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This is caused by an imbalance between factors that relax the endothelium, such as nitric oxide (NO), prostacyclin (PGI 2 ), and down regulation of endothelioum-dependent hyperpolarization (EDH) and factors that cause contraction such as thromboxane A 2 (TxA 2 ) and upregulation of endothelin-1 (ET-1)

However, these two hexapeptides have no similarities with ghrelin in terms of structure, as highlighted by the work of Bowers et al in 2012

Short-term effects of metformin and myo-inositol in women with polycystic ovarian syndrome (PCOS): a meta-analysis of randomized clinical trials

Leo F et al (2021) Red blood cell and endothelial eNOS independently regulate circulating nitric oxide metabolites and blood pressure