The ACTH receptor plays a role in
glucose metabolism when expressed in white adipose cells. When bound to ACTH, a short-term
insulin-resistance occurs, and it stimulates
lipolysis via
hormone sensitive lipase. Demonstrated in mice, ACTH promotes lipolysis in response to increased energy demand, notably in times of stress. Lipolytic activity due to
melanocortin receptors has been demonstrated in several types of test animals: rats and hamsters primarily respond to ACTH, rabbits respond to alpha and beta MSH's (therefore not using the ACTH receptor), and guinea pigs responding to both ACTH and other MSH's. In humans, ACTH has little lipolytic effect on adipose tissue. ACTH receptor activation also influences immune function. Melanocortins, including ACTH, have
anti-inflammatory effects which can be exerted via
GC-dependent and -independent pathways. The GC-dependent pathway activates ACTH receptors to increase levels of cortisol which bind GC receptors. Via
genomic and faster non-genomic pathways, this causes, among other immune responses, a reduction in
leukocyte and
neutrophil infiltration,
cytokine production, especially of cytokine CXCL-1, and increased
phagocytosis of
apoptotic neutrophils. These profound anti-inflammatory effects and the ability to increase GC's are why ACTH therapy is still used today. It is often used as treatment for
infantile spasms,
multiple sclerosis,
nephrotic syndrome,
gout,
ulcerative colitis,
Crohn's disease,
rheumatoid arthritis, and
systemic lupus erythematosus. This is problematic long-term and can lead to ACTH-receptor pathway-related side effects including:
Cushing's syndrome,
fluid retention,
glaucoma, and
cardiovascular disorders. Mutation of the receptor gene causes 25% of FGD, and mutation on the MRAP gene causes 20% of FGD. Mutations of ACTH can also contribute to this pathology: mutation of the "message sequence" inhibits cAMP production when bound to the ACTH receptor, and mutation of the "address sequence" inhibits binding to the receptor altogether. == Evolution ==