Perioperative treatment with human growth hormone down-regulates apoptosis and increases superoxide production in PMN from patients undergoing infrarenal abdominal aortic aneurysm repair.
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.
Decker
Dorothee
D
Department of General-, Visceral-, Thoracic- and Vascular-Surgery, University Bonn, Sigmund-Freud-Str. 25, 53105 Bonn, Germany. pd_decker@hotmail.com
Springer
Wolfram
W
Tolba
Rene
R
Lauschke
Holger
H
Hirner
Andreas
A
von Ruecker
Alexander
A
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
D011994:Recombinant Proteins; D013481:Superoxides; D019382:Human Growth Hormone; D007334:Insulin-Like Growth Factor I; D015054:Zymosan