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The term growth factor is generally used to describe a protein or peptide whose function is predominantly, although not exclusively, related to the regulation of target tissue growth and potential proliferation. Growth factors are, therefore, proteins or peptides that are produced by a variety of different cell types and when released into the vasculator interact with and bind to specific receptors on the cell surface eliciting responses within the taerget tissue. The primary result of activating growth factor receptors is cellular proliferation and/or differentiation. Many growth factors are quite versatile, stimulating not only cell growth but also cellular division in numerous different cell types, while others are specific to a particular cell-type.












Cytokines are a class of signaling proteins that are used extensively in cellular communication, immune function and embryogenesis. Cytokines are produced by a variety of hematopoietic and non-hematopoietic cell types and can exert autocrine, paracrine and endocrine effects as do the hormones. They are, therefore, more correctly related to hormones than to growth factors in their overall functions. However, many cytokines also exhibit growth factor activity so they are discussed here as well as in the Peptide Hormones page.

Numerous tissues produce and secrete peptides and proteins that exert effects that, in some cases are growth stimulating, and in others are metabolic and/or cellular homeostasis regulating. Using the terminology adopted for hematopoietic modulating proteins (the cytokines) the descriptors for these peptides and proteins includes "kine" as the suffix. Adipose tissue secretes in excess of 50 different homeostatic regulatory proteins and these factors are collectively termed adipokines. Similarly the liver, primarily hepatocytes, also secretes a number of homeostatic regulatory factors and they are collectively referred to as hepatokines. Skeletal muscle also synthesizes and secretes several homeostatic regulatory peptides and proteins termed myokines. Although many of these peptides and proteins are exclusive to a specific tissues many of the adipokins, hepatokines, and myokines are not exclusive to these tissues but are produced by several other tissues and cells. Many of these factors are also classical peptide hormones and more details are discussed in the Peptide Hormones page.

The lists in the following Tables, as well as the descriptions of several factors, are not intended to be comprehensive nor complete but a look at some of the more commonly known factors and their principal activities.

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Growth Factors

Factor Principal Source Primary Activity Comments
EGF submaxillary gland, Brunners gland promotes proliferation of mesenchymal, glial and epithelial cells represents the founding member of the EGF-family of proteins that includes, but is not limited to, transforming growth factor-α (TGF-α), amphiregulin, and the neuregulins (neuregulin-1, -2, -3, and -4)
Erythropoietin kidney promotes proliferation and differentiation of erythrocytes  
FGF wide range of cells; protein is associated with the ECM promotes proliferation of many cells; inhibits some stem cells; induces mesoderm to form in early embryos at least 18 family members, 5 distinct receptors
IGF-1 primarily liver promotes proliferation of many cell types related to IGF-2 and proinsulin, also called somatomedin C
IGF-2 variety of cells promotes proliferation of many cell types primarily of fetal origin related to IGF-1 and proinsulin
NGF mast cells, eosinophils, bone marrow stromal cells, keratinocytes promotes neurite outgrowth and neural cell survival member of a family of proteins termed neurotrophins that promote proliferation and survival of neurons; neurotrophin receptors are a class of related proteins first identified as proto-oncogenes: TrkA ("trackA"), TrkB, TrkC
PDGF platelets, endothelial cells, placenta promotes proliferation of connective tissue, glial and smooth muscle cells represents a family of four peptides encoded by four distinct genes: A, B, C, and D; these four peptides form either homo- or heterodimers such that five distinct biologically active PDGF isoforms (AA, AB, BB, CC, DD) result
TGF-α macrophages, keratinocytes, hypothalamic astrocytes; commonly expressed by transformed cells important for normal wound healing, cellular proliferation, female reproductive maturation, embryogenesis is a member of the EGF-family of proteins; functions by binding to the EGF receptor
TGF-β activated Th1 cells (T-helper) and natural killer (NK) cells anti-inflammatory (suppresses cytokine production and class II MHC expression), promotes wound healing, inhibits macrophage and lymphocyte proliferation at least 100 different family members

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Interleukins and Cytokines

Cytokines are a unique family of growth factors. Secreted primarily from leukocytes, cytokines stimulate both the humoral and cellular immune responses, as well as the activation of phagocytic cells. Cytokines that are secreted from lymphocytes are termed lymphokines, whereas those secreted by monocytes or macrophages are termed monokines. A large family of cytokines are produced by various cells of the body. Many of the lymphokines are also known as interleukins (ILs), since they are not only secreted by leukocytes but also able to affect the cellular responses of leukocytes. Specifically, interleukins are growth factors targeted to cells of hematopoietic origin. The list of identified interleukins grows continuously with the total number of individual activities now at 43 (18 are listed in the Table below).

Interleukins Principal Source Primary Activity
IL1-α and -β macrophages and other antigen presenting cells (APCs) co-stimulation of APCs and T cells, inflammation and fever, acute phase response, hematopoiesis
IL-2 activated Th1 cells, NK cells proliferation of B cells and activated T cells, NK functions
IL-3 activated T cells growth of hematopoietic progenitor cells
IL-4 Th2 and mast cells B cell proliferation, eosinophil and mast cell growth and function, IgE and class II MHC expression on B cells, inhibition of monokine production
IL-5 Th2 and mast cells eosinophil growth and function
IL-6 activated Th2 cells, APCs, other somatic cells such as hepatocytes and adipocytes acute phase response, B cell proliferation, thrombopoiesis, synergistic with IL-1β and TNF on T cells
IL-7 thymic and marrow stromal cells T and B lymphopoiesis
IL-8 macrophages, other somatic cells chemoattractant for neutrophils and T cells
IL-9 T cells hematopoietic and thymopoietic effects
IL-10 activated Th2 cells, CD8+ T and B cells, macrophages inhibits cytokine production, promotes B cell proliferation and antibody production, suppresses cellular immunity, mast cell growth
IL-11 bone marrow stromal cells synergisitc hematopoietic and thrombopoietic effects
IL-12 B cells, T cells, macrophages, dendritic cells proliferation of NK cells, INF-γ production, promotes cell-mediated immune functions
IL-13 Th2 cells, B cells, macrophages stimulates growth and proliferation of B cells, inhibits production of macrophage inflammatory cytokines
IL-14 T cells and malignant B cells regulates the growth and proliferation of B cells
IL-15 monocytes, thyroid, lymph nodes, myocytes induces production of NK cells
IL-16 eosinophils, CD8+ T cells, lymphocytes, epithelial cells chemoattractant for CD4+ cells
IL-17: six isoforms all from different genes;
IL-17A, B, C, D, E, and F (IL-17E also called IL-25)
A and F forms only expressed in a subset of T cells; B expressed in leukocytes and peripheral tissues; C up-regulated during inflammation; D expressed in nervous system and skeletal muscle; E expressed in peripheral tissues increases production of inflammatory cytokines, angiogenesis, affects endothelial and epithelial cells
IL-18 macrophages increases NK cell activity, induces production of INF-γ
Interferons Principal Source Primary Activity
INF-α and -β macrophages, neutrophils and some somatic cells antiviral effects, induction of class I MHC on all somatic cells, activation of NK cells and macrophages
INF-γ activated Th1 and NK cells induces of class I MHC on all somatic cells, induces class II MHC on APCs and somatic cells, activates macrophages, neutrophils, NK cells, promotes cell-mediated immunity, antiviral effects

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Adipose tissue is not merely an organ designed to passively store excess carbon in the form of fatty acids esterified to glycerol (triglycerides). Mature adipocytes synthesize and secrete numerous enzymes, growth factors, cytokines and hormones that are involved in overall energy homeostasis. Many of the factors that influence adipogenesis are also involved in diverse processes in the body including lipid homeostasis and modulation of inflammatory responses. In addition, a number of proteins secreted by adipocytes play important roles in these same processes. In fact recent evidence has demonstrated that many factors secreted from adipocytes are proinflammatory mediators and these proteins have been termed adipocytokines or adipokines. Members of this class of protein secreted from adipocytes include TNF-α, IL-6 and leptin. Listed in the Table below is only a subset of proteins known to be secreted by adipose tissue and the focus is on those that effect overall metabolic homeostasis and modulate inflammatory processes. As is clear from the Table, not all the proteins are unique to adipose tissue.

Factor Principal Source Major Actions / Comments
also called adipocyte complement factor 1q-related protein (ACRP30), and adipoQ
adipocytes see Adipose Tissue page
adipsin (also called complement factor D) adipocytes, liver, monocytes, macrophages rate limiting enzyme in complement activation
apelin adipocytes, vascular stromal cells, heart levels increase with increased insulin, exerts positive hemodynamic effects, may regulate insulin resistance by facilitating expression of BAT uncoupling proteins (e.g. UCP1, thermogenein)
chemerin adipocytes, liver modulates expression of adipocyte genes involved in glucose and lipid homeostasis such as GLUT4 and fatty acid synthase (FAS); potent anti-inflammatory effects on macrophages expressing the chemerin receptor (chemokine-like receptor-1, CMKLR1)
C-reactive protein (CRP) hepatocytes, adipocytes is a member of the pentraxin family of calcium-dependent ligand binding proteins; assists complement interaction with foreign and damaged cells; enhances phagocytosis by macrophages; levels of expression regulated by circulating IL-6; modulates endothelial cell functions by inducing expression of various cell adhesion molecules, e.g. ICAM-1, VCAM-1, and selectins; induces MCP-1 expression in endothelium; attenuates NO production by downregulating NOS expression; increase expression and activity of PAI-1
IL-6 adipocytes, hepatocytes, skeletal muscle, activated Th2 cells, and antigen-presenting cells (APCs) acute phase response, B cell proliferation, thrombopoiesis, synergistic with IL-1 and TNFα on T cells; enhances fatty acid uptake and glucose metabolism in liver and adipose tissue; enhances insulin production by pancreas
leptin predominantly adipocytes, mammary gland, intestine, muscle, placenta see Adipose Tissue page
monocyte chemotactic protein-1 (MCP-1) leukocytes, adipocytes is a chemokine defined as CCL2 (C-C motif, ligand 2); recruits monocytes, T cells, and dendritic cells to sites of infection and tissue injury
omentin visceral stromal vascular cells of omental adipose tissue the omentum is one of the peritoneal folds that connects the stomach to other abdominal tissues, enhances insulin-stimulated glucose transport, levels in the blood inversely correlated with obesity and insulin resistance
plasminogen-activator inhibitor-1 (PAI-1) adipocytes, monocytes, placenta, platelets, endometrium see the Blood Coagulation page
resistin adipocytes, spleen, monocytes, macrophages, lung, kidney, bone marrow, placenta see Adipose Tissue page
TNFα primarily activated macrophages, adipocytes induces expression of other autocrine growth factors, increases cellular responsiveness to growth factors and induces signaling pathways that lead to proliferation
vaspin visceral and subcutaneous adipose tissue is a serine protease inhibitor, levels decrease with worsening diabetes, increase with obesity and impaired insulin sensitivity
visfatin; also called pre-B cell colony-enhancing factor (PBEF); these two independent activities are identical to the enzyme nicotinamide phosphoribosyltransferase (NAMPT) ubiquitously expressed with highest levels of expression in visceral white adipose tissue was originally reported to have insulin mimetic effects but that paper was subsequently retracted; the intracellular version of NAMPT (sometimes referred to as iNAMPT) has nicotinamide phosphoribosyltransferase activity; the extracellular version (eNAMPT) exhibits cytokine-like activity; conflicting results relative to insulin receptor binding but blocking insulin receptor signaling interferes with effects of eNAMPT; changes in NAMPT activity occur during fasting and positively regulate the activity of the NAD+-dependent deacetylase, SIRT1, leading to alterations in gene expression

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Hepatocytes produce and secrete hundreds of proteins and peptides. Indeed, a major function of the liver is to produce a multitude of proteins that are found circulating in the vasculature and perform a wide array of functions. The proteins and peptides presented in the following Table are not intended to be a complete assessment of all the hepatocte derived factors but is a focus on several highly significant proteins that have been shown to exert autocrine, paracrine, and endocrine effects. In particular, the focus is on many of the factors that, when released from the liver, exert global whole body homeostatic processes. The major pathophysiologically significant hepatokines are those that exert regulatory effects on overall lipoid and glucose homeostasis. As might be expected, disruptions in the regulated synthesis and release of these hepatokines contribute to the pathologies of obesity and type 2 diabetes. Many of the hepatokines indicated in the following Table are not unique to the liver but are also expressed and secreted from other tissues as well such as identified adipokines (outlined in the previous Table) and myokines (outlined in the next Table).

Factor Principal Source Major Actions / Comments
angiopoietin-like 3 (ANGPTL3) hepatocytes more details in Lipoproteins page
angiopoietin-like 4 (ANGPTL4) hepatocytes more details in Lipoproteins page
angiopoietin-like 6 (ANGPTL6) hepatocytes originally identified as angiopoietin-related growth factor (AGF); functional ANGPTL6 is associated with lean body mass, protection from obesity, and enhanced insulin sensitivity; conversely reduced levels of ANGPTL6 are correlated with obesity and insulin resistance, accumulation of lipid in the liver and skeletal muscle, and reduced overall energy expenditure
angiopoietin-like 8 (ANGPTL8) hepatocytes more details in Lipoproteins page
C-reactive protein (CRP) hepatocytes, adipocytes is a member of the pentraxin family of calcium-dependent ligand binding proteins; assists complement interaction with foreign and damaged cells; enhances phagocytosis by macrophages; levels of expression regulated by circulating IL-6; modulates endothelial cell functions by inducing expression of various cell adhesion molecules, e.g. ICAM-1, VCAM-1, and selectins; induces MCP-1 expression in endothelium; attenuates NO production by downregulating NOS expression; increase expression and activity of PAI-1
fetuin A (AHSG) hepatocytes member of the family of liver produced and secreted binding proteins that function as cargo transporters in the blood; (albumin represents archetypal family member); name derived from the fact that levelsare most abundant in fetal blood; protein is derived from the α2-HS-glycoprotein (AHSG) gene; originally associated with inhibition of vascular calcification; is a naturally occuring inhibitor of insulin receptor tyrosine kinase activity in liver and skeletal muscle; polymorphism in the AHSG gene associated with type 2 diabetes; levels of fetuin A in circulation increase in hepatic steatosis (fatty infiltration of the liver); strongly enhances inflammatory cytokine production in macrophages and adipocytes; inhibits adipocyte production of adiponectin
fetuin B hepatocytes encoded by FETUB gene; reduces glucose effectiveness; expression increased in non-alcoholic fatty liver disease (NAFLD); increased circulating levels associated with type 2 diabetes
FGF21 hepatocytes, adipose tissue, myocytes, pancreas, duodenum hepatic expression enhanced by glucagon through AMPK and PPARα effects; thyroid hormones and glucocorticoids also enhance hepatic FGF21 expression; increases fat utilization and energy expenditure, reduces body weight, reduces whole-body fat mass, reduces lipid content in hepatocytes, improves glucose tolerance, enhances hepatic and peripheral insulin sensitivity; levels of hepatic expression increase in pathologic states such as hepatic steatosis, type 2 diabetes, obesity, and insulin resistance
fibrinogen-like protein 1 (hepassocin) hepatocytes encoded by the FGL1 gene; functions as a hepatocyte growth factor involved in liver regeneration; increased secretion from hepatocytes is associated with insulin resistance and impaired glucose tolerance; enhances the potential for hepatic steatosis
insulin-like growth factor 1 (IGF-1) hepatocytes provide the vast majority of circulating IGF-1 see the IGF-1 section below
leukocyte cell-derived chemotaxin 2 (LECT2) hepatocytes provide the vast majority of circulating LECT2; other cells express the LECT2 gene such as adipocytes and smooth muscle cells chemoattractant for neutrophils; regulator of chondrocyte differentiation; levels of LECT2 in circulation are associated with obesity, type 2 diabetes, and non-alcoholic fatty liver disease (NAFLD)
selenoprotein P (SELPP) hepatocytes major selenium transport protein; increased circulating levels associated with insulin resistance; expression reduced in response to insulin; expression elevated by glucose and fatty acids (primarily palmitate); elevated serum selenoprotein P associated with insulin resistance and vascular inflammation; levels of selenoprotein P are inversely correlated to those of adiponectin
serum hormone binding globulin (SHBG) hepatocytes; also brain, uterus, testes, placenta normally binds androgens and estrogen in plasma; high circulating levels protect from type 2 diabetes development; reduced levels associated with increased risk for cardiovascular disease; levels decline with hepatic steatosis; polymorphisms in SHBG gene associated with insulin resistance and type 2 diabetes

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Like adipose tissue and the liver, skeletal mucle produces and secretes a number of proteins and peptides that exert autocrine, paracrine, and endocrine effects. These proteins are collectively referred to as myokines. Like adipokines and hepatokines, many of ther regulatory proteins secreted from skeletal muscle are also secreted by other tissues such as the liver and adipose tissue.

Factor Principal Source Major Actions / Comments
angiopoietin 1 (ANGPT1) cardiac myocytes, smooth muscle promotes muscle growth and homeostasis; prevents insulin resistance
brain derived neurotrophic factor (BDNF) cardiac myocytes; smooth muscle; various brain regions increased β-oxidation of fatty acids; increased glucose oxidation; enhances neurogenesis in the brain improving cognition and spatial memory
ciliary neurotrophic factor receptor (CNTFR) cardiac myocytes, smooth muscle functions as a muscle paracrine factor stimulating innervation cell differentiation, and overall muscle homeostasis
FGF21 hepatocytes, adipose tissue, myocytes, pancreas, duodenum increases fat utilization and energy expenditure, reduces body weight, reduces whole-body fat mass, reduces lipid content in hepatocytes, improves glucose tolerance, enhances hepatic and peripheral insulin sensitivity
follistatin-like protein 1 (FSTL1) cardiac myocytes, smooth muscle, adipocytes exerts cardioprotective effects
IL-6 adipocytes, hepatocytes, skeletal muscle, activated Th2 cells, and antigen-presenting cells (APCs) enhances fatty acid uptake and glucose metabolism in liver and adipose tissue; enhances insulin production by pancreas
IL-15 monocytes, thyroid, lymph nodes, myocytes enhances muscle hypertrophy; enhances fatty acid β-oxidation and thermogenesis in brown adipose tissue (BAT)
insulin-like growth factor 1 (IGF-1) hepatocytes provide the vast majority of circulating IGF-1; myocytes produce locally acting IGF-1 see the IGF-1 section below
irisin skeletal muscle see the Peptide Hormones page
musclin skeletal muscle is encoded by the osteocrin (OSTN) gene; highly related to natriuretic peptides; expression of the OSTN gene stimulated by insulin; production and secretion stimulated by exercise to promote exercise tolerance via enhanced oxidative phosphorylation; exhibits cardioprotective effects; modulates cardiovascular functions such as blood pressure
myonectin skeletal muscle functions as a nutrient responsive regulator of total body fatty acid metabolism; enhances liver and adipose tissue fatty acid uptake and glucose metabolism
myostatin skeletal muscle also known as growth differentiation factor 8 (GDF8); enhances glucose and fatty acid oxidation in skeletal muscle; involved in muscle growth and overall homeostasis; stimulates bone formation and maintenance
vascular endothelial growth factor A (VEGFA) myocytes; numerous other cell types enhances fatty acid and glucose oxidation in skeletal muscle; promotes myocyte differentiation; enhances vasodilation promoting fuel delivery to muscle

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Epidermal Growth Factor (EGF)

EGF is synthesized as a preproprotein that is processed to a 53 amino acid functional growth factor. The EGF preproprotein is derived from the EGF gene which is located on chromosome 4q25 and is composed of 26 exons that generate three alternatively spliced mRNAs. There are several proteins that are related to EGF in that they bind and activate the same receptors. The EGF family of proteins includes TGF-α, amphiregulin, epiregulin, heparin-binding EGF-like growth factor (HB-EGF), epigen (epithelial mitogen), betacellulin, and the four neuregulin proteins.

Like all growth factors, EGF binds to specific high-affinity, low-capacity receptors (EGFR) on the surface of responsive cells. Intrinsic to the EGF receptor is tyrosine kinase activity, which is activated in response to EGF binding. The kinase domain of the EGF receptor phosphorylates the EGF receptor itself (autophosphorylation; also referred to as transphosphorylation) as well as other proteins, in signal transduction cascades, that associate with the receptor following its activation by EGF or other ligands.

The EGF receptor is derived from the EGFR gene which is located on chromosome 7p12 and is composed of 30 exons that generate four alternatively spliced mRNAs, each of which encode a distinct protein. The major transmembrane-spanning EGF receptor is derived from the EGFR isoform a encoding mRNA. This precursor protein is composed of 1210 amino acids. The EGFR isoforms b, c, and d mRNAs encoded proteins that only contain the extracellular domain of the full-length isoform a receptor.

The EGFR gene encoded protein is also known as HER1 for human EGF receptor 1 or as ERBB1. There are three additional EGF receptor family proteins that are encoded by the ERBB2, ERBB3, and ERBB4 genes. These designations refer to their initial identification as being receptors for the ERB-B2 oncogene. The ERBB2 gene encoded protein is also known as the NEU proto-oncogene and is also referred to as HER2. The ERBB3 gene encoded protein is also known as HER3 and the ERBB4 gene encoded protein is also referred to as HER4. In addition to EGF the EGFR encoded protein is known to bind several members of the EGF family of proteins that includes TGF-α, amphiregulin, epiregulin, epigen, HB-EGF, and betacellulin. The ERBB2 encoded protein does not bind ligand but resides in the membrane in a conformation that closely mimics ligand-bound EGFR, ERBB3, and ERBB4 encoded proteins. The ERBB3 encoded protein is the receptor for neuregulin 1 and neuregulin 2. The ERBB4 encode protein binds HB-EGF and all four of the neuregulin proteins. Upon ligand binding the EGFR encoded protein forms homodimers but can also form heterodimers with the ERBB2 encoded receptor. The ERBB2 encoded receptor also forms heterodimers with the ERBB3 and ERBB4 encoded receptors.

EGF has proliferative effects on cells of both mesodermal and ectodermal origin, particularly keratinocytes and fibroblasts. EGF exhibits negative growth effects on certain carcinomas as well as hair follicle cells. Growth-related responses to EGF include the induction of nuclear proto-oncogene expression, such as FOS, JUN and MYC. EGF also exerts effects on metabolic processes such as decreasing gastric acid secretion, and increasing the rate of glycolysis.

The growth and proliferative effects of EGF as well as the metabolic effects are exerted in response to the activation of numerous divergent signal transduction pathways in response to EGF-mediated activation of the EGFR. As indicated, activation of the EGFR results in the incorporation of phosphate residues onto tyrosine residues in the receptor protein itself. These phosphotyrosine residues act as docking sites for numerous signal transduction proteins that contain an SH2 domain.

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Platelet-Derived Growth Factor (PDGF)

The PDGF is either a homodimeric or heterodimeric growth factor. The PDGF composition is determined by the expression of four distinct polypeotides encoded by four different genes. The PDGF peptides are identified as PDGF-A, -B, -C, and -D. These four PDGF peptides result in five distinct dimeric forms of PDGF (PDGF-AA, -AB, -BB, -CC, and -DD). The SIS proto-oncogene has been shown to be homologous to the PDGF-B peptide. Only dimeric forms of PDGF interact with the PDGF receptors. The PDGF-A preproprotein is derived from the PDGFA gene which is located on chromosome 7p22 and is composed of 9 exons that generate two alternatively spliced mRNAs. PDGF-A isoform 1 is a 211 amino acid preproprotein and isoform 2, which lacks the coding information from exon 6, is a 196 amino acid preproprotein. The PDGF-B preproprotein is derived from the PDGFB gene which is located on chromosome 22q13.1 and is composed of 8 exons that generate two alternatively spliced mRNAs. PDGF-B isoform 1 is a 241 amino acid preproprotein. The PDGF-B isoform 2 protein may not undergo processing to a function protein. The PDGF-C preproprotein is derived from the PDGFC gene which is located on chromosome 4q32 and is composed of 9 exons that encode a 345 amino acid preproprotein. The PDGF-D preproprotein is derived from the PDGFD gene which is located on chromosome 11q22.3 and is composed of 7 exons that generate two alternatively spliced mRNAs. PDGF-D isoform 1 is a 370 amino acid preproprotein ans PDGF-D isoform 2 is a 364 amino acid preproprotein.

Three distinct forms of the PDGF receptor have been identified that result from the dimerization of proteins expressed from two different genes. The composition of these three receptor types are αα, αβ, and ββ. Like the EGF receptor, the PDGF receptors have intrinsic tyrosine kinase activity. Following autophosphorylation of the PDGF receptor, numerous signal-transducing proteins associate with the receptor and are subsequently tyrosine phosphorylated. The PDGF receptor α (alpha) protein is encoded by the PDGFRA gene which is located on chromosome 4q12 and is composed of 28 exons that encode a 1089 amino acid precursor protein. The PDGF receptor β (beta) protein is encoded by the PDGFRB gene which is located on chromosome 5q33.1 and is composed of 26 exons that encode a amino acid precursor protein. The PDGF-AA isoform binds exclusively to the PDGFR-αα type receptor. The PDGF-BB isoform can bind to all three types for PDGFR. The PDGF-AB isoform binds to the PDGFR-αα and PDGFR-αβ type receptors. The PDGF-CC isoform, like the PDGF-AB isoforms, specifically binds to the PDGFR-αα and PDGFR-αβ type receptors. The PDGF-DD isoform binds with highest affinity to the PDGFR-ββ type receptors.

Proliferative responses to PDGF action are exerted on many mesenchymal cell types. Other growth-related responses to PDGF include cytoskeletal rearrangement and increased polyphosphoinositol turnover. Again, like EGF, PDGF induces the expression of a number of nuclear localized proto-oncogenes, such as FOS, MYC and JUN. Indeed, the primary effects of TGF-β are due to the induction, by TGF-β, of PDGF expression.

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Fibroblast Growth Factors (FGFs)

The fibroblast growth factor (FGF) family consists of 22 genes in the human genome. Of these 22 genes there are currently 18 that produce growth factors that have been characterized to function through activation of the FGF receptors. These members are numbered FGF1–FGF10 and FGF16–FGF23. These 18 proteins are divided into six different FGF families based upon differences in sequence homology.

Family 1 (FGF1 subfamily): FGF1 and FGF2

Family 2 (FGF7 subfamily): FGF3, FGF7, FGF10, and FGF22

Family 3 (FGF4 subfamily): FGF4, FGF5, and FGF6

Family 4 (FGF8 subfamily): FGF8, FGF17, and FGF18

Family 5 (FGF9 subfamily): FGF9, FGF16, and FGF20

Family 6 (FGF19 subfamily):FGF19, FGF21, and FGF23

There are four additional genes in humans that express FGF-related proteins (FGF11–FGF14; also referred to as the FGF11 subfamily). Although the FGF11 subfamily proteins contain amino acid sequence homology to members of the six functional FGF subfamilies they do not activate the FGF receptors and are thus, not considered members of the FGF family but are FGF homologous factors. Of note is the fact that human FGF19 is the orthologue of mouse FGF15.

The two originally characterized FGFs were identified by biological assay and are termed FGF1 (acidic-FGF, aFGF) and FGF2 (basic-FGF, bFGF). In mice, the mammary tumor virus integrates at two predominant sites in the mouse genome identified as Int-1 and Int-2. The protein encoded by the Int-2 locus turned out to be a homologue of the FGF family of growth factors and is now called FGF3. Kaposi sarcoma cells (prevalent in patients with AIDS) were found to secrete a homologue of FGF originally called the K-FGF proto-oncogene, it is now known as FGF4.

Studies of human disorders as well as gene knock-out studies in mice show the prominent role for FGFs is in the development of the skeletal system and nervous system in mammals. FGFs also are neurotrophic for cells of both the peripheral and central nervous system. Additionally, several members of the FGF family are potent inducers of mesodermal differentiation in early embryos. Non-proliferative effects include regulation of pituitary and ovarian cell function. The members of the first five families of FGFs all function in a paracrine manner (meaning the target tissue is near the site of hormone synthesis and release).

The FGF19 Subfamily

The proteins of the sixth FGF subfamily (members FGF19, FGF21, and FGF23) each act in an endocrine manner (meaning the target tissue is distant from the site of hormone synthesis and release) to regulate glucose, cholesterol, bile acid, vitamin D, and phosphate homeostasis. Although FGF19, FGF21, and FGF23 interact with known FGF receptors they do so only in the presence of a binding partner. This binding partner is identified as Klotho (also known as alpha Klotho: αKlotho). The Klotho gene was originally isolated from a mouse model of age-related disorders and thus the gene was named after the Fate of Greek mythology who spins the thread of life. Subsequent to the isolation of the αKlotho gene another related gene termed βKlotho was identified. Both αKlotho and βKlotho are involved in the interactions of FGF19, FGF21, and FGF23 with FGF receptors. Although these three FGFs belong to a distinct FGF subfamily and each acts as an endocrine factor they have distinct physiological roles. FGF19 is involved in the control of cholesterol and bile acid synthesis. FGF19 is also involved is the control feeding behaviors through its effects within the hypothalamus. The details of FGF19 function in the regulation of hypothalamic activity are discussed in the Gut-Brain Interrelationships page. FGF21 is a liver-derived hormone involved in the regulation of glucose and lipid homeostasis. FGF21 is also important to digestive processes through its actions on exocrine pancreatic cells stimulating them to release their zymogen granule contents into the small intestine. FGF21 mimetics are currently being studied in human trials to ascertain their utility in the treatment of obesity and type 2 diabetes. Studies with FGF21 mimetics in humans demonstrated that in obese individuals there was a significant improvement in overall serum lipid levels. FGF23 is a bone-derived hormone that plays an important role as a potent regulator of vitamin D and phosphate metabolism. The effects of FGF23 are exerted primarily within the kidney where its actions result in increased phosphate excretion and suppression of calcitriol (1,25-dihydroxyvitamin D3) synthesis.

The FGF Receptors, FGFR

The FGFs interact with specific cell-surface receptors. There are five distinct receptor types, identified as FGFR1–FGFR4, and FGFRL1, that bind the various FGF ligands. Due to alternative splicing the FGFR1 and FGFR2 genes generate several receptor isoforms each. The complexity of FGF receptor isoforms is further compounded by a complex nomenclature system. Each of the FGFR gene encoded proteins contains multiple immunoglobulin-like (Ig-like) loops in the extrcellular portion of the protein. If the resultant protein contains three Ig-like loops it is referred to as an alpha(α)-type receptor. If the protein possesses only the second and third Ig-like loops it is referred to as a beta(β)-type receptor. If the encoded protein lacks a secretory signal it is referred to as a gamma(γ)-type receptor. The binding sites for FGF span the second and third Ig-like loops. The third Ig-like loop (identified by the Roman numeral system: III) of both the FGFR1 and FGFR2 encoded proteins exists in three isoforms identified as IIIa, IIIb, and IIIc. The IIIa isoform is a secreted form of the FGFR. The IIIb and IIIc isoforms of the receptors differ in specificity for different FGF proteins for example the FGFR1 IIIb isoform binds FGF1 while the IIIc form binds FGF1, FGF2, and FGF7. Within the cytoplasmic portion of the receptors if there is a Thr-Val insert distal to the membrane spanning domain the receptor is identified as an "a" form, if the insert is absent it is identified as a "b" form. Finally, with respect to the tyrosine kinase domain, a full catalytic domain receptor is form 1 while a truncated cataytic domain receptor is form 2. As an example, the FGFR1 isoform identifed as αa2(IIIc) results from the alternatively spliced mRNA from the FGFR1 gene that encodes a protein containing three Ig-like loops in the extracellular region, a Thr-Val insert after the transmembrane domain, a truncated tyrosine kinase domain, and the IIIc variant of the third Ig-like loop.

Each of the four receptors encoded by the FGFR1–FGFR4 genes has intrinsic tyrosine kinase activity similar to other receptor tyrosine kinase (RTK) family members such as the EGF and PDGF receptors. As with all transmembrane receptors tha have tyrosine kinase activity, autophosphorylation of the receptor is the immediate response to FGF binding. Following activation of FGF receptors, numerous signal-transducing proteins associate with the receptor and become tyrosine-phosphorylated. The additional protein of the FGF receptor family encoded by the FGF receptor like 1 (FGFRL1) gene is distinct from the FGFR1–FGFR4 receptors. The FGFRL1 gene was originally identified as FGFR5, however, unlike the other four FGF receptors the protein encoded by the FGFRL1 gene does not possess a cytoplasmic tyrosine kinase domain.

The FLG proto-oncogene is a homologue of the FGF receptor family. The FGFR1 receptor also has been shown to be the portal of entry into cells for herpes viruses. FGFs also bind to cell-surface heparan-sulfated proteoglycans with low affinity relative to that of the specific receptors. The purpose in binding of FGFs to these proteoglycans is not completely understood but may allow the growth factor to remain associated with the extracellular surface of cells that they are intended to stimulate under various conditions.

The FGF receptors are widely expressed in developing bone and several common autosomal dominant disorders of bone growth have been shown to result from mutations in the FGFR genes. The most prevalent is achondroplasia, ACH. ACH is characterized by disproportionate short stature, where the limbs are shorter than the trunk, and macrocephaly (excessive head size). Almost all persons with ACH exhibit a glycine to arginine substitution in the transmembrane domain of FGFR3. This mutation results in ligand-independent activation of the receptor. FGFR3 is predominantly expressed in quiescent chondrocytes where it is responsible for restricting chondrocyte proliferation and differentiation. In mice with inactivating mutations in FGFR3 there is an expansion of long bone growth and zones of proliferating cartilage further demonstrating that FGFR3 is necessary to control the rate and amount of chondrocyte growth.

Human FGF Receptor-Related Disorders

Several other disorders of bone growth collectively identified as craniosynostosis syndromes have been shown to result from mutations in FGFR1, FGFR2 and FGFR3. Sometimes the same mutation can cause two or more different craniosynostosis syndromes. A cysteine to tyrosine substitution in FGFR2 can cause either Pfeiffer or Crouzon syndrome. This phenomenon indicates that additional factors are likely responsible for the different phenotypes. For additional information on the craniosynostosis syndromes see the GeneReviews page on these disorders.

Affected Receptor Syndrome Phenotypes
FGFR1 Pfeiffer craniosynostosis (premature skull bone fusion); hypertelorism (wide-spaced eyes); micrognathia (small jaw); beaked nose; high forehead; brachydactyly (short fingers and toes); syndachtyly (digit fusion); autosomal dominant inheritance; type 1 disease associated with either FGFR1 or FGFR2 mutaitons, type 2 and 3 disease caused by FGFR2 mutations only
FGFR2 Apert craniosynostosis (premature skull bone fusion); fusion of digits; mild to moderate mental retardation; autosomal dominant inheritance
FGFR2 Beare-Stevenson craniosynostosis (premature skull bone fusion); cutis gyrata (corrugated skin); acanthosis nigricans (thick, dark skin patches); fewer than 20 person world-wide known to have disease; autosoaml dominant inheritance
FGFR2 Crouzon craniosynostosis (premature skull bone fusion); ocular proptosis (eyeball protrusion); hearing loss; underdeveloped upper jaw; autosomal dominant inheritance
FGFR2 Jackson-Weiss craniosynostosis (premature skull bone fusion); syndachtyly; wide and short big toes that point away from other toes; autosomal dominant inheritance
FGFR2 Pfeiffer same as for FGFR1 mutations
FGFR3 Achondroplasia short-limbed dwarfism; macrocephaly; lordosis (sway back); bowed legs; kyphosis (abnormal front-to-back spine curvature); autosomal dominant inheritance; 80% due to new mutaitons, highly correlated to increased age of father
FGFR3 Crouzonodermoskeletal syndrome craniosynostosis (premature skull bone fusion); acanthosis nigricans; beaked nose; underdeveloped upper jaw; ocular proptosis; strabismus (eyes that point in different directions); autosomal dominant inheritance

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Transforming Growth Factors-β (TGFs-β)

A more detailed description of the TGF-β family of growth factors and associated signaling pathways can be found on the Signaling by Wnts and TGFs-β/BMP page.

TGF-β was originally characterized as a protein (secreted from a tumor cell line) that was capable of inducing a transformed phenotype in non-neoplastic cells in culture. This effect was reversible, as demonstrated by the reversion of the cells to a normal phenotype following removal of the TGF-β. Subsequently, many proteins homologous to TGF-β have been identified. The four closest relatives are TGF-β1 (the original TGF-β) through TGF-β5 (TGF-β1 is the same as TGF-β4). All four of these proteins share extensive regions of similarity in their amino acids. Many other proteins, possessing distinct biological functions, have stretches of amino-acid homology to the TGF-β family of proteins, particularly the C-terminal region of these proteins.

The TGF-β-related family of proteins includes the activin and inhibin proteins. There are activin A, B and AB proteins, as well as an inhibin A and inhibin B protein. The Mullerian inhibiting substance (MIS) is also a TGF-β-related protein, as are members of the bone morphogenetic protein (BMP) family of bone growth-regulatory factors. Indeed, the TGF-β family may comprise as many as 100 distinct proteins, all with at least one region of amino-acid sequence homology.

There are several classes of cell-surface receptors that bind different TGFs-β with differing affinities. There also are cell-type specific differences in receptor sub-types. Unlike the EGF, PDGF and FGF receptors, the TGF-β family of receptors all have intrinsic serine/threonine kinase activity and, therefore, induce distinct cascades of signal transduction.

TGFs-β have proliferative effects on many mesenchymal and epithelial cell types. Under certain conditions TGFs-β will demonstrate anti-proliferative effects on endothelial cells, macrophages, and T- and B-lymphocytes. Such effects include decreasing the secretion of immunoglobulin and suppressing hematopoiesis, myogenesis, adipogenesis and adrenal steroidogenesis. Several members of the TGF-β family are potent inducers of mesodermal differentiation in early embryos, in particular TGF-β and activin A.

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Transforming Growth Factor-α (TGF-α)

TGF-α, like the original founding member of the TGF-β family, was first identified as a substance secreted from certain tumor cells that, in conjunction with TGF-β1, could reversibly transform certain types of normal cells in culture. The TGF-α precursor protein is derived from the TGFA gene which is located on chromosome 2p13 and is composed of 7 exons that generate four alternatively spliced mRNAs. The predominant TGF-α preproprotein contains 160 amino acids. Following processing of the preproprotein, TGF-α can be function as a transmembrane-bound ligand or it can be fully processed to the secreted extracellular growth factor form. TGF-α binds to the EGF receptor and it is this interaction that is responsible for the growth factor's effect. The predominant sources of TGF-α are carcinomas, but activated macrophages, keratinocytes (and possibly other epithelial cells), and hypothalamic astrocytes also produce and secrete TGF-α. In normal cell populations, TGF-α is a potent keratinocyte growth factor; forming an autocrine growth loop by virtue of the protein activating the very cells that produce it. Within the brain, TGF-α regulates the synthesis and release of the anterior pituitary hormone, luteinizing hormone-releasing hormone, LHRH. This latter effect of TGF-α is important in the maturation of the secondary female sex characteristics.

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Erythropoietin (EPO)

Erythropoietin (EPO) is a glycoprotein hormone that is synthesized interstitial fibroblasts near the proximal convoluted tubules of the kidney. EPO is the primary regulator of erythropoiesis. Although EPO is synthesized by the fetal liver, this location is of no significance to EPO synthesis in the adult. Synthesis and release of EPO occurs in response to hypoxic conditions. EPO stimulates the proliferation and differentiation of immature erythrocytes; it also stimulates the growth of erythoid progenitor cells (e.g. erythrocyte burst-forming and colony-forming units: CFU-E) and induces the differentiation of erythrocyte CFU-E into proerythroblasts.

The EPO protein is derived from the EPO gene which is located on chromosome 7q22 and is composed of 5 exons that encode a 193 amino acid precursor protein. The effects of EPO are exerted in response to the hormone binding to a specific EPO receptor. Activation of the EPO receptor results in signal transduction events involving the Jak/STAT pathway. The EPO receptor is derived from the EPOR gene which is located on chromosome 19p13.2 and is composed of 8 exons that encode a 508 amino acid precursor protein.

When patients suffering from anemia, due to kidney failure or as a result of cancer therapy, are administered human recombinant EPO (hrEPO: Procrit and Epogen), the result is a rapid and significant increase in red blood cell count.

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Insulin-Like Growth Factor-1 (IGF-1)

IGF-1 (originally called somatomedin C) is a growth factor structurally related to insulin. IGF-1 is the primary protein involved in responses of cells to growth hormone (GH): that is, IGF-1 is produced in response to GH and then induces subsequent cellular activities. It is the activity of IGF-1, in response to GH, that gave rise to the term somatomedin. Subsequent studies demonstrated that IGF-1 has autocrine and paracrine activities in addition to the initially observed endocrine activities on bone. IGF-1 belongs to the insulin-like growth factor system that includes IGF-1, IGF-2 (described in the next section), IGF binding proteins, and the receptors that bind the growth factors.

The IGF-1 precursor is derived from the IGF1 gene which is located on chromosome 12q23.2 and is composed of 7 exons that generate multiple mRNAs via alternative splicing and alternative polyadenylation site utilization. In addition, IGF1 gene expression is controlled by multiple transcriptional initiation sites. Two classes of IGF-1 mRNA result from this complex control such that class 1 mRNAs initiate from promoter elements in exon 1, whereas class 2 mRNAs initiate from promoters in exon 2. IGF-1 mRNAs initiating from promoter 1 in exon 1 are found in multiple tissues, whereas, transcriptional initiation from promoter 2 in exon 2 is restricted to the liver and the kidney. Expression of the IGF-1 gene in the liver is the major source of secreted IGF-1 hormone accounting for 75% of total serum IGF-1. The longest IGF-1 preproprotein contains 158 amino acids. Despite the complex transcriptional regulation and the generation of multiple prepro-IGF-1 proteins, all of the resultant mature hormones are 70 amino acids in length.

IGF-1 exerts its biological effects primarily as a resutl of binding to, and activating, the IGF-1 receptor. The IGF-1 receptor (IGF1R), like the insulin receptor, is composed of disulfide bonded α- and β-peptides that are derived by proteolytic processing of the primary translation product. In addition, like the insulin receptor, the IGF1R has intrinsic tyrosine kinase activity. Owing to their structural similarities IGF-1 can bind to the insulin receptor but does so at a much lower affinity than does insulin itself. The IGF1R gene is located on chromsome 15q26.3 and is composed of 24 exons that generate two alternatively spliced mRNAs encoding IGF1R isoform 1 precursor (1367 amino acids) and isoform 2 precursor (1366 amino acids).

In addition to binding to the IGF-1 receptor, IGF-1 activity (as well as IGF-2 activity, see next section) is controlled by binding to one of several IGF binding proteins (IGFBP). Humans express six IGFBPs (IGFBP1–IGFBP6) that sequester IGFs in serum resulting in control of their interaction with IGF receptors. About 75% of circulating IGFs are bound in ternary complexes that are composed of IGF-1 or IGF-2, IGFBP-3 and IGFBP acid-labile subunit (IGFALS). IGFALS is synthesized by, and secreted from, the liver. The IGFBP1 gene is located on chromosome 7p12.3 and is composed of 4 exons that encode a 259 amino acid precursor protein. The IGFBP2 gene is located on chromosome 2q35 and is composed of 4 exons that generate four alternatively spliced mRNAs encoding three distinct precursor proteins, only one of which is secreted. The IGFBP3 gene is located on chromosome 7p12.3 and is composed of 5 exons that generate two altetrnatively spliced mRNAs encoding isoform a precursor (297 amino acids) and isoform b precursor (291 amino acids). The IGFBP4 gene is located on chromosome 17q21.2 and is composed of 4 exons that encode a 258 amino acid precursor protein. The IGFBP5 gene is located on chromosome 2q35 and is composed of 4 exons that encode a 272 amino acid precursor protein. The IGFBP6 gene is located on chromosome 12q13 and is composed of 4 exons that encode a 240 amino acid precursor protein. The IGFALS gene is located on chromosome 16p13.3 and is composed of 4 exons that generate two alternatively spliced mRNAs encoding two distinct precusor proteins.

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Insulin-Like Growth Factor-2 (IGF-2)

Like IGF-1, IGF-2 is a growth factor that is structurally related to insulin and shares 67% amino acid identity with IGF-1. IGF-2 is almost exclusively expressed in embryonic (fetal and placental) and neonatal tissues. Following birth, in humans, the level of IGF-2 rises in early childhood and remains relatively steady throughout adulthood until old age when it declines. During adult life the level of serum IGF-2 is approximately 3 times that of IGF-1. Due to the fetal and placental expression of IGF-2, it was originally thought to be primarily a fetal growth factor. However, evidence clearly indicates that IGF-2 does indeed exert important metabolic effects in the adult. The primary tissue responsible for adult IGF-2 expression is the liver. The IGF2 gene is located on chromosome 11p15.5 and is composed of 9 exons that generate five alternatively spliced mRNAs that collectively encode two distinct preproproteins of 236 and 180 amino acids. The 236 amino acid preproprotein originates from translational initiation at an upstream AUG codon not found in two of the other four mRNA splice variants. Prepro-IGF-2 contains a 24-amino acid signal peptide. Within the Golgi apparatus, pro-IGF-2 is O-glycosylated and then further proteolyzed to the mature IGF-2 form via the action of prohormone convertase 4. Post-translational processing of IGF-2 is an incomplete process such that several pro-IGF-2 peptides (collectively referred to as "big" IGF-2) are secreted into the blood, accounting for 10%–20% of total serum IGF-2.

Expression of the IGF2 gene is controlled by the epigenetic phenomenon of genomic imprinting. Expression of the IGF2 gene is restricted to the paternal allele, in most tissues, via the imprinting phenomenon. The IGF-2 gene also contains four promoters (identified as P1–P4) from which IGF-2 is transcribed. The P2–P4 promoters control IGF-2 transcription in the embryo, whereas transcription occurs from all four promoters in the liver of adult humans. Expression of the IGF-2 gene in the liver of adults occurs from both the paternal and the maternal alleles which may explain why circulating IGF-2 concentrations remain elevated throughout adult life.

IGF-2 exerts its biological effects by interacting with the IGF1R as well as the A form of the insulin receptor (IR-A). IGF-2 also binds to another receptor, that is specific for this particular IGF family member, identified as the IGF2R. The IGF2R is also a mannose-6-phosphate (M6P) receptor, similar to the M6P receptor that is responsible for the integration of lysosomal enzymes (which contain mannose-6-phosphate residues) into the lysosomes. Binding of IGF-2 to the IGF2R is responsible for clearance of IGF-2 from the circulation and does not contribute to IGF-2-mediated signal transduction. The IGF2R gene is located on chromosome 6q26 and is composed of 48 exons that encode a 2491 amino acid precursor protein. The IGF2R protein is a cation-independent mannose-6-phosphate receptor and therefore, is also referred to as the M6P/IGF2 receptor. In addition to IGF-2, the IGF2R has been shown to bind a diverse array of mannose-6-phosphate-containing proteins as well as several non-glycosylated proteins.

The initial observations that suggested the role of IGF-2 was most significant for fetal development only were obtained in knockout mouse studies. In these mice, fetal development was severely retarded yet following birth the mice grew normally and were fertile. Whereas in mice the level of IGF-2 falls following birth, in humans it does not. Studies in humans have shown that IGF-2 has a role in fetal growth and development by promoted formation of mesodermal germ layer. The level of IGF-2, in utero, is ten times higher than that of IGF-I. The growth effects of IGF-2 during fetal development are primarily exerted by its binding to, and activating, the IR-A form of the insulin receptor. Fetal actions of IGF-2 also involve activation of the IGF1R. In addition to its role in fetal development, IGF-2 is also an important regulator of placetal growth where it promotes nutrient transport, trophoblast invasion and proliferation and survival of cytotrophoblasts.

Post-natally IGF-2 exerts a potent angiogenic effect, central to its role in organ development and maintenance. The angiogenic effect of IGF-2 is the result of the growth factor inducing an up regulation of the expression of vascular endothelial growth factor, VEGF. IGF-2 has also been shown to exert growth promoting effects within the immune system. IGF-2 promotes granulocyte macrophage colony formation, stimulates the growth of B cells, and stimulates the growth of erythroid and myeloid precursor cells. Within specific organ systems IGF-2 exerts import growth and proliferative effects such as pancreatic β-cell proliferation and survival, development and maintenance of the musculoskeletal system, and development of bone. IGF-2, like insulin, exerts both growth factor functions and metabolic hormone regulating effects. These hormonal effects are most significant within adipose tissue, skeletal muscle and liver. Within the liver, IGF-2 actions result in the suppression of hepatic glucose output and increased glycogen synthesis. In adipose tissue and skeletal muscle, as well as several other peripheral tissues, IGF-2 induces glucose uptake and oxidation and increases synthesis of lipids and proteins.

In addition to its normal growth and metabolic functions, dysregulation of IGF-2 function has been associated with numerous pathologies, in particular in obesity and type 2 diabetes. Serum IGF-2 concentrations have been shown to increase in obesity and these levels correlate positively with BMI. The increased serum concentration of IGF-2 in obesity most likely represents an appropriate physiological response designed to promote energy storage in response to increased dietary supply. When overweight and obese individuals lose weight there is an associated decrease in total serum IGF-2 levels. In humans with normally low levels of serum IGF-2 there is an increased risk for weight gain and obesity. Although the mechanism by which the low levels of IGF-2 contribute to future weight gain is not clearly understood, it is an important prognostic indicator. Numerous studies have shown that IGF-2 is also dysregulated in diabetes. In type 2 diabetics, who are also obese, the levels of IGF-2 are even higher than in obese individuals that do not also exhibit insulin resistance typical of type 2 diabetes. Although the cause of the diabetes-related increase in IGF-2 is unknown, it believed to be primarily the result of increased adipose tissue secretion in response to hyperglycemia. The increases in serum IGF-2 seen in obese individuals has been shown to predispose these individuals to future development of insulin resistance and type 2 diabetes. Several studies have shown a strong correlation between obesity and cancer. In this context, the IGF systems are known to be causally linked to this phenomenon. The contribution to cancer development in obese patients, where IGF-2 levels are elevated, is thought to be exerted via IGF-2 binding to the IR-A form of the insulin receptor. When IGF-2 binds and activates this receptor, a set of signaling proteins, distinct from those activated by insulin binding, is activated that favor a mitogenic program increasing the likelihood for cancer.

Obesity in pregnant females has been shown to correlate with epigenetic changes in the IGF2 gene. These changes are reflected in a reduced level of methylation of the control region of the maternal IGF2 gene leading to increased expression of IGF-2 and increased IGF-2 concentrations in umbilical cord blood. The consequences of the altered maternal epigenome are evidenced by an adverse metabolic health of the fetus. Paternal obesity has also been associated with changes in the epigenome of the IGF2 gene. However, in the case of paternal obesity the reduced methylation is observed in the fetal IGF2 gene. Defects in imprinting at the IGF2 locus are seen in Beckwith-Wiedemann syndrome, BWS. As a result of the chromosomal alterations in BWS patients there is fetal overgrowth, organomegaly and an increased risk of developing tumours. Dysregulated, over-expression of IGF-2 in the BWS fetus is believed to account for the majority of the clinical features observed in this disease.

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Tumor Necrosis Factor (TNF) Superfamily

The tumor necrosis factor superfamily (TNFSF) of signaling proteins, and the receptors to which these proteins bind (identified as the TNF receptor superfamily, TNFRSF), represents an important class of proteins involved in the regulation of a variety of stimulus-responsive processes. Humans express 18 genes that encode proteins of the TNF superfamily. Although the TNFSF proteins are known to be required for numerous processes in cells, many of the proteins are critical to the regulation of immune functions. The original member of the TNFSF is tumor necrosis factor which is encoded by the TNF gene. At one point this protein was called TNF alpha (TNFα; as well as cachectin). Proteins of the TNFSF are major immune response-modifying cytokines produced primarily by activated macrophages. TNF induces the expression of other autocrine growth factors, increases cellular responsiveness to growth factors and induces signaling pathways that lead to proliferation. Like other growth factors, TNF induces expression of a number of nuclear proto-oncogenes as well as several interleukins and pro-inflammatory cytokines.

Human TNFSF Proteins

TNFSF Gene Symbol Protein Name(s) Functions / Comments
TNF tumor necrosis factor-alpha (TNF-α); cachectin component of acute phase reaction of inflammatory responses; induces fever, activates apoptosis, inhibits tumorigenesis, inhibits viral replication; synthesized primarily by macrophages but also by other luekocytes such as neutrophils, mast cells, eosinophils, and natural killer (NK) cells; exerts its effects by binding to two TNF receptor superfamily (TNFRSF) members: TNFR1 (encoded by the TNFRSF1A gene) and TNFR2 (encoded by the TNFRSF1B gene)
LTA lymphotoxin-α (LT-α); tumor necrosis factor-beta; TNF-β secreted and forms a homotrimericcomplex; kills a number of different cell types; induces terminal differentiation in many cell types; inhibition of lipoprotein lipase (LPL) present on the surface of vascular endothelial cells; can form heterodimers with LT-β; predominant site of synthesis is cytotoxic T-lymphocytes (CTL); binds to TNFR1, TNFR2, and HVEM (Herpes Virus Entry Mediator; encoded by the TNFRSF14 gene)
LTB lymphotoxin-β (LT-β); tumor necrosis factor C (TNF-C) membrane-associated (type II transmembrane) protein; LT-α binds to cell-surface LT-β in a LT-α1/LT-β2 heterotrimeric complex; the LT-α1/LT-β2 complex induces inflammatory responses through its binding to the LT-β receptor (encoded by the TLTBR gene) on adjacent cells; the LTBR encoded protein is a member of the TNF receptor superfamily identified as TNFRSF3
TNFSF4 TNF superfamily member 4; OX40 ligand TNFSF4 binds to the cell surface CD134 protein; enhances Th2 type cell differentiation; binds to the cell surface OX40 protein which is a member of the TNF receptor superfamily (encoded by the TNFRSF4 gene)
CD40LG CD40 ligand; TNF superfamily member 5 expressed predominantly on activated T cells; binds to the cell surface CD40 protein (also identified as TNFRSF5) on antigen presenting cells
FASLG FAS ligand; FASL; TNF superfamily member 6 membrane-associated (type II transmembrane) protein which contains death domain (DD) in intracellular portion; functions as a homotrimeric complex by interacting with the cell surface receptor identified as FAS; interaction of FASL on one cell with FAS on an adjacent cell triggers apoptosis via the formation of what is referred to as a death-inducing signaling complex (DISC); upon FASL:FAS interaction the intracellular adapter protein FAS-associated death domain (FADD) binds to the DD of FASL triggering the signaling resulting in activation of apoptosis; in the TNF receptor superfamily nomenclature FAS is TNFRSF6
CD70 TNF superfamily member 7; CD27 ligand expressed on activated T and B cells, particularly T and B lymphoma cells; binds to cell surface CD27 (also identified as TNFRSF7)
TNFSF8 TNF superfamily member 8; CD30 ligand binds to cell surface CD30 (encoded by the TNFRSF8 gene) which which is a member of the TNF receptor superfamily
TNFSF9 TNF superfamily member 9; 4-1BB ligand membrane-associated (type II transmembrane) protein; expressed on activated T cells; binds to the TNF receptor superfamily protein encode by the TNFRSF9 gene also identified as 4-1BB
TNFSF10 TNF superfamily member 10; TNF-Related Apoptosis-Inducing Ligand (TRAIL) expressed and secreted by numerous cell types; induces apoptosis in a variety of tumor cells; binds to several TNF receptor superfamily proteins that are members of the death receptor (DR) subfamily; binds to several transmembrane and soluble proteins including TRAIL receptor 1 (TRAILR1, TNFRSF10A, DR4), TRAILR2 (TNFRSF10B, DR5), TRAILR3 (this is a soluble decoy receptor also known as DcR1; encoded by the TNFRSF10C gene), TRAILR4 (TNFRSF10D, DcR2), and TNFRSF11B (also known as osteoprotegrin: OPG)
TNFSF11 TNF superfamily member 11; Receptor Activator of NF-κB Ligand (RANKL) membrane-associated (type II transmembrane) protein; regulates apoptosis and also controls bone regeneration and remodeling; binds to RANK (encoded by the TNFRSF11A gene)
TNFSF12 TNF superfamily member 12; TNF-related WEAK inducer of apoptosis (TWEAK) activity similar to that of TNF; binds to the TWEAK receptor encoded by the TNFRSF12A gene
TNFSF13 TNF superfamily member 13; A PRoliferation-Inducing Ligand (APRIL) involved in B cell develpment; functions by binding to the TNF receptor superfamily 17 protein encoded by the TNFRSF17 gene (also identified as B cell maturation antigen, BCMA)
TNFSF13B TNF superfamily member 13B; B-cell Activating Factor (BAFF) membrane-associated (type II transmembrane) protein; expressed on numerous cell types; also known as B lymphocyte stimulator (BLyS); activates NF-kB signaling; binds three TNF receptor superfamily members encoded by the TNFRSF13B (also known as transmembrane activator and calcium modulator and cyclophilin ligand interactor, TACI), TNFRSF13C (also known as BAFF receptor, BAFFR), and TNFRSF17
TNFSF14 TNF superfamily member 14; LIGHT (homologous to Lymphotoxin, exhibits Inducible expression and competes with HSV Glycoprotein D for binding to Herpesvirus entry mediator, a receptor expressed on T lymphocytes) secreted protein; functions as a costimulatory molecule and an inhibitor to herpesvirus infection; binds to the TNF receptor superfamily proteins encoded by the TNFRSF14 (also known as HVEM) and TNFRSF6B (also identified as decoy receptor 3, DcR3) genes
TNFSF15 TNF superfamily member 15; Vascular Endothelial cell Growth Inhibitor (VEGI) abundantly expressed by endothelial cells; expression induced TNF and IL-1α; binds to the TNF receptor superfamily 25 protein (encoded by the TNFRSF25 gene) which is also identified as death receptor 3 (DR3); functions as an autocrine inducer of apoptosis in endothelial cells
TNFSF18 TNF superfamily member 18; Glucocorticoid-Induced TNF Receptor family-related gene Ligand (GITRL) expressed in endothelail cells; binds to the TNF receptor superfamily 18 protein encoded by the TNFRSF18 gene
EDA ectodysplasin A membrane-associated (type II transmembrane) protein; functiona as a homotrimeric complex; involved in the development of ectodermal organs; binds to the ectodysplasin A receptor (encoded by the EDAR gene)

TNF Receptor Super Family: TNFRSF

The TNF receptor superfamily (TNFRSF) members are transmembrane proteins having cysteine-rich motifs in their extracellular domains. Humans express 29 genes that encode receptor proteins of the TNF receptor superfamily. Many of the genes that express receptors for TNF superfamily member proteins are identified by the designation TNFRSF followed by a number. For example the TNF receptors identified as TNFR1 and TNFR2 are encoded by the TNFSFR1A and TNFRSF1B genes, respectively. The 29 TNFRSF proteins can be divided into three different subfamilies that are dependent upon the specific intracellular signals that are induced by the receptors upon ligand binding. These three receptor groups are the death domain (DD)-containing receptors, the decoy receptors (DcR), and the TNF receptor-associated factor (TRAF)-binding receptors. The DD-containing members of the TNFRSF include TNFR1 (TNFRSF1A), FAS (TNFRSF6), death receptor 3 (DR3; encoded by the TNFRSF25 gene), DR4 (TNFRSF10A), DR5 (TNFRSF10B), and DR6 (TNFRSF21). The TNF receptor superfamily proteins that contain a TRAF-interacting motif (TIM) include TNFR2 (TNFRSF1B), lymphotoxin-β receptor (LTBR gene; also identified as TNFRSF4), OX40 (TNFRSF4), CD40 (TNFRSF5), CD27 (TNFRSF7), CD30 (TNFRSF8), receptor activator of NF-κB (RANK; encoded by the TNFRSF11A gene), and glucocorticoid-induced TNF receptor family-related gene (GITR; encoed by the TNFRSF18 gene). As the name implies, the TRAF-binding subfamily of TNFRSF proteins bind TRAF proteins which are adaptor molecules that activate multiple downstream signaling pathways such as NF-κB, Janus kinase (JNK), ERK, p38MAPK, and PI3K. Although some TNFRSF proteins contain their own intracellular death domains, other members interact with intracellular proteins that contain death domains. These intracellular DD proteins serve as scaffolds for binding pro-caspases which then undergo auto-cleavage. The cleavage of a pro-caspase to an active caspase results in the formation of the death-inducing signaling complex (DISC) and induction of apoptosis.

Clinical Utility of TNFSF Inhibition

Inhibition of the activity of members of the TNF superfamily has proven to be effective in the treatment of certain autoimmune disorders such as rheumatoid arthritis, RA. Currently there are seven anti-TNF biologicals (Adalimumab, Adalimumab-atto, Etanercept, Etanecept-szzs, Infliximab, Golimumab, and Certolizumab) that have been approved for use by the US FDA. These therapies are used in the treatment of various forms autoimmune disease such as RA, psoriatic arthritis, ulcerative colitis, Crohn disease, ankylosing spondylitis, and juvenile arthritis. Several of these biologicals bind to soluble TNF molecules and prevent their binding to their cognate receptors resulting in a loss of the normal activation of synthesis and secretion of pro-inflammatory cytokines such as IL-1 and IFN-γ.

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Last modified: February 8, 2018