GHRL and polycystic ovary syndrome: However, in disease states, gut microbiota and satiety mediators as ghrelin have different effects; in patients with polycystic ovary syndrome, ghrelin levels were negatively correlated with chronic inflammation-related gram-negative bacteria as Bacteroides, Escherichia/Shigella and Blautia species, and positively correlated with Akkermansia species, which are involved in maintaining intestinal integrity [61].