The GH receptor and GH insensitivity.

Growth hormone (GH) resistance/insensitivity (GHIS) is the finding of elevated GH levels associated with a reduction in the biologic actions of GH. It may be congenital or acquired. In congenital GHIS, over 30 mutations in the GH receptor (GHR) have been described. Dimerization of the GHR activates phosphorylation cascades involving MAP kinases and the Janus kinase, JAK2. This in turn activates the STAT (Signal transducers and activators of transcription) proteins, which translocate to the nucleus. A soluble form of the GHR circulates as a GH binding protein (GHBP), and is derived from the proteolytic cleavage of the extracellular domain of the GHR. The majority of GHR mutations resulting in GHIS are though to affect GH binding, hence the finding of low levels of GHBP in many patients. However, a small group of patients with GHIS have been identified in whom there are normal or high levels of GHBP. Mutations in these patients include, among others, a splice-site mutation that results in the skipping of exon 9. The resultant protein is a truncated GHR that lacks 97% of the intracellular domain of the normal receptor. Patients heterozygous for this mutation have GHIS. In vitro studies have shown the truncated receptor acts as a dominant-negative inhibitor of receptor signalling. The truncated receptor lacks the domains essential for internalization, and is therefore highly expressed on the cell surface. It heterodimerizes with the full-length receptor and blocks signaling. Analysis of GHIS has increased our understanding of the molecular basis for GHIS and helped elucidate the factors that regulate GHR trafficking and signalling.