Characterization of growth hormone enhanced donor site healing in patients with large cutaneous burns

David Herndon, Hal K. Hawkins, Thuan T. Nguyen, Edgar Pierre, Robert Cox, Robert E. Barrow

Research output: Contribution to journalArticle

111 Citations (Scopus)

Abstract

Background: Human growth hormone is an anabolic agent that attenuates injury induced catabolism and stimulates protein synthesis. Recombinant human growth hormone (rhGH) administered therapeutically to patients with massive burns has been shown to increase the rate of skin graft donor site healing. It has been postulated that growth hormone affects wound healing and tissue repair by stimulating the production of insulin-like growth factor-1 (IGF-1) by the liver to increase circulating IGF-1 concentrations. The mechanism by which it improves wound healing, however, remains in question. The authors hypothesize that rhGH up-regulates IGF-1 receptors and IGF-1 levels both systemically and locally in the wound site to stimulate cell mitosis and increase synthesis of laminin, collagen types IV and VII, and cytokeratin. This hypothesis was tested in nine patients with burns covering >40% of total body surface area. Objective: The authors assessed the efficacy of rhGH in promoting several major building materials in the donor site of patients with massive burns. Methods: Ten massively burned patients with full-thickness burns covering more than 40% of total body surface area were participants in a placebo controlled prospective study to determine the efficacy of 0.2 mg/kg/day rhGH on donor site wound healing and to identify some of the major components involved in wound healing and its integrity. Results: Donor sites in burn patients receiving rhGH showed an increased coverage by the basal lamina ot 26% for placebo to 68% coverage of the dermal-epidermal junction. Insulin-like growth factor-1 receptors and laminin, types IV and VII collagen, and cytokeratin-14 all increased significantly. Healing times of the donor sites were significantly decreased compared with patients receiving placebo. Conclusion: Results indicate that growth hormone or its secondary mediators may directly stimulate the cells of the epidermis and dermis during wound healing to produce the structural proteins and other components needed to rebuild the junctional structures.

Original languageEnglish (US)
Pages (from-to)649-659
Number of pages11
JournalAnnals of Surgery
Volume221
Issue number6
StatePublished - Jun 1995

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Human Growth Hormone
Burns
Growth Hormone
Tissue Donors
Wound Healing
Skin
Somatomedins
Body Surface Area
Placebos
Collagen Type VII
Keratin-14
Somatomedin Receptors
Anabolic Agents
IGF Type 1 Receptor
Collagen Type IV
Wounds and Injuries
Laminin
Dermis
Keratins
Mitosis

ASJC Scopus subject areas

  • Surgery

Cite this

Herndon, D., Hawkins, H. K., Nguyen, T. T., Pierre, E., Cox, R., & Barrow, R. E. (1995). Characterization of growth hormone enhanced donor site healing in patients with large cutaneous burns. Annals of Surgery, 221(6), 649-659.

Characterization of growth hormone enhanced donor site healing in patients with large cutaneous burns. / Herndon, David; Hawkins, Hal K.; Nguyen, Thuan T.; Pierre, Edgar; Cox, Robert; Barrow, Robert E.

In: Annals of Surgery, Vol. 221, No. 6, 06.1995, p. 649-659.

Research output: Contribution to journalArticle

Herndon, D, Hawkins, HK, Nguyen, TT, Pierre, E, Cox, R & Barrow, RE 1995, 'Characterization of growth hormone enhanced donor site healing in patients with large cutaneous burns', Annals of Surgery, vol. 221, no. 6, pp. 649-659.
Herndon D, Hawkins HK, Nguyen TT, Pierre E, Cox R, Barrow RE. Characterization of growth hormone enhanced donor site healing in patients with large cutaneous burns. Annals of Surgery. 1995 Jun;221(6):649-659.
Herndon, David ; Hawkins, Hal K. ; Nguyen, Thuan T. ; Pierre, Edgar ; Cox, Robert ; Barrow, Robert E. / Characterization of growth hormone enhanced donor site healing in patients with large cutaneous burns. In: Annals of Surgery. 1995 ; Vol. 221, No. 6. pp. 649-659.
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abstract = "Background: Human growth hormone is an anabolic agent that attenuates injury induced catabolism and stimulates protein synthesis. Recombinant human growth hormone (rhGH) administered therapeutically to patients with massive burns has been shown to increase the rate of skin graft donor site healing. It has been postulated that growth hormone affects wound healing and tissue repair by stimulating the production of insulin-like growth factor-1 (IGF-1) by the liver to increase circulating IGF-1 concentrations. The mechanism by which it improves wound healing, however, remains in question. The authors hypothesize that rhGH up-regulates IGF-1 receptors and IGF-1 levels both systemically and locally in the wound site to stimulate cell mitosis and increase synthesis of laminin, collagen types IV and VII, and cytokeratin. This hypothesis was tested in nine patients with burns covering >40{\%} of total body surface area. Objective: The authors assessed the efficacy of rhGH in promoting several major building materials in the donor site of patients with massive burns. Methods: Ten massively burned patients with full-thickness burns covering more than 40{\%} of total body surface area were participants in a placebo controlled prospective study to determine the efficacy of 0.2 mg/kg/day rhGH on donor site wound healing and to identify some of the major components involved in wound healing and its integrity. Results: Donor sites in burn patients receiving rhGH showed an increased coverage by the basal lamina ot 26{\%} for placebo to 68{\%} coverage of the dermal-epidermal junction. Insulin-like growth factor-1 receptors and laminin, types IV and VII collagen, and cytokeratin-14 all increased significantly. Healing times of the donor sites were significantly decreased compared with patients receiving placebo. Conclusion: Results indicate that growth hormone or its secondary mediators may directly stimulate the cells of the epidermis and dermis during wound healing to produce the structural proteins and other components needed to rebuild the junctional structures.",
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