Journal of Neurology

, Volume 258, Issue 6, pp 982–990 | Cite as

Postprandial ghrelin response is reduced in patients with Parkinson’s disease and idiopathic REM sleep behaviour disorder: a peripheral biomarker for early Parkinson’s disease?

  • Marcus M. Unger
  • Jens C. Möller
  • Katharina Mankel
  • Karla M. Eggert
  • Katharina Bohne
  • Maren Bodden
  • Karin Stiasny-Kolster
  • Peter H. Kann
  • Geert Mayer
  • Johannes J. Tebbe
  • Wolfgang H. Oertel
Original Communication


Ghrelin, an orexigenic peptide, has multiple functions, which include promoting gastrointestinal motility and influencing higher brain functions. Experimental data suggest that ghrelin has neuroprotective potential in the MPTP mouse model of Parkinson’s disease (PD). PD patients show delayed gastric emptying and other symptoms that may relate to disturbed excretion of ghrelin. No data are available on postprandial ghrelin response in patients with PD and idiopathic REM sleep behaviour disorder (iRBD)––a condition considered a putative preclinical stage of PD. We measured fasting and postprandial ghrelin serum concentrations in 20 healthy controls, 39 (including 19 drug-naïve) PD patients and 11 iRBD patients using a commercial radioimmunoassay for total ghrelin. For statistical analysis we employed ANCOVA and post-hoc testing with Bonferroni’s method. Controls showed a decrease of mean fasting ghrelin serum concentrations in the early postprandial phase, followed by a recuperation starting 60 min after the test meal and reaching a maximum at 300 min. This recuperation was less pronounced in PD and iRBD; the slope of relative postprandial ghrelin recovery was different between the investigated groups (p = 0.007). Post-hoc testing showed a difference between controls and PD patients (p = 0.002) and between controls and iRBD patients (p = 0.037). The dynamic regulation of ghrelin in response to food intake is partially impaired in subjects at putative preclinical (iRBD) and clinical stages of PD. Reduced ghrelin excretion might increase the vulnerability of nigrostriatal dopaminergic neurons as suggested by animal studies. The impaired ghrelin excretion might qualify as a peripheral biomarker and be of diagnostic or therapeutic value.


Parkinson’s disease REM sleep behaviour disorder (RBD) Ghrelin Vagal innervation, biomarker 



This work was supported by a grant from the Michael J. Fox Foundation for Parkinson’s Research, USA (to M.M.U. and W.H.O.) and by resources of the BMBF-founded “Competence Network Parkinson”, Germany (to K.M.E. and W.H.O.).

Conflict of interest

All authors declare that there are no financial or personal relationships with other people or organisations that could inappropriately influence this work. The authors declare that there is no conflict of interest regarding this work.

Supplementary material

415_2010_5864_MOESM1_ESM.docx (52 kb)
Blood glucose levels in mg/dl over the time of assessment. Mean total blood glucose levels (in mg/dl) and the respective 95%-confidence intervals for each time point of assessment are given for healthy controls, PD patients and iRBD patients. (DOCX 53 kb)
415_2010_5864_MOESM2_ESM.docx (74 kb)
Habitual breakfast times of enrolled subjects. Fig. S2 shows the mean habitual breakfast time and the respective 95% confidence intervals for healthy controls, iRBD patients as well as for drug-naïve and treated PD patients that could be retrospectively contacted by telephone. The percentage and the absolute number of subjects in each group that could be re-contacted by telephone to obtain this information are given in brackets. Habitual breakfast times were similarly distributed between the groups and the majority of enrolled subjects in each group reported their habitual breakfast time to be around the time of the test meal. (DOCX 73 kb)


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Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Marcus M. Unger
    • 1
  • Jens C. Möller
    • 1
    • 2
  • Katharina Mankel
    • 1
  • Karla M. Eggert
    • 1
  • Katharina Bohne
    • 3
  • Maren Bodden
    • 1
  • Karin Stiasny-Kolster
    • 1
  • Peter H. Kann
    • 4
  • Geert Mayer
    • 5
  • Johannes J. Tebbe
    • 3
    • 6
  • Wolfgang H. Oertel
    • 1
  1. 1.Department of NeurologyPhilipps-Universität MarburgMarburgGermany
  2. 2.Neurocentro della Svizzera Italiana, Clinical Trials UnitOspedale Regionale di LuganoLuganoSwitzerland
  3. 3.Division of GastroenterologyPhilipps-University MarburgMarburgGermany
  4. 4.Division of Endocrinology and DiabetologyPhilipps-University MarburgMarburgGermany
  5. 5.Department of NeurologyHephata-Clinic Schwalmstadt-TreysaSchwalmstadt-TreysaGermany
  6. 6.Deparment of Internal Medicine, Division of GastroenterologyKlinikum LippeDetmoldGermany

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