Cheyuo C, Jacob A, Wang P. Ghrelin-mediated sympathoinhibition and suppression of inflammation in sepsis. Am J Physiol Endocrinol Metab 302: E265-E272, 2012. First published November 8, 2011 doi:10.1152/ajpendo.00508.2011.-Sepsis, a systemic inflammatory response to infection, continues to carry a high mortality despite advances in critical care medicine. Elevated sympathetic nerve activity in sepsis has been shown to contribute to early hepatocellular dysfunction and subsequently multiple organ failure, resulting in a poor prognosis, especially in the elderly. Thus, suppression of sympathetic nerve activity represents a novel therapeutic option for sepsis. Ghrelin is a 28-amino acid peptide shown to inhibit sympathetic nerve activity and inflammation in animal models of tissue injury. Age-related ghrelin hyporesponsiveness has also been shown to exacerbate sepsis. However, the mechanistic relationship between ghrelin-mediated sympathoinhibition and suppression of inflammation remains poorly understood. This review assesses the therapeutic potential of ghrelin in sepsis in the context of the neuroanatomical and molecular basis of ghrelin-mediated suppression of inflammation through inhibition of central sympathetic outflow. sympathoexcitation; ventrolateral medulla; ␣ 2A-adrenergic receptor; norepinephrine DESPITE STRIDES IN CRITICAL CARE, the 751,000 annual cases of sepsis in the United States continue to be costly, causing 215,000 deaths, with an estimated economic burden of 16.7 billion dollars on the United States annually. Multiple organ failure, resulting in part from the deleterious effects of proinflammatory cytokines, is responsible for most deaths in sepsis (5,70). We discovered that norepinephrine released from the gut causes early hepatocellular dysfunction in sepsis by stimulating ␣ 2A -adrenoceptors on Kupffer cells, potentiating lipopolysaccharide (LPS)-stimulated NF-B-mediated cytokine release (56). The proinflammatory cytokines released by Kupffer cells contribute to multiple organ failure. Thus, suppression of sympathetic nerve activity and norepinephrine release represents a promising novel therapeutic approach to sepsis.Ghrelin is a stomach-derived 28-amino acid peptide that exerts anti-inflammatory effects in sepsis. Serum ghrelin levels are reduced during sepsis, and administration of exogenous ghrelin improves survival in sepsis (69,85,86). Ghrelin can act centrally to inhibit peripheral sympathetic nerve activity following tissue injury (67,73,87). However, the mechanisms of central ghrelin-mediated sympathoinhibition and how this translates into suppression of systemic inflammation in sepsis remain poorly understood. This review assesses the therapeutic potential of ghrelin in sepsis by discussing the neuroanatomical and molecular bases of ghrelin-mediated inhibition of central sympathetic outflow and the relation to suppression of inflammation and attenuation of tissue injury in sepsis. Guided by the current recommendations of the surviving sepsis campaign (19), we make suggestions for...