Total IGF-1 Levels Research Articles

Conventional and novel biomarkers of treatment outcome in patients with acromegaly: discordant results after somatostatin analog treatment compared with surgery

Control of disease activity in acromegaly is critical, but the biochemical definitions remain controversial. To compare traditional and novel biomarkers and health status in patients with acromegaly treated with either surgery alone or somatostatin analog (SA). Sixty-three patients in long-term remission based on normalized total IGF1 levels after surgery alone (n=36) or SA (n=27) were studied in a cross-sectional manner. The groups were comparable at diagnosis regarding demographic and biochemical variables. Each subject underwent 3 h of serum sampling including a 2-h oral glucose tolerance test (OGTT). Health status was measured by two questionnaires: EuroQoL and Acrostudy (Patient-assessed-Acromegaly symptom questionnaire (PASQ)). Total and bioactive IGF1 (μg/l) levels were similar (total: 185 ± 10 (SA) versus 171 ± 8 (surgery) (P=0.28); bioactive: 1.9 ± 0.2 vs 1.9 ± 0.1 (P=0.70)). Suppression of total and free GH (μg/l) during OGTT was blunted in the SA group (total GH(nadir): 0.59 ± 0.08 (SA) versus 0.34 ± 0.06 (surgery) (P=0.01); free GH(nadir): 0.43 ± 0.06 vs 0.19 ± 0.04 (P<0.01)). The insulin response to OGTT was delayed, and the 2-h glucose level was elevated during SA treatment (P=0.02). Disease-specific health status was better in patients after surgery (P=0.02). i) Despite similar and normalized IGF1 levels, SA treatment compared with surgery alone was associated with less suppressed GH levels and less symptom relief; ii) this discordance may be due to specific suppression of hepatic IGF1 production by SA; iii) we suggest that biochemical assessment during SA treatment should include both GH and IGF1.

Abstract 2883: Genetic reduction of circulating IGF-1 inhibits growth of COX-2- and Kras-induced pancreatic tumors in orthotopic transplant models

Abstract Chronic pancreatitis dramatically increases the risk of pancreatic cancer, the 4th deadliest malignancy in the US. KRAS mutations, the predominant genetic lesion found in pancreatic cancer, are detectable in 30% of patients with chronic pancreatitis. We previously found that calorie restriction (CR) protected against the tumorigenic effects of chronic pancreatitis in the cyclooxygenase (COX)-2-driven (BK5.COX-2) transgenic mouse model of pancreatic cancer. The protection conferred by CR was associated with dramatically reduced circulating levels of insulin-like growth factor (IGF)-1, an established mitogen in a variety of cancer cell lines. We hypothesized that circulating IGF-1 levels have a crucial role in tumor progression in both pancreatitis- and KRAS-induced pancreatic cancer. To test this, mouse pancreatic cancer cells derived from either a BK5.COX-2 transgenic mouse (JC101) or a KrasG12D/INK4a+/− mouse (NB508) were orthotopically transplanted in liver-specific IGF-1-deficient (LID, n=16 per cell line) and wild-type (WT, n=11 per cell line) mice. LID mice were randomized to receive Alzet miniature osmotic pumps (implanted subcutaneously) continuously infusing either vehicle (n=8) or 1 µg/hr of recombinant human IGF-1 (rhIGF-1, Increlex®, Tercica, Inc., Brisbane, CA; n=8). WT mice were infused with vehicle. Mice were euthanized 28 days after tumor and pump implantation, and blood was collected and tumors were weighed and fixed in 10% normal buffered formalin. Immunohistochemical staining for Ki-67 was performed on paraffin-embedded tumors to assess proliferation. In LID mice serum IGF-1 levels were reduced approximately 70% relative to WT (p&amp;lt;0.05), while infusion of rhIGF-1 resulted in total serum IGF-1 levels (murine plus rhIGF-1) exceeding those in LID and WT mice. Insulin levels were higher in LID mice (p&amp;lt;0.01), relative to WT, but administration of rhIGF-1 reduced insulin to levels comparable to WT. Genetic reduction of circulating IGF-1 in LID mice reduced JC101 tumor burden by 60% (p&amp;lt;0.05) and NB508 tumor burden by 75% (p&amp;lt;0.05), relative to tumors in WT mice. Administration of rhIGF-1 to LID mice restored tumor burden to levels comparable to that of WT mice. Tumors from LID mice also displayed lower expression of the proliferation marker Ki-67 than tumors from WT mice or LID mice administered rhIGF-1. We conclude that reduction of circulating IGF-1 inhibits pancreatic cancer driven by alterations in two common but distinct protumorigenic pathways (chronic inflammation and KRAS alterations), and underscores the potential of IGF-1 pathway inhibition for prevention and treatment of pancreatic cancer. Work supported by NIH grants R25T CA57730 and CA135386. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 2883.

Abstract A102: Genetic reduction of circulating IGF-1 decreases growth of pancreatic tumors in an orthotopic transplant model

Abstract Pancreatic cancer is the 4th deadliest cancer in the U.S. Obesity has emerged as a significant and modifiable risk factor for pancreatic cancer. Calorie restriction (CR) is an anti-obesity intervention that has been shown in many model systems to have potent anticancer effects. Levels of bioavailable insulin-like growth factor (IGF)-1, an established mitogen in a variety of cancer cell lines, increase in response to positive energy balance and decrease with CR. We hypothesized that the genetic reduction of circulating IGF-1 levels seen in liver-specific IGF-1-deficient (LID) mice would diminish the tumor burden of orthotopically transplanted pancreatic cancer cells, similar to CR, while administration of exogenous IGF-1 would restore the tumor burden. To test this hypothesis, mouse pancreatic cancer cells (JC101, derived from our BK5-COX-2 transgenic mouse model of spontaneous pancreatic cancer) were orthotopically transplanted in LID and littermate control (LC) mice. LID mice were also randomized to receive Alzet miniature osmotic pumps (implanted subcutaneously) continuously infusing either vehicle (n=8) or 1 µg/hr of recombinant human IGF-1 (Increlex®, Tercica, Inc., Brisbane, CA; n=8). LC mice were infused with vehicle (n=8). Mice were killed 28 days after injection, blood was collected by cardiac puncture and serum samples were stored at −80°C, and tumors were weighed and fixed in 10% normal buffered formalin for histological and immunohistochemical (IHC) analysis. IHC staining was performed on paraffin-embedded tissues using antibodies against Ki67 and cyclin D1 to assess proliferation. LID mice exhibited significantly smaller tumors (0.20 ± 0.02 g) than LC mice (0.45 ± 0.11 g, p&amp;lt;0.05) or LID + IGF-1 mice (0.57 ± 0.14 g, p&amp;lt;0.01). Serum IGF-1 levels were reduced approximately 60% in the LID mice relative to the LC mice (p&amp;lt;0.01), while infusion of human IGF-1 resulted in total serum IGF-1 levels (murine plus human IGF-1) exceeding either LC or LID mice (p&amp;lt;0.01). In contrast, insulin and leptin levels in LID mice were significantly higher than those seen in LC (p&amp;lt;0.05) or LID+IGF-1 (p&amp;lt;0.01) mice. Consistent with tumor burden data, LID tumors, relative to LC and LID + IGF-1, displayed less expression of proliferative markers. These findings suggest that genetic reduction of circulating IGF-1 levels decreases transplanted pancreatic tumor growth despite increased levels of insulin and leptin, underscoring the importance of the IGF-1 pathway as a pancreatic cancer prevention target. Citation Information: Cancer Prev Res 2010;3(1 Suppl):A102.

Abstract B123: A phase I study of R1507, a human monoclonal antibody IGF-1R (insulin-like growth factor receptor) antagonist in patients with advanced solid tumors

Abstract Background: R1507 is a fully human monoclonal antibody (IgG1) which selectively inhibits insulin-like growth factor receptor (IGF-1R). This phase I dose-escalation study in patients with advanced malignant solid tumors explored the safety, pharmacokinetics (PK) and pharmacodynamics (PD) of R1507 manufactured using a Chinese hamster ovarian (CHO) cell line. Materials and Methods: R1507 was administered as a weekly (qW) or every 3 weeks (q3W) infusion until dose-limiting toxicity (DLT) or progressive disease were observed. Standard phase 1 inclusion criteria were used including adequate organ function, lack of uncontrolled intercurrent illnesses, and CD4 count &amp;gt;200/µl. Clinical assessments for safety and DLT, tumor assessments (every 6 weeks), PK and PD blood sampling were performed. Results: 36 pts were sequentially enrolled in dose levels 3 mg/kg (n= 3), 6 mg/kg (n= 13), 9 mg/kg (n= 7) qW or 16 mg/kg q3W (n= 13). Median pt age 52 yrs (range 18–80), M:F 21:15. Efficacy: 12 (33%) pts showed stable disease (mean duration 25 weeks, range 11–50 weeks) [prostate 4, sarcoma 4; adrenal, appendix, soft tissue, stomach 1 each], including 1 pt with prostate cancer on study for 72+ weeks. Safety: No DLT was observed and a maximum-tolerated dose (MTD) was not reached. Drug-related adverse events (AEs) by CTCAE were mostly grade 1 or 2: fatigue (11 pts), myalgia and nausea (5 each), hyperglycemia and muscle spasms (4 each), and anorexia (3). Fourteen pts had 20 SAEs, of which 2 were related to R1507: dyspnea and pyrexia. Six pts (17%) had 9 drug-related AEs grade ≥3: hyperglycemia and fatigue (2 each), diabetes mellitus, performance status decreased, weight decreased, thrombocytopenia, and dyspnea. PK: R1507 pharmacokinetics were nonlinear. After a single IV infusion, mean clearance (CL) decreased from ∼1000 mL/Day (CV=17.4%) at 3 mg/kg qW to 580 mL/Day (CV=25.7%) in the 16 mg/kg q3W dose group, suggesting saturable elimination. Volume of distribution (Vd) was relatively small, ranging from 5.8 – 7.8 L (CV=7.8–77%), and the mean half life was 10.5 days (CV=28.2%). At week 10, mean trough concentration at steady state (Css,min) was 40.5, 97.3, 127.5, and 90.3 ug/mL for the 3, 6, 9 qW and 16 mg/kg q3W groups respectively. Mean CL and Vd values calculated after multiple administrations were comparable to those calculated after single administration. PD: Dose proportional increase in total IGF-1 levels was observed after treatment with R1507. This increase was sustained until redosing at the 9 mg/kg qW dose level but not sustained in the 16 mg/kg q3W dose level. Conclusions: Treatment with R1507 is tolerable at the doses tested without DLT and has resulted in stable disease. The 9 mg/kg qW dose achieves sustained PK and PD effects and is currently being evaluated in phase II trials. Doses higher than 16 mg/kg q3W are being explored. Citation Information: Mol Cancer Ther 2009;8(12 Suppl):B123.

Heterophilic antibodies may be a cause of falsely low total IGF1 levels

A low serum total IGF1 is considered as a diagnostic indicator of GH deficiency (GHD) in the presence of hypopituitarism. Introduction of IRMA and chemiluminescent immunometric assay (CLIA) IGF1 immunoassays has introduced endogenous antibodies as a new source of interference. In general, this goes unnoticed and might lead to unnecessary diagnostic and therapeutic interventions. A 56-year-old man was referred with a decline in physical performance, unexplained osteopenia, and weight loss of 3 kg over the past 8 months. Although clinical signs and symptoms were unremarkable, laboratory results pointed to secondary hypothyroidism and secondary hypogonadism. In addition, the serum total IGF1 level (CLIA; Siemens Medical Solutions Diagnostics) was in the low normal range. Two GH stimulation tests were performed, but these tests did not support the diagnosis GHD. Moreover, IGF1 bioactivity measured by the kinase receptor activation assay was normal. Interference of heterophilic antibodies was considered. After pretreatment with specific heterophilic blocking tubes that contain blocking reagents to eliminate heterophilic antibodies, serum-free thyroxine, testosterone, and IGF1 levels turned out to be normal. To the best of our knowledge, we here describe the first case in the literature of a patient with low serum total IGF1 levels due to interference from heterophilic antibodies in the used IGF1 immunoassay. When confronted with low-IGF1 levels that do not fit the clinical picture, interference of heterophilic antibodies should be considered in the differential diagnosis.

Effect of aromatizable and unaromatizable androgen replacement in hypogonadal men on GH responsiveness

Although studies have clearly demonstrated that oestrogen replacement affects GH responsiveness by causing relative GH resistance, the effect of androgen replacement is unknown. Circumstantial evidence only suggests that androgen replacement may increase GH sensitivity and/or responsiveness. To examine the impact of androgens on GH responsiveness, hypogonadal men underwent the IGF-1 generation test in the unreplaced state, replaced with testosterone (T) and also replaced with dihydrotestosterone (DHT), its nonaromatizable metabolite. Twelve hypogonadal men with a normal GH axis were recruited. Each subject in random order had 4 weeks off T (NoRx), 4 weeks on T gel (TG) and 4 weeks on DHT gel (DHTG) applied daily, with 1 week washout between each preparation. An IGF-1 generation test using a subcutaneous injection of 7 mg of GH was performed at the end of each of these 4-week phases. Serum GHBP, total and free IGF-1, IGFBP-3 and acid-labile subunit (ALS) levels were measured at baseline and 24 h (peak) after GH administration. Despite a decrease in GHBP during the TG and DHTG phases, there were no observed differences in baseline, peak or increment (peak - baseline) total or free IGF-1 between the NoRx, TG or DHTG phases. There is no evidence of fluctuation in GH responsiveness in hypogonadal men, untreated or replaced with T or DHT alone. This implies that the increased level of oestradiol as a consequence of T replacement in hypogonadal men does not impact significantly on GH responsiveness, nor is there evidence of an androgen effect with elevated DHT levels as a consequence of either T or DHT replacement.

Measurement of insulin-like growth factor-1 and insulin-like growth factor binding protein-3 after delayed separation of whole blood samples

Objectives: Epidemiological studies benefit from unbiased blood specimens collected with minimal cost and effort of blood collection and storage. We evaluated the stability of IGF-1 and IGFBP-3 in whole blood samples stored at room temperature to justify delays in blood processing. Design and methods: Total IGF-1 and IGFBP-3 levels were measured in EDTA plasma ( n = 12), heparin plasma ( n = 12) and serum ( n = 10) samples of healthy volunteers after blood processing delays up till 14 days. Stability of measured IGF-1 and IGFBP-3 levels was tested by paired t-test and a linear mixed effect model. Results: Longitudinal analysis showed that IGF-1 levels were not significantly affected by blood processing delays in EDTA tubes ( p = 0.18) and IGFBP-3 levels were marginally stable ( p = 0.06). In heparin plasma and serum, however, IGF-1 increased over time of delayed processing and IGFBP-3 levels tended to decrease ( p < 0.01). Conclusion: Total IGF-1 and IGFBP-3 levels are stable in whole blood collected in EDTA tubes at room temperature up till 7 days, allowing a delay in blood processing to reduce costs in large multi-center studies.

Serum measurements of testosterone, insulin-like growth factor 1, and insulin-like growth factor binding protein-3 in the diagnosis of prostate cancer among Korean men

To investigate the relationships of serum testosterone, insulin-like growth factor (IGF)-1 and IGF-binding protein (IGFBP)-3 levels with prostate cancer risk and also with known prognostic parameters of prostate cancer in Korean men who received radical retropubic prostatectomy (RRP) for clinically-localized prostate cancer. Serum levels of total testosterone, free testosterone, IGF-1 and IGFBP-3 were determined in 592 patients who subsequently received prostate biopsy. Results were compared between patients who eventually received RRP for prostate cancer (n=159) and those who were not diagnosed with prostate cancer from biopsy (control group, n=433). Among the prostate cancer only patients, serum hormonal levels obtained were analyzed in relation to serum prostate specific antigen (PSA), pathological T stage and pathological Gleason score. Prostate cancer patients and the control group demonstrated no significant differences regarding serum levels of total testosterone, free testosterone, IGF-1 and IGFBP-3 across the different age groups. Among the cancer only patients, no significant associations were observed for serum levels of total testosterone, free testosterone, IGF-1 and IGFBP-3 levels with pathological T stage, pathological Gleason score and preoperative PSA. Our data indicate that simple quantifications of serum testosterone and IGF-1 along with IGFBP-3 levels might not provide useful clinical information in the diagnosis of clinically localized prostate cancer in Korean men. Also, our results suggest that serum levels of testosterone, IGF-1 and IGFBP-3 might not be significantly associated with known prognostic factors of clinically localized prostate cancer in Korean men.

Low IGF-1 levels are associated with cardiovascular risk factors in haemodialysis patients

Cardiovascular diseases (CVD) constitute a significant risk and may, in part, explain the high morbidity and mortality rates among haemodialysis (HD) patients. Several studies have implicated reduced insulin like growth factor (IGF-1) levels in the development of CVD. However, it is not clear whether IGF-1, and its relationship with other hormones such as leptin, insulin, and growth hormone (GH), as well as anthropometric variables may explain the high incidence of vascular complications in chronic kidney disease (CKD) patients. This study was designed to measure total serum IGF-1, leptin, insulin and GH levels in CKD patients and in age-matched control subjects and to elucidate the relationship between IGF-1 and GH, leptin, and insulin as well as other known aetiological risk factors for CVD including blood pressure, body mass index (BMI), and age. The study consisted of 50 CKD patients [36 M and 14 F; mean age; 41.8 +/- 10.3 years) on maintenance haemodialysis and 50 healthy control subjects (36 M and 14 F; mean age 41.6 +/- 10.2 years) matched for age and sex. None of the subject among patients and controls reported either smoking or history of diabetes mellitus. The circulating levels of IGF-1 were significantly lower (P < 0.001) in both male and female patients compared to the control subjects. Moreover, IGF-1 was strongly and inversely correlated with both systolic blood pressure (SBP) (r = -0.360; P < 0.01) and diastolic blood pressure (DBP) (r = -0.512; P < 0.001) in the CKD group, and when the two groups were combined SBP (r = -0.396; P < 0.001) and DBP (r = -0.296; P < 0.01). When adjusted for age, the correlation was more significant, however, when adjusted for BMI no significant correlation was observed between IGF-1 and blood pressure. IGF-1 was inversely correlated with age (r = -0.367; P < 0.01) and BMI (r = -0.310; P < 0.05) in the control group, but not the patient group. In controls and patients, respectively, a positive correlation between leptin and BMI (r = 0.358; P < 0.01; r = 0.640, P < 0.001) was observed. The results show that circulating levels of IGF-1 were significantly lower in CKD patients as compared to healthy normal subjects and were inversely correlated with SBP and DBP independent of age, but not BMI indicative of a strong relationship between cardiovascular risk factors and low IGF-1 levels. Although, the data do not clearly indicate low IGF-1 levels as a cause or an effect of these cardiovascular risk factors, they do point to an interesting relationship between low IGF-1 levels and increased cardiovascular risk factors among CKD patients as compared to age-matched healthy control subjects.

Intravenous Tissue Plasminogen Activator in Patients With Stroke Increases the Bioavailability of Insulin-Like Growth Factor-1

Insulin-like growth factor (IGF)-1 has potent neuroprotective properties. We investigated the effects of intravenous administration of tissue plasminogen activator (tPA) on serum levels of IGF-1 and IGF-binding protein (IGFBP)-3 in patients with acute ischemic stroke. Serum levels of total IGF-1, free IGF-1, and IGFBP-3 were measured by radioimmunoassay in 10 patients with ischemic stroke treated with intravenous tPA (0.9 mg/kg body weight) and 10 untreated controls. During tPA treatment, total IGF-1 and IGFBP-3 serum levels did not change, but there was an &70% increase in free IGF-1 serum levels from 0.98+/-0.25 at baseline to 1.69+/-0.18 nmol/L at the end of the 1-hour infusion (P=0.01). Intravenous therapy with tPA enhances the bioavailability of IGF-1.

Variation in Plasma Insulin-Like Growth Factor-1 and Insulin-Like Growth Factor Binding Protein-3: Genetic Factors

Insulin-like growth factors (IGFs) play key roles in cell proliferation and apoptosis. Whereas relatively stable within individuals, IGFs vary substantially between individuals, and a large component of this variation may be determined by genetic factors. Several polymorphisms in IGF genes have been identified, although their functional significance is not clear. We evaluated the association of polymorphisms in IGF-1 and IGFBP-3 and circulating levels of IGF-1 and IGFBP-3 in 323 population-based control subjects enrolled in a case-control study of colorectal cancer from September 1999 through February 2002. Total IGF-1 and IGFBP-3 levels were measured using ELISA assays, and all subjects were genotyped for a microsatellite polymorphism in IGF-1 and a single nucleotide polymorphism in IGFBP-3. Multiple linear regression was used to assess the association of genotype with circulating IGFs. IGF-1 levels were unrelated to either polymorphism. IGFBP-3 was significantly associated with IGFBP-3 genotype, with IGFBP-3 levels increasing from CC (1,895 ng/mL) --> GC (2,029 ng/mL) --> GG (2,182 ng/mL), (p-trend < 0.001). Having an IGF-1 genotype other than homozygous for the 19-repeat allele was associated with higher IGFBP-3 levels (1,945 versus 2,052 ng/mL). Furthermore, both IGF-1 and IGFBP-3 genotypes modified the relationship between postmenopausal hormone use and IGFs. This analysis provides evidence that common variation in IGF genes may contribute to the variation in circulating levels observed between individuals.

Delayed Age-Associated Decrease in Growth Hormone Pulsatile Secretion and Increased Orexigenic Peptide Expression in the Lou C/Jall Rat

Since modifications in the growth hormone/insulin-like growth factor 1 (GH/IGF-1) axis and/or caloric restriction are involved in the ageing process, GH secretory profiles, total IGF-1, ghrelin, and leptin plasma levels and expression of genes implicated in somatotrope axis and food intake regulation in hypothalamus and pituitary were compared in 3-, 12-, and 24-month-old male Lou C/Jall rats and their parent strain, the Wistar rats. The Lou C/Jall strain may appear as a healthy ageing model, since it does not become obese with age and maintains its caloric intake at 2 years of age. The GH pulsatile secretion decreased from 3 months in Wistar, but only after 12 months in Lou C/Jall rats. The IGF-1 levels were lower in Lou C/Jall rats and decreased more steeply with ageing as compared with Wistar rats. The total ghrelin levels were higher in young Lou C/Jall rats than in Wistar rats, but increased similarly with age in both strains. The leptin concentrations increased with ageing only in Wistar rats. By semiquantitative reverse-transcription polymerase chain reaction, pituitary GH secretagogue receptors and GH mRNA levels were more abundant in Lou C/Jall rats, and the latter decreased with ageing in Wistar rats only. Hypothalamic growth-hormone-releasing hormone and GH secretagogue receptor mRNA levels were similar in both strains and transiently increased only in middle-aged Wistar rats. Agouti-related peptide, neuropeptide Y, and orexin mRNA levels were more abundant in the Lou C/Jall rat hypothalamus, and the two former tended to further increase with age only in this strain. Conversely, the hypothalamic pro-opiomelanocortin mRNA levels were higher in old Wistar rats. In conclusion, ageing in Lou C/Jall rats is associated with a delayed decrease in pulsatile GH secretion in the presence of a lower IGF-1 tone and an increase in the expression of orexigenic neuropeptides in the hypothalamus.

The age-related down-regulation of the growth hormone/insulin-like growth factor-1 axis in the elderly male is reversed considerably by donepezil, a drug for Alzheimer's disease

GH secretion declines by 14%/decade of adult life, leading to the suggestion that people over the age of 60 years are functionally GH deficient. Recently, rivastigmine, a novel cerebral selective cholinesterase-inhibitor (ChEI), was shown to be a powerful drug to enhance GH release to repeated GHRH stimulation in healthy elderly human subjects. The present study was designed as a randomised controlled trial to evaluate long term effects of donepezil, a cerebral selective ChEI, on basal GH and IGF-1 levels and on GH response to GHRH (1 μg/kg i.v., GHRH test) before and after an 8-week donepezil treatment period. Donepezil was given orally 5 mg per day for 4 weeks and 10 mg per day for another 4 weeks. Twenty four healthy male volunteers ( n=2×12, placebo group vs. donepezil group, age: 61–70 years) were studied. Donepezil treatment group: basal GH levels taken at 08:30 a.m. doubled from 0.4±0.3 to 0.8±0.4 ng/ml ( p=0.008). GHRH-test: GH-AUC was 318±227 ng/ml/h and increased by 53% to 485±242 ng/ml/h ( p=0.009). Total serum IGF-1 levels, taken simultaneously with the basal GH levels, showed a considerable increase, too: the baseline IGF-1 levels increased by 31% from 84±19 to 110±21 ng/ml ( p=0.007). This study demonstrated that the age-related down-regulation of the GH/IGF-1 axis is reversed considerably by donepezil in the elderly male. Future investigation will reveal whether such a new therapeutic intervention can delay the onset or even reverse some manifestations of the somatopause in the long term and evaluate its benefit/risk ratio concerning new treatment implications.

Growth Hormone and Prader-Willi Syndrome: What We Know and Have Yet to Learn

Prader-Willi syndrome (PWS) is characterized by hypothalamic dysfunction resulting in obesity, hypotonia, hypogonadism, and behavioral abnormalities. Body composition and growth hormone features in PWS resemble states of growth hormone (GH) deficiency (decreased total lean body mass, IGF-1 levels, and poor linear growth), in contrast to common nutritional obesity. Marked reductions in muscle mass are associated with diminished strength, physical function, and energy expenditure. Thus, individuals with PWS experience a variety of lifelong morbidities including obesity, hypotonia, osteoporosis, type 2 diabetes, respiratory disorders, and cardio-respiratory failure related to obesity and hypotonia. The past decade has seen important developments in the understanding of Prader-Willi syndrome (PWS) and the treatment of its morbidities associated with obesity. Much of this work has focused on the role of underlying growth hormone deficiency (GHD), and the effects of GH therapy. Metabolic effects of GH therapy, including changes in physical strength and agility, appear to be more important than height gain for this particular pediatric population This disorder has highlighted the impetus for a broader view of the anabolic “nongrowth” effects of GH in children. This review will focus upon the effects of GH in children with PWS, and upon outcomes related to changes in body composition, hypotonia, strength and agility, and carbohydrate and lipid metabolism.

Changes in free insulin-like growth factor-1 and leptin concentrations during acute metabolic decompensation in insulin withdrawn patients with type 1 diabetes.

To determine the effect of acute insulin withdrawal and its subsequent replacement on components of the insulin-like growth factor (IGF)-1 binding protein system and on circulating leptin levels in patients with type 1 diabetes. Seventeen patients (age 31 yr +/-10) with type 1 diabetes treated with continuous subcutaneous insulin infusion (HbA1c 7.6% +/-1.0) were studied. The protocol consisted of two phases: acute insulin withdrawal of up to 8 h followed by a further 2-h period of insulin replacement. For the first phase the basal insulin infusion was stopped (at 0300 h), and for the second a single dose of either regular human or insulin lispro was given subcutaneously (0.2 U/kg). Plasma insulin, glucose, growth hormone, glucagon, IGF-1, free IGF-1, IGFBP-1, -2, -3 and leptin were measured. After interruption of the basal insulin infusion, plasma free insulin levels fell from 60+/-12.0 pmol/L to 10.8+/-4.2 pmol/L, and plasma glucose rose from 5.6+/-0.4 mmol/L to 14.8+/-1.2 mmol/L (P< 0.01). During insulin withdrawal, IGFBP-1 increased by more than 6-fold (from 32+/-8 to 205+/-17 ng/mL, P<0.001), IGFBP-3 increased significantly (from 2631+/-118 to 3053+/-101 ng/mL, P<0.001), and total IGF-1 levels declined modestly (from 226+/-33 to 182+/-26 ng/mL, P<0.001). In contrast, free IGF-1 concentrations (0.72+/-0.22 ng/mL at baseline) were markedly suppressed during insulin withdrawal to values below the detection limit of the assay (0.08 ng/mL) in 15 of the 17 patients (P<0.001). Circulating plasma leptin declined markedly in females from 20+/-3 ng/mL to 11+/-2 ng/mL (P<0.0001) and in males from 10+/-2 ng/mL to 7+/-2 ng/mL (P<0.02). Within 2 h of insulin replacement, the changes in circulating concentrations of IGFBP-1 and IGFBP-3 were partially reversed, and free IGF-1 levels rebounded to 0.54+/-0.22 ng/mL (P<0.1 vs. insulin withdrawal). Growth hormone, glucagon, and IGFBP-2 levels did not change significantly throughout the study. Despite the rapid restoration of plasma insulin and substrate levels, circulating leptin levels continued to fall in the 2-h period after insulin replacement in both females and males. The marked reduction in circulating free IGF-1 after insulin withdrawal and its increase after insulin administration suggest that acute changes in IGFBP concentrations induced by insulin are important regulators of IGF-1 bioavailability in patients with type 1 diabetes. In both males and females, the rapid induction of severe insulin deficiency is associated with a consistent fall in plasma leptin levels.

Comparison of monthly intramuscular injections of Sandostatin LAR with multiple subcutaneous injections of octreotide in the treatment of acromegaly; effects on growth hormone and other markers of growth hormone secretion

To compare the effects of monthly intra-muscular injections of a long acting preparation of octreotide, Sandostatin LAR, with multiple daily subcutaneous injections of octreotide and to study the interrelationships between mean 24 h growth hormone profile, serum total and free IGF-1 levels, 24 h urinary growth hormone levels and serum IGFBP-3. Patients were assessed by 24 h GH profile off octreotide or any other GH modifying drug therapy; on subcutaneous octreotide (200-600 micrograms daily in divided doses for six weeks); and 28 days after the second of two injections of Sandostatin LAR (20 mg by intra-muscular injection) administered 28 days apart. Serum total and free IGF-1, serum IGFBP-3 and 24 h urinary GH were also measured on each occasion. Sandostatin LAR was well tolerated. None of the patients reported any adverse effect and all completed the study uneventfully. Mean GH off treatment was 10.1 +/- 3.0 micrograms/l falling equally significantly (P < 0.05) during therapy with subcutaneous octreotide to 3.0 +/- 0.7 micrograms/l and Sandostatin LAR to 2.8 +/- 0.7 micrograms/l. Fasting 0900 h GH was significantly reduced (P < 0.05) on Sandostatin LAR (3.0 +/- 0.7 micrograms/l) compared with subcutaneous octreotide (5.1 +/- 1.2 micrograms/l). Mean total IGF-1 off treatment was 658.6 +/- 56.1 micrograms/l and was reduced to a comparable extent with subcutaneous octreotide and Sandostatin LAR (466.0 +/- 59.7 and 448.6 +/- 59.5 micrograms/l respectively; both P < 0.05). Free IGF-1 off treatment was 3.1 +/- 0.6 micrograms/l and was reduced equally by subcutaneous octreotide and Sandostatin LAR (1.2 +/- 0.2 and 1.2 +/- 0.2 micrograms/l; both P < 0.05). IGFBP-3 was reduced to a greater extent during Sandostatin LAR than during subcutaneous octreotide (4518.2 +/- 247.3 vs 5132.8 +/- 280.7 micrograms/l; P < 0.05). Twenty-four hour urinary GH excretion was reduced to a comparable extent with both therapies. Highly significant positive correlations were found between mean 24 h GH levels and free IGF-1 (r = 0.66, P < 0.0001) and 24 h urinary GH excretion (r = 0.94, P < 0.0001). The relationships between mean 24 h GH levels and total IGF-1 and IGFBP-3 although significant showed less powerful correlations. These results suggest that Sandostatin LAR is well tolerated and as effective as subcutaneous octreotide. In addition, urinary growth hormone and serum free IGF-1 may prove valuable for outpatient follow-up of acromegalic patients, as both correlate well with mean 24 h serum growth hormone levels.

Insulin-Like Growth Factor–I Treatment to Enhance Renal Function in Advanced Chronic Renal Failure

Because of the potential for IGF-1 to enhance renal function in advanced chronic renal failure (CRF) we set out to determine whether IGF-1 can induce a sustained increase in renal function in patients with near end-stage renal failure. To this end we first examined the impact of CRF on the pharmacokinetics of IGF-1 and then we examined the effect of prolonged IGF-I treatment on the renal function of patients with an average GFR of 17mL/min/1.73m2. Interestingly the metabolic clearance rate of IGF-1 in CRF subjects was similar to that in normal subjects even though the total serum IGF-1 levels rose to higher maximum levels. This increase was due to a reduced volume of IGF-1 distribution, a consequence of the elevated serum IGF binding proteins in CRF subjects. Treatment with IGF-I (60 mg/kg twice daily sc) for 31 days resulted in a 14% and 18% increase in the inulin and PAIL clearances respectively (n = 6 patients). These parameters returned to basal levels on stopping treatment. Serum immunoreactive IGFBP-3 levels fell and IGFBP-2 and -3 levels rose during IGF-1 therapy. Adverse effects were mild, of short duration and easily manage-able. Thus IGF-I pharmacokinetics are largely unchanged in CRF and the administration of IGF-1 produces a modest improvement in the GFR. These results appear to justify more extensive examination of the therapeutic role of IGF-1 in the treatment of CRF.

Insulin-like growth factors (IGFs) and IGF binding proteins-1, -2, and -3 in newborn serum: relationships to fetoplacental growth at term.

Cord sera were obtained from term, Chilean newborns exhibiting various patterns of intrauterine growth and assayed for IGF-1, IGF-2, IGFBP-1, IGFBP-2, and IGFBP-3 by specific radioimmunoassays (RIA). Serum levels of each peptide were correlated with birth weight (BW), ponderal index (PI), and placental weight (PW). Total IGF-1 levels correlated with BW (r = 0.665, P = 0.0001). PI (r = 0.527, P = 0.004), and PW (r = 0.596, P = 0.0017). In contrast, IGF-2 failed to correlate with any growth parameter. Of the three binding proteins, IGFBP-3 exhibited the strongest relationship to each growth parameter. IGFBP-3 correlated significantly with BW (r = 0.71, P < 0.0001), PI (r = 0.782, P < 0.0001), and PW (r = 0.57, P = 0.0029). In addition IGFBP-3 levels positively correlated to IGF-1 levels (r = 0.614, P = 0.0005). By contrast, circulating IGFBP-1 and IGFBP-2 were inversely related to IGF-1 levels. All five peptides were subjected to multiple regression analysis and related to BW. Significant relationships between the predicted BW and the actual BW were observed in these infants (r = 0.802, P = 0.0006). The BWs of a cohort of unrelated North American infants were also predicted using the Chilean-derived equation and found to be significantly related to their actual BWs (r = 0.453, P = 0.0033). These relationships were strengthened by the inclusion of estimated gestational age (EGA) as an independent variable. These data point to particularly important roles for IGF-1 and IGFBP-3 in regulating fetal growth at term, and suggest that they are regulated in a coordinated manner during the latter stage of gestation. Furthermore, they suggest that IGFBPs play multiple, and potentially opposing, regulatory roles in modulating IGF action. Lastly, an integrated expression of IGF activity derived from one population significantly correlated with newborn BW in a geographically and culturally distinct population.

Acute changes in atrial natriuretic peptide, insulin-like growth factor-1, and lactate levels during left anterior descending coronary artery angioplasty

This study examines acute changes in circulating levels of atrial natriuretic peptide (ANP) and insulin-like growth factor (IGF-1) during short periods of myocardial ischemia experienced at coronary angioplasty. Ten patients (mean age 55.7 ± 3.9 years, nine men) undergoing angioplasty to the left anterior descending coronary artery were studied. Angioplasty of the left anterior descending coronary artery was performed with the balloon inflations maintained at 6 to 10 atm for 20 to 90 seconds. Blood was sampled from the coronary sinus for ANP, IGF-1 (both total and free), and lactate levels at (1) after catheterization of the coronary sinus, (2) after the initial left coronary angiography, (3) immediately after balloon deflation, and (4) 5 minutes after deflation. ANP levels (pmol/L ± SEM) rose significantly at the end of balloon deflation (13.4 ± 2.8; p < 0.01) compared with baseline levels (8.8 ± 1.9). This rise was sustained for at least 5 minutes after balloon deflation (13.7 ± 3.1; p < 0.01). ANP levels were not affected by the injections of angiographic contrast media. Free IGF-1 levels rose after injections of radiographic contrast but not after balloon inflation or deflation. Total IGF-1 levels did not change significantly at any of the sampling times. Lactic acid (mmol/L) levels rose at the end of balloon inflation (2.66 ± 0.6) compared with baseline (2.13 ± 0.7; p < 0.05) but returned to normal within 5 minutes of balloon deflation. Neither lactic acid levels nor release of ANP or IGF-1 correlated with the initial left ventricular end-diastolic pressure or the degree of electrocardiographic ST depression during the procedure. Three patients had clinical and angiographic restenosis within 6 months of the angioplasty. These patients had higher levels of IGF-1 and greater IGF-1 release with injection of contrast media. We conclude that regional myocardial ischemia results in release of ANP from the myocardium and a transient increase in lactate concentrations. Total IGF-1 levels do not appear to be altered by ischemia, but this peptide appears to be displaced from the transporter protein by radiographic imaging media. IGF-1 may be a factor in the development of restenosis after angioplasty.

Circulating levels of IGFs and IGF binding proteins in human cord serum: relationships to intrauterine growth.

Cord sera were obtained from 44 term, human infants exhibiting various patterns of intrauterine growth and were assayed for IGF-1, IGF-2, and IGFBP-1, 2, and 3 by specific RIAs. Serum levels were correlated with birth weight (BW), ponderal index (PI), and placental weight (PW). Total IGF-1 levels correlated significantly with BW (r = 0.392), PW (r = 0.351), and PI (r = 0.481). By contrast, the correlation of IGF-2 with birth weight was not statistically significant (r = 0.264, P = 0.091). The association of IGF-2 with PI, however, was significant (r = 3.348, P = 0.024). IGFBP-3 exhibited significant correlations with BW, PI, and PW, similar to those seen with IGF-1. IGFBP-1 and IGFBP-2, however, were not significantly related to growth parameters. IGF-1 levels correlated strongly with IGFBP-3 levels (r = 0.646, P = 0.001). By contrast, IGF-1 correlated with the reciprocal of both IGFBP-1 and IGFBP-2. Based upon in vitro affinity constants, theoretical concentrations for each [IGF/IGFBP] complex, free IGFs, and free IGFBPs were calculated for each infant. Multiple regression analysis was performed including all 11 calculated variables and correlated with each growth parameter. This analysis revealed that an integrated expression of IGF activity exhibited stronger correlations with growth than each individual peptide species (BW, r = 0.681; PI, r = 0.660; PW, r = 0.658). These data further support roles for IGF related peptides (IGFRPs) in human fetal and placental growth and suggest regulatory/counterregulatory roles for the IGFBPs. It also supports the hypothesis that individual IGFRPs interact in a complex manner to define 'net IGF activity' in relation to fetal growth and/or metabolic status.