Early-set POMC methylation variability is accompanied by increased risk for obesity and is addressable by MC4R agonist treatment

Abstract

Increasing evidence points toward epigenetic variants as a risk factor for developing obesity. We analyzed DNA methylation of the <i>POMC</i> (pro-opiomelanocortin) gene, which is pivotal for satiety regulation. We identified sex-specific and nongenetically determined <i>POMC</i> hypermethylation associated with a 1.4-fold (confidence interval, 1.03 to 2.04) increased individual risk of developing obesity. To investigate the early embryonic establishment of <i>POMC</i> methylation states, we established a human embryonic stem cell (hESC) model. Here, hESCs (WA01) were transferred into a naïve state, which was associated with a reduction of DNA methylation. Naïve hESCs were differentiated via a formative state into POMC-expressing hypothalamic neurons, which was accompanied by re-establishment of DNA methylation patterning. We observed that reduced <i>POMC</i> gene expression was associated with increased <i>POMC</i> methylation in <i>POMC</i>-expressing neurons. On the basis of these findings, we treated <i>POMC</i>-hypermethylated obese individuals (<i>n</i> = 5) with an MC4R agonist and observed a body weight reduction of 4.66 ± 2.16% (means ± SD) over a mean treatment duration of 38.4 ± 26.0 weeks. In summary, we identified an epigenetic obesity risk variant at the <i>POMC</i> gene fulfilling the criteria for a metastable epiallele established in early embryonic development that may be addressable by MC4R agonist treatment to reduce body weight.