Dear Editor,
I have read the article by Hakeem et al. [1]: “Cirrhosis in Werner’s syndrome: An unusual presentation of premature aging”.The authors described to a 25-year-old man who presented a history of Werner’s syndrome (W S ) since the age of 16 years. A rare form of progeria, or premature aging [2]. Thereby, I would like to comment our personal experience with omental transplantation on the optic chiasma and rejuvenation, in a 82-year-old man [3].
On July 1990, Rudman and associated [4] published for the first time their clinical discovery about the rejuvenation following the subcutaneous administration of biosynthetic human growth hormone (HGH ) (somatotropin ).They observed that after the use of HGH for six months to 12 healtly men from 61 to 81 years old, the HGH injections reverted the anging process of 10 to 20 years. Clinical findings suggestive that the symptoms associated with aging are caused by a decline of HGH levels in our bodies. Later on, another authors [5,6] have supported these results and concluded that the somatotropin can delay and reverse the aging process. In other words, there is a direct correlation between decreasing HGH levels and the effects of aging, especially after the 30 years of age.
Although an autosomal recessive disorder in the etiology of WS has received attention [2,7]; I think that the “natural biological process “ of aging may serve as model to explain the premature aging in patients with WS. So therefore, based on clinical [4–6] and neurosurgical [3] findings, I have postulated that the aging process is caused initially by progressive ischemia in the producing hypothalamic nuclei of growth hormone-releasing hormone (GHRH ) and later on, ischemic injury may affect to another hypothalamic nuclei [8,9] and surrounding areas [10]; due to atherosclerotic plaques located at the mouths of the anterior perforating arteries originated from the supraclinoid carotids and circle of Willis [3,8,9].
Previous studies have demonstrated that about 25 to 30 years of age, there are a parallelism decreasing between the cerebral blood flow, the daily secretion of somatotropin by the adenohypophysis, the serum HGH levels, and the appearance of atherosclerotic plaques in the supraclinoid carotids and its branches [3,8]. For these reasons, I believe that the human aging is initiated by progressive ischemia in the producing hypothalamic nuclei of GHRH (Figure 1), because, in contrast to this, its revascularization by means of omental tissue produced rejuvenation [3].Characterized by progressive rejuvenation in the hair, skin texture, energy level, body fat loss, muscle strength,memory improvement and increase of libido/sexual potency among another changes.
In conclusion, these clinical and neurosurgical onservations suggest that the “normal aging “ and the WS, both of them are caused by progressive ischemia in the producing hypothalamic nuclei of GHRH. The first, due basically to atherosclerotic changes in the supraclinoid carotids, whereas the WS is related,possibly, with anomalies at the internal carotid arteries and/or its branches.
Sincerelly,
Hernando Rafael

References:
1. Hakeem A, Reza SH, Moinuddin S et al: Cirrhosis in Werner’s syndrome: An unusual presentation of premature aging. Med Sci Monit, 2007; 13(5): CS61–66
2. Tsianakas A, Müller FB, Hunzelmann N, Kuwert C: Werner’s syndrome. Dtsch Med Wochenschr, 2007; 132: 91–94
3. Rafael H: Rejuvenation after omental transplantation on the optic chiasma and carotid bifurcation. Case Rep Clin Pract Rev, 2006; 7(2): 48–51, www.crcpr-online.com
4. Rudman D, Feller AG, Nagraf HS et al: Effects of human growth hormone in men over 60 years old. N Engl J Med, 1990; 323: 1–6
5. Kerckoff H: Manejo de la somatotropina sintética como terapia anti-envejecimiento. Rev Climaterio, 2004; 7(42): 245–49, www.revistasmedicasmexicanas.com.mx
6. Verhoeven HC: Growth hormone replacement therapy: Is it safe? The Aging Male, 2005; 8(2): 121–22 (Abstract)
7. Nehlin J, Skogaard GL,Bohr VA: The Werner syndrome: A model for the study of human aging. Ann NY Acad Sci, 2000; 908: 167–79
8. Rafael H, Mego R, Moromizato P et al: Omental transplantation for type 2 diabetes mellitus: A report of two cases. Case Rep Clin Pract Rev, 2004; 5: 481–86
9. Rafael H: Neurogenic hypertension. J Neurosurg, 2003; 99: 1117–18 (Letter)
10. Rafael H: Cerebral atherosclerosis and oxidative stress in some challenging diseases. J Neurol Sci (Turk), 2004; 21(4): 343–49, www.jns.dergisi.org

Keywords: Adolescent, Aged, 80 and over, Aging, atherosclerosis, Growth Hormone - secretion, Hypothalamus - pathology, Ischemia - pathology, Models, Biological, Progeria - pathology