Cancer-Associated Hypercalcemia Signals Through the Hindbrain to cause Anorexia

Abstract

Hypercalcemia, caused by tumor secretion of parathyroid hormone-related protein (PTHrP), is associated with anorexia and weight loss. We demonstrate that overexpression of PTHrP by tumor cells in a transgenic model of breast cancer causes anorexia and rapid weight loss. These changes are accompanied by activation of neurons in the area postrema (AP), the nucleus tractus solitarius (NTS) and the parabrachial nucleus (PBN), a hindbrain circuit regulating food intake. Blocking hypercalcemia prevents anorexia and activation of these brain centers in tumor bearing mice, whereas injecting calcium activates the same circuit in wild-type mice. Neurons in the AP express the calcium-sensing receptor (CaSR) and the same AP/NTS/PBN circuit is stimulated by treating WT mice with cinacalcet, an allosteric activator of the CaSR. Finally, treating diet-induced obese mice with cinacalcet reduces food intake and causes weight loss. These results suggest that CaSR-expressing neurons in the AP might be a pharmacologic target for obesity.