Reduction of venous pressure during the resection of liver metastases compromises enteric blood flow: IGFBP-1 as a novel biomarker of intestinal barrier injury

OBJECTIVES: Disruption of the intestinal barrier and bacterial translocation commonly occur when intestinal blood flow is compromised. The aim of this study was to determine whether liver resection induces intestinal damage. METHODS: We investigated intestinal fatty-acid binding protein and insulin-like growth factor binding protein levels in the plasma of patients who underwent liver resection. RESULTS: We show that liver resection is associated with significant intestinal barrier injury, even if the Pringle maneuver is not performed. CONCLUSION: We propose the use of insulin-like growth factor binding protein-1 as a novel biomarker of intestinal damage in such situations.

Predição do parto prematuro: avaliação sequencial do colo uterino e do teste para proteína-1 fosforilada ligada ao fator de crescimento insulina-símile / Preterm birth prediction: sequential evaluation of the cervix and the test for phosphorylated protein-1 linked to insulin-like growth factor

OBJETIVOS: Averiguar a utilidade da medida do comprimento do colo uterino e do teste para proteína-1 fosforilada ligada ao fator de crescimento insulina-símile (phIGFBP-1), realizados de maneira sequencial, na predição do parto prematuro e a existência de correlação entre os testes. MÉTODOS: Foram submetidos a análise secundária os dados de 101 gestantes assintomáticas com antecedente de prematuridade. A medida ultrassonográfica do comprimento do colo e o teste para phIGFBP-1 foram realizados em paralelo a cada três semanas, entre a 24ª e a 34ª semana. O melhor valor de corte do colo uterino para cada avaliação foi estabelecido por meio de curva ROC, e ambos os testes foram comparados entre si por meio de testes não paramétricos. Foram obtidas a sensibilidade, a especificidade e os valores preditivos de cada teste e da associação dos exames para a ocorrência de parto antes de 37 semanas. RESULTADOS: Houve 25 partos prematuros (24,8%). O comprimento do colo apresentou maior sensibilidade e foi capaz de predizer o parto prematuro em todas as avaliações, com acurácia semelhante em diferentes idades gestacionais. O teste para phIGFBP-1 não foi útil na 24ª semana, porém foi capaz de predizer independentemente a prematuridade na 27ª à 30ª e 33ª semana. A associação dos exames elevou a sensibilidade (81,8%) e o valor preditivo negativo (93,7%) quando comparada à utilização isolada dos testes. O comprimento cervical médio foi menor em gestantes com teste positivo. CONCLUSÕES: Tanto o comprimento cervical quanto o teste para phIGFBP-1 foram capazes de predizer independentemente o parto prematuro, e a associação sequencial de ambos os exames apresentou elevada sensibilidade e alto valor preditivo negativo.

PURPOSE: To investigate the usefulness of the measurement of cervical length and of the test for phosphorylated insulin-like growth factor binding protein-1 (phIGFBP-1) performed sequentially in the prediction of preterm birth and the correlation between tests. METHODS: We analyzed data from 101 asymptomatic pregnant women with a history of premature delivery. The ultrasound measurement of cervical length and phIGFBP-1 test were performed in parallel every three weeks, between 24 and 34 week. The best cutoff value for each cervical evaluation was established by the ROC curve, and the two tests were compared using nonparametric tests. We determined the sensitivity, specificity and predictive values of each test and of the association of the exams for the occurrence of delivery before the 37th weeks. RESULTS: There were 25 preterm births (24.8%). The cervix length showed the highest sensitivity and was able to predict preterm birth in all evaluations, with similar accuracy at different gestational ages. The test for phIGFBP-1 was not helpful at 24 weeks, but was able to predict prematurity when performed at 27, 30 and 33 weeks. The combination of tests increased the sensitivity (81.8%) and negative predictive value (93.7%) when compared to the separate use of each test. The mean cervical length was lower in women with a positive test. CONCLUSIONS: Both cervical length and the test for phIGFBP-1 were able to predict premature delivery, and sequential combination of both tests showed a high sensitivity and high negative predictive value.

Insulin-like growth factors-I and -II and insulin-like growth factor binding protein-1 during normal pregnancy: pattern of secretion and correlation with other placental hormones.

OBJECTIVES: To describe pattern of secretion of insulin-like growth factor (IGF)-I, IGF-II, IGF binding protein (IGFBP)-1 and their correlation with each other and major placental hormones during normal pregnancy. DESIGN: Longitudinal study. SETTING: Academic Institutions and a Tertiary Care Maternity Hospital. PARTICIPANTS: Healthy women with singleton uncomplicated pregnancies (N = 35). MEASUREMENTS: Serum levels of IGF-I, IGF-II, IGFBP-1, chorionic gonadotrophin (HCG), placental lactogen (HPL), prolactin, oestradiol and progesterone were studied thrice during the antenatal period and within 24 h of delivery. RESULTS: IGF-I, IGFBP-1, HPL, prolactin, oestradiol and progesterone increased and HCG decreased significantly with advancing gestation (Repeated measures ANOVA: P < 0.01 to 0.0001). IGF-II levels were not significantly affected by period of gestation. Significant negative correlations (multiple regression analysis) were seen between IGFBP-1 and prolactin at 28 +/- 2 (P = 0.0226) and 36 +/- 2 (P = 0.0417) weeks of amenorrhoea (WOA) and between oestradiol and IGF-II at 36 +/- 2 WOA (P = 0.037). Prolactin and IGF-I at 14 +/- 2 WOA (P = 0.0225) and progesterone and IGFBP-1 at 28 +/- 2 WOA (P = 0.0216) correlated positively. CONCLUSIONS: Maternal IGF-I and IGFBP-1 but not IGF-II significantly increase as pregnancy advances. Components of the IGF system regulate or are affected by some of the placental hormones and the effects vary with the period of gestation.

A decrease in circulating levels of immunoreactive insulin-like growth factor binding protein-1 (IGFBP-1) after endometrial ablation using a gynecologicresectoscope

To determine how endometrium alone would contribute to maintaining the circulating levels of Insulin-like growth factor binding protein-1 in vivo, serum immunoreactive IGFBP-1 levels were measured in 19 patients undergoing endometrial ablation using gynecologic resectoscopy. After endometrial ablation there was a significant decrease in the mean levels of circulating IGFBP-1, which was not correlated with the menstrual cycle. This result indicates that the endometrium is one of the sources of the circulating IGFBP-1.

Insulin-like growth factor [IGF] -1, IGF-II, IGF-binding protein -1 [IGFBP-1] and IGFBP-3 in children with insulin dependent diabetes mellitus

The existing literature on serum insulin like growth factors [IGFs] and their binding proteins [IGFBPs] levels in insulin dependent diabetes mellitus [IDDM] is conflicting. In the present study, 44 children and adolescents with IDDM [22 newly diagnosed and 22 old known cases] aged from 5 to 14 years, 18 girls and 26 boys, together with 18 apparently healthy control children of matchable age and sex were subjected to estimation of serum levels of IGF-I, IGF II, IGFBP-1, IGFBP-3 and fasting serum glucose. Glycemic control was assessed by glycosylated hemoglobin [HbA[1C]]. Diabetic children showed significantly lower serum levels of IGF-I, IGF-II and IGFBP-3 [p<0.01, p<0.01 and p<0.001 respectively] and significantly higher levels of IGFBP-1 [p<0.05] than controls. This was true for the diabetic cases in general, for newly diagnosed cases and for those with poor metabolic control. Old diabetic cases and patients with average glycemic control differed from the control children only regarding IGF-II [p<0.001 for both] and regarding IGFBP-3 [p<0.001] and p<0.05 respectively]. While prepubertal cases showed significantly lower IGF-I than controls [p<0.05], pubertal cases lacked this difference. IGF-I levels were negatively correlated with each of HbA[1C] [r=-0.52, p<0.001] and IGFBP-1 [r=-0.45, p<0.002], and were positively correlated with each of IGFBP 3 [r=0.31, p<0.05] and body mass index [BMI] [r=0.43, p<0.004]. IGFBP-1 levels were positively correlated with fasting serum glucose [r=0.46, p<0.002]. In conclusion, alterations in the IGF/IGFBP system are observed in children with IDDM in the present study. Improvement of glycemic control may help to decrease this alteration. The impact of these alterations on the health of diabetic children is still unsettled

Serum and synovial fluid insulin like growth factor-1 and its binding protein-3 in rheumatoid arthritis

Insulin-like growth factor-1 [IGF-1] and its binding protein-3 [IGFBP-3] in human synovial fluid play an important role in maintaining articular cartilage metabolism. In this study, we measured serum and synovial fluid [SF] concentrations of IGF-1 and IGFBP-3 in 20 rheumatoid arthritis patients [RA] and 10 matched controls [with traumatic knee effusion] using radioimmunoassay. Also, we tried to correlate serum and synovial levels with each other and with disease activity and severity measures. Our results showed a significant increase in synovial fluid level of both IGF-1 and IGFBP-3 in RA patients as compared to controls. Serum IGF-1 correlated with synovial fluid level but serum IGFBP-3 did not correlate with synovial fluid level. Disease activity markers correlated significantly with synovial fluid IGF-12 and IGFBP-3 levels, but did not show significant correlation with their serum level. In conclusion the pattern of IGF-1 and IGFBP-3 in SF differs in inflammatory versus non-inflammatory joints