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Ghrelin: integrative neuroendocrine peptide in health and disease.
Wu, JT, Kral, JG
Annals of surgery. 2004;(4):464-74
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Abstract
OBJECTIVE Ghrelin is a novel gastric hormone recognized in 1999 as a mediator of growth hormone release. Since growth hormone is anabolic, an important function of ghrelin may be to coordinate energy needs with the growth process. Newly discovered biologic roles of ghrelin imply that it may have other important physiological functions as well. This is a review of recent clinically relevant, yet less well-known, physiologic actions of ghrelin. SUMMARY BACKGROUND DATA Ghrelin has profound orexigenic, adipogenic, and somatotrophic properties, increasing food intake and body weight. Secreted predominantly from the stomach, ghrelin is the natural ligand for the growth hormone secretagogue receptor in the pituitary gland, thus fulfilling criteria of a brain-gut peptide. The brain-gut axis is the effector of anabolism by regulating growth, feeding, and metabolism via vagal afferents mediating ghrelin signaling. However, the wide tissue distribution of ghrelin suggests that it may have other functions as well. METHODS Systematic literature review of all PubMed citations between 1999 and August 2003 focusing on clinically relevant biochemical and physiological characteristics of ghrelin. RESULTS Ghrelin is an important component of an integrated regulatory system of growth and metabolism acting via the vagus nerve, and is implicated in a variety of altered energy states such as obesity, eating disorders, neoplasia, and cachexia. It also enhances immune responses and potentially down-regulates anti-inflammatory molecules. Ghrelin's role as a brain-gut peptide emphasizes the significance of afferent vagal fibers as a major pathway to the brain, serving the purpose of maintaining physiologic homeostasis. CONCLUSIONS The discovery of ghrelin has increased our understanding of feeding regulation, nutritional homeostasis, and metabolic processes. Further characterization of ghrelin's functions will likely generate new pharmacological approaches to diagnose and treat different disease entities including those related to the over-nutrition of obesity and the catabolic response to surgical trauma.
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Interactions between the enteric nervous system and the immune system: role of neuropeptides and nutrition.
Genton, L, Kudsk, KA
American journal of surgery. 2003;(3):253-8
Abstract
Neuropeptidergic synthesis occurs in enteric nerves and immune cells of the gut-associated lymphoid tissue. Lymphocytes, macrophages, mast cells, and intestinal epithelial cells are capable of responding to these neuropeptides. Neuropeptides generate proliferative or antiproliferative responses of mucosal lymphocytes and intestinal epithelial cells, affect cytokine production and immunoglobulin synthesis by immune cells, and control secretion of water and electrolytes. Some neuropeptides, particularly cholecystokinin, gastrin-releasing peptide, and neurotensin, appear promising to maintain mucosal immunity in patients who cannot receive enteral feeding during critical illness or after GI tract loss. Exogenous administration of neuropeptides to preserve normal immune defenses represents a potential new field of pharmacotherapeutics against bacterial invasion.