Adult height and long-term outcomes after rhIGF-1 therapy in two patients with PAPP-A2 deficiency

Growth Horm IGF Res. 2021 Oct-Dec:60-61:101419. doi: 10.1016/j.ghir.2021.101419. Epub 2021 Jul 25.

Abstract

PAPP-A2 deficiency is a novel syndrome characterized by short stature due to low IGF bioactivity, skeletal abnormalities and decreased bone mineral density (BMD). Treatment with recombinant human IGF-1 (rhIGF-1) for 1 year demonstrated to increase growth velocity and BMD, without reported adverse effects, but data regarding the long-term efficacy and safety of rhIGF-1 administration in this entity has not yet been reported. Two Spanish siblings with short stature due to a homozygous loss-of-function mutation in the PAPP-A2 gene (p.D643fs25*) were treated with rhIGF-1 twice daily for six years. Growth velocity continued to increase and both patients achieved their target height. Free IGF-1 concentrations increased notably after rhIGF-1 administration, with serum IGFBP-3, IGFBP-5 and ALS levels also being higher during treatment. BMD was progressively normalized and an increase in lean mass was also noted during treatment. No episodes of hypoglycemia or any other adverse effects were documented. An increase in the growth of kidney and spleen length was observed in one of the patients.

Keywords: Bone density; Free IGF-1; GH/IGF-1; Growth; PAPP-A2; Total IGF-1; rhIGF-1.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Body Height*
  • Child
  • Female
  • Follow-Up Studies
  • Growth Disorders / drug therapy*
  • Growth Disorders / genetics
  • Growth Disorders / metabolism
  • Growth Disorders / pathology
  • Human Growth Hormone / administration & dosage*
  • Humans
  • Insulin-Like Growth Factor Binding Protein 3 / metabolism*
  • Insulin-Like Growth Factor I / metabolism*
  • Male
  • Pregnancy-Associated Plasma Protein-A / deficiency*
  • Pregnancy-Associated Plasma Protein-A / genetics
  • Prognosis
  • Recombinant Proteins / administration & dosage*

Substances

  • IGF1 protein, human
  • IGFBP3 protein, human
  • Insulin-Like Growth Factor Binding Protein 3
  • Recombinant Proteins
  • Human Growth Hormone
  • Insulin-Like Growth Factor I
  • PAPPA2 protein, human
  • Pregnancy-Associated Plasma Protein-A