Table 1411

Wound Healing and Insulin Growth Factor-1a

General wound healing stimulant Increases cell replication Increases epithelialization rate Increases angiogenesis rate

Reverses both diabetes- and corticosteroid-induced impaired healing aAnimal studies.

The wound healing effects are described in Table 14.11.74-78 IGF-1 is considered to be a wound healing stimulant, increasing cell proliferation and collagen synthesis. In addition, IGF-1 infusion has been shown to reverse the diabetes- and corticoster-oid-induced impairment in wound healing. It is important to point out that these properties have largely been reported in animal studies. No direct effect on wound healing has been shown in man. However, increasing overall anabolism should benefit a wound.

Complications

The main complication is that of hypoglycemia. This agent, in general, appears to have fewer side effects than HGH.

insulin

Actions

The hormone insulin is known to have anabolic activities in addition to its effect on glucose and fat metabolism.79 In a catabolic state, exogenous insulin administration has been shown to decrease proteolysis in addition to increasing protein synthe-sis.80-83 The anabolic activity appears to mainly affect the muscle and skin protein in the lean body mass compartment (Table 14.12). An increase in circulating amino acids produced by wound amino acid intake increases the anabolic and anticatabolic effect in both normal adults and populations in a catabolic state.80-83

Results of Exogenous Use

A number of clinical trials, mainly in burn patients (Table 14.13) have demonstrated the stimulation of protein synthesis, decreased protein degradation, and a net nitrogen uptake, especially in skeletal muscle.84-92 An increase in anabolic activity is also evident in diabetics who are provided more insulin. The positive insulin effect on protein synthesis decreases with aging.89 This response is different from that found with the use of HGH and anabolic steroids, where age does not appear to blunt the anabolic response.

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