Repeated Administration of Recombinant Human Insulin-Like Growth Factor-I in Patients After Gastric Surgery: Effect on Metabolic and Hormonal Patterns

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Abstract

Objective

The primary objective of this investigation was to evaluate the anticatabolic effects of repeated subcutaneous administration of recombinant human insulin-like growth factor-l (rhIGF-l) in patients after gastric surgery.

Summary Background Data

The anabolic and protein-sparing effects of growth hormone are primarily mediated by IGF-I. Malnutrition and catabolic states result in increasing blood levels of growth hormone and decreasing levels of IGF-I. Experimental data showed that exogenous IGF-I could attenuate or reverse catabolism.

Methods

After giving their written informed consent, 38 male and female patients undergoing gastrectomy (age 40–75 years, body mass index 17–30 kg/m2) were treated with 80 9/kg body weight rhIGF-l or placebo in a prospective, randomized, double-blind study for 5 consecutive days. Patients received a standardized total parenteral nutritional regimen with 3 g/kg body weight glucose and 0.1 g/kg body weight nitrogen. Nitrogen balance and 3-methylhistidine excretion were measured daily. Hormone profiles (IGF-I, IGFBP1, IGFBP3, cortisol, insulin, glucagon, triiodothyronine [T3], levothyroxine [T4], and thyroxine-binding globulin) were taken.

Results

Exogenous rhIGF-l was tolerated well. Anabolic action could not be proven by nitrogen balances or 3-methylhistidine excretion.

Conclusions

The course of serum IGF-I, IGFBP1, and IGFBP3 concentrations suggest counterregulatory mechanisms that overcome the anabolic effects of rhIGF-l.

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