Lack of an association between clinical INSTI-related body weight gain and direct interference with MC4 receptor (MC4R), a key central regulator of body weight

PLoS One. 2020 Feb 28;15(2):e0229617. doi: 10.1371/journal.pone.0229617. eCollection 2020.

Abstract

An increasing prevalence of overweight and obesity in people living with HIV has been associated with initiation of antiretroviral therapy with integrase strand transfer inhibitors (INSTIs). An off-target inhibition of the endogenous ligand binding to the human melanocortin 4 receptor (MC4R) has been suggested as a potential mechanism for clinical body weight gain following initiation of dolutegravir, an INSTI. In this study, we interrogated several INSTIs for their capacity for antagonism or agonism of MC4R in an in vitro cell-based assays including at concentrations far exceeding plasma concentrations reached at the recommended dosages. Our results indicate that while INSTIs do exhibit the capacity to antagonize MC4R, this occurs at concentrations well above predicted clinical exposure and is thus an implausible explanation for INSTI-associated weight gain.

MeSH terms

  • Body Weight
  • HIV Infections / drug therapy
  • HIV Integrase Inhibitors / adverse effects*
  • HIV Integrase Inhibitors / pharmacology
  • HIV Integrase Inhibitors / therapeutic use
  • Humans
  • Receptor, Melanocortin, Type 4 / agonists
  • Receptor, Melanocortin, Type 4 / antagonists & inhibitors
  • Receptor, Melanocortin, Type 4 / drug effects*
  • Weight Gain / drug effects*

Substances

  • HIV Integrase Inhibitors
  • MC4R protein, human
  • Receptor, Melanocortin, Type 4

Grants and funding

The funder (Gilead Sciences) provided support in the form of salaries for all authors, but did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The specific roles of these authors are articulated in the ‘author contributions’ section.