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Medical Meeting Reports

American College of Surgery Clinical Congress

October 10-15, 1999


RECOMBINANT HUMAN GROWTH HORMONE TREATS THE HYPERMETABOLIC RESPONSE TO BURN INJURY
font=>by Karen Sandrick

According to David Herndon, MD, of Galveston Shriners Burn Center, recombinant human growth hormone ameliorates the hypermetabolic state that follows severe burn injury by improving protein balance. It also accelerates wound and donor site healing and enhances collagen production.

Trauma surgeons use a number of pharmacologic agents to reduce the magnitude of the hypermetabolic response after burn injury and make it easier to meet patients' metabolic needs. Narcotics and antianxiety medications help considerably because they address the afferent pain stimuli that underlie the hypermetabolic response. Beta blockers decrease heart rate from pathologic levels (170 bpm in children with more than 80% total body surface area burned) to 130 bpm. Propanolol administered every eight hours throughout hospitalization also preserves lean body mass, most likely because of its effect on the release of pituitary growth hormone.

In addition to beta blockers, Dr. Herndon has experimented with anabolic agents because burned patients characteristically are more anabolic than healthy individuals. Dr. Herndon gave 0.2 mg/kg recombinant human growth hormone to 48 severely burned children throughout their hospitalization. He assessed the results of this treatment with those of 54 randomly selected burn patients who received placebo. Dr. Herndon also compared the effect of growth hormone to placebo in patients matched by age and burn size who were treated over the last decade.

Study Results

According to findings from these studies, human recombinant growth hormone decreased the total length of hospitalization because the drug allowed surgeons to debride the burn wound in a single operation and to recrop donor sites at weekly intervals. Growth hormone accelerated the rate of healing of the burn wound in one child by promoting epithelialization between meshed autografts that were placed underneath cadaver grafts. Growth hormone also increased the rate of healing of donor sites as measured by daily evaluation of margins.

Electron microscopic pictures taken at donor sites five days after grafting revealed that the basal laminin was markedly improved in individuals who received growth hormone. Patients treated with growth hormone had a three-to ten-fold increase in the production of basal laminin as well as type IV and type VII collagen. These substances cause epithelium to bind with underlying dermis; they are the adhesion molecules that prevent donor sites and burn wounds from blistering. As a result, Dr. Herndon stated that recombinant growth hormone not only accelerated wound healing, it also improved the structural integrity of healing wounds.

Other Benefits

Recombinant growth hormone raised by approximately two-fold the rate of synthesis of protein in an isolated body part as well throughout the body. The hormone increased blood flow in the extremities and enhanced cardiac output. It reduced the amount of albumin needed to be administered to maintain serum levels at 2 mg/dL throughout hospitalization. This finding provided indirect evidence that protein was being synthesized not only in muscle but also in the liver. Dr. Herndon concluded that recombinant human growth hormone was safe and effective in the treatment of severely burned pediatric patients.

For professional correspondence, please contact Dr. Herndon at herndon@utmb.edu.

Ortho Biotech

Funded through an unrestricted educational grant by Ortho Biotech.



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