Effect of sex hormone administration on circulating ghrelin levels in peripubertal children

Association of adipocytokines and adipocytokine ratios with cardiovascular risk factors in Japanese preadolescents

OBJECTIVES

Asians are particularly susceptible to obesity-associated disorders and rapid progression of obesity from childhood to adulthood. Data on the association between adipocytokine parameters, particularly adipocytokine ratios, and cardiovascular risk factors in childhood remain limited. Herein, we assessed the association of resistin, adiponectin, and leptin levels and leptin/adiponectin and resistin/adiponectin ratios with selected cardiovascular risk factors and the influence of unhealthy weight on such associations in children aged 9-10 years.

METHODS

We included 380 children aged 9-10 years from three public elementary schools in Japan.

RESULTS

The body mass index (BMI) was significantly higher in male preadolescents than in female adolescents (median 16.5 kg/m² vs. 16.2 kg/m², p=0.032). No differences in height, weight, waist circumference (WC), waist/height ratio (W/Hr), total cholesterol and high-density lipoprotein cholesterol levels, or atherosclerosis index (AI) were observed between the sexes. Of the adipocytokine levels and ratios analyzed, only the leptin level and leptin/adiponectin ratio (L/Ar) were strongly and significantly positively correlated with the cardiovascular risk factors WC, W/Hr, and BMI (all p<0.05). The AI was not strongly correlated with any adipocytokine levels or ratios. Apart from the strong positive correlation between the L/Ar and W/Hr, no other significant associations were observed between any of the adipocytokine levels or ratios and the selected cardiovascular risk factors.

CONCLUSIONS

Our findings confirmed the value of adipocytokine ratios in risk assessment in pediatric populations, with leptin levels and leptin/adiponectin ratios strongly correlating with risk factors in children aged 9-10 years.

Elevated Ghrelin Promotes Hippocampal Ghrelin Receptor Defects in Humanized Amyloid-β Knockin Mice During Aging

BACKGROUND

Emerging evidence has revealed that dysregulation of the hormone ghrelin and its receptor, growth hormone secretagogue receptor (GHSR), contributes to the pathogenesis of Alzheimer's disease (AD). Specifically, defective GHSR function and resultant hippocampal ghrelin resistance are linked to hippocampal synaptic injury in AD paradigms. Also, AD patients exhibit elevated ghrelin activation. However, the detailed molecular mechanisms of hippocampal GHSR dysfunction and the relevance of ghrelin elevation to hippocampal ghrelin resistance in AD-relevant pathological settings are not fully understood.

OBJECTIVE

In the current study, we employed a recently established mouse line of AD risk [humanized amyloid beta knockin (hAβ KI mice), also referred to as a mouse model of late-onset AD in previous literature] to further define the role of ghrelin system dysregulation in the development of AD.

METHODS

We employed multidisciplinary techniques to determine the change of plasma ghrelin and the functional status of GHSR in hAβ KI mice as well as primary neuron cultures.

RESULTS

We observed concurrent plasma ghrelin elevation and hippocampal GHSR desensitization with disease progression. Further examination excluded the possibility that ghrelin elevation is a compensatory change in response to GHSR dysfunction. In contrast, further in vitro and in vivo results show that agonist-mediated overstimulation potentiates GHSR desensitization through enhanced GHSR internalization.

CONCLUSIONS

These findings suggest that circulating ghrelin elevation is a pathological event underlying hippocampal GHSR dysfunction, culminating in hippocampal ghrelin resistance and resultant synaptic injury in late-onset AD-related settings.

The Role of the Gastric Hormones Ghrelin and Nesfatin-1 in Reproduction

Ghrelin and nesfatin-1 are enteroendocrine peptide hormones expressed in rat X/A-like and human P/D1cells of the gastric mucosa. Besides their effect on food intake, both peptides are also implicated in various other physiological systems. One of these is the reproductive system. This present review illustrates the distribution of ghrelin and nesfatin-1 along the hypothalamus-pituitary-gonadal (HPG) axis, their modulation by reproductive hormones, and effects on reproductive functions as well as highlighting gaps in current knowledge to foster further research.

The Role of the Gastric Hormones Ghrelin and Nesfatin-1 in Reproduction

Ghrelin and nesfatin-1 are enteroendocrine peptide hormones expressed in rat X/A-like and human P/D1cells of the gastric mucosa. Besides their effect on food intake, both peptides are also implicated in various other physiological systems. One of these is the reproductive system. This present review illustrates the distribution of ghrelin and nesfatin-1 along the hypothalamus–pituitary–gonadal (HPG) axis, their modulation by reproductive hormones, and effects on reproductive functions as well as highlighting gaps in current knowledge to foster further research.

Reproductive health in women with type 2 diabetes mellitus

As type 2 diabetes mellitus (T2DM) reaches epidemic proportions in the developed world and the age at diagnosis decreases, more women of reproductive age are being affected. In this article, we provide a synoptic view on potential mechanisms and relevant factors underlying menstrual cycle disorders and fertility issues in women with T2DM. The article discusses the function of the hypothalamic-pituitary-ovarian (HPO) axis, the central role of the hypothalamus in the homeostasis of this system, the central modulators of the axis, and the peripheral metabolic signals involved in neuroendocrine control of reproduction. The available literature on the relationship between T2DM and the female reproductive lifespan, menstrual cycle disorders, fertility issues, and gestational health in women with T2DM are also discussed. The data so far indicate that there is a "U-shaped" relationship between menarche, menopause, and T2DM, both early and late menarche/menopause being risk factors for T2DM. Hyperglycemia and its consequences may be responsible for the effects of T2DM on reproductive health in women, but the exact mechanisms are not as yet fully understood; thus, more studies are needed in order to identify factors causing disruption of the HPO axis.

Effects of Testosterone Supplementation on Ghrelin and Appetite During and After Severe Energy Deficit in Healthy Men

BACKGROUND

Severe energy deficits cause interrelated reductions in testosterone and fat free mass. Testosterone supplementation may mitigate those decrements, but could also reduce circulating concentrations of the orexigenic hormone ghrelin, thereby exacerbating energy deficit by suppressing appetite.

OBJECTIVE

To determine whether testosterone supplementation during severe energy deficit influences fasting and postprandial ghrelin concentrations and appetite.

DESIGN AND METHODS

Secondary analysis of a randomized, double-blind trial that determined the effects of testosterone supplementation on body composition changes during and following severe energy deficit in nonobese, eugonadal men. Phase 1 (PRE-ED): 14-day run-in; phase 2: 28 days, 55% energy deficit with 200 mg testosterone enanthate weekly (TEST; n = 24) or placebo (PLA; n = 26); phase 3: free-living until body mass recovered (end-of-study; EOS). Fasting and postprandial acyl ghrelin and des-acyl ghrelin concentrations and appetite were secondary outcomes measured during the final week of each phase.

RESULTS

Fasting acyl ghrelin concentrations, and postprandial acyl and des-acyl ghrelin concentrations increased in PLA during energy deficit then returned to PRE-ED values by EOS, but did not change in TEST (phase-by-group, P < 0.05). Correlations between changes in free testosterone and changes in fasting acyl ghrelin concentrations during energy deficit (ρ = -0.42, P = 0.003) and body mass recovery (ρ = -0.38; P = 0.01) were not mediated by changes in body mass or body composition. Transient increases in appetite during energy deficit were not affected by testosterone treatment.

CONCLUSIONS

Testosterone supplementation during short-term, severe energy deficit in healthy men prevents deficit-induced increases in circulating ghrelin without blunting concomitant increases in appetite.

CLINICAL TRIALS REGISTRATION

www.clinicaltrials.gov NCT02734238 (registered 12 April 2016).

Physiological Effect of Ghrelin on Body Systems

Ghrelin is a relatively novel multifaceted hormone that has been found to exert a plethora of physiological effects. In this review, we found/confirmed that ghrelin has effect on all body systems. It induces appetite; promotes the use of carbohydrates as a source of fuel while sparing fat; inhibits lipid oxidation and promotes lipogenesis; stimulates the gastric acid secretion and motility; improves cardiac performance; decreases blood pressure; and protects the kidneys, heart, and brain. Ghrelin is important for learning, memory, cognition, reward, sleep, taste sensation, olfaction, and sniffing. It has sympatholytic, analgesic, antimicrobial, antifibrotic, and osteogenic effects. Moreover, ghrelin makes the skeletal muscle more excitable and stimulates its regeneration following injury; delays puberty; promotes fetal lung development; decreases thyroid hormone and testosterone; stimulates release of growth hormone, prolactin, glucagon, adrenocorticotropic hormone, cortisol, vasopressin, and oxytocin; inhibits insulin release; and promotes wound healing. Ghrelin protects the body by different mechanisms including inhibition of unwanted inflammation and induction of autophagy. Having a clear understanding of the ghrelin effect in each system has therapeutic implications. Future studies are necessary to elucidate the molecular mechanisms of ghrelin actions as well as its application as a GHSR agonist to treat most common diseases in each system without any paradoxical outcomes on the other systems.

Acute decrease in plasma testosterone and appetite after either glucose or protein beverages in adolescent males

OBJECTIVE

Chronic testosterone blood concentrations associate with food intake (FI), but acute effects of testosterone on appetite and effect of protein and glucose consumption on testosterone response have had little examination.

METHODS

In a randomized, crossover study, twenty-three adolescent (12-18 years old) males were given beverages containing either: (a) whey protein (1 g/kg body weight), (b) glucose (1 g/kg body weight) or (c) a calorie-free control (C). Plasma testosterone, luteinizing hormone (LH), GLP-1 (active), ghrelin (acylated), glucose, insulin and subjective appetite were measured prior (0) and at 20, 35 and 65 minutes after the consumption of the beverage. FI at an ad libitum pizza meal was assessed at 85 minutes.

RESULTS

Testosterone decreased acutely to 20 minutes after both protein and glucose with the decrease continuing after protein but not glucose to 65 minutes (P = 0.0382). LH was also decreased by both protein and glucose, but glucose had no effect at 20 minutes in contrast to protein (P < 0.001). Plasma testosterone concentration correlated positively with LH (r = 0.58762, P < 0.0001) and negatively with GLP-1 (r = -0.50656, P = 0.0003). No associations with appetite, ghrelin or glycaemic markers were found. Food intake was not affected by treatments.

CONCLUSION

Protein or glucose ingestion results in acute decreases in both plasma testosterone and LH in adolescent males. The physiological significance of this response remains to be determined as no support for testosterone's role in acute regulation of food intake was found.

Risk Factors for Unhealthy Weight Gain and Obesity among Children with Autism Spectrum Disorder

Autism Spectrum Disorder (ASD) is a developmental disorder characterized by social and communication deficits and repetitive behaviors. Children with ASD are also at a higher risk for developing overweight or obesity than children with typical development (TD). Childhood obesity has been associated with adverse health outcomes, including insulin resistance, diabetes, heart disease, and certain cancers. Importantly some key factors that play a mediating role in these higher rates of obesity include lifestyle factors and biological influences, as well as secondary comorbidities and medications. This review summarizes current knowledge about behavioral and lifestyle factors that could contribute to unhealthy weight gain in children with ASD, as well as the current state of knowledge of emerging risk factors such as the possible influence of sleep problems, the gut microbiome, endocrine influences and maternal metabolic disorders. We also discuss some of the clinical implications of these risk factors and areas for future research.

Gender-Specific Association of Desacylated Ghrelin with Subclinical Atherosclerosis in the Metabolic Syndrome

OBJECTIVE

Ghrelin, a gastric hormone with pleiotropic effects modulates vascular function and may influence atherosclerosis. Plasma ghrelin is reduced in the metabolic syndrome (MS), which is also characterized by early atherosclerosis. Ghrelin circulates in acylated (AG) and desacylated (DAG) forms. Their relative impact and that of gender on subclinical atherosclerosis in MS is unknown.

AIM OF THE STUDY

To investigate potential associations of total, AG and DAG with carotid atherosclerosis and with gender in the MS.

METHODS

Plasma total ghrelin, AG, DAG and carotid artery IMT (cIMT) were measured in 46 MS patients (NCEP-ATP III criteria, 22M/24F).

RESULTS

Compared with males, females had higher (p <0.05) total and DAG. In the association analysis, age and plasma glucose were positively (p <0.05) correlated with cIMT in all MS patients. The positive (p <0.05) association between cIMT and age was also confirmed in males, while that between cIMT and glucose was significant in women. In contrast, neither total ghrelin nor AG and DAG were associated with cIMT in all MS patients nor in the male subgroup. In females, a negative (p <0.05) association between carotid artery IMT, DAG and glucose was detected, but not between cIMT, total ghrelin and AG. In multivariate modeling, DAG remained negatively (p <0.05) associated with cIMT after adjusting for plasma glucose and cardiovascular risk factors.

CONCLUSIONS

These data indicate a negative independent association between DAG and cIMT in middle-aged women with the MS and suggest a gender-specific modulatory function of DAG in the development of atherosclerosis.

Blood ghrelin, adiponectin and resistin levels during controlled ovarian stimulation in IVF cycles

The aim of the present study was to investigate changes of blood ghrelin, adiponectin and resistin levels in IVF/ICSI-ET cycles. Twenty women were stimulated with recombinant FSH in a GnRH agonist short protocol for IVF/ICSI. Blood samples were taken on cycle day 2 before the commencement of injections, on cycle day 6 and on the days of HCG injection, oocyte pick up (OPU), embryo transfer (ET) as well as 7 and 12 days post-ET. Serum E2 levels increased during the stimulation, peaking on the HCG day and declined thereafter (p<0.001). Serum progesterone levels started to increase on the OPU day, peaking on the ET day (p<0.001) and decreased on days 7 and 12 post-ET. Plasma ghrelin remained unchanged during the whole cycle. Serum adiponectin levels remained stable during the stimulation period until the ET day and decreased on days 7 and 12 post-ET (p<0.001). Serum resistin levels increased until the ET day (p<0.05), remained unchanged on day 7 post-ET and decreased on day 12 post-ET (p<0.05). The present study shows for the first time that ghrelin levels did not change significantly during IVF/ICSI-ET cycles. Resistin levels increased during the stimulation period while adiponectin levels remained stable decreasing during the luteal phase.

Physiology of Food Intake Control in Children

The purpose of this review is to draw attention to the limited information available on food intake (FI) control in children and adolescents 7-17 y of age, which is essential for developing food policies and guidelines in this population. Although environmental factors have been the overwhelming focus of research on the causative factors of obesity, research focusing on the physiologic control of appetite in children and adolescents is a neglected area of research. To present this message, a review of FI regulation and the role of food and food components in signaling processes are followed by an examination of the role of hormones during puberty in intake regulation. To examine the interaction of environment and physiology on FI regulation, the effects of exercise, television programs, and food advertisements are discussed. In conclusion, although limited, this literature review supports a need for children and adolescents to be a greater focus of research that would lead to sound nutrition policies and actions to reduce chronic disease. A focus on the environment must be balanced with an understanding of physiologic and behavioral changes associated with this age group.

Acute decrease in serum testosterone after a mixed glucose and protein beverage in obese peripubertal boys

BACKGROUND AND OBJECTIVES

Delayed puberty and lower levels of testosterone (T) have been observed in adult obese males and some adolescent males. In adult men, enteral glucose ingestion results in acute lowering of serum testosterone levels; however, this has not been studied in adolescents. We aimed to examine the acute effect of a glucose/protein beverage on serum T concentration changes in obese peripubertal males. A second objective was to determine whether change in T concentration was related to appetite hormone levels.

PATIENTS AND METHODS

Twenty-three overweight and obese males aged 8-17 in pre-early (Tanner stage 1-2) and mid-late (Tanner stage 3-5) puberty were included in this cross-sectional study at the Clinical investigative unit at the Hospital for Sick Children. Participants consumed a beverage containing glucose and protein, and blood samples measuring pubertal hormones, ghrelin and glucagon-like peptide-1 (GLP-1) were taken over 60 min.

RESULTS

Across pubertal stages, there was a significant decrease in T levels in adolescent boys (-18·6 ± 3·1%, P < 0·01) with no proportional differences between pre-early and mid-late puberty (P = 0·09). Decrease in T was associated with a decrease in LH (r = 0·52, P = 0·02), and fasting T was inversely correlated with fasting ghrelin (r = -0·51, P = 0·03) with no correlation with GLP-1.

CONCLUSIONS

Intake of a mixed glucose/protein beverage acutely decreases T levels in overweight and obese peripubertal boys. A potential mechanism for this decrease may be secondary to an acute decrease in LH, but this requires further evaluation.

Altered ghrelin levels in boys with autism: a novel finding associated with hormonal dysregulation

Autism is a neurodevelopmental disorder with unclear pathogenesis. Many clinical observations and hormone studies have suggested the involvement of the neuroprotective hormone ghrelin in autism. The current study aimed to investigate the potential role of ghrelin in autism and to elucidate the associated hormonal dysregulation. This case-control study investigated acyl ghrelin (AG), des-acyl ghrelin (DG), total testosterone (TT), free testosterone (FT), leptin and growth hormone (GH) levels in 31 male children with autism and 28 healthy age and sex-matched controls. Hormone levels were measured in the blood using enzyme-linked immunosorbent assay and chemiluminescence immunoassay kits. AG, DG and GH levels were significantly lower in the autism group than in the control group (p ≤ 0.001, p ≤ 0.005 and p ≤ 0.05, respectively). However, TT, FT and leptin levels were significantly higher in the autism group than in the control group (p ≤ 0.05, p ≤ 0.001 and p ≤ 0.01, respectively). Our results for the first time demonstrate low AG and DG levels in autistic children. Considering the capacity of ghrelin to affect neuroinflammatory and apoptotic processes that are linked to autism, this study suggests a potential role for the hormone ghrelin in the pathogenesis of autism.

The relationship between gut and adipose hormones, and reproduction

BACKGROUND

Reproductive function is tightly regulated by nutritional status. Indeed, it has been well described that undernutrition or obesity can lead to subfertility or infertility in humans. The common regulatory pathways which control energy homeostasis and reproductive function have, to date, been poorly understood due to limited studies or inconclusive data. However, gut hormones and adipose tissue hormones have recently emerged as potential regulators of both energy homeostasis and reproductive function.

METHODS

A PubMed search was performed using keywords related to gut and adipose hormones and associated with keywords related to reproduction.

RESULTS

Currently available evidence that gut (ghrelin, obestatin, insulin, peptide YY, glucagon-like peptide-1, glucose-dependent insulinotropic peptide, oxyntomodulin, cholecystokinin) and adipose hormones (leptin, adiponectin, resistin, omentin, chemerin) interact with the reproductive axis is presented. The extent, site and direction of their effects on the reproductive axis are variable and also vary depending on species, sex and pubertal stage.

CONCLUSIONS

Gut and adipose hormones interact with the reproductive axis as well as with each other. While leptin and insulin have stimulatory effects and ghrelin has inhibitory effects on hypothalamic GnRH secretion, there is increasing evidence for their roles in other sites of the reproductive axis as well as evidence for the roles of other gut and adipose hormones in the complex interplay between nutrition and reproduction. As our understanding improves, so will our ability to identify and design novel therapeutic options for reproductive disorders and accompanying metabolic disorders.

Acylated and unacylated ghrelin levels in normal weight and obese children: influence of puberty and relationship with insulin, leptin and adiponectin levels

BACKGROUND

Ghrelin circulates in blood as acylated (AG) and unacylated (UAG) ghrelin. The physiological role of the two forms is poorly understood, in particular in childhood. Aim of the study was to evaluate the AG and UAG levels in obese and normal weight (NW) children, pre-pubertal and pubertal, and their relationship with insulin, leptin and adiponectin levels.

SUBJECTS AND METHODS

A population based study in which AG, UAG, leptin, adiponectin, glucose, insulin, testosterone or estradiol levels, insulinemic indexes were evaluated in 82 NW and 58 obese (OB) children.

RESULTS

Both ghrelin forms in NW were higher (AG, p<0.02; UAG, p<0.0001) than in OB subjects, with similar ratio AG/UAG . While no differences were observed for gender, puberty AG (p<0.01) and UAG (p<0.0001) levels were higher in pre-pubertal than pubertal NW and OB subjects. Adiponectin levels in NW subjects were higher (p<0.001), while leptin and insulin levels were lower (p<0.0001) than in OB subjects. NW children showed homeostasis model assessment (HOMA) and HOMAβ indices lower than OB children (p<0.0001) with a higher a quantitative insulin sensitivity check index (p<0.0001). AG and UAG levels correlated to each other (p<0.0001), each showing a negative correlation to age, height, weight and body mass index. Both forms, but more strongly UAG, correlated with adiponectin, leptin, and insulin.

CONCLUSIONS

OB children show lower levels of both AG and UAG when compared to NW subjects, with lower levels during puberty. These results demonstrate a peculiar strong relationship between UAG levels and metabolic parameters in the pediatric population, suggesting a role for UAG in metabolic functions.

Variations of plasma leptin in show horses during a work season

Leptin is an adipocytokine mainly expressed by adipose tissue. Secretion of leptin in healthy animals is closely related to fat mass and metabolic activity. The aim of this study was to investigate plasma leptin variations, in relation to nutritional and exercise parameters in adult show horses during a work season. EDTA-blood samples were taken at rest from 37 Iberian horses. Body weight, body condition score and fat percentage determined by ultrasonic measurement of rump fat thickness were measured. Plasma leptin was determined with a multi-species RIA kit. Linear mixed effects model was used to assess relationship between plasma leptin and other biological parameters. Plasma leptin concentration was <12.6 ng/ml (mean = 2.8 ± 1.6 ng/ml) and was significantly higher during training periods (p < 0.0001) (4.5 ± 1.7 ng/ml) than in show periods (2.0 ± 1.1 ng/ml), despite a significant increase (p < 0.0001) in energy intake. The body weight remained almost constant. The plasma leptin concentrations were significantly affected by exercise (p < 0.0001), body weight (p = 0.04) and BCS (p < 0.0001), but were not affected by percentage of fat. In conclusion, the marked decrease in leptin values observed during a period of intense (i.e. excessive) exercise could result from an adaptation to cumulative alterations in energy balance, to exercise per se or to a combination of both.

Television viewing at mealtime reduces caloric compensation in peripubertal, but not postpubertal, girls

The effect of television viewing (TVV) and pubertal status of 9- to 14-y-old girls on mealtime food intake (FI) after a premeal glucose drink was determined. On four separate mornings, girls randomly received equally sweetened drinks containing Sucralose (control) or glucose (1.0 g/kg body weight) in 250 mL of water 2 h after a standardized breakfast. FI from an ad libitum pizza meal was measured 30 min later with or without TVV. Appetite was measured at 15 min intervals to lunch and postmeal. TVV at mealtime had no effect on FI, however, glucose suppressed FI more with no TVV compared with TVV (24 versus 10%, p < 0.001), primarily because of its effect in peripubertal girls (p < 0.028). In postpubertal girls (n = 8), glucose reduced FI by ~27% in both the no TVV and TVV conditions, but in peripubertal girls (n = 17), reduction in FI was 22% without TVV and only 1% while TVV. Appetite correlated with FI at 30 min only in postpubertal girls. TVV at mealtime reduced caloric compensation after consumption of the glucose drink in peripubertal, but not postpubertal, girls, with no effect on mealtime FI. (Clinical trial number NCT01025687.)

Maternal deprivation has sexually dimorphic long-term effects on hypothalamic cell-turnover, body weight and circulating hormone levels

Maternal deprivation (MD) has numerous outcomes, including modulation of neuroendocrine functions. We previously reported that circulating leptin levels are reduced and hypothalamic cell-turnover is affected during MD, with some of these effects being sexually dimorphic. As leptin modulates the development of hypothalamic circuits involved in metabolic control, we asked whether MD has long-term consequences on body weight, leptin levels and the expression of neuropeptides involved in metabolism. Rats were separated from their mother for 24h starting on postnatal day (PND) 9 and sacrificed at PNDs 13, 35 and 75. In both sexes MD reduced body weight, but only until puberty, while leptin levels were unchanged at PND 35 and significantly reduced at PND 75. Adiponectin levels were also reduced at PND 75 in females, while testosterone levels were reduced in males. At PND 13, MD modulated cell-turnover markers in the hypothalamus of males, but not females and increased nestin, a marker of immature neurons, in both sexes, with males having higher levels than females and a significantly greater rise in response to MD. There was no effect of MD on hypothalamic mRNA levels of the leptin receptor or metabolic neuropeptides or the mRNA levels of leptin and adiponectin in adipose tissue. Thus, MD has long-term effects on the levels of circulating hormones that are not correlated with changes in body weight. Furthermore, these endocrine outcomes are different between males and females, which could be due to the fact that MD may have sexually dimorphic effects on hypothalamic development.

Identification of a cDNA encoding for Ghrelin in the testis of the frog Pelophylax esculentus and its involvement in spermatogenesis

GHRELIN (GHRL) is an acylated peptide that contains 28-amino acids prevalently expressed in the stomach of several species. Specifically, it contributes to energy balance, but some new evidence highlights its role in the regulation of reproductive functions. In fact, this protein has been detected at testicular level in the tubular and interstitial compartments of several vertebrate species, and previous research has demonstrated that GHRL affects various aspects of spermatogenesis and steroidogenesis. GHRL clearly plays an inhibitory role in mammalian reproduction, in contrast GHRL stimulates reproductive functions in non mammalian vertebrate. We have focused our attention on the comparative aspect of GHRL, thus studying its expression in an amphibian seasonal breeder, Pelophylax esculentus, to verify the presence and localization, of Ghrl transcript variations during the frog reproductive cycle, in order to demonstrate that Pelophylax esculentus may represent a useful animal model to assess the role of GHRL in male fertility.

Integrating GHS into the Ghrelin System

Oligopeptide derivatives of metenkephalin were found to stimulate growth-hormone (GH) release directly by pituitary somatotrope cells in vitro in 1977. Members of this class of peptides and nonpeptidyl mimetics are referred to as GH secretagogues (GHSs). A specific guanosine triphosphatate-binding protein-associated heptahelical transmembrane receptor for GHS was cloned in 1996. An endogenous ligand for the GHS receptor, acylghrelin, was identified in 1999. Expression of ghrelin and homonymous receptor occurs in the brain, pituitary gland, stomach, endothelium/vascular smooth muscle, pancreas, placenta, intestine, heart, bone, and other tissues. Principal actions of this peptidergic system include stimulation of GH release via combined hypothalamopituitary mechanisms, orexigenesis (appetitive enhancement), insulinostasis (inhibition of insulin secretion), cardiovascular effects (decreased mean arterial pressure and vasodilation), stimulation of gastric motility and acid secretion, adipogenesis with repression of fat oxidation, and antiapoptosis (antagonism of endothelial, neuronal, and cardiomyocyte death). The array of known and proposed interactions of ghrelin with key metabolic signals makes ghrelin and its receptor prime targets for drug development.

The effect of estrogens on plasma ghrelin concentrations in women

BACKGROUND

Data regarding the possible effects of estrogen on ghrelin secretion in humans are limited and contradictory.

AIM

To investigate the effect of estradiol (E2) on ghrelin levels in normal pre- and post-menopausal women.

SUBJECTS AND METHODS

A total of 21 women divided into 3 groups, i.e.13 normally cycling women (no.=7, group 1 and no.=6, group 2) and 8 post-menopausal women (group 3). Women of group 1 received increasing doses of E2 through skin patches from cycle days 3 to 5. Women of group 2, underwent total abdominal hysterectomy plus bilateral salpingo-oophorectomy (TAH+BSO) on cycle day 3. Women of group 3 received po increasing doses of E2 valerate for 15 days. Acylated ghrelin and E2 were measured in all blood samples.

RESULTS

In group 1, plasma ghrelin levels did not show any significant changes for the week following cycle day 3. In group 2, ghrelin levels were similar before and after TAH+BSO and remained stable during the first 7 post-operative days. In group 3, no significant changes in plasma ghrelin levels were seen during the 15 days of E2 administration.

CONCLUSIONS

The present study demonstrates for the first time that ghrelin values were not affected either by exogenous short-term estrogen administration to pre- and post-menopausal women or following ovariectomy in pre-menopausal women. It is suggested that ovarian hormones are not involved in the regulation of ghrelin secretion in women.

Glucagon stimulation test for childhood growth hormone deficiency: timing of the peak is important

OBJECTIVES

In the glucagon stimulation test (GST) growth hormone (GH) secretion is considered sufficient when at least 1 value is >10 ng/mL. Because GH typically peaks at 90 or 120 minutes, we evaluated whether peak occurrence at other times ("atypical") signifies abnormal GH secretion.

STUDY DESIGN

A retrospective review of 222 GSTs was conducted to determine these outcomes: 1) frequency of GH deficiency per confirmatory clonidine or arginine stimulation test in typical versus atypical GSTs, and 2) growth velocity standard deviation score (GVSDS) in patients with typical versus atypical GSTs.

RESULTS

Of 222 tests, 57 GST results (25.7%) were atypical, and 54 GST results (24.3%) were deficient. Atypical deficient tests had a higher chance than typical deficient tests of predicting GH deficiency per confirmatory test (15/21, 71.4% versus 14/33, 42.4%; P < .05). Patients with deficient atypical GST results and sufficient confirmatory tests (n = 6) had a lower GVSDS than patients with deficient typical GST results (n = 18; -1.58 [-3.2-1.76], versus 0.23 [-1.54-3.95], P = .03). Overall, 75% of atypical deficient GST results were followed by atypical timing in a clonidine test. Three of the 222 tests (1.3%) peaked at 180 minutes.

CONCLUSIONS

The GST can be terminated at 150 minutes without sacrificing sensitivity. A GH peak at a time other than 90 or 120 minutes may be a new important indicator of GH deficiency.

Gender difference of circulating ghrelin and leptin concentrations in chronic Helicobacter pylori infection

BACKGROUND

Both ghrelin and leptin are important appetite hormones secreted from the stomach. We examined whether demographic background, Helicobacter pylori infection, or its related gastritis severity could be associated with circulating ghrelin and leptin levels.

METHODS

This study prospectively enrolled 341 dyspeptic patients (196 females, 145 males), who had received endoscopy to provide the gastric specimens over both antrum and corpus for histology reviewed by the updated Sydney's system. The fasting blood sample of each patient was obtained for total ghrelin and leptin analysis.

RESULTS

Without H. pylori infection, there were similar ghrelin levels between female and male patients. In the H. pylori-infected patients, the males had lower plasma ghrelin levels than females (1053 vs. 1419 pg/mL, p < .001). Only in males, not in females, the H. pylori infection and its related acute and chronic inflammation scores were significantly associated with a lower ghrelin level (p < or = .04). The multivariate regression disclosed that only the chronic inflammation score independently related to a lower ghrelin level. Only in males, the ghrelin levels ranked in a downward trend for the gastritis feature as with limited-gastritis, with antrum-predominant gastritis, and with corpus-gastritis (1236, 1101, and 977 pg/mL). Leptin level was not related to H. pylori-related gastritis, but positively related to body mass index.

CONCLUSION

There should be a gender difference to circulating total ghrelin levels, but not leptin levels, in response to H. pylori infection and its related chronic gastritis.

Effect of pubertal development and physical activity on plasma ghrelin concentration in boys

The aim of the present study was to assess the influence of regular physical activity on plasma ghrelin concentration in pre-pubertal and pubertal boys. In addition, the impact of ghrelin concentration on bone mineral density (BMD) was examined. In total, 56 healthy schoolboys aged between 10 and 16 yr were divided into the swimming (no.=28) and the control (no.=28) groups. The subjects were matched by age and body mass index (BMI), generating 9 matched pairs in pubertal group I (Tanner stage 1), 11 pairs in group II (Tanner stages 2 and 3), and 8 pairs in group III (Tanner stages 4 and 5). Swimmers in pubertal groups II and III had significantly (both p<0.05) higher mean ghrelin levels than the controls (group II: 1126.8+/-406.0 vs 868.3+/-411.2 pg/ml; group III: 1105.5+/-337.5 vs 850.8+/-306.0 pg/ml, respectively), whereas no difference was seen in the pubertal group I (1230.8+/-386.0 vs 1272.7+/-424.4 pg/ml). Ghrelin was the most important hormonal determinant for total BMD and lumbar apparent volumetric BMD (BMAD) (R2=27.2% and R2=19.8%, respectively) in swimmers, whereas in control boys, plasma IGF-I was the most important hormonal predictor accounting for 41.8% of the variability of total BMD and 20.4% of the variability of lumbar BMAD. In conclusion, ghrelin concentration decreased during puberty in physically inactive boys, while in regularly physically active boys it remained relatively unchanged. Ghrelin appears to be an important hormonal predictor for BMD in physically active boys, while BMD is mostly determined by IGF-I in physically inactive boys.

Meal-related changes in ghrelin, peptide YY, and appetite in normal weight and overweight children

OBJECTIVE

Ghrelin and peptide YY (PYY) are two gut hormones that have effects on appetite. Our objectives were to characterize the patterns of secretion of these hormones in response to feeding in school-age children and determine whether there were differences between normal weight (NW) and overweight (OW) subjects.

METHODS AND PROCEDURES

This was a cross-sectional study at one tertiary care center. Subjects were 7- to 11-year-old healthy NW and OW volunteers recruited from local advertisements. Following an overnight fast, the subjects were given a standardized breakfast and lunch and had nine hourly blood samples for total ghrelin and total PYY. We assessed whether ghrelin and PYY levels changed from the preprandial to postprandial state and corresponded to reported hunger/satiety.

RESULTS

Hunger ratings were similar between the two groups throughout the study period. Ghrelin was not suppressed after eating, did not rise prior to the next meal, and did not correspond to hunger ratings in either group. PYY increased postprandially and decreased preprandially in the NW group, but OW children exhibited this pattern for only part of the day. PYY levels incompletely corresponded to reported satiety in the OW group.

DISCUSSION

Mixed meal consumption had little effect on ghrelin secretion and a variable effect on PYY secretion in young children in our study. Differences that were observed between the groups do not suggest that an abnormality in their secretion contributes to the development of obesity.

Safety, tolerability and pharmacokinetics of intravenous ghrelin for cancer-related anorexia/cachexia: a randomised, placebo-controlled, double-blind, double-crossover study

Twenty-one adult patients were randomised to receive ghrelin on days 1 and 8 and placebo on days 4 and 11 or vice versa, given intravenously over a 60-min period before lunch: 10 received 2 μg kg⁻¹ (lower-dose) ghrelin; 11 received 8 μg kg⁻¹ (upper-dose) ghrelin. Active and total ghrelin, growth hormone (GH), and insulin-like growth factor 1 levels were monitored at baseline (4–5 days before day 1), during treatment days, and at end of study (day 17/18). Drug-related adverse events (assessed by NCI-CTC-toxicity criteria and cardiac examination) did not differ between ghrelin and placebo. No grade 3/4 toxicity or stimulation of tumour growth was observed. The peak increase of GH, a biological marker of ghrelin action, was 25 ng ml⁻¹ with lower-dose and 42 ng ml⁻¹ with upper-dose ghrelin. Morning fasting total ghrelin levels were higher (P<0.05) for upper-dose patients at end of study (3580 pg ml⁻¹) than at baseline (990 pg ml⁻¹). Insulin-like growth factor 1 levels did not change. At day 8, 81% of patients preferred ghrelin to placebo as against 63% at the end of study. Nutritional intake and eating-related symptoms, measured to explore preliminary efficacy, did not differ between ghrelin and placebo. Ghrelin is well tolerated and safe in patients with advanced cancer. For safety, tolerance, and patients' preference for treatment, no difference was observed between the lower- and upper-dose group.

Regular Physical Activity Influences Plasma Ghrelin Concentration in Adolescent Girls

PURPOSE

We examined the effect of regular physical activity on plasma ghrelin concentration after onset of puberty in girls. In addition, we also examined the association of fasting plasma ghrelin concentration with various plasma biochemical, body composition, and aerobic capacity variables in healthy adolescent girls.

METHOD

Fifty healthy schoolgirls ages 11 to 16 yr were divided either into a physically active (N = 25) or a physically inactive (N = 25) group. The physically active group consisted of swimmers who had trained on an average of 6.2 +/- 2.0 h.wk(-1) for the last 2 yr, whereas the inclusion criterion for the physically inactive group was the participation in physical education classes only. The subjects were matched for age (+/- 1 yr) and body mass index (BMI; +/- 2 kg.m(-2)). Maturation I group (14 matched pairs) included pubertal stages 2 and 3, and maturation II group (11 matched pairs) included pubertal stages 4 and 5.

RESULTS

Physically active girls had significantly higher (P < 0.05) mean plasma ghrelin levels than the physically inactive girls (maturation I: 1152.1 +/- 312.9 vs 877.7 +/- 114.8 pg.mL(-1); maturation II: 1084.0 +/- 252.5 vs 793.4 +/- 164.9 pg.mL(-1)). Plasma ghrelin concentration was negatively related to percent body fat, fat mass, peak oxygen consumption per kilogram of body mass, leptin, estradiol, insulin, and insulin-like growth factor-I (IGF-I) (r > -0.298; P < 0.05). Multivariate linear regression analysis to determine the predictors of ghrelin concentration using the variables that were significantly associated with ghrelin concentration demonstrated that plasma IGF-I was the most important predictor of plasma ghrelin concentration (beta = -0.396; P = 0.008).

CONCLUSION

Regular physical activity influences plasma ghrelin concentrations in girls with different pubertal maturation levels. Plasma IGF-I concentration seems to be the main determinant of circulating ghrelin in healthy, normal-weight adolescent girls.

Impact of fatness, fitness, and ethnicity on the relationship of nocturnal ghrelin to 24-hour luteinizing hormone concentrations in adolescent girls

CONTEXT

Ghrelin is related to energy balance that regulates food intake.

OBJECTIVE

The aim was to explore whether ghrelin would be linked to differences in fitness in adolescent girls, whose menstrual cycles are sensitive to changes in energy balance.

METHODS

A total of 72 girls, ages 14-21 yr, including five with amenorrhea, were studied in the follicular phase. LH was sampled every 10 min over 24-h, and ghrelin was measured hourly between 2300 and 0300 h. Body composition was measured by dual x-ray absorptiometry. Fitness was characterized by reported frequency of exercise per week and by maximal oxygen consumption with "high" vs. "low" fitness groups defined from maximal oxygen consumption norms for this population. Data were analyzed with SAS software (SAS Institute Inc., Cary, NC).

RESULTS

Ghrelin was related to percent body fat (P = 0.038; R(2) 0.07), weekly exercise (P = 0.032; R(2) 0.07), and 24-h mean LH (P = 0.002; R(2) 0.13). The ghrelin relationship with LH was more pronounced in the low-fitness group. In multiple regression models, 24-h LH was an independent predictor of ghrelin after adjusting for percent body fat, fitness, exercise, or age. Ghrelin was higher in Caucasian girls than in African-American girls after adjusting for covariates at 0200 h (P = 0.017).

CONCLUSIONS

Twenty-four-hour LH is an independent predictor of nighttime ghrelin concentrations in postpubertal adolescent girls. Diverging patterns in ghrelin may reflect differences in exercise patterns and/or may be influenced by ethnicity. These data introduce ghrelin as a biomarker of individual differences in energy balance during the menstrual cycle and across ethnicities.

Ghrelin suppresses secretion of luteinizing hormone in humans

CONTEXT

Ghrelin affects the hypothalamic-pituitary-gonadal axis in various nonhuman mammalians, predominantly by suppressing secretion of LH. However, for humans, no such evidence exists.

OBJECTIVE

Our objective was to study the effect of ghrelin on secretion of LH and testosterone in humans.

DESIGN, PARTICIPANTS, AND INTERVENTION

Nocturnal (2000-0700 h) secretion profiles of LH and testosterone were determined in 10 healthy males (25.7 +/- 3.0 yr) twice, receiving 50 microg ghrelin or placebo at 2200, 2300, 2400, and 0100 h, in this single-blind, randomized, cross-over study.

RESULTS

Ghrelin was associated with significantly (P < 0.05) lower mean plasma levels of both LH (2340-0200 h) and testosterone (0040-0300 h) than placebo. LH peak levels of the pulse after first administration of ghrelin/placebo were significantly (P = 0.014) smaller in the ghrelin (2.98 +/- 1.34 mIU/ml) than in the placebo condition (4.37 +/- 1.09 mIU/ml). In addition, the interval between this and the preceding peak was significantly (P = 0.010) longer in the ghrelin (255.8 +/- 79.1 min) than in the placebo condition (190.8 +/- 51.0 min). Significantly (P = 0.005) more LH pulses occurred with placebo (3.2 +/- 0.75) than ghrelin (2.6 +/- 0.7) subsequent to ghrelin/placebo administration.

CONCLUSIONS

Ghrelin caused both a delay and suppression of the amplitude of LH pulses. These findings are in accordance with those in nonhuman mammalians.

Estro-progestin supplementation enhances the growth hormone secretory responsiveness to ghrelin infusion in postmenopausal women

OBJECTIVE

To assess the effects of estro-progestin supplementation on ghrelin-mediated GH release, we studied the consequence of ghrelin or saline injection before and after 60 days of hormone therapy or placebo administration in postmenopausal subjects.

DESIGN

A prospective double blind, placebo-controlled, and parallel cohort study.

SETTING

Catholic University of Sacred Heart, Operative Division of Endocrinological Gynecology.

PATIENT(S)

Eighteen postmenopausal women participated in the study.

INTERVENTION(S)

Ten women were randomized to receive estro-progestin treatment (2 mg of hemihydrate E(2) and 10 mg of dydrogesterone in a continuous sequential regimen); eight women were treated with placebo. All patients underwent in a randomized order a ghrelin test (1 microg/kg IV bolus) or a saline infusion (2-mL IV bolus) on two different days, before and after 60 days of treatment.

MAIN OUTCOME MEASURE(S)

Basal hormonal assays, including ghrelin basal levels. The GH levels were measured at baseline and after 15, 30, 60, 90 minutes of ghrelin or saline injection.

RESULT(S)

The acute ghrelin injection released a notable GH secretion in all postmenopausal women. After estro-progestin therapy the ghrelin-stimulated GH response was significantly higher than before treatment. In particular, the percent increase of ghrelin GH-releasing effect, expressed as incremental area under the curve (AUCi-GH) was more than 50% after hormone therapy.

CONCLUSION(S)

In postmenopausal women estro-progestin treatment clearly influenced the ghrelin-stimulated GH secretion.

Regulation of appetite in lean and obese adolescents after exercise: role of acylated and desacyl ghrelin

CONTEXT

Increased physical activity is an integral part of weight loss programs in adolescents. We hypothesized that exercise could affect appetite-regulating hormones and the subjective desire to eat, which could partly explain the poor success rate of the existing interventions.

OBJECTIVE

The objective of this study was to investigate prospectively the effects of exercise on acylated ghrelin (AG) and desacyl ghrelin (DG) concentrations and on appetite.

SETTING

The setting for this study was a tertiary care center.

PARTICIPANTS

Normal-weight [NW; body mass index (mean +/- se), 20.7 +/- 0.5 kg/m2] and overweight (OW; body mass index, 32.4 +/- 1.7) male adolescents (n = 17/group, age 15.3 +/- 0.2 yr) were studied.

INTERVENTION

Those studied participated in 5 consecutive days of aerobic exercise (1 h/d).

MAIN OUTCOME

Changes in AG and DG concentrations and in appetite during a test meal were studied.

RESULTS

Exercise did not significantly affect insulin sensitivity or body weight. Fasting total (AG and DG) ghrelin concentrations were lower in OW (600 +/- 33 pg/ml) compared with NW (764 +/- 33 pg/ml, P < 0.05) boys and were not affected by exercise. In contrast, there was a differential effect of exercise on both AG and DG (P <or= 0.019). AG significantly increased after exercise, and this increase was greater in NW compared with OW adolescents (P < 0.05). Higher AG concentrations were correlated with an increase in markers of appetite (P < 0.05).

CONCLUSION

Exercise differentially affects AG and DG in NW and OW male adolescents. Our data suggest that total ghrelin does not adequately reflect AG and DG concentrations and that the influence of exercise-induced hormonal changes should be considered to ensure success in weight management.

Relationship between ghrelin and anthropometrical, body composition parameters and testosterone levels in boys at different stages of puberty

The aim of this study was to investigate the relationships between fasting serum ghrelin concentration, anthropometrical and body composition data in boys at different pubertal stages. Sixty healthy non-obese Estonian schoolboys (10 to 18 yr) were divided into 3 groups based on Tanner classification--group I was prepubertal, group II included stages 2 and 3, and group III stages 4 and 5. Additionally, we analyzed subjects as a total group. Fasting ghrelin, leptin, testosterone, insulin and glucose were collected between 08:00 and 10:00 h. Body fat % and lean body mass (LBM) were determined by dual-energy X-ray absorptiometry. Fasting ghrelin decreased, while leptin and insulin did not change and testosterone increased during puberty. There was a negative correlation between serum ghrelin and testosterone concentrations in group II (r=-0.51, p<0.05) and in the total group (r=-0.59, p<0.001). Ghrelin was also related to body height, body mass and LBM in group II and total group also with body mass index in total group. Stepwise multiple regression analysis showed that body height from auxological, LBM from body composition and testosterone from biochemical data explained 38.1, 41.7 and 33.7% of the ghrelin variance in the total group, respectively. In conclusion, body height, LBM and serum testosterone are the major determinants of serum ghrelin among parameters studied. Negative correlation between serum ghrelin and testosterone concentrations indicates that ghrelin may also have a role in male pubertal development.

Effects of the IGF-I/IGFBP-3 complex on GH and ghrelin nocturnal concentrations in low birth weight children

OBJECTIVE

There is limited information regarding the effects of IGF-I and/or IGFBP-3 on circulating ghrelin concentrations. To determine the effects of IGF-I on GH and ghrelin concentrations, we examined the GH and ghrelin nocturnal profiles before and after the administration of the IGF-I/-IGFBP-3 complex (Iplex) to low birth weight children.

DESIGN

The children were studied on two separate occasions, the first under basal conditions, and the second time after the sc administration of 1 mg/kg of Iplex at 2100 h. Blood samples for determination of GH and ghrelin were obtained every 20 min between 2300 h and 0700 h, while the children were sleeping. In each patient, we calculated the mean GH and ghrelin area under the curve (GH AUC and GHR AUC), both under basal conditions and after the administration of the IGF-I/IGFBP-3 complex.

SETTING

The study was performed at a University Research Centre located at a General Hospital in Santiago, Chile.

PATIENTS

Twenty prepubertal children (11 boys and 9 girls), born after a full-term pregnancy with a birth weight below 2.8 kg were studied at a mean +/- SEM age of 7.3 +/- 0.5 years (range 4-11 years). Their mean height was -1.8 +/- 0.3 standard deviation score (SDS) and their mean BMI was 0.1 +/- 0.2 SDS at the time of the study.

MAIN OUTCOME AND RESULTS

Mean nocturnal GH AUC exhibited a significant decrease (2903 +/- 185 vs 1860 +/- 122 ng/ml min, P < 0.01), whereas mean GHR AUC showed a significant increase after administration of the IGF-I/IGFBP-3 complex (68 +/- 16 vs 288 +/- 36 ng/ml min, P < 0.01).

CONCLUSIONS

These findings indicate that the IGF-I/IGFBP-3 complex appears to have opposite effects on circulating GH and ghrelin concentrations in low birth weight children, suggesting that, in addition to its known negative feed-back effect on GH, IGF-I and/or IGFBP-3 may have a positive feed-back effect on ghrelin.

Estradiol potentiates ghrelin-stimulated pulsatile growth hormone secretion in postmenopausal women

CONTEXT

Ghrelin and an estrogen-rich milieu individually amplify pulsatile GH secretion by increasing the amount of hormone released per burst. However, how these distinct agonists interact in controlling pulsatile GH output is not known.

OBJECTIVE

The objective of the study was to test the hypothesis that elevated estradiol (E(2)) concentrations potentiate hypothalamo-pituitary responses to a near-physiological ghrelin stimulus.

DESIGN

This was a double-blind, placebo-controlled, prospectively randomized, parallel-cohort study.

SETTING

The study was conducted at an academic medical center.

SUBJECTS

Twenty-one postmenopausal women participated in the study.

INTERVENTIONS

Eleven subjects received placebo (Pl) and 10 others E(2) transdermally in escalating doses over 3 wk to mimic late follicular-phase E(2) concentrations. Saline or a submaximally stimulatory amount of ghrelin (0.3 microg/kg) was infused iv on separate randomly ordered mornings fasting after 17-21 d of Pl or E(2) administration.

OUTCOMES

Outcomes included serum concentrations of E(2), ghrelin, GH, IGF-I, IGF binding protein (IGFBP)-1 and IGFBP-3, and the estimated mass and waveform of stimulated GH secretory bursts.

RESULTS

Administration of E(2) yielded late follicular-phase E(2) concentrations. Compared with Pl, E(2) did not alter ghrelin concentrations but reduced IGF-I and IGFBP-3 and elevated IGFBP-1 concentrations. Compared with saline, ghrelin infusion amplified pulsatile GH secretion by 7.1-fold (P < 0.01). The effect of E(2) alone was 2.0-fold placebo and that of combined ghrelin/E(2) 10.4-fold (P < 0.01). Ghrelin and E(2) accelerated initial GH release individually but nonadditively by more than 2-fold (P < 0.01).

CONCLUSIONS

Estrogen augments ghrelin's near-physiological stimulation of pulsatile GH secretion and mimics ghrelin's acceleration of initial GH release. Thus, we hypothesize that estrogen and a GH secretagogue act via independent as well as convergent mechanisms.