Two forms of ghrelin, acylated and desacyl, circulate in plasma. Although acylation is thought to be essential for ghrelin biological activities, recent studies have suggested that desacyl ghrelin may also possess biological activity. A new commercial ELISA system has now enabled us to measure plasma levels of each of these two ghrelin forms separately. This assay system directly measures levels using small amounts of plasma. To evaluate the utility of this assay system, we measured the plasma levels of the two forms of ghrelin in healthy volunteers. Although acylated ghrelin levels were equivalent to those measured previously by RIA, desacyl ghrelin levels were lower than those expected from the total ghrelin levels previously determined by RIA. The ratios of acylated to desacyl ghrelin significantly correlated with previously determined acylated, but not desacyl, ghrelin levels. After BMI adjustment, the levels of acylated, but not desacyl, ghrelin plasma levels were higher in female subjects than those in males. Several metabolic and hormonal parameters significantly correlated with either plasma acylated or desacyl ghrelin levels. These findings indicate that separate measurements of the two ghrelin form levels may provide valuable information on their structure, gender differences, and physiological implications.
The correlation of circulating acylated ghrelin levels with the subjective symptom score and the A/D ratio in FD patients suggest that acylated ghrelin may play a role in the pathophysiology of FD.
The prevalence of IBS among medical outpatients in Japan is high (31%). IBS subjects among medically ill patients are thought to have more perceived stress and less regular life styles.
Background: Ghrelin plays a major role in the regulation of food intake (FI), which makes it a strong candidate for the treatment of anorexia. Objective: We attempted to evaluate the clinical response to repeated ghrelin administration in patients with anorexia caused by functional disorders, such as functional dyspepsia (FD). Subjects and methods: Subjects included in this study were those who 1) were diagnosed with functional anorexia, including FD and other eating disorders with the exception of anorexia nervosa; 2) were lean (body mass index (BMI)!22 kg/m 2 ); and 3) exhibited decreased FI. Subjects received an i.v. infusion of ghrelin (3 mg/kg) for 30 min twice a day (before breakfast and dinner) for 2 weeks. We investigated the effects of ghrelin administration on FI, appetite, hormones, and metabolic parameters. Results: Six patients with FD were enrolled in this study. Ghrelin administration tended to increase daily FI in comparison with levels before and after completion of treatment, but this difference that was the primary endpoint of this study did not reach statistical significance (PZ0.084). Hunger sensation was significantly elevated at the end of drip infusion (P!0.0001). No severe adverse effects were observed. Conclusions: These results suggest that ghrelin administration is safe and that this treatment has stimulatory effects on appetite in patients with FD. Further studies are necessary to confirm the efficacy of ghrelin treatment for anorexia-related disorders.
Emotional awareness and somatic interoceptive awareness are essential processes for human psychosomatic health. A typical trait of lacking emotional awareness related to psychosomatic symptoms is alexithymia. In contrast, alexisomia refers to the trait of lacking somatic awareness. Links between emotional and somatic awareness and homeostatic processing are also significant for the psychosomatic health. The purpose of the present paper is to review the links among emotional awareness, somatic interoceptive awareness and autonomic homeostatic processing. On the basis of the collected evidence, the following arguments were presented1: (1) The main subcortical neural substrates for these processes are limbic-related systems, which are also responsible for autonomic functions for optimization of homeostatic efficiency. (2) Considerable studies have shown that autonomic activity and/or reactivity to stress correlate with both emotional and interoceptive awareness. A hypothesis was advocated about the links between the two types of awareness and autonomic function: Autonomic dysfunction, especially high sympathetic tone at baseline and/or attenuated reactivity or variability to stress, appears to be involved in disturbance of emotional and interoceptive awareness. (3) Several studies suggest that a link or a cooperative relationship exists between emotional and somatic awareness, and that somatic awareness is the more fundamental of the two types of awareness. Emotional awareness, somatic awareness and autonomic homeostatic processing generally occur in parallel or concurrently. However, some complex features of pathologies include coexistence of reduced interoceptive awareness and somatosensory amplification. The autonomic homeostatic process is fundamentally involved in emotional and somatic awareness. Investigation of these types of awareness with both neuroimaging evaluations and estimation of peripheral autonomic function are required as next steps for exploration of the relationship between awareness and human somatic states including somatic symptoms as well as general psychosomatic health.
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