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Giorgioni G, Del Bello F, Quaglia W, Botticelli L, Cifani C, Micioni Di Bonaventura E, Micioni Di Bonaventura MV, Piergentili A. Advances in the Development of Nonpeptide Small Molecules Targeting Ghrelin Receptor. J Med Chem 2022; 65:3098-3118. [PMID: 35157454 PMCID: PMC8883476 DOI: 10.1021/acs.jmedchem.1c02191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Ghrelin is an octanoylated peptide acting by the activation of the growth hormone secretagogue receptor, namely, GHS-R1a. The involvement of ghrelin in several physiological processes, including stimulation of food intake, gastric emptying, body energy balance, glucose homeostasis, reduction of insulin secretion, and lipogenesis validates the considerable interest in GHS-R1a as a promising target for the treatment of numerous disorders. Over the years, several GHS-R1a ligands have been identified and some of them have been extensively studied in clinical trials. The recently resolved structures of GHS-R1a bound to ghrelin or potent ligands have provided useful information for the design of new GHS-R1a drugs. This perspective is focused on the development of recent nonpeptide small molecules acting as GHS-R1a agonists, antagonists, and inverse agonists, bearing classical or new molecular scaffolds, as well as on radiolabeled GHS-R1a ligands developed for imaging. Moreover, the pharmacological effects of the most studied ligands have been discussed.
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Affiliation(s)
- Gianfabio Giorgioni
- School of Pharmacy, Medicinal Chemistry Unit, University of Camerino, Via Madonna delle Carceri, 62032 Camerino, Italy
| | - Fabio Del Bello
- School of Pharmacy, Medicinal Chemistry Unit, University of Camerino, Via Madonna delle Carceri, 62032 Camerino, Italy
| | - Wilma Quaglia
- School of Pharmacy, Medicinal Chemistry Unit, University of Camerino, Via Madonna delle Carceri, 62032 Camerino, Italy
| | - Luca Botticelli
- School of Pharmacy, Pharmacology Unit, University of Camerino, Via Madonna delle Carceri 9, 62032 Camerino, Italy
| | - Carlo Cifani
- School of Pharmacy, Pharmacology Unit, University of Camerino, Via Madonna delle Carceri 9, 62032 Camerino, Italy
| | - E Micioni Di Bonaventura
- School of Pharmacy, Pharmacology Unit, University of Camerino, Via Madonna delle Carceri 9, 62032 Camerino, Italy
| | - M V Micioni Di Bonaventura
- School of Pharmacy, Pharmacology Unit, University of Camerino, Via Madonna delle Carceri 9, 62032 Camerino, Italy
| | - Alessandro Piergentili
- School of Pharmacy, Medicinal Chemistry Unit, University of Camerino, Via Madonna delle Carceri, 62032 Camerino, Italy
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Behavioural characterization of ghrelin ligands, anamorelin and HM01: Appetite and reward-motivated effects in rodents. Neuropharmacology 2020; 168:108011. [PMID: 32067989 DOI: 10.1016/j.neuropharm.2020.108011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 02/12/2020] [Accepted: 02/13/2020] [Indexed: 12/14/2022]
Abstract
The ghrelinergic system has been steadily investigated as a therapeutic target in the treatment of metabolic disorders and modulation of appetite. While endogenous ghrelin activates the full complement of the growth hormone secretagogue receptor (GHSR-1a) pathways, synthetic GHSR-1a ligands display biased signalling and functional selectivity, which have a significant impact on the intended and indeed, unintended, therapeutic effects. The widespread expression of the GHSR-1a receptor in vivo also necessitates an imperative consideration of the biodistribution of GHSR-1a ligands. Here, we investigate anamorelin and HM01, two recently described synthetic GHSR-1a ligands which have shown promising effects on food intake in preclinical and clinical studies. We compare the downstream signalling pathways in cellular in vitro assays, including calcium mobilization, IP-one, internalization and β-arrestin recruitment assays. We describe a novel divergent activation of central reward circuitry by anamorelin and HM01 using c-Fos immunostaining as well as behavioural effects in food intake and reward paradigms. Interestingly, we found a paradoxical reduction in reward-related behaviour for anamorelin and HM01 treated animals in our chosen paradigms. The work highlights the critical importance to consider signalling bias in relation to future ghrelin-based therapies. In addition, central access of GHSR-1a ligands, particularly to reward areas of the brain, remains a crucial factor in eliciting potent appetite-stimulating effects. The precise characterization of downstream ghrelinergic signalling and biodistribution of novel GHSR-1a ligands will be decisive in their successful development and will allow predictive modelling and design of future synthetic ligands to combat metabolic and appetite disorders involving the ghrelinergic system. This article is part of the special issue on 'Neuropeptides'.
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3
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Danila GM, Puiu M, Zamfir LG, Bala C. Early Detection of Growth Hormone Secretagogue Receptor Antagonists Exploiting Their Atypical Behavior in Competitive Assays. Anal Chem 2019; 91:14812-14817. [PMID: 31702907 DOI: 10.1021/acs.analchem.9b03845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We report the proof-of-concept of a bioaffinity format designed for the early detection of growth hormone secretagogue receptor (GHS-R1a) antagonists in urine samples. We exploit here their atypical behavior in competitive experiments with labeled ghrelin (GHR), namely, the strong promoting effect on the GHR/GHS-R1a interaction at low molar ratios GHR/antagonist. The antagonists potentiate the GHR/GHS-R1a interaction, and they display the same effect on the interaction of GHS-R1a with other agonists listed as doping agents. The developed assay allows the estimation of affinity constants of ligand/receptor and antagonist/receptor binding and is amenable to optical, electrochemical, and mass-sensitive detection. The estimated affinity constants for GHR/GHS-R1a and antagonist/GHS-R1a in the absence of G proteins are in good agreement with recently reported data.
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Affiliation(s)
- George Madalin Danila
- Laboratory for Quality Control and Process Monitoring , University of Bucharest , 030018 Bucharest , Romania.,Romanian Doping Control Laboratory , 022103 Bucharest , Romania
| | - Mihaela Puiu
- Laboratory for Quality Control and Process Monitoring , University of Bucharest , 030018 Bucharest , Romania
| | - Lucian-Gabriel Zamfir
- Laboratory for Quality Control and Process Monitoring , University of Bucharest , 030018 Bucharest , Romania.,ICUB , University of Bucharest , 050107 Bucharest , Romania
| | - Camelia Bala
- Laboratory for Quality Control and Process Monitoring , University of Bucharest , 030018 Bucharest , Romania.,Department of Analytical Chemistry , University of Bucharest , 030018 Bucharest , Romania
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Torres-Fuentes C, Golubeva AV, Zhdanov AV, Wallace S, Arboleya S, Papkovsky DB, El Aidy S, Ross P, Roy BL, Stanton C, Dinan TG, Cryan JF, Schellekens H. Short-chain fatty acids and microbiota metabolites attenuate ghrelin receptor signaling. FASEB J 2019; 33:13546-13559. [DOI: 10.1096/fj.201901433r] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- Cristina Torres-Fuentes
- Alimentary Pharmabiotic Centre (APC) Microbiome Ireland, University College Cork, Cork, Ireland
| | - Anna V. Golubeva
- Alimentary Pharmabiotic Centre (APC) Microbiome Ireland, University College Cork, Cork, Ireland
- Department of Anatomy and Neuroscience, University College Cork, Cork, Ireland
| | | | - Shauna Wallace
- Alimentary Pharmabiotic Centre (APC) Microbiome Ireland, University College Cork, Cork, Ireland
| | - Silvia Arboleya
- Alimentary Pharmabiotic Centre (APC) Microbiome Ireland, University College Cork, Cork, Ireland
- Teagasc Food Research Centre, Cork, Ireland
| | | | - Sahar El Aidy
- Alimentary Pharmabiotic Centre (APC) Microbiome Ireland, University College Cork, Cork, Ireland
| | - Paul Ross
- Alimentary Pharmabiotic Centre (APC) Microbiome Ireland, University College Cork, Cork, Ireland
| | | | - Catherine Stanton
- Alimentary Pharmabiotic Centre (APC) Microbiome Ireland, University College Cork, Cork, Ireland
- Teagasc Food Research Centre, Cork, Ireland
| | - Timothy G. Dinan
- Alimentary Pharmabiotic Centre (APC) Microbiome Ireland, University College Cork, Cork, Ireland
- Department of Psychiatry and Neurobehavioral Science, University College Cork, Cork, Ireland
| | - John F. Cryan
- Alimentary Pharmabiotic Centre (APC) Microbiome Ireland, University College Cork, Cork, Ireland
- Department of Anatomy and Neuroscience, University College Cork, Cork, Ireland
| | - Harriet Schellekens
- Alimentary Pharmabiotic Centre (APC) Microbiome Ireland, University College Cork, Cork, Ireland
- Department of Anatomy and Neuroscience, University College Cork, Cork, Ireland
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A Dairy-Derived Ghrelinergic Hydrolysate Modulates Food Intake In Vivo. Int J Mol Sci 2018; 19:ijms19092780. [PMID: 30223587 PMCID: PMC6165545 DOI: 10.3390/ijms19092780] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 09/10/2018] [Accepted: 09/12/2018] [Indexed: 12/13/2022] Open
Abstract
Recent times have seen an increasing move towards harnessing the health-promoting benefits of food and dietary constituents while providing scientific evidence to substantiate their claims. In particular, the potential for bioactive protein hydrolysates and peptides to enhance health in conjunction with conventional pharmaceutical therapy is being investigated. Dairy-derived proteins have been shown to contain bioactive peptide sequences with various purported health benefits, with effects ranging from the digestive system to cardiovascular circulation, the immune system and the central nervous system. Interestingly, the ability of dairy proteins to modulate metabolism and appetite has recently been reported. The ghrelin receptor (GHSR-1a) is a G-protein coupled receptor which plays a key role in the regulation of food intake. Pharmacological manipulation of the growth hormone secretagogue receptor-type 1a (GHSR-1a) receptor has therefore received a lot of attention as a strategy to combat disorders of appetite and body weight, including age-related malnutrition and the progressive muscle wasting syndrome known as cachexia. In this study, a milk protein-derivative is shown to increase GHSR-1a-mediated intracellular calcium signalling in a concentration-dependent manner in vitro. Significant increases in calcium mobilisation were also observed in a cultured neuronal cell line heterologously expressing the GHS-R1a. In addition, both additive and synergistic effects were observed following co-exposure of GHSR-1a to both the hydrolysate and ghrelin. Subsequent in vivo studies monitored standard chow intake in healthy male and female Sprague-Dawley rats after dosing with the casein hydrolysate (CasHyd). Furthermore, the provision of gastro-protected oral delivery to the bioactive in vivo may aid in the progression of in vitro efficacy to in vivo functionality. In summary, this study reports a ghrelin-stimulating bioactive peptide mixture (CasHyd) with potent effects in vitro. It also provides novel and valuable translational data supporting the potential role of CasHyd as an appetite-enhancing bioactive. Further mechanistic studies are required in order to confirm efficacy as a ghrelinergic bioactive in susceptible population groups.
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Ramirez VT, van Oeffelen WEPA, Torres-Fuentes C, Chruścicka B, Druelle C, Golubeva AV, van de Wouw M, Dinan TG, Cryan JF, Schellekens H. Differential functional selectivity and downstream signaling bias of ghrelin receptor antagonists and inverse agonists. FASEB J 2018; 33:518-531. [PMID: 30020830 DOI: 10.1096/fj.201800655r] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The ghrelin receptor [growth hormone secretagogue receptor (GHSR)-1a] represents a promising pharmacologic target for the treatment of metabolic disorders, including obesity and cachexia, via central appetite modulation. The GHSR-1a has a complex pharmacology, highlighted by G-protein-dependent and -independent downstream signaling pathways and high basal constitutive activity. The functional selectivity and signaling bias of many GHSR-1a-specific ligands has not been fully characterized. In this study, we investigated the pharmacologic properties of ghrelin, MK-0677, L692,585, and [d-Lys3]-growth hormone-releasing peptide-6 (Dlys), JMV2959, and [d-Arg(1),d-Phe(5),d-Trp(7, 9),Leu(11)]-substance P (SP-analog). We investigated their effect on basal GHSR-1a constitutive signaling, ligand-directed downstream GHSR-1a signaling, functional selectivity, and signaling bias. Dlys behaved as a partial antagonist with a strong bias toward GHSR-1a-β-arrestin signaling, whereas JMV2959 acted as a full unbiased GHSR-1a antagonist. Moreover, the SP-analog behaved as an inverse agonist increasing G-protein-dependent signaling, but only at high concentrations, whereas, at low concentrations, the SP-analog attenuated β-arrestin-dependent signaling. Considering the limited success in the clinical development of GHSR-1a-targeted drugs so far, these findings provide a novel insight into the pharmacologic characteristics of GHSR-1a ligands and their signaling bias, which has important implications in the design of novel, more selective GHSR-1a ligands with predictable functional outcome and selectivity for preclinical and clinical drug development.-Ramirez, V. T., van Oeffelen, W. E. P. A., Torres-Fuentes, C., Chruścicka, B., Druelle, C., Golubeva, A. V., van de Wouw, M., Dinan, T. G., Cryan, J. F., Schellekens, H. Differential functional selectivity and downstream signaling bias of ghrelin receptor antagonists and inverse agonists.
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Affiliation(s)
- Valerie T Ramirez
- Alimentary Pharmabiotic Centre (APC) Microbiome Ireland, University College Cork, Cork, Ireland
| | | | - Cristina Torres-Fuentes
- Alimentary Pharmabiotic Centre (APC) Microbiome Ireland, University College Cork, Cork, Ireland
| | - Barbara Chruścicka
- Alimentary Pharmabiotic Centre (APC) Microbiome Ireland, University College Cork, Cork, Ireland
| | - Clementine Druelle
- Alimentary Pharmabiotic Centre (APC) Microbiome Ireland, University College Cork, Cork, Ireland
| | - Anna V Golubeva
- Alimentary Pharmabiotic Centre (APC) Microbiome Ireland, University College Cork, Cork, Ireland
| | - Marcel van de Wouw
- Alimentary Pharmabiotic Centre (APC) Microbiome Ireland, University College Cork, Cork, Ireland.,Department of Anatomy and Neuroscience, University College Cork, Cork, Ireland
| | - Timothy G Dinan
- Alimentary Pharmabiotic Centre (APC) Microbiome Ireland, University College Cork, Cork, Ireland.,Department of Psychiatry, University College Cork, Cork, Ireland; and
| | - John F Cryan
- Alimentary Pharmabiotic Centre (APC) Microbiome Ireland, University College Cork, Cork, Ireland.,Department of Anatomy and Neuroscience, University College Cork, Cork, Ireland.,Food for Health Ireland, University College Cork, Cork, Ireland
| | - Harriët Schellekens
- Alimentary Pharmabiotic Centre (APC) Microbiome Ireland, University College Cork, Cork, Ireland.,Department of Anatomy and Neuroscience, University College Cork, Cork, Ireland.,Food for Health Ireland, University College Cork, Cork, Ireland
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Torres-Fuentes C, Pastor-Cavada E, Cano R, Kandil D, Shanahan R, Juan R, Shaban H, McGlacken GP, Schellekens H. Quinolones Modulate Ghrelin Receptor Signaling: Potential for a Novel Small Molecule Scaffold in the Treatment of Cachexia. Int J Mol Sci 2018; 19:E1605. [PMID: 29848961 PMCID: PMC6032407 DOI: 10.3390/ijms19061605] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 05/21/2018] [Accepted: 05/22/2018] [Indexed: 02/06/2023] Open
Abstract
Cachexia is a metabolic wasting disorder characterized by progressive weight loss, muscle atrophy, fatigue, weakness, and appetite loss. Cachexia is associated with almost all major chronic illnesses including cancer, heart failure, obstructive pulmonary disease, and kidney disease and significantly impedes treatment outcome and therapy tolerance, reducing physical function and increasing mortality. Current cachexia treatments are limited and new pharmacological strategies are needed. Agonists for the growth hormone secretagogue (GHS-R1a), or ghrelin receptor, prospectively regulate the central regulation of appetite and growth hormone secretion, and therefore have tremendous potential as cachexia therapeutics. Non-peptide GHS-R1a agonists are of particular interest, especially given the high gastrointestinal degradation of peptide-based structures, including that of the endogenous ligand, ghrelin, which has a half-life of only 30 min. However, few compounds have been reported in the literature as non-peptide GHS-R1a agonists. In this paper, we investigate the in vitro potential of quinolone compounds to modulate the GHS-R1a in both transfected human cells and mouse hypothalamic cells. These chemically synthesized compounds demonstrate a promising potential as GHS-R1a agonists, shown by an increased intracellular calcium influx. Further studies are now warranted to substantiate and exploit the potential of these novel quinolone-based compounds as orexigenic therapeutics in conditions of cachexia and other metabolic and eating disorders.
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Affiliation(s)
| | | | - Rafael Cano
- School of Chemistry and the Analytical and Biological Chemistry Research Facility (ABCRF), University College Cork, T12 YT20 Cork, Ireland.
| | - Dalia Kandil
- Food for Health Ireland, University College Cork, T12 YT20 Cork, Ireland.
- Department of Anatomy and Neuroscience, University College Cork, T12 YT20 Cork, Ireland.
| | - Rachel Shanahan
- School of Chemistry and the Analytical and Biological Chemistry Research Facility (ABCRF), University College Cork, T12 YT20 Cork, Ireland.
| | - Rocio Juan
- Plant Biology and Ecology Department, Seville University, 41012 Seville, Spain.
| | - Hamdy Shaban
- Food for Health Ireland, University College Cork, T12 YT20 Cork, Ireland.
| | - Gerard P McGlacken
- School of Chemistry and the Analytical and Biological Chemistry Research Facility (ABCRF), University College Cork, T12 YT20 Cork, Ireland.
| | - Harriët Schellekens
- APC Microbiome Ireland, University College Cork, T12 YT20 Cork, Ireland.
- Food for Health Ireland, University College Cork, T12 YT20 Cork, Ireland.
- Department of Anatomy and Neuroscience, University College Cork, T12 YT20 Cork, Ireland.
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8
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Ó Muimhneacháin E, Reen FJ, O'Gara F, McGlacken GP. Analogues ofPseudomonas aeruginosasignalling molecules to tackle infections. Org Biomol Chem 2018; 16:169-179. [DOI: 10.1039/c7ob02395b] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The emergence of antibiotic resistance coupled with the lack of investment by pharmaceutical companies necessitates a new look at how we tackle bacterial infections.
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Affiliation(s)
- Eoin Ó Muimhneacháin
- School of Chemistry and Analytical and Biological Chemistry Research Facility
- University College Cork
- College Road
- Cork
- Ireland
| | - F. Jerry Reen
- School of Microbiology
- University College Cork
- Ireland
- BIOMERIT Research Centre
- School of Microbiology
| | - Fergal O'Gara
- BIOMERIT Research Centre
- School of Microbiology
- University College Cork
- Ireland
- School of Biomedical Sciences
| | - Gerard P. McGlacken
- School of Chemistry and Analytical and Biological Chemistry Research Facility
- University College Cork
- College Road
- Cork
- Ireland
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Howick K, Alam R, Chruscicka B, Kandil D, Fitzpatrick D, Ryan AM, Cryan JF, Schellekens H, Griffin BT. Sustained-release multiparticulates for oral delivery of a novel peptidic ghrelin agonist: Formulation design and in vitro characterization. Int J Pharm 2017; 536:63-72. [PMID: 29175643 DOI: 10.1016/j.ijpharm.2017.11.051] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 10/29/2017] [Accepted: 11/22/2017] [Indexed: 02/01/2023]
Abstract
There is an impetus to provide appropriate sustained release oral delivery vehicles to protect biofunctional peptide loads from gastric degradation in vivo. This study describes the generation of a high load capacity pellet formulation for sustained release of a freely water-soluble dairy-derived hydrolysate, FHI-2571. The activity of this novel peptidic ghrelin receptor agonist is reported using in vitro calcium mobilization assays. Conventional extrusion spheronization was then used to prepare peptide-loaded pellets which were subsequently coated with ethylcellulose (EC) film coats using a fluid bed coating system in bottom spray (Wurster) mode. Aqueous-based EC coating dispersions produced mechanically brittle coats which fractured due to osmotic pressure build-up within pellets in simulated media. In contrast, an ethanolic-based EC coating solution provided robust, near zero-order release in both USP Type 1 and Type 4 dissolution studies. Interestingly, the functionality of aqueous-based EC film coats was restored by first layering pellets with a methacrylic acid copolymer (MA) subcoat, thereby hindering pellet core swelling in acidic media. Broadband Acoustic Resonance Dissolution Spectroscopy (BARDS) was utilised as a complementary technique to confirm the results seen in USP dissolution studies. Retention of activity of the ghrelinergic peptide hydrolysate in the final encapsulated product was confirmed as being greater than 80%. The described pellet formulation is amenable to oral dosing in small animal studies in order to assess in vivo efficacy of the whey-derived ghrelinergic hydrolysate. In more general terms, it is also suitable as a delivery vehicle for peptide-based bioactives to special population groups e.g paediatric and geriatric.
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Affiliation(s)
- Ken Howick
- School of Pharmacy, University College Cork, Cork, Ireland; Department of Anatomy & Neuroscience, University College Cork, Cork, Ireland; Food for Health Ireland, University College Cork, Cork, Ireland
| | - Ryan Alam
- School of Pharmacy, University College Cork, Cork, Ireland
| | - Barbara Chruscicka
- Department of Anatomy & Neuroscience, University College Cork, Cork, Ireland; APC Microbiome Institute, University College Cork, Cork, Ireland
| | - Dalia Kandil
- Department of Anatomy & Neuroscience, University College Cork, Cork, Ireland; Food for Health Ireland, University College Cork, Cork, Ireland
| | - Dara Fitzpatrick
- Department of Chemistry, Analytical and Biological Chemistry Research Facility (ABCRF), University College Cork, Cork, Ireland
| | - Aoife M Ryan
- Food for Health Ireland, University College Cork, Cork, Ireland; Department of Food & Nutritional Sciences, University College Cork, Cork, Ireland
| | - John F Cryan
- Department of Anatomy & Neuroscience, University College Cork, Cork, Ireland; APC Microbiome Institute, University College Cork, Cork, Ireland
| | - Harriët Schellekens
- Department of Anatomy & Neuroscience, University College Cork, Cork, Ireland; Food for Health Ireland, University College Cork, Cork, Ireland; APC Microbiome Institute, University College Cork, Cork, Ireland
| | - Brendan T Griffin
- School of Pharmacy, University College Cork, Cork, Ireland; Food for Health Ireland, University College Cork, Cork, Ireland.
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Abstract
Introduction Cachexia is a common complication of many and varied chronic disease processes, yet it has received very little attention as an area of clinical research effort until recently. We sought to survey the contemporary literature on published research into cachexia to define where it is being published and the proportion of output classified into the main types of research output. Methods I searched the PubMed listings under the topic research term "cachexia" and related terms for articles published in the calendar years of 2015 and 2016, regardless of language. Searches were conducted and relevant papers extracted by two observers, and disagreements were resolved by consensus. Results There were 954 publications, 370 of which were review articles or commentaries, 254 clinical observations or non-randomised trials, 246 original basic science reports and only 26 were randomised controlled trials. These articles were published in 478 separate journals but with 36% of them being published in a core set of 23 journals. The H-index of these papers was 25 and there were 147 papers with 10 or more citations. Of the top 100 cited papers, 25% were published in five journals. Of the top cited papers, 48% were review articles, 18% were original basic science, and 7% were randomised clinical trials. Discussion This analysis shows a steady but modest increase in publications concerning cachexia with a strong pipeline of basic science research but still a relative lack of randomised clinical trials, with none exceeding 1000 patients. Research in cachexia is still in its infancy, but the solid basic science effort offers hope that translation into randomised controlled clinical trials may eventually lead to effective therapies for this troubling and complex clinical disease process.
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