ABSTRACT
OBJECTIVES: In addition to its roles in the stimulation of growth hormone secretion and the regulation of appetite and metabolism, ghrelin exerts immunomodulatory, anti-inflammatory and antioxidant actions in several organ systems. In this study, we investigated the effects of ghrelin on the healing of experimental colonic anastomoses. METHODS: Wistar rats were randomly divided into two groups (n = 10 in each). A segment of colon was excised, and an end-to-end anastomosis was performed in the distal colon. The Ghrelin Group received 10 ng/kg/day IP ghrelin for seven days postoperatively, whereas the Control Group received an identical volume of saline. On the seventh postoperative day, the anastomotic bursting pressures and hydroxyproline levels were measured, and adhesion formation around the anastomoses was examined. Histopathological analyses were performed to evaluate inflammatory cell infiltration, fibroblast infiltration, collagen density and neovascularization. RESULTS: In the Ghrelin Group, the bursting pressure and hydroxyproline levels were significantly higher than in the Control Group. The adhesion formation scores were lower in the Ghrelin Group than in the Control Group. Although the inflammatory cell infiltration was diminished in the Ghrelin Group, the degrees of fibroblast infiltration, collagen density and neovascularization were not significantly different between the groups. CONCLUSION: Our results indicate that ghrelin improves the healing of colonic anastomoses in rats.
Subject(s)
Animals , Male , Rats , Colon/surgery , Ghrelin/therapeutic use , Wound Healing/drug effects , Anastomosis, Surgical , Collagen/biosynthesis , Collagen/drug effects , Disease Models, Animal , Fibroblasts/physiology , Random Allocation , Rats, Wistar , Tissue Adhesions , Treatment OutcomeABSTRACT
La amenorrea hipotalámica funcional (AHF)presenta un proceso de adaptación homeostática frente al disbalance energético (consumo/gasto calórico) . En este síndrome participan hormonas hipotalámicas y neuropéptidos periféricos provenientes del tejido graso (leptina, adiponectina y otras adipokinas), el tracto gastrointestinal superior Ghrelin y el páncreas (insulina). Este "circuito periférico está funcionalmente interrelacionado con un "circuito central "o hipotalámico. El descenso de la leptina, (un péptido anorexígeno), potencia el efecto orexígeno del Ghrelin. Los niveles basales de esta citokina están elelevados en la AHF e inducen en el hipotálamo, un aumento de la actividad del CRH. Esta hormona, a su vez, inhibe la secreción pulsátil del GnRH. El Ghrelin, además de ser un potente GH secretagogo, influye en la secreción de insulina e interviene en la metabolización de los glúcidos y lípidos. Normalmente se puede observar un ascenso preprandial del Ghrelin, seguido por un descenso posprandial relacionado con la sensación de saciedad. En los obesos, este descenso es menos pronunciado y lento. En cambio, en las mujeres anoréxicas la caída de este orexígeno es más rápida. Ambos comportamientos resultan ser acciones desfavorables para sus respectivas patologías. La administración de Ghrelin induce un rápido incremento de la glucemia y reducción de los niveles de insulina. Este aumento de la glucemia precede al descenso de la insulina, sugiriendo que el Ghrelin podría estimular directamente la glucogenólisis en el hígado. La hiperghrelemia podría entonces ser considerada como un probable mecanismo defensivo tendiente a prevenir la hipoglucemia de estas pacientes amenorreicas y desnutridas. Por otro lado, la hiperghrelemia basal en la AHF sería un efecto secundario a la resistencia a la insulina, la cual a su vez, es inducida por los niveles elevados de los ácidos grasos provenientes de la lipólisis que se encuentra acentuada en estas pacientes. La correlación negativa entre la insulina y el Ghrelin probablemente es mediada por el sistema vagal, como lo sugiere el aumento del polipéptido pancreático, un marcador confiable de la actividad vagal. Adicionalmente, el hipercortisolismo de estas pacientes y posiblemente la somatostatina a través de sus receptores en el páncreas, podrían regular en forma negativa la actividad de los receptores de insulina, con el consiguiente incremento del Ghrelin. Conclusión: el ascenso del Ghrelin en la AHF y sus particulares interrelaciones con la insulina y el eje adrenal convergen para mantener el equilibrio homeostático, intentando facilitar así el aporte de metabolitos energéticos a estas pacientes desnutridas, frecuentemente osteosporóticas, inmunodeprimidas y con un alto riesgo cardiovascular.
Functional Hypothalamic Amenorrhoea (FHA) reflects a homeostatic adaptive process resulting from a negative energy balance (increased caloric output/expenditure with inadequate nutrient replenishment). Hypothalamic hormones and peripheral neuropeptides from the fat tissue (leptin, adiponectin and other adipokines), the upper gastrointestinal tract (Ghrelin) and pancreas (insulin) are involved in this syndrome. This "peripheral circuit is functionally interrelated with the central hypothalamic circuit controlling appetite and satiety. The decrease in leptin, an anorexigenic signal, potentiates the orexigenic effect of Ghrelin (the basal levels of Ghrelin are elevated in FHA) and induces an increased CRH activity within the hypothalamus. This hormone, in turn, inhibits pulsatile GnRH secretion. Besides its potent GH secretagogue activity, Ghrelin is a peptide that influences insulin secretion and affects the metabolism of carbohydrates and lipids. Usually, a preprandial increase in Ghrelin levels is observed, followed by a postprandial decrease related to satiety. In obese subjects, this decrease is less marked and slower. Conversely, in anorexic women, the drop in this orexigenic peptide is faster. Both behaviours are unfavourable for the pathologies in which they occur. Ghrelin administration induces a rapid increase in blood glucose and a decrease in insulin levels. The fact that an increase in blood glucose precedes a decrease in insulin might suggest that Ghrelin could directly stimulate hepatic glucogenolysis activity. Thus, hyperghrelinemia might be considered as a potential defence mechanism to prevent hypoglycaemia in undernourished amenorrheic patients. Basal hyperghrelinemia in FHA is secondary to insulin resistance and it is induced by elevated free fatty acids resulting from lipolysis, a process that is increased in patients with FHA. The negative correlation between insulin and Ghrelin is probably mediated by the vagal system, as suggested by the increase in the pancreatic polypeptide, a reliable marker of vagal activity. Additionally, the hypercortisolism that typically occurs in patients with FHA, and possibly somastotatin through its pancreas receptors, could negatively regulate the activity of insulin receptors, with a consequent increase in Ghrelin. Conclusion: the increase in Ghrelin in FHA and its particular interrelations with insulin and the hypothalamic-pituitary-adrenal axis reflect an attempt to maintain the homeostatic balance, contributing to facilitate the supply of energy metabolites in these undernourished patients. These patients commonly develop osteoporosis, immunosuppression and a high risk of cardiovascular disease.
Subject(s)
Humans , Female , Energy Malnutrition , Ghrelin/analysis , Ghrelin/metabolism , Malnutrition/physiopathology , Ghrelin/therapeutic use , Homeostasis , Hypothalamo-Hypophyseal System/physiology , Insulin/analysis , Insulin/metabolismABSTRACT
A secreção do hormônio de crescimento (GH) é modulada pelo hormônio liberador de hormônio de crescimento (GHRH) e pela somatostatina. Na última década foi descoberto um terceiro mecanismo de controle, envolvendo os secretagogos de GH (GHS). A ghrelina, o ligante endógeno do receptor dos GHS, é um peptídeo acilado produzido no estômago, que também é sintetizado no hipotálamo. Este peptídeo é capaz de liberar GH, além de aumentar a ingesta alimentar. A ghrelina endógena parece amplificar o padrão básico de secreção de GH, ampliando a resposta do somatotrofo ao GHRH, estimulando múltiplas vias intracelulares interdependentes. Entretanto, seu local de atuação predominante é o hipotálamo. Neste trabalho, será apresentada revisão sobre a descoberta da ghrelina, os mecanismos de ação e o possível papel fisiológico dos GHS e da ghrelina na secreção de GH e, finalmente, as possíveis aplicações terapêuticas destes compostos.
Growth hormone-releasing hormone (GHRH) and somatostatin modulate growth hormone (GH) secretion. A third mechanism was discovered in the last decade, involving the action of growth hormone secretagogues (GHS). Ghrelin, the endogenous ligand of the GHS-receptor, is an acylated peptide mainly produced by the stomach, but also synthesized in the hypothalamus. This compound increases both GH release and food intake. Endogenous ghrelin might amplify the basic pattern of GH secretion, optimizing somatotroph responsiveness to GHRH, activating multiple interdependent intracellular pathways. However, its main site of action is the hypothalamus. In the current paper it is reviewed the available data on the discovery of this peptide, the mechanisms of action and possible physiological roles of the GHS and ghrelin on GH secretion, and finally, the possible therapeutic applications of these compounds.
Subject(s)
Humans , Ghrelin/metabolism , Growth Hormone-Releasing Hormone/metabolism , Human Growth Hormone , Receptors, Ghrelin/metabolism , Dwarfism, Pituitary/drug therapy , Ghrelin/therapeutic use , Human Growth Hormone/therapeutic use , Oligopeptides/metabolism , Receptors, Ghrelin/therapeutic useABSTRACT
Gastrointestinal (GI) motility has a crucial role in the food consumption, digestion and absorption, and also controls the appetite and satiety. In obese patients, various alterations of GI motility have been investigated. The prevalence of GERD and esophageal motor disorders in obese patients are higher than those of general population. Gastric emptying of solid food is generally accelerated and fasting gastric volume especially in distal stomach is larger in obese patients without change in accommodation. Contractile activity of small intestine in fasting period is more prominent, but orocecal transit is delayed. Autonomic dysfunction is frequently demonstrated in obese patients. These findings correspond with increased appetite and delayed satiety in obese patients, but causes or results have not been confirmed. Therapeutic interventions of these altered GI motility have been developed using botulinum toxin, gastric electrical stimulation in obese patients. Novel agents targeted for GI hormone modulation (such as ghrelin and leptin) need to be developed in the near future.