Ghrelin synergizes with growth hormone-releasing hormone (GHRH) to potentiate growth hormone (GH) response through a mechanism not yet fully characterized. This study was conducted to analyze the role of GHRH as a potential ligand of the ghrelin receptor, GHS-R1a. The results show that hGHRH(1-29)NH 2 (GHRH) induces a dose-dependent calcium mobilization in HEK 293 cells stably transfected with GHS-R1a an effect not observed in wildtype HEK 293 cells. This calcium rise is also observed using the GHRH receptor agonists JI-34 and JI-36. Radioligand binding and cross-linking studies revealed that calcium response to GHRH is mediated by the ghrelin receptor GHS-R1a. GHRH activates the signaling route of inositol phosphate and potentiates the maximal response to ghrelin measured in inositol phosphate turnover. The presence of GHRH increases the binding capacity of 125 I-ghrelin in a dose dependent-fashion showing a positive binding cooperativity. In addition, confocal microscopy in CHO cells transfected with GHS-R1a tagged with enhanced green fluorescent protein shows that GHRH activates the GHS-R1a endocytosis. Furthermore, the selective GHRH-R antagonists, JV-1-42 and JMR-132, act also as antagonists of the ghrelin receptor GHS-R1a. Our findings suggest that GHRH interacts with ghrelin receptor GHS-R1a, and, in consequence, modifies the ghrelin-associated intracellular signaling pathway. This interaction may represent a form of regulation, which could play a putative role in the physiology of GH regulation and appetite control.Ghrelin ͉ Ghrelin receptor ͉ GHRH T he recognition of ghrelin as the natural ligand for the growth hormone secretagogue receptor type 1a (GHS-R1a) added a new element to the complex physiological regulation for growth hormone (GH) secretion and clarified some of its aspects that were previously not fully understood (1, 2). However, this system is not as simple as it was initially thought. Ghrelin and its receptor became recognized not only for stimulating GH release but also for the findings that they exert an important role on several aspects of energy homeostasis and perhaps contribute to the metabolic syndrome (3, 4). One of the peculiar features of ghrelin and GH secretagogues (GHS) is the synergistic relationship with growth hormone-releasing hormone (GHRH) in the release of GH (5Ϫ7). The mechanism of this synergistic interaction remains a subject of debate in view of the fact that ghrelin and GHS act on both the hypothalamus and the pituitary. The evidence that this interaction requires a functional hypothalamus was obtained from patients with tumoral mass producing a hypothalamoϪpituitary disconnection in whom GH secretion is preserved after GHRH stimulation while GHS/ghrelin-induced GH secretion is blocked and the synergistic action between GHRH and GHS is absent (8, 9). Similar findings were observed in children with neonatal stalk transection (10). These observations led to the hypothesis that the action of ghrelin/GHS is mediated through an unknown hypothalamic factor with GHreleasi...