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Review
. 2016 Oct-Dec:30-31:75-80.
doi: 10.1016/j.ghir.2016.09.005. Epub 2016 Sep 28.

IGF-I in the clinics: Use in retinopathy of prematurity

Ann Hellström  1 , David Ley  2 , Ingrid Hansen-Pupp  2 , Boubou Hallberg  3 , Luca A Ramenghi  4 , Chatarina Löfqvist  5 , Lois E H Smith  6 , Anna-Lena Hård  5
Affiliations
Review

IGF-I in the clinics: Use in retinopathy of prematurity

Ann Hellström et al. Growth Horm IGF Res. 2016 Oct-Dec.

Abstract

Retinopathy of prematurity is a potentially blinding disease, which is associated with low neonatal IGF-I serum concentrations and poor growth. In severe cases impaired retinal vessel growth is followed by pathologic neovascularization, which may lead to retinal detachment. IGF-I may promote growth even in catabolic states. Treating preterm infants with recombinant human (rh) IGF-I to concentrations normally found during gestation has been suggested to have a preventative effect on ROP. A recent phase 2 study treating infants (gestational age between 23weeks+0days and 27weeks +6days) with rhIGF-I/IGF binding protein-3 until 30 postmenstrual weeks showed no effect on ROP but a 53% reduction in severe bronchopulmonary dysplasia and 44% reduction in severe intraventricular hemorrhage. Oxygen is a major risk factor for ROP and during the phase 2 study oxygen saturation targets were increased to 90-95%, due to national guidelines, which might have affected ROP rate and severity making increased IGF-I a weaker preventative factor for ROP.

Keywords: Fetus; IGF-I; Metabolism; Postnatal growth; Preterm infant; Preterm morbidity.

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Conflict of interest statement

Prevention of ROP by administering IGF-I are covered by patent owned by or licensed to Premacure AB, Uppsala, Sweden. AH, DL, IHP, CL and ALH owns shares in a company with financial interest in Premacure AB. AH, DL, IHP, BH and LEHS work as consultants for Shire pharmaceuticals. All funding for the review is stated in acknowledgement.

Figures

Figure 1
Figure 1
Normal intrauterine IGF-1 concentrations obtained from the umbilical cord with cordocentesis over 18 to 42 weeks of gestation (GA) (n=174) (10,19) compared to preterm infants of matched postmenstrual ages (red dots) (20–22).
Figure 2
Figure 2. Stages of ROP
Stage I — Mildly abnormal blood vessel growth. Stage II — Moderately abnormal blood vessel growth. Stage III — Severely abnormal blood vessel growth. The abnormal blood vessels grow toward the center of the eye instead of following their normal growth pattern along the surface of the retina. When infants have a certain degree of Stage III and “plus disease” develops, treatment is considered. “Plus disease” means that the blood vessels of the retina have become enlarged and twisted, indicating a worsening of the disease. Stage IV — Partially detached retina. Stage V — Completely detached retina and the end stage of the disease. (Painting by Lisa Hård)
Figure 3
Figure 3
Major pathways of ROP
See this image and copyright information in PMC

References

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