A potentially lethal complication of trauma, malignancy, and infection is a progressive erosion of muscle protein mass that is not readily reversed by nutritional support. Growth hormone is capable of improving total body nitrogen balance, but its role in myofibrillar protein synthesis in humans is unknown. The acute, in situ muscle protein response to an infusion of methionyl human growth hormone was investigated in the limbs of nutritionally depleted subjects during a period of intravenous refeeding. A 6-hr methionyl growth hormone infusion achieved steady-state serum levels comparable to normal physiologic peaks and was associated with a significant increase in limb amino acid uptake, without a change in body amino acid oxidation. Myosin heavy-chain mRNA levels, measured by quantitative dot blot hybridization, were also significantly elevated after growth hormone administration. The data indicate that methionyl growth hormone can induce intracellular amino acid accrual and increased levels of myofibrillar protein mRNA during hospitalized nutritional support and suggest growth hormone to be a potential therapy of lean body wasting.Cachexia in hospitalized patients frequently results in severe lean body wasting that may threaten survival. Skeletal muscle myofibrillar protein losses are particularly prominent in patients afflicted with infection, malignancy, and trauma. Under such circumstances, nutritional supplementation may not reverse these losses of skeletal muscle protein, despite massive caloric and protein intake (1). Additional anabolic stimuli have therefore been proposed to enhance the rate of skeletal muscle protein repletion (2-4), but to date none have been shown to positively effect cellular conditions for myofibrillar protein accrual in vivo.Growth hormone (GH) is presently used in the treatment of pituitary dwarfism (5). Although in vitro data are conflicting with regard to the direct anabolic properties of GH (6-8) and suggest that many of the biological activities of this hormone may be mediated by secondary mediators such as insulin-like growth factors (IGFs) (7)(8)(9), it is clear that administration of this peptide to animals (10) and humans (11) promotes weight gain and whole body nitrogen retention. However, a mechanistic analysis of these effects in humans has previously been limited partly by the restricted quantities of the hormone and by possible contaminants in pituitary extracts of this hormone (12). Human in vivo experiments are now feasible with the availability of recombinant DNA-produced GH. To examine whether an infusion of recombinant methionyl human GH (Met-hGH) may acutely produce intracellular conditions favorable for myofibrillar protein synthesis, we infused this hormone in hospitalized volunteers during intravenous nutritional repletion.
MATERIALS AND METHODSSubjects. Six normal male adult volunteers (26.1 ± 1.2 years, 180 ± 2 cm, 73 ± 3 kg) were admitted to the Clinical Research Center ofThe New York Hospital-Cornell Medical Center (NYH-CMC) after giving informe...