Ghrelin-induced hypothermia: A physiological basis but no clinical risk

Ghrelin increases food intake and decreases energy expenditure, promoting a positive energy balance. We observed a single case of serious hypothermia during sustained ghrelin treatment in a male subject, suggesting that ghrelin may play a role in the regulation of body temperature. We therefore investigated the effect of ghrelin treatment on body temperature in rodents and humans under controlled conditions. Intriguingly, we could demonstrate ghrelin binding in axon terminals of the medial preoptic area of the hypothalamus located in the vicinity of cold-sensitive neurons. This localization of ghrelin receptors provides a potential anatomical basis for the regulation of body temperature by ghrelin. However, our follow-up studies also indicated that neither a chronic i.c.v. application of ghrelin in rats, nor a single s.c. injection under cold exposure in mice resulted in a relevant decrease in body core temperature. In addition, a four-hour intravenous ghrelin infusion did not decrease body surface temperature in healthy humans. We concluded that while there is a theoretical molecular basis for ghrelin to modify body temperature in mammals, its magnitude is irrelevant under physiologic circumstances. Hypothermia is not likely to represent a serious risk associated with this agent and pathway.

Research highlights
► Severe hypothermia occurred in a cancer cachexia patient with repeated ghrelin treatment.
► Ghrelin binds to neurons in the hypothalamic MPOA, a key area in thermoregulation.
► Exogenous ghrelin administration in rodents did not cause hypothermia.
► Peripheral ghrelin infusion did not decrease body surface temperature in humans.
► The relevance of ghrelin binding to MPOA neurons for thermoregulation is still open.