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

Objective: To 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. Design: Longitudinal trial with each patient serving as their own control. Setting: University-affiliated pediatric burn center. Patients: Nine children, 15 yrs of age or less, with burns covering >40% of the total body surface area. Interventions: Standard burn care with early burn wound excision and grafting. Blood sampled at defined time points before and after operative procedures. Measurements and Results: Determination 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. Conclusions: Low-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.