Effects of Recombinant Human Growth Hormone on Donor-site Healing in Severely Burned Children

Abstract

The beneficial effects of growth hormone on wound healing in severely burned children were studied. Forty patients who were 2 to 18 years old, with 40% or more total body surface area (TBSA) and 20% or more TBSA full-thickness flame or scald burns, were randomized in a double-blind study to receive placebo or 0.1 mg/kg/day recombinant human growth hormone (rHGH) until the first donor site healed or to receive 0.2 mg/kg/day rHGH or placebo from admission throughout hospitalization. Patients receiving 0.2 mg/kg/day rHGH demonstrated significantly higher serum IGF-1 levels at 4.8 +/- 1.7 U/mL compared to placebos at 1.6 +/- 0.4 U/mL (p less than 0.05) and a significant decrease in donor-site healing times compared to placebo (p less than 0.05). Length of hospital stay (LOS/%TBSA) was decreased from 0.80 +/- 0.10 days/%TBSA burned in the placebo group to 0.54 +/- 0.04 days/%TBSA burned in the 0.2 mg/kg/day treatment group (p less than 0.05). This translates, for the average 60% TBSA burned patient, to a decrease in LOS from 46 to 32 days.

IGF-I gene transfer in thermally injured rats

“…14,21 There is evidence that rhGH improves wound healing through stimulation of IGF-I. 9,17,22,23 In turn, IGF-I enhances wound healing by stimulating collagen formation and mitogenicity in fibroblasts and keratinocytes by binding to their receptors. 17,23 In this study we show that the administration of liposome-encapsulated IGF-I cDNA constructs improved the area of burn wound reepithelization as well as wound linear re-epithelization when compared with rhIGF-I protein or liposomes containing the lacZ gene for ␤-galactosidase.…”

Biodistribution and Feasibility of Non-Viral IGF-I Gene Transfers in Thermally Injured Skin

“…The rates of transfection, transcription, and translation in the skin and systemic cells were based on ␤-galactosidase and IGF-I expression. The biological efficacy of the translated IGF-I gene was evaluated by the mitogenic activity in dermal cells and the rate of re-epithelization (Herndon et al, 1990;Martin, 1997).…”

Growth hormone therapy in pediatric hypercatabolic state: a systematic review and meta-analysis

“…Ramirez et al 23 , reported that it was observed in 30 patients from 48 in rhGH group and 22 from 54 in placebo group. Herndon et al reported hyperglycemia in 2 of 10 patients of rhGH group versus none in placebo group 21 . Hart et al 24 reported that it was not observed in none of 19 patients in treatment group and 21 from placebo group.…”

“…All trials used the subcutaneous or intramuscular rhGH administration route and the therapy was given at least for 7 days. Effects of rhGH on donor site healing: Gilpin 20 and Herndon 21 involved a total of 48 burned children in treatment group with rhGH, versus 44 placebo-controls. The treatment was effective in reducing donor-site time healing (Weighted Mean Difference: -1.77 day, p < 0.00001 for overall effect).…”

“…No significant differences were observed for organ dysfunction, septic or hemodynamic complications between rhGH and placebo [21][22][23][24] . Other issues: Herndon et al 21 reported into a small randomized and double-blinded study that treatment with rhGH was able to reduce length of hospital for severely burned children (from 46 to 32 days, p < 0.05). klein et al reported that rhGH was ineffective in improving bone formation in burned children 27 .…”