Author Archives: Senior Researcher

Our Personal Stories Over The Regret On How Our Growth Was Stunted And We Never Reached Our True Maximum Potential Height

I was talking with my GF that other day and she again express how she wished that she could be at least 4 inches taller since that would make it easier for her to kiss me. At 1.61 meters tall, she is a little less than 5′ 3 1/2″ tall, which I think is actually supposed to be quite average for a young Korean woman these days. The Wikipedia article on average human height by country states that for measured females at the age of 17-18 based on the 2011 Census the value for average height of Korean females is 1.6111 m (5 ft 3 1⁄2 in). So it seems her desires to be taller may not be due to aesthetic reasons, but very much utilitarian. The whole process is sort of putting a strain on her neck, and she finds it most comfortable that we almost see eye to eye when we both step on an escalator and she gets on the higher step.

I still have not shown her this website but I do think about these things. I am left to wonder just how her adult height was the result of the type of lifestyle choices she made in earlier life. After knowing her for almost a year now, I am aware that she has some habits which would have stunted her growth.

  1. She eats very little.
  2. She prefers to not enough meat
  3. She can go days, even weeks with eating only rice and vegetables, which would not have any protein value.
  4. She seems to hate drinking milk, although she seems to enjoy cheese

The energy from carbohydrates converts into glucose when broken down. It also gets converted into glycogen when you have too much glucose which gets stored in the liver and fat. When you need a extra energy to perform a strenuous task, a 3rd compound called glucagon gets activated which converts the glycogen back into glucose. In part of this process where the simple carbohydrates is involved does the stimulation of anabolic, growth promotion process get stimulated. This suggests to me that a diet that is full of high protein should be good for better growth rates when a person is in their younger days. These sugars are short term energy boost, and the human body needs proteins to build tissues. With only sugars, it becomes rather easy to use up all of the energy provided by both the glucose and glycogen. Runners have this happen to them during long runs in a phenomena known as “Hitting the Wall”

So from the perspective on her dietary choices, she was probably going to end up shorter than average, since she is just not consuming enough of the right types of foods to allow for anabolic process to occur.

  1. She also suffered from some severe psychological issue when she was younger, going through a few bouts of depression. (nothing too serious)
  2. Being raise in a difficult environment which was definitely not healthy mentally or emotionally for a child.

So it could be that her below average in stature is from multiple situations in her early life like the choosing to not go for the foods that promote growth, the occurrence of high stress level situations, bouts of depression might have all contributed to her ultimate adult height.

However, it is also important to consider the issue of genetics. Her father is very small, and that might mean that her current height was always the intended height from birth. I have never met her mother but I would assume she can’t be very big either. From just looking at the two parents, I have a guess at where she should be, but I did state in a recent article that the average human can probably change/increase their final height by as much as 3-4 inches from extremely good eating habits when they are young, as evidenced by the physical body types of professional football players. So is the height one obtains really just genetics, or can things happen to us after we are born to increase or stunt our growth?

I have studied the link between human height growth and mental pathologies in children and there is some clear evidence that having a difficult childhood with dysfunctional families or surroundings can cause stunted growth, although there is a unique situation of catch up growth that happens if the child gets moved to a much more healthier family who can raise them. It seems that the body might try to compensate for the stunted growth by going into overdrive on the bone longitudinal growth.

As for myself, I have had my own stories on why my own adult height is not optimized to be the maximum height possible.

  1. I went through a traumatic situation during the last year of my middle school years.
  2. I went on diets of only juice in my middle school days. I would not eat real food
  3. I went on diets of only soup during my middle school years since I was in sports.
  4. I choose to not eat multiple times in high schools in need to save money
  5. I also suffered a few mental pathologies, which lead to me to choose lifestyles that were not healthy for a kid who was stilling growing.
  6. My earliest years involved eating very little meat or protein but only low in nutrition soups.
  7. I was born and raise in a rather unsanitary conditions compared to the babies born today.
  8. Going through multiple bouts of sever lack of sleep in my high school years.

Now, like I will always say. This is my personal story. This is my own way of trying to rationalize the idea that I never reached the real height I was supposed to be intended for, which is to be at least 3 inches taller because the conditions of my life were not perfect, but quite dysfunctional during the years of my life when I was still in the growing mode. Do I regret my un-optimized growth because of many stupid choices I made as a teenager? Most definitely, if I was to be completely honest with myself.

(Note: Most people when questioned about past decisions leading to negative outcomes and the regret behind them, might try to say that they have never regretted any decision of their life, and say that everything bad that happened was for a reason. They bring up the existence of god to justify why bad luck happened. I for one don’t believe that and think that they are just trying to lie to themselves to protect their own egos to not feel the dreaded emotion of self-doubt when they have to confront their own flaws as a human, since I don’t believe in god. I understand that I am flawed, a human, make big mistakes, and allow myself to feel regret sometimes. There are many things I wish I could change from the past, but I can’t so I live with it, bury painful past memories in the recess of the back of my mind, and hope that one day things get better.)

So I would say that in terms of what my height could be, it has been stunted as well, probably by as much as 3 inches. 

However, I also have to ask whether this idea that some of the lifestyle choices we did have as children really did lead to stunted growth or not. I mean, we all have our own stories on how we did not end up being as tall as we ‘should be’ because we were raised in a bad environment and had to go through so much suffering, trials, and tribulations.

From a purely medical point of view, maybe we are supposed to be as tall as we are now, and the low amount of nutritious foods we ate as children and the amount of psychological damaging experiences we had as children has no determinant in terms of stunting our growth. Could it be that all that matters is our genes?

From an article written by a Harvard Medical School Professor entitled “Can We Predict Height?”

The observation that family members tend to be of similar stature is born out by formulas designed to predict height. One commonly quoted formula uses parental height and gender to predict adult height (in inches) as follows:

   For men: (height of mother + height of father + 5)/2
   For women: (height of mother + height of father – 5)/2

If you know your parents’ heights, see if this formula predicts yours well; for most people, this will accurately predict your height within 2 or 3 inches.

All of these methods can only approximate ultimate height; they cannot predict with precision. In addition, formulas and growth charts to predict height are based on large numbers of normal children and do not perform well in predicting the ultimate height of an individual child who is unusually short or tall, has been ill, or has a genetic disorder.

The doctor who teaches at HMS is sort of stating that our height doesn’t really change much, and is mostly determined by our height, by as much as 60-80% in some studies. I can agree with that, but I am sure that stunted growth happens a lot, and people are not given the best environment to grow up in, and end up smaller.

All I really wanted to write is this….

“Do you have a story from your own life to explain why you feel that you ended up much smaller than where you ‘should’ be, in terms of bad choices or environments leading to stunted growth?”

I would like to here your stories, you reasons.

Total Knee Replacement Surgery and Articular Cartilage Between The Femur And Tibia

MSNBC did a full report the other day on how so many mid-age Americans, the Baby Boomers have started to reach the age where they need to get what are know as “Total Knee Replacement Surgery“. The two stories were…

This type of surgery is required when the person is going through an extremely high level of pain due to the fact that the articular cartilage that is on the distal end of the femur and the proximal end of the tibia are both rubbed away from years of loading and compressing.

In terms of the numbers, from the 2nd article it states, “Over the past decade the rate of knee surgeries has risen dramatically from 378,000 in 2003 to an estimated 704,000 in 2012, according to a government report released in 2012.” It seems that the two main determinants on whether a person will develop bad knees is from genetics and whether old injuries really did heal properly. The increase in the decision to go through with knee replacement surgery seems to be from both an increase in the rate of obsity putting more weight on the body and the increased effectiveness o fthe surgery. The knee replacements are better and can replicate almost exactly the movements of what a natural knee is supposed to be like. The surgeries are also getting less invasive through.

As for the patients, they often wait a little too long to go through with the surgery to remove the pain. It often has to reach the point where the pain becomes unbearable before someone decides to go through with the surgery. What is really interesting was a passage from the article that reminds me of how people feel about going through with surgery to become taller, using the limb lengthening surgery.

 ‘Look, my knee hurts and it’s interfering with my activities. I’d like you to do what you can: pills, shots, therapy, whatever, so long as it’s not surgery.’

Again, the idea of surgery is something that almost everyone has wanted to put as the last resort. Why are everyone so hesitant and afraid of surgery if it can relieve what could be years of pain? I can state for a fact that often the surgery option is the only option that works, and it is definitely true towards adult height increase and knee pain relief.

Again, the desire to postpone surgery is stated again…

“… She did everything she could to postpone surgery even though her doctors said she needed it to quiet the excruciating pain in her joints.”

The Science Behind Total Knee Replacement Surgery

The thing to realize is that the knee is not actually replaced. It is the cartilage in the synovial cavity that is replaced. It is replaced with metal and plastic. The key idea is to replace the layer of the cartilage to something else so that the bones are not grinding against each other. From Wikipedia…

“…the surgery consists of replacing the diseased or damaged joint surfaces of the knee with metal and plastic components shaped to allow continued motion of the knee”

Common causes of knee pain

  • meniscus tears
  • cartilage defects
  • ligament tears
  • osteoarthritis

It states that when people start out in adulthood, there is a total of 3/8 th of an inch of layering of hyaline articular cartilage. This is a combined total of both sides. There is actually 3/16th of an inch of cartilage on the ends of each long bone in the legs. The pain seems to start when there is usually less than 1 millimeter of cartilage left.

The most likely times when pain is noticed is when the knees are put in a situation where they have to be more extensive in the motion.

The replacements are actually very durable, lasting up to 20 years. It is advised by the surgeons to not to do any type of intensive running with the new knees where the replacements can be ruined.

Knee_diagram.svgThe Actual Steps Of The Surgery (General Outline)

  1. The skin over the knee is cut to reveal the tissue underneath
  2. The vastus medialis which is the muscle of the quads are cut/ detached from the patella bone
  3. The patella is then pushed to the side
  4. The distal end of the femur and the proximal end of the tibia are then cut in a very specific way to shape the ends of the long bone.
  5. The articular cartilage (what is left on the ends of the femur and tibia) on both bones are removed, along with the anterior cruciate ligament. (Sometimes the posterior cruciate ligament is also removed)
  6. You want to NOT remove the lateral collateral ligaments which connect the tibia to the femur
  7. You have prefabricated metal parts that are very specific in dimensions and length. That is why you cut the bone ends to very specific guideline numbers.
  8. You pop on the metal parts on the ends of the precisely cut bone epiphysis.
  9. Glue the metal parts in place using polymethylmethacrylate (PMMA) cement.
  10. Some alternative ways of gluing the metal pieces involves making the metal prosthetic porous, allowing for the bone tissue to naturally bind with the metal as the bone grows through the metal piece filling out the holes.

After reading over the articles about it on NBC NEWS, it is interesting to note that many people wrote comments in response to this story to give their own story of how knee pain and cartilage loss has affected their own lives. Many tell their surgery stories.

JointFrom personal experience I am aware that my grandmother herself had to get total knee replacement surgery, and that it has reached the point where she has no cartilage left in the synovial cavity. I was told this to me by my mother who told me that in her knees, it has reached the point where bone is grinding against bone when she moved her legs around.

Future Treatment Types That Are In Development

Something that is going to become very attractive is the new biomedical field of electro-spinning aka bioprinting. Bioprinting is using a 3-D Printer to print organic tissue that can be insert into the human body. I wrote about this radical new idea in the post “Increase Height And Grow Taller Through Bioprinting And Electrospinning“. This idea is a technique that many orthopaedic surgeons have considered and is waiting for over the next 2 decades to see whether the fabricated cartilage from the bioprinters will pan out and is strong enough to take the loading of humans.

Ultimately, humans probably don’t like the idea of putting metal parts into their body which will stay in there for the rest of their lives. Imagine the metal detector at all airports going off each time we walk past it.

The study that was published in PubMed entitled “Direct human cartilage repair using three-dimensional bioprinting technology.” shows that the 3D Bioprinting Technology is being developed. Will it arrive in time before we also start to develop pains in our knees? Let’s hope.

Bioprinting Cartilage

The fact is that bioprinted ears already exist, done at Wake Forest University. Since ears are just cartilage themselves, although not as fibrously arranged as say the menisus or hyaline cartilage that are in the knees, it does show that we can already grow cartilage into human parts that will be implanted back into humans.

Conclusion

The main point of this post is to show that even though our research has always been primarily about trying to figure out how to turn bone tissue into cartilage tissue to restart the longitudinal growth of our bones, our research is very applicable for other causes. Not only does our research help people figure out ways to grow taller, this website has also led to insights on how we can….

  • Reverse Cavities – there are ways to heal the fractures that are in the dentin
  • Completely regrow teeth to be implanted back into the jaw
  • Prevent Periodontal Disease
  • Treat osteoporosis
  • Treat Osteoarthritis, and Rheumatoid Arthritis
  • Treat flat foot
  • Treat rickets
  • Treat bow legs

Almost all research that has ever been done in terms of cartilage regeneration was to help people who suffer from cartilage degeneration from osteoporosis, arthritis, old age, disk compression. In terms of mechanical engineering principles, we can say that the weakest area in the human body in terms of structural integrity would be at the knees.

The knees are so often one of the main causes for pain in older individuals.

The 2nd area of the body that suffers the most injuries would be the lower back, since the tissue that forms the intervertebral discs are just not as strong and durable as human bone tissue. After the lower back, comes the hips and ankles. Note how all of the areas that cause the problems most frequently is not actually bone, but areas between bones.

This website will not just be a place where people will learn about the latest research on what we have done to figure out how to increase height, but also a place where new idea on how to treat multiple orthopedic disorders.

Update #5 – Having Legal Problems While Trying To Get Help – August 1st, 2013

Update #5 – Having Legal Problems While Trying To Get Help – August 1st, 2013

The month of July was very productive for me because I managed to get into a groove in terms of being very consistent in the amount of research, and writing for this website. This website is getting more and more influential each month I think as the ways at which it can reach people has increased.

Things that happened in July…

Big Thing #1

The month of July has also been very difficult in terms of Legal and Technical Issue for the website. The people who represent a certain company who sell a product which I personally stated is ineffective had written a Cease & Desist Letter which I call a DMCA to my hosting company to try to take down the post I had written about this product. I contacted my hosting company and they gave me bad legal advice on what to do and I followed through on their advice by issuing a counter-DMCA which turned out to be wrong since a person can not do counter-DMCAs due to a complaint on Trademarks, but only for Copyright. This website was threatened multiple times and was taken down for over a day before I had to negotiate the terms of my website with my hosting company to bring it back. The problem with the website is currently resolve.

The entire thing was a big wake up call on just what can happen when one becomes too big and starts to be a threat to other corporations in the same niche. I plan to make sure that this type of situation does not happen again by being more protective on the information on the website.

Big Thing #2

After exchanging emails with Tyler at a snails pace over the last 3 months on getting him to join the website, I managed to create a profile for him as one of the administrators of this website with the title of Editor. He has written two posts on what his progress has been and how his proposed Lateral Synovial Joint Loading has been going for other experimenters.

I was planning on actually doing another Podcast episode where we two get back together to talk about the research we have recently been up to. However, I am currently having technical difficulties over getting the Voice Recording Software for Skype to work. I don’t know what is wrong, but it just doesn’t seem to be able to turn on or record properly anymore. So this means that even though I want to, I can’t record any phone calls or do any interviews with people over Skype for the podcast currently.

Big Thing #3

I plan on shifting my focus away from the website temporarily for around 1-2 months as I divert all of my effort, time, and energy to working on another business project I have started. In addition, some personal issue with my family has come up and I need more time to resolve some issues while I travel outside the country (again).

There will be one last big post I will put up this month, which is “A Complete Guide To Limb Lengthening Surgery“ which will be the best, most informative guide I can currently create from reading multiple threads on the Make Me Taller boards. (I hope that people can comment on the post so that I can edit, add, and revise it to make it better and more informative for future readers. It will be put in as its own page/category on the website, under the Supplement Guide tab in the header).

After that, I am hoping that Tyler can take over the load in research and writing so that I can focus elsewhere. He is a great contribution to the website and to the cause and so far, his insight, feedback, and expertise has been very useful in helping me and other researchers see what is missing in our own understanding of what needs to work.

Epic Posts

This month lead to me really sitting down and studying on the research and really analyzing just what is causing the biggest amount of problems and where we are stuck. I managed to write a post that is almost 6,500 words to explain just why the research is so difficult entitled “Why Growing Taller With Closed Growth Plates Is So Difficult To Figure Out And Impossible To Almost All People“. 

The connection between pregnancy and unusual cases where women gain height is brought back with at least 4 new cases where women noticed that they were getting taller form being pregnant. I wrote about it in the post “Another Case Of Pregnancy Causing Woman To Grow Taller And Increase In Height“

It was found that there have been some new compounds which we discovered which has very osteogenic uses like pleiotrophin, as well as Vitamin K2 (menaquinone type 4) combined with Vitamin D3 which has resulted in some unique cases of adult height increase.

Changes In Height and Weight

So the obvious question is “Has my own height changed in the last month?” – It has been very hard to tell since my hair has been growing out like everyone else’s hair. With the way that my hair naturally falls, it sometimes looks like I might be 1-2 inches taller than I really am. I tried to measure every morning and night but the results have not been good. I did cut my hair very recently and looked at the mirror and seem to have stayed the same as before.

  • Height when getting out of bed in the morning: 6′ 0″ (exactly or 1.828 meters tall)
  • Height at night when going to bed:  a little less than 5′ 11.25″ (or around 1.81 meters tall) 

The 3 mm of increase from a few months ago is still noticeable and stayed around. I have a very accurate measurement tape.

So have I been doing to increase flexibility and height this month? 

I have been focusing on trying to do two exercises, 1) the supine flexion for stretching out the lower back and 2) doing aquatic vertical suspensions where I float on the surface of the water with weights hanging  out on my feet

I wrote about both of these techniques in the the following posts…

I have been trying to clamp on my knees doing LSJL for a few days but did not keep up the routine. I have been trying to test which location and at what angle of loading on the knees would be the most effective.

As for weight

My weight is another story, which has gotten better from last month. I changed my diet dramatically by reducing my rice/noodle/grain intake by half. Any time I go out to eat, I look for meat & vegetable intensive foods and eat only half of the grain. The protein-sugar theory seems to be true.

Changes in Exercises and Training

Starting Swimming

Recently I found out that my weight was around 97 kgs or 213 lbs and that meant that my weight did decrease from the 219 lb it was last month when I took the trip to Osaka. I was at the Olympic Pool at the Sports Complex in Gangnam, Seoul which was where the Olympics were held in 1988. Olympic sized pools are 50 meters long (164 feet) while most pool in the US, which uses american units, are 25 yards long (75 feet long). The pool at the Sports Complex is really great since the cost of one swim is only around 5000 korean won but the amount of time is very little, only 45-50 minutes before the lifeguard blow the whistle and kick everyone out. I usually only manage to get 15-16 laps in before it is over.

Getting back to Pushups & Situps

My goal to reach at the end of this year is to be able to do 100 pushups, and 200 situps consistently (everyday). So far, since the days are soooo HOT where I live, and the exercise equipment is outside in the sun, I have been very hesitant to get out in the sun, risk melanoma, just to get skinnier.

Using a Back Massager 

Some places do sell a hand held back massager (I got two , one for 30,000 korean won and other for 60,000 korean won) which really works well to release the tension in the back muscles. This allows for the intervertebral discs to rehydrate and increase in thickness. I currently have something known as the Swan Softouch Handheld Percussion Massager , which is very good for kneading muscles that are very tight or cramped. It worked miracles for my tight lower back muscles when I got it back in 2008 and it still does a reasonably good job in making the lower back decrease in tension, reducing the likelihood of injuries.

IGF-1 Promotes Longitudinal Bone Growth by Augmenting Chondrocyte Hypertrophy (Breakthrough!)

After we learned that the old somatomedin hypothesis (that IGF-1 was the mediator between the GH and growth plate chondrocytes) was not completely correct and needed to be altered to account for the ability of GH to affect the chondrocytes directly, as well as the fact that besides the liver, IGF-1 seems to be produced in all types of organs and tissue, I wanted to focus on just how exactly IGF-1 helps the GH in longitudinal growth. It was shown that for lab rats that were genetically manipulated to be IGF-1 null, it was shown that the number of chondrocytes in the resting zone and the proliferation rate of the chondrocytes did not change that much.

This study I found seems to suggest that IGF-1 augments the effects of GH by acting only on the chondrocytes that are differentiating into the hypertrophy stage.

Study #1: Igf1 promotes longitudinal bone growth by insulin-like actions augmenting chondrocyte hypertrophy – JIE WANG, JIAN ZHOU and CAROLYN A. BONDY

Abstract

Longitudinal bone growth, and hence stature, are functions of growth plate chondrocyte proliferation and hypertrophy. Insulin-like growth factor 1 (Igf1) is reputed to augment longitudinal bone growth by stimulating growth plate chondrocyte proliferation. In this study, however, we demonstrate that chondrocyte numbers and proliferation are normal in Igf1 null mice despite a 35% reduction in the rate of long bone growth. Igf1 null hypertrophic chondrocytes differentiate normally in terms of expressing specialized proteins such as collagen X and alkaline phosphatase, but are smaller than wild-type at all levels of the hypertrophic zone. The terminal hypertrophic chondrocytes, which form the scaffold on which long bone growth extends, are reduced in linear dimension by 30% in Igf1 null mice, accounting for most of their decreased longitudinal growth. The expression of the insulin-sensitive glucose transporter, GLUT4, is significantly decreased and the insulin-regulated enzyme glycogen synthase kinase 3β (GSK3) is hypo-phosphorylated in Igf1 null chondrocytes. Glycogen levels were significantly decreased and ribosomal RNA levels were reduced by almost 75% in Igf1 null chondrocytes. These data suggest that Igf1 promotes longitudinal bone growth by ‘insulin-like’ anabolic actions which augment chondrocyte hypertrophy.

—Wang, J., Zhou, J., Bondy, C. A. Igf1 promotes longitudinal bone growth by insulin-like actions augmenting chondrocyte hypertrophy.

Analysis

This study is one of the most interesting studies I have found in a long time. This study shows that when it comes to modulation of the growth plate chondrocytes, the IGF-1 has an affect mainly on the process of differentiating into the hypertrophy stage. The most interesting is that the number of chondrocytes and the rate of proliferation does not seem to change for lab rodents which were born with the IGF1 gene deactivated.

This means that the IGF-1 has effects only on hypertrophy.

The effects of the having a deficient IGF-1 gene are the following…

  1. a 35% reduction in the rate of long bone growth
  2. have lower levels and rates of collagen type X and alkaline phosphatase release by the hypertrophic chondrocytes
  3. the hypertrophic chondrocytes are reduced in linear dimension by 30%
  4. expression of GLUT4 is significantly decreased
  5. GSK3 is hypo-phosphorylated
  6. Glycogen levels were significantly decreased
  7. ribosomal RNA levels were reduced by almost 75%

If we look at the last 4 of the effects, they are all related to insulin like effects on the tissues. IGF-1 is very similar to Insulin in structure and function. This shows that its function for the growth plates is also from insulin similar anabolic actions which combines with the GH to get chondrocyte hypertrophy.

We see that at least for lab rats that while the bone length is not completely stunted, there is still a very substantial reduction, by as much as 35%. This could potentially turn a guy from 6 feet to 5 feet tall. The releasing of the specific proteins that are indicators of hypertrophic chondrocytes do occur but dramatically decreased.

This study reveals that it might be possible to modulate the growth rate of children through IGF-1 increase, while making sure that it does not reach levels that are too high resulting in disruptions to other types of metabolisms.

BMN 111 A CNP Analogue Promotes Skeletal Growth Treating Children Suffering From Achondroplasia

This was a post that I found from a new blog I discovered which seems to write about the short stature condition known as Achondroplasia which is caused usually by a mutation on the FGFR3 gene. It seems that there is a company Biomarin, a pharmaceutical company working in therapies for rare and genetic conditions, which stated that they were coming out with a drug that can treat the mutation of the FGFR3 that has been responsible for Achondroplasia. It is supposed to be the first pharmacological therapy out there for Achondroplasia treatment.

The article is taken from the blog http://tratando-acondroplasia.blogspot.com/ entitled “CNP, the first potential pharmacological therapy for achondroplasia” (the blog is written in Portuguese so using the browser Chrome would be better to instantly translate what is on the pages into English)

Under great expectations, parents and relatives of children bearing the fibroblast growth factor receptor type 3 (FGFR3) mutation, the cause of achondroplasia, have been following the news about the development of the first real potential drug therapy to treat this condition. In the last quarter of 2010, Biomarin, a pharmaceutical company working in therapies for rare and genetic conditions, announced it was planning to start the clinical research with a compound called BMN-111. BMN-111 was described as a C-type Natriuretic Peptide (CNP) analogue. An analogue is a compound (or molecule) which has a very similar structure compared to the original one, normally keeping the same properties or with enhancements to a given characteristic of that compound.

During 2011, new updates have been released and, in the last International Congress of Human Genetics held in Montreal, a poster describing the results of the BMN-111 tests made in a mouse model of achondroplasia was presented, showing impressive results in terms of the ability of this molecule in restoring the bone growth of those animals: F. Lorget et al. BMN 111, a CNP analogue, promotes skeletal growth and rescues dwarfism in two transgenic mouse models of Fgfr3-related chondrodysplasia.

December 2011, Biomarin has released new information about the pre-clinical development of BMN-111, presenting results of tests made not only in mice but also in non-human primates, a requisition for any candidate drug to be accepted as an investigational new drug (IND) by regulatory bodies such as the Food and Drug Administration (FDA).

More recently, Biomarin has also announced that it was starting the first clinical trial, a Phase 1 study, to learn how the drug acts in the human body.

Step by step, it seems that the first medicine made to help bones grow in achondroplasia is advancing in its development, an exciting perspective. But, before lighting fireworks, it would be interesting to learn more about the CNP and what we should expect about its use in the treatment of ACH children.

 The Natriuretic Peptide Family

Peptides are molecules made of amino acids, like proteins, but they are smaller and, like their larger cousins, they are also encoded in genes. Natriuretic means a property of something that causes sodium to be eliminated in the urine. The name natriuretic came after the description of one of the first recognized properties of these peptides, which is exactly promoting the elimination of sodium in urine.

The history of the natriuretic peptides begins about 30 years ago when the first peptide of the family was discovered in extracts of rat atria and for this was called atrial natriuretic peptide(ANP). Not much longer, BNP was identified in extracts of pig brains and then CNP, and as it was the third in the row, received the C-type NP name (this is a link to a good review on CNP by Olney RC). While ANP and BNP are most found in cardiac tissue and are linked to cardiac physiology and related diseases, CNP is expressed in a number of other body tissues and remarkably found within the cartilage growth plate, where it exerts the most important of its actions. This link will take you to a figure showing the three peptides.

CNP

CNP is a known positive player in the growing bone according to many studies made in animal models and also in related mutations in spontaneous human cases. For instance, genetic mutations in the CNP gene causing its overexpression lead to overgrowth. The research also showed that slight changes in the natriuretic peptide receptor type C structure (NPR-C, one NP receptor that is thought to serve as a CNP clearance system) may be responsible for the higher final height found in people from some of the Northern European countries (Estrada K et al.;Bocciardi et al.).

This peptide is expressed (produced) locally in the growth plate. When it binds to its preferential receptor enzyme, NPR-B, located across the cell membrane (in the same way FGFR3 is) of the chondrocyte, it activates this receptor, which in turn causes the activation of other enzymes in the cell cytoplasm. Interestingly, this CNP cascade of chemical reactions will then cross with one of the most important cascades responding to FGFR3 activation, the RAF-RAS-MAPK pathway (discussed here).

activated by FGFR3, the RAS-RAF-MAPK pathway will lead to one of the most well characterized consequences of achondroplasia, which is slowing down the rate the chondrocytes enlarge (hypertrophy) and mature, thus impairing the entire cartilage growth pace. By the other side, when CNP activates its receptor, the chemical messages emitted by its cascade will turn off or reduce the RAS-RAF-MAPK cascade activity, so causing an inverse action in terms of bone growth. The main observed characteristic of growth plates of ACH mice models treated with CNP is an enlargement of the hypertrophic zone of the growth plate. Take a look in this article (free access) by Drs Yasoda and Nakao, two of the most prominent researchers of CNP in achondroplasia. They tell the history and results of their research, which has strongly contributed to the understanding of CNP in achondroplasia. This article also has a very didactic graphic showing the two cascades described above.

With the reassuring results of the research by scientists like Drs. Yasoda and Nakao, it became clear that CNP could be used somehow to rescue the bone growth arrest in achondroplasia. But how?

The Japanese group developed a mouse model where the CNP was naturally produced in large quantities by the animal body, in a strategy to simulate a situation where the peptide would be given continuously to the patient. This was necessary because of the nature of CNP. Being a small peptide, it is a usual target of several enzymes present in the blood stream calledpeptidases. This is so true that CNP, after a single intravenous injection, would last less than five minutes circulating. With such a short half-life (the way scientists describe the interval of time half the quantity of a drug will take to be processed by the body) giving multiple injections would not be a clever strategy to treat any situation. So they probably thought about a therapeutic scheme where their CNP would be given trough a continuous pump infusion, in the same way other clinical conditions have been treated in the past. Their work showed CNP indeed cause bone growth in an achondroplasia +/CNP+ composite mouse model, rescuing the bone growth arrest.

However, this solution, although feasible, has a lot of practical challenges easy to foresee. Then, is there any other way we could give CNP to a child to treat achondroplasia? The answer is yes. Given the strategy announced by Biomarin, in which their CNP analogue will be given subcutaneously once a day, there are other ways. As there is no publicly available information about the compound formula or structure we can only speculate about the solution they found, but it might be related to the knowledge we have about the metabolism of the NPs. Let’s talk a little bit about this.

As mentioned above, CNP and the other related peptides are natural victims of peptidases present in the blood and other tissues. However, the most relevant of these enzymes, neprilysin, does not cleave (cut) the NPs in the same way. Neprilysin has different affinities with the NPs, being ANP and CNP more easily cut than BNP. If you visited the figure I presented above, you may have already identified the structural differences among the three NPs. BNP has two “legs” or branches leaving the main ring while CNP has only one. Evidence exists that the longer BNP branch would be the responsible to its relative resistance to neprilysin (Potter LR, free access). So, there is a chance Biomarin could have developed a CNP analogue bearing a slight modification in its only branch structure (like in BNP) that would give it more resistance to neprilysin activity. This change could give this CNP analogue more time to circulate and diffuse into the tissues and especially into the cartilage growth plate.

It looks like a very smart solution. Tests made with animals have been showing positive results (links above) and, given the FDA authorization to let them proceed to clinical trials, results have been robust enough in terms of efficacy and safety in those animal models.

Testing CNP in clinical trials

Now is the time to test the CNP analogue in humans. What we should expect about these experiments in terms of safety and efficacy?

Safety

First, as CNP is closely related to the other NPs, and that both ANP and BNP have significant effects in the blood pressure and other circulatory parameters, a strict oversight on cardiologic and other circulatory indexes must be carried on. Biomarin has showed during a public presentation in December that the CNP analogue did cause a decrease in the blood pressure in monkeys after each injection.

Second, CNP is found in other tissues throughout the body, including the brain. A recently published study by Dr Nakao and colleagues showed that CNP can influence the body weight, possibly by acting directly in the brain. The mouse model used by the Japanese group does not reproduce the real life, so their results must be understood under this context. Nevertheless, it will be important to follow patients using CNP chronically to understand this aspect of CNP.

Third, bones are not equal, some are thin others thicker. Furthermore, achondroplasia is described as a rhizomelic (rhizo means root) bone dysplasia. This means that it is recognized that proximal (to the trunk) bones are more affected that the distal ones (those in the extremities). There is a theory this could be caused by distinct influences FGFR3 would have across the skeleton, with some bones being more affected than others by the mutation. In some of the papers published by the Dr. Nakao’s group, pictures of mice treated with continuous CNP could cause the impression that had thinner spines and longer feet and tails than the control (normal, non-treated) animals. Again, here the kind of exposure those animals had was quite different of what we would expect in the real life or with a single CNP shot a day. Nevertheless, this could be a good aspect to be observed throughout future studies in affected patients.

Fourth, another aspect to be taken in account is the kind of effect the extra CNP would have in other cartilaginous tissues such as the joints, ears, nose and trachea. Although having some specific patterns, chondrocytes tend to behave similarly to the same stimuli wherever they are located, so this is also a question that will need an answer, too.

Efficacy

How will the efficacy of the treatment of CNP be measured? Growth is not a parameter easy to measure in the short term. However, there are some indexes which can be used to monitor the growth rate in children under treatment. For instance the average growth speed rates can be derived from the NCHS series. You can see how this was made by examining this Brazilian Ministry of Health guideline directed to pediatric health care which uses these derived curves (sorry, it is in Portuguese, but look at the page 21 to see the derived graphic.

Growth tends to be fast in the first year after birth and then it starts to slow down up until puberty. It is likely that in children with achondroplasia, taking in account the intrinsic growth impairment, the growth pace could be similar (actually, this would have to be proved. I am not aware of any study addressing this feature).

The idea could be to plot the already known child heights over the years and create an individual graphic. With the exposure to CNP it would be expected that the growth speed would increase and this can be better measured comparing to the previous pace and to the expected ongoing pace. This is more than just measuring the absolute height.

Another possible marker of growth could be to take measures of the four member bones or, in other words, the lengths of the arms and forearms and thighs and legs could be taken. Then, during the treatment these measures could be readdressed to look for trends in the growth pace in the different member segments. Achondroplasia is a rhizomelic dysplasia, so it would be interesting to learn about the response of the proximal bones to the treatment and also this measure would help to spot earlier any tendency for overgrowth of the extremities.

We must remember that everything in a child with achondroplasia is normal but the workaholic FGFR3. So, if the mutated receptor is compensated what we can expect in terms of bone growth? Doctors know, for a long time, the ‘catch up growth’ phenomenon, seen in several distinct clinical conditions. When the reason for growth impairment is resolved, the affected child tends to grow faster than the average for the age until an individual mark is reached and the growth normalizes. Could the catch-up growth phenomenon happen to children with achondroplasia treated with CNP? This is difficult to say, because in this case the receptor would still be active (so, in a future therapy with a FGFR3 inhibitor, the catch up growth could be expected). Nevertheless, measuring the growth speed would give an insight about this phenomenon in the context of the treatment of achondroplasia with CNP.

arrival of the CNP analogue as the first potential therapy to help children with achondroplasia to rescue, at least partially, the bone growth, is remarkable. There are several steps to be taken in this phase of its development; the drug must prove to be safe and to have the expected efficacy.  Growing more, affected children could be spared from suffering the many common interventions seen in achondroplasia, from removal of tonsils and adenoids to serious orthopedic and neurological complications. At this moment we must be rational, not presuming that the bone growth will be restored to its full potential. However, in the case of this first possible therapy succeed, a better quality of life could be expected for children with achondroplasia.

The Link Between FGFR3 and CNP Expression – Raja’s Research Summarized

Ever since the a commenter who calls himself Raja has shown me the study of the link between FGFR3 and Achondroplasia and I realized that it might be one of the easier, most promising ways that real companies have been doing to try to help at least children increase in height, I realized that I should take a more serious look at what this researcher had to say. So I asked him/her about the research they have been doing. Here is our exchange of emails.

Me —> D Inventor

Your response to one of my posts have been very interesting. I plan to write a detailed post about the study and see where it will take the research.

I have done mostly studies on fgf2 and basic fgf2, nothing on fgf 3 yet.

So can you show me the research you have been doing?
and how comfortable do you feel about coming on the podcast and explain your own research?

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What I’ve found so far.

Children: To the best of our knowledge there is currently only one company worldwide, that researches an innovative height increase therapy: ProChon Biotech (http://www.prochon.com), established in  Israel in 1997. ProChon is developing a monoclonal antibody for the treatment of achondroplasia. This antibody approach targets specifially the FGFR3-gene and hasn´t reached the stage of human clinical trials yet. If it is successful, it will only work for children with achondroplasia. – http://www.makemetaller.org/index.php/topic,578.0.html

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D Inventor —> Me

I’ll give you a summary of what I’m working on.

Basically, our bodies are designed to only grow to a certain extent – this is really why our height is determined by our genes. Growing taller than our “predetermined” height is called skeletal overgrowth. When I started researching, I found an article on CNP in which scientists increased substantially the plasma concentration of CNP, which resulted in skeletal overgrowth of the mice models (1, 2). You can really just google this for more info, but I’ve provided the links at the end of this message. I read another article which found a family with genetic mutation that caused an overexpression of the NPPC gene, which controls the expression and production of CNP (3). Basically, everyone in this family was really tall.

Another interesting article was on FGFR3 knockout, which lead to skeletal overgrowth in mice models (4). CNP works as an antagonist to FGFR3, which is evident as CNP is able to rescue achondroplasia models with constitutive FGFR3 activation.

Here’s how CNP works (just some technical information, but this is important for when we get into the pharmaceuticals specifications):

– CNP activates its receptor GC-B, which releases cGKII (5)
– cGKII works by inhibiting the conversion of Ras into Raf (look up FGFR3 phosphorylation)
– This acts as a inhibitor to the activation of the MAPK cascade. This is important to endochondral ossification as it inhibits ERK1/2 phosphorylation.

Essentially, one way that CNP exerts its bone promoting effects is through the inhibition of ERK1/2 activation (one of two pathways that are activated with FGFR3). You can really just search up “ERK1/2 inhibition” on google and see that other scientists have achieved skeletal overgrowth in mice models in which they inhibited ERK1/2.

OKAY, enough with background info. If I’m rabbling, I apologize. It’s just that there really is a lot of information on this.

Back to FGFR3 – its inhibition leads to skeletal overgrowth and it WILL increase a person’s final height. Many people with mutations that diminish FGFR3 expression have really tall stature.

So, for us, people who want to be taller, the easiest way for us to get taller is to inhibit FGFR3. The article I posted on your website discusses how there was an increase in the height of the growth plate in a person whose growth plate was about to close (or was in fact closed). This is interesting because in the article, the individual’s growth plate was reduced to a growth scar. This usually happens when the growth plate is just about to close. However, if used in conjuction with LSLJ (if this method really does cause microfractures), then it MIGHT be effective for people with closed growth plates, since it MIGHT just help regrow growth “plates” on a micro scale, and could possibly lead to a few more inches.

So, back to FGFR3 inhibition. As far as I’ve researched, this seems to be an effective method for people with open growth plates. The problem with current FGFR3 tyrosine kinase inhibitors is the lack of specificity. But, I’ve found a novel drug which seems very specific to the FGFR family, called AZD 4547. So far, at least in vitro studies, it is by far the most selective that I’ve found, towards FGFR3. The benefit of chemical inhibitors is that they target everywhere in the body, so that growth is proportional.

While I can’t really advise anyone to take this compound, I’m trying to find a synthesis method for this compound.

If you need any more info, feel free to ask.

References:

1. Chronically elevated plasma C-type natriuretic peptide level stimulates skeletal growth in transgenic mice, Source: http://ajpendo.physiology.org/content/297/6/E1339.full.pdf

2. C-type natriuretic peptide and overgrowth. , Source: http://www.ncbi.nlm.nih.gov/pubmed/19293575

3. An Overgrowth Disorder Associated with Excessive Production of cGMP Due to a Gain-of-Function Mutation of the Natriuretic Peptide Receptor 2 Gene, Source: http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0042180

4. Skeletal overgrowth and deafness in mice lacking fibroblast growth factor receptor 3. , Source: http://www.ncbi.nlm.nih.gov/pubmed/8630492

*Just a note, while it says it causes deafness, this on a genetic knockout study. Deafness is caused by a developmental defect when the mice are embryos or just as they are growing. In humans (that are mature and fully developed), with inhibition of FGFR3, there should not be any problems with deafness (to the best of my knowledge).

5. Cyclic GMP-dependent protein kinase II plays a critical role in C-type natriuretic peptide-mediated endochondral ossification. – Source: http://www.ncbi.nlm.nih.gov/pubmed/12193576

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My Response to D Inventor

Tyler noted the link between FGFR3 and CNP as well as the link between FGFR3 and ERK 1 & 2. I  have absolutely no research on ERK 1&2 and don’t even know what they are yet. I can not comment or make any good judgement on how ERK affects everything.

I’ve done the research on CNP before and the research was done by many other height increase researchers in the past from the GrowTallForum.com which is now closed. They tried to increase their height through finding compounds that could increase the level of CNP or Nitric Oxide in their systems. I found at least one patent by some Japanese guy who showed that increased CNP would help children who are suffering from idiopathic short stature.

It is very clear that there is a chance that increased CNP levels in the blood would negate the function of FGFR3 to a certain level in humans suffering from Achondroplasia. Refer to the post CNP, the first potential pharmacological therapy for achondroplasia. 

From that post, it states “Biomarin, a pharmaceutical company working in therapies for rare and genetic conditions, announced it was planning to start the clinical research with a compound called BMN-111. BMN-111 was described as a C-type Natriuretic Peptide (CNP) analogue.”

So from this article, it shows that there is still a lot of options and hope for kids who are still growing . CNP does not have to be the only option.

I read over the article you referenced quite extensively entitled “Cartilage Dysplasia and Tissue Mineralization in the Rat Following Administration of a FGF Receptor Tyrosine Kinase Inhibitor”

I wanted to first make the point that the study was done on lab rats, not humans. It might not even be able to be translated to humans. The reason for this is like I said before, mature rats still have growth plate cartilage.

In the paper, the mature mice were defined to be around 11 months old. I googled the term “at what age do rats stop growing”. The information is mixed but the general answer is that they usually stop growing around the 8-10 month range. Refer to RatForum.com. So technically the “mature” rats in the experiment should have stopped growing in bone length.

The paper does say that the cartilage in the mature rats did go through hyperplasia. However, the main point and problem I would bring up is that unlike humans, even mature and old rats (and possible mice) still have bands of cartilage in their limbs. The long bones of old rats are not completely bone, but have portions that are stil cartilage. Humans don’t have that physiology. Our limbs become all bone except at the ends.

Remember that most of the people who ever ask about how to grow taller already have their plates fused. They are already in a very difficult position when they start to ask for help and look for solutions.

What happens usually is that while a person is still young and have open plates, even if they are short they still rationalize in their mind and hope that they just haven’t gotten the chance to go through their growth spurts yet, even if they never will get one. Everyone hopes that they would be one of the lucky ones who gets to go through a 6-7 inch growth spurt and that would happen to them. For most people, that doesn’t happen. So they wait and don’t do much except wish and hope, and they run out of time when the cartilage is all gone. After they notice that they are still short even after puberty, then they start worrying since they never got the growth spurt that they ‘deserved’ or expected to get and start to search. It is already too late.

Me and the other researchers have found multiple ways for children with open growth plates get taller. That is easy. Finding a way for fused cartilage has been the problem, and will always be the problem. That is the real solution we want to find.

What we always focused on was a solution for people with bone maturity, because we all understand that ultimately, that is the real solution.