The overarching goal of our study was to develop a high translational value rodent behavioral assay, that supports the development of new chemogenetic systems in various CNS indications, offering a simple but robust in vivo efficacy readout to straightforwardly prove the effectiveness of any new chemogenetic constructs. Additionally, we were aiming to utilize the same assay to provide a simple way to estimate the basic pharmacokinetic properties of systemically applied actuator drugs. Finally, we also aimed to provide the first human translatable in vivo POC validating the therapeutic potential of chemogenetic treatments in obesity indication.
We utilized exenatide as a food-intake-reducing reference drug to validate the human relevance of our model and to prove the translational power and predictability of our results. Exenatide is presumed to primarily promote weight loss in humans by reducing food consumption [21, 22], via acting as a mimetic of glucagon-like peptide 1 (GLP-1). Accordingly, the reported exenatide-induced robust food-intake-reducing effects (Fig. 1) validated the current preclinical model and proved its high translational value and human relevance.
We hereby demonstrated that several methodological parameters could affect the overall biological effectiveness of chemogenetic methods, including the serotype of the applied AAV viruses, the characteristics of the actuator drug, including its brain penetration, pharmacokinetic/pharmacodynamic properties, dose, and application route (i.e., oral or parenteral). From the currently investigated several parameters, we identified the AAV9 serotype, and DCZ with s.c. application, as the most effective combination of factors, producing a robust food intake decrease in rats comparable to the effects of exenatide (Fig. 3/C). Nevertheless, the AAV5 serotype, DCZ with oral application, and CNO were also shown to be significantly effective, but with a slightly weaker efficacy (Fig. 2, Fig. 3). We also noticed that with all applied combinations of experimental parameters, the first 30-min food intake (after re-feeding) provided the greatest effect, therefore this seems to be the most ideal experimental endpoint. We also demonstrated that with different actuator pre-treatment times the timespan of the effect of any actuator molecule can be conveniently assessed, and the acquired data can be used as an indirect pharmacokinetic estimation, that could be valuable when optimizing the effectiveness of newly developed actuator-receptor combinations, without the need of separate pharmacokinetic/pharmacodynamic studies. Finally, in terms of AAV serotype effectiveness, AAV9 seemed to provide a more robust hypothalamic (LH) and possibly some scattered extra-hypothalamic expression (Fig. 4) that seemed to correlate with its somewhat higher food intake decreasing potential. The AAV5 serotype, on the other hand, showed a slightly smaller, more focused LH infection, which, in turn, can possibly explain its marginally less efficacy. If one would like to further explore the food intake or obesity-related effects of selective LH chemogenetic inhibition, it would be a logical next step to try to investigate the effectiveness of other serotypes (e.g., AAV2 or AAV8), and perhaps to try to reduce the affected brain area size by decreasing the applied virus volume (< 1000 nL) and/or the virus titer (< 10¹2 vg/ml).
Taken these methodological considerations together, we have successfully developed, optimized, and validated an in vivo preclinical experimental model that is suitable for supporting various chemogenetic drug discovery projects, by providing a robust and reliable, but, at the same time, inexpensive and simple tool that can serve as a “first in vivo” model for characterizing the effectiveness of any newly developed CNS-targeted chemogenetic treatments. Secondarily, we are presenting hereby the first human translatable evidence that CNS-targeted neuron-specific, however, subtype general chemogenetic stimulation can be similarly effective in reducing food intake than the currently most effective GLP-1 agonist pharmacological therapy available on the market in obesity indication [23]. Since food intake is a primary etiological biomarker for obesity and weight loss, the current study can be considered as the first indirect POC, that verifies the feasibility of the chemogenetic approach inhibiting LH neurons, as a potential new human treatment opportunity in obesity. Subsequent studies are warranted to provide a direct POC via using diet-induced obesity models, and weight loss, as the primary endpoint, and possibly investigating other feasible target areas of the hypothalamus that could similarly induce food intake decrease and weight loss, like the arcuate nucleus.
As a third major outcome of this study, we provided proof – in accordance with previous preclinical reports [7, 8, 24, 25] - showing that DCZ is a more ideal chemogenetic actuator molecule for stimulating muscarinic DREADDs, compared to CNO, therefore we also do recommend a transition from the still widespread use of CNO to DCZ in all CNS-targeted preclinical studies. We agree with the previous reports, that the higher efficacy and faster pharmacodynamic effect of DCZ can be explained by its better brain penetrance, better selectivity for the M3/M4 DREADD receptors, and its better metabolic stability, meaning that the effects of DCZ are not compromised by its metabolites with divergent pharmacological properties like in the case of CNO [5, 26].
Furthermore, the current results will strengthen the hypothesis that emerging innovative “genetic neuroengineering” techniques, like G-protein coupled DREADD chemogenetics, can be very promising potential future human therapeutic strategies, in general. This assumption is mostly based on the idea that chemogenetics can provide superior spatial targeting and selectivity, compared to conventional CNS pharmacotherapy methods. The only currently approved CNS therapeutic option, with similarly high spatial neuromodulatory ability is DBS, however, DBS needs chronically implanted devices that are permanently left in the brain, posing a considerable risk factor that might negatively influence the success of the otherwise highly effective method in the clinic [3].
To conclude our current report, the impact of the present research can be numerous. As it was described above, first and foremost, it provides a high translational value preclinical evidence for the feasibility of LH chemogenetic stimulation as a tool for CNS-targeted chemogenetic drug discovery, and simultaneously, it delivers the first translatable indirect in vivo POC for the therapeutic feasibility of chemogenetics in obesity indication. Based on our current results, we also support the hypothesis that future genetic neuroengineering treatments can offer highly effective alternative therapeutic options to both DBS and conventional pharmacotherapy in various CNS conditions, providing better spatial selectivity than pharmacotherapy, and offering a more tolerable approach for DBS-eligible patients. To aid this development, future studies must further explore the effectiveness (e.g., length of effect, viral serotype, titer, and dose dependence, etc.) and also the side-effect profile (e.g., potential neurotoxicity) of AAV-delivered CNS-targeted chemogenetic approaches in relevant preclinical models of obesity.