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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. OPEN ACCESS Citation: McMahon C, Trevaskis JL, Carter C, Holsapple K, White K, Das M, et al. (2020) 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 15(2): e0229617. https://doi.

The method was successfully employed to analyze clonidine DBS samples from an in-house toxicology study, where clonidine hydrochloride was administered to cynomolgus monkeys to produce hypotensive effects. Of 55 DBS samples collected post-dose, a total of 52 samples were within the curve range of 0.1-50 ng/ml, where valid clonidine PK profiles were obtained. The PK parameters agreed well with the onset of hemodynamic changes measured with implanted miniature telemetry blood pressure transmitters. In comparison, only 21 samples were within the curve range of 2 to 1000 ng/ml from a HILIC-MS/MS method, which limited useful injection volume to 5 µl.

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