Hypothalamic proopiomelanocortin (POMC) gene expression is reduced in many forms of obesity and diabetes, particularly in those attributable to deficiencies in leptin or its receptor. To assess the functional significance of POMC in mediating metabolic phenotypes associated with leptin deficiency, leptin-deficient mice bearing a transgene expressing the POMC gene under control of the neuron-specific enolase promoter were produced. The POMC transgene attenuated fastinginduced hyperphagia in wild-type mice. Furthermore, the POMC transgene partially reversed obesity, hyperphagia, and hypothermia and effectively normalized hyperglycemia, glucosuria, glucose intolerance, and insulin resistance in leptin-deficient mice. Effects of the POMC transgene on glucose homeostasis were independent of the partial correction of hyperphagia and obesity. Furthermore, the POMC transgene normalized the profile of hepatic and adipose gene expression associated with gluconeogenesis, glucose output, and insulin sensitivity. These results indicate that central POMC is a key modulator of glucose homeostasis and that agonists of POMC products may provide effective therapy in treating impairments in glucose homeostasis when hypothalamic POMC expression is reduced, as occurs with leptin deficiency, hypothalamic damage, and aging. Diabetes 52:2675-2683, 2003 M any forms of obesity and diabetes are associated with impairments in the production of (1-5), processing of (6,7), or sensitivity to (8,9) products of the proopiomelanocortin (Pomc) gene. In particular, ablation of leptin or its receptor causes reduced hypothalamic expression of POMC as well as obesity and impairments in glucose metabolism (1-3). Fasting also leads to reduced leptin and reduced expression of hypothalamic POMC (3). Similarly, hypothalamic POMC expression is reduced in other conditions involving impairments in glucose metabolism caused by hypothalamic lesions (10), mutations in the tubby and nhlh2 genes (11,12), aging (13), or insulin deficiency (14). The suggestion that reduced POMC may actually be a cause of the metabolic impairments comes from the observation that mutations in the Pomc gene lead to metabolic impairments in humans (4) and mice (5).It is plausible that the POMC-derived peptide ␣-melanocyte-stimulating hormone (MSH) mediates many of the effects of hypothalamic POMC on metabolic function, as central injection of ␣-MSH or an ␣-MSH agonist decreases food intake and increases energy expenditure (8,15,16), whereas central injection of a melanocortin receptor antagonist increases food intake and decreases energy expenditure (17-19). Because the blockade of ␣-MSH signaling blocks the acute effects of leptin on feeding behavior (20), ␣-MSH may mediate some of leptin's metabolic effects and therefore reduced hypothalamic POMC may mediate effects of leptin deficiency on metabolic and neuroendocrine impairments. Accumulating genetic data also support a role for the melanocortin system in the regulation of glucose metabolism. Agouti mice develop obesity, hyperphagia...