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Inhibitory Effect of Exogenous Orexin A on Gastric Emptying, Plasma Leptin, and the Distribution of Orexin and Orexin Receptors in the Gut and Pancreas in Man

Division of Surgery (M.E., E.N.), Danderyd Hospital, Karolinska Institutet, Stockholm SE-182 88, Sweden; Departments of Clinical Chemistry (T.G.), Nuclear Medicine (P.G., H.J.), and Gastroenterology and Hepatology (P.M.H., A.F.), Karolinska University Hospital Solna, Karolinska Institutet, SE-171 76 Stockholm, Sweden; and NPS Pharmaceuticals (A.K.), Toronto, Ontario, Canada MSG 1K2

Address all correspondence and requests for reprints to: Marcus Ehrström, M.D., Department of Surgery, Danderyd Hospital, SE-182 88 Stockholm, Sweden. E-mail: marcus.ehrstrom{at}kir.ds.sll.se.

Orexin A (OXA) is a novel peptide that appears to play a role in the regulation of food intake, arousal, and energy balance. The aim of this study was to study the effect of iv infusion of OXA on gastric emptying, appetite, leptin, ghrelin, and glucose metabolism in man (six normal men) and the localization of OXA and orexin receptors (OXRs) 1 and 2 in the human gut. Gastric emptying was studied scintigraphically after ingestion of a ^99mTc-labeled omelet and iv infusion of OXA (10 pmol/kg·min). Appetite ratings and blood samples were obtained at regular intervals. The immunohistochemical distribution of OXA and OXRs was examined using antibodies recognizing OXA, OX1R, and OX2R in human gastrointestinal tissue. OXA had no effect on lag phase or gastric half-emptying time. However, the gastric emptying rate was significantly slower without affecting appetite ratings. Plasma concentrations of insulin were increased by OXA, whereas plasma leptin decreased and ghrelin was unchanged. OXA immunoreactivity was observed in a subset of neurons and varicose nerve fibers in the mucosa, ganglia, and circular muscle layer and mucosal endocrine cells in the stomach and small intestine. OXA-immunoreactive cells in the islets of Langerhans contained insulin with a subset expressing OX2R. In conclusion, peripheral OXA seems to slightly affect the regulation of gastric emptying in humans without affecting appetite ratings. OXA decreased plasma levels of leptin, suggesting a possible interaction between leptin and OXA in the regulation of energy homeostasis.

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