title: Ten-year improvement of insulin resistance and growth with recombinant human insulin-like growth factor 1 in a patient with insulin receptor mutations resulting in leprechaunism.
abstract: Leprechaunism, a rare genetic disease resulting from mutations in two alleles of the insulin receptor gene, is characterized by severe insulin resistance, retarded growth and, usually, premature death. The ability of treatment with recombinant human insulin-like growth factor 1 (rhIGF1) to improve metabolic and clinical parameters in the long-term is still controversial.
  
  
  
  Mutations were looked for in the insulin receptor gene of a four-month-old female baby with leprechaunism. The patient's skin fibroblasts were analyzed for response to insulin and IGF1. At the clinical level, the very long-term effects of treatment with rhIGF1/rhIGFBP3 were evaluated by clinical and metabolic parameters.
  
  
  
  The patient's diagnosis was based on compound heterozygous mutations in two alleles of the insulin receptor gene, thus confirming leprechaunism. Cultured fibroblasts showed a decreased number of insulin receptors and were insulin-resistant. However, IGF1 was able to stimulate IGF1 receptor signalling, suggesting possible activation of a salvage pathway. Treatment with IGF1/IGFBP3 for 8.7 years, then IGF1 for 2 years, resulted in normalization of circulating levels of IGF1 and IGFBP3. Large daily variations in glycaemia and insulinaemia persisted, but mean glycaemia decreased. Regarding growth, the patient's BMI Z score normalized and length/height score improved. Our patient presented normal neurological development and academic achievement. The treatment was free of adverse effects.
  
  
  
  Our results provide evidence that rhIGF1 with and without rhIGFBP3 can prevent fatal outcomes, and improve growth and metabolic parameters, for more than 10 years in a patient with leprechaunism. Long-term rhIGF1 for severe insulin resistance syndrome should be considered.
authors.affiliation: Pediatric Endocrinology Unit, University Hospital, Rennes, France. Electronic address: marc.de.kerdanet@chu-rennes.fr.
authors.forename: M
authors.initials: M
authors.lastname: de Kerdanet
authors.affiliation: INSERM, UMR-S 938, CDR Saint-Antoine, 75012 Paris, France; Sorbonne University UPMC Université Paris 06, UMR-S 938, 75012 Paris, France; Institute of Cardiometabolism and Nutrition (ICAN), AP-HP, GH HUEP, 75012 Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Caron-Debarle
authors.affiliation: Pediatric Endocrinology Unit, University Hospital, Rennes, France.
authors.forename: S
authors.initials: S
authors.lastname: Nivot
authors.affiliation: Pediatric Endocrinology Unit, University Hospital, Rennes, France.
authors.forename: T
authors.initials: T
authors.lastname: Gaillot
authors.affiliation: INSERM, UMR-S 938, CDR Saint-Antoine, 75012 Paris, France; Sorbonne University UPMC Université Paris 06, UMR-S 938, 75012 Paris, France; Institute of Cardiometabolism and Nutrition (ICAN), AP-HP, GH HUEP, 75012 Paris, France.
authors.forename: O
authors.initials: O
authors.lastname: Lascols
authors.affiliation: Pediatric surgery service, University Hospital, Rennes, France.
authors.forename: B
authors.initials: B
authors.lastname: Fremont
authors.affiliation: Pediatric Endocrinology Unit, University Hospital, Rennes, France.
authors.forename: M
authors.initials: M
authors.lastname: Bonaure
authors.affiliation: Pediatric Endocrinology Unit, University Hospital, Rennes, France.
authors.forename: S
authors.initials: S
authors.lastname: Gie
authors.affiliation: Laboratory of Molecular Genetic and Hormonology, University Hospital, Rennes, France.
authors.forename: C
authors.initials: C
authors.lastname: Massart
authors.affiliation: INSERM, UMR-S 938, CDR Saint-Antoine, 75012 Paris, France; Sorbonne University UPMC Université Paris 06, UMR-S 938, 75012 Paris, France; Institute of Cardiometabolism and Nutrition (ICAN), AP-HP, GH HUEP, 75012 Paris, France.
authors.forename: J
authors.initials: J
authors.lastname: Capeau
mesh_terms: D015703:Antigens, CD / Q000235:genetics*; D002648:Child; D002657:Child Development / Q000187:drug effects; D002675:Child, Preschool; D056731:Donohue Syndrome / Q000188:drug therapy* / Q000235:genetics / Q000378:metabolism / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D020249:Hormone Replacement Therapy; D006801:Humans; D007223:Infant; D007333:Insulin Resistance / Q000235:genetics*; D007334:Insulin-Like Growth Factor I / Q000378:metabolism / Q000627:therapeutic use*; D009154:Mutation; D011972:Receptor, Insulin / Q000235:genetics*; D011994:Recombinant Proteins / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D015703:Antigens, CD; D011994:Recombinant Proteins; D007334:Insulin-Like Growth Factor I; C435941:INSR protein, human; D011972:Receptor, Insulin
keywords: Insulin resistance; Leprechaunism; rhIGF1; rhIGFBP3