Abstract
Resistance to growth hormone (GH) is a significant complication of advanced chronic renal failure. Thus while the circulating GH levels are normal or even elevated in uremia, resistance to the hormone leads to stunting of body growth in children and contributes to muscle wasting in adults. Insensitivity to GH is the consequence of multiple defects in the GH/insulin-like growth factor-1 (IGF-1) system. Expression of the GH receptor may be reduced, although this is not a consistent finding, GH activation of the Janus kinase 2-signal transducer (JAK2) and activator of transcription (STAT) signal transduction pathway is depressed and this leads to reduced IGF-1 expression, and finally there is resistance to IGF-1, a major mediator of GH action. We review these various defects with an emphasis on the GH-activated JAK2-STAT5 pathway, since this pathway is essential for normal body growth and there has been recent progress in our understanding of the perturbations that occur in uremia.
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References
Kaskel F (2003) Chronic renal disease: a growing problem. Kidney Int 64:1141–1151
Tonshoff B, Blum WF, Mehls O (1997) Derangements of the somatotropic hormone axis in chronic renal failure. Kidney Int [Suppl] 58:S106–113
Wuhl E, Schaefer F (2002) Effects of growth hormone in patients with chronic renal failure: experience in children and adults. Horm Res 58 [Suppl] 3:35–38
Rabkin R (2003) Therapeutic use of growth factors in renal disease. In: Kopple JD, Massry SG (eds) Kopple and Massry’s nutritional management of renal disease. Lipincott and Williams and Wilkins, Philadelphia, pp 581–592
Schaefer F, Rabkin R (2003) Insulin-like growth factor and the kidney. In: LeRoith WZD, Baxter RC (eds) Insulin-like growth factors. Kluwer, New York, pp 244–255
Woelfle J, Chia DJ, Rotwein P (2003) Mechanisms of growth hormone (GH) action. Identification of conserved Stat5 binding sites that mediate GH-induced insulin-like growth factor-I gene activation. J Biol Chem 278:51261–51266
Teglund S, McKay C, Schuetz E, Deursen JM van, Stravopodis D, Wang D, Brown M, Bodner S, Grosveld G, Ihle JN (1998) Stat5a and Stat5b proteins have essential and nonessential, or redundant, roles in cytokine responses. Cell 93:841–850
Rabkin R, Guest S, Schaefer F (2004) The kidney and the insulin-like growth factor system in health and disease. In: Houston M, Holly J, Feldman E, Totawa NJ (eds) IGF and nutrition in health and disease. Humana, pp 227–247
Roelfsema V, Clark RG (2001) The growth hormone and insulin-like growth factor axis: its manipulation for the benefit of growth disorders in renal failure. J Am Soc Nephrol 12:1297–1306
Pombo M, Pombo CM, Garcia A, Caminos E, Gualillo O, Alvarez CV, Casanueva FF, Dieguez C (2001) Hormonal control of growth hormone secretion. Horm Res 55 [Suppl] 1:11–16
Butler AA, Le Roith D (2001) Control of growth by the somatropic axis: growth hormone and the insulin-like growth factors have related and independent roles. Annu Rev Physiol 63:141–164
Feneberg R, Schaefer F, Veldhuis JD (2003) Neuroendocrine adaptations in renal disease. Pediatr Nephrol 18:492–497
Schaefer F, Veldhuis JD, Stanhope R, Jones J, Scharer K (1994) Alterations in growth hormone secretion and clearance in peripubertal boys with chronic renal failure and after renal transplantation. Cooperative Study Group of Pubertal development in Chronic Renal Failure. J Clin Endocrinol Metab 78:1298–1306
Tonshoff B, Veldhuis JD, Heinrich U, Mehls O (1995) Deconvolution analysis of spontaneous nocturnal growth hormone secretion in prepubertal children with preterminal chronic renal failure and with end-stage renal disease. Pediatr Res 37:86–93
Veldhuis JD, Iranmanesh A, Wilkowski MJ, Samojlik E (1994) Neuroendocrine alterations in the somatotropic and lactotropic axes in uremic men. Eur J Endocrinol 131:489–498
Ramirez G, Bercu BB, Bittle PA, Ayers CW, Ganguly A (1990) Response to growth hormone-releasing hormone in adult renal failure patients on hemodialysis. Metabolism 39:764–768
Garcia E, Santos F, Rodriguez J, Martinez V, Rey C, Veldhuis J, Krieg RJ Jr (1997) Impaired secretion of growth hormone in experimental uremia: relevance of caloric deficiency. Kidney Int 52:648–653
Metzger DL, Kerrigan JR, Krieg RJ Jr, Chan JC, Rogol AD (1993) Alterations in the neuroendocrine control of growth hormone secretion in the uremic rat. Kidney Int 43:1042–1048
Haffner D, Schaefer F, Girard J, Ritz E, Mehls O (1994) Metabolic clearance of recombinant human growth hormone in health and chronic renal failure. J Clin Invest 93:1163–1171
Blum WF (1991) Insulin-like growth factors (IGFs) and IGF binding proteins in chronic renal failure: evidence for reduced secretion of IGFs. Acta Paediatr Scand [Suppl] 379:24–31
Fouque D, Peng SC, Kopple JD (1995) Pharmacokinetics of recombinant human insulin-like growth factor-1 in dialysis patients. Kidney Int 47:869–875
Rabkin R, Fervenza FC, Maidment H, Ike J, Hintz R, Liu F, Bloedow DC, Hoffman AR, Gesundheit N (1996) Pharmacokinetics of insulin-like growth factor-1 in advanced chronic renal failure. Kidney Int 49:1134–1140
Tonshoff B, Powell DR, Zhao D, Durham SK, Coleman ME, Domene HM, Blum WF, Baxter RC, Moore LC, Kaskel FJ (1997) Decreased hepatic insulin-like growth factor (IGF)-I and increased IGF binding protein-1 and -2 gene expression in experimental uremia. Endocrinology 138:938–946
Hanna JD, Santos F, Foreman JW, Chan JC, Han VK (1995) Insulin-like growth factor-I gene expression in the tibial epiphyseal growth plate of growth hormone-treated uremic rats. Kidney Int 47:1374–1382
Schaefer F, Chen Y, Tsao T, Nouri P, Rabkin R (2001) Impaired JAK-STAT signal transduction contributes to growth hormone resistance in chronic uremia. J Clin Invest 108:467–475
Sun D, Zheng Z, Tummala P, Oh J, Schaefer F, Rabkin R (2004) Chronic uremia attenuates growth hormone induced signal transduction in skeletal muscle. J Am Soc Nephrol 15:2630–2636
Zheng Z, Sun D, Tummala P, Rabkin R (2005) Cardiac resistance to growth hormone in uremia. Kidney Int (in press)
Tonshoff B, Eden S, Weiser E, Carlsson B, Robinson IC, Blum WF, Mehls O (1994) Reduced hepatic growth hormone (GH) receptor gene expression and increased plasma GH binding protein in experimental uremia. Kidney Int 45:1085–1092
Edmondson SR, Baker NL, Oh J, Kovacs G, Werther GA, Mehls O (2000) Growth hormone receptor abundance in tibial growth plates of uremic rats: GH/IGF-I treatment. Kidney Int 58:62–70
Villares SM, Goujon L, Maniar S, Delehaye-Zervas MC, Martini JF, Kleincknecht C, Postel-Vinay MC (1994) Reduced food intake is the main cause of low growth hormone receptor expression in uremic rats. Mol Cell Endocrinol 106:51–56
Baumann G (2001) Growth hormone binding protein 2001. J Pediatr Endocrinol Metab 14:355–375
Baumann G (2002) Growth hormone binding protein. The soluble growth hormone receptor. Minerva Endocrinol 27:265–276
Tonshoff B, Cronin MJ, Reichert M, Haffner D, Wingen AM, Blum WF, Mehls O (1997) Reduced concentration of serum growth hormone (GH)-binding protein in children with chronic renal failure: correlation with GH insensitivity. The European Study Group for Nutritional Treatment of Chronic Renal Failure in Childhood. The German Study Group for Growth Hormone Treatment in Chronic Renal Failure. J Clin Endocrinol Metab 82:1007–1013
Baumann G (1996) Growth hormone binding protein and free growth hormone in chronic renal failure. Pediatr Nephrol 10:328–330
Postel-Vinay MC, Tar A, Crosnier H, Broyer M, Rappaport R, Tonshoff B, Mehls O (1991) Plasma growth hormone-binding activity is low in uraemic children. Pediatr Nephrol 5:545–547
Powell DR, Liu F, Baker BK, Hintz RL, Lee PD, Durham SK, Brewer ED, Frane JW, Watkins SL, Hogg RJ (1997) Modulation of growth factors by growth hormone in children with chronic renal failure. The Southwest Pediatric Nephrology Study Group. Kidney Int 51:1970–1979
Greenstein J, Guest S, Tummala P, Tan J, Rabkin R (2003) Growth hormone receptor expression in uremia. J Am Soc Nephrol SA–PO1085
Fisker S, Vahl N, Jorgensen JO, Christiansen JS, Orskov H (1997) Abdominal fat determines growth hormone-binding protein levels in healthy nonobese adults. J Clin Endocrinol Metab 82:123–128
Fisker S, Hansen B, Fuglsang J, Kristensen K, Ovesen P, Orskov H, Jorgensen JO (2004) Gene expression of the GH receptor in subcutaneous and intraabdominal fat in healthy females: relationship to GH-binding protein. Eur J Endocrinol 150:773–777
Fisker S, Kristensen K, Rosenfalck AM, Pedersen SB, Ebdrup L, Richelsen B, Hilsted J, Christiansen JS, Jorgensen JO (2001) Gene expression of a truncated and the full-length growth hormone (GH) receptor in subcutaneous fat and skeletal muscle in GH-deficient adults: impact of GH treatment. J Clin Endocrinol Metab 86:792–796
Piwien-Pilipuk G, Huo JS, Schwartz J (2002) Growth hormone signal transduction. J Pediatr Endocrinol Metab 15:771–786
Wormald S, Hilton DJ (2004) Inhibitors of cytokine signal transduction. J Biol Chem 279:821–824
Woelfle J, Billiard J, Rotwein P (2003) Acute control of insulin-like growth factor-I gene transcription by growth hormone through Stat5b. J Biol Chem 278:22696–22702
Woelfle J, Rotwein P (2003) In vivo regulation of growth hormone-stimulated gene transcription by STAT5b. Am J Physiol Endocrinol Metab 286:E393–401
Yoshimura A, Mori H, Ohishi M, Aki D, Hanada T (2003) Negative regulation of cytokine signaling influences inflammation. Curr Opin Immunol 15:704–708
Greenhalgh CJ, Bertolino P, Asa SL, Metcalf D, Corbin JE, Adams TE, Davey HW, Nicola NA, Hilton DJ, Alexander WS (2002) Growth enhancement in suppressor of cytokine signaling 2 (SOCS-2)-deficient mice is dependent on signal transducer and activator of transcription 5b (STAT5b). Mol Endocrinol 16:1394–1406
Kaysen GA (2001) The microinflammatory state in uremia: causes and potential consequences. J Am Soc Nephrol 12:1549–1557
Powell DR, Liu F, Baker BK, Hinzt RL, Kale A, Suwanichkul A, Durham SK (2000) Effect of chronic renal failure and growth hormone therapy on the insulin-like growth factors and their binding proteins. Pediatr Nephrol 14:579–583
Ding H, Gao XL, Hirschberg R, Vadgama JV, Kopple JD (1996) Impaired actions of insulin-like growth factor 1 on protein synthesis and degradation in skeletal muscle of rats with chronic renal failure. Evidence for a postreceptor defect. J Clin Invest 97:1064–1075
Tsao T, Fervenza F, Friedlaender M, Chen Y, Rabkin R (2002) Effect of prolonged uremia on insulin-like growth factor-I receptor autophosphorylation and tyrosine kinase activity in kidney and muscle. Exp Nephrol 10:285–292
Cecchin F, Ittoop O, Sinha MK, Caro JF (1988) Insulin resistance in uremia: insulin receptor kinase activity in liver and muscle from chronic uremic rats. Am J Physiol 254:E394–E401
Friedman JE, Dohm GL, Elton CW, Rovira A, Chen JJ, Leggett-Frazier N, Atkinson SM Jr, Thomas FT, Long SD, Caro JF (1991) Muscle insulin resistance in uremic humans: glucose transport, glucose transporters, and insulin receptors. Am J Physiol 261:E87–E94
Acknowledgements
This review and work from the authors′ laboratory were supported by a Merit Review Grant from the Research Service of the Department of Veterans Affairs and funding from the American Heart Association and a Norman S. Coplon Grant from Satellite Research. Apologies are extended in advance to those authors who are not referenced in this review because of its relative brevity.
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This work was presented in part at the IPNA Seventh Symposium on Growth and Development in Children with Chronic Kidney Disease: The Molecular Basis of Skeletal Growth, 1–3 April 2004, Heidelberg. Germany
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Rabkin, R., Sun, D.F., Chen, Y. et al. Growth hormone resistance in uremia, a role for impaired JAK/STAT signaling. Pediatr Nephrol 20, 313–318 (2005). https://doi.org/10.1007/s00467-004-1713-8
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DOI: https://doi.org/10.1007/s00467-004-1713-8