IGFALS gene dosage effects on serum IGF-I and glucose metabolism, body composition, bone growth in length and width, and the pharmacokinetics of recombinant human IGF-I administration

Wolfgang Högler, David D. Martin, Nicola Crabtree, Peter Nightingale, Jeremy Tomlinson, Lou Metherell, Ron Rosenfeld, Vivian Hwa, Stephen Rose, Joanna Walker, Nicholas Shaw, Timothy Barrett, Jan Frystyk

Research output: Contribution to journalArticle

16 Scopus citations

Abstract

Context: Acid labile subunit (ALS) deficiency, caused by IGFALS mutations, is a subtype of primary IGF-I deficiency (PIGFD) and has been associated with insulin resistance (IR) and osteopenia. Whether patients respond to recombinant human IGF-I (rhIGF-I) is unknown. Objective and Design: This study determined the 14-hour pharmacokinetic response of free and total IGF-I and IGF binding protein 3 (IGFBP-3) to a single sc dose of rhIGF-I (120-g/kg) in four ALS-deficient patients, compared with severe PIGFD, moderate PIGFD, and controls. Intravenous glucose tolerance tests, fasting bloodlevels,dual-energyX- rayabsorptiometry,peripheralquantitativecomputedtomography,andmetacarpal radiogrammetry were performed in the four patients and 12 heterozygous family members. Results: IGF-I and IGFBP-3 increased above baseline (P < .05) for 2.5 hours, returning to baseline 7 hours after rhIGF-I injection. Mean (SD) IGF-I Z-score increased by 2.49 (0.90), whereas IGFBP-3 Z-score increased by 0.57 (0.10) only. IGF-I elimination rates in ALS deficiency were similar, but the IGF-I increment was lower than those for severe PIGFD. Significant gene dosage effects were found for all IGF-I peptides, height, forearm muscle size,andmetacarpal width.Boneanalysisshowedthat ALS deficiency creates a phenotype of slender bones with normal size-corrected density. Abnormal glucose handling and IR was found in three of four patients and 6 of 12 carriers. Conclusions: These gene dosage effects demonstrate that one functional IGFALS allele is insufficient to maintain normal ALS levels, endocrine IGF-I action, full growth potential, muscle size, and periosteal expansion. Similar gene dosage effects may exist for parameters of IR. Despite similar IGF-I elimination comparedwith severe PIGFD, ALS-deficient patients cannotmountasimilar response. Alternativeways of rhIGF-I administration should be sought.

Original languageEnglish (US)
Pages (from-to)E703-E712
JournalJournal of Clinical Endocrinology and Metabolism
Volume99
Issue number4
DOIs
StatePublished - Apr 2014

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ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Biochemistry
  • Endocrinology
  • Clinical Biochemistry
  • Biochemistry, medical

Cite this

Högler, W., Martin, D. D., Crabtree, N., Nightingale, P., Tomlinson, J., Metherell, L., Rosenfeld, R., Hwa, V., Rose, S., Walker, J., Shaw, N., Barrett, T., & Frystyk, J. (2014). IGFALS gene dosage effects on serum IGF-I and glucose metabolism, body composition, bone growth in length and width, and the pharmacokinetics of recombinant human IGF-I administration. Journal of Clinical Endocrinology and Metabolism, 99(4), E703-E712. https://doi.org/10.1210/jc.2013-3718