Pharmacokinetics of IGF-1 in PAPP-A2-Deficient Patients, Growth Response, and Effects on Glucose and Bone Density

Catalina Cabrera-Salcedo, Tomoyuki Mizuno, Leah Tyzinski, Melissa Andrew, Alexander A Vinks, Jan Frystyk, Halley Wasserman, Catherine M Gordon, Vivian Hwa, Philippe Backeljauw, Andrew Dauber, Catalina Cabrera-Salcedo, Tomoyuki Mizuno, Leah Tyzinski, Melissa Andrew, Alexander A Vinks, Jan Frystyk, Halley Wasserman, Catherine M Gordon, Vivian Hwa, Philippe Backeljauw, Andrew Dauber

Abstract

Context: The pregnancy-associated plasma protein A2 (PAPP-A2) cleaves insulinlike growth factor binding proteins 3 and 5, releasing free insulinlike growth factor 1 (IGF-1). Homozygous mutations in PAPP-A2 result in growth failure with elevated total but low free IGF-1.

Objective: To determine the 24-hour pharmacokinetic (PK) profile of free and total IGF-1 after a dose of recombinant human insulinlike growth factor 1 (rhIGF-1). We describe the growth response and effects on glucose metabolism and bone mineral density (BMD) after 1 year of rhIGF-1 therapy.

Design and patients: Three affected siblings, their heterozygous parents, and two healthy controls participated. The subjects received a dose of rhIGF-1, followed by serial blood samples collected over 24 hours. The two younger siblings were started on rhIGF-1 treatment. An oral glucose tolerance test and dual-energy X-ray absorptiometry scans were obtained at baseline and after 1 year of treatment.

Results: Subcutaneous administration of rhIGF-1 increased the concentration of free and total IGF-1 in patients with PAPP-A2 deficiency. The PK profile was comparable in all participants. At baseline, all three subjects demonstrated insulin resistance and below-average BMD. Treatment with rhIGF-1 is ongoing in the youngest patient but was discontinued in his brother because of the development of pseudotumor cerebri. The treated patient had an increase in height velocity from 3.0 to 6.2 cm/y, resolution of insulin resistance, and an increase in total body BMD.

Conclusions: rhIGF-1 at standard dosages resulted in similar PK characteristics in patients with PAPP-A2 deficiency, heterozygous relatives, and healthy controls. The youngest affected patient experienced a modest growth response to therapy with rhIGF-1, as well as beneficial effects on glucose metabolism and bone mass.

Trial registration: ClinicalTrials.gov NCT02636270.

Copyright © 2017 Endocrine Society

Figures

Figure 1.
Figure 1.
Free and total IGF-1 response to an SC injection of 120 µg/kg rhIGF-1 in PAPP-A2-deficient patients (P1, P3, and P3), their heterozygous parents (M and D), and healthy controls (Con 1 and Con 2). (A) Uncorrected serum concentration–time profile. (B) Baseline-corrected serum concentration–time profile.
Figure 2.
Figure 2.
(A) Growth chart of the male patient with PAPP-A2 deficiency who was treated with rhIGF-1 at a dosage of 120 µg/kg. The red arrow points to the initiation of treatment. (B) Growth chart of the male patient with PAPP-A2 deficiency who was not treated with rhIGF-1. Therapy was discontinued because of the development of intracranial hypertension.
Figure 3.
Figure 3.
OGTT results at baseline (dotted lines) and at 12 months (solid lines). P3 was treated with rhIGF-1.

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Source: PubMed

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