Adjuvant recombinant human growth hormone stimulates insulin-like growth factor binding protein-3 secretion in critically ill trauma patients.
The early catabolic phase of severe injury is associated with acute growth hormone (GH), insulin-like growth factor-1 (IGF-1), and insulin-like growth factor binding protein-3 (IGFBP-30 deficiency. The metabolic half-life of circulating IGF-1 is prolonged by its binding to IGFBP-3. The role of this binding protein in nutritionally repleted multiple-injury patients has not been previously evaluated. We have measured plasma levels of these polypeptides and nitrogen (N) balance in 18 adult (15 males/3 females; mean age, 45 years), severely injured, hypermetabolic, and highly catabolic trauma patients within 48 to 60 hours after injury, when they were receiving maintenance fluids without calories or N and during 6 days of total parenteral nutrition (TPN). Before instituting TPN, the patients were randomized to receive (group H, n = 9) or not to receive (group C, n = 9) daily recombinant human growth hormone (rhGH), 0.15 mg/kg IM. Adjuvant rhGH significantly increases plasma levels of GH, IGF-1, IGFBP-3, and insulin. In addition, it shows better improvement in N balance. The bioavailability of IGF-1 is increased, as indicated by the decrease in IGFBP-3:IGF-1 ratio. A significant correlation between IGF-1 and IGFBP-3 levels is present in the trauma patients who received TPN and rhGH. A GH/IGF-1/IGFBP-3 axis that closely regulates the metabolic status of the patient is established in trauma.
Petersen
S R
SR
Trauma Center, St. Joseph's Hospital and Medical Center, Phoenix, Arizona 85013, USA.
Jeevanandam
M
M
Holaday
N J
NJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002153:Calorimetry, Indirect; D002352:Carrier Proteins / Q000097:blood / Q000378:metabolism*; D005260:Female; D013006:Growth Hormone / Q000097:blood / Q000627:therapeutic use*; D006801:Humans; D018970:Insulin-Like Growth Factor Binding Protein 1; D007334:Insulin-Like Growth Factor I / Q000032:analysis / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000378:metabolism* / Q000628:therapy; D009584:Nitrogen / Q000378:metabolism; D010101:Oxygen Consumption; D010289:Parenteral Nutrition, Total; D011994:Recombinant Proteins; D012121:Respiration, Artificial
D002352:Carrier Proteins; D018970:Insulin-Like Growth Factor Binding Protein 1; D011994:Recombinant Proteins; D007334:Insulin-Like Growth Factor I; D013006:Growth Hormone; D009584:Nitrogen