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Division of Endocrinology and Metabolism (J.D.V.), Department of Internal Medicine, Mayo Medical and Graduate Schools of Medicine, General Clinical Research Center, Mayo Clinic, Rochester, Minnesota 55905; Endocrine Service (A.I.), Medical Section, Salem Veterans Affairs Medical Center, Salem, Virginia 24153; and Department of Statistics (D.M.K.), University of Virginia, Charlottesville, Virginia 22908
Address all correspondence and requests for reprints to: Johannes D. Veldhuis, Division of Endocrinology and Metabolism, Department of Internal Medicine, Mayo Medical and Graduate Schools of Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, Minnesota 55905. E-mail: veldhuis.johannes{at}mayo.edu.
| Abstract |
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In conclusion, noninvasive analyses predict that attenuation of endogenous Te feedback restraint on the hypothalamo-pituitary unit may be an early biological marker of adaptive changes in the GnRH-LH-Te ensemble axis in the healthy O male.
| Introduction |
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Recent noninvasive approaches to appraise coordinate regulation of an interlinked feedback and feedforward control system include regularity statistics designed to detect subtle adaptations in feedback-sensitive control of the orderliness and synchrony of LH and Te release patterns (8). Such measures predict significantly impaired integrative control of LH and Te sec or Te and LH sec in healthy successfully aging, compared with young (Y), men (9, 10, 11). An emergent query then becomes whether inferred pathway disruption in the aging male is due to a reduction in: 1) pulsatile LH-dependent stimulation (feedforward) of Te sec; and/or 2) circulating Te-enforced inhibition (feedback) of LH sec; or 3) both.
The current study implements a novel analytical platform designed to compare bidirectional in vivo signaling between LH and Te (feedforward) and Te and LH (feedback) noninvasively in successfully aging O and Y men. The outcome measure is the relative strength of the linkage between the physiological input (effector con) and the time-lagged physiological output (glandular sec) (Subjects and Methods). Thereby, we quantitate the impact of age stratum in healthy men on endogenous: 1) pulsatile LH con stimulation of Te sec; and 2) time-varying Te con inhibition of LH sec.
| Subjects and Methods |
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Volunteers comprised healthy Y (n = 13; ages 1830 yr) and O (n = 13; ages 6078 yr) community-dwelling men with (mean ± SEM) body mass index values of 23 ± 1.4 and 25 ± 1.7 kg/m2, respectively. Inclusion criteria were: an unremarkable medical history, physical examination, and biochemical screening tests of hepatic, renal, metabolic, and hematologic function; total Te con more than 320 ng/dl (multiply by 0.0347 for nmol/liter); estradiol less than 45 pg/ml (multiply by 3.67 for pmol/liter); LH, 0.810 IU/liter; FSH, 415 IU/liter (both First International Reference Preparation); prolactin, 212 µg/liter; hematocrit more than 38%; and provision of voluntary informed consent approved by the local Institutional Review Board. Exclusion criteria were: hepatic, renal, hematologic, metabolic, or endocrine abnormalities on biochemical screening (above); a history of cryptorchidism, delayed puberty, or male infertility; steroid, alcohol, or drug abuse; exposure to any neuroactive or pychotropic medications within 5 biological half-lives; shift work or transmeridian travel (exceeding three time zones in the prior week); weight loss or gain (
2 kg change in 6 wk); and failure to provide informed consent.
Subjects were admitted to the General Clinical Research Center for two nights and the intervening day. After overnight adaptation to a forearm iv catheter, subjects underwent repetitive blood sampling (2.0 ml) every 10 min for 24 h beginning at 0800 h. Three meals were provided daily. Participants were allowed to sit in a chair and ambulate to the lavatory but not to exercise, smoke, or drink caffeinated or alcoholic beverages. Lights were extinguished at 2300 h.
Laboratory analysis
LH and Te con (145 samples/subject) were quantitated in duplicate in a single run by immunoradiometric assay and solid-phase RIA, exactly as described (12, 13). Some data series were used earlier as controls in smaller interventional studies. None have been reported in the manner analyzed here. Within-assay coefficients of variation were 6.2 and 5.8%, and between-assay coefficients of variation were 8.3 and 7.9%, for LH and Te, respectively. No samples fell within fewer than 3 SDs of the assay threshold (LH, 0.3 IU/liter; and Te, 24 ng/dl) determined on hypopituitary serum.
Quantitation of hormone sec rates
LH and Te sec rates were estimated via a differential equation-based biexponential model of hormone sec and elimination (elim), as described recently mathematically (10, 14, 15). This methodology first estimates pulse-onset times of LH (and thereby implicitly Te) by an image boundary-detection technique (11). Based upon the resultant set of a priori values, coupled convolution equations are used for statistical estimation of all parameters of LH and Te sec and elim simultaneously in continuous time. Further analyses (below) used the estimated sample (discretized) LH and Te con (reconvolved) and sec (deconvolved) values (14, 15, 16, 17). Earlier experimental validation comprised direct sampling of all three of GnRH, LH, and Te con in the awake unrestrained ram and stallion every 5 min for 12 h and 4 h, respectively, and both LH and Te con in the human spermatic vein every 15 min for 17 h (18).
Cross-correlation procedure
Auto- and cross-correlation analyses were applied to relevantly paired effector-response (input-output) time series, viz: 1) LH con and Te sec; 2) Te con and LH sec; and 3) LH sec and Te sec in both directions. The first two linkages define feedforward and feedback interactions, respectively. The cross-correlation coefficient, r, provides a measure of the relative strength of linear coupling between the two measures at any given time lag (delay in min separating the correlated values) (19, 20, 21). To avoid spurious cross-correlation estimates due to autocorrelation within individual LH and Te time series, the complete auto- and cross-covariance matrix was evaluated at each time lag for all four of LH/Te, LH/LH, Te/LH, and Te/Te relationships (21). To obviate inflation of the type I (false-positive) statistical error rate associated with assessing different time delays between LH and Te, statistical confidence intervals (CIs) for r were adjusted for lag time (Appendix).
Statistical contrasts
Statistical contrasts by age were made by comparing lag-adjusted analytical 95% CIs of the mean difference in cohort r values.
| Results |
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Figure 1
presents paired LH con (A) and Te con (B) time series measured in blood sampled every 10 min for 24 h in four Y (left) and four O (right) men. Asterisks placed on the x-axis line mark the beginning of individual LH pulses. Visual inspection suggested lower-amplitude and more irregular LH pulses in the elderly cohort. Te con values in O men hovered in the range of 400 ng/dl (14 nmol/liter).
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Figure 6
highlights the dispersion of individual feedforward/feedback r values and time lags in all 26 subjects for each of the four cross-correlation models; i.e. relationships defined by LH con/Te con (top), LH con/Te sec (upper middle), LH sec/Te con (lower middle), and LH sec/Te sec (bottom). Inspection of these scatterplots establishes a range of interindividual biological variability, which would not otherwise be evident from mean correlation values (above). For example, occasional O men maintain relatively strong LH-Te or Te-LH correlations, and conversely for Y men.
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| Discussion |
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The primary finding is that, in the absence of experimental intervention, elderly, compared with Y, men manifest quantifiably reduced feedback restraint of LH sec by total Te con, while maintaining analytically similar submaximal feedforward drive of Te sec by pulsatile LH con. Both outcomes depend upon mathematical estimation of paired LH and Te con and sec rates via a coupled differential equation-based deconvolution model validated independently in three mammalian species (14, 15, 18, 22). At present, we are unaware of any comparable statistical appraisal of bidirectional LH and Te feedforward and feedback control from which to draw complementary inferences.
By way of qualification, first, quantitatively reduced negative-feedback signaling by endogenous total Te con in O subjects would not exclude significant inhibition of LH sec by higher con of exogenously delivered Te. Analogously, preserved steroidogenic responsiveness to midphysiological (submaximally effective) LH con in elderly volunteers would not exclude diminished testis responses to pharmacological stimulation by hCG. Second, given the relatively small size of the cohorts evaluated here (n = 13 Y, n = 13 O men), further investigations will be needed to establish the populational generality of our inferences. And, third, aging of the male gonadal axis putatively gives rise to a graded spectrum of mechanistic adaptations, which are modified by comorbidity (7). For example, the present focus on successfully aging men detects impairment of inhibitory Te-LH signaling without any change in the mean (24-h) LH con, but a significant reduction in the molar Te/SHBG con ratio. In other contexts of aging, LH con may be increased (in healthy individuals or subjects with primary gonadal failure) or decreased (in a subset of apparently healthy men or O patients with comorbidity affecting hypothalamo-pituitary function) (1, 7, 23, 24). The precise relationship among such mechanistic categories has not been elucidated.
In earlier clinical studies, pharmacological supplementation with Te or 5
-dihydro Te by iv, transdermal, or im routes variously suppressed LH con equivalently, more or less in O than Y men (7, 25, 26, 27, 28, 29). The basis for such disparate reports is not clear. From a clinical vantage, pertinent factors might include: differences in subject selection and cohort size; type, dose, route, and duration of exogenous Te or 5
-dihydro Te administration; duration and frequency of blood sampling; specificity of the LH assay; and/or timing and method of analyzing LH release. From an experimental perspective, earlier approaches of monitoring the fall in single-sample or mean LH con induced by exogenous Te or its reduced derivative differ from appraising endogenous time-varying Te-dependent inhibition of pulsatile LH sec based on repetitive sampling over 24 h. Implementation of a noninvasive analytical formalism in the current investigation was intended to more faithfully reflect individual biological differences in: 1) pulsatile LH and Te con and sec; and 2) undisturbed bidirectional signaling between the hypothalamo-pituitary unit and the testis. Both objectives are relevant, inasmuch as, in Y men, both Te con and the time pattern Te delivery into the bloodstream determine feedback suppression of LH sec (7, 14, 15, 16). For example, short-term pharmacological depletion of Te con followed by continuous iv or sc addback of a midphysiological amount of Te reduces 24-h mean LH con and sec more than pulsatile iv infusion of the same total dose of Te (30, 31, 32). Assuming that both the amount and time course of Te availability determine negative-feedback signaling, then attenuated total Te con-dependent inhibition of LH sec in elderly men may reflect: 1) reduction in free and/or bioavailable (non-SHBG-bound) Te con; and/or 2) alteration in the con pattern of secreted Te, as inferred by statistical regularity analyses (Introduction). In the first regard, the SHBG con was higher and the molar ratio of Te/SHBG con significantly lower in O volunteers. Lower Te bioavailability would not require or exclude concomitantly impaired target-tissue sensitivity to any given Te con (33, 34). In principle, therefore, inferred erosion of negative feedback by total Te con in O individuals could result from diminished Te bioavailability, disruption of the Y adult-like regularity of Te con patterns in the blood, and/or diminished hypothalamo-pituitary responses to Te. Controlled Te infusion paradigms, combined with novel techniques to estimate pulsatile sec of free and albumin-bound Te noninvasively, will be required to distinguish among these mechanistic considerations (18, 35).
Maximal cross-correlation r values of LH con-dependent drive of Te sec were statistically indistinguishable in the 13 Y and 13 O individuals evaluated here. Feedforward time delays were also comparable by age. Analysis of paired LH sec and Te sec time series corroborated age-invariance of the strength and timing of unmanipulated LH-Te feedforward coupling. Collectively, these data indicate that submaximal stimulation of total Te sec by endogenous LH con may be preserved when very healthy O male volunteers are studied.
In pharmacological paradigms, hCG injection increases total Te con less in O than Y men (36, 37, 38, 39). HCG administration provides a complementary test of Leydig-cell steroidogenesis by assessing maximal rather than submaximal Te sec responses. In particular, hCG differs fundamentally from LH in several respects: 1) hCG binds to the LH/hCG receptor nearly irreversibly; 2) at the doses typically employed, hCG has at least 100-fold greater lutropic effect than an endogenous LH pulse; and 3) hCG injection significantly down-regulates Te sec by the testis (1, 7, 23, 33, 34, 35, 36, 37, 38, 39). Supraphysiological LH drive, induced by doubling LH con during a 14-d iv infusion of GnRH pulses every 90 min, also fails to increase Te con maximally in O compared with Y men (13). And, LH/hCG efficacy is reduced in the aged male rodent as assessed by ex vivo testis perfusion and in vitro Leydig-cell culture (40, 41). The present analysis is unique by way of examining Te sec stimulated by endogenous, physiological, nonmaximal, pulsatile LH con. In this circumstance, we hypothesize that LH potency (half-maximally stimulatory LH con) and/or testis sensitivity (slope of implicit LH con-Te sec response function) may be preserved in O men. In contradistinction, our data do not directly address endogenous LH efficacy (maximal stimulatory response). Recent implementation of a new nonlinear technical platform for in vivo dose-response estimation, in fact, predicts that endogenous LH efficacy (extrapolated asymptotically) declines significantly in successfully aging men (35). Thus, viewed statistically, the present linear cross-correlation strategy provides strongly complementary mechanistic insights into submaximal LH-Te feedforward activity and unveils, for the first time, significant loss of endogenous Te feedback on LH sec in healthy aging men.
In summary, the current study combines intensive and extended blood sampling, deconvolution-based reconstruction of LH and Te con and sec, and time-lagged (feedback and feedforward) cross-correlation analysis of effector-response coupling strength in 13 O and 13 Y healthy men. Thereby, we estimate feedforward and feedback actions of LH and Te without experimental manipulation of the gonadal axis. This noninvasive analytical approach discloses: 1) undetectable Te con-dependent feedback inhibition of LH sec, and significantly reduced negative coupling between LH sec and Te sec in O men; 2) comparable LH con-dependent feedforward stimulation of Te sec, and preserved positive coupling between LH sec and Te sec in elderly individuals; and 3) similar 24-h mean LH but a lower ratio of Te/SHBG con in O volunteers. These collective outcomes allow the hypothesis that aging-related erosion of negative feedback by Te con of hypothalamo-pituitary drive of LH sec reflects biologically reduced availability, altered sec patterns, and/or impaired action of Te on the hypothalamo-pituitary unit.
Technical appendix
Secretion and kinetic estimation.
The sample set comprises 145 paired LH and Te con measurements in each of 13 Y and 13 O men (Subjects and Methods). As a first stage in the estimation of sec and elim parameters, underlying LH pulse-onset times, TL1, TL2,... , TLm, are predicted by a previously described method (22). Then, conditional on these pulse times, all parameters defining LH and Te sec, ZL and ZTe, and biexponential elim are estimated simultaneously by a maximum-likelihood procedure (see Refs.17, 18, 19). The elim function has a fast,
(1), and slow,
(2), phase of elim and a fixed (populationally defined) proportion of rapid to total elim. In this construction, the rapid rate constant reflects primarily advection and diffusion of secreted molecules in the bloodstream, and the slow rate constant incorporates irreversible metabolic clearance (18, 19). The model allows valid estimation of an unknown admixture of basal (ßL, ßTe) and pulsatile (burst-like) LH and Te sec. Basal is defined as time-invariant release. Pulsatile sec arises via a flexible sec-burst shape (waveform), which is represented statistically by a three-parameter generalized Gamma probability density. The latter function relates the instantaneous sec rate within a burst to time:
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is normalized to integrate to unity, which renders the waveform estimate analytically independent of sec-burst mass. Pulsatile LH sec is the product of the normalized waveform and the three-part sum of ongoing accumulation of releasable hormone (
0,L), a weak correlation (
1,L) effect of the length of the prior interpulse interval (TLj TLj1) and sec-burst mass (ALj). Total LH sec is the sum of basal and pulsatile sec:
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The secretion rate of Te (ZTe) is described as a logistic function, driven by the LH feedforward signal (18). Convolution of the sec and elim functions gives rise to the time-varying hormone con(X), as formulated earlier (14, 15, 16, 17, 18, 35). Observed LH and Te con time series are then a discrete time sampling of the foregoing underlying continuous processes plus observational error:
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Figures 13![]()
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illustrate statistical estimates of LH and Te sec rates, ^L,i, ^Te,i, and analytically reconstructed LH and Te con profiles by this methodology.
Cross-correlation analyses.
To account for short-term trends or epochs in hormone release, a 2-h time-moving average is removed from con profiles before cross-correlation analysis. The resulting stationarized LH and Te con series are designated by
L,i and
Te,i. By construction, multivariate (stationary) time-series methods can be applied to the discrete time-dependent process defined by the interlinked set of con and sec estimates. To this end, let
Lc,Tes (·) denote the feedforward cross-correlation function linking LH con (c) and Te sec (s), and let
Tes,Ls (·) define the corresponding negative-feedback relationship. The estimate of
Lc,Tes (h) for lag h (
0) is given by:
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Based upon estimation of both autocorrelation functions (LH/LH and Te/Te) and both cross-correlation functions (LH/Te, Te/LH), the multivariate Bartletts formula (40) is applied to calculate asymptotic variances for each time lag h and k:
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The square root of each variance estimate forms the basis for computing the corresponding SD of lag-specific r values shown in Figs. 4
and 5
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| Acknowledgments |
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| Footnotes |
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Abbreviations: CI, Confidence interval; con, concentration(s); elim, elimination; NS, nonsignificant; O, older; sec, secretion; Te, testosterone; Y, young.
Received February 27, 2004.
Accepted July 30, 2004.
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