Prolactin Response to a Submaximal Dose of Ghrelin in Different Phases of the Normal Menstrual Cycle

Background and Objectives: A similar secretory pattern of prolactin (PRL) and growth hormone (GH) during the menstrual cycle has been reported in response to a high dose of ghrelin in adult healthy women. The present study aimed to assess the pattern of PRL and GH secretions in response to a submaximal dose of ghrelin during different menstrual phases in adult healthy women. Materials and Methods: Eight female subjects with normal cyclicity were enrolled. These subjects were either in the early follicular (EF), late follicular (LF), or mid-luteal (ML) phase of their cycles. Each subject received an IV dose of normal saline (2 mL each time) during the first cycle after enrollment, followed by an IV dose of ghrelin (0.30 μg/kg bw) in the second cycle. The blood samples were collected before and after the IV dosage at -15, 0, 15, 30, 45, 60, 75, 90 and 120 min, where 0 min denotes the time of IV dosage. Results: All the enrolled subjects experienced ovulatory cycles as assessed by increased serum progesterone levels. Serum estradiol levels were significantly higher in the LF than in the EF (p < 0.001) and ML phases (p < 0.01); these levels were also significantly higher in the ML than in the EF phase (p < 0.01). The administration of saline did not affect serum GH or PRL levels. Following the administration of ghrelin, plasma ghrelin levels and serum GH levels increased significantly (p < 0.001). The response amplitude of GH was similar in the three stages of cycle 2. In contrast to GH, the ghrelin injection induced a significant increase in serum PRL levels only in the LF phase (p < 0.05). Conclusions: These results show, for the first time, a different pattern of PRL and GH in response to a submaximal dose of ghrelin during the normal menstrual cycle. It is suggested that the ghrelin threshold for pituitary lactotrophs is higher than for somatotrophs and that, unlike GH, ghrelin-stimulated PRL secretion can be influenced by ovarian steroids.

Ghrelin is associated with anti-mullerian hormone levels in Chinese systemic lupus erythematosus

PROBLEM

Ghrelin has been thought of as a potential link between energy homeostasis and fertility. The aim of this study was to evaluate levels of ghrelin in obese and non-obese systemic lupus erythematosus (SLE) patients, and to reveal a possible association between ghrelin and Anti-Mullerian hormone (AMH) in SLE patients.

METHOD OF STUDY

One hundred SLE patients (50 obese and 50 non-obese subjects) at childbearing age and 100 age-matched healthy controls (50 obese and 50 non-obese subjects) were included. Ghrelin and leptin were examined by enzyme-linked immunosorbent assay. AMH was tested through electrochemiluminescence. Demographics, clinical and laboratory indicators were obtained from medical records.

RESULTS

Ghrelin levels were significantly lower in obese SLE patients than non-obese SLE patients (P = .000) and obese controls (P = .002). Non-obese SLE patients and non-obese controls had similar ghrelin levels. Ghrelin levels were correlated positively with AMH (r = .2683, P = .0070) in SLE patients. And ghrelin were negatively associated with leptin (r = -.1969, P = .0496) and BMI (r = - .2401, P = .0161).

CONCLUSION

Our results provide evidence for a potential relationship between ghrelin and AMH in SLE patients, indicating that ghrelin may play a part in energy homeostasis and ovarian damage of SLE patients.

Integration of Circadian and Metabolic Control of Reproductive Function

Optimal fertility in humans and animals relies on the availability of sufficient metabolic fuels, information about which is communicated to the brain via levels of the hormones leptin and insulin. The circadian clock system is also critical; this input is especially evident in the precise timing of the female-specific surge of GnRH and LH secretion that triggers ovulation the next day. Chronodisruption and metabolic imbalance can both impair reproductive activity, and these two disruptions exacerbate each other, such that they often occur simultaneously. Kisspeptin neurons located in the anteroventral periventricular nucleus of the hypothalamus are able to integrate both circadian and metabolic afferent inputs and use this information to modulate the timing and magnitude of the preovulatory GnRH/LH surge. In an environment in which exposure to high caloric diets and chronodisruptors such as artificial night lighting, shift work, and transmeridian travel have become the norm, the implications of these factors for couples struggling to conceive deserve closer attention and more public education.

Pathophysiological features of development of functional hypothalamic amenorrhea in patients with anorexia nervosa

The energy deficit is the result of insufficient energy intake compared to its high costs. The development of energy deficiency is often associated with the desire to lose weight, a strict diet, as well as the woman's concern about her weight along with a change in eating behavior. The result of eating disorders in combination with a decrease in body weight is anorexia nervosa, accompanied by an energy deficit. Physiological changes occurring against a background of chronic energy deficiency contribute to the inclusion of compensatory mechanisms of energy conservation to provide vital physiological functions. The most frequent metabolic changes include hypoleptinemia in the presence of a decrease in the percentage of fat tissue, a decrease in triiodothyronine, and an increase in the concentrations of ghrelin, peptide YY and neuropeptide Y. The effect of energy and metabolic changes leads to suppression of the hypothalamic-pituitary-ovarian axis, gonadotropin releasing hormone secretion, with the subsequent suppression of the release of luteinizing and follicle stimulating hormones. The suppression of the hypothalamic-pituitary-ovarian axis leads to chronic estrogen deficiency, which is accompanied by the development of functional hypothalamic amenorrhea.

Submaximal doses of ghrelin do not inhibit gonadotrophin levels but stimulate prolactin secretion in postmenopausal women

OBJECTIVE

An inhibitory effect of ghrelin on gonadotrophin secretion has been reported in normally menstruating women possibly modulated by endogenous oestrogen. The aim of this study was to examine the effect of ghrelin on gonadotrophin and prolactin (PRL) secretion in oestrogen-deprived postmenopausal women.

DESIGN

Prospective intervention study.

PATIENTS AND MEASUREMENTS

Ten healthy postmenopausal volunteer women were studied during two 15-days periods of oestrogen treatment (A and B) a month apart. Four experiments (Exp) were performed in total, two on day 1 (Exp 1A and Exp 1B) and two on day 15 (Exp 15A and Exp 15B) of the two periods. The women received in Exp 1A and in Exp 15A two iv injections of ghrelin (0.15 μg/kg at time 0 minute and 0.30 μg/kg at time 90 minutes) and in Exp1B and in Exp 15B normal saline (2 mL), respectively. Blood samples were taken at -15, 0, 30, 60, 90, 120, 150 and 180 minutes.

RESULTS

After oestrogen treatment, late follicular phase serum oestradiol levels were attained on day 15 of periods A and B. Ghrelin administration did not affect serum levels of follicle-stimulating hormone (FSH) and luteinizing hormone (LH), whereas it increased significantly those of growth hormone (GH) and PRL. In Exp 15A, serum PRL increment in response to ghrelin (area under the curve, net increment) was significantly greater than in Exp 1A (P<.05).

CONCLUSIONS

This study demonstrates for the first time that in oestrogen-deprived postmenopausal women, ghrelin administration affects neither FSH nor LH levels but stimulates PRL secretion, that is amplified by exogenous oestrogen administration.

Ghrelin is independently associated with anti-mullerian hormone levels in obese but not non-obese women with polycystic ovary syndrome

Ghrelin is an endogenous appetite stimulant that may have a role in ovarian function. Women with polycystic ovary syndrome have anovulation and frequently weight management issues; however the associations between ghrelin and hormonal markers in polycystic ovary syndrome have not been well studied. In order to characterize the association between total ghrelin levels and ovarian function and the possible modification of this relationship by obesity, we examined total ghrelin levels and anti-mullerian hormone, total testosterone, and insulin in obese and non-obese women with and without polycystic ovary syndrome. Total ghrelin levels were lower in obese women with polycystic ovary syndrome (n = 45) compared to obese controls (n = 33) (p = 0.005), but similar in non-obese women with polycystic ovary syndrome (n = 20) compared to non-obese controls (n = 21) (p = NS). In the obese polycystic ovary syndrome group, anti-mullerian hormone was associated with ghrelin levels independent of age, insulin, and total testosterone (p = 0.008). There was no association between total ghrelin and anti-mullerian hormone levels in non-obese women with polycystic ovary syndrome, non-obese controls, or obese controls (p = NS). Our results provide evidence for a potential relationship between ghrelin and ovarian function in obese women with polycystic ovary syndrome that was not observed in non-obese women with polycystic ovary syndrome or controls.

The physiology of functional hypothalamic amenorrhea associated with energy deficiency in exercising women and in women with anorexia nervosa

An energy deficiency is the result of inadequate energy intake relative to high energy expenditure. Often observed with the development of an energy deficiency is a high drive for thinness, dietary restraint, and weight and shape concerns in association with eating behaviors. At a basic physiologic level, a chronic energy deficiency promotes compensatory mechanisms to conserve fuel for vital physiologic function. Alterations have been documented in resting energy expenditure (REE) and metabolic hormones. Observed metabolic alterations include nutritionally acquired growth hormone resistance and reduced insulin-like growth factor-1 (IGF-1) concentrations; hypercortisolemia; increased ghrelin, peptide YY, and adiponectin; and decreased leptin, triiodothyronine, and kisspeptin. The cumulative effect of the energetic and metabolic alterations is a suppression of the hypothalamic-pituitary-ovarian axis. Gonadotropin releasing hormone secretion is decreased with consequent suppression of luteinizing hormone and follicle stimulating hormone release. Alterations in hypothalamic-pituitary secretion alters the production of estrogen and progesterone resulting in subclinical or clinical menstrual dysfunction.

Effects of intracerebroventricular infusions of ghrelin on secretion of follicle-stimulating hormone in peripubertal female sheep

Reproduction depends on mechanisms responsible for the regulation of energy homeostasis and puberty is a developmental period when reproductive and somatic maturity are achieved. Ghrelin affects the activity of the hypothalamo–pituitary–gonadal axis under conditions of energy insufficiency. An in vivo model based on intracerebroventricular (i.c.v.) infusions was used to determine whether centrally administered acyl ghrelin affects transcriptional and translational activity of FSH in peripubertal lambs and whether ghrelin administration mimics the effects of short-term fasting. Standard-fed lambs received either Ringer–Lock (R-L) solution (120 µL h–1) or ghrelin (120 µL h–1, 100 µg day–1). Animals experiencing a short-term (72 h) fast were treated only with R-L solution. In each experimental group, i.c.v. infusions occurred for 3 consecutive days. Immunohistochemistry, in situ hybridisation and real-time reverse transcription quantitative polymerase chain reaction analyses revealed that short-term fasting, as well as exogenous acyl ghrelin administration to standard-fed peripubertal lambs, augmented FSHβ mRNA expression and immunoreactive FSH accumulation. In addition to the effects of ghrelin on FSH synthesis in standard-fed animals, effects on gonadotrophin release were also observed. Acyl ghrelin increased the pulse amplitude for gonadotrophin release, which resulted in an elevation in mean serum FSH concentrations. In conclusion, the present data suggest that ghrelin participates in an endocrine network that modulates gonadotrophic activity in peripubertal female sheep.

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.

Human ghrelin decreases pituitary response to GnRH in superovulated ewes

In addition to its metabolic role, ghrelin has been found to suppress luteinizing hormone secretion in many species acting mainly at the hypothalamic level. The objectives of the present study were to test the hypothesis that besides its effects on the hypothalamic level, ghrelin exerts a direct action on the pituitary. Twelve cycling ewes were synchronized, using progestagen intravaginal sponges and superovulated using eCG. At the time of sponge withdrawal, animals were allocated into two groups, ghrelin-treated (Gh) and control. Two days after the sponge removal, GnRH was given to synchronize ovulations. Simultaneously with GnRH treatment, animals of the Gh group received the first of four treatments of acylated human ghrelin at a dose of 6 μg/kg body weight iv; three additional treatments of ghrelin iv were given every 15 minutes thereafter. Control animals received saline iv. Blood samples were collected before challenge (-30 and 0 minutes) and at 30, 60, 75, 90, 105, 120, 135, 150, and 180 minutes after GnRH treatment, and were analyzed for LH, FSH, estradiol, progesterone, insulin, and insulin-like growth factor-I concentrations. Ghrelin treatment attenuated GnRH-induced a preovulatory surge of both gonadotrophins, with the effect being greater for LH. No difference was detected for insulin, estradiol, and progesterone concentrations, and insulin-like growth factor-I levels were increased in the Gh group. Our results imply that in sheep, ghrelin conducts specific regulatory effects on the GnRH/LH axis, and provide for the first time strong evidence that besides its central action, ghrelin might regulate gonadotrophin release acting at the pituitary level.

Clinical review: The human experience with ghrelin administration

CONTEXT

Ghrelin is an endogenous stimulator of GH and is implicated in a number of physiological processes. Clinical trials have been performed in a variety of patient populations, but there is no comprehensive review of the beneficial and adverse consequences of ghrelin administration to humans.

EVIDENCE ACQUISITION

PubMed was utilized, and the reference list of each article was screened. We included 121 published articles in which ghrelin was administered to humans.

EVIDENCE SYNTHESIS

Ghrelin has been administered as an infusion or a bolus in a variety of doses to 1850 study participants, including healthy participants and patients with obesity, prior gastrectomy, cancer, pituitary disease, diabetes mellitus, eating disorders, and other conditions. There is strong evidence that ghrelin stimulates appetite and increases circulating GH, ACTH, cortisol, prolactin, and glucose across varied patient populations. There is a paucity of evidence regarding the effects of ghrelin on LH, FSH, TSH, insulin, lipolysis, body composition, cardiac function, pulmonary function, the vasculature, and sleep. Adverse effects occurred in 20% of participants, with a predominance of flushing and gastric rumbles and a mild degree of severity. The few serious adverse events occurred in patients with advanced illness and were not clearly attributable to ghrelin. Route of administration may affect the pattern of adverse effects.

CONCLUSIONS

Existing literature supports the short-term safety of ghrelin administration and its efficacy as an appetite stimulant in diverse patient populations. There is some evidence to suggest that ghrelin has wider ranging therapeutic effects, although these areas require further investigation.

Ghrelin suppresses secretion of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) in women

CONTEXT

Ghrelin has been shown to suppress secretion of LH and, less regularly, of FSH in male and female animals and human males. However, no such evidence exists for human females.

OBJECTIVE

The aim was to study the effect of ghrelin on secretion of LH and FSH in women. DESIGN/PARTICIPANTS/INTERVENTION: Nocturnal (2000-0700 h) secretion profiles of LH and FSH were determined in six healthy women (age, 25.5±2.9 yr) twice, receiving 50 μg ghrelin or placebo at 2200, 2300, 2400, and 0100 h in this single-blind, randomized, crossover study.

RESULTS

LH secretion after ghrelin injection as assessed by the area under the curve (4.01±1.37 mIU/min·ml) was significantly (P=0.031) lower than after placebo injection (5.46±1.33 mIU/min·ml). Also, FSH secretion after ghrelin injection (5.54±0.64 mIU/min·ml) was significantly (P=0.038) lower than after placebo injection (5.87±0.56 mIU/min·ml). LH pulses occurred significantly (P=0.007) less frequently after ghrelin injection (2.3±0.5) than after placebo injection (3.8±0.9). Accordingly, the interval between first and second LH pulse after treatment was significantly (P=0.002) longer after ghrelin injection (300±86 min) than after placebo injection (187±60 min). One of the six women exhibited clear FSH pulses, which overall paralleled LH pulses; two FSH and LH pulses occurred after ghrelin injection, but three occurred after placebo in this woman.

CONCLUSIONS

This is the first report that ghrelin suppresses the secretion of LH and FSH in women. These findings resemble those in male and female animals and in men.

Role of ghrelin on estrogen and progesterone secretion in the adult rat ovary during estrous cycle

The objective of the present study was to evaluate the effects of ghrelin on the concentrations of estrogen (E(2)) and progesterone (P(4)) in serum and the mRNA expression of estrogen receptor beta (ER(β)) and progesterone receptor (PR(A+B)) in ovary in rats during estrous cycle. Adult female Sprague Dawley rats were intracerebroventricularly (i.c.v.) injected with 3 nmol ghrelin during the estrous cycle, and sacrificed 15 min later. Blood samples and ovaries were collected. The concentrations of serum E(2) and P(4) were measured by radioimmunoassay, while the amount of ER(β) and PR(A+B) mRNA was assessed by real-time quantitative PCR. Our studies showed that ghrelin could significantly reduce the serum concentration of E(2) throughout the estrous cycle (P < 0.05), the serum level of P(4) (P < 0.05), and the amount of ER(β) mRNA during metestrus (P < 0.05). Meanwhile, the amount of PR(A+B) mRNA was only reduced during diestrus (P < 0.05). Overall, our present findings provide the first evidence that i.c.v. injection of ghrelin could reduce the serum concentration of E(2) and P(4) and the level of ER(β) and PR(A+B) mRNA expression, supporting the role of ghrelin in reproduction.

Neuroendocrine and metabolic activities of ghrelin gene products

Acylated ghrelin (AG) is a 28 amino acid gastric peptide a natural ligand for the growth hormone secretagogue (GHS) receptor type 1a (GHS-R1a), endowed with GH-secreting and orexigenic properties. Besides, ghrelin exerts several peripheral metabolic actions, including modulation of glucose homeostasis and stimulation of adipogenesis. Notably, AG administration causes hyperglycemia in rodents as in humans. Ghrelin pleiotropy is supported by a widespread expression of the ghrelin gene, of GHS-R1a and other unknown ghrelin binding sites. The existence of alternative receptors for AG, of several natural ligands for GHS-R1a and of acylation-independent ghrelin non-neuroendocrine activities, suggests that there might be a complex 'ghrelin system' not yet completely explored. Moreover, the patho-physiological implications of unacylated ghrelin (UAG), and obestatin (Ob), the other two ghrelin gene-derived peptides, need to be clarified. Within the next few years, we may better understand the 'ghrelin system', where we might envisage clinical applications.

Effect of food restriction and intense physical training on estrous cyclicity and plasma leptin concentrations in rats

Intense physical training and dietary energy restriction have been associated with consequences such as nutritional amenorrhea. We investigated the effects of intense physical training, food restriction or the combination of both strategies on estrous cyclicity in female rats, and the relationship between leptin ad these effects. Twenty-seven female Wistar rats were distributed into four groups: SF: sedentary, fed ad libitum; SR: sedentary subjected to 50% food restriction (based on the food intake of their fed counterparts); TF: trained (physical training on a motor treadmill with a gradual increase in speed and time), fed ad libitum; TR: trained with 50% food restriction. We analysed estrous cyclicity, plasma leptin and estradiol as well as chemical composition of the carcass, body weight variation, and weight of ovaries and perirenal adipose tissue. Data demonstrate that physical training alone was not responsible for significant modifications in either carcass chemical composition or reproductive function. Food restriction reduced leptin levels in all animals and interrupted the estrous cyclicity in some animals, but only the combination of food restriction and physical training was capable of interrupting the estrous cyclicity in all animals. Leptin was not directly related to estrous cyclicity. From our findings, it may be concluded that there is an additive or synergistic effect of energy intake restriction and energy expenditure by intense physical training on estrous cyclicity. Leptin appears to be one among others factors related to estrous cycle, but it probably acts indirectly.

Homocysteine and ghrelin link with polcystic ovary syndrome in relation to obesity

AIM

Elevated levels of plasma homocysteine and depressed ghrelin levels have been found to be associated with insulin resistance in a number of clinical situations, such as polycystic ovary syndrome. This study was designed to determine the relationship of plasma homocysteine and ghrelin levels with obesity in polycystic ovary syndrome.

MATERIAL AND METHODS

Forty-four adolescents and young women (24 lean, 20 obese) 16-21 years old with polycystic ovary syndrome and age matched 20 healthy adolescents and young women were participated the study. Fasting samples were collected for serum vitamin B12, folate, plasma total homocysteine and ghrelin levels. Serum levels of follicle-stimulating hormone, luteinizing hormone, dehydroepiandrosterone sulfate, insulin, 17-hydroxyprogesterone, free testosterone, sex-hormone binding globulin were measured. Also, serum concentrations of total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides were determined. Oral glucose tolerance test was done, and HOMA-IR index was used to define insulin resistance.

RESULTS

Plasma total homocysteine levels were significantly higher in women with polycystic ovary syndrome and their plasma ghrelin levels were depressed compared to control group (P < 0.05). Obese adolescents with polycystic ovary syndrome had more depressed plasma ghrelin levels compared to lean ones (P < 0.05). Homocysteine levels didn't correlate with body mass index, but positively correlated with insulin resistance (P < 0.05).

CONCLUSION

Elevated plasma homocysteine levels in polycystic ovary syndrome was independent from obesity. Adversely ghrelin levels were depressed with polycystic ovary syndrome in relation to obesity.

Effect of ghrelin and metoclopramide on prolactin secretion in normal women

BACKGROUND

Administration of ghrelin to women stimulates the secretion of PRL but the mechanism is not known.

AIM

The aim of the study was to investigate the effect of the dopamine receptor blocker, metoclopramide, on ghrelin-induced PRL release.

SUBJECTS AND METHODS

Ten healthy normally cycling women were studied in the midluteal phase of 4 menstrual cycles. A single dose of normal saline (cycle 1), ghrelin (1 μg/kg) (cycle 2), metoclopramide (20 mg) (cycle 3), and ghrelin plus metoclopramide (cycle 4) was given to the women iv. Blood samples in relation to the iv injection (time 0) were taken at -15, 0, 15, 30, 45, 60, 75, 90, and 120 min. The response of PRL and GH was assessed.

RESULTS

Following ghrelin administration (cycles 2 and 4), plasma ghrelin and serum PRL and GH levels increased rapidly, peaking at 30 min (p<0.001). PRL was also increased after the injection of metoclopramide (p<0.001, cycle 3), but the increase was much greater than after the administration of ghrelin. The combination of ghrelin and metoclopramide stimulated PRL secretion to the same extent with metoclopramide alone. No changes in GH and PRL levels were seen after saline injection.

CONCLUSIONS

These results demonstrate that the stimulating effect of ghrelin on PRL secretion is not additive with that of metoclopramide, although a dose range study might provide further information.

Current and potential roles of ghrelin in clinical practice

Ghrelin is a novel GH-releasing peptide, which has been identified as an endogenous ligand for GH-secretagogue receptor. Ghrelin is mainly secreted by the stomach and plays a critical role in a variety of physiological processes including endocrine, metabolic, cardiovascular, immunological, and other actions. Ghrelin stimulates food intake via hypothalamic neurons and causes a positive energy balance and body weight gain by decreasing fat utilization and promoting adiposity. Given the multiple effects of ghrelin, its potential clinical applications have been evaluated in various conditions. Preliminary trials have shown that it may prove valuable in the management of disease-induced cachexia. Ghrelin may improve the wasting syndrome through GH-dependent or GH-independent effects. Moreover, ghrelin may play a role in the management of disorders of gut motility and obesity. Finally, other potential clinical applications of ghrelin include the treatment of patients with diabetes mellitus, infections, rheumatological diseases or GH deficiency and the diagnosis of this hormonal disorder.

Ghrelin: an emerging player in the regulation of reproduction in non-mammalian vertebrates

The endocrine regulation of vertebrate reproduction is achieved by the coordinated actions of multiple endocrine factors mainly produced from the brain, pituitary, and gonads. In addition to these, several other tissues including the fat and gut produce factors that have reproductive effects. Ghrelin is one such gut/brain hormone with species-specific effects in the regulation of mammalian reproduction. Recent studies have shown that ghrelin and ghrelin receptor mRNAs, and protein are expressed in the ovary and testis of mammals, indicating a direct effect for ghrelin in the control of reproduction. Ghrelin regulates mammalian reproduction by modulating hormone secretion from the brain and pituitary, and by acting directly on the gonads to influence reproductive tissue development and steroid hormone release. Based on the studies reported so far, ghrelin seems to have a predominantly inhibitory role on mammalian reproduction. The presence of ghrelin and ghrelin receptor has been found in the brain, pituitary and gonads of several non-mammalian vertebrates. In contrast to mammals, ghrelin seems to have a stimulatory role in the regulation of non-mammalian reproduction. The main objective of this review is to do a perspective analysis of the comparative aspects of ghrelin regulation of reproduction.

Ghrelin affects the hypothalamus-pituitary-thyroid axis in humans by increasing free thyroxine and decreasing TSH in plasma

OBJECTIVE

Ghrelin promotes a positive energy balance, e.g. by increasing food intake. Stimulation of the activity of the hypothalamus-pituitary-thyroid (HPT) axis promotes a negative energy balance, e.g. by increasing energy expenditure. We therefore hypothesized that ghrelin suppresses the HPT axis in humans, counteracting its energy-saving effect.

DESIGN AND METHODS

In this single-blind, randomized, cross-over study, we determined secretion patterns of free triiodothyronine (fT(3)), free thyroxine (fT(4)), TSH, and thyroid-binding globulin (TBG) between 2000 and 0700 h in 20 healthy adults (10 males and 10 females, 25.3+/-2.7 years) receiving 50 microg ghrelin or placebo at 2200, 2300, 0000, and 0100 h.

RESULTS

FT(4) plasma levels were significantly higher after ghrelin administration than after placebo administration from 0000 h until 0620 h except for the time points at 0100, 0520, and 0600 h. TSH plasma levels were significantly lower from 0200 until the end of the study at 0700 h except for the time points at 0540, 0600, and 0620 h. The relative increase of fT(4) (area under the curve (AUC) 0130-0700 h (ng/dl x min): placebo: 1.31+/-0.03; ghrelin: 1.39+/-0.03; P=0.001) was much weaker than the relative decrease of TSH (AUC 0130-0700 h (mIU/ml x min): placebo: 1.74+/-0.12; ghrelin: 1.32+/-0.12; P=0.007). FT(3) and TBG were not affected.

CONCLUSIONS

This is the first study to report that ghrelin affects the HPT axis in humans. The early fT(4) increase was possibly induced by direct ghrelin action on the thyroid where ghrelin receptors have been identified. The TSH decrease might have been caused by ghrelin-mediated inhibition at hypothalamic level by feedback inhibition through fT(4), or both.

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.

Ghrelin in female and male reproduction

Ghrelin and one of its functional receptors, GHS-R1a (Growth Hormone Secretagogue Receptor 1a), were firstly studied about 15 years. Ghrelin is a multifunctional peptide hormone that affects several biological functions including food intake, glucose release, cell proliferation… Ghrelin and GHS-R1a are expressed in key cells of both male and female reproductive organs in several species including fishes, birds, and mammals suggesting a well-conserved signal through the evolution and a role in the control of fertility. Ghrelin could be a component of the complex series of nutrient sensors such as adipokines, and nuclear receptors, which regulate reproduction in function of the energy stores. The objective of this paper was to report the available information about the ghrelin system and its role at the level of the hypothalamic-pituitary-gonadal axis in both sexes.

Growth hormone and prolactin response to ghrelin during the normal menstrual cycle

OBJECTIVE

It has been suggested that exogenous oestradiol augments ghrelin-induced growth hormone (GH) secretion in postmenopausal women. Whether endogenous oestrogens exert a similar effect during the normal menstrual cycle is not known. The aim of this study was to test the hypothesis that physiological changes in ovarian steroids during the normal menstrual cycle modulate GH and prolactin (PRL) response to ghrelin.

DESIGN

Healthy women were studied in three phases of the normal menstrual cycle.

PATIENTS

Ten healthy normally cycling women.

MEASUREMENTS

A single dose of ghrelin (1 microg/kg) was administered intravenously in the early and late follicular phases and in the mid-luteal phase of the cycle. Saline was injected in the preceding cycle. Blood samples were taken before ghrelin or saline injection (time 0) and also at -15, 15, 30, 45, 60, 75, 90 and 120 min. The GH and PRL responses were assessed.

RESULTS

Serum oestradiol and progesterone concentrations showed the variations of a normal menstrual cycle. After ghrelin administration, in the three phases of the cycle, plasma ghrelin and serum GH and PRL levels increased rapidly, peaking at 30 min and declining gradually thereafter (P < 0.001). There were no significant differences in the hormone levels between the three phases at all time points. No changes in GH and PRL levels were seen after saline injection.

CONCLUSIONS

These results demonstrate that GH and PRL responses to ghrelin do not change across the menstrual cycle. It is suggested that the action of ghrelin on the pituitary somatotrophs is modulated differentially by endogenous and exogenous ovarian steroids.