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Mendias CL, Enselman ERS, Olszewski AM, Gumucio JP, Edon DL, Konnaris MA, Carpenter JE, Awan TM, Jacobson JA, Gagnier JJ, Barkan AL, Bedi A. The Use of Recombinant Human Growth Hormone to Protect Against Muscle Weakness in Patients Undergoing Anterior Cruciate Ligament Reconstruction: A Pilot, Randomized Placebo-Controlled Trial. Am J Sports Med 2020; 48:1916-1928. [PMID: 32452208 PMCID: PMC7351248 DOI: 10.1177/0363546520920591] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Anterior cruciate ligament (ACL) tears are common knee injuries. Despite undergoing extensive rehabilitation after ACL reconstruction (ACLR), many patients have persistent quadriceps muscle weakness that limits their successful return to play and are also at an increased risk of developing knee osteoarthritis (OA). Human growth hormone (HGH) has been shown to prevent muscle atrophy and weakness in various models of disuse and disease but has not been evaluated in patients undergoing ACLR. HYPOTHESIS Compared with placebo treatment, a 6-week perioperative treatment course of HGH would protect against muscle atrophy and weakness in patients undergoing ACLR. STUDY DESIGN Randomized controlled trial; Level of evidence, 2. METHODS A total of 19 male patients (aged 18-35 years) scheduled to undergo ACLR were randomly assigned to the placebo (n = 9) or HGH (n = 10) group. Patients began placebo or HGH treatment twice daily 1 week before surgery and continued through 5 weeks after surgery. Knee muscle strength and volume, patient-reported outcome scores, and circulating biomarkers were measured at several time points through 6 months after surgery. Mixed-effects models were used to evaluate differences between treatment groups and time points, and as this was a pilot study, significance was set at P < .10. The Cohen d was calculated to determine the effect size. RESULTS HGH was well-tolerated, and no differences in adverse events between the groups were observed. The HGH group had a 2.1-fold increase in circulating insulin-like growth factor 1 over the course of the treatment period (P < .05; d = 2.93). The primary outcome measure was knee extension strength, and HGH treatment increased normalized peak isokinetic knee extension torque by 29% compared with the placebo group (P = .05; d = 0.80). Matrix metalloproteinase-3 (MMP3), which was used as an indirect biomarker of cartilage degradation, was 36% lower in the HGH group (P = .05; d = -1.34). HGH did not appear to be associated with changes in muscle volume or patient-reported outcome scores. CONCLUSION HGH improved quadriceps strength and reduced MMP3 levels in patients undergoing ACLR. On the basis of this pilot study, further trials to more comprehensively evaluate the ability of HGH to improve muscle function and potentially protect against OA in patients undergoing ACLR are warranted. REGISTRATION NCT02420353 ( ClinicalTrials.gov identifier).
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Affiliation(s)
- Christopher L. Mendias
- Address correspondence to Christopher L. Mendias, PhD, ATC, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA () (Twitter: @ChrisMendias)
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Sigalos JT, Pastuszak AW. The Safety and Efficacy of Growth Hormone Secretagogues. Sex Med Rev 2018; 6:45-53. [PMID: 28400207 PMCID: PMC5632578 DOI: 10.1016/j.sxmr.2017.02.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 02/22/2017] [Accepted: 02/24/2017] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Growth hormone (GH) increases lean body mass, decreases fat mass, increases exercise tolerance and maximum oxygen uptake, enhances muscle strength, and improves linear growth. Long-term studies of GH administration offer conflicting results on its safety, which has led to strict Food and Drug Administration criteria for GH use. The potential drawbacks of exogenous GH use are believed to be due in part to impaired regulatory feedback. AIM To review the literature on GH secretagogues (GHSs), which include GH-releasing peptides and the orally available small-molecule drug ibutamoren mesylate. METHODS Review of clinical studies on the safety and efficacy of GHSs in human subjects. MAIN OUTCOME MEASURE Report on the physiologic changes from GHS use in human subjects including its safety profile. RESULTS GHSs promote pulsatile release of GH that is subject to negative feedback and can prevent supra-therapeutic levels of GH and their sequelae. To date, few long-term, rigorously controlled studies have examined the efficacy and safety of GHSs, although GHSs might improve growth velocity in children, stimulate appetite, improve lean mass in wasting states and in obese individuals, decrease bone turnover, increase fat-free mass, and improve sleep. Available studies indicate that GHSs are well tolerated, with some concern for increases in blood glucose because of decreases in insulin sensitivity. CONCLUSION Further work is needed to better understand the long-term impact of GHSs on human anatomy and physiology and more specifically in the context of a diversity of clinical scenarios. Furthermore, the safety of these compounds with long-term use, including evaluation of cancer incidence and mortality, is needed. Sigalos JT, Pastuszak AW. The Safety and Efficacy of Growth Hormone Secretagogues. Sex Med Rev 2018;6:45-53.
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Affiliation(s)
| | - Alexander W Pastuszak
- Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX, USA; Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA.
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Clemmons DR, Miller S, Mamputu JC. Safety and metabolic effects of tesamorelin, a growth hormone-releasing factor analogue, in patients with type 2 diabetes: A randomized, placebo-controlled trial. PLoS One 2017; 12:e0179538. [PMID: 28617838 PMCID: PMC5472315 DOI: 10.1371/journal.pone.0179538] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 05/25/2017] [Indexed: 01/13/2023] Open
Abstract
Objective Use of growth hormone is associated with side effects, including insulin resistance. The objective of this study was to determine whether tesamorelin, a stabilized growth hormone-releasing hormone analogue, would alter insulin sensitivity or control of diabetes. Design A 12-week randomized, placebo-controlled study of 53 patients with type 2 diabetes. Three treatment groups: placebo, 1 and 2 mg tesamorelin. Measurements Fasting glucose, glucose and insulin from oral glucose tolerance test, glycosylated hemoglobin (HbA1c), home blood glucose, insulin-like growth factor-1, and lipids. Main outcome measure Relative insulin response following oral ingestion of glucose. Results No significant differences were observed between groups in relative insulin response over the 12-week treatment period. At Week 12, fasting glucose, HbA1c and overall diabetes control were not significantly different between groups. In addition, relevant modifications in diabetes medications were similar between groups. Total cholesterol (-0.3±0.6 mmol/L) and non-HDL cholesterol (-0.3±0.5 mmol/L) significantly decreased from baseline to Week 12 in the tesamorelin 2 mg group (p<0.05 vs. placebo). No patient discontinued the study due to loss of diabetes control. Conclusions Treatment of type 2 diabetic patients with tesamorelin for 12 weeks did not alter insulin response or glycemic control. Trial registration ClinicalTrials.gov NCT01264497.
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Affiliation(s)
- David R Clemmons
- Division of Endocrinology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Sam Miller
- SAM Clinical Research Center, San Antonio, Texas, United States of America
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Badowski M, Pandit NS. Pharmacologic management of human immunodeficiency virus wasting syndrome. Pharmacotherapy 2014; 34:868-81. [PMID: 24782295 DOI: 10.1002/phar.1431] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Pharmacologic interventions for human immunodeficiency virus (HIV) wasting have been studied since the 1990s, but the results of these interventions have been difficult to compare because the studies used different HIV wasting definitions and assessed various patient outcomes. Thus, we performed a systematic review of the current literature to identify studies that evaluated pharmacologic management of HIV wasting and to compare and contrast treatment options. Further, we provide a comprehensive review of these treatment options and describe the definition of HIV wasting used in each study, the outcomes assessed, and whether antiretroviral therapy was used during the HIV wasting treatment. Literature searches of the PubMed/Medline (1946-2014) and Google Scholar databases were performed, and a review of the bibliographies of retrieved articles was performed to identify additional references. Only English-language articles pertaining to humans and HIV-infected individuals were evaluated. Thirty-six studies were identified that assessed pharmacologic interventions to treat HIV wasting. Appetite stimulants, such as megestrol acetate, have been shown to increase total body weight (TBW) and body mass index in HIV-infected patients with wasting. Studies evaluating dronabinol showed conflicting data on TBW increases, but the drug may have minimal benefit on body composition compared with other appetite stimulants. Testosterone has been shown to be effective in HIV wasting for those who suffer from hypogonadism. Recombinant human growth hormone has been evaluated for HIV wasting and has shown promising results for TBW and lean body mass increases. Thalidomide has been studied; however, its use is limited due to its toxicities. Although megestrol acetate and dronabinol are approved by the U.S. Food and Drug Administration (FDA) for the treatment of HIV wasting, it is important to recognize other comorbidities such as depression or hypogonadism that may contribute to the patient's appetite and weight loss. If a patient is diagnosed with hypogonadism and HIV wasting, testosterone would be a good therapeutic option. Although mirtazapine is not FDA approved for the management of HIV wasting, it has been shown to promote weight gain while treating depression symptoms. Mirtazapine may be a promising pharmacologic option in the management of HIV wasting and depression, but further research is needed.
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Affiliation(s)
- Melissa Badowski
- University of Illinois at Chicago College of Pharmacy, Chicago, Illinois
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5
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Mbada CE, Onayemi O, Ogunmoyole Y, Johnson OE, Akosile CO. Health-related quality of life and physical functioning in people living with HIV/AIDS: a case-control design. Health Qual Life Outcomes 2013; 11:106. [PMID: 23802924 PMCID: PMC3698161 DOI: 10.1186/1477-7525-11-106] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2012] [Accepted: 06/19/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Health-Related Quality of Life (HRQoL) and functional exercise capacity are important area of therapeutic interventions needed to improve the general health of People Living with HIV/AIDS (PLWH). However, the relationship between self-report and Performance-based Measure of Functional Capacity (PMFC) of PLWH is still obscure. This study compared the HRQoL and PMFC between a homogenous sample of clinical stage I PLWH and apparently healthy controls. METHODS This case-control study involved 74 consenting participants (37 PLWH and 37 controls) who completed the self-report SF-12 questionnaire and PMFC assessment using Six Minute Walk Test (6MWT). PMFC was expressed in terms of Six-Minute Walk Distance (6MWD), Six-Minute Walk Work (6MWW) and Maximum oxygen uptake (VO2max). Data were analyzed using descriptive statistics of mean and inferential statistics of independent t-test, ANOVA and Pearson's product moment correlation. Alpha level was set at 0.05. RESULTS There was no significant difference in the SF-12 Physical-health Component Score (PCS) of PLWH and the controls (p=0.782). However, the SF-12 Mental-health Component Score (MCS) of PLWH was higher than that of controls (p=0.040). 6MWD, 6MWW and VO2max were significantly lower for PLWH (p<0.05). Among PLWH, there was no significant gender differences in the PMFC (p>0.05) while PCS was higher among females. There was no significant correlation between PMFC variables and each of PCS and MCS for PLWH and controls (p>0.05) respectively. CONCLUSION Self-report physical health of clinical stage 1 PLWH and controls was comparable, while self-report mental health capacity was higher in PLWH than the controls. PMFC of PLWH was significantly lower compared to healthy controls without gender bias. Overall, self-report and performance-based measure of physical functional capacity of PLWH was not inter-related. Therefore understanding the factors that may influence exercise capacity of PLWH may help to develop effective exercise programmes for PLWH.
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Affiliation(s)
- Chidozie Emmanuel Mbada
- Department of Medical Rehabilitation, College of Health Sciences, Obafemi Awolowo University, Ile – Ife, Nigeria
| | - Olaniyi Onayemi
- Department of Dermatology and Veneriology, Faculty of Clinical Sciences, College of Health Sciences, Obafemi Awolowo University, Ile – Ife, Nigeria
| | - Yewande Ogunmoyole
- Department of Physiotherapy, Obafemi Awolowo University Teaching Hospitals Complex, Ile – Ife, Nigeria
| | - Olubusola Esther Johnson
- Department of Medical Rehabilitation, College of Health Sciences, Obafemi Awolowo University, Ile – Ife, Nigeria
| | - Christopher O Akosile
- Department of Medical Rehabilitation, College of Health Sciences, Nnamdi Azikiwe University, Nnewi Campus, Nnewi, Anambra State, Nigeria
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Steinman J, DeBoer MD. Treatment of cachexia: melanocortin and ghrelin interventions. VITAMINS AND HORMONES 2013; 92:197-242. [PMID: 23601426 DOI: 10.1016/b978-0-12-410473-0.00008-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Cachexia is a condition typified by wasting of fat and LBM caused by anorexia and further endocrinological modulation of energy stores. Diseases known to cause cachectic symptoms include cancer, chronic kidney disease, and chronic heart failure; these conditions are associated with increased levels of proinflammatory cytokines and increased resting energy expenditure. Early studies have suggested the central melanocortin system as one of the main mediators of the symptoms of cachexia. Pharmacological and genetic antagonism of these pathways attenuates cachectic symptoms in laboratory models; effects have yet to be studied in humans. In addition, ghrelin, an endogenous orexigenic hormone with receptors on melanocortinergic neurons, has been shown to ameliorate symptoms of cachexia, at least in part, by an increase in appetite via melanocortin modulation, in addition to its anticatabolic and anti-inflammatory effects. These effects of ghrelin have been confirmed in multiple types of cachexia in both laboratory and human studies, suggesting a positive future for cachexia treatments.
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Affiliation(s)
- Jeremy Steinman
- Division of Pediatric Endocrinology, Department of Pediatrics, P.O. Box 800386, University of Virginia, Charlottesville, Virginia, USA
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Wetzel JL, Fry DK, Pfalzer LA. Six-minute walk test for persons with mild or moderate disability from multiple sclerosis: performance and explanatory factors. Physiother Can 2011; 63:166-80. [PMID: 22379256 DOI: 10.3138/ptc.2009-62] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE The primary purpose of this study was to determine the extent to which health factors, functional measures, and pulmonary impairment explain performance on 6-Minute Walk Test (6MWT) distance in ambulatory persons with multiple sclerosis (MS). Another purpose was to determine the effect of disability and age on 6MWT performance and explanatory factors. METHODS A cross-sectional study design was used to evaluate factors that explain performance on the 6MWT in 64 community-dwelling persons with MS-related disability (Expanded Disability Status Scale [EDSS] 3.8±1.6). Of the 64 participants, 43 (67.2%) exhibited mild disability (EDSS <4.0) and 21 (32.8%) had moderate disability (EDSS 4.0-6.5). A regression analysis compared 6MWT performance to measures of health factors (EDSS, number of medications, number of comorbidities, resting HR, systolic and diastolic blood pressure [BP]); physical performance (functional stair test [FST], sit-to-stand test [SST], static standing balance [BAL], Fatigue Severity Scale [FSS], Activities-specific Balance Confidence [ABC] Scale); and pulmonary function (forced expiratory volume in 1 second [FEV(1)], forced vital capacity [FVC], maximal voluntary ventilation [MVV], maximal inspiratory pressure [MIP], maximal expiratory pressure [MEP]). RESULTS EDSS, ABC, FST, SST, BAL, MVV, MIP, and MEP were significantly associated with 6MWT distance after adjusting for age. Multiple step-wise linear regression analysis revealed that ABC, FST, and BAL were significant and independent explanatory factors of 6MWT distance. ABC and FST explained 75% of the variance in 6MWT performance (R(2)=0.75). Curvilinear regression analysis revealed that the FST is the most significant explanatory factor for 6MWT distance, explaining 79% of the variance (R(2)=0.79). CONCLUSIONS 6MWT performance in persons with MS was explained by balance confidence (ABC) and stair-climbing ability (FST). The ABC and FST may be practical clinical measures for explaining walking ability and determining risk for disablement in persons with MS.
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Affiliation(s)
- Jane L Wetzel
- Jane L. Wetzel, PT, PhD: Associate Professor, Department of Physical Therapy, Youngstown State University, Youngstown, Ohio (current); Duquesne University, Pittsburgh, Pennsylvania (at time of study)
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Curtis VA, Allen DB. Boosting The Late Blooming Male: Use of growth promoting agents in the athlete with constitutional delay of growth and puberty. Sports Health 2010; 3:32-40. [PMID: 21691451 PMCID: PMC3117584 DOI: 10.1177/1941738110386705] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Context: The indications for use of growth hormone have broadened with the availability of unlimited recombinant human growth hormone. The Food and Drug Administration’s approval for use of growth hormone in growth hormone–sufficient patients with idiopathic short stature includes some children with constitutional delay of growth and puberty. This is a normal growth pattern variation that includes delayed puberty and prolonged linear growth, usually leading to normal adult height. Use of recombinant human growth hormone to increase growth in short-statured children with constitutional growth delay has been challenged for its modest efficacy in increasing ultimate height, high cost, limited evidence for psychosocial benefit, and some unresolved concerns about long-term posttreatment safety. An additional controversy for the young athlete with constitutional growth delay is the concern for fairness in competition. Evidence Acquisition: A PubMed search of the literature from 1957 through May 2010 was conducted. Data sources were limited to peer-reviewed publications. Results: Recombinant human growth hormone is a safe and effective therapy for increasing growth rate in short children with constitutional growth delay, but it does not markedly increase ultimate stature nor confer a clear benefit in athletic performance. Conclusions: Prescribing physicians should use recombinant human growth hormone treatment responsibly to bring children disabled by short stature into just the normal range.
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Affiliation(s)
- Vanessa A Curtis
- Department of Pediatric Endocrinology and Diabetes, University of Wisconsin, Madison, Wisconsin, United States
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Predictors and treatment strategies of HIV-related fatigue in the combined antiretroviral therapy era. AIDS 2010; 24:1387-405. [PMID: 20523204 DOI: 10.1097/qad.0b013e328339d004] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess predictors and reported treatment strategies of HIV-related fatigue in the combined antiretroviral (cART) era. METHOD Five databases were searched and reference lists of pertinent articles were checked. Studies published since 1996 on predictors or therapy of HIV-related fatigue measured by a validated instrument were selected. RESULTS A total of 42 studies met the inclusion criteria. The reported HIV-related fatigue prevalence in the selected studies varied from 33 to 88%. The strongest predictors for sociodemographic variables were unemployment and inadequate income. Concerning HIV-associated factors, the use of cART was the strongest predictor. Comorbidity and sleeping difficulties were important factors when assessing physiological influences. Laboratory parameters were not predictive of fatigue. The strongest and most uniform associations were observed between fatigue and psychological factors such as depression and anxiety. Reported therapeutic interventions for HIV-related fatigue include testosterone, psycho-stimulants (dextroamphetamine, methylphenidate hydrochloride, pemoline, modafinil), dehydroepiandrosterone, fluoxetine and cognitive behavioural or relaxation therapy. CONCLUSION HIV-related fatigue has a high prevalence and is strongly associated with psychological factors such as depression and anxiety. A validated instrument should be used to measure intensity and consequences of fatigue in HIV-infected individuals. In the case of fatigue, clinicians should not only search for physical mechanisms, but should question depression and anxiety in detail. There is a need for intervention studies comparing the effect of medication (antidepressants, anxiolytics) and behavioural interventions (cognitive-behavioural therapy, relaxation therapy, graded exercise therapy) to direct the best treatment strategy. Treatment of HIV-related fatigue is important in the care for HIV-infected patients and requires a multidisciplinary approach.
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Gullett NP, Hebbar G, Ziegler TR. Update on clinical trials of growth factors and anabolic steroids in cachexia and wasting. Am J Clin Nutr 2010; 91:1143S-1147S. [PMID: 20164318 PMCID: PMC2844687 DOI: 10.3945/ajcn.2010.28608e] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
This article and others that focused on the clinical features, mechanisms, and epidemiology of skeletal muscle loss and wasting in chronic diseases, which include chronic kidney disease, cancer, and AIDS, were presented at a symposium entitled "Cachexia and Wasting: Recent Breakthroughs in Understanding and Opportunities for Intervention," held at Experimental Biology 2009. The clinical and anabolic efficacy of specific growth factors and anabolic steroids (eg, growth hormone, testosterone, megestrol acetate) in malnutrition and other catabolic states has been the subject of considerable research during the past several decades. Research on the effects of these agents in cachexia or wasting conditions, characterized by progressive loss of skeletal muscle and adipose tissue, focused on patients with AIDS in the early 1990s, when the devastating effects of the loss of body weight, lean body mass, and adipose tissue were recognized as contributors to these patients' mortality. These same agents have also been studied as methods to attenuate the catabolic responses observed in cancer-induced cachexia and in wasting induced by chronic obstructive pulmonary disease, congestive heart failure, renal failure, and other conditions. This article provides an updated review of recent clinical trials that specifically examined the potential therapeutic roles of growth hormone, testosterone, oxandrolone, and megestrol acetate and emerging data on the orexigenic peptide ghrelin, in human cachexia and wasting.
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Affiliation(s)
- Norleena P Gullett
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA, USA
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Oursler KK, Katzel LI, Smith BA, Scott WB, Russ DW, Sorkin JD. Prediction of cardiorespiratory fitness in older men infected with the human immunodeficiency virus: clinical factors and value of the six-minute walk distance. J Am Geriatr Soc 2009; 57:2055-61. [PMID: 19793156 DOI: 10.1111/j.1532-5415.2009.02495.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To investigate factors related to cardiorespiratory fitness in older human immunodeficiency virus (HIV)-infected patients and to explore the utility of 6-minute walk distance (6-MWD) in measuring fitness. DESIGN Cross-sectional study in clinic-based cohort. SETTING Veterans Affairs Medical Center, Baltimore, Maryland. PARTICIPANTS Forty-three HIV-infected men, median age 57 (range 50-82), without recent acquired immunodeficiency syndrome-related illness and receiving antiretroviral (ARV) therapy. MEASUREMENTS Peak oxygen utilization (VO(2)peak) according to treadmill graded exercise testing, 6-MWD, grip strength, quadriceps maximum voluntary isometric contraction, cross-sectional area, muscle quality, and muscle adiposity. RESULTS There was a moderate correlation between VO(2)peak (mean +/- SD; 18.4 +/- 5.6 mL/kg per minute) and 6-MWD (514 +/- 91 m) (r=0.60, P<.001). VO(2)peak was lower in subjects with hypertension (16%, P<.01) and moderate anemia (hemoglobin 10-13 gm/dL; 15%, P=.09) than in subjects without these conditions. CD4 cell count (median 356 cells/mL, range 20-1,401) and HIV-1 viral load (84% nondetectable) were not related to VO(2)peak. Among muscle parameters, only grip strength was an independent predictor of VO(2)peak. Estimation of VO(2)peak using linear regression, including age, 6-MWD, grip strength, and hypertension as independent variables, explained 61% of the variance in VO(2)peak. CONCLUSION Non-AIDS-related comorbidity predicts cardiorespiratory fitness in older HIV-infected men receiving ARV therapy. The 6-MWD is a valuable measure of fitness in this patient population, but a larger study with diverse subjects is needed.
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Affiliation(s)
- Krisann K Oursler
- Department of Medicine, School of Medicine, University of Maryland, Baltimore, Maryland 21201, USA.
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Graham MR, Baker JS, Evans P, Hullin D, Thomas NE, Davies B. Potential benefits of recombinant human growth hormone (rhGH) to athletes. Growth Horm IGF Res 2009; 19:300-307. [PMID: 19539505 DOI: 10.1016/j.ghir.2009.04.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/03/2009] [Indexed: 12/29/2022]
Abstract
Athletes have enjoyed almost a thirty year amnesty of rhGH abuse, which they consider has contributed to the winning of medals and the breaking of world records. Such a reprieve is almost at an end, since WADA have identified a method to detect rhGH abuse. Or have they? The anecdotal word "on the street" is that rhGH is still undetectable and athletes believe that the benefits, at the dosages they administer, far outweigh the risks! Scientists are aware that in a hormone deficiency condition, replacement can halt and in certain situations reverse some of the adverse effects. Growth hormone deficiency can lead to a loss of skeletal muscle mass and an increase in abdomino-visceral obesity, which is reversed on replacement with rhGH. Since the availability of GH, athletes have been trying to extrapolate these effects from the deficiency state to the healthy corpus and increase their sporting prowess. Past confessions from athletes, such as Ben Johnson, Kelly White, Tim Montgomery, Marion Jones and currently Dwain Chambers have demonstrated that they are prepared to tread the very fine lines that separate the "men from the boys". Rewards are so great, that anonymous surveys have identified that athletes will risk ill health, if they believe they can cheat, win and not get caught. The question that still needs to be answered is, "does growth hormone enhance performance"? Recent research suggests that it could. There is also a suspicion that in "cycled" low supraphysiological doses, it is no where near as harmful as WADA claim it to be.
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Affiliation(s)
- Michael R Graham
- The Newman Centre for Sport and Exercise Research, Newman University College, Birmingham, UK.
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Abstract
Approximately half of patients with HIV-infection develop abnormal body fat distribution, characterized by increased abdominal, breast, and dorsocervical adiposity and decreased fat in the limbs and face in association with antiretroviral therapy. Changes in fat distribution are associated with dyslipidemia, insulin resistance, and increased cardiovascular risk in patients with HIV lipodystrophy. Growth hormone secretion is reduced and responses to standardized stimulation testing altered, suggesting relative growth hormone deficiency in this population. Growth hormone secretion is characterized by normal pulse frequency, but decreased pulse amplitude, pulse width, and trough GH levels compared to weight matched, non-HIV-infected patients. Abnormalities in GH secretion are strongly associated with body composition and metabolic abnormalities in patients with HIV lipodystrophy, particularly with increased visceral fat and elevated free fatty acids. Increased somatostatin tone and decreased ghrelin concentrations may also contribute to reduced GH levels. Administration of exogenous GH or growth hormone releasing hormone (GHRH) to normalize growth hormone concentrations is effective to reduce visceral fat and improve lipid parameters in HIV-infected patients. Treatment with supraphysiologic GH is limited by side effects and exacerbation of insulin resistance, whereas administration of physiologic doses of GH demonstrates more modest treatment effects but fewer adverse effects. Initial studies of GHRH also show significant reductions in visceral adipose tissue (VAT) with potentially fewer adverse effects. GHRH may be particularly useful to normalize GH dynamics in patients with HIV lipodystrophy by increasing endogenous GH pulse height, GH pulse width, and trough GH levels, while preserving the negative feedback of IGF-I on pituitary GH secretion.
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Affiliation(s)
- Takara L Stanley
- Program in Nutritional Metabolism and Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, LON5-207, 55 Fruit St., Boston, MA, 02114, USA
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Apor P, Tihanyi J, Costa A. [Increase of muscle mass and strength with hormones and other drugs, combined with physical training]. Orv Hetil 2007; 148:451-6. [PMID: 17350911 DOI: 10.1556/oh.2007.27793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Increasing muscle mass and strength is the aim of some body builders and sportsmen, and is a therapeutic target in hormonal deficiencies, as well as in many clinical situations, when muscle devastation is a life-limiting factor. Human growth hormone, insulin-like growth factor, anabolic-androgen steroids and regulating proteins influencing muscle development and differentiation are used also for delaying the aging processes. Some of the practices are hailed by several myths, mainly because doping cases in certain competitive sports. Physiology, and therapeutic experiences with these substances are reviewed with special reference to physical exercise and to some frail conditions.
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Affiliation(s)
- Péter Apor
- Semmelweis Egyetem, Testnevelési és Sporttudományi Kar Humán Kineziológia Szak Budapest Czakó u. 9. 1016 Apor-Med Bt. Budapest, Hungary.
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Esposito JG, Thomas SG, Kingdon L, Ezzat S. Comparison of body composition assessment methods in patients with human immunodeficiency virus-associated wasting receiving growth hormone. J Clin Endocrinol Metab 2006; 91:2952-9. [PMID: 16757527 DOI: 10.1210/jc.2006-0431] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Bioelectrical impedance spectroscopy (BIS) and skinfold anthropometry (SKF) have been used to monitor body composition among patients with HIV wasting; however, validation of these techniques during recombinant human GH (rhGH) treatment has not been performed. OBJECTIVE Our objective was to evaluate the degree of agreement between criterion measurements of dual-energy x-ray absorptiometry (DXA) and those of BIS and SKF in patients with HIV wasting treated with rhGH. DESIGN AND SETTING We conducted a randomized, double-blinded, placebo-controlled, two-period crossover trial at the University of Toronto and Mount Sinai Hospital (Toronto, Canada). PATIENTS A referred sample of 27 community-dwelling men with HIV-associated weight loss (> or =10% over preceding 12 months) despite optimal antiretroviral therapy participated in the study. INTERVENTION Intervention was one daily injection of rhGH (6 mg) or placebo self-administered for 3 months in a crossover fashion with a 3-month washout. MAIN OUTCOME MEASURES Fat-free mass (FFM) and fat mass (FM) were measured by BIS, SKF, and DXA before and after rhGH and placebo treatment. RESULTS FFM(BIS) was not significantly different from FFM(DXA) after rhGH treatment (P = 0.10). Mean differences (bias +/- sd) according to Bland-Altman analysis were smaller for SKF than for BIS (P < 0.05) at all time points, yet treatment-induced change in FM was better detected with BIS than with SKF. BIS estimates of FFM and FM showed better agreement with those of DXA after rhGH treatment (1.6 +/- 4.6 kg and -2.1 +/- 3.9 kg) compared with baseline (3.8 +/- 3.5 kg and -4.1 +/- 3.6 kg) and placebo (2.7 +/- 4.4 kg and -3.1 +/- 4.6) (P < 0.05). BIS overestimated and SKF underestimated the treatment-induced changes in FFM and FM. CONCLUSIONS SKF was more accurate than BIS when measuring body composition in patients with HIV wasting before and after rhGH treatment; nonetheless, the accuracy of BIS increased after treatment. Change in FM because of treatment was not accurately assessed with SKF.
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Affiliation(s)
- John G Esposito
- Graduate Department of Rehabilitation Science, University of Toronto, Toronto, Ontario, Canada M5G 1V7
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Chetta A, Zanini A, Pisi G, Aiello M, Tzani P, Neri M, Olivieri D. Reference values for the 6-min walk test in healthy subjects 20-50 years old. Respir Med 2006; 100:1573-8. [PMID: 16466676 DOI: 10.1016/j.rmed.2006.01.001] [Citation(s) in RCA: 208] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2005] [Revised: 12/24/2005] [Accepted: 01/01/2006] [Indexed: 01/06/2023]
Abstract
In 102 healthy Caucasians, 20-50 years old, we investigated the effect of anthropometrics on the 6-min walk test (6MWT), in order to provide reference values for walk distance (6MWD), oxygen saturation (SpO2), pulse rate (PR), respiratory rate (RR), breathlessness perception (VAS) and for the walking distance and body weight product (DW). The mean 6MWD and DW values were 593 +/- 57 and 638+/-44 m (P < 0.01) and 35,030 +/- 5306 and 48,882 +/- 6555 kg m (P < 0.01), respectively for women and for men. While walking, SpO2 remained unaltered and subjects reached 67 +/- 10% of their maximal predicted heart rate and a RR mean value of 19 +/- 4 bpm. VAS ratings were significantly higher in females as compared to males (24 +/- 15 vs. 18 +/- 5 mm, P < 0.05), however, when corrected for PR change while walking, they were not different. The equation by stepwise multiple regression analysis included height, age and gender for the 6MWD and accounted for 42% of the total variance. This study confirms the relevant effect of anthropometrics on walking capacity and suggests that when rating dyspnea, the change in heart rate during walking should be considered.
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Affiliation(s)
- Alfredo Chetta
- Department of Clinical Sciences, Section of Respiratory Diseases, University of Parma, Italy.
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