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IGF-I in the clinics: Use in retinopathy of prematurity
Ann Hellström1, David Ley2, Ingrid Hansen-Pupp2
1Section for Ophthalmology, Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden.
Insights
Recombinant human insulin-like growth factor-I (rhIGF-I) did not prevent retinopathy of prematurity in preterm infants. However, it significantly reduced severe bronchopulmonary dysplasia and intraventricular hemorrhage.
Area of Science:
- Neonatal Medicine
- Ophthalmology
- Endocrinology
Background:
- Retinopathy of prematurity (ROP) is a leading cause of blindness in preterm infants, linked to low insulin-like growth factor-I (IGF-I) levels.
- Impaired retinal vascular growth in severe ROP can lead to neovascularization and retinal detachment.
- IGF-I's growth-promoting properties suggest potential therapeutic benefits, even in catabolic states.
Purpose of the Study:
- To evaluate the preventative effect of recombinant human IGF-I (rhIGF-I) on retinopathy of prematurity (ROP) in preterm infants.
- To assess the impact of rhIGF-I/IGF binding protein-3 treatment on ROP incidence and severity.
Main Methods:
- A phase 2 study involved preterm infants (23 0/7 to 27 6/7 weeks gestational age) treated with rhIGF-I/IGF binding protein-3 until 30 postmenstrual weeks.
- Oxygen saturation targets were increased to 90-95% during the study, adhering to national guidelines.
Main Results:
- Treatment with rhIGF-I showed no significant effect on preventing ROP.
- A notable 53% reduction in severe bronchopulmonary dysplasia and a 44% reduction in severe intraventricular hemorrhage were observed.
- Increased oxygen saturation levels may have influenced ROP rates, potentially masking rhIGF-I's preventative effect.
Conclusions:
- rhIGF-I/IGF binding protein-3 treatment did not prevent ROP in this cohort of preterm infants.
- The intervention demonstrated significant benefits in reducing the severity of bronchopulmonary dysplasia and intraventricular hemorrhage.
- Further research is needed to clarify the role of IGF-I in ROP and its interaction with oxygen management strategies.
Abstract:
Retinopathy of prematurity is a potentially blinding disease, which is associated with low neonatal IGF-I serum concentrations and poor growth. In severe cases impaired retinal vessel growth is followed by pathologic neovascularization, which may lead to retinal detachment. IGF-I may promote growth even in catabolic states. Treating preterm infants with recombinant human (rh) IGF-I to concentrations normally found during gestation has been suggested to have a preventative effect on ROP. A recent phase 2 study treating infants (gestational age between 23weeks+0days and 27weeks +6days) with rhIGF-I/IGF binding protein-3 until 30 postmenstrual weeks showed no effect on ROP but a 53% reduction in severe bronchopulmonary dysplasia and 44% reduction in severe intraventricular hemorrhage. Oxygen is a major risk factor for ROP and during the phase 2 study oxygen saturation targets were increased to 90-95%, due to national guidelines, which might have affected ROP rate and severity making increased IGF-I a weaker preventative factor for ROP.
