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Growth Hormone Treatment Prevents the Decrease in Insulin-Like Growth Factor I Gene Expression in Patients Undergoing Abdominal Surgery¹

Research Center for Endocrinology and Metabolism (R.B., R.W., M.H., B.C., L.M.S.C.); the Department of Medicine, International Pediatric Growth Research Center (R.B.); and the Department of Pediatrics, University of Goteborg, Goteborg; and the Clinical Research Laboratory, Department of Surgery, St. Goran Hospital, Karolinska Institute (F.H.), Stockholm, Sweden

Address all correspondence and requests for reprints to: Dr. Ragnar Bjarnason, International Pediatric Growth Research Center, Department of Pediatrics, Sahlgren’s University Hospital/East, S-416 85 Goteborg, Sweden. E-mail: ragnar.bjarnason{at}pediat.gu.se

Acquired GH resistance together with reduced skeletal muscle mass are found in patients with increased protein catabolism due, for example, to sepsis, trauma, or major surgery. Both administration of glutamine-containing parenteral nutrition and GH treatment have been found to diminish this catabolism. The effects of GH are mediated in part by insulin-like growth factor I (IGF-I) that is produced in the liver and locally in GH target tissues. The aim of this study was to investigate the effect of GH treatment on expression of the IGF-I gene and GH receptor (GHR) gene in skeletal muscle after major surgery. A new quantitative RT-PCR-based assay was established to measure IGF-I gene expression.

Metabolically healthy patients, without significant preoperative weight loss, who were undergoing elective abdominal surgery were included in the study. Five patients (one woman and four men) were treated with daily injections of GH (0.3 IU/kg·day) in addition to being given total parenteral nutrition including glutamine (0.28 g/kg·day). The control group consisted of eight patients (three women and five men), who were given glutamine-enriched total parenteral nutrition but no GH. A muscle biopsy was taken from the lateral portion of the quadriceps femoris muscle preoperatively (day 0) after induction of anesthesia. A second biopsy was taken under local anesthesia on postoperative day 3. Total ribonucleic acid (RNA) was extracted from the muscle biopsies, and IGF-I messenger RNA (mRNA) and GHR mRNA were measured by competitive quantitative RT-PCR assays. IGF-I mRNA and GHR mRNA levels were related to the expression of a housekeeping gene (cyclophilin). In the control group, IGF-I mRNA levels decreased from 1505 ± 265 (mean ± SEM) transcripts/cpm cyclophilin on day 0 to 828 ± 172 on day 3 (P < 0.05). In contrast, IGF-I mRNA levels did not change in the GH-treated group (1188 ± 400 transcripts/cpm cyclophilin on day 0 vs. 1089 ± 342 transcripts/cpm cyclophilin on day 3). No statistically significant changes were seen in GHR expression.

We conclude that administration of GH prevents the reduction in IGF-I gene expression in skeletal muscle after abdominal surgery.

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