Publicaciones científicas

Ghrelin Reduces TNF-α-Induced Human Hepatocyte Apoptosis, Autophagy, and Pyroptosis: Role in Obesity-Associated NAFLD

01-ene-2019 | Revista: The Journal of Clinical Endocrinology and Metabolism

Ezquerro S (1,2), Mocha F (1), Frühbeck G (1,2,3), Guzmán-Ruiz R (2,4), Valentí V (2,5), Mugueta C (6), Becerril S (1,2), Catalán V (1,2), Gómez-Ambrosi J (1,2), Silva C (2,3), Salvador J (2,3), Colina I (7), Malagón MM (2,4), Rodríguez A (1,2).

(1) Metabolic Research Laboratory, Clínica Universidad de Navarra, Pamplona, Spain.
(2) CIBER Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain.
(3) Department of Endocrinology & Nutrition, Clínica Universidad de Navarra, Pamplona, Spain.
(4) Department of Cell Biology, Physiology, and Immunology, Instituto Maimónides de Investigación Biomédica, University of Córdoba, Reina Sofía University Hospital, Córdoba, Spain.
(5) Department of Surgery, Clínica Universidad de Navarra, Pamplona, Spain.
(6) Department of Biochemistry, Clínica Universidad de Navarra, Pamplona, Spain.
(7) Department of Internal Medicine, Clínica Universidad de Navarra, Pamplona, Spain.


Human obesity is associated with increased circulating TNF-α, a proinflammatory cytokine that induces hepatocyte cell death.


The potential beneficial effects of acylated and desacyl ghrelin in the progression of nonalcoholic fatty liver disease (NAFLD) to nonalcoholic steatohepatitis in obesity via the inhibition of TNF-α-induced hepatocyte apoptosis, autophagic cell death, and pyroptosis were investigated.

Design, Settings, and Participants:

Plasma ghrelin isoforms and TNF-α were measured in 158 participants, and hepatocyte cell death was evaluated in liver biopsies from 76 patients with morbid obesity undergoing bariatric surgery with available liver echography and pathology analysis. The effect of acylated and desacyl ghrelin on basal and TNF-α-induced cell death was determined in vitro in human HepG2 hepatocytes.


Circulating TNF-α and the acylated/desacyl ghrelin ratio were increased, whereas desacyl ghrelin levels were decreased in patients with obesity and NAFLD. Six months after bariatric surgery, decreased acylated/desacyl ghrelin levels, and improved hepatic function were found. Patients with obesity and type 2 diabetes showed increased hepatic ghrelin O-acyltransferase transcripts as well as an increased hepatic apoptosis, pyroptosis, and compromised autophagy. In HepG2 hepatocytes, acylated and desacyl ghrelin treatment reduced TNF-α-induced apoptosis, evidenced by lower caspase-8 and caspase-3 cleavage, as well as TUNEL-positive cells and pyroptosis, revealed by decreased caspase-1 activation and lower high-mobility group box 1 expression. Moreover, acylated ghrelin suppressed TNF-α-activated hepatocyte autophagy, as evidenced by a decreased LC3B-II/I ratio and increased p62 accumulation via AMPK/mTOR.


Ghrelin constitutes a protective factor against hepatocyte cell death. The increased acylated/desacyl ghrelin ratio in patients with obesity and NAFLD might constitute a compensatory mechanism to overcome TNF-α-induced hepatocyte apoptosis, autophagy, and pyroptosis.

CITA DEL ARTÍCULO J Clin Endocrinol Metab. 2019 Jan 1;104(1):21-37. doi: 10.1210/jc.2018-01171