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1 The Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA
2 The Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
3 The Department of Pediatrics, University of Michigan School of Medicine, Ann Arbor, Michigan, USA
* To whom correspondence should be addressed. E-mail: lee.denson{at}cchmc.org.
Background: Children with cholestatic liver diseases, in particular Biliary Atresia (BA), may
develop an acquired growth hormone (GH) resistance. This is characterized by normal GH
secretion, reduced liver GH receptor (GHR) abundance, and reduced circulating Insulin-Like
Growth Factor 1 (IGF-1). Consequences include linear growth failure, reduced muscle mass,
and increased perioperative morbidity and mortality. However, the molecular basis for altered
GH signaling in liver and skeletal muscle in cholestatic liver disease is not known. We
hypothesized that reduced IGF-1 expression in obstructive cholestasis would be associated with
down regulation of the GHR and impaired phosphorylation of STAT5 transcription factors.
Methods: Body composition was determined in C57BL/6J male mice after bile duct ligation
(BDL) relative to pair fed (PF) and Ad Lib (AL) fed controls. GHR, STAT5, Sp3, and IGF-1
expression and/or DNA binding were assessed using immunoblots (IB), electrophoretic mobility
shift assays (EMSA), and/or real time RT-PCR. Results: Fat free mass (FFM) was reduced in
PF mice relative to AL fed controls. BDL led to a further reduction in fat mass (FM) and FFM
relative to PF controls. TNF
was increased in liver and skeletal muscle of BDL mice. This was
associated with reduced GH dependent STAT5 activation and IGF-1 RNA expression. GHR
expression was reduced in BDL mice; in liver this was associated with reduced Sp3 binding to a
GHR gene promoter cis element. Conclusions: Wasting in murine obstructive cholestasis is
due to combined effects of reduced caloric intake and biliary obstruction. Growth hormone
resistance due to down regulation of GHR expression may be attributed primarily to the
obstructive cholestasis; therapies which specifically increase GHR expression may restore GH
signaling in this setting.
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