Endocrinology Vol. 139, No. 9 3855-3862
Copyright © 1998 by The Endocrine Society
Growth Hormone and Insulin-Like Growth Factor I Induce Bone Morphogenetic Proteins 2 and 4: A Mediator Role in Bone and Tooth Formation?1
H. Li,
P. M. Bartold,
C. Z. Zhang,
R. W. Clarkson,
W. G. Young and
M. J. Waters
Departments of Dentistry (H.L., P.M.B., C.Z.Z., W.G.Y.) and
Physiology and Pharmacology (R.W.C., M.J.W.), University of Queensland,
St. Lucia, Queensland 4072, Australia
Address all correspondence and requests for reprints to: Prof. M. J. Waters, Department of Physiology and Pharmacology, University of Queensland, St. Lucia, Queensland 4072, Australia. E-mail
m.waters{at}mailbox.uq.edu.au
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Abstract
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GH is known to increase the formation of bone and hard tissues of the
tooth (dentine, cementum, and enamel), as do bone morphogenetic
proteins. GH receptors are expressed in these tissues and could mediate
local growth responses. Here we report that both GH and
insulin-like growth factor I (IGF-I) are able to increase
expression of bone morphogenetic protein-2 and -4 messenger RNAs 4- to
5-fold in human dental pulp fibroblasts in vitro.
Induction was seen at physiological concentrations of hormone (25100
ng/ml GH; 50200 ng/ml IGF-I) and reached a maximum at 48 h.
Immunoblot analysis demonstrated that the increase in messenger RNAs
resulted in an increase in expressed protein. Anti-IGF-I inhibition
experiments indicate that GH is able to induce the response without a
requirement for local IGF-I production. These results raise the
possibility that bone morphogenetic proteins mediate the local
osteogenic actions of GH and IGF-I, and lend support to the view that
GH can act through the mediation of factors other than IGF-I. These
factors may combine with IGF-I in different tissues to enhance GH
action and specificity.
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Introduction
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A NUMBER of studies have shown that GH is
able to increase the formation of hard tissues in vivo
[e.g. bone (1, 2, 3), dentine (4, 5, 6), enamel (6, 7),
and cementum (8)]. Several in vitro studies have shown GH
has the ability to stimulate the proliferation of osteoblasts,
including bone marrow stromal osteoblasts (9), and to induce markers of
bone formation such as Gla protein and
1-procollagen (3). Likewise,
GH is able to induce proliferation of epithelial stem cells in molar
tooth buds, along with preameloblast differentiation and dentine matrix
formation (10). It is believed that these actions on bone-forming cells
are mediated by local or endocrine insulin-like growth factor I (IGF-I)
(11, 12), according to the somatomedin hypothesis. However, evidence is
accumulating that GH may also use other mediators to sustain its
actions, e.g. hepatocyte growth factor (HGF) in liver (13),
fibroblast growth factor in chondrocytes (14), epidermal growth factor
(EGF) in kidney and liver (15, 16), and estrogen in uterus (17),
through induction of either the growth factor or its receptor. Because
of the potent morphogenetic effects of bone morphogenetic proteins
(BMPs) in bone, tooth, and cartilage formation, we have sought to test
the possibility that GH induces these proteins, providing an additional
avenue for its actions.
BMPs have been shown to be involved in a number of processes,
such as induction of mesoderm (18), skeletal patterning (19), tooth
development (20), and limb morphogenesis (21). They regulate diverse
processes, including cell proliferation, determination,
differentiation, morphogenesis, and apoptosis (22). Indeed, one of the
actions of BMPs is to promote the entry of uncommitted multipotent stem
cells into the chondrogenic or osteogenic, rather than myogenic,
lineages (22). BMPs also mediate the epithelial-mesenchymal
interactions needed for formation of many mixed lineage tissues such as
tooth (20) and kidney (22). In particular, BMP-4 is involved in earlier
stages of tooth formation, and BMP-2 is involved in later stages (20),
where BMP-2 mediates epithelial-mesenchymal interactions through the
epithelial enamel knot. In later stages of tooth formation, BMPs have
been shown to be expressed in ameloblasts, odontoblasts, and dentine
matrix and can induce established dental pulp mesenchymal cells to
proliferate and then differentiate into odontoblast cells (20, 23).
Consequently, BMPs are able to induce osteodentine and tubular dentine
formation in vivo. As we have reported the ability of GH to
induce dentine, enamel, and cementum formation (24), and the concurrent
expression of GH receptor and GH itself in different stages of tooth
formation (25), it was appropriate to determine whether GH is able to
induce BMPs in dental pulp fibroblasts. We report here the use of a
sensitive and specific competitive PCR assay to establish that GH is
able to induce BMP-2 and -4 mRNA expression by these cells in
vitro.
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Materials and Methods
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Materials
Recombinant human GH (hGH) was a gift from Bresagen (Adelaide,
Australia), and recombinant hIGF-I was purchased from Gropep (Adelaide,
Australia). Recombinant BMP-2 and -4 were obtained from the Genetics
Institute (Cambridge, MA). Goat antihuman BMP-2/4 polyclonal antibody
(sc-6267) was obtained from Santa Cruz Biotechnology (Santa Cruz, CA).
The anti-hIGF-I monoclonal antibody (Sm 1.2) was purchased from Upstate
Biotechnology (Lake Placid, NY).
Cell culture
Human third molars extracted for orthodontic or prosthetic
reasons were used to obtain explant cultures of fibroblasts from dental
pulp of these teeth (26). For the experiments described here, fifth
passage cells were cultured in DMEM (ICN Flow, Sydney, Australia)
supplemented with 10% FCS (CSL, Victoria, Australia). Upon reaching
confluence (4 x 105 cells/well, six-well plate),
cells were treated with varying concentrations of recombinant hGH (25,
50, 100, and 200 ng/ml) or recombinant hIGF-I (50, 100, 200, and 300
ng/ml) in 10% FCS, normally for 48 h. To study the response over
time, cells were treated with hGH (100 ng/ml) or hIGF-I (100 ng/ml) for
2, 4, 8, 24, and 48 h. Antihuman IGF-I monoclonal antibody (40
µg/ml) was added to the cultured cells with hGH (100 ng/ml) or IGF-I
(100 ng/ml) where appropriate.
RNA isolation and complementary DNA (cDNA) synthesis
Total cellular RNA was isolated from cultured cells by
guanidine hydrochloride extraction (27). The RNA concentration of all
samples was determined by spectrometer at the same time, and RNA
quality was checked by gel electrophoresis. Extracted RNA was reverse
transcribed under the following conditions: 1 µg RNA with 12.5
ng/µl oligo(deoxythymidine)15 (Promega, Madison, WI) made
to 12 µl with distilled water were heated at 70 C for 10 min, then at
37 C for 60 min with reverse transcription buffer (20 mM
Tris-HCl, pH 8.3; 375 mM KCl; and 15 mM MgCl),
50 mM dithiothreitol, 1 U/µl RNasin (Promega), 500
mM mixed deoxy (d)-NTPs (dATP, dGTP, dCTP, and dTTP), and 5
U/µl Moloneys murine leukemia virus reverse transcriptase
(Promega) (28).
Construction of BMP-2 and BMP-4 competitor cDNA
Competitive PCR requires an internal reference DNA to
amplify along with target cDNA, using the same primers (29, 30). We
constructed homologous reference DNAs of a different size from target
cDNA to allow for visualization and quantitation of target and
reference products on the PCR gel (Fig. 1
) (31). To construct the BMP-2
competitor, BMP-2 PCR sequence-1 (886 bp) was synthesized using the
primers A-1 (5'-CTA CAT TCT AGA CCT GTA TCG C) and B-2
(5'-TGC TGT ACT ATC GAT ACC CAC; see below for conditions).
Primer A contains an XbaI site, and primer B contains a
ClaI site (underlined). The BMP-2 PCR sequence-1
was then subcloned into the XbaI and ClaI sites
of pBluescript II KS- (Stratagene, La Jolla, CA) to create
pBII-BMP2. Unique NcoI and AflII sites within the
subcloned BMP-2 PCR sequence were used to excise a 200-bp fragment from
pBII-BMP2 (Fig. 1
). The resulting truncated construct (pBII-BMP2COM)
was recircularized by end-filling with Klenow polymerase (New England
Biolabs, Beverly, MA) and blunt end ligated with T4 DNA ligase
(Boehringer Mannheim, Mannheim, Germany).

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Figure 1. A schematic diagram showing the construction of a
BMP-2 competitor DNA. Primers A and B are forward and reverse primers,
common to both human BMP-2 cDNA and competitive DNAs.
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To construct BMP-4 competitor DNA, two oligonucleotide primers, A
(5'-ACT TCG AGG CGA CAC TTA TGC) and B (5'-GCT GAA GTC CAC ATA GAG CGA
GTG), were used to PCR the BMP-4-coding sequence (788 bp; see below for
conditions). BMP-4 competitive DNA (495 bp) was created by digestion
with ApaI to remove a 293-bp fragment and religation with T4
DNA ligase.
The sizes of BMP-2 and BMP-4 PCR products and their respective
competitor DNA are shown in Fig. 2
.
Dideoxy sequencing of the BMP-2 and BMP-4 primer products yielded a
sequence identical to the predicted sequence.

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Figure 2. PCR products synthesized from BMP-2 and BMP-4 cDNA
in hormone-treated human cultured dental pulp fibroblasts and their
competitive DNAs. The upper left band is BMP-2 PCR
product (818 bp); the lower left band is BMP-2
competitor DNA PCR product (618 bp). The upper right
band is BMP-4 PCR product (788 bp); the lower right band
is BMP-4 competitor DNA PCR product (495 bp). Upper
bands were amplified from same amount of target cDNA.
Lower bands were amplified from a dilution series of
competitor DNA. For BMP-2, competitor DNA concentrations were, from the
left, 2.4, 1.2, 0.6, 0.3, 0.15, 0.075, 0.038, and 0.019
pg. For BMP-4, 2.5, 1.25, 0.625, 0.312, 0.156, 0.078, 0.039, and 0.02
pg of competitor DNA were used.
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Semiquantitative competitive PCR
For competitive PCR, the target template is coamplified
together with a dilution series of the competitor DNA of known
concentration using the same specific oligonucleotide primers (Table 1
) (29, 30). PCR reactions were carried
out simultaneously in a total volume of 20 µl, comprising target cDNA
(4 µl, from 0.2 µg RNA), competitive DNA (4 µl), 1x reaction
buffer, dNTPs (0.4 mM), MgCl2 (1.5
mM), 0.5 U Taq DNA polymerase (Advanced
Biotechnologies, Surrey, UK), and 0.2 mM of each
primer. Amplification was carried out in a PTC-100TM thermal cycler
(Bresatec, Adelaide, Australia). Cycle conditions for both BMP-2 and
BMP-4 were as follows: denaturation at 93 C for 3 min, followed by 35
cycles of denaturation at 93 C for 1 min, annealing at 60 C for 30 sec,
and extension at 72 C for 1.5 min, followed by further extension at 72
C for 10 min. For each treatment, target cDNAs were amplified from
three separate cell cultures.
Analysis of competitive PCR products
After competitive PCR, samples were electrophoresed in
1.0% agarose Tris-borate EDTA gels and photographed. The
amounts of target DNA and competitive DNA present in each band were
determined by densitometry using the NIH Image program (see Fig. 3
). The band intensity data were
converted to ratios of target DNA to competitive DNA and plotted
logarithmically against the known concentrations of competitive DNA.
The unknown target DNA concentration was determined from the equation
of the linear regression line. The point of equivalence (1:1 ratio when
log y = 0) is where competitive DNA equals target DNA
and represents the concentration of target cDNA in the unknown.

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Figure 3. Standard curve for BMP-2 and BMP-4 mRNA
determination in cultured human pulp fibroblasts. Ratios of target
BMP-2 and BMP-4 cDNA to their competitor DNA (cDNA) were plotted
logarithmically against the known concentrations of competitor DNA.
Unknown target DNA (tDNA) was determined from the equation of the
linear regression line shown under the graph.
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Immunoblot analysis
Cells were scraped from 10-cm dishes, pelleted in cold
PBS, and then resuspended in 300 µl/well lysis buffer (10
mM Tris-HCl, pH 8.0; 5 mM MgCl2; 25
mM KCl; 0.5% Nonidet P-40; 2 mM
phenylmethylsulfonylfluoride; 2 µg/ml leupeptin; 2 µg/ml aprotinin;
and 1 mM EDTA). The lysate was passed 15 times through a
27-gauge needle and incubated in ice for 10 min, and NaCl was then
added to 0.25 M. Cell supernatants were obtained by
centrifugation at 15,000 rpm for 1 h in a microfuge at 4
C.
Expressed BMP-2/4 was immunoprecipitated with 10 µg/ml goat antihuman
BMP-2/4 polyclonal antibody for 1 h at room temperature, followed
by incubation with 20 µl protein G-Sepharose (Pharmacia Biotech,
Uppsala, Sweden) at a 1:1 suspension in PBS for 3 h at 4 C. The
bound antibody complexes were collected by centrifugation at
10,000 x g for 30 sec and then washed twice with
immunoprecipitation buffer (as for lysis buffer, but without Nonidet
P-40) by resuspension, followed by centrifugation.
For immunoblot analysis, 20 µl Laemmli sample buffer (2% SDS, 10%
glycerol, 100 mM dithiothreitol, and 60 mM
Tris-HCl pH 6.8) were added to protein G pellets, and they were heated
at 80 C for 5 min. All of the liquid was then loaded onto 12.5% (for
BMP-2) or 10% (for BMP-4) SDS-polyacrylamide gels. Proteins were
transferred onto nitrocellulose membrane (Hybond C, Amersham,
Aylesbury, UK) using semidry transfer. Membranes were then blocked for
45 min with 5% low fat milk-TBST (20 mM Tris base, 137
mM NaCl, and 0.1% Tween-20, pH 7.6). To detect the BMP-2/4
proteins, blocked membranes were incubated with 2 µg/ml goat
antihuman BMP-2/4 polyclonal antibody in 5% low fat milk-TBST for
3 h at room temperature, then washed three times for 10 min each
time in TBST. Membranes were subsequently incubated with antigoat
horseradish peroxidase-conjugated antibody (NA 9310, Amersham) for 20
min at room temperature, then washed with TBST three times for 10 min
each time. Horseradish peroxidase activity was detected using enhanced
chemiluminescence (ECL+plus, Amersham), followed by exposure to x-ray
film.
Statistics
In all cases comparisons between experimental groups were
undertaken with pooled data using ANOVA and Tukeys
post-hoc test for multiple comparisons. P <
0.05 was considered significant.
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Results
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Effects of GH and IGF-I on BMP expression in human dental pulp
fibroblasts
As shown in Fig. 4
, both hGH and
IGF-I are able to induce BMP-2 messenger RNA (mRNA) and BMP-4 mRNA. GH
is able to stimulate mRNA expression up to 5-fold for BMP-2 and 4-fold
for BMP-4, whereas IGF-I gives a maximum 5-fold stimulation with BMP-2
message and a 3-fold stimulation for BMP-4 mRNA. These stimulations are
seen well within the range of circulating hormone concentrations. The
dose-response curve for GH declines at higher GH concentration for
reasons that are unclear, but the decline is not a result of toxicity,
as this hGH preparation supported maximal proliferation of a Baf/B03
line expressing the hGH receptor up to 500 ng/ml (M. J. Waters,
unpublished observation). Although receptor site 1 occupancy by GH at
high concentrations can produce a bell-shaped curve, the decline is
normally seen only above 1000 ng/ml (32).

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Figure 4. Expression of BMP-2 and -4 RNA in response to
varying concentration of hGH and IGF-I. Relative to control cultures in
10% FCS, significant differences for each treatment are shown as
P < 0.05 (*) and P < 0.01
(**) by ANOVA with Tukeys multiple range test. The error
bars represent the SD. This experiment was
performed three times, each with three separate wells.
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Induction of cellular BMP-2 and BMP-4 proteins was demonstrated by
immunoblot analysis after concentration of cellular BMP by
immunoprecipitation (Fig. 5
). In accord
with the absolute levels of mRNA, induction of BMP-2 protein was
clearly seen after 6 h of hormone treatment, with a low level of
induction seen in the 10% FCS medium control. Induction of BMP-4
protein was more difficult to visualize because the protein runs just
above the light chain of the immunoprecipitating antibody. Again in
agreement with the absolute levels of BMP-4 mRNA, induction of BMP-4
protein was seen after an overnight (16-h) incubation with GH and
IGF-I.

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Figure 5. Immunoblot showing induction of BMP-2 and -4
protein by GH and IGF-I. Human pulpal fibroblasts were treated with
hormones in 10% FCS or 10% FCS alone (6 h for BMP-2, 16 h for
BMP-4) and solubilized, then BMPs were immunoprecipitated with goat
anti-BMP-2/4 antibody, immunoblotted with the same antibody, and then
visualized by ECL as described in Materials and Methods.
A: Lane 1, Recombinant BMP-2, without immunoprecipitation; lane 2,
immunoprecipitation without cells; lane 3, 10% FCS medium control;
lane 4, hGH (100 ng/ml); lane 5, IGF-I (100 ng/ml). B: Lane 1,
Recombinant BMP-4; lane 2, immunoprecipitation without cells; lane 3,
10% FCS medium control; lane 4, hGH (100 ng/ml); lane 5, IGF-I (100
ng/ml). As can be seen from the upper constitutive band, in this
experiment immunoprecipitation recovery from the GH treatment was low,
and that from the IGF-I treatment was high, but in both cases an
induced band was present that is not seen in the control lanes.
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Time course of induction
Induction of BMP-2 and -4 mRNA at optimum hormone concentrations
is shown in Fig. 6
, AD, along with the 10% FCS medium control. Absolute levels of BMP-2
mRNA increased rapidly to a maximum at 4 h, declined, and then
increased slowly over 48 h (Fig. 6A
). When expressed as fold
induction over the 10% FCS medium control, however, there was a
sustained relative induction of BMP-2 mRNA (Fig. 6C
). Absolute levels
of BMP-4 mRNA increased more slowly (Fig. 6B
), but the induction
relative to 10% FCS was quite rapid, reaching a maximum by 4 h
and being sustained thereafter (Fig. 6D
).

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Figure 6. Time course of induction by GH
(100 ng/ml) and IGF-I (100 ng/ml) of BMP-2 mRNA and BMP-4 mRNA in
cultured human dental pulp fibroblasts. A and B, Absolute levels of
mRNA, showing values for 10% FCS medium control for comparison. C and
D, Values expressed as fold induction at each time relative to the 10%
FCS medium control. The error bars represent the
SD. Significant differences from 10% FCS alone were seen
at all time points. The experiment was performed three times, in each
case in triplicate.
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Effect of IGF-I antibody neutralization
To determine whether the actions of GH are mediated through the
induction of IGF-I, anti-hIGF-I was coincubated with the dental pulp
cells during hormone induction. As is apparent from Fig. 7
, although
the antibody was effective in abrogating the IGF-I stimulation, it was
without effect on the GH stimulation of either BMP-2 or BMP-4 mRNA.

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Figure 7. Antibodies against human IGF-I (IGF-IAb) in the
culture medium neutralize the ability of IGF-I, but not GH, to induce
BMP mRNA: GH (100 ng/ml) or IGF-I (100 ng/ml) in 10% FCS or 10% FCS
alone (medium control) was added to human dental pulp fibroblasts and
incubated for 48 h. The third column in each set
shows the effect of simultaneous incubation with anti-hIGF-I (40
µg/ml). Pooled data from three experiments are shown, each with three
wells per point. Values are the mean ± SD.
Significant increases relative to 10% FCS were seen only with IGF-I
alone, but with GH, the antibody incubations were also significantly
different from the 10% FCS control value.
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Discussion
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This study demonstrates for the first time that both GH and IGF-I
are able to induce two important morphogens, BMP-2 and BMP-4. A 4- to
5-fold local induction of these proteins could be expected to result in
many of the inductive effects of BMP seen in the tooth, such as
odontoblast differentiation, dentine formation, and enamel formation.
Epithelial-mesenchymal interactions play a central role in the
regulation of these events. When tissues are dissected from early tooth
germs before the bud stage, only the dental epithelium
instructs tooth development if cultured with nondental neural
crest-derived mesenchyme. After the bud stage, only dental
mesenchyme instructs tooth development when cultured
with nondental epithelium (33, 34). Along with other molecules in the
transforming growth factor-ß superfamily, BMPs are thought to be
involved in tooth development partly because of their expression in
developing tooth germs and partly because of their inductive ability
in vivo (20). BMP-4 mRNA is present in the thickened
presumptive dental epithelium before the tooth bud stage, and
expression subsequently shifts to the condensing dental mesenchyme.
BMP-2 mRNA is expressed in dental epithelium from the early bud stage
until the cap stage, then shifts to mesenchyme (20). Such localization
data suggest that BMPs are associated with the shift of developmental
potential from epithelium to mesenchyme. It is of considerable
relevance, therefore, that GH, GH receptor, and binding protein are
detected at these tissue and developmental stages in rat tooth germs
(25). Furthermore, application of BMPs to exposed dental pulp
mesenchyme (corresponding to the fibroblasts studied here) resulted in
stimulation of rapid fibrodentine (osteodentine) matrix formation and
polarized odontoblast-like cells, which are an indication of cell
differentiation, and are only found in association with this primitive
osteotypic response (23, 35). Likewise, in the same model of the
developing tooth germ, we have demonstrated that both GH and IGF-I
exert inductive effects on differentiation of dental epithelium and
mesenchymal cells (the odontoblasts) in vitro (10, 24).
It may be that GH acts on mesenchymal fibroblasts elsewhere during
later fetal development and postnatally to promote the formation of
tissues where BMP is thought to play such a role, e.g. bone,
cartilage, kidney, lung, gut, skin, and hair, and the reproductive
organs (22). GH receptors are present in all of these tissues, in some
cases at a higher level perinatally than in the adult (36). For
example, hypertrophic chondrocytes forming the secondary ossification
center in the tibia express GH receptors in a location correlating with
BMP action in endochondral ossification (37). The putative involvement
of BMPs in organs undergoing branching through epithelio-mesenchymal
interactions suggest that the ability of GH to induce duct formation in
the mammary gland, for example (38), is a result of its ability to
induce BMPs. As GH and functional GH receptors are expressed first at
the very earliest stages of preimplantation development (39), the
possibility arises that some of the important actions of BMP in
induction of limb patterning and tissue morphogenesis could be a result
of local GH action. The normalcy of these processes in GH-insensitive
Laron dwarfs may be a result of the ability of IGF-I to substitute in
such a role.
The question of mediation of the BMP response by IGF-I was addressed
here in Fig. 7
. The results indicate that
either GH or IGF-I can induce these BMPs, and that GH can still induce
BMPs when IGF-I is inhibited. This result can be explained by parallel
signaling pathways that trans-activate the BMP promoters. These
certainly exist; both GH and IGF-I, for example, activate insulin
receptor substrate-1 and -2, phosphatidylinositol 3- kinase,
and mitogen-activated protein kinase pathways (40, 41). Such parallel
pathways would be advantageous in maintaining signal input; initially,
the GH pulse would initiate an induction of BMP along with IGF-I,
followed by a second induction as a result of IGF-I action, which would
sustain the signal. This would be expected to occur in vivo;
with our in vitro system it appears that local production of
IGF-I is not contributing significantly to GH induction of BMPs over
the 8-h maximum. Confluent adult fibroblasts such as those used here do
synthesize less IGF-I in response to mitogens (42), and the IGF-I
response to GH is less than that to other mitogens (43).
This study raises the issue of the primacy of IGF-I mediation in GH
action. As indicated in the introduction, GH induces a number of other
growth factors or their receptors that could carry out roles in
addition to those of IGF-I. Examples include HGF in the liver (13) and
probably in the tooth, where HGF is also involved in tooth
morphogenesis (44), and fibroblast growth factor in chondrocytes, for
which FGF mRNA is induced much more effectively by GH than is IGF-I
mRNA (14). FGF is a powerful mitogen for chondrocytes (14). Other
examples include induction of TGFß in hepatocytes (45), induction of
EGF receptors in liver and granulosa cells (16, 46), induction of EGF
itself in kidney (15), induction of interleukin-6 in osteoblast-like
cells (47), and induction of thymulin in thymus (48). It seems likely
that GH acts selectively on target tissues by inducing growth factor
combinations as mediators. These may be induced either by pituitary
endocrine GH or by locally synthesized GH, as in the forming tooth germ
(25) or mammary tissue (49).
In conclusion, it is necessary to modify our thinking regarding the
actions of GH on bone and tooth in light of the finding reported here
that GH acts to induce formation of BMPs important in bone and
cartilage formation. The fact that both BMP-4 and IGF-I stimulate
35SO4 incorporation into cartilage (50), and
that both are locally induced by GH should alert us to the likelihood
of that cartilage and bone formation involves more than just the
intermediacy of IGF-I. Thus, a general multi-effector hypothesis
appears more appropriate to explain the many of the actions of GH than
the more traditional dual effector hypothesis (51).
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Acknowledgments
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We thank Xiaoyi Zhu and Tang-sheng Zeng for advice.
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Footnotes
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1 This work was supported by a National Health and Medical Research
Council (Australia) grant. 
Received April 13, 1998.
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