A M Umpleby, D L Russell-Jones

While all the hormones described have regulatory effects on the rates of protein synthesis and breakdown there is a complex interaction between them in this control process. Insulin, GH and IGF-I play a dominant role in the day-to-day regulation of protein metabolism. In humans insulin appears to act primarily to inhibit proteolysis while GH stimulates protein synthesis. In the post-absorptive state IGF-I has acute insulin-like effects on proteolysis but in the fed state, or when substrate is provided for protein synthesis in the form of an amino acid infusion, IGF-I has been shown to stimulate protein synthesis. Growth hormone and testosterone have an important role during growth but continue to be required to maintain body protein during adulthood. Thyroid hormones are also required for normal growth and development. The hormones glucagon, glucocorticoids and adrenaline are all increased in catabolic states and may work in concert to increase protein breakdown in muscle tissue and to increase amino acid uptake in liver for gluconeogenesis. While increased glucocorticoids result in reduced muscle mass the effects of glucagon may be predominantly in the liver resulting in increased uptake of amino acids. In contrast to the catabolic effect of adrenaline on glucose and lipid metabolism, studies to date suggest that adrenaline may have an anti-catabolic effect on protein metabolism. Despite this adrenaline increases the production of the gluconeogenic amino acid alanine by muscle and its uptake by the splanchnic bed. There is considerable interest in the use of anabolic hormones, either alone or in combination, in the treatment of catabolic states. GH combined with insulin has been shown to improve whole-body and skeletal muscle kinetics while GH combined with IGF-I has a greater positive effect on protein metabolism in catabolic states than either hormone alone. If catabolic states are to be treated successfully a greater understanding of the role of the catabolic hormones in these states and the possible treatment of these states with anabolic hormones is required.