JE NORMALIZACE CÉVNÍCH CYTOADHEZIVNÍCH POCHODŮ VYSVĚTLENÍM ANTIATEROSKLEROTICKÉHO PŮSOBENÍ RŮSTOVÉHO HORMONU?

Can the Fall to Normal of the Cytoadhesive Activity in Blood Vessels Explain Antiatherosclerotic Effect of Growth Hormone?

Background.
The increased mortality caused by premature atherosclerosis has been shown among patients with hypopituitarism receiving conventional hormone treatment but with unsubstituted growth hormone deficiency. This experience belongs among the most important arguments in favour of replacement with growth hormone. The mechanisms of the antiatherogenic effect of growth hormone are poorly understood. The protective effect of growth hormone on the vascular endothel and its intervention in the clotting process, which have not been yet elucidated, may be the causative factors. Methods and Results. The endothelial damage as given by measuring of circulating soluble cytoadhesive molecules sE-selectin, sP-selectin and intercellular adhesive molecule 1 (ICAM 1) was measured in 15 adult panhypopituitaric patients before and after 1 year treatment with recombinant human growth hormone. The blood levels of all of these cytoadhesive molecules decreased significantly (p < 0.01) during the treatment. None of the concomitantly followed coagulation tests (prothrombin time, activated partial thromboplastin time, fibrinogen, antithrombin III, von Willebrand´s factor and D-dimer) was significantly changed during the treatment. The tendency to decrease (p = 0.054) was observed with antithrombin III. Conclusions. The decrease of circulating cytoadhesive molecules in blood during the treatment of growth hormone gives evidence for its protective effect, either direct or mediated, on the vascular endothel. These findings could bring an explanation for the premature atherosclerotic changes in hypopituitarism and antiatherogenic effect of growth hormone.

Key words:
Hypopituitarism in adults, growth hormone, cytoadhesive molecules, selectins, coagulation factors, atherosclerosis.