Increased Serum and Bone Matrix Levels of the Secreted Wnt Antagonist DKK-1 in Patients With Growth Hormone Deficiency in Response to Growth Hormone Treatment

Context: Growth hormone (GH) substitution of adult-onset growth hormone deficiency (aoGHD) patients partially reverses unfavorable body composition profile. Wntsignaling pathway has being acknowledged as an important modulator of bone mass and of energy metabolism in adipose tissue and in beta-cells. Objective: To assess the role of selected Wnt antagonists in bone and glucose metabolism before and after GH replacement in aoGHD. Patients and Methods: Patients from two randomized placebo-controlled studies of GH replacement in aoGHD were used. In study 1, 39 patients received GH or placebo for 9 months with 4 months wash-out. In study 2, iliac bone biopsies were obtained before and after GH or placebo (n = 10 each) for 12 months. Body composition and serum (study 1) and bone matrix (study 2) levels of Wnt antagonists (DKK-1, sFRP-3, WIF-1, and SOST) were quantified before and after GH. In vitro effect ofGHandIGF-1onDKK-1secretionandexpression of Wntsignaling modulators was assessed in human osteoblasts and mature adipocytes. Results: GH replacement increased circulating and bone matrix levels of DKK-1, but not sFRP-3, WIF-1, and SOST. Furthermore, DKK-1 secretion increased in human osteoblasts stimulated by GH in vitro, with no effects on other cells. At baseline and after treatment, circulating DKK-1 was negatively associated with bone mass, but not fat mass or measures of insulin resistance, in aoGHD patients. Conclusions: An increase in DKK-1 may limit the effects of GH on bone mass, but does not seem to impact the increase in insulin resistance following GH substitution.