Method of treating melanocortin-4 receptor pathway-associated disorders

1. A method of treating a disorder in a subject in need thereof, comprising:

administering an agonist of the melanocortin-4 receptor (MC4R) at a daily dosage of about 0.1 mg to about 10 mg wherein the disorder comprises

a disorder characterized by a hypermethylated POMC gene

and

wherein the agonist is a structure of Formula (I):

(R 2 R 3 )-A 1 - c (A 2 -A 3 -A 4 -A 5 -A 6 -A 7 -A 8 -A 9 )-A 10 -R 1   (I),

wherein:

A 1 is Acc, HN—(CH 2 ) m —C(O), L- or D-amino acid, or deleted;

A 2 is Cys, D-Cys, hCys, D-hCys, Pen, D-Pen, Asp, or Glu;

A 3 is Gly, Ala, β-Ala, Gaba, Aib, D-amino acid, or deleted;

A 4 is His, 2-Pal, 3-Pal, 4-Pal, Taz, 2-Thi, 3-Thi, or (X 1 , X 2 , X 3 , X 4 , X 5 )Phe;

A 5 is D-Phe, D-1-Nal, D-2-Nal, D-Trp, D-Bal, D-(X 1 , X 2 , X 3 , X 4 , X 5 )Phe, L-Phe or D-(Et)Tyr;

A 6 is Arg, hArg, Dab, Dap, Lys, Orn, or HN—CH((CH 2 ) n —N(R 4 R 5 ))—C(O);

A 7 is Trp, 1-Nal, 2-Nal, Bal, Bip, D-Trp, D-2-Nal, D-Bal or D-Bip;

A 8 is Gly, D-Ala, Acc, Ala, 13-Ala, Gaba, Apn, Ahx, Aha, HN—(CH 2 ) s —C(O), or deleted;

A 9 is Cys, D-Cys, hCys, D-hCys, Pen, D-Pen, Dab, Dap, Orn, or Lys;

A 10 is Acc, HN—(CH 2 ) t —C(O), L- or D-amino acid, or deleted;

R 1 is OH or NH 2 ;

each of R 2 and R 3 is, independently for each occurrence, selected from the group consisting of H, (C 1 -C 30 )alkyl, (C 1 -C 30 )heteroalkyl, (C 1 -C 30 )acyl, (C 2 -C 30 )alkenyl, (C 2 -C 30 )alkynyl, aryl(C 1 -C 30 )alkyl, aryl(C 1 -C 30 )acyl, substituted (C 1 -C 30 )alkyl, substituted (C 1 -C 30 )heteroalkyl, substituted (C 1 -C 30 )acyl, substituted (C 2 -C 30 )alkenyl, substituted (C 2 -C 30 )alkynyl, substituted aryl(C 1 -C 30 )alkyl, and substituted aryl(C 1 -C 30 )acyl;

each of R 4 and R 5 is, independently for each occurrence, H, (C 1 -C 40 )alkyl, (C 1 -C 40 )heteroalkyl, (C 1 -C 40 )acyl, (C 2 -C 40 )alkenyl, (C 2 -C 40 )alkynyl, aryl(C 1 -C 40 )alkyl, aryl(C 1 -C 40 )acyl, substituted (C 1 -C 40 )alkyl, substituted (C 1 -C 40 )heteroalkyl, substituted (C 1 -C 40 )acyl, substituted (C 2 -C 40 )alkenyl, substituted (C 2 -C 40 )alkynyl, substituted aryl(C 1 -C 40 )alkyl, substituted aryl(C 1 -C 40 )acyl, (C 1 -C 40 )alkylsulfonyl, or —C(NH)—NH 2 ;

m is, independently for each occurrence, 1, 2, 3, 4, 5, 6 or 7;

n is, independently for each occurrence, 1, 2, 3, 4 or 5;

s is, independently for each occurrence, 1, 2, 3, 4, 5, 6, or 7;

t is, independently for each occurrence, 1, 2, 3, 4, 5, 6, or 7;

X′, X 2 , X 3 , X 4 , and X 8 each is, independently for each occurrence, H, F, Cl, Br, I, (C 1-10 )alkyl, substituted (C 1-10 )alkyl, (C 2-10 )alkenyl, substituted (C 2-10 )alkenyl, (C 2-10 )alkynyl, substituted (C 2-10 )alkynyl, aryl, substituted aryl, OH, NH 2 , NO 2 , or CN.

2. The method of claim 1 , wherein the daily dosage is 0.1 mg to 10 mg.

3. The method of claim 1 , comprising administering the agonist in a unit dosage suitable for injection.

4. The method of claim 1 , wherein the subject is obese or hyperphagic.

5. The method of claim 1 , wherein the subject:

has failed one or more previous therapies prior to administration of the agonist or at the time of the first administration.

6. The method of claim 1 , wherein administration of the agonist results in one or more of:

(i) a reduction of weight in the subject compared to the weight of the subject before treatment of about 1 kg to 3 kg after 1 week of treatment, or about 1 kg to 6 kg after 2 weeks of treatment, or about 2 kg to 12 kg after 4 weeks of treatment, or about 4 kg to 24 kg after 8 weeks of treatment, or about 8 kg to 48 kg after 16 weeks of treatment;

(ii) weight loss in the subject at a rate of about 1-2 kg/week;

(iii) hunger level in the subject compared to the hunger level of the subject before treatment;

(iv) no detectable/significant decrease in resting energy expenditure (REE) in the subject, as compared to a control REE;

(v) an increase in resting energy expenditure (REE) in the subject, as compared to a control REE;

(vi) a reduction in food intake by the subject compared to a control, wherein the food intake is daily food intake or food intake over a period of 24 hours, or one week;

(vii) a reduction in food intake of at least 100 kilocalories compared to a control, wherein the food intake is daily food intake or food intake over a period of 24 hours;

(viii) a reduction in waist circumference of at least 2 in the subject compared to a control, as measured 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 weeks or more after initiation of treatment;

(ix) no detectable increase in blood pressure of the subject compared to the blood pressure of the subject prior to treatment, as measured 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 weeks or more after initiation of treatment;

(x) a reduction in blood pressure of the subject compared to the blood pressure of the subject prior to treatment, as measured 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 weeks or more after initiation of treatment;

(xi) a reduction in systolic blood pressure of the subject of at least 3 mmHg compared to the blood pressure of the subject prior to treatment, as measured 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 weeks or more after initiation of treatment; and

(xii) a reduction in diastolic blood pressure of the subject of at least 4 mmHg compared to the blood pressure of the subject prior to treatment, as measured 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 weeks or more after initiation of treatment.

7. The method of claim 1 , wherein the subject is a mammal.

8. The method of claim 1 , wherein the agonist is Ac-Arg-c(Cys-D-Ala-His-D-Phe-Arg-Trp-Cys)-NH 2 (SEQ ID NO: 140).