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Setmelanotide-mediated MC4R activation improves hypothalamic obesity via CaMKK2/AMPK pathways

Title: Setmelanotide-mediated MC4R activation improves hypothalamic obesity via CaMKK2/AMPK pathways
Authors: Junjie Peng; Yichao Ou; Mingfeng Zhou; Xingqin Wang; Xi’an Zhang; Hao Long; Guangsen Wu; Mengjie Che; Kai Li; Le Yang; Zhu Zhang; Ken Kin Lam Yung; Songtao Qi; Zhanpeng Feng
Source: Frontiers in Pharmacology, Vol 16 (2026)
Publisher Information: Frontiers Media S.A., 2026.
Publication Year: 2026
Collection: LCC:Therapeutics. Pharmacology
Subject Terms: CaMKK2/AMPK signaling; GPCRs; hypothalamic obesity; melanocortin 4 receptor; neuropharmacology; setmelanotide; Therapeutics. Pharmacology; RM1-950
Description: Hypothalamic obesity (HO) is a disabling disease caused by central nervous system (CNS) damage due to neurosurgery, trauma, or tumors, especially in hypothalamus. The pathological mechanism of its neural circuits is still unclear, and there is currently no corresponding drug due to the complex etiology. G protein-coupled receptors (GPCRs) regulate neural function in many CNS diseases. Among them, melanocortin 4 receptor (MC4R) regulate metabolism and appetite in the hypothalamus. Setmelanotide, an MC4R agonist, has demonstrated anti-obesity effects in genetic forms of obesity; however, its efficacy and mechanisms in HO remain unexplored. This study explored the potential of treating HO by setmelanotide-targeted activation of MC4R in the paraventricular nucleus (PVN). We established a rat hypothalamic injury model to replicate human HO symptoms, such as hyperphagia (50% increase in food intake), elevated Lee index, and more than 25% weight gain. Immunofluorescence and immunoblot analysis showed that HO disrupted the PVN neuropeptides, leading to the inhibition of MC4R via calmodulin-dependent protein kinase kinase 2 (CaMKK2) and AMP-activated protein kinase (AMPK) signaling. Crucially, administration of setmelanotide restored CaMKK2/AMPK activity, reactivated MC4R neurons, and normalized appetite and feeding behavior during fasting-refeeding and the long-term treatment of obese rats (60% reduction in food intake), ultimately reversing obesity (23% weight loss). These findings underscore the critical role of MC4R dysfunction in hypothalamic injury and highlight the strategies to pharmacologically activate MC4R via CaMKK2/AMPK signaling to restore metabolic homeostasis, proposing a translatable therapeutic agent to manage obesity caused by CNS injury.
Document Type: article
File Description: electronic resource
Language: English
ISSN: 1663-9812
Relation: https://www.frontiersin.org/articles/10.3389/fphar.2025.1730786/full; https://doaj.org/toc/1663-9812
DOI: 10.3389/fphar.2025.1730786
Access URL: https://doaj.org/article/ccd0059dcafe4616b902fcf0e5f0c39d
Accession Number: edsdoj.0059dcafe4616b902fcf0e5f0c39d
Database: Directory of Open Access Journals