title: Perioperative treatment with human growth hormone down-regulates apoptosis and increases superoxide production in PMN from patients undergoing infrarenal abdominal aortic aneurysm repair.
abstract: BACKGROUND
  Recombinant human growth hormone (hGH) therapy has a beneficial effect on catabolism and wound healing after major surgery. Polymorphonuclear neutrophils (PMN) play an important role in this context. In a prospective, double-blind, randomized, placebo-controlled trial we studied the effect of perioperative hGH treatment on postoperative wound healing and on changes in superoxide generation and susceptibility to apoptosis of PMN in elderly patients undergoing elective abdominal aortic aneurysm repair.
  
  
  METHODS
  Seven patients were treated with high-dose hGH (16 U/d) for nine days, seven patients with a placebo. IGF-I, neutrophil count, O2-production induced by opsonized zymosan and apoptosis of PMN were measured and correlated with clinical outcome.
  
  
  RESULTS
  Perioperative hGH treatment more than doubled the O2- production in PMN before and 24 h after surgery (p < 0.01). The long-term capacity of PMN to generate O2 in vitro was prolonged (p < 0.001) in the hGH group. Spontaneous and Fas-inducible apoptosis was strongly down-regulated in PMN after surgery in all patients (p < 0.01). hGH-treatment distinctly reduced apoptosis in PMN before and after surgery (p < 0.01). Clinical outcome was similar in both groups.
  
  
  CONCLUSIONS
  Perioperative hGH treatment results in an enhanced O2- production in PMN and in a prolongation of the functional life span of these cells. This may improve immune function and help to overcome the postoperative anergic state of the immune system especially in elderly individuals.
authors.affiliation: Department of General-, Visceral-, Thoracic- and Vascular-Surgery, University Bonn, Sigmund-Freud-Str. 25, 53105 Bonn, Germany. pd_decker@hotmail.com
authors.forename: Dorothee
authors.initials: D
authors.lastname: Decker
authors.forename: Wolfram
authors.initials: W
authors.lastname: Springer
authors.forename: Rene
authors.initials: R
authors.lastname: Tolba
authors.forename: Holger
authors.initials: H
authors.lastname: Lauschke
authors.forename: Andreas
authors.initials: A
authors.lastname: Hirner
authors.forename: Alexander
authors.initials: A
authors.lastname: von Ruecker
mesh_terms: D000368:Aged; D001012:Aorta, Abdominal / Q000473:pathology / Q000601:surgery; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D017209:Apoptosis / Q000187:drug effects*; D015536:Down-Regulation; D005260:Female; D019382:Human Growth Hormone / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D007334:Insulin-Like Growth Factor I / Q000032:analysis; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D009504:Neutrophils / Q000187:drug effects* / Q000378:metabolism; D019990:Perioperative Care; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use; D013481:Superoxides / Q000378:metabolism*; D013530:Surgical Wound Infection / Q000517:prevention & control*; D014945:Wound Healing / Q000187:drug effects; D015054:Zymosan / Q000494:pharmacology
chemical_list: D011994:Recombinant Proteins; D013481:Superoxides; D019382:Human Growth Hormone; D007334:Insulin-Like Growth Factor I; D015054:Zymosan