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Effect of Recombinant Human Insulin-like Growth Factor I and Early Total Parenteral Nutrition on Immune Depression Following Severe Head Injury

Effect of Recombinant Human Insulin-like Growth Factor I and Early Total Parenteral Nutrition on... Abstract Objective: To determine the effects of insulin-like growth factor I (IGF-I) and aggressive nutrition on CD4/CD8 ratios following head injury. Design: Randomized controlled trial. Setting: An urban level 1 trauma center. Participants: Head-injured patients with a Glasgow Coma Scale score of 4 to 10 within 6 hours of hospital admission requiring no major extracranial surgery with the exception of isolated lower-extremity fracture fixation. Fourteen patients were recruited and 11 completed the study. Interventions: Patients were randomized to a continuous infusion of saline or 0.01 mg/kg per hour of recombinant human (rh) IGF-I. Both groups received parenteral nutrition and rapidly advanced to a total protein intake of 2 g/kg per day and a maximum nonprotein calorie intake of 40 kcal/kg per day. The nonprotein prescription was 1.25 times the metabolic energy expenditure determined by metabolic cart not to exceed a nonprotein calorie intake of 40/kcal. Main Outcome Measures: The CD4/CD8 ratios and serum IGF-I levels on days 1, 7, and 14. Results: Administration of early aggressive nutrition eliminated the depressed CD4/CD8 ratio usually seen after head injury; administration of IGF-I increased the CD4/CD8 ratio while IGF-I levels were elevated. Conclusions: Infusion of rhIGF-I and aggressive early intravenous nutrition affects the immunologic response of patients with severe head injury.(Arch Surg. 1994;129:66-71) References 1. Lin C-N, Howng S-L, Liu W-J, Hu S-H, Kwan A-L. The significance of immunosuppression and hormonal alteration in neurotraumatology . Kao Hsiung J Med Sci . 1992;8:202-212. 2. Cryer HG. Immunologic dysfunction following trauma . In: Maull KI, ed. Advances in Trauma and Critical Care, 6 . St Louis, Mo: Mosby—Year Book Co; 1991:53-71. 3. McRitchie DM, Girotti MJ, Rotstein OD, Teodorczyk-Injeyan JA. Impaired antibody production in blunt trauma: possible role for T-cell dysfunction . Arch Surg . 1990;125:91-96.Crossref 4. Hoyt DB, Ozkan AN, Hansbrough JF, Marshall L, van Berkum-Clark M. Head injury: an immunologic deficit in T-cell activation . J Trauma . 1990;30:759-767.Crossref 5. Quattrocchi KB, Frank EH, Miller CH, Amin A, Issel BW, Wagner FC. Impairment of helper T-cell function and lymphokine-activated killer cytotoxicity following severe head injury . J Neurosurg . 1991;75:766-773.Crossref 6. Twyman D, Young AB, Ott L, Norton JA, Bivins BA. High protein enteral feedings: a means of achieving positive nitrogen balance in head injured patients . JPEN J Parenter Enteral Nutr . 1985:9:679-684.Crossref 7. Ott L, Young B, Phillips R, McClain C. Brain injury in nutrition . Nutr Clin Pract . 1990;5:68-73.Crossref 8. Chwals WJ, Bistrian BR. Role of exogenous growth hormone and insulin-like growth factor I in malnutrition and acute metabolic stress: a hypothesis . Crit Care Med . 1991;19:1317-1322.Crossref 9. Behrman SW, Wojtysiak S, Brown RO, Vehe KL, Fabian TC, Kudsk KA. The effect of growth hormone on nutritional markers in enterally fed, immobilized trauma patients . Surg Forum . 1990;41:20-22. 10. Johnson EW, Jones LA, Kozak RW. Expression and function of insulin-like growth factor receptors on anti-CD3-activated human T lymphocytes . J Immunol . 1992;148:63-71. 11. Lieberman SA, Bukar J, Chen SA, et al. Effects of recombinant human insulin-like growth factor-l (rhIGF-l) on total and free IGF-l concentrations, IGF-binding proteins, and glycemic response in humans . J Clin Endocrinol Metab . 1992;75:30-36. 12. Kudsk KA, Croce MA, Fabian TC, et al. Enteral vs parenteral feeding: effects on septic morbidity following blunt and penetrating trauma . Ann Surg . 1992;215: 503-513.Crossref 13. Moore FA, Moore EE, Jones TN, McCroskey BL, Peterson VM. TEN vs. TPN following major abdominal trauma—reduced septic morbidity . J Trauma . 1989; 29:916-923.Crossref 14. Ott L, Young B, Phillips R, et al. Altered gastric emptying in the head-injured patient: relationship to feeding intolerance . J Neurosurg . 1991;74:738-742.Crossref 15. Grahm TW, Zadrozny DB, Harrington T. The benefits of early jejunal hyperalimentation in the head-injured patient . Neurosurgery . 1989;25:729-735.Crossref 16. Chandra RK. Numerical and functional deficiency in T helper cells in protein energy malnutrition . Clin Exp Immunol . 1983;51:126-132. 17. Meakins JL, Christon NC, Shizgal H, et al. Therapeutic approaches to anergy in surgical patients . Ann Surg . 1979;190:285-296.Crossref 18. Chen SA, Bukar JG, Mohler MA, et al. Recombinant human IGF-l infusion results in transient improvement in nitrogen balance: evidence for IGF-l autoregulation. Presented at the 75th Endocrine Society Meeting, June 9, 1993; Las Vegas, Nev. 19. Stuart CA, Meehan RT, Neale LS, Cintron NM, Furlanetto RW. Insulin-like growth factor-l binds selectively to human peripheral blood monocytes and B-lymphocytes . J Clin Endocrinol Metab . 1991;72:1117-1122.Crossref 20. Roldan AE, Charreaur E, Shillaci R, Eugui EM, Allison AC. Insulin-like growth factor I increases the mitogenic response of human peripheral blood lymphocytes to phytohemagglutinin . Immunol Lett . 1989;20:5-8.Crossref 21. Shimpff RM, Repellin AM, Salvatoni A, Thieriot-Prevost G, Chatelain P. Effect of purified somatomedins on thymidine incorporation into lectin-activated human lymphocytes . Acta Endocrinol . 1983;102:21-26. 22. Binz K, Joller P, Froesch P, Binz H, Zapf J, Froesch ER. Repopulation of the atrophied thymus in diabetic rats by insulin-like growth factor I . Proc Natl Acad Sci U S A . 1990;87:3690-3694.Crossref 23. Tapson VF, Boni-Schnetzler M, Pilch PF, Center DM, Berman JS. Structural and functional characterization of the human T-lymphocyte receptor for IGF-l in vitro . J Clin Invest . 1988;82:950-957.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Effect of Recombinant Human Insulin-like Growth Factor I and Early Total Parenteral Nutrition on Immune Depression Following Severe Head Injury

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References (28)

Publisher
American Medical Association
Copyright
Copyright © 1994 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1994.01420250078010
Publisher site
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Abstract

Abstract Objective: To determine the effects of insulin-like growth factor I (IGF-I) and aggressive nutrition on CD4/CD8 ratios following head injury. Design: Randomized controlled trial. Setting: An urban level 1 trauma center. Participants: Head-injured patients with a Glasgow Coma Scale score of 4 to 10 within 6 hours of hospital admission requiring no major extracranial surgery with the exception of isolated lower-extremity fracture fixation. Fourteen patients were recruited and 11 completed the study. Interventions: Patients were randomized to a continuous infusion of saline or 0.01 mg/kg per hour of recombinant human (rh) IGF-I. Both groups received parenteral nutrition and rapidly advanced to a total protein intake of 2 g/kg per day and a maximum nonprotein calorie intake of 40 kcal/kg per day. The nonprotein prescription was 1.25 times the metabolic energy expenditure determined by metabolic cart not to exceed a nonprotein calorie intake of 40/kcal. Main Outcome Measures: The CD4/CD8 ratios and serum IGF-I levels on days 1, 7, and 14. Results: Administration of early aggressive nutrition eliminated the depressed CD4/CD8 ratio usually seen after head injury; administration of IGF-I increased the CD4/CD8 ratio while IGF-I levels were elevated. Conclusions: Infusion of rhIGF-I and aggressive early intravenous nutrition affects the immunologic response of patients with severe head injury.(Arch Surg. 1994;129:66-71) References 1. Lin C-N, Howng S-L, Liu W-J, Hu S-H, Kwan A-L. The significance of immunosuppression and hormonal alteration in neurotraumatology . Kao Hsiung J Med Sci . 1992;8:202-212. 2. Cryer HG. Immunologic dysfunction following trauma . In: Maull KI, ed. Advances in Trauma and Critical Care, 6 . St Louis, Mo: Mosby—Year Book Co; 1991:53-71. 3. McRitchie DM, Girotti MJ, Rotstein OD, Teodorczyk-Injeyan JA. Impaired antibody production in blunt trauma: possible role for T-cell dysfunction . Arch Surg . 1990;125:91-96.Crossref 4. Hoyt DB, Ozkan AN, Hansbrough JF, Marshall L, van Berkum-Clark M. Head injury: an immunologic deficit in T-cell activation . J Trauma . 1990;30:759-767.Crossref 5. Quattrocchi KB, Frank EH, Miller CH, Amin A, Issel BW, Wagner FC. Impairment of helper T-cell function and lymphokine-activated killer cytotoxicity following severe head injury . J Neurosurg . 1991;75:766-773.Crossref 6. Twyman D, Young AB, Ott L, Norton JA, Bivins BA. High protein enteral feedings: a means of achieving positive nitrogen balance in head injured patients . JPEN J Parenter Enteral Nutr . 1985:9:679-684.Crossref 7. Ott L, Young B, Phillips R, McClain C. Brain injury in nutrition . Nutr Clin Pract . 1990;5:68-73.Crossref 8. Chwals WJ, Bistrian BR. Role of exogenous growth hormone and insulin-like growth factor I in malnutrition and acute metabolic stress: a hypothesis . Crit Care Med . 1991;19:1317-1322.Crossref 9. Behrman SW, Wojtysiak S, Brown RO, Vehe KL, Fabian TC, Kudsk KA. The effect of growth hormone on nutritional markers in enterally fed, immobilized trauma patients . Surg Forum . 1990;41:20-22. 10. Johnson EW, Jones LA, Kozak RW. Expression and function of insulin-like growth factor receptors on anti-CD3-activated human T lymphocytes . J Immunol . 1992;148:63-71. 11. Lieberman SA, Bukar J, Chen SA, et al. Effects of recombinant human insulin-like growth factor-l (rhIGF-l) on total and free IGF-l concentrations, IGF-binding proteins, and glycemic response in humans . J Clin Endocrinol Metab . 1992;75:30-36. 12. Kudsk KA, Croce MA, Fabian TC, et al. Enteral vs parenteral feeding: effects on septic morbidity following blunt and penetrating trauma . Ann Surg . 1992;215: 503-513.Crossref 13. Moore FA, Moore EE, Jones TN, McCroskey BL, Peterson VM. TEN vs. TPN following major abdominal trauma—reduced septic morbidity . J Trauma . 1989; 29:916-923.Crossref 14. Ott L, Young B, Phillips R, et al. Altered gastric emptying in the head-injured patient: relationship to feeding intolerance . J Neurosurg . 1991;74:738-742.Crossref 15. Grahm TW, Zadrozny DB, Harrington T. The benefits of early jejunal hyperalimentation in the head-injured patient . Neurosurgery . 1989;25:729-735.Crossref 16. Chandra RK. Numerical and functional deficiency in T helper cells in protein energy malnutrition . Clin Exp Immunol . 1983;51:126-132. 17. Meakins JL, Christon NC, Shizgal H, et al. Therapeutic approaches to anergy in surgical patients . Ann Surg . 1979;190:285-296.Crossref 18. Chen SA, Bukar JG, Mohler MA, et al. Recombinant human IGF-l infusion results in transient improvement in nitrogen balance: evidence for IGF-l autoregulation. Presented at the 75th Endocrine Society Meeting, June 9, 1993; Las Vegas, Nev. 19. Stuart CA, Meehan RT, Neale LS, Cintron NM, Furlanetto RW. Insulin-like growth factor-l binds selectively to human peripheral blood monocytes and B-lymphocytes . J Clin Endocrinol Metab . 1991;72:1117-1122.Crossref 20. Roldan AE, Charreaur E, Shillaci R, Eugui EM, Allison AC. Insulin-like growth factor I increases the mitogenic response of human peripheral blood lymphocytes to phytohemagglutinin . Immunol Lett . 1989;20:5-8.Crossref 21. Shimpff RM, Repellin AM, Salvatoni A, Thieriot-Prevost G, Chatelain P. Effect of purified somatomedins on thymidine incorporation into lectin-activated human lymphocytes . Acta Endocrinol . 1983;102:21-26. 22. Binz K, Joller P, Froesch P, Binz H, Zapf J, Froesch ER. Repopulation of the atrophied thymus in diabetic rats by insulin-like growth factor I . Proc Natl Acad Sci U S A . 1990;87:3690-3694.Crossref 23. Tapson VF, Boni-Schnetzler M, Pilch PF, Center DM, Berman JS. Structural and functional characterization of the human T-lymphocyte receptor for IGF-l in vitro . J Clin Invest . 1988;82:950-957.Crossref

Journal

Archives of Surgery – American Medical Association

Published: Jan 1, 1994

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