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Biomedical subjects

D Clemmons

Publications and source records attributed to D Clemmons.

8 recordsLinked to original sources
PubMed1995

Serum insulin-like growth factor-binding protein-3 levels in the diagnosis of acromegaly.

Insulin-like growth factor-binding protein-3 (IGFBP-3) is a GH-dependent protein that binds insulin-like growth factor-I (IGF-I) in the circulation and modulates its action at the tissue level. Because IGFBP-3 is a stable and specific marker of somatotroph function, we hypothesized that it would be a useful biochemical marker in the diagnosis of patients with acromegaly and the assessment of surgical cure. We, therefore, investigated the sensitivity of serum IGFBP-3 levels to detect GH excess in 44 patients with clinical acromegaly and pathologically confirmed somatotroph adenomas, including a cohort of 18 patients with untreated disease evaluated before transsphenoidal surgery and medical therapy. IGFBP-3 levels were compared to IGF-I and random GH levels before and after transsphenoidal surgery. Concordance among IGFBP-3, IGF-I, and GH suppressibility by glucose was also determined. In addition, the response of IGFBP-3 to glucose suppression was investigated. All 18 patients with untreated acromegaly had elevated serum IGFBP-3 levels, ranging from 4,186-10,026 micrograms/L (mean +/- SD, 6566 [plusm] 1800 micrograms/L). There was no overlap with the age-adjusted normative ranges (P = 0.0001 in patients 18-55 yr old and P = 0.0176 in patients > 55 yr old) or with the levels obtained in age-comparable controls (P = 0.0001). In 11% of untreated patients with clinical findings of acromegaly and a pathologically confirmed adenoma, IG-FBP-3 levels were elevated, although GH was suppressed to less than 2 micrograms/L with glucose. In these patients, IGF-I levels were either normal or minimally elevated and considered nondiagnostic. IGFBP-3 and IGF-I levels were correlated in patients with untreated acromegaly (r = 0.650; P = 0.0162) and after transsphenoidal surgery (r = 0.644; P = 0.0001). Neither IGF-I nor IGFBP-3 correlated with random GH levels before surgery. However, both IGF-I (r = 0.471; P = 0.0001) and IGFBP-3 (r = 0.259; P = 0.041) correlated with random GH levels in patients studied more than 1 month after transsphenoidal surgery. IGFBP-3 and IGF-I levels were concordant with GH suppressibility by glucose (P = 0.0039) and IGFBP-3 decreased with glucose suppression in 7 of 10 patients. These data indicate that IGFBP-3 is a sensitive physiological marker of somatotroph function and is concordant with glucose suppression and IGF-I levels before and after transsphenoidal surgery.(ABSTRACT TRUNCATED AT 250 WORDS)

Acromegaly↗
PubMed1992

NIH conference. Insulin-like growth factors in health and disease.

The insulin-like growth factor (IGF) family of peptides, binding proteins, and receptors are ubiquitous and important for normal human growth and development. Modern techniques including specific radioimmunoassays, radioreceptor assays and recombinant DNA technology have improved our understanding of the role of IGFs in growth and development. In addition to enhancing our understanding of normal physiology, these techniques assess changes in these hormones, binding proteins, and receptors in pathologic conditions including growth retardation, acromegaly, malnutrition, diabetes, and malignancy. Further, these studies have led to improvement in the assessment of responses to certain therapies used in the treatment of these diseases and may lead to improvements in these therapies.

Biomarkers↗
PubMed1987

Platelet-derived growth factor-induced alterations in vinculin distribution in porcine vascular smooth muscle cells.

Exposure of porcine vascular smooth muscle cells to platelet-derived growth factor (PDGF; 18-180 ng/ml) but not epidermal growth factor (EGF; 30 ng/ml), somatomedin C (SmC; 30 ng/ml), or insulin (10 microM), results in a rapid, reversible, time- and concentration-dependent disappearance of vinculin staining in adhesion plaques; actin-containing stress fibers also become disrupted following exposure of cells to PDGF. Disappearance of vinculin staining from adhesion plaques is also caused by 12-O-tetradecanoyl-phorbol-13-acetate (TPA; 200-400 nM), though the time course of the disappearance of vinculin staining under these conditions takes longer than in cells exposed to PDGF. The PDGF-induced removal of vinculin from adhesion plaques was inhibited in a concentration-dependent fashion by 8-(N,N-diethylamino) octyl-3,4,5-trimethoxybenzoate (TMB-8; 0.25-4 microM) and leupepetin (2-300 microM), and by n-alpha-tosyl-L-lysine chloromethylketone (TLCK; 100 microM) and trifluoperazine (TFP; 2.5 microM). Addition of PDGF to vascular smooth muscle cells caused a rapid, transient increase in cytosolic free calcium, from a basal resting level of 146 +/- 6.9 nM (SEM, n = 62) to 414 +/- 34 nM (SEM, n = 22) as determined using the calcium-sensitive indicator Fura-2 and Digitized Video Microscopy. This increase in cellular calcium preceded the disappearance of vinculin from adhesion plaques and was partially blocked by pretreatment of cells with TMB-8 but not leupeptin. This rise in cytosolic free calcium was found to occur in approximately 80% of the sample population and displayed both spatial and temporal subcellular heterogeneity. Exposure of cells to TPA (100 nM) did not result in a change in cytosolic free calcium. Both PDGF (20 ng/ml) and TPA (100 nM) caused cytosolic alkalinization which occurred after PDGF-induced disruption of vinculin from adhesion plaques, as determined using the pH-sensitive indicator BCECF and Digitized Video Microscopy. PDGF stimulated DNA synthesis and vinculin disruption in a similar dose-dependent fashion. Both could be inhibited by leupeptin or TMB-8. These results suggest that 1) exposure of vascular smooth muscle cells to PDGF is associated with the disruption of vinculin from adhesion plaques, 2) PDGF-induced vinculin disruption is regulated by an increase in cytosolic calcium (but not cytosolic alkalinization), and involves proteolysis; 3) activation of protein kinase C also causes vinculin removal from adhesion plaques but by a calcium-independent mechanism, and 4) the cellular response to PDGF-stimulated increases in cytosolic free calcium is heterogeneous.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗
PubMed1983

Program evaluation in epilepsy rehabilitation.

The Vocational Services Program of the University of Washington Regional Epilepsy Center is described, and data relating to the first 106 clients who entered the program are examined. A major emphasis of the study was characteristic differences between those clients later competitively employed and program dropouts. Other study purposes related to examining client satisfaction ratings of different aspects of services and establishing whether a relationship existed between seizure occurrences and job loss. Stepwise discriminant function analysis indicated that "months employed in the last 24" appeared to be the stable discriminator between the employed and dropout groups. The group later employed averaged 12 of the prior 24 months in employment, whereas dropouts approximated 7. Associated psychiatric/addictions treatment was initially a key outcome discriminator, but it did not hold up on cross-validation. Subjects were more satisfied with individualized client services (e.g., counseling sessions) than with group activities (e.g., Job Club). As opposed to seizures, emotional/attitudinal difficulties with this rehabilitation population appeared to be the primary reason for job loss. A work adjustment or job station program can be critical for these individuals and others with neurological impairments. The importance of counselor follow-up after the initial job placement is also underscored. This program, with about half of its clients entering unsubsidized jobs, basically replicated the results of other community-oriented epilepsy rehabilitation programs.

Academic Medical Centers↗
PubMed1983

Relationship of General Aptitude Test Battery scores to successful employment for epileptics in a rehabilitation setting.

The US Employment Service's (USES) General Aptitude Test Battery (GATB), when used with USES-developed cut-off scores, has been found to be an accurate predictor of successful job performance. In the present study, results of the GATB scores obtained by vocational rehabilitation clients (n = 15) who were successfully placed into permanent employment were evaluated with reference to published GATB norms and cut-off scores. The major finding of this study was that the scores were not accurate predictors of successful employment for this population. Subjects' subtest scores averaged between 1/2 and 2 SD below the published means, with scores on subtests measuring motor speed and dexterity producing the lowest values. Subtests measuring verbal and visual--spatial ability produced relatively higher values. In only 3 instances was successful employment predicted by the cut-off scores. For the entire sample, GATB scores were frequently low enough to indicate poor job performance in nearly all occupations covered by published cut-off scores. Based on the results from the present study, and considering the wide-spread use of the GATB in the United States, a more comprehensive research project is being implemented to adapt GATB material for use with the targeted population.

Adult↗
PubMed1981

Pure alpha-secreting pituitary adenomas.

Isolated hypersecretion of the alpha subunit of the glycoprotein hormones occurred in two men with previously diagnosed "nonfunctioning chromophobe adenomas." The alpha hypersecretion was unresponsive to hypothalamic releasing hormone, thyroid hormone, and sex-steroid hormones. After trans-sphenoidal surgery and conventional pituitary irradiation, alpha secretion was decreased. Increased quantities of immunologically active and biologically inactive luteinizing hormone (LH) material were detected in serum and in tumor homogenate. Immunologic and gel-chromatographic studies determined that only the alpha subunit was present and that it was cross-reacting in the LH immunoassay. These studies suggest that the alpha subunit may be a useful marker of pituitary tumors, particularly in patients without clinical evidence of hormonal hypersecretion.

Adenoma, Chromophobe↗