Bariatric Embolization for Suppression of the Hunger Hormone Ghrelin in a Porcine Model

Published Online:

Bariatric embolization can significantly suppress the appetite hormone ghrelin and significantly affect weight gain; our study represents an important step in the development of an image-guided intervention toward the treatment of obesity.


To prospectively test in a porcine model the hypothesis that bariatric embolization with commercially available calibrated microspheres can result in substantial suppression of systemic ghrelin levels and affect weight gain over an 8-week period.

Materials and Methods

The institutional animal care and use committee approved this study. Twelve healthy growing swine (mean weight, 38.4 kg; weight range, 30.3–47.0 kg) were evaluated. Bariatric embolization was performed by infusion of 40-μm calibrated microspheres selectively into the gastric arteries that supply the fundus. Six swine underwent bariatric embolization, while six control animals underwent a sham procedure with saline. Weight and fasting plasma ghrelin and glucose levels were obtained in animals at baseline and at weeks 1–8. Statistical testing for differences in serum ghrelin levels and weight at each time point was performed with the Wilcoxon signed rank test for intragroup differences and the Wilcoxon rank sum test for intergroup differences.


The pattern of change in ghrelin levels over time was significantly different between control and experimental animals. Weekly ghrelin levels were measured in control and experimental animals as a change from baseline ghrelin values. Average postprocedure ghrelin values increased by 328.9 pg/dL ± 129.0 (standard deviation) in control animals and decreased by 537.9 pg/dL ± 209.6 in experimental animals (P = .004). The pattern of change in weight over time was significantly different between control and experimental animals. The average postprocedure weight gain in experimental animals was significantly lower than that in control animals (3.6 kg ± 3.8 vs 9.4 kg ± 2.8, respectively; P = .025).


Bariatric embolization can significantly suppress ghrelin and significantly affect weight gain. Further study is warranted before this technique can be used routinely in humans.

© RSNA, 2012


  • 1 Druce MR, Small CJ, Bloom SR. Minireview: gut peptides regulating satiety. Endocrinology 2004;145(6):2660–2665. Crossref, MedlineGoogle Scholar
  • 2 Strader AD, Woods SC. Gastrointestinal hormones and food intake. Gastroenterology 2005;128(1):175–191. Crossref, MedlineGoogle Scholar
  • 3 Inui A, Asakawa A, Bowers CY, et al.. Ghrelin, appetite, and gastric motility: the emerging role of the stomach as an endocrine organ. FASEB J 2004;18(3):439–456. Crossref, MedlineGoogle Scholar
  • 4 Hayashida T, Murakami K, Mogi K, et al.. Ghrelin in domestic animals: distribution in stomach and its possible role. Domest Anim Endocrinol 2001;21(1):17–24. Crossref, MedlineGoogle Scholar
  • 5 Takiguchi S, Adachi S, Yamamoto K, et al.. Mapping analysis of ghrelin producing cells in the human stomach associated with chronic gastritis and early cancers. Dig Dis Sci 2012;57(5):1238–1246. Crossref, MedlineGoogle Scholar
  • 6 Maksud FA, Alves JS, Diniz MT, Barbosa AJ. Density of ghrelin-producing cells is higher in the gastric mucosa of morbidly obese patients. Eur J Endocrinol 2011;165(1):57–62. Crossref, MedlineGoogle Scholar
  • 7 Cummings DE, Shannon MH. Ghrelin and gastric bypass: is there a hormonal contribution to surgical weight loss? J Clin Endocrinol Metab 2003;88(7):2999–3002. Crossref, MedlineGoogle Scholar
  • 8 Hu Z, Cha SH, van Haasteren G, Wang J, Lane MD. Effect of centrally administered C75, a fatty acid synthase inhibitor, on ghrelin secretion and its downstream effects. Proc Natl Acad Sci U S A 2005;102(11):3972–3977. Crossref, MedlineGoogle Scholar
  • 9 Murray CD, Kamm MA, Bloom SR, Emmanuel AV. Ghrelin for the gastroenterologist: history and potential. Gastroenterology 2003;125(5):1492–1502. Crossref, MedlineGoogle Scholar
  • 10 Loftus TM, Jaworsky DE, Frehywot GL, et al.. Reduced food intake and body weight in mice treated with fatty acid synthase inhibitors. Science 2000;288(5475):2379–2381. Crossref, MedlineGoogle Scholar
  • 11 Wren AM, Small CJ, Abbott CR, et al.. Ghrelin causes hyperphagia and obesity in rats. Diabetes 2001;50(11):2540–2547. Crossref, MedlineGoogle Scholar
  • 12 Arepally A, Barnett BP, Montgomery E, Patel TH. Catheter-directed gastric artery chemical embolization for modulation of systemic ghrelin levels in a porcine model: initial experience. Radiology 2007;244(1):138–143. LinkGoogle Scholar
  • 13 Arepally A, Barnett BP, Patel TH, et al.. Catheter-directed gastric artery chemical embolization suppresses systemic ghrelin levels in porcine model. Radiology 2008;249(1):127–133. LinkGoogle Scholar
  • 14 Spurlock ME, Gabler NK. The development of porcine models of obesity and the metabolic syndrome. J Nutr 2008;138(2):397–402. Crossref, MedlineGoogle Scholar
  • 15 Kojima M, Hosoda H, Date Y, Nakazato M, Matsuo H, Kangawa K. Ghrelin is a growth-hormone-releasing acylated peptide from stomach. Nature 1999;402(6762):656–660. Crossref, MedlineGoogle Scholar
  • 16 Cummings DE, Purnell JQ, Frayo RS, Schmidova K, Wisse BE, Weigle DS. A preprandial rise in plasma ghrelin levels suggests a role in meal initiation in humans. Diabetes 2001;50(8):1714–1719. Crossref, MedlineGoogle Scholar
  • 17 Nakazato M, Murakami N, Date Y, et al.. A role for ghrelin in the central regulation of feeding. Nature 2001;409(6817):194–198. Crossref, MedlineGoogle Scholar
  • 18 Cummings DE, Weigle DS, Frayo RS, et al.. Plasma ghrelin levels after diet-induced weight loss or gastric bypass surgery. N Engl J Med 2002;346(21):1623–1630. Crossref, MedlineGoogle Scholar
  • 19 Frühbeck G, Diez Caballero A, Gil MJ. Fundus functionality and ghrelin concentrations after bariatric surgery. N Engl J Med 2004;350(3):308–309. Crossref, MedlineGoogle Scholar
  • 20 Tritos NA, Mun E, Bertkau A, Grayson R, Maratos-Flier E, Goldfine A. Serum ghrelin levels in response to glucose load in obese subjects post-gastric bypass surgery. Obes Res 2003;11(8):919–924. Crossref, MedlineGoogle Scholar
  • 21 Goldfine AB, Shoelson SE, Aguirre V. Expansion and contraction: treating diabetes with bariatric surgery. Nat Med 2009;15(6):616–617. Crossref, MedlineGoogle Scholar
  • 22 Chuang VP, Reuter SR. Selective arterial embolization for the control of traumatic splenic bleeding. Invest Radiol 1975;10(1):18–24. Crossref, MedlineGoogle Scholar
  • 23 Padia SA, Geisinger MA, Newman JS, Pierce G, Obuchowski NA, Sands MJ. Effectiveness of coil embolization in angiographically detectable versus non-detectable sources of upper gastrointestinal hemorrhage. J Vasc Interv Radiol 2009;20(4):461–466. Crossref, MedlineGoogle Scholar
  • 24 Rösch J, Keller FS, Kozak B, Niles N, Dotter CT. Gelfoam powder embolization of the left gastric artery in treatment of massive small-vessel gastric bleeding. Radiology 1984;151(2):365–370. LinkGoogle Scholar
  • 25 Lee HJ, Shin JH, Yoon HK, et al.. Transcatheter arterial embolization in gastric cancer patients with acute bleeding. Eur Radiol 2009;19(4):960–965. Crossref, MedlineGoogle Scholar
  • 26 Larsen MO, Rolin B. Use of the Göttingen minipig as a model of diabetes, with special focus on type 1 diabetes research. ILAR J 2004;45(3):303–313. Crossref, MedlineGoogle Scholar
  • 27 Sumithran P, Prendergast LA, Delbridge E, et al.. Long-term persistence of hormonal adaptations to weight loss. N Engl J Med 2011;365(17):1597–1604. Crossref, MedlineGoogle Scholar
  • 28 Beckman LM, Beckman TR, Earthman CP. Changes in gastrointestinal hormones and leptin after Roux-en-Y gastric bypass procedure: a review. J Am Diet Assoc 2010;110(4):571–584. Crossref, MedlineGoogle Scholar
  • 29 Beckman LM, Beckman TR, Sibley SD, et al.. Changes in gastrointestinal hormones and leptin after Roux-en-Y gastric bypass surgery. JPEN J Parenter Enteral Nutr 2011;35(2):169–180. Crossref, MedlineGoogle Scholar
  • 30 Perboni S, Inui A. Appetite and gastrointestinal motility: role of ghrelin-family peptides. Clin Nutr 2010;29(2):227–234. Crossref, MedlineGoogle Scholar
  • 31 Connor P. Gastric pacing. DOC News 2005;2(2):18. Google Scholar
  • 32 Cigaina V. Long-term follow-up of gastric stimulation for obesity: the Mestre 8-year experience. Obes Surg 2004;14(Suppl 1):S14–S22. Crossref, MedlineGoogle Scholar
  • 33 Hanusch-Enserer U, Cauza E, Brabant G, et al.. Plasma ghrelin in obesity before and after weight loss after laparoscopical adjustable gastric banding. J Clin Endocrinol Metab 2004;89(7):3352–3358. Crossref, MedlineGoogle Scholar
  • 34 Leonetti F, Silecchia G, Iacobellis G, et al.. Different plasma ghrelin levels after laparoscopic gastric bypass and adjustable gastric banding in morbid obese subjects. J Clin Endocrinol Metab 2003;88(9):4227–4231. Crossref, MedlineGoogle Scholar

Article History

Received January 30, 2012; revision requested April 10; revision received July 4; accepted July 26; final version accepted August 15.
Published online: Feb 2013
Published in print: Feb 2013