Background:The melanocortin-4 receptor, MC4R, regulates satiety, but the signaling mechanism is unknown. Results: K ϩ -dependent Na ϩ /Ca 2ϩ -exchanger, NCKX4, knock-out mice are lean and hypophagic and display MC4R-dependent, Ca 2ϩ -sensitive, constitutive activation of paraventricular nucleus neurons. Conclusion: Ca 2ϩ signaling is required for MC4R action, and its dysregulation in Nckx4 Ϫ/Ϫ mice leads to anorexia.