ESPE Abstracts

COVID-19 is a worldwide pandemic caused by SARS-CoV-2, to which adults are usually more susceptible than children. Growth hormone (GH) levels differ between children and adults and decrease with age. There is bidirectional crosstalk between the GH/insulin-like growth factor-1 (IGF-1) pathway and the immune system that plays a significant role in SARS-CoV-2 infection. We evaluated the association between somatotropin treatment (GH replacement therapy) and the risk for SARS-CoV-2 positivity (a marker for COVID-19 infection) in children with growth hormone issues (GHI): growth hormone deficiency (GHD) and idiopathic short stature (ISS). A population-based cross-sectional study in Leumit-Health-Services (LHS) was performed using the electronic health record (EHR) database. The rates of SARS-CoV-2 positivity were evaluated among children with GHI, treated or untreated with somatotropin. Higher rates of SARS-CoV-2 positivity were found in GHI children, influenced by the same confounders reported in the pediatric population. A lower prevalence of SARS-CoV-2 PCR-positivity was found among the somatotropin-treated children. A multivariate analysis documented that somatotropin treatment was associated with a reduced risk of SARS-CoV-2 positivity (OR=0.47, CI 0.25-0.96, P = 0.036). Thus, somatotropin might be a protective factor against SARS-CoV-2 infections, possibly related to its immunomodulatory activity. The possible protective effect of somatotropin treatment was found to be independent of other factors. Our study is in line with previous publications demonstrating that male gender, high BMI, ADHD, and low 25-OH vitamin D levels are risk factors for COVID-19 infection, while asthma and influenza vaccination are protective factors. Notably, somatotropin treatment was found to be protective in all GHI children including ISS and GHD children. Although the specific mechanisms involved in the protective effect are unclear, it may be related to the immunomodulatory effects of somatotropin. To our knowledge, this is the first study that examined the role of somatostatin in the global COVID-19 pandemic. It should be noted, however, that our results are in concert with a previous study demonstrating the possible protective immunomodulatory effect of somatotropin administration. Further studies are needed to elucidate the precise mechanisms by which GH attenuates the susceptibility to COVID-19 infection.