IGFs and Cytokines in Celiac Disease

« Back to Volume 24, Issue 1, May 2008 - Table of Contents

The interesting study reported in this paper is the result of one of the few productive collaborations between pediatric endocrinologists and their gastroenterologist colleagues. This endocrine group from Parma, Italy has already published papers on the interaction of the cytokine and insulin-like growth factor (IGF) systems in Crohn’s disease and cystic fibrosis. Growth failure is a well known feature of childhood celiac disease, however the precise mechanisms are not established and the possible influences of pro-inflammatory cytokines have not been well explored. The patients studied had “atypical” celiac disease, ie, they presented after the classical period of infancy. These patients were not extremely short at diagnosis but BMI SDS was decreased and both height and BMI increased significantly after treatment with a gluten-free diet.

Baseline values of IGF-I were reduced compared to controls (P<0.05) and interlukin (IL)-6 and tumor-necrosis factor (TNF)-α values were significantly elevated. IGF binding protein (IGFBP)-2 acts as an acute phase protein and, as reported in inflammatory bowel disease and childhood malignancy, values were elevated in affected subjects compared to controls. On treatment with a gluten-free diet, IGF-I and IGFBP-3 normalized and IL-6 and TNF-α decreased significantly. This study provides indirect evidence that cytokines may be involved in the abnormalities in the IGF system and when mucosal inflammation is suppressed, as occurs with treatment of celiac disease, and leads to the increases of IGFs and IGFBP-3 which facilitate normalization of linear growth.

Street ME, Volta C, Ziveri MA, et al. Changes and relationships of IGFS and IGFBPS and cytokines in coeliac disease at diagnosis and on gluten-free diet. Clin Endocrinol (Oxf). 2008;68:22-8.

Editor’s Comment

The celiac disease debate remains as to whether it is improvement in nutrition or suppression of inflammation which drives the recovery of growth. Both factors probably contribute, however as shown in Crohn’s disease,1 suppression of inflammation can independently result in increase of serum IGF-I, therefore the contribution of active inflammation may be subtle, but should not be discounted.

Martin O. Savage, MD

Reference - (linked to )

Banerjee KK, Camacho-Hubner C, Babinska K, et al. Anti-inflammatory and Growth Stimulating Effects Precede Nutritional Restitution During Enteral Feeding in Crohn’s Disease. J Pediatr Gastr Nutr. 2004;38;270-275.

« Back to Volume 24, Issue 1, May 2008 - Table of Contents

Last Updated: 04/30/2008