Growth hormone in inflammatory bowel disease

B. De Pascalis, A. Bianchi, M.A. Satta, A. Lupascu, M.C. Mentella, D. Leo, F. Fiore, P. Fedeli, A. Pontecorvi, P. Pola, D. Melina, A. Gasbarrini, L. De Marinis, A. Armuzzi

Department of Internal Medicine, Catholic University of Sacred Heart – Rome (Italy)

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• Gastroenterology

Abstract. – Crohn’s disease and ulcerative colitis are inflammatory diseases of the gastrointestinal tract characterized by chronic relapsing inflammation and catabolism. Growth hormone/insulin-like growth factor-I axis is important in inflammatory bowel disease, because of the effects on epithelial cell kinetics, collagen deposition and immunomodulation. The potential of growth hormone as a therapeutic option in inflammatory bowel disease has been proven in various clinical settings. Acquired growth hormone resistance in inflammatory bowel disease seems to be mediated by a combination of undernutrition and active inflammation. In particular, proinflammatory cytokines, such as TNF-alpha and interleukin-6, have been implicated as potential mediators of growth hormone resistance. The introduction of anti-TNF-alpha monoclonal antibodies has proven very efficacious in patients with inflammatory bowel disease. By reducing cytokines levels in inflammatory cells of intestinal mucosa, infliximab could interfere with cytokine-induced growth hormone resistance. Recent in vivo data have shown that acquired growth hormone resistance in patients with inflammatory bowel disease may be reversed after the administration of anti-TNF-alpha therapy.