AJP - Regulatory, Integrative and Comparative Physiology, Vol 268, Issue 4 970-R977, Copyright © 1995 by American Physiological Society
Alterations in the insulin-like growth factor system in trauma patients
M. M. Wojnar, J. Fan, R. A. Frost, M. C. Gelato and C. H. Lang
Department of Surgery, State University of New York at Stony Brook 11794, USA.
The aim of the present study was to elucidate changes in the growth hormone
(GH)-insulin-like growth factor (IGF) axis in trauma patients throughout
their stay in the surgical intensive care unit (SICU). The first venous
blood sample was obtained within 24 h after admission to the SICU and
before the start of nutritional support; the last sample was obtained
within 24 h of each patient's discharge from the SICU. All patients were
receiving nutritional support at this later time. Control subjects were
healthy volunteers, matched for age and sex and fasted approximately 18 h
before blood sampling. GH in trauma patients was increased 25-fold on the
first day and was still elevated > or = 5-fold on the last day. Trauma
decreased circulating levels of both IGF-I (50-60%) and IGF-II (33-45%)
throughout the duration of the patients' stay in the SICU. A sustained
reduction in plasma IGF-binding protein (BP)-3 (55-75%) was observed in
trauma patients throughout the protocol. In contrast, IGFBP-1 levels
increased more than threefold during this same period. Furthermore, IGFBP-1
in these patients had undergone posttranslational modification and existed
primarily in a highly phosphorylated form. Blood, collected from a cohort
(n = 3) of these patients within 24 h of their discharge from the hospital,
indicated that IGF-I and IGF-II were still reduced (30%) and that the
decrease in IGFBP-3 and the elevation in IGFBP-1 were still evident at this
time.(ABSTRACT TRUNCATED AT 250 WORDS)
