Resistance to the lipolytic action of epinephrine: a new feature of protein Gs deficiency.

Deficiency of protein Gs (Gs; OMIM no.103580), the stimulatory regulator of adenylyl cyclase, is associated with resistance to PTH and other hormones, sc calcifications, short stature, and skeletal defects (Albright's hereditary osteodystrophy). It is caused by heterozygous loss of function mutations in GNAS 1, the gene encoding the alpha-subunit of Gs. Obesity is a classical feature of patients with Gs deficiency, but the mechanism leading to fat accumulation has not been elucidated. We measured glycerol flux, using a nonradioactive tracer dilution approach, to analyze the lipolytic response to epinephrine in 6 patients with Gs deficiency and PTH resistance and compared it to six age-matched normal controls and nine massively obese children. Basal glycerol production was reduced by 50%, and lipolytic response to epinephrine was reduced by 67%, in Gs-deficient children, as compared with controls. The degree of impairment of lipolysis was similar in Gs-deficient children who were only moderately overweight and in morbidly obese children. These findings extend the spectrum of hormonal resistance in Gs deficiency. Besides beta-adrenergic receptors, Gs protein itself should be examined as a possible step involved in the decreased lipolysis observed in common obesity.

Local action of phosphate depletion and insulin-like growth factor 1 on in vitro production of 1,25-dihydroxyvitamin D by cultured mammalian kidney cells.

The hormonal form of vitamin D, 1,25(OH)2D, is synthesized mostly in proximal renal tubular cells. Experimental and clinical studies suggest that the growth hormone may be involved in growth-related fluctuations of plasma 1,25(OH)2D and in the increase of 1,25(OH)2D induced by in vivo phosphate deprivation, an action possibly mediated by insulin-like growth factor 1 (IGF 1). We tested the effects of phosphate depletion and IGF 1 addition on 1,25(OH)2D3 production in cultured kidney cells: opossum kidney (OK) cells, LLC-PK 1, and rabbit's proximal tubular cells. Confluent cell monolayers were preincubated in various phosphate concentrations, in the presence and absence of IGF 1. Then, 5 nM of [3H]25 (OH)D3 or 2 microM of 25 (OH)D3 were added to the medium and the cells were incubated for a further 120 min. The amount of biosynthesized 1,25(OH)2D3 in lipid extracts was determined after two different straight phase high performance liquid chromatographies. The experiment showed the following: (a) LLC-PK 1 and rabbit's cells expressed a detectable ability to synthesize 1,25(OH)2D3, while OK cells did not. (b) Partial or total phosphate deprivation increased the amount of 1,25(OH)2D3 produced, respectively in LLC-PK 1 and in rabbit's cells. (c) IGF 1 (25 ng/ml) increased 1,25(OH)2D3 production in rabbit's cells, particularly in phosphate-free medium (1.6-fold), and in LLC-PK 1 cells, in partial phosphate depletion (2.75-fold in 1 mM phosphate, P = 0.015, n = 5, and 3.2-fold in 0.5 mM phosphate, P = 0.043, n = 4). Our findings demonstrate a local action of phosphate depletion and of IGF 1 on 1,25-dihydroxyvitamin D3 production.

Acquired sideroblastic anaemia during treatment of Wilson's disease with triethylene tetramine dihydrochloride.

We report one case of acquired sideroblastic anaemia in a patient treated for Wilson's disease with triethylene tetramine dihydrochloride (TTH). No other cause of acquired sideroblastic anaemia was found, and neither iron nor pyridoxine therapy could correct this anaemia. In contrast, decreasing the dose of TTH led to disappearance of ringed sideroblasts. Thus TTH should be added as a further cause of secondary acquired sideroblastic anaemia. The pathophysiology of this finding, probably linked to an abnormality of mitochondrial iron metabolism, is briefly discussed.