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Hemoglobin level is linked to growth hormone-dependent proteins in short children
E Vihervuori1, M Virtanen, H Koistinen
1Children's Hospital and the Department of Obstetrics and Gynecology, University of Helsinki, Finland.
Insights
Growth hormone (GH) treatment boosts hemoglobin in children with short stature and skeletal dysplasia. The GH-IGF axis plays a role in childhood hemoglobin elevation.
Area of Science:
- Pediatric Endocrinology
- Hematology
- Growth Factor Research
Background:
- Erythropoiesis regulation in children with growth disorders is not fully understood.
- The role of the growth hormone-insulin-like growth factor (GH-IGF) axis in hemoglobin production requires further investigation.
Purpose of the Study:
- To investigate erythropoiesis in children with short stature and skeletal dysplasia during growth hormone (GH) therapy.
- To examine the relationship between hemoglobin levels, growth, and serum concentrations of insulin-like growth factor I (IGF-I), IGF binding protein-3 (IGFBP-3), and erythropoietin (EPO).
Main Methods:
- Studied 32 children with short stature and 8 with skeletal dysplasia over 12 months of recombinant human GH treatment.
- Monitored blood hemoglobin, serum IGF-I, IGFBP-3, and EPO levels before, during, and after treatment.
- Analyzed correlations between hemoglobin, growth parameters, and growth factor levels.
Main Results:
- Hemoglobin positively correlated with height, IGF-I, and IGFBP-3, but not EPO.
- GH treatment increased hemoglobin, IGF-I, and IGFBP-3, accelerating growth.
- Children with skeletal dysplasia showed a pronounced hemoglobin increase, with strong correlations between hemoglobin, IGF-I, and IGFBP-3.
Conclusions:
- The GH-IGF axis is implicated in the physiological elevation of hemoglobin during childhood.
- GH therapy positively impacts erythropoiesis in children with short stature and skeletal dysplasia.
- Specific correlations highlight the GH-IGF axis's role in hemoglobin regulation in skeletal dysplasia.
Abstract:
Erythropoiesis was investigated in 32 children wih short stature and in eight children with skeletal dysplasia by studying blood hemoglobin in relation to growth and to serum concentrations of insulin-like growth factor I (IGF-I), IGF binding protein-3 (IGFBP-3), and erythropoietin (EPO) before, during, and after 12 months of recombinant human growth hormone (GH) treatment. Blood hemoglobin concentration was positively correlated with relative body height and with serum IGF-I and IGFBP-3 levels (P = .001 to .02), but not with the concentrations of EPO. The normal age-dependency of hemoglobin was lacking. Hemoglobin levels and their responses to GH treatment were similar in the patients with GH deficiency and those with normal GH secretion. Treatment with GH accelerated growth and elevated the concentrations of hemoglobin, IGF-I, and IGFBP-3. In the eight patients with skeletal dysplasia, body mass increased similarly, but gain in height was less than in the other patients, and the increase in hemoglobin was markedly pronounced. In this group, the correlations between hemoglobin, IGF-I, and IGFBP-3 were extremely close (r = 0.80 to 0.85, P = .031 to .008). These findings are in accord with earlier observations from in vitro and animal studies, and suggest that the GH-IGF axis is involved in the physiologic elevation of hemoglobin levels during childhood.