The impairment of the Growth Hormone/Insulin-like growth factor 1 (IGF-1) axis in heart failure: A possible target for future therapy

Abstract

Hormonal abnormalities are quite common in chronic heart failure (CHF). The most studied hormonal axis in CHF is the impairment of Growth Hormone (GH)/Insulin Growth Factor-1(IGF-1), which in turn is defined either by a blunted response to GH stimulation test or low serum IGF-1 values. Several independent groups reported that the presence of an abnormal GH/IGF-1 status in CHF is associated with a more severe disease, impaired functional capacity and reduced Survival rates. After the first encouraging results, double -blind controlled trials showed a neutral effect of the GH administration in patients. However, further studies reported positive results, when a GH-therapy is implemented only in those patients presenting a GH deficiency (replacement therapy).

Body composition and maximal exercise capacity after heart transplantation

“…Of note, impairment of the growth hormone (GH)/insulin‐like growth factor 1 (IGF‐1) axis is a frequent finding in severe heart failure associated with lower pVO 2 , ventilatory efficiency, and squelettal muscle performance 33 . Because complete resolution of this anabolic pathway has been previously reported after HTx, 34 it may be suspected to play a role in the observed changes in the present study.…”

Pathophysiological pathways related to high plasma growth differentiation factor 15 concentrations in patients with heart failure

“…be reduced in HF, particularly with comorbid cachexia. 45,48 These findings suggest that IGF-1 might become a novel treatment target of cachectic HF patients. Paradoxically, patients with higher GDF-15 concentrations also had higher GH concentrations.…”

Insulin Growth Factor Phenotypes in Heart Failure With Preserved Ejection Fraction, an INSPIRE Registry and CATHGEN Study

“…As reduction of the IGF axis appears to be mainly protective, further blocking of GH/IGF-1 pathway could be considered using GH receptor antagonists, somatostatin analogs, and anti-IGF-1R antibodies. 21,36 These therapies may however have several side effects and the IGF may have many redundant pathways limiting efficacy of a targeted blockage. 21,36 A more efficient way to target the IGF system will likely be the use of medications with pleotropic effects that also target the IGF pathway.…”