Longitudinal evaluation of the association between Insulin-like growth factor-1, Bone specific alkaline phosphatase and changes in mandibular length

Tulika Tripathi,Navneet Singh,Prateek Gupta,Vinod Kumar Gupta,Priyank Rai,Jitender Sharma,Mahesh Verma

doi:10.1038/s41598-019-48067-7

Abstract

The aim of the current longitudinal study was to assess the levels of serum Bone-specific alkaline phosphatase (BALP) and serum Insulin like growth factor-1 (IGF-1) in different cervical vertebral maturation index (CVMI) stages and observe their association with the mandibular growth. Blood samples and lateral cephalograms of 63 subjects (age group of 11–17 years) were obtained at two time points, 12 months apart. On the basis of CVMI, all subjects were divided into six groups based on whether the subjects remained in same CVMI stage or transitioned to the next CVMI stage. Annual mandibular length was related with serum BALP and serum IGF-1 levels estimated using ELISA. Serum IGF-1 and BALP attained highest levels at CVMI stage 3 with peak BALP levels observed earlier than IGF-1. Although a positive correlation was determined between IGF-1 and BALP but BALP followed skeletal growth pattern more precisely. Overall IGF-1 and BALP were negatively correlated with mandibular length with notable growth in CVMI groups 3–3 (P < 0.01), 3-4 (P < 0.01), 4-4 (P < 0.001) and 5-5 (P < 0.001). In conclusion, BALP is a potential biomarker for skeletal growth assessment. However, the mandibular growth pattern was independent of changes in IGF-1 and BALP.

Highlights

Identification of skeletal pattern and residual growth potential entails precise association of the growth and development with the maturational stage of each individual in order to decide a proper treatment plan[1]
Cervical vertebral maturation index (CVMI) is the contemporary method which allows for appraisal of skeletal maturation on the basis of the morphology of second to fourth cervical vertebrae visualized on lateral cephalogram
Since promising results of Bone-specific alkaline phosphatase (BALP) and Insulin like growth factor-1 (IGF-1) in depicting skeletal growth has been observed in cross sectional studies in regard to concordance with CVMI21–27, we ventured into longitudinal assessment of the changes in serum IGF-1 and BALP during active growth period and further study the relationship between these biomarkers and mandibular length

Summary

Introduction

Identification of skeletal pattern and residual growth potential entails precise association of the growth and development with the maturational stage of each individual in order to decide a proper treatment plan[1]. Radiographic exposure, variability in subjective assessment of the radiographs and unsuitability in predicting intensity of mandibular growth spurt are some of the limitations, which affect the reliability of CVMI7–9. Cervical vertebrae morphological assessment is difficult due to variability in cervical area of vertebral column in different skeletal relationships of the jaws, body posture and shapes of facial components. Assessment of biochemical markers, signified as molecular representatives of the process of skeletal growth, possibly predict bone growth more accurately[15]. Since promising results of BALP and IGF-1 in depicting skeletal growth has been observed in cross sectional studies in regard to concordance with CVMI21–27, we ventured into longitudinal assessment of the changes in serum IGF-1 and BALP during active growth period and further study the relationship between these biomarkers and mandibular length

Methods

Results

Conclusion