Endocannabinoids and ghrelin are potent appetite stimulators and are known to interact at a hypothalamic level. However, both also have important peripheral actions, including beneficial effects on the ischemic heart and increasing adipose tissue deposition, while ghrelin has direct effects on carbohydrate metabolism. The AMP-activated protein kinase (AMPK) is a heterotrimeric enzyme that functions as a fuel sensor to regulate energy balance at both cellular and whole body levels, and it may mediate the action of anti-diabetic drugs such as metformin and peroxisome proliferator-activated receptor ␥ agonists. Here we show that both cannabinoids and ghrelin stimulate AMPK activity in the hypothalamus and the heart, while inhibiting AMPK in liver and adipose tissue. These novel effects of cannabinoids on AMPK provide a mechanism for a number of their known actions, such as the reduction in infarct size in the myocardium, an increase in adipose tissue, and stimulation of appetite. The beneficial effects of ghrelin on heart function, including reduction of myocyte apoptosis, and its effects on lipogenesis and carbohydrate metabolism, can also be explained by its ability to activate AMPK. Our data demonstrate that AMPK not only links the orexigenic effects of endocannabinoids and ghrelin in the hypothalamus but also their effects on the metabolism of peripheral tissues.Endocannabinoids, acting via the presynaptic cannabinoid type 1 receptor (CB 1 ), 1 stimulate appetite in the hypothalamus(1), but direct peripheral effects have also been observed in animal studies implicating endocannabinoids in peripheral signaling of nutritional status and lipogenesis (2). The CB 1 antagonist rimonabant (SR141716) inhibits food intake, and phase III clinical trials have shown sustained effects on weight loss in humans through effects on glucose and fat metabolism (3-5).Ghrelin is a circulating brain-gut peptide with growth hormone-releasing and appetite-inducing effects, with predominant expression in the gastric mucosa but low level widespread expression throughout the body (6 -8). Intracerebroventricular (i.c.v.) ghrelin treatment increases appetite and body weight, with a direct stimulatory effect on adipose tissue deposition demonstrated in both in vivo and in vitro studies (9, 10). It has been suggested that ghrelin favors preservation of lipid stores and the catabolism of carbohydrate-derived fuel, thereby increasing the respiratory quotient (11, 12). Ghrelin levels are high during fasting and in subjects with low body mass index, while low ghrelin levels are observed after food intake and in patients with insulin-resistant states such as type 2 diabetes, obesity, or polycystic ovarian syndrome (8). Both cannabinoids and ghrelin have been shown to have beneficial effects on the ischemic heart (13, 14). We have previously shown that ghrelin and the endocannabinoid system interact, as subanorectic doses of rimonabant can inhibit the orexigenic effect of ghrelin (15). Here we demonstrate a previously unrecognized interaction betw...