SESSION IV The Korean Journal of Pancreas and Biliary Tract 2014;19(Suppl. 1) 위장관호르몬과소화 동국대학교의과대학동국대학교일산병원내과 이준규 Gastrointestinal Hormones and Digestion Jun Kyu Lee Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea The digestive system contributes to homeostasis by regulating intake, breaking down and absorbing nutrients, where complicated neurohumoral pathways are involved. Secretion of gastrin, which belongs to the strongest secretogogues of gastric acid, is increased by peptides or amino acids from ingested proteins and inhibited by gastric inhibitory peptide. Cholecystikinin is produced by stimulation of fatty acids from fat or amino acids and induces secretion of bile and pancreatic enzymes. Secretin is released when the acidity of duodenal lumen is increased and a potent stimulator of pancreatic juice. Vasoactive intestinal peptide shares structural and functional similarities with secretin. Somatostatin inhibits production of a variety of gastrointestinal hormones and peptides and secretion of digestive juices. Recently, regulators of appetite such as ghrelin or peptide YY have been highlighted for their potential application in the treatment of obesity. Keywords: Digestion, Digestive system, Homeostasis, Hormone, Peptide 서론 (neurohumoral pathway) (peptide) (homeostasis). (foreign body) (enteroendocrine cell, EEC) (gastrin) (secretin) (blood stream), (homeostasis). (histamine) (serotonin) EEC (interstitial space) (diffusion) (paracrine), vasoactive intestinal peptide (VIP) substance P (neurocrine). (cholecystokinin, CCK), (motilin), (somatostatin). 1. 가스트린 Corresponding author : Jun Kyu Lee Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, 27 Dongguk-ro, Ilsandong-gu, Goyang 410-773, Korea Tel. +82-31-961-7750 Fax. +82-31-961-9309 E-mail; jeromee1971@yahoo.co.kr (gastric antrum), EEC G. (phenylalanine, Phy) http://www.kpba.kr 29
이준규 (tryptophan, Tryp), (parietal cell)., (vagal nerve) gastrin releasing peptide (GRP), Ca ++ (epinephrine)., (trophic action),. ph 3.0 G D. gastric inhibitory peptide (GIP),, VIP, (glucagon), (calcitonin). (gastrinoma, Zollinger-Ellison ) 200 ng/l. (pernicious anemia). 콜레시스토키닌 (CCK) CCK. (jejunum) I, I. (ileum) (neuron). CCK, Phy Tryp. (trypsin). CCK-releasing peptide (CCK-RP) (acinar cell) (monitor peptides). CCK,.,,. (pyloric sphincter) (gastric empting),. (trypsinogen) (enterokinase),.. CCK (positive feedback). CCK (digestive product), CCK.. 세크레틴 S. VIP, GIP,, 5. HCO - 3, CCK (acetylcholine). G. CCK. CCK. glucagon VIP. ph 4.5-5, (bile acid). (Met-enkephalin), secretin-releasing peptide (SRP).. HCO - 3. (magnetic resonance cholangiopancreatography, MRCP) (endoscopic ultrasonography, EUS). 2,3 30 The Korean Journal of Pancreas and Biliary Tract
Gastrointestinal Hormones and Digestion Vasoactive intestinal peptide (VIP) VIP. (myenteric) (submucosal plexus),.,,,. 2.,. (circular smooth muscle) (longitudinal). VIP (VIPoma) (achlorhydria). VIP 60-80% (neuroendocrine tumor), 10%. 4 Gastric inhibitory peptide (GIP) GIP K.. G.. GIP (islet cell).. 5 모틸린 M,. (interdigestive state) 90-100 (migrating motor complex, MMC). erythromycin. 소마토스타틴. 14 (growth hormone, GH) (GH inhibitory hormone, -14).,, D, 28 ( -28).,, VIP, GIP,.,,,.. (somatostatinoma),,. (somatostatin analogue) (octreotide),. 6 Pancreatic polypeptide family: Pancreatic polypeptide (PP), Peptide YY (PYY), Neuropeptide Y (NPY) Pancreatic polypeptide family pancreatic polypeptide (PP), peptide YY (PYY), neuropeptide Y (NPY), 36. PP PP,,,,. PYY (tyrosine, Y) (residue), 36 PYY 1-36 PYY 3-36. PYY L Session IV Digestion and Pancreatobiliary System 31
이준규,,,. NYP,.,. Substance P Substance P.. Substance P neurokinin-1 (NK-1),,. Aprepitant NK-1. 식욕조절관련호르몬및펩티드 : 그렐린 (ghrelin) 등. 7 (ghrelin),,,. GH (GH releasing hormone, GHRH) (synergism). (arcuate nucleus) NYP/ agouti-related protein (AgRP) GH-secretogogue-receptor 1a (GHS-R1a). 1-2. 1,.. ghrelin O-acyltransferase (GOAT). 8 PYY 3-36 NYP Y2 (Y2R), PYY 3-36 Y2R. 9-11 CCK, (agonist). 12,13 VIP. 14 결론및요약.,. GIP. CCK,.,. VIP.,,., PYY. 국문색인 : 소화, 위장관, 펩티드, 항상성, 호르몬 REFERENCES 1. 정인식. 소화관호르몬. 대한소화기학회지 1990;22:242-252. 2. Mensel B, Messner P, Mayerle J, et al. Secretin-stimulated MRCP in volunteers: assessment of safety, duct visualization, and pancreatic exocrine function. AJR Am J Roentgenol 2014;202:102-108. 3. Law R, Lopez R, Costanzo A, Parsi MA, Stevens T. Endoscopic pancreatic function test using combined secretin and cholecystokinin stimulation for the evaluation of chronic pancreatitis. Gastrointestinal Endoscopy 2012;75:764-768. 4. Fraker DL, Norton JA. The role of surgery in the management of islet 32 The Korean Journal of Pancreas and Biliary Tract
Gastrointestinal Hormones and Digestion cell tumors. Gastroenterol Clin North Am 1989;18:805-830. 5. Elahi D, Andersen DK, Brown JC, et al. Pancreatic alpha- and beta-cell responses to GIP infusion in normal man. Am J Physiol 1979;237:E185-191. 6. 이우진. 위장관호르몬및췌장내분비종양. In: 김정룡소화기계질환. 제3판. 2011:1064-1079. 7. 조영혜, 이상엽. 음식섭취와위장관호르몬. 대한비만학회지 2013;22:197-204. 8. Barnett BP, Hwang Y, Taylor MS, et al. Glucose and weight control in mice with a designed ghrelin O-acyltransferase inhibitor. Science 2010;330:1689-1692. 9. Batterham RL, Cowley MA, Small CJ, et al. Gut hormone PYY(3-36) physiologically inhibits food intake. Nature 2002;418:650-654. 10. Batterham RL, Cohen MA, Ellis SM, et al. Inhibition of food intake in obese subjects by peptide YY3-36. N Engl J Med 2003;349:941-948. 11. Abbott CR, Small CJ, Kennedy AR, et al. Blockade of the neuropeptide Y Y2 receptor with the specific antagonist BIIE0246 attenuates the effect of endogenous and exogenous peptide YY(3-36) on food intake. Brain Res 2005;1043:139-144. 12. Covasa M, Marcuson JK, Ritter RC. Diminished satiation in rats exposed to elevated levels of endogenous or exogenous cholecystokinin. Am J Physiol Regul Integr Comp Physiol 2001;280:R331-337. 13. Irwin N, Frizelle P, Montgomery IA, Moffett RC, O Harte FP, Flatt PR. Beneficial effects of the novel cholecystokinin agonist (pglu- Gln)-CCK-8 in mouse models of obesity/diabetes. Diabetologia 2012;55:2747-2758. 14. Ghourab S, Beale KE, Semjonous NM, et al. Intracerebroventricular administration of vasoactive intestinal peptide inhibits food intake. Regul Pept 2011;172:8-15. Session IV Digestion and Pancreatobiliary System 33