Central mechanisms involved with catabolism

Metabolic Support in Acute Respiratory Distress Syndrome: A Narrative Review

Nutritional support for acute respiratory distress syndrome (ARDS) patients shares metabolic notions common to other critically ill conditions. Nevertheless, it generates specific concern regarding the primary limitation of oxygen supply and the complications of carbon dioxide elimination, as well as the significant metabolic alterations due to the body's response to illness. In the present narrative review, after briefly summarizing the pathophysiology of critical illness stress response and patients' metabolic requirements, we focus on describing the characteristics of metabolic and artificial nutrition in patients with acute respiratory failure. In patients with ARDS, several aspects of metabolism assume special importance. The physiological effects of substrate metabolism are described for this setting, particularly regarding energy consumption, diet-induced thermogenesis, and the price of their clearance, transformation, and storage. Moreover, we review the possible direct effects of macronutrients on lung tissue viability during ARDS. Finally, we summarize the noteworthy characteristics of metabolic control in critically ill patients with ARDS and offer a suggestion as to the ideal methods of metabolic support for this problem.

Area postrema neurons mediate interleukin-6 function in cancer-associated cachexia

Interleukin-6 (IL-6) has been long considered a key player in cancer-associated cachexia ^1-15 . It is believed that sustained elevation of IL-6 production during cancer progression causes brain dysfunctions, which ultimately result in cachexia ^16-20 . However, how peripheral IL-6 influences the brain remains poorly understood. Here we show that neurons in the area postrema (AP), a circumventricular structure in the hindbrain, mediate the function of IL-6 in cancer-associated cachexia in mice. We found that circulating IL-6 can rapidly enter the AP and activate AP neurons. Peripheral tumor, known to increase circulating IL-6 ^{1-5,15,18,21-23} , leads to elevated IL-6 and neuronal hyperactivity in the AP, and causes potentiated excitatory synaptic transmission onto AP neurons. Remarkably, neutralization of IL-6 in the brain of tumor-bearing mice with an IL-6 antibody prevents cachexia, reduces the hyperactivity in an AP network, and markedly prolongs lifespan. Furthermore, suppression of Il6ra , the gene encoding IL-6 receptor, specifically in AP neurons with CRISPR/dCas9 interference achieves similar effects. Silencing of Gfral-expressing AP neurons also ameliorates the cancer-associated cachectic phenotypes and AP network hyperactivity. Our study identifies a central mechanism underlying the function of peripheral IL-6, which may serve as a target for treating cancer-associated cachexia.

The association between sarcopenia and functional outcomes in patients undergoing convalescent rehabilitation

Sarcopenia is widely believed to be linked to poorer outcomes in inpatient rehabilitation. This study aimed to assess the impact of sarcopenia on functional outcomes and dietary intake during hospitalization in adults undergoing convalescent rehabilitation. We conducted a retrospective cohort analysis at a single rehabilitation institution. The Asian Working Group Consensus Criteria for Sarcopenia was used to diagnose. The Functional Independence Measure (FIM) score was used at hospital discharge to measure the primary functional outcome. Energy and protein intakes during hospitalization were calculated as part of the nutritional assessment. There were 126 patients in the research (median age, 73 yr;54% women). Stroke (n = 73;53.4% sarcopenia) and musculoskeletal disorders (n = 53;56.6% sarcopenia) were among the admission diagnoses. Multiple linear regression analysis revealed that the FIM total score at discharge was modestly associated with sarcopenia only in stroke patients (? = 0.1872, P = 0.09), as well as significantly and independently associated with protein intake during admission only in stroke patients (? = 0.3217, P < 0.05). In hospitalized stroke patients undergoing convalescent therapy, sarcopenia is related to lower functional results. Early identification of sarcopenia and treatment with rehabilitation nutrition should be implemented in this population. J. Med. Invest. 70 : 457-463, August, 2023.

Plasma Ghrelin Levels in Children with Chronic Renal Failure on Peritoneal Dialysis

Objectives

Malnutrition and loss of appetite represent a serious problem in children with chronic renal failure. Ghrelin is a newly described hormone involved in control of growth hormone secretion, stimulation of food intake, and regulation of energy balance.

Methods

Plasma ghrelin levels were compared between 12 children on automated peritoneal dialysis (APD) and 9 children on conservative treatment of chronic renal failure. Eight healthy children matched for age and body mass index (BMI) served as a control group.

Results

Plasma ghrelin levels were similar in children on APD (698.3 ± 59.7 pg/mL) and children on conservative treatment (675.4 ± 41.9 pg/mL) compared to healthy controls (700.1 ± 24.7 pg/mL). There was no difference in plasma ghrelin levels in children with chronic renal failure regardless of the method of treatment (peritoneal dialysis vs conservative treatment). The plasma ghrelin index was similar in all three investigated groups: APD 40.2 ± 8.7 vs conservative treatment 39.1 ± 5.6 vs controls 41.0 ± 7.8 (pg/mL)/BMI (kg/m2). Plasma ghrelin levels did not correlate with age, duration of dialysis treatment, height, weight, BMI, creatinine and urea levels, adequacy parameters, or nightly glucose load.

Conclusion

Plasma ghrelin levels in children on APD were not different from levels in children on conservative treatment or healthy controls with comparable BMI. The persistent state of toxic influence of uremic end-products could be responsible for such a lack of correlation with anthropometrical parameters. Further studies on a larger group of children on APD are needed to clarify the effect of ghrelin on nutritional status in children with chronic renal failure.

Effects of unilateral nasal obstruction on the characteristics of jaw-closing muscles in growing rats

OBJECTIVES

Mouth breathing caused by nasal obstruction (owing to abnormal pressure of masticatory muscles) affects craniofacial growth and development. The influence of unilateral nasal obstruction on jaw-closing muscles was investigated in rats to reveal one of the etiologic mechanisms.

MATERIALS AND METHODS

Forty 8-day-old male Wistar rats were used in this study. Experimental rats were subjected to left-sided nasal obstruction by burning the external nostril tissue at the age of 8 days. Pulse oxygen saturation was recorded each week. Morphologic changes were evaluated by staining with hematoxylin and eosin (to assess the cross-sectional area) and by adenosine triphosphatase activity staining (to assess the myosin heavy chain isoform composition). Immunohistochemical and reverse transcription quantitative real-time polymerase chain reaction analyses of tumor necrosis factor-α and glucose transporter 4 were carried out at 5 and 9 weeks of age.

RESULTS

The cross-sectional area of the jaw-closing muscles was lower in the experimental group at 9 weeks of age. The percentage of myosin heavy chain-2a in masseter muscles was increased in the experimental group compared with the control group. An increase in the tumor necrosis factor-α messenger RNA and protein levels and a decrease in the glucose transporter 4 messenger RNA and protein levels at 5 and 9 weeks of age in the jaw-closing muscles in the experimental group were noted.

CONCLUSIONS

Unilateral nasal obstruction could affect the morphology and contractile characteristics of jaw-closing muscles during growth in rats.

A Different Approach to the Nutritional Therapy in Intensive Care Units: Nutrition Software (ICNUS)

Critically ill patients receive nutritional support in addition to extensive organ support therapies in the intensive care units. The transcription of the data obtained by multiple devices from a wide spectrum of usage areas is a challenging process and is prone to errors. Software specifically designed for usage in intensive care units do offer numerous advantages. Primarily, it facilitates to improve the management of time and workflow for the benefit of patients. Therefore, we believed that a different approach was needed for the nutritional regime of our critically ill patients. Following nearly 2 years of research, we developed and implemented the Intensive Care Nutrition Software (ICNUS), which is explained in this article.

Stress, cortisol, and obesity: a role for cortisol responsiveness in identifying individuals prone to obesity

There is a strong inter-relationship between activation of the hypothalamo-pituitary-adrenal axis and energy homeostasis. Patients with abdominal obesity have elevated cortisol levels. Furthermore, stress and glucocorticoids act to control both food intake and energy expenditure. In particular, glucocorticoids are known to increase the consumption of foods enriched in fat and sugar. It is well-known that, in all species, the cortisol response to stress or adrenocorticotropin is highly variable. It has now emerged that cortisol responsiveness is an important determinant in the metabolic sequelae to stress. Sheep that are characterized as high-cortisol responders (HRs) have greater propensity to weight gain and obesity than low-cortisol responders (LRs). This difference in susceptibility to become obese is associated with a distinct metabolic, neuroendocrine, and behavioral phenotype. In women and ewes, HR individuals eat more in response to stress than LR. Furthermore, HR sheep have impaired melanocortin signaling and reduced skeletal muscle thermogenesis. High-cortisol responder sheep exhibit reactive coping strategies, whereas LRs exhibit proactive coping strategies. This complex set of traits leads to increased food intake and reduced energy expenditure in HR and thus, predisposition to obesity. We predict that cortisol responsiveness may be used as a marker to identify individuals who are at risk of weight gain and subsequent obesity.

Ghrelin is an orexigenic peptide and elicits anxiety-like behaviors following administration into discrete regions of the hypothalamus

Previous evidence indicates that peripherally administered ghrelin significantly increases corticotropin releasing hormone (CRH) mRNA and serum corticosterone. In addition, intraventricular administration of ghrelin has been reported to elicit anxiety-like behaviors suggesting that the peptide plays a role in mediating neuroendocrine and behavioral responses to stress. In the present study, we characterized the orexigenic, metabolic, and anxiogenic actions of ghrelin following microinjection into the arcuate nucleus (ARN), paraventricular nucleus (PVN), perifornical hypothalamus (PFH), and ventromedial nucleus (VMN). To assess ghrelin's role in anxiogenic behavior, rats were injected with vehicle or 50-800pmol of ghrelin and then placed in an elevated plus maze (EPM) for 10min. Each test was performed as a single trial per animal. In separate behavioral testing we measured the induction of stereotypic behaviors. Doses of 200pmol or higher administered into the ARN and PVN elicited anxiety-like behaviors, including an increased avoidance of the open arms of the EPM. However, in the PFH and VMN, higher doses of ghrelin (400-800pmol) were required to induce anxiety. Ghrelin doses as low as 50pmol stimulated eating and altered energy substrate oxidation (respiratory quotient; RQ) when injected into the ARN and PVN. Injections into the PFH and VMN elicited more modest effects on eating and RQ at doses of 400pmol or greater. Our findings indicate that regions of the hypothalamus appear to be differentially sensitive and responsive to the feeding-stimulant, metabolic, and anxiogenic actions of ghrelin and that the ARN and PVN, in particular, exert a primary role in mediating these effects.

Immune-metabolic balance in stressed rats during Candida albicans infection

We evaluated the host metabolic response to chronic varied stress during infection with the fungus Candida albicans. We used four groups of female Wistar rats: normal uninfected and unstressed, stressed, C. albicans infected and infected, and stressed. Infected rats reacted with rapid metabolic adjustments, evident as anorexia and body weight loss, partly mediated by glucocorticoids and TNF-alpha. Higher circulating levels of IL-6 and glucose (p < 0.05) revealed the progress and catabolic effect of the inflammatory response. Infected and stressed rats instead showed anorexia associated with infection and weight loss as the result of reduced food intake. This group exhibited a prompt reduction in circulating leptin on day 3 (p < 0.05), reduction in glucose levels and depletion of hepatic glycogen depots. We also evaluated the contribution of TNF-alpha, glucocorticoids, and food deprivation to liver damage. Lipid peroxidation in liver detected in the infected and infected-stressed groups was exacerbated by the glucocorticoid receptor antagonist RU 486, suggesting the modulatory activity of glucocorticoids, while hepatic fat accumulation and glycogen depletion decreased with anti-TNF-alpha treatment. Food deprivation exacerbated liver injury while the response to stress contributed to greater fungal colonization. Our findings emphasize the impact of metabolic alterations on tissue damage when the host immune activity is modulated by stress mediators.

TNF-alpha modulates iNOS expression in an experimental rat model of indomethacin-induced jejunoileitis

Multiple mucosal immune factors, such as TNF-alpha and IL-1beta, are thought to be key mediators involved in inflammatory bowel disease. We evaluated the role of the pro-inflammatory cytokine TNF-alpha on nitric oxide synthase (NOS) expression in indomethacin-induced jejunoileitis in rats. Jejunoileitis was induced in rats with subcutaneous injections of indomethacin (7.5 mg/kg) 24 h apart for two consecutive days, and animals were randomized into four groups. Group 1 received only indomethacin. Group 2 was treated with a daily dose of phosphodiesterase (PDE) inhibitor (theophylline or pentoxifylline) by oral gavage for 2 days before and 4 days after indomethacin. Group 3 received a single dose of anti-TNF-alpha monoclonal antibody (TNF-Ab, IP) 30 min before indomethacin. Group 4 was treated with 1 h hyperbaric oxygenation (HBO(2)) for 5 days after indomethacin. Rats were sacrificed at 12 h or 4 days after final indomethacin injection. PDE inhibitor, TNF-Ab, or HBO(2) treatment significantly decreased indomethacin-induced ulceration, myeloperoxidase activity, and disease activity index. Although indomethacin significantly increased serum TNF-alpha and nitrate/nitrite (NOx) concentrations above control values at 12 h, inducible NOS (iNOS) expression was detected only at day 4. Serum IL-1beta levels did not change at 12 h but increased 4-fold after 4 days. Indomethacin had no effect on constitutive NOS. Treatment with PDE inhibitor, TNF-Ab, or HBO(2) significantly reduced serum/tissue TNF-alpha, IL-1beta, NOx, and iNOS expression. Our data show TNF-alpha plays an early pro-inflammatory role in indomethacin-induced jejunoileitis. Additionally, down-regulation of NOx by PDE inhibitors, TNF-Ab, or HBO(2) suggests that TNF-alpha modulates iNOS expression.

The cytokine basis of cachexia and its treatment: are they ready for prime time?

Cachexia is a hypercatabolic condition that is often associated with the terminal stages of many diseases, in which the patient's resting metabolic rate is high and loss of muscle and fat tissue mass occur at an alarming rate. The patient also usually has concurrent anorexia, amplifying the wasting syndrome that is cachexia. The greater the extent of cachexia (regardless of underlying disease), the worse the prognosis. Efforts to treat cachexia over the years have fallen short of satisfactorily reversing the wasting syndrome. This article reviews the pathophysiology of cachexia, enumerating the different pro-inflammatory cytokines that contribute to the syndrome and attempting to illustrate their interwoven pathways. We also review the different treatments that have been explored, as well as the recent literature addressing the use of anti-cytokine therapy to treat cachexia.

The role of ghrelin and ghrelin analogues in wasting disease

PURPOSE OF REVIEW

The purpose of this review is to summarize recent studies that investigated the role of ghrelin and ghrelin analogs in wasting conditions.

RECENT FINDINGS

Numerous studies have demonstrated potential beneficial effects exerted by ghrelin in a number of diseases associated with wasting. Besides ghrelin's orexigenic effect, anabolic as well as anti-inflammatory activity mediated by ghrelin have been investigated in wasting conditions such as cancer, diabetes mellitus, malabsorptive diseases, chronic obstructive pulmonary disease, anorexia nervosa, renal failure, liver failure, and chronic heart failure. Encouraging results have been obtained from experimental studies and a few clinical trials using subcutaneous administration of ghrelin and ghrelin agonists in cachexia. In-vitro studies have shown ghrelin and des-acyl ghrelin biological activities on proliferation of tumor cells and abnormal tissues.

SUMMARY

The recent studies support the possible positive effects of ghrelin in therapeutic approaches and adjunct treatment of a number of diseases associated with wasting. Utilization of agonists of the ghrelin receptor growth hormone secretagogue-1a is a promising approach for clinical use. Randomized and placebo-controlled studies, including large number of patients are further required.

Corticotropin-releasing factor (CRF) in stress and disease: a review of literature and treatment perspectives with special emphasis on psychiatric disorders

The CRF family of neuropeptides and receptors is involved in a variety of stress responses, in the regulation of appetite, metabolic and inflammatory processes as well as intestinal movements. From a primarily psychiatric perspective, the present paper reviews the literature on its anatomy, physiology and its involvement in psychiatric, neurological and inflammatory diseases. Finally, recent developments in the pharmacological aspects of CRF in these diseases are reviewed.

Effects of intranasal administration of a leptin-secreting Lactococcus lactis recombinant on food intake, body weight, and immune response of mice

Leptin is an adipocyte-derived pleiotropic hormone that modulates a large number of physiological functions, including control of body weight and regulation of the immune system. In this work, we show that a recombinant strain of the food-grade lactic acid bacterium Lactococcus lactis (LL-lep) can produce and efficiently secrete human leptin. The secreted leptin is a fully biologically active hormone, as demonstrated by its capacity to stimulate a STAT3 reporter gene in HEK293 cells transfected with the Ob-Rb leptin receptor. The immunomodulatory activity of leptin-secreting L. lactis was evaluated in vivo by coexpression with the human papillomavirus type 16 E7 protein. In C57BL/6 mice immunized intranasally with a recombinant L. lactis strain coproducing leptin and E7 antigen, the adaptive immune response was significantly higher than in mice immunized with recombinant L. lactis producing only E7 antigen, demonstrating adjuvanticity of leptin. We then analyzed the effects of intranasally administered LL-lep in obese ob/ob mice. We observed that daily administration of LL-lep to these mice significantly reduced body weight gain and food intake. These results demonstrate that leptin can be produced and secreted in an active form by L. lactis and that leptin-producing L. lactis regulates in vivo antigen-specific immune responses, as well as body weight and food consumption.

The anxiogenic drug yohimbine activates central viscerosensory circuits in rats

Systemic administration of the alpha(2)-adrenoceptor antagonist yohimbine (YO) activates the HPA stress axis and promotes anxiety in humans and experimental animals. We propose that visceral malaise contributes to the stressful and anxiogenic effects of systemic YO and that YO recruits brainstem noradrenergic (NA) and peptidergic neurons that relay viscerosensory signals to the hypothalamus and limbic forebrain. To begin testing these hypotheses, the present study explored dose-related effects of YO on food intake, conditioned flavor avoidance (CFA), and Fos immunolabeling in rats. Systemic YO (5.0 mg/kg BW, i.p.) inhibited food intake, supported CFA, and increased Fos immunolabeling in identified NA neurons in the ventrolateral medulla, nucleus of the solitary tract, and locus coeruleus. YO also increased Fos in the majority of corticotropin releasing hormone-positive neurons in the paraventricular nucleus of the hypothalamus. YO administered at 1.0 mg/kg BW did not inhibit food intake, did not support CFA, and did not increase Fos immunolabeling. Retrograde neural tracing demonstrated that neurons activated by YO at 5.0 mg/kg BW included medullary and pontine neurons that project to the central nucleus of the amygdala and to the lateral bed nucleus of the stria terminalis, the latter region receiving comparatively greater input by Fos-positive neurons. We conclude that YO produces anorexigenic and aversive effects that correlate with activation of brainstem viscerosensory inputs to the limbic forebrain. These findings invite continued investigation of how central viscerosensory signaling pathways interact with hypothalamic and limbic regions to influence interrelated physiological and behavioral components of anxiety, stress, and visceral malaise.

Programming the offspring of the pig by prenatal social stress: neuroendocrine activity and behaviour

This study provides evidence in the pig that stress experienced during gestation has long-lasting effects on offspring daughters, including their maternal behaviour. Thirty-six primiparous sows were divided into control and two groups that were stressed (by social mixing) during either the second (Mix 2) or third (Mix 3) trimester of pregnancy. We found detrimental effects of mixing on the mothers' growth, body lesions, and cortisol secretion, but did not observe any significant effects on reproductive parameters including birth weight. At 60 days of age, 48 daughters were randomly selected from the three treatments: half were challenged using a restraint and isolation test. Then, all were culled and brain tissue was collected. In situ hybridisation measurements showed increased expression of CRH mRNA in the PVN in unrestrained Mix 2 and in the amygdala of Mix 2 and Mix 3 daughters. At 67 days, 24 further daughters were mixed to measure their responses to this social stress. All showed increased salivary cortisol secretion, but Mix 2 and Mix 3 daughters showed a greater and longer response than controls. Finally, all 24 were inseminated and at parturition maternal behaviour was measured. Mix 2 and Mix 3 daughters were more restless and more responsive to piglets that approached the head of the sow, traits which previously have been shown to be a component of abnormal maternal behaviour. Indeed, Mix 2 and Mix 3 daughters also tended to bite at their piglets more than control daughters.

Inhibition of TNF-alpha improves indomethacin-induced enteropathy in rats by modulating iNOS expression

TNF-alpha, including other proinflammatory cytokines alone or in combination, induces iNOS expression and upregulates inflammatory responses. We evaluated the relationship between TNF-alpha and iNOS expression in indomethacin-induced jejunoileitis in male Sprague-Dawley rats. Rats were fed a daily dose of a phosphodiesterase inhibitor-either theophylline or pentoxifylline-for 2 days. Jejunoileitis was induced with two subcutaneous injections of indomethacin (7.5 mg/kg) 24 hr apart and theophylline or pentoxifylline continued for 12 hr or 4 days. Other rats received a single intraperitoneal injection of anti-TNF-alpha monoclonal antibody (TNF-Ab) 30-min before indomethacin. At 4 days TNF-Ab, theophylline, or pentoxifylline treatment significantly decreased indomethacin-induced ulceration, myeloperoxidase activity, and disease activity index. Although indomethacin significantly increased serum TNF-alpha and nitrate/nitrite levels over the control value as early as 12 hr, iNOS expression was detected only after 4 days. Serum IL-1beta level did not change at 12 hr but increased fourfold at 4 days. Treatment with TNF-Ab, theophylline, or pentoxifylline significantly reduced serum/tissue TNF-alpha, IL-1beta, nitrate/nitrite, and iNOS expression. The downregulation of nitrate/nitrite by these inhibitors suggests that TNF-alpha modulates iNOS expression.

CaV2.3 calcium channels control second-phase insulin release

Concerted activation of different voltage-gated Ca( (2+) ) channel isoforms may determine the kinetics of insulin release from pancreatic islets. Here we have elucidated the role of R-type Ca(V)2.3 channels in that process. A 20% reduction in glucose-evoked insulin secretion was observed in Ca(V)2.3-knockout (Ca(V)2.3(-/-)) islets, close to the 17% inhibition by the R-type blocker SNX482 but much less than the 77% inhibition produced by the L-type Ca(2+) channel antagonist isradipine. Dynamic insulin-release measurements revealed that genetic or pharmacological Ca(V)2.3 ablation strongly suppressed second-phase secretion, whereas first-phase secretion was unaffected, a result also observed in vivo. Suppression of the second phase coincided with an 18% reduction in oscillatory Ca(2+) signaling and a 25% reduction in granule recruitment after completion of the initial exocytotic burst in single Ca(V)2.3(-/-) beta cells. Ca(V)2.3 ablation also impaired glucose-mediated suppression of glucagon secretion in isolated islets (27% versus 58% in WT), an effect associated with coexpression of insulin and glucagon in a fraction of the islet cells in the Ca(V)2.3(-/-) mouse. We propose a specific role for Ca(V)2.3 Ca(2+) channels in second-phase insulin release, that of mediating the Ca(2+) entry needed for replenishment of the releasable pool of granules as well as islet cell differentiation.

Ghrelin and adiponectin in patients with Cushing's disease before and after successful transsphenoidal surgery

BACKGROUND

Ghrelin, an endogenous ligand of the GH secretagogue receptor that exerts orexigenic activity, is negatively correlated with body mass index (BMI) and insulin resistance. Conversely, low levels of adiponectin (ApN), a circulating adipocytokine with antidiabetic, antiatherogenic and anti-inflammatory properties, have been found in several insulin-resistant conditions. Although Cushing's syndrome causes several metabolic and hormonal changes leading to insulin resistance and central obesity, few data concerning the impact of glucocorticoid excess on ghrelin and ApN levels are so far available.

DESIGN

We evaluated ghrelin and ApN levels in 14 women (age +/- SE 39.5 +/- 3.9 years, BMI +/- SE 25.8 +/- 1.4 kg/m2) with Cushing's disease (CD) at baseline and after successful transsphenoidal surgery (TSS) and in 14 age- and BMI-matched healthy women.

RESULTS

Despite similar levels of fasting glucose, insulin, homeostatic model assessment-estimated insulin resistance (HOMA-IR) and quantitative insulin sensitivity check index (QUICKI) values, patients with CD had ghrelin levels lower than controls (117.8 +/- 21.5 vs. 269.6 +/- 51.4 pmol/l, P < 0.01), and ghrelin levels did not correlate with ACTH, cortisol, androgen and GH levels. Patients and controls showed similar ApN levels (11.1 +/- 1.6 vs. 11.5 +/- 2.0 mg/l), which correlated negatively with insulin, HOMA-IR and BMI and positively with QUICKI and high density lipoprotein (HDL)-cholesterol only in controls. At 10.2 +/- 0.7 months after successful TSS, patients showed a significant increase in ghrelin levels compared to pretreatment values (342.5 +/- 25.6 vs. 117.8 +/- 21.5 pmol/l, P < 0.005) along with significant modifications in BMI, insulin, HOMA-IR and HDL-cholesterol and no change in ApN levels. In two patients tested on days 2-4 after TSS, no modification in ghrelin and ApN levels was observed, despite a dramatic reduction in cortisol levels.

CONCLUSION

Cortisol excess did not directly affect ghrelin and ApN levels in patients with CD. The observation that ghrelin levels were low during the active phase of CD and increased after recovery suggests that glucocorticoids may influence ghrelin levels indirectly by modulating adiposity and metabolic signals over the long term.

Is there a role of ghrelin in preventing catabolism?

Catabolism is a metabolic process in which muscle and fat cell tissues are broken down in their constituent parts to provide nutrients and energy for the body. Whilst undoubtedly a potent stimulator of GH secretion in pharmacological doses, at present no clear physiological role for ghrelin in the regulation of GH secretion has been identified in man. In addition to its GH-releasing properties, ghrelin stimulates food intake and adipogenesis. The role of ghrelin has been extensively studied in three human models of catabolism: anorexia nervosa, cardiac cachexia and cancer cachexia. In this review we discuss the role of ghrelin in the etiology and treatment of catabolism using these three human models of catabolism. In the presence of clear catabolism in all the three conditions plasma total ghrelin levels are increased, suggesting that ghrelin does not increase food intake and/or anabolism in these circumstances. In addition, it is at present unknown whether administration of additional ghrelin in these conditions may reduce (or attenuate) the development of cachexia. In conclusion, the anabolic effects of ghrelin in man have still to be demonstrated.

Hyperglycemia induced by acute central fluoxetine administration: role of the central CRH system and 5-HT3 receptors

Brain serotonin and CRH systems participate in the control of blood glucose levels. We have previously demonstrated that the pharmacological stimulation of central 5-HT3 receptors, the target for several therapeutic agents used as antiemetics in the course of chemotherapy, induces hyperglycemia. The aim of the present study was to investigate the participation of the brain CRH component and 5-HT3 receptors in basal blood glucose levels as well as in the hyperglycemia induced by third ventricle injections of fluoxetine, a serotonin reuptake inhibitor with a broad range of clinical use. In this study, we used fasted adult Wistar male rats (220 +/- 20 g) whose third ventricles were cannulated 7 days prior to the experiments. Acute third ventricle injections of fluoxetine caused a significant increase in plasma glucose levels throughout the experiment. Pretreatment with alpha-helical CRH, a selective CRH antagonist, significantly blunted fluoxetine-induced hyperglycemia. Also, pretreatment with two distinct selective 5-HT3 receptor antagonists (LY-278,584 and ondansetron) significantly impaired the rise in plasma glucose levels observed in fluoxetine-treated animals pretreated with isotonic saline solution. None of these antagonists was able to modify blood glucose levels when injected alone into the third ventricle. Animals receiving third ventricle injections of fluoxetine, in spite of being hyperglycemic, presented plasma insulin levels similar to those displayed by normoglycemic, saline-treated controls. It is suggested that the acute increase in brain serotonergic activity caused by third ventricle injections of fluoxetine induces a hyperglycemic response that requires the functional integrity of the brain CRH system and 5-HT3 receptors. Also, it is proposed that the absence of a compensatory increase in plasma insulin levels may contribute to the generation of a hyperglycemic response after central fluoxetine administration.

Identification of 2-{2-[2-(5-Bromo-2- methoxyphenyl)-ethyl]-3-fluorophenyl}-4,5-dihydro-1H-imidazole (ML00253764), a Small Molecule Melanocortin 4 Receptor Antagonist That Effectively Reduces Tumor-Induced Weight Loss in a Mouse Model

The melanocortin 4 receptor (MC4R) plays an important role in body weight regulation and energy homeostasis. Administration of peptidic MC4R antagonists (usually by intracerebro ventricular injection) has been shown in the literature to increase body weight and/or food intake in several rodent models. We report here the identification of a novel nonpeptidic MC4R antagonist and its effects on tumor-induced weight loss in mice following peripheral administration.

Effects of cortisol on food intake, growth, and forebrain neuropeptide Y and corticotropin-releasing factor gene expression in goldfish

Although elevated plasma cortisol levels and a reduction in food intake are common features of the response to stress in fish, the potential role of cortisol in the regulation of food intake in these animals is poorly understood. In this study, goldfish (Carassius auratus) were fed ad libitum for 21 days diets prepared to contain 0 (Control), 50 (Low) or 500 (High) microg cortisol/g of food. While feeding remained unchanged in controls and in fish fed the High cortisol diet, daily food intake gradually increased in the Low cortisol diet group and was significantly elevated between days 9 and 21. At the end of the feeding trial, specific growth rate was lowest in fish fed the High cortisol diet, intermediate in those fed the Low cortisol diet, and highest in the controls. Feed conversion efficiency, on the other hand, was significantly reduced in both groups of fish fed the cortisol diets. After 3 weeks on the diets and relative to controls, the Low cortisol diet group was characterized by a 34% increase in neuropeptide Y (NPY) and a 22% decrease in corticotropin-releasing factor (CRF) mRNA levels in the telencephalon-preoptic brain region. In contrast, the High cortisol diet group was characterized by a 46% decrease in CRF mRNA levels and no significant change in NPY gene expression. In a separate experiment, intraperitoneal implants of cortisol (150 and 300 microg cortisol/g body weight) elicited a dose-dependent increase in NPY and decrease in CRF mRNA levels in the telencephalon-preoptic region at 72 h post-treatment. These results show that while moderate increases in plasma cortisol can stimulate food intake slowly over days, larger catabolic doses of glucocorticoids may mask the appetite-stimulatory effects of cortisol. Therefore, excess cortisol in goldfish can be associated with poor growth despite normal food intake. Furthermore, our results indicate that forebrain NPY and CRF may play a role in mediating the effects of cortisol on food intake in goldfish.

Cachexia and obesity: two sides of one coin?

PURPOSE OF REVIEW

Leptin, a member of the interleukin-6 superfamily of proteins, modifies the gene expression and synthetic pathway of both orexigenic (appetite-stimulating) and anorexigenic (appetite-suppressing) molecules in the hypothalamus, thereby controlling adipocyte energy stores. Lack of leptin secretion or the inability of leptin to interact with these molecules via leptin receptors, prevent leptin's effects and lead to obesity. It is not well known, however, how these feeding-regulatory molecules are affected in cachexia associated with cancer and other critical conditions in which cytokines such as interleukin-1 and interleukin-6 may have a key role.

RECENT FINDINGS

Decreased leptin and increased leptin-like signaling by cytokines in the hypothalamus are the hallmark of obesity and cachexia, respectively. Increased orexigenic and impaired anorexigenic signaling produces hyperphagia and obesity, while the reverse applies to anorexia-cachexia in which adaptive feeding response to starvation is lacking or insufficient.

SUMMARY

Imbalanced operation of orexigenic and anorexigenic circuits perturbs the homeostatic loop of body weight regulation leading to either obesity or cachexia. Modifiers of the central effects on appetite and energy metabolism could restore the balance and be effective for treating both conditions. In cachexia this may especially be true when combined with agents that target muscle and protein breakdown.

Presence of melanocortin (MC4) receptor in spiny dogfish suggests an ancient vertebrate origin of central melanocortin system

We report the cloning, expression, pharmacological characterization and tissue distribution of a melanocortin (MC) receptor gene in a shark, the spiny dogfish (Squalus acanthias) (Sac). Phylogenetic analysis showed that this receptor is an ortholog of the MC4 subtype, sharing 71% overall amino acid identity with the human (Hsa) MC4 receptor. When expressed and characterized by radioligand binding assay for the natural MSH (melanocyte-stimulating hormone) peptides alpha-, beta-, and gamma-MSH, the SacMC4 receptor showed pharmacological properties very similar to the HsaMC4 receptor. Stimulation of SacMC4 receptor transfected cells with alpha-MSH caused a dose-dependent increase in intracellular cAMP levels. The SacMC4 receptor has Ala in position 59 where all other cloned MC receptors have Glu. We confirmed that this was not due to individual polymorphism and subsequently mutated the residue 'back' to Glu but the mutation did not affect the pharmacological properties of the receptor. SacMC4 receptor mRNA was detected by RT-PCR in the optic tectum, hypothalamus, brain stem, telencephalon and olfactory bulb but not in cerebellum or in peripheral tissues. This study describes the first characterization of an MC receptor in a cartilaginous fish, the most distant MC receptor gene cloned to date. Conservation of gene structure, pharmacological properties and tissue distribution suggests that this receptor may have similar roles in sharks as in mammals and that these were established more than 450 million years ago.