Long-term Pegylated GH for Children With GH Deficiency: A Large, Prospective, Real-world Study.

CONTEXT: The evidence of long-term polyethylene glycol recombinant human GH (PEG-rhGH) in pediatric GH deficiency (GHD) is limited. OBJECTIVE: This study aimed to examine the effectiveness and safety of long-term PEG-rhGH in children with GHD in the real world, as well as to examine the effects of dose on patient outcomes. DESIGN: A prospective, observational, posttrial study (NCT03290235). SETTING, PARTICIPANTS AND INTERVENTION: Children with GHD were enrolled from 81 centers in China in 4 individual clinical trials and received weekly 0.2 mg/kg/wk (high-dose) or 0.1 to <0.2 mg/kg/wk (low-dose) PEG-rhGH for 30 months. MAIN OUTCOMES MEASURES: Height SD score (Ht SDS) at 12, 24, and 36 months. RESULTS: A total of 1170 children were enrolled in this posttrial study, with 642 patients in the high-dose subgroup and 528 in the low-dose subgroup. The Ht SDS improved significantly after treatment in the total population (P < 0.0001), with a mean change of 0.53 ± 0.30, 0.89 ± 0.48, 1.35 ± 0.63, 1.63 ± 0.75 at 6 months, 12 months, 24 months, and 36 months, respectively. In addition, the changes in Ht SDS from baseline were significantly improved in the high-dose subgroup compared with the low-dose subgroup at 6, 12, 24, and 36 months after treatment (all P < 0.05). A total of 12 (1.03%) patients developed serious adverse events. There was no serious adverse event related to the treatment, and no AEs leading to treatment discontinuation or death occurred. CONCLUSIONS: PEG-rhGH showed long-term effectiveness and safety in treating children with GHD. Both dose subgroups showed promising outcomes, whereas PEG-rhGH 0.2 mg/kg/wk might show additional benefit.

Short-term efficacy and safety of a lower dose of polyethylene glycol recombinant human growth hormone in children with growth hormone deficiency: A randomized, dose-comparison study.

Objective: Polyethylene glycol recombinant human growth hormone (PEG-rhGH, Jintrolong®) is the first long-acting rhGH preparation that is approved to treat children with growth hormone deficiency (GHD) in China. Clinical experience with dose selections of PEG-rhGH is scarce. The present study compared the efficacy and safety of a lower dose to increase dosing regimens of PEG-rhGH treatment. Methods: A multicenter, randomized, open-label, dose-comparison clinical study was conducted to compare the improvements in the height standard deviation score (Ht SDS), height velocity (HV), insulin-like growth factor-1 (IGF-1) SDS, and safety profiles of children with GHD who are treated with 0.2 mg/kg/week of PEG-rhGH dose or 0.14 mg/kg/week for 26 weeks. Results: Ht SDS, HV, and IGF-1 SDS increased significantly after PEG-rhGH treatment in the two dose groups (p < 0.05). The improvements of Ht SDS, HV, and IGF-1 SDS were more significant in the high-dose group than in the low-dose group (p < 0.05). Ht SDS improvement in low-dose group was not non-inferiority to that in the high-dose group (p = 0.2987). The incidences of adverse events were comparable between the two groups. Conclusion: The improvements of Ht SDS, HV, and IGF-1 SDS were more significant in the high-dose group than in the low-dose group (p < 0.05). PEG-rhGH at the dose of 0.14 mg/kg/week was effective and safe for children with GHD. Clinical Trial Registration: clinicaltrials.gov, identifier NCT02908958.

A Cytochrome P450 Monooxygenase in Nondefoliating Strain of Verticillium dahliae Manipulates Virulence via Scavenging Reactive Oxygen Species.

Verticillium dahliae is a broad host-range phytopathogenic fungus that causes destructive vascular wilt on plants worldwide. Cytochrome P450 monooxygenases, also known as CYPs/P450s, are broadly distributed in organisms and are involved in a diverse array of molecular/metabolic processes. In this study, using reverse transcription quantitative PCR analysis, we observed that the expression of a P450 gene (Chr2g00380) in the E-class P450, group IV from V. dahliae isolate JR2 was highly induced during tomato infection. Targeted deletion of Chr2g00380 in JR2 did not affect hyphal growth and morphology; however, the mutants exhibited increased sensitivity to H2O2 and defects in melanized microsclerotia formation compared with the wild type. Loss of Chr2g00380 resulted in reduced virulence on tomato and tobacco plants but did not cause phenotypic changes in infection structure formation or in the penetration of cellophane membranes. These data provide evidence for an involvement of a cytochrome P450 monooxygenase in virulence in V. dahliae.

Convergent and distinctive functions of transcription factors VdYap1, VdAtf1, and VdSkn7 in the regulation of nitrosative stress resistance, microsclerotia formation, and virulence in Verticillium dahliae.

Reactive oxygen/nitrogen species (ROS/RNS) play a fundamental role in plant-fungal interactions. How pathogenic fungi manipulate plant-derived ROS/RNS is of importance to the outcomes of these interactions. In this study, we explored the individual and combined contributions of three transcription factors, VdAtf1, VdYap1, and VdSkn7, in the response to ROS/RNS, microsclerotia formation, and virulence in the plant wilt pathogen Verticillium dahliae. We showed that VdYap1 is essential for ROS response. Additionally, mutants lacking any combination of the three genes shared significant hypersensitivity to nitro-oxidative stress like sodium nitroprusside dehydrate and double deletions lacking VdYap1 and VdAtf1 resulted in further increased sensitivity to ROS. Double deletion of VdAtf1 and VdSkn7 reduced melanin production and virulence while simultaneous lack of VdSkn7 and VdYap1 disrupted nitrogen metabolism and ROS resistance. Finally, comparison of transcriptional profiles of the respective single or double mutants in response to nitro-oxidative stress revealed that the three transcription factors are involved in denitrification of nitrated alkanes and lipids to protect against nitro-oxidative stress. Taken together, our results demonstrate convergent and distinctive functions of VdYap1, VdAtf1, and VdSkn7 in V. dahliae, and provide new data on their roles in response to ROS/RNS in fungi.

The prevalence of premature thelarche in girls and gynecomastia in boys and the associated factors in children in Southern China.

BACKGROUND: To investigate the prevalence and risk factors of premature thelarche (PT) in girls and gynecomastia (GM) in boys in Southern China. METHODS: We conducted a cross-sectional study of preschool children across 9 cities in Zhejiang province. A total of 6273 children in the age-group of 2-7 years were recruited from January 2014 to March 2015. Relevant information was collected from mothers through face-to-face interviews. Logistic regression models were used to examine the correlates of PT and GM. Odds ratios (ORs) with 95% confidence intervals (CIs) are reported. RESULTS: The prevalence of PT among girls was 4.8% and that of GM among boys was 0.8%. One hundred girls were diagnosed with PT before the age of 2 years; 69 (69.0%) of these girls experienced spontaneous resolution of PT. Twenty-four boys were diagnosed with GM before the age of 2 years; 10 (41.7%) of these experienced spontaneous resolution of GM. Children borne of mothers with early onset of menarche and those belonging to high-income families were at a higher risk of premature breast development. Greater consumption of eggs was associated with premature breast development in early childhood. CONCLUSIONS: Socioeconomic status of family, early onset of menarche in mother, and consumption of eggs were strongly associated with premature breast development in early childhood.

[Effects of gonadotropin releasing hormone analog and growth hormone on height in girls with idiopathic central precocious puberty].

OBJECTIVE: To determine the effect of gonadotropin releasing hormone agonist (GnRHa), by itself alone or in combination with recombinant human growth hormone (rhGH), on height in young girls (bone age≥10 years) with idiopathic central precocious puberty (ICPP). METHODS: Eighty girls with ICPP (9.0±0.7 years old) from six medical centers across Southeast and Southwest China participated in this study. They were allocated to treatment with GnRHa+rhGH (n=31) and GnRHa (n=49) respectively. Girls in the GnRHa+rhGH group (bone age 11.18 ±0.53 years) were treated with GnRHa for 25.29±6.92 months and rhGH for 12.87±7.02 months. Girls in the GnRHa group (bone age 11.03 ±0.50 years) were treated with GnRHa for 25.96±8.95 months. The height standard deviation for bone age (HtSDS-BA), predicted adult height, near-adult height and net height increase before and after treatment were recorded for girls in both groups. RESULTS: HtSDS-BA was significantly improved after treatment for both groups (P<0.01) and the HtSDS-BA value was superior in the GnRHa+rhGH group over the GnRHa group (P<0.01). Values in near adult height (157±6 cm vs 157±4 cm), net height increase after treatment (4.68 cm vs 3.89 cm), and predicted adult height after drug withdrawal (161±5 cm vs 158±5 cm) were higher in the GnRHa+rhGH group than the GnRHa group, but the differences were not significant. CONCLUSIONS: Both GnRHa plus rhGH and GnRHa alone can improve the near adult height in girls with ICPP with a bone age ≥10 years to a similar extent. Adult height predicted based on bone age in ICPP girls following drug withdrawal is usually overestimated and precautions should be taken when this parameter is used.