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, isolat ed from the stomach, that may also cause a positive energy balance by stimu lating food intake and inducing adiposity. We sought to investigate the pat hophysiology of ghrelin in the cachexia associated with chronic heart failu re (CHF). Methods and Results-Plasma ghrelin was measured in 74 patients with CHF and 12 control subjects, together with potentially important anabolic and cata bolic factors, such as GH and tumor necrosis factor (TNF-a). Patients with CHF were divided into two groups, those with cachexia (n=28) and those with out cachexia (n=46). Plasma ghrelin did not significantly differ between al l CHF patients and controls (181 +/- 10 versus 140 +/- 14 fmol/mL, P=NS). H owever, plasma ghrelin was significantly higher in CHF patients with cachex ia than in those without cachexia (237 +/- 18 versus 147 +/- 10 fmol/mL, P <0.001). Circulating GH, TNF-alpha, norepinephrine, and angiotensin 11 were also significantly higher in CHF patients with cachexia than in those with out cachexia. Interestingly, plasma ghrelin correlated positively with GH ( r=0.28, P <0.05) and TNF-alpha (r=0.3 1, 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, ass ociated with increases in GH and TNF-a and a decrease in body mass index. C onsidering ghrelin-induced positive energy effects, increased ghrelin may r epresent a compensatory mechanism under catabolic-anabolic imbalance in cac hectic patients with CHF.