The role of IGFs in catabolism.
The hypercatabolic response to trauma, extensive surgery and sepsis is characterized by an increased metabolic rate, severe muscle wasting and a negative nitrogen balance. This process of 'autocannibalism' may be in part a consequence of a disordered growth hormone (GH)/insulin-like growth factor (IGF) axis. In this chapter the normal physiology of the GH/IGF axis is first briefly reviewed. This is followed by a discussion of the changes that accompany fasting and catabolic illness, the effects of IGF-1 administration in health and disease and a comparison of the effects of IGF-1, GH and insulin on catabolism. Although initial investigations of IGF-1 administration in animals and human volunteers have often been encouraging, studies in catabolic patients have so far proved disappointing. Combined treatment with GH, IGF-1 (and insulin) or with IGF-1 and its major binding protein, may prove more effective, especially when used in conjunction with nutritional supplements such as glutamine.
Botfield
C
C
Department of Intensive Care, St. Bartholomew's Hospital, Smithfield, London, UK.
Ross
R J
RJ
Hinds
C J
CJ
D000818:Animals; D016638:Critical Illness; D005215:Fasting / Q000502:physiology; D013006:Growth Hormone / Q000502:physiology; D006262:Health; D006801:Humans; D007328:Insulin / Q000502:physiology; D008660:Metabolism / Q000502:physiology*; D013002:Somatomedins / Q000502:physiology*
D007328:Insulin; D013002:Somatomedins; D013006:Growth Hormone