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Recombinant human growth hormone replacement increases CD34+ cells and improves endothelial function in adults with growth hormone deficiency

A van der Klaauw, Endocrinology and Metabolism, Leiden University Medical Center, Leiden, 2333 ZA, Netherlands
A Pereira, Endocrinology and Metabolism, Leiden University Medical Center, leiden, Netherlands
T Rabelink, Nephrology, Leiden University Medical Center, Leiden, Netherlands
E Corssmit, Endocrinology and Metabolism, Leiden University Medical Center, Leiden, Netherlands
A Zonneveld, Nephrology, Leiden University Medical Center, Leiden, Netherlands
H Pijl, Endocrinology and Metabolism, Leiden University Medical Center, Leiden, Netherlands
H de Boer, Nephrology, Leiden University Medical Center, Leiden, Netherlands
J Smit, Endocrinology and Metabolism, Leiden University Medical Center, Leiden, Netherlands
J Romijn, Endocrinology and Metabolism, Leiden University Medical Center, Leiden, Netherlands
E de Koning, Endocrinology and Metabolism, Leiden University Medical Center, Leiden, Netherlands

Correspondence: Aa van der Klaauw, Email: a.a.van_der_klaauw{at}lumc.nl

Abstract

Objective: Adult patients with growth hormone deficiency (GHD) are at increased risk for cardiovascular morbidity and mortality. Endothelial function, vascular stiffness and loss of circulating CD34+ cells are considered biomarkers for cardiovascular disease. The aim of this study was to assess vascular structure and function in relation to circulating CD34+ cells in adults with GHD before and during 1 year of recombinant human growth hormone (rhGH) replacement.

Design: 1 year intervention with rhGH

Patients and methods: Vascular function (flow-mediated dilatation (FMD)) and structure (pulse wave velocity (PWV) and analysis) were assessed in 14 adult patients (9 men) with GHD (mean age 57 yrs, range 27-71 year). In addition, the number of CD34+ cells was evaluated using flow cytometric analysis. Study parameters were analyzed at baseline, and after 6 months and 1 year of rhGH replacement.

Results: RhGH replacement increased IGF-I levels from 10.4 ± 4.5 mmol/l at baseline to 18.4 ± 10.1 mmol/l, and 20.5 ± 8.0 mmol/l, at 6 months, and 1 year, resp. (P=0.001). FMD increased from 3.5 ± 1.8% to 6.0 ± 2.5% and 5.1 ± 2.5% during 1 yr rhGH replacement, P=0.008). There was no beneficial effect on PWV, central pulse pressure, central systolic pressure and augmentation index. The number of CD34+ cells increased from 794.9 ± 798.8 cells/ml to 1270.7 ± 580.1 cells/ml and to 1356.9 ± 759.0 cells/ml (P=0.010).

Conclusion: One year of rhGH replacement in adults with GHD improves endothelial function and increases the number of circulating CD34+ cells.