Does insulin-like growth factor 1 contribute in red blood cell transfusions to the pathogenesis of retinopathy of prematurity during retinal neovascularization?
BACKGROUND
Red blood cell (RBC) transfusions are associated with the development of retinopathy of prematurity (ROP). During the period of retinal neovascularization a rise of insulin-like growth factor 1 (IGF-1) may trigger rapid growth of new blood vessels.


OBJECTIVE
To study endocrine factors in RBC transfusions that might be of importance for ROP.


METHODS
IGF-1, IGF-2 and their binding proteins 1-3 (IGFBP-1-3) were determined by radioimmunoassays in 7 very-low-birthweight (VLBW) infants with ROP >or= stage 2 receiving a RBC transfusion, in 10 controls (VLBW infants with ROP <or= stage 1, no transfusion), in supernatants of 7 RBCs and of 5 washed RBCs (WRBC).


RESULTS
IGF-1 (mean +/- SD) in infants with ROP was 20.0 +/- 4.2 microg/l, in controls 35.9 +/- 15.2 microg/l (Mann-Whitney U test, p = 0.030). IGF-1 in RBC was 12.88 +/- 5.03 microg/l and in WRBC 0.45 +/- 0.74 microg/l (average of the three-course washing procedure). IGF-2 in infants with ROP was 485.67 +/- 158.73 microg/l, in controls 389.9 +/- 102.8 microg/l (not significant), in RBC 109.50 +/- 117.89 microg/l, in WRBC 61.07 +/- 30.0 microg/l. Except for IGFBP-3 other IGFBPs were barely or not detectable in RBC or WRBC.


CONCLUSIONS
Considering lower IGF-1 concentrations in preterm infants than in adults (factor 20), the IGF-1 in RBC transfusions is equivalent to a single dose of 1 microg/kg IGF-1 (5-10% of the adult dose with proved metabolic responses). Endocrinological relationships between the donor's load and the acceptor's individual features are a new aspect of potential side effects of RBC transfusions. Further research is necessary to clarify the share of the described IGF administration on the development of ROP.
Hübler
Axel
A
Department of Pediatric, Friedrich-Schiller-University of Jena, Jena, Germany. Axel.Huebler@med.uni-jena.de
Knote
Kerstin
K
Kauf
Eberhard
E
Barz
Dagmar
D
Schlenvoigt
Dorothea
D
Schramm
Dirk
D
D017707:Erythrocyte Transfusion / Q000009:adverse effects*; D006801:Humans; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D018970:Insulin-Like Growth Factor Binding Protein 1 / Q000097:blood; D018971:Insulin-Like Growth Factor Binding Protein 2 / Q000097:blood; D018972:Insulin-Like Growth Factor Binding Protein 3 / Q000097:blood; D007334:Insulin-Like Growth Factor I / Q000032:analysis / Q000502:physiology*; D007335:Insulin-Like Growth Factor II / Q000032:analysis; D009389:Neovascularization, Pathologic / Q000209:etiology*; D012171:Retinal Vessels / Q000503:physiopathology*; D012178:Retinopathy of Prematurity / Q000209:etiology* / Q000503:physiopathology
D018970:Insulin-Like Growth Factor Binding Protein 1; D018971:Insulin-Like Growth Factor Binding Protein 2; D018972:Insulin-Like Growth Factor Binding Protein 3; D007334:Insulin-Like Growth Factor I; D007335:Insulin-Like Growth Factor II