Clinical Implications of a Novel Biomarker of Growth

Growth is a complicated phenomenon that begins in utero and is completed after puberty. Growth is regulated by numerous factors including nutrition, which dominates prenatally through age 2 years, endocrine modulators such as thyroid hormone, Growth Hormone (GH), insulin-like growth factor-1 and sex steroids, and other genes that regulate growth, including direct effects on the growth plate. Normal growth is a global indicator of child health, and variants of growth can be normal or pathologic. Environmental causes of poor growth include malnutrition, social determinants of health, and severe psychological stress. Primary causes include genetic diseases and syndromes. Acquired causes are common, including chronic disease, late effects of cancer treatment and endocrine dysfunction. Growth concerns including growth failure (abnormal growth rate) and short stature (<3rd%ile for age/gender) comprise about 20% of all referrals to paediatric endocrinologists. Clinical evaluation may reveal a primary cause (e.g., familial short stature), an acquired cause (e.g., hypothyroidism) or constitutional delay of growth and puberty, which is a normal variant and a common reason for referral.

Our best tool for assessing growth is a child’s height and growth velocity, both of which require serial measurements of height from birth until after puberty. However, in a slowgrowing child, determining an accurate growth rate requires height measurements at least 6 months apart. Screening all slowly growing or short children for pathologic causes is costly and has a very low positive predictive value. A “real time” biomarker of growth that could identify normal variants from pathologic disorders and indicate response to a growthpromoting treatment would be an ideal clinical tool. This biomarker may have been found. A recent study by Coghlan and colleagues describes data supporting the potential use of collagen X biomarker (CXM) as a real time marker of growth. CXM is a degradation by-product of type X collagen that is produced by hypertrophic chondrocytes during endochondral ossification, which in children occurs almost exclusively at growth plates. It is released into the circulation in proportion to overall growth plate activity and can be measured in blood.

Full Length Article: https://www.imedpub.com/articles/clinical-implications-of-a-novel-biomarker-of-growth.pdf

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