Elevated circulating level of ghrelin in cachexia associated with chronic heart failure: relationships between ghrelin and anabolic/catabolic factors.
BACKGROUND
Ghrelin is a novel growth hormone (GH)-releasing peptide, isolated from the stomach, that may also cause a positive energy balance by stimulating food intake and inducing adiposity. We sought to investigate the pathophysiology of ghrelin in the cachexia associated with chronic heart failure (CHF).


RESULTS
Plasma ghrelin was measured in 74 patients with CHF and 12 control subjects, together with potentially important anabolic and catabolic factors, such as GH and tumor necrosis factor (TNF-alpha). Patients with CHF were divided into two groups, those with cachexia (n=28) and those without cachexia (n=46). Plasma ghrelin did not significantly differ between all CHF patients and controls (181+/-10 versus 140+/-14 fmol/mL, P=NS). However, plasma ghrelin was significantly higher in CHF patients with cachexia than in those without cachexia (237+/-18 versus 147+/-10 fmol/mL, P<0.001). Circulating GH, TNF-alpha, norepinephrine, and angiotensin II were also significantly higher in CHF patients with cachexia than in those without cachexia. Interestingly, plasma ghrelin correlated positively with GH (r=0.28, P<0.05) and TNF-alpha (r=0.31, P<0.05) and negatively with body mass index (r=-0.35, P<0.01).


CONCLUSIONS
Plasma ghrelin was elevated in cachectic patients with CHF, associated with increases in GH and TNF-alpha and a decrease in body mass index. Considering ghrelin-induced positive energy effects, increased ghrelin may represent a compensatory mechanism under catabolic-anabolic imbalance in cachectic patients with CHF.
Nagaya
N
N
Department of Internal Medicine, National Cardiovascular Center, Osaka, Japan. nagayann@hsp.ncvc.go.jp
Uematsu
M
M
Kojima
M
M
Date
Y
Y
Nakazato
M
M
Okumura
H
H
Hosoda
H
H
Shimizu
W
W
Yamagishi
M
M
Oya
H
H
Koh
H
H
Yutani
C
C
Kangawa
K
K
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000450:Aldosterone / Q000097:blood; D000804:Angiotensin II / Q000097:blood; D015992:Body Mass Index; D002100:Cachexia / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology*; D002908:Chronic Disease; D004734:Energy Metabolism; D005260:Female; D054439:Ghrelin; D013006:Growth Hormone / Q000097:blood; D006333:Heart Failure / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000097:blood; D036361:Peptide Hormones; D010455:Peptides / Q000097:blood*; D011237:Predictive Value of Tests; D012083:Renin / Q000097:blood; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism
D054439:Ghrelin; D036361:Peptide Hormones; D010455:Peptides; D014409:Tumor Necrosis Factor-alpha; D000804:Angiotensin II; D000450:Aldosterone; D013006:Growth Hormone; D012083:Renin; D009638:Norepinephrine