenia (BMD Z-scores: -2.3, -1.3, and -1.1). BMD did not correlate significantly with age. Paternal and maternal femoral neck BMD values correlated significantly with lumbar spine BMD of the patients (r=0.65, P<0.05, and r=0.80, P<0.01). Lumbar spine BMD Z-scores correlated negatively with urinary Ca excretion when values both from patients and parents were jointly analyzed (r=-0.43, P<0.05). Plasma calcium concentration was significantly higher (P<0.001) and plasma phosphate Z-score was significantly lower (P<0.05) in the patients than in the parents. However, no significant differences were observed in values for intact PTH, 1,25 (OH)(2)D(3) and 25 (OH)D(3). Intact PTH values correlated positively with BMD Z-scores at lumbar spine (r=0.45, P<0.05) and at femoral neck (r=0.63, P<0.01). Age-corrected biochemical markers of bone formation (plasma alkaline phosphatase and osteocalcin concentrations) were normal whereas age-corrected markers of bone reabsorption (urinary PYD and DPD excretion) were significantly higher than parental values (P<0.01 and <0.05, respectively). We conclude that: (1) reduced BMD is not an exclusive feature of neonatal BS and it can be also observed in classic BS; (2) the loss of bone mineral is not progressive, probably because of the hypocalciuric effect of indomethacin therapy; and (3) this study did not determine whether loss of bone mass is the cause or the consequence of hypercalciuria although the beneficial effect of indomethacin therapy implies the latter.
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Affiliation(s)
- Juan Rodríguez-Soriano
- Division of Pediatric Nephrology, Department of Pediatrics, Hospital de Cruces and Basque University School of Medicine, Bilbao, Spain.
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Aly H, Moustafa MF, Amer HA, Hassanein S, Keeves C, Patel K. Gestational age, sex and maternal parity correlate with bone turnover in premature infants. Pediatr Res 2005; 57:708-11. [PMID: 15774820 DOI: 10.1203/01.pdr.0000160591.70409.c8] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Factors affecting bone turnover in premature infants are not entirely clear but certainly are different from those influencing bones of adults and children. To identify fetal and maternal factors that might influence bone turnover, we prospectively studied 50 infants (30 preterm and 20 full-term) born at Ain Shams University Obstetric Hospital in Cairo, Egypt. Maternal parity and medical history and infant's weight, gestational age, gender and anthropometrical measurements were recorded. Cord blood samples were collected and serum type I collagen C-terminal propeptide (PICP) was assessed as a marker for fetal bone formation. First morning urine samples were collected and pyridinoline cross-links of collagen (Pyd) were measured as an index for bone resorption. Serum PICP was higher in premature infants when compared with full-term infants (73.30 +/- 15.1 versus 64.3 +/- 14.7, p = 0.022) and was higher in male premature infants when compared with females (81.64 +/- 9.06 versus 66.0 +/- 15.7, p = 0.018). In a multiple regression model using PICP as the dependent variable and controlling for different infant and maternal conditions, PICP significantly correlated with infant gender (r = 8.26 +/- 4.1, p = 0.05) maternal parity (r = -2.106 +/- 0.99, p = 0.041) and diabetes (r = 22.488 +/- 8.73, p = 0.041). Urine Pyd tended to increase in premature infants (612 +/- 308 versus 434 +/- 146, p = 0.057) and correlated significantly with gestational age (r = -63.93 +/- 19.55, p = 0.002). Therefore, bone formation (PICP) is influenced by fetal age and gender, as well as maternal parity and diabetes. Bone resorption (Pyd) is mostly dependent on gestational age only. Further in-depth studies are needed to enrich management of this vulnerable population.
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Affiliation(s)
- Hany Aly
- Neonatalogy Department, the George Washington University & the Children's National Medical Center, Washington DC 20037, USA.
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13
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D'Antiga L, Ballan D, Luisetto G, Cillo U, Guariso G, Zancan L. Long-Term Outcome of Bone Mineral Density in Children who Underwent a Successful Liver Transplantation. Transplantation 2004; 78:899-903. [PMID: 15385811 DOI: 10.1097/01.tp.0000136987.38729.c0] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND It has previously been shown that bone mineral density (BMD) during the first year after orthotopic liver transplantation (OLT) in children with osteodystrophy increases remarkably and according to height. The effect of posttransplant factors possibly influencing bone mass in the long-term after a successful OLT in children is unknown. METHODS Eighteen patients (9 male), median age 13.3 (range 4.7-23.7) years, median time after OLT 8.3 (1.1-17.3) years were enrolled. Indications for OLT were biliary atresia (8), Alagille (3), hepatoblastoma (2), NonA-NonG acute liver failure (2), intrahepatic cholestasis, cryptogenic cirrhosis, and cholesteryl-ester disease (1 each). At OLT, all were prepubertal and 12 were severely cholestatic. We recorded anthropometric data, immunosuppression, dual-energy x-ray absorptiometry (DXA), biochemical markers of bone metabolism, and liver function. RESULTS Six children were on steroid therapy, eight were on cyclosporine, nine on tacrolimus. Median L1 to L4 spinal BMD was 0.720 (range 0.524-1.127) g/cm3, Z score -0.70 (-2.2- +2.1), height Z score -0.31 (-1.83- +1.96). Median bone mineral apparent density was 0.112 (0.084-0.142) (normal value 0.10-0.14) g/cm3. Median alanine aminotransferase level was 22 (range 11-79) IU/L, urinary free deoxypyridinolines 20.6 (7.1-62) nmol/mmol creatinine, osteocalcin 14 (2.3-45) microg/L, parathyroid hormone 51 (2-87) ng/L, Vitamin D3 67 (17-102) nmol/L. CONCLUSION BMD after the first year from a successful pediatric liver transplantation is normal. Our study suggests that normal bone density in this setting is maintained for at least 1 decade.
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Penido MGMG, Lima EM, Marino VSP, Tupinambá ALF, França A, Souto MFO. Bone alterations in children with idiopathic hypercalciuria at the time of diagnosis. Pediatr Nephrol 2003; 18:133-9. [PMID: 12579402 DOI: 10.1007/s00467-002-1036-6] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2002] [Revised: 08/26/2002] [Accepted: 10/02/2002] [Indexed: 12/17/2022]
Abstract
Some children with idiopathic hypercalciuria (IH) develop bone alterations at some stage of the disease. The aims of this study were to evaluate bone mass in 88 children with IH (G1) at the time of diagnosis and to compare the findings with data for a control group of 29 normal children (G2). Kidney and bone metabolism markers were measured in both groups, and bone densitometry was performed. Serum alkaline phosphatase, intact parathyroid hormone, urinary calcium and uric acid were significantly higher in G1, whereas urinary volume and urinary citrate excretion were lower. The following densitometric parameters were significantly lower in G1: (1) lumbar spine (L(2)-L(4)) bone mineral density (BMD), bone mineral content (BMC), BMC corrected for height and for width of the vertebra, volumetric BMD (BMDvol), and Z score; (2) whole-body BMD; (3) femoral neck BMD. Lumbar spine BMDvol was reduced (osteopenia) in 35% of the patients compared with G2. N telopeptide, a urinary marker of bone resorption, was significantly higher in G1 than in G2, and was negatively correlated with lumbar spine BMD and BMDvol. Children with urinary lithiasis or idiopathic hyperuricosuria associated with IH showed no significant differences in bone metabolism compared with children without these associations. We conclude that (1) there is an altered bone metabolism in IH, with osteopenia already present at diagnosis in 35% of the patients; (2) N telopeptide is one of the most useful markers of bone alterations in IH, especially at an early stage of the disease; (3) investigation of bone metabolism is necessary in IH to prevent future serious consequences such as osteoporosis and bone fractures.
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Rauch F, Georg M, Stabrey A, Neu C, Blum WF, Remer T, Manz F, Schoenau E. Collagen Markers Deoxypyridinoline and Hydroxylysine Glycosides: Pediatric Reference Data and Use for Growth Prediction in Growth Hormone-deficient Children. Clin Chem 2002. [DOI: 10.1093/clinchem/48.2.315] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
AbstractBackground: In children and adolescents, markers of bone and collagen metabolism reflect the dynamics of skeletal growth and development. The aim of this study was to assess the relationship of the urinary collagen markers deoxypyridinoline (DPD) and hydroxylysine (Hyl) and its glycosides [galactosyl-Hyl (Gal-Hyl) and glucosyl-Gal-Hyl] with growth.Methods: Urine samples from 240 apparently healthy children and adolescents (6–19 years; 124 girls) and from 51 prepubertal children with growth hormone (GH) deficiency (3–14 years; 14 girls) were analyzed. Urinary Hyl and its glycosides were quantified by HPLC, and DPD was assessed by chemiluminescence assay. Urinary concentrations of all markers were related to urinary creatinine.Results: Multiple regression analysis revealed that only age and height velocity were independently associated with these markers in healthy children. In GH-deficient patients, the urinary excretion of both analytes after 4 weeks of GH therapy correlated significantly with the height increase during the first treatment year (r = 0.79 for Gal-Hyl; r = 0.70 for DPD; P <0.001 each). In a multivariate linear regression model using Gal-Hyl concentrations at 4 weeks, baseline concentrations of insulin-like growth factor 1 and height velocity after 3 months accounted for 80% of the variability in height gain during the first treatment year. A model using DPD concentrations at 4 weeks, in place of Gal-Hyl concentrations, as well as baseline concentrations of insulin-like growth factor 1 and height velocity after 3 months accounted for 83% of the variability.Conclusions: These urinary bone and collagen markers give some early indication of growth response, but the prediction of an individual marker is too imprecise to serve as a basis for clinical decisions. Markers of bone and collagen metabolism might be more useful as components of multivariate growth prediction models.
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Affiliation(s)
- Frank Rauch
- Children’s Hospital, University of Cologne, Josef-Stelzmann Strasse 9, 50924 Cologne, Germany
| | - Mareile Georg
- Children’s Hospital, University of Cologne, Josef-Stelzmann Strasse 9, 50924 Cologne, Germany
| | - Angelika Stabrey
- Children’s Hospital, University of Cologne, Josef-Stelzmann Strasse 9, 50924 Cologne, Germany
| | - Christina Neu
- Children’s Hospital, University of Cologne, Josef-Stelzmann Strasse 9, 50924 Cologne, Germany
- Research Institute for Child Nutrition, Heinstück 11, 44225 Dortmund, Germany
| | - Werner F Blum
- Children’s Hospital, University of Giessen, Germany and Lilly Deutschland GmbH, Saalburgstrasse 153, 61350 Bad Homburg, Germany
| | - Thomas Remer
- Research Institute for Child Nutrition, Heinstück 11, 44225 Dortmund, Germany
| | - Friedrich Manz
- Research Institute for Child Nutrition, Heinstück 11, 44225 Dortmund, Germany
| | - Eckhard Schoenau
- Children’s Hospital, University of Cologne, Josef-Stelzmann Strasse 9, 50924 Cologne, Germany
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Vesper HW, Demers LM, Eastell R, Garnero P, Kleerekoper M, Robins SP, Srivastava AK, Warnick GR, Watts NB, Myers GL. Assessment and Recommendations on Factors Contributing to Preanalytical Variability of Urinary Pyridinoline and Deoxypyridinoline. Clin Chem 2002. [DOI: 10.1093/clinchem/48.2.220] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AbstractBackground: Pyridinoline (PYD) and deoxypyridinoline (DPD) are two of the most extensively characterized biochemical bone markers, but the interpretation of results is hampered by biologic and other preanalytical variability. We reviewed factors contributing to preanalytical variation of pyridinium cross-links in urine.Methods: We searched four databases for English-language reports on PYD and/or DPD in urine. Searches were restricted to humans, except for studies of stability, when the search was expanded to other species. The 599 identified articles were supplemented with references from those articles and with articles known to the authors.Results: The mean reported within-day variability was 71% for PYD (range, 57–78%) and 67% for DPD (range, 53–75%). The mean interday variability was 16% for both DPD and PYD (range for PYD, 12–21%; range for DPD, 5–24%). The mean intersubject variabilities across studies were 26% for PYD (range, 12–63%) and 34% for DPD (range, 8–98%) for healthy premenopausal women and 36% (range, 22–61%) and 40%, (range, 27–54%) for postmenopausal women, respectively. Specimen instability and errors in creatinine measurements were additional sources of variability.Conclusions: Intra- and intersubject variability can be reduced by collecting specimens at a specific time of the day and by maintaining similar patient status at each specimen collection regarding factors such as medications and dietary supplements.
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Affiliation(s)
- Hubert W Vesper
- Centers for Disease Control and Prevention, Atlanta, GA 30341-3724
| | | | | | | | | | - Simon P Robins
- The Rowett Research Institute, Aberdeen AB21 9SB, United Kingdom
| | | | | | | | - Gary L Myers
- Centers for Disease Control and Prevention, Atlanta, GA 30341-3724
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Baxter-Jones AD, Helms PJ. Early introduction of inhaled steroids in wheezing children presenting in primary care. A pilot study. EASE Study Group. Clin Exp Allergy 2000; 30:1618-26. [PMID: 11069572 DOI: 10.1046/j.1365-2222.2000.00941.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Recurrent wheezing illness in childhood is a frequent reason for consultation in both primary and secondary care and whilst there is widespread support for the earlier introduction of inhaled corticosteroids (ICS) concerns remain about potential adverse systemic effects. OBJECTIVE We sought to identify the feasibility and size of study required to assess the benefits, adverse effects and cost-effectiveness of early introduction of ICS. METHODS We entered 86 children (mean age 4.5 years) with at least two consecutive wheezing episodes into a pragmatic randomized controlled trial. All children were already being prescribed beta2-agonist and those allocated to ICS were prescribed twice daily beclomethasone dipropionate 200 microg or budesonide 200 microg. At entry and 3 and 6 months age appropriate lung function (FEV(1), T(ptef):T(e)), respiratory symptoms, quality of life of children and carers, growth and sexual maturation, bone mass and bone turnover, and health care costs were assessed. RESULTS Drop out rate was 8% (7 of 86). No significant differences were found in FEV(1) or T(ptef):T(e) at 6 months. Respiratory symptoms and health-related quality of life of children and carers improved equally in both groups. No significant differences were found in growth rates or in bone mass. In the ICS group markers of bone turnover (Pyd:Cr) fell (271 vs 237 nmol/mmol) in contrast to a rise in those on beta(2) alone (255 vs 319 nmol/mmol) P < 0.05. Combined health care costs were higher in the ICS group. CONCLUSIONS The low drop out rate provided evidence that the protocol was practical and acceptable. In order to confirm these results, and using the same study design, power estimates indicated that 260 children would need to be randomized.
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Affiliation(s)
- A D Baxter-Jones
- Department of Child Health, University of Aberdeen, Foresterhill, Aberdeen, UK
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Soylu H, Aras S, Kutlu NO, Egri M, Sahin K. Urinary excretion of deoxypyridinoline in 24-hour and first-void samples in healthy Turkish children. Clin Biochem 2000; 33:269-72. [PMID: 10936584 DOI: 10.1016/s0009-9120(00)00072-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Collagen cross-links are formed during the maturation process of bone matrix. They have been considered as valuable markers in some metabolic, endocrinologic, and neoplastic bone disorders. As an advantage, it can be measured in urine as well as in serum samples. However, the excretion characteristics remains controversial. DESIGN AND METHODS We investigated urinary free deoxypyridinoline (f-Dpd) excretion in first-void urine samples and in 24-hour collections in healthy Turkish children. We also evaluated the possible correlations and gender-related differences in Dpd excretion between these sampling methods. Both urine samples of 62 subjects (aged from 31 to 120 months) were analyzed by Immulite chemiluminescent technique. RESULTS There were no remarkable differences in f-Dpd excretion between first-void and 24-hour urine samples, although f-Dpd values of the first-void samples were slightly higher (Dpd: creatinine, mean +/- SD, 20.5 +/- 5.8 nmol/mmol vs. 19.6 +/- 5.6 nmol/mmol, respectively, p > 0.05). A strong linear correlation was found between 24-hour and first-void urine f-Dpd excretions (r = 0.77, p < 0.05). In addition, f-Dpd showed no gender-related differences between boys and girls in either 24-hour or first-void urine samples (p > 0.05). CONCLUSIONS Because of difficulties in long-time urine collection in infants and young children, f-Dpd assessment in first-void single urine samples is an easy, safe, and non-invasive method.
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Affiliation(s)
- H Soylu
- Department of Pediatrics, Inönü University, Turgut Ozal Medical Center, Malatya, Turkey.
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Tillmann V, Gill MS, Thalange NK, Birkinshaw G, Price DA, Fraser WD, Clayton PE. Short-term changes in growth and urinary growth hormone, insulin-like growth factor-I and markers of bone turnover excretion in healthy prepubertal children. Growth Horm IGF Res 2000; 10:28-36. [PMID: 10753590 DOI: 10.1054/ghir.1999.0136] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Childhood growth is a non-linear process. To assess whether there is a biochemical correlate of non-linear growth, we have measured free pyridinoline (fPYR) and deoxypyridinoline (fDPYR) excretion in seven healthy prepubertal children, aged 6.1-7.7 years. To examine the link between short-term growth and hormone output, urinary growth hormone (uGH) and insulin-like growth factor-I (uIGF-I) were also measured. Height and weight were measured and a timed overnight urine was collected three times per week from September to July, with results expressed as a weekly change in height (Dheight(w)) or weight (Dweight(w)), and as weekly average hormone or bone marker excretion (uGH(w), uIGF-I(w), fPYR(w), fDPYR(w)). Subject specific SD scores (SDS) were derived for each variable.Dheight(w)and Dweight(w)did not correlate to uGH(w), uIGF-I(w), fPYR(w)or fDPYR(w). Dheight(w)SDS was weakly but significantly correlated to fPYR(w)SDS (r = +0.16;P<0.05) and fDPYR(w)SDS (r = +0.15;P<0.05). The percentage of high frequency (2-4 weeks) variation in uGH(w)excretion, as defined by time series analysis, was correlated with the mean uIGF-I(w)(r = +0.81;P<0.05), which in turn was significantly reduced (92 +/- 38 vs 120 +/- 47 ng;P<0.001) during periods of slow growth (Dheight(w)< 0.05 cm/week). We conclude that in normal children the amount of urinary fPYR, fDPYR, GH and IGF-I does not provide a direct biochemical correlate of growth from week to week. However good growth is associated with a relative increase in fPYR and fDPYR excretion, while poor growth is associated with reduced IGF-I excretion, which in turn is influenced by the temporal secretory pattern of GH over 2-4 weeks.
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Affiliation(s)
- V Tillmann
- Department of Child Health, Royal Manchester Children's Hospital, Pendlebury, Manchester, M27 4HA, UK
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