This Article Full Text Full Text (PDF) Submit a related Letter to the Editor Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Copyright Permission Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Klein, G. L. Articles by Herndon, D. N. Search for Related Content PubMed PubMed Citation Articles by Klein, G. L. Articles by Herndon, D. N.

Effect of Therapy with Recombinant Human Growth Hormone on Insulin-Like Growth Factor System Components and Serum Levels of Biochemical Markers of Bone Formation in Children After Severe Burn Injury¹

Departments of Pediatrics (G.L.K., B.S.K.) and Surgery (S.E.W., Si.M., D.N.H.), University of Texas Medical Branch and the Shriners Burns Institute (G.L.K., S.E.W., Si.M., M.N., D.N.H.), Galveston, Texas 77555; Nephrology Division, Children’s Memorial Hospital and the Northwestern University Medical School (C.B.L., D.E.S.), Chicago, Illinois 60614; the Maine Center for Osteoporosis Research, St. Joseph Hospital (C.J.R., C.S.), Bangor, Maine 04401; and the Jerry L. Pettis VA Medical Center and Loma Linda University School of Medicine (Su.M.), Loma Linda, California 92357

Address all correspondence and requests for reprints to: Gordon L. Klein, M.D., Pediatric Gastroenterology Division, Room 3.240B, Children’s Hospital, University of Texas Medical Branch, 301 University Boulevard, Galveston, Texas 77555-0352. E-mail: gklein{at}utmb.edu

Burn injury in children is associated with low bone formation and long-term bone loss. Because recombinant human GH (rHGH) may accelerate burn wound healing, and because rHGH increases bone formation and density in GH-deficient patients, we studied the short-term effects of rHGH on bone formation, reflected by osteocalcin and type I procollagen propeptide levels in a randomized, double-blind, placebo-controlled study. Nineteen patients were enrolled and received either rHGH (0.2 mg/kg·day) or an equal volume of saline. Mean burn size and age were not different between the groups, and test substances were given from admission to time of wound healing (mean: 43 ± 22 days). At wound healing, serum levels of insulin-like growth factor (IGF)-1 and IGF binding protein (IGFBP)-3 in the rHGH group rose to mean values of 229% and 187% of the respective means of the placebo group (P < 0.025). Serum osteocalcin concentrations remained below normal in both groups, and type I procollagen propeptide levels achieved a low normal level. IGFBP-4 levels were twice that of normal on admission and doubled further at wound healing; IGFBP-5 levels were low on admission but rose to normal at wound healing. We conclude that large doses of rHGH were ineffective in improving disordered bone formation despite increasing serum IGF-1 and IGFBP-3. The rHGH-independent rise in serum levels of the inhibitory binding protein IGFBP-4 suggests a mechanism by which improved bone formation is prevented despite successful elevation of IGF-1 and IGFBP-3 in the burned child.