Alterations in the insulin-like growth factor system in trauma patients.
The aim of the present study was to elucidate changes in the growth hormone (GH)-insulin-like growth factor (IGF) axis in trauma patients throughout their stay in the surgical intensive care unit (SICU). The first venous blood sample was obtained within 24 h after admission to the SICU and before the start of nutritional support; the last sample was obtained within 24 h of each patient's discharge from the SICU. All patients were receiving nutritional support at this later time. Control subjects were healthy volunteers, matched for age and sex and fasted approximately 18 h before blood sampling. GH in trauma patients was increased 25-fold on the first day and was still elevated > or = 5-fold on the last day. Trauma decreased circulating levels of both IGF-I (50-60%) and IGF-II (33-45%) throughout the duration of the patients' stay in the SICU. A sustained reduction in plasma IGF-binding protein (BP)-3 (55-75%) was observed in trauma patients throughout the protocol. In contrast, IGFBP-1 levels increased more than threefold during this same period. Furthermore, IGFBP-1 in these patients had undergone posttranslational modification and existed primarily in a highly phosphorylated form. Blood, collected from a cohort (n = 3) of these patients within 24 h of their discharge from the hospital, indicated that IGF-I and IGF-II were still reduced (30%) and that the decrease in IGFBP-3 and the elevation in IGFBP-1 were still evident at this time.(ABSTRACT TRUNCATED AT 250 WORDS)
Wojnar
M M
MM
Department of Surgery, State University of New York at Stony Brook 11794, USA.
Fan
J
J
Frost
R A
RA
Gelato
M C
MC
Lang
C H
CH
D000293:Adolescent; D000328:Adult; D002352:Carrier Proteins / Q000097:blood / Q000378:metabolism; D015331:Cohort Studies; D005260:Female; D013006:Growth Hormone / Q000097:blood; D006801:Humans; D018970:Insulin-Like Growth Factor Binding Protein 1; D018969:Insulin-Like Growth Factor Binding Proteins; D007334:Insulin-Like Growth Factor I / Q000378:metabolism*; D007335:Insulin-Like Growth Factor II / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D011499:Protein Processing, Post-Translational; D014947:Wounds and Injuries / Q000378:metabolism*
D002352:Carrier Proteins; D018970:Insulin-Like Growth Factor Binding Protein 1; D018969:Insulin-Like Growth Factor Binding Proteins; D007334:Insulin-Like Growth Factor I; D007335:Insulin-Like Growth Factor II; D013006:Growth Hormone