Modulation of types I and II acute phase reactants with insulin-like growth factor-1/binding protein-3 complex in severely burned children

OBJECTIVETo determine whether 0.5 mg/kg insulin-like growth factor (IGF)-1/binding protein (IGFBP)-3, given intravenously, effectively alters the acute phase response in severely burned children. DESIGNLongitudinal trial with each patient serving as their own control. SETTINGUniversity-affiliated pediatric burn center. PATIENTSNine children, 15 yrs of age or less, with burns covering >40% of the total body surface area. INTERVENTIONSStandard burn care with early burn wound excision and grafting. Blood sampled at defined time points before and after operative procedures. MEASUREMENTS AND RESULTSDetermination of types I and II acute phase reactant proteins, constitutive serum proteins, serum cytokines, serum IGF-1, IGFBP-3, and growth hormone levels. Treatment with IGF-1/BP-3 attenuated increases in type I (complement 3, α1-acidglycoprotein) and type II (haptoglobin, α1-antitrypsin) acute phase proteins. Further, IGF-1/BP-3 increased constitutive serum protein levels (prealbumin, retinol binding protein, transferrin) and decreased serum IL-6 levels. CONCLUSIONSLow-dose IGF-1/BP-3 effectively attenuated the type I and type II hepatic acute phase response, increased serum levels of constitutive proteins, and modulated the hypermetabolic response.