Postoperative decrease in plasma acyl ghrelin levels after pediatric living donor liver transplantation in association with hepatic damage due to ischemia and reperfusion injury

Assessment of liver injury using indocyanine green fluorescence imaging

Background

To investigate whether indocyanine green (ICG) fluorescence imaging can be used to evaluate chronic and acute liver injury induced by either a high-fat (HF) diet or carbon tetrachloride (CCl₄).

Methods

Sprague-Dawley (SD) rats were randomly divided into three groups: control group, HF diet-induced model group, and CCl₄-induced model group. The chronic and acute liver injury models were induced by a HF diet and intraperitoneal injection of CCl₄, respectively. After HF feeding, the liver index, levels of serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) of the rats were determined. The livers were also collected to evaluate histopathology damage by hematoxylin and eosin (H&E) staining. After in vitro perfusion of the liver and ICG administration, the liver fluorescence intensity and corresponding spectral value were measured by using real-image guided system (REAL-IGS).

Results

After HF feeding, the liver index and levels of serum ALT and AST were significantly increased, and the livers of the rats showed severe histopathological changes. Compared with the control group, the hepatic lobes of the model rats exhibited incomplete green fluorescence, and the corresponding spectral value was markedly reduced.

Conclusions

ICG fluorescence imaging can be used to evaluate liver injury induced by either a HF diet or CCl₄.

Importance of plasma ghrelin levels with special reference to nutritional metabolism and energy expenditure in pediatric patients with severe motor and intellectual disabilities

BACKGROUND & AIMS

Nutritional metabolism is complex in pediatric patients with severe motor and intellectual disability (SMID), and therefore, appropriate estimation of the energy requirements is difficult. Focusing on ghrelin's role in energy metabolism regulation, we investigated plasma ghrelin levels in pediatric SMID patients and analyzed its nutritional significance as a regulatory marker of energy reserve.

METHODS

Fasting plasma total, acyl, and des-acyl ghrelin levels in 40 patients with SMID, including cerebral palsy (CP) (n = 20) and muscular disease (MD) (n = 8), and healthy controls (n = 13) were investigated. The correlations of plasma ghrelin levels with anthropometry, blood nutritional markers, energy intake, and resting energy expenditure (REE) measured with indirect calorimetry were analyzed. A p value < 0.05 was considered significant.

RESULTS

SMID patients had significantly higher acyl ghrelin, and lower body mass index (BMI), z-scores of body weight (BW), body height and BMI, and albumin than controls. CP patients had significantly higher total and acyl ghrelin, z-score of the mid-upper arm circumference (MUAC), retinol-binding protein, transthyretin, creatinine, and glucose than MD patients. Total and acyl ghrelin in CP patients and des-acyl ghrelin in MD patients had significant negative correlations with MUAC and upper arm fat area. In CP patients, total and acyl ghrelin had significant positive correlations with REE/BW (kcal/kg), and total ghrelin was predictive of REE/BW (r² = 0.625, p < 0.0001).

CONCLUSIONS

An increase in acyl ghrelin observed in SMID patients possibly indicates energy reserve deficiency. In CP patients, total and acyl ghrelin inversely reflected total body fat mass, resulting in strongly positive correlations with REE/BW. The measurement of plasma ghrelin may be useful to assess nutritional metabolism and energy reserve in pediatric SMID patients, such as CP and MD patients.

Ghrelin Plasma Levels After 1 Year of Ketogenic Diet in Children With Refractory Epilepsy

The ketogenic diet (KD) is a high-fat, low carbohydrate nutritional treatment adopted in several countries for refractory epilepsy. However, the use of KD is limited by adverse events including growth retardation. In a previous investigation, we demonstrated that ghrelin is reduced in children maintained on KD for 3 months. As ghrelin regulates growth hormone (GH) secretion, it can be hypothesized that growth retardation depends on the reduced ghrelin availability. To assess this hypothesis, in this study we evaluate ghrelin and growth during 1 year of KD. We examined a small cohort of 6 children (2 males and 4 females, age range 3-10.4 years) affected by refractory epilepsy, who received the KD as add-on treatment. All patients were on drug polytherapy. Endpoints of the study were: (i) ghrelin plasma levels at 0, 15, 30, 90, and 365 days from KD onset, (ii) growth, and (iii) seizure control by ketogenesis. Ghrelin levels were -53 and -47% of basal levels, respectively, at 90 and 365 days (P < 0.05 for both). Mean height index z scores were reduced, but not significantly, by comparing basal values with those at the end of observation. Instead, body mass index z scores slightly increased. Ketosis induced by the KD was within 2-5 mmol/L and satisfactorily reduced the seizure frequency (>50%) in all patients. We show that ghrelin plasma levels are consistently reduced in children with refractory epilepsy and maintained on the KD. This change was associated with low growth indexes in the majority of patients.