title: The effects of GH and hormone replacement therapy on serum concentrations of mannan-binding lectin, surfactant protein D and vitamin D binding protein in Turner syndrome.
abstract: OBJECTIVE
  Studies in animals and humans indicate that growth hormone (GH) and insulin-like growth factor-I (IGF-I) modulate immune function. Recently, it was reported that GH therapy increased the level of mannan-binding lectin (MBL) in normal patients, and that treatment of acromegalics with pegvisomant decreased the levels of MBL. The effect on MBL was thought to be due to a specific action of GH, since IGF-I treatment did not affect MBL. Whether it is advantageous or not to have high or low levels of MBL is not known. Likewise, it is not clear how the modifications induced by GH affect immune function. In the present study we examined whether GH or hormone replacement therapy (HRT) in Turner syndrome (TS) influence the serum concentrations of MBL and two other proteins partaking in the innate immune defence, surfactant protein D (SP-D) and vitamin D binding protein (DBP).
  
  
  METHODS
  Study 1: a double-blind crossover study of 12 healthy TS adolescents examined during treatment with either placebo or GH for 2 months, and compared with a control group. Study 2: triple-blind crossover study of 9 healthy TS adolescents randomized to treatment with placebo, GH or GH+17beta-estradiol. Study 3: 60 adult TS patients (55 received HRT) compared with 59 age-matched controls. Study 4: 27 patients with TS were examined before and during sex hormone replacement with 17beta-estradiol and norethisterone and compared with age-matched controls (n=24).
  
  
  METHODS
  Measurement of MBL, SP-D, DBP, and other inflammation markers.
  
  
  RESULTS
  Study 1: the levels of MBL (P=0.002) and SP-D (P=0.012) increased during GH treatment, whereas no changes were observed in comparison with controls. DBP was unchanged by GH, but was significantly higher in TS compared with controls (P=0.017). Study 2: treatment with GH increased MBL (P=0.045) and SP-D (P=0.05) concentrations in TS, while treatment with GH+17beta-estradiol did not increase levels further. DBP was unchanged by treatment. Study 3: levels of MBL, SP-D, and DBP were similar in adult TS and control subjects. Study 4: DBP levels decreased in response to HRT, while MBL and SPD levels were unchanged. Levels of all three plasma proteins were similar to controls.
  
  
  CONCLUSIONS
  We show that treatment with GH significantly increases MBL and SP-D concentrations in TS, while HRT marginally decreases DBP. Whether the present findings, suggesting a link between the endocrine and the immune system, have clinical consequences needs to be studied further.
authors.affiliation: Medical Department M (Endocrinology and Diabetes) and Medical Research Laboratories, Arhus Kommunehospital, Arhus University Hospital, 8000 Arhus C, Denmark. ch.gravholt@dadlnet.dk
authors.forename: Claus Højbjerg
authors.initials: CH
authors.lastname: Gravholt
authors.forename: Rikke
authors.initials: R
authors.lastname: Leth-Larsen
authors.forename: Anna Lis
authors.initials: AL
authors.lastname: Lauridsen
authors.forename: Steffen
authors.initials: S
authors.lastname: Thiel
authors.forename: Troels Krarup
authors.initials: TK
authors.lastname: Hansen
authors.forename: Uffe
authors.initials: U
authors.lastname: Holmskov
authors.forename: Rune Weis
authors.initials: RW
authors.lastname: Naeraa
authors.forename: Jens Sandahl
authors.initials: JS
authors.lastname: Christiansen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002097:C-Reactive Protein / Q000378:metabolism; D002648:Child; D018592:Cross-Over Studies; D004311:Double-Blind Method; D004958:Estradiol / Q000627:therapeutic use; D015914:Estrogen Replacement Therapy; D005260:Female; D006242:Haptoglobins / Q000378:metabolism; D019382:Human Growth Hormone / Q000627:therapeutic use*; D006801:Humans; D037601:Mannose-Binding Lectin / Q000097:blood*; D008875:Middle Aged; D009640:Norethindrone / Q000627:therapeutic use; D037663:Pulmonary Surfactant-Associated Protein D / Q000097:blood*; D014168:Transferrin / Q000378:metabolism; D014424:Turner Syndrome / Q000097:blood* / Q000188:drug therapy*; D014809:Vitamin D-Binding Protein / Q000097:blood*
chemical_list: D006242:Haptoglobins; D037601:Mannose-Binding Lectin; D037663:Pulmonary Surfactant-Associated Protein D; D014168:Transferrin; D014809:Vitamin D-Binding Protein; D019382:Human Growth Hormone; D004958:Estradiol; D002097:C-Reactive Protein; D009640:Norethindrone