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Henry JA, Couch LS, Rider OJ. Myocardial Metabolism in Heart Failure with Preserved Ejection Fraction. J Clin Med 2024; 13:1195. [PMID: 38592048 PMCID: PMC10931709 DOI: 10.3390/jcm13051195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 02/11/2024] [Accepted: 02/18/2024] [Indexed: 04/10/2024] Open
Abstract
Heart failure with preserved ejection fraction (HFpEF) is increasingly prevalent and now accounts for half of all heart failure cases. This rise is largely attributed to growing rates of obesity, hypertension, and diabetes. Despite its prevalence, the pathophysiological mechanisms of HFpEF are not fully understood. The heart, being the most energy-demanding organ, appears to have a compromised bioenergetic capacity in heart failure, affecting all phenotypes and aetiologies. While metabolic disturbances in heart failure with reduced ejection fraction (HFrEF) have been extensively studied, similar insights into HFpEF are limited. This review collates evidence from both animal and human studies, highlighting metabolic dysregulations associated with HFpEF and its risk factors, such as obesity, hypertension, and diabetes. We discuss how changes in substrate utilisation, oxidative phosphorylation, and energy transport contribute to HFpEF. By delving into these pathological shifts in myocardial energy production, we aim to reveal novel therapeutic opportunities. Potential strategies include modulating energy substrates, improving metabolic efficiency, and enhancing critical metabolic pathways. Understanding these aspects could be key to developing more effective treatments for HFpEF.
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Affiliation(s)
- John Aaron Henry
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford OX3 9DU, UK (O.J.R.)
- Department of Cardiology, Jersey General Hospital, Gloucester Street, St. Helier JE1 3QS, Jersey, UK
| | - Liam S. Couch
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford OX3 9DU, UK (O.J.R.)
| | - Oliver J. Rider
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford OX3 9DU, UK (O.J.R.)
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2
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Correale M, Tricarico L, Croella F, Alfieri S, Fioretti F, Brunetti ND, Inciardi RM, Nodari S. Novelties in the pharmacological approaches for chronic heart failure: new drugs and cardiovascular targets. Front Cardiovasc Med 2023; 10:1157472. [PMID: 37332581 PMCID: PMC10272855 DOI: 10.3389/fcvm.2023.1157472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 05/15/2023] [Indexed: 06/20/2023] Open
Abstract
Despite recent advances in chronic heart failure (HF) management, the prognosis of HF patients is poor. This highlights the need for researching new drugs targeting, beyond neurohumoral and hemodynamic modulation approach, such as cardiomyocyte metabolism, myocardial interstitium, intracellular regulation and NO-sGC pathway. In this review we report main novelties on new possible pharmacological targets for HF therapy, mainly on new drugs acting on cardiac metabolism, GCs-cGMP pathway, mitochondrial function and intracellular calcium dysregulation.
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Affiliation(s)
- Michele Correale
- Department of Cardiothoracic, Policlinico Riuniti University Hospital, Foggia, Italy
| | - Lucia Tricarico
- Department of Cardiothoracic, Policlinico Riuniti University Hospital, Foggia, Italy
| | - Francesca Croella
- Department of Medical & Surgical Sciences, University of Foggia, Foggia, Italy
| | - Simona Alfieri
- Department of Medical & Surgical Sciences, University of Foggia, Foggia, Italy
| | - Francesco Fioretti
- Cardiology Section, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, ASST Spedali Civili Hospital and University of Brescia, Brescia, Italy
| | | | - Riccardo M. Inciardi
- Cardiology Section, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, ASST Spedali Civili Hospital and University of Brescia, Brescia, Italy
| | - Savina Nodari
- Cardiology Section, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, ASST Spedali Civili Hospital and University of Brescia, Brescia, Italy
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3
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Barker FJ, Hart A, Sayer AA, Witham MD. Effects of nicotinamide adenine dinucleotide precursors on measures of physical performance and physical frailty: A systematic review. JCSM CLINICAL REPORTS 2022. [DOI: 10.1002/crt2.56] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Fred J. Barker
- AGE Research Group, Translational and Clinical Research Institute and Biomedical Research Centre Newcastle University and Newcastle Upon Tyne Hospitals NHS Foundation Trust Newcastle upon Tyne UK
| | - Ashley Hart
- AGE Research Group, Translational and Clinical Research Institute and Biomedical Research Centre Newcastle University and Newcastle Upon Tyne Hospitals NHS Foundation Trust Newcastle upon Tyne UK
| | - Avan A. Sayer
- AGE Research Group, Translational and Clinical Research Institute and Biomedical Research Centre Newcastle University and Newcastle Upon Tyne Hospitals NHS Foundation Trust Newcastle upon Tyne UK
| | - Miles D. Witham
- AGE Research Group, Translational and Clinical Research Institute and Biomedical Research Centre Newcastle University and Newcastle Upon Tyne Hospitals NHS Foundation Trust Newcastle upon Tyne UK
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Yurista SR, Chen S, Welsh A, Tang WHW, Nguyen CT. Targeting Myocardial Substrate Metabolism in the Failing Heart: Ready for Prime Time? Curr Heart Fail Rep 2022; 19:180-190. [PMID: 35567658 PMCID: PMC10950325 DOI: 10.1007/s11897-022-00554-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/26/2022] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW We review the clinical benefits of altering myocardial substrate metabolism in heart failure. RECENT FINDINGS Modulation of cardiac substrates (fatty acid, glucose, or ketone metabolism) offers a wide range of therapeutic possibilities which may be applicable to heart failure. Augmenting ketone oxidation seems to offer great promise as a new therapeutic modality in heart failure. The heart has long been recognized as metabolic omnivore, meaning it can utilize a variety of energy substrates to maintain adequate ATP production. The adult heart uses fatty acid as a major fuel source, but it can also derive energy from other substrates including glucose and ketone, and to some extent pyruvate, lactate, and amino acids. However, cardiomyocytes of the failing heart endure remarkable metabolic remodeling including a shift in substrate utilization and reduced ATP production, which account for cardiac remodeling and dysfunction. Research to understand the implication of myocardial metabolic perturbation in heart failure has grown in recent years, and this has raised interest in targeting myocardial substrate metabolism for heart failure therapy. Due to the interdependency between different pathways, the main therapeutic metabolic approaches include inhibiting fatty acid uptake/fatty acid oxidation, reducing circulating fatty acid levels, increasing glucose oxidation, and augmenting ketone oxidation.
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Affiliation(s)
- Salva R Yurista
- Cardiovascular Research Center, Corrigan Minehan Heart Center, Massachusetts General Hospital, Harvard Medical School, 149 13th Street, Boston, MA, 02129, USA.
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA.
| | - Shi Chen
- Cardiovascular Research Center, Corrigan Minehan Heart Center, Massachusetts General Hospital, Harvard Medical School, 149 13th Street, Boston, MA, 02129, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Aidan Welsh
- Cardiovascular Research Center, Corrigan Minehan Heart Center, Massachusetts General Hospital, Harvard Medical School, 149 13th Street, Boston, MA, 02129, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - W H Wilson Tang
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
- Cardiovascular Innovation Research Center, Cleveland Clinic, Cleveland, OH, USA
| | - Christopher T Nguyen
- Cardiovascular Research Center, Corrigan Minehan Heart Center, Massachusetts General Hospital, Harvard Medical School, 149 13th Street, Boston, MA, 02129, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
- Division of Health Science Technology, Harvard-Massachusetts Institute of Technology, Cambridge, MA, USA
- Cardiovascular Innovation Research Center, Cleveland Clinic, Cleveland, OH, USA
- Imaging Institute, Cleveland Clinic, Cleveland, OH, USA
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5
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Yu Y, Jin C, Zhao C, Zhu S, Meng S, Ma H, Wang J, Xiang M. Serum Free Fatty Acids Independently Predict Adverse Outcomes in Acute Heart Failure Patients. Front Cardiovasc Med 2022; 8:761537. [PMID: 35004879 PMCID: PMC8727366 DOI: 10.3389/fcvm.2021.761537] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 11/15/2021] [Indexed: 12/21/2022] Open
Abstract
Background: Perturbation of energy metabolism exacerbates cardiac dysfunction, serving as a potential therapeutic target in congestive heart failure. Although circulating free fatty acids (FFAs) are linked to insulin resistance and risk of coronary heart disease, it still remains unclear whether circulating FFAs are associated with the prognosis of patients with acute heart failure (AHF). Methods: This single-center, observational cohort study enrolled 183 AHF patients (de novo heart failure or decompensated chronic heart failure) in the Second Affiliated Hospital, Zhejiang University School of Medicine. All-cause mortality and heart failure (HF) rehospitalization within 1 year after discharge were investigated. Serum FFAs were modeled as quartiles as well as a continuous variable (per SD of FFAs). The restricted cubic splines and cox proportional hazards models were applied to evaluate the association between the serum FFAs level and all-cause mortality or HF rehospitalization. Results: During a 1-year follow-up, a total of 71 (38.8%) patients had all-cause mortality or HF rehospitalization. The levels of serum FFAs positively contributed to the risk of death or HF rehospitalization, which was not associated with the status of insulin resistance. When modeled with restricted cubic splines, the serum FFAs increased linearly for the incidence of death or HF rehospitalization. In a multivariable analysis adjusting for sex, age, body-mass index, coronary artery disease, diabetes mellitus, hypertension, left ventricular ejection fraction and N-terminal pro-brain natriuretic peptid, each SD (303.07 μmol/L) higher FFAs were associated with 26% higher risk of death or HF rehospitalization (95% confidence interval, 2–55%). Each increasing quartile of FFAs was associated with differentially elevated hazard ratios for death or HF rehospitalization of 1 (reference), 1.71 (95% confidence interval, [0.81, 3.62]), 1.41 (95% confidence interval, [0.64, 3.09]), and 3.18 (95% confidence interval, [1.53, 6.63]), respectively. Conclusion: Serum FFA levels at admission among patients with AHF were associated with an increased risk of adverse outcomes. Additional studies are needed to determine the causal-effect relationship between FFAs and acute cardiac dysfunction and whether FFAs could be a potential target for AHF management.
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Affiliation(s)
- Yi Yu
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Chunna Jin
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Chengchen Zhao
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Shiyu Zhu
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Simin Meng
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hong Ma
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jian'an Wang
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Meixiang Xiang
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Adipose Lipolysis Regulates Cardiac Glucose Uptake and Function in Mice under Cold Stress. Int J Mol Sci 2021; 22:ijms222413361. [PMID: 34948160 PMCID: PMC8703875 DOI: 10.3390/ijms222413361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 12/07/2021] [Accepted: 12/09/2021] [Indexed: 02/04/2023] Open
Abstract
The heart primarily uses fatty acids as energy substrates. Adipose lipolysis is a major source of fatty acids, particularly under stress conditions. In this study, we showed that mice with selective inactivation of the lipolytic coactivator comparative gene identification-58 (CGI-58) in adipose tissue (FAT-KO mice), relative to their littermate controls, had lower circulating FA levels in the fed and fasted states due to impaired adipose lipolysis. They preferentially utilized carbohydrates as energy fuels and were more insulin sensitive and glucose tolerant. Under cold stress, FAT-KO versus control mice had >10-fold increases in glucose uptake in the hearts but no increases in other tissues examined. Plasma concentrations of atrial natriuretic peptide and cardiac mRNAs for atrial and brain-type natriuretic peptides, two sensitive markers of cardiac remodeling, were also elevated. After one week of cold exposure, FAT-KO mice showed reduced cardiac expression of several mitochondrial oxidative phosphorylation proteins. After one month of cold exposure, hearts of these animals showed depressed functions, reduced SERCA2 protein, and increased proteins for MHC-β, collagen I proteins, Glut1, Glut4 and phospho-AMPK. Thus, CGI-58-dependent adipose lipolysis critically regulates cardiac metabolism and function, especially during cold adaptation. The adipose-heart axis may be targeted for the management of cardiac dysfunction.
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7
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Pasqua T, Rocca C, Giglio A, Angelone T. Cardiometabolism as an Interlocking Puzzle between the Healthy and Diseased Heart: New Frontiers in Therapeutic Applications. J Clin Med 2021; 10:721. [PMID: 33673114 PMCID: PMC7918460 DOI: 10.3390/jcm10040721] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 02/05/2021] [Accepted: 02/07/2021] [Indexed: 12/14/2022] Open
Abstract
Cardiac metabolism represents a crucial and essential connecting bridge between the healthy and diseased heart. The cardiac muscle, which may be considered an omnivore organ with regard to the energy substrate utilization, under physiological conditions mainly draws energy by fatty acids oxidation. Within cardiomyocytes and their mitochondria, through well-concerted enzymatic reactions, substrates converge on the production of ATP, the basic chemical energy that cardiac muscle converts into mechanical energy, i.e., contraction. When a perturbation of homeostasis occurs, such as an ischemic event, the heart is forced to switch its fatty acid-based metabolism to the carbohydrate utilization as a protective mechanism that allows the maintenance of its key role within the whole organism. Consequently, the flexibility of the cardiac metabolic networks deeply influences the ability of the heart to respond, by adapting to pathophysiological changes. The aim of the present review is to summarize the main metabolic changes detectable in the heart under acute and chronic cardiac pathologies, analyzing possible therapeutic targets to be used. On this basis, cardiometabolism can be described as a crucial mechanism in keeping the physiological structure and function of the heart; furthermore, it can be considered a promising goal for future pharmacological agents able to appropriately modulate the rate-limiting steps of heart metabolic pathways.
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Affiliation(s)
- Teresa Pasqua
- Department of Health Science, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy;
| | - Carmine Rocca
- Laboratory of Cellular and Molecular Cardiovascular Pathophysiology, Department of Biology, E. and E.S. (Di.B.E.S.T.), University of Calabria, 87036 Rende (CS), Italy
| | - Anita Giglio
- Department of Biology, E. and E.S. (Di.B.E.S.T.), University of Calabria, 87036 Rende (CS), Italy;
| | - Tommaso Angelone
- Laboratory of Cellular and Molecular Cardiovascular Pathophysiology, Department of Biology, E. and E.S. (Di.B.E.S.T.), University of Calabria, 87036 Rende (CS), Italy
- National Institute of Cardiovascular Research (I.N.R.C.), 40126 Bologna, Italy
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Watson WD, Timm KN, Lewis AJ, Miller JJJ, Emmanuel Y, Clarke K, Neubauer S, Tyler DJ, Rider OJ. Nicotinic acid receptor agonists impair myocardial contractility by energy starvation. FASEB J 2020; 34:14878-14891. [PMID: 32954525 DOI: 10.1096/fj.202000084rr] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 08/08/2020] [Accepted: 08/25/2020] [Indexed: 11/11/2022]
Abstract
Nicotinic acid receptor agonists have previously been shown to cause acute reductions in cardiac contractility. We sought to uncover the changes in cardiac metabolism underlying these alterations in function. In nine humans, we recorded cardiac energetics and function before and after a single oral dose of nicotinic acid using cardiac MRI to demonstrate contractile function and Phosphorus-31 (31 P) magnetic resonance spectroscopy to demonstrate myocardial energetics. Nicotinic Acid 400 mg lowered ejection fraction by 4% (64 ± 8% to 60 ± 7%, P = .03), and was accompanied by a fall in phosphocreatine/ATP ratio by 0.4 (2.2 ± 0.4 to 1.8 ± 0.1, P = .04). In four groups of eight Wistar rats, we used pyruvate dehydrogenase (PDH) flux studies to demonstrate changes in carbohydrate metabolism induced by the nicotinic acid receptor agonist, Acipimox, using hyperpolarized Carbon-13 (13 C) magnetic resonance spectroscopy. In rats which had been starved overnight, Acipimox caused a fall in ejection fraction by 7.8% (67.5 ± 8.9 to 60 ± 3.1, P = .03) and a nearly threefold rise in flux through PDH (from 0.182 ± 0.114 to 0.486 ± 0.139, P = .002), though this rise did not match pyruvate dehydrogenase flux observed in rats fed carbohydrate rich chow (0.726 ± 0.201). In fed rats, Acipimox decreased pyruvate dehydrogenase flux (to 0.512 ± 0.13, P = .04). Concentration of plasma insulin fell by two-thirds in fed rats administered Acipimox (from 1695 ± 891 ng/L to 550 ± 222 ng/L, P = .005) in spite of glucose concentrations remaining the same. In conclusion, we demonstrate that nicotinic acid receptor agonists impair cardiac contractility associated with a decline in cardiac energetics and show that the mechanism is likely a combination of reduced fatty acid availability and a failure to upregulate carbohydrate metabolism, essentially starving the heart of fuel.
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Affiliation(s)
- William D Watson
- Department of Cardiovascular Medicine, Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford, UK
| | - Kerstin N Timm
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK
| | - Andrew J Lewis
- Department of Cardiovascular Medicine, Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford, UK
| | - Jack J J Miller
- Department of Cardiovascular Medicine, Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford, UK
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK
- Department of Physics, University of Oxford, Oxford, UK
| | - Yaso Emmanuel
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK
| | - Kieran Clarke
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK
| | - Stefan Neubauer
- Department of Cardiovascular Medicine, Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford, UK
| | - Damian J Tyler
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK
| | - Oliver J Rider
- Department of Cardiovascular Medicine, Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford, UK
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9
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Smithline HA, Donnino M, Blank FSJ, Barus R, Coute RA, Knee AB, Visintainer P. Supplemental thiamine for the treatment of acute heart failure syndrome: a randomized controlled trial. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2019; 19:96. [PMID: 31060559 PMCID: PMC6501378 DOI: 10.1186/s12906-019-2506-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 04/16/2019] [Indexed: 11/10/2022]
Abstract
Background The purpose of this pilot study was to determine if a definitive clinical trial of thiamine supplementation was warranted in patients with acute heart failure. We hypothesized that thiamine, when added to standard of care, would improve dyspnea (primary outcome) in hospitalized patients with acute heart failure. Peak expiratory flow rate, type B natriuretic peptide, free fatty acids, glucose, hospital length of stay, as well as 30-day rehospitalization and mortality were pre-planned secondary outcome measures. Methods This was a blinded experimental study at two urban academic hospitals. Consecutive patients admitted from the Emergency Department with a primary diagnosis of acute heart failure were recruited over 2 years. Patients on a daily dietary supplement were excluded. Randomization was stratified by type B natriuretic peptide and diabetes medication categories. Subjects received study drug (100 mg thiamine or placebo) in the evening of their first and second day. Outcome measures were obtained 8 h after study drug infusion. Dyspnea was measured on a 100-mm visual analog scale sitting up on oxygen, sitting up off oxygen, and lying supine off oxygen with 0 indicating no dyspnea. Data were analyzed using mixed-models as well as linear, negative binomial and logistic regression models to assess the impact of group on outcome measures. Results Of 130 subjects randomized, 118 had evaluable data (55 in the control and 63 in the treatment groups), 89% in both groups were adjudicated to have primarily AHF. Thiamine values increased significantly in the treatment group and were unchanged in the control group. One patient had thiamine deficiency. Only dyspnea measured sitting upright on oxygen differed significantly by group over time. No change was found for the other measures of dyspnea and all of the secondary measures. Conclusions In mild-moderate acute heart failure patients without thiamine deficiency, a standard dosing regimen of thiamine did not improve dyspnea, biomarkers, or other clinical parameters. Trial registration ClinicalTrials.gov: NCT00680706, May 20, 2008 (retrospectively registered). Electronic supplementary material The online version of this article (10.1186/s12906-019-2506-8) contains supplementary material, which is available to authorized users.
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10
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Lipotoxicity in Obesity: Benefit of Olive Oil. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 960:607-617. [PMID: 28585218 DOI: 10.1007/978-3-319-48382-5_26] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The clinical implication of Lipotoxicity in obesity derives primarily from its potential to progress to insulin resistance, endothelial dysfunction and atherosclerosis. Olive oil rich diet decrease accumulation of triglyceride in the liver, improved postprandial triglyceride levels, improve glucose and GLP-1 response in insulin resistant subjects, and up regulate GLUT-2 expression in the liver. The exact molecular mechanism is unknown but, decreasing NFkB activation, decreasing LDL oxidation and improving insulin resistance by less production of inflammatory cytokines (TNF-a, IL-6) and improvement of kinases JNK-mediated phosphorylation of IRS-1 are the principle mechanisms. The beneficial effect of the Mediterranean diet derived from monounsaturated fatty acids (MUFA), mainly from olive oil. In this review we document lipotoxicity in obesity and the benefit of olive oil.
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11
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Abstract
The heart utilizes large amounts of fatty acids as energy providing substrates. The physiological balance of lipid uptake and oxidation prevents accumulation of excess lipids. Several processes that affect cardiac function, including ischemia, obesity, diabetes mellitus, sepsis, and most forms of heart failure lead to altered fatty acid oxidation and often also to the accumulation of lipids. There is now mounting evidence associating certain species of these lipids with cardiac lipotoxicity and subsequent myocardial dysfunction. Experimental and clinical data are discussed and paths to reduction of toxic lipids as a means to improve cardiac function are suggested.
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Affiliation(s)
- P Christian Schulze
- From the Divisions of Cardiology, Friedrich-Schiller-University Jena, Germany, and Columbia University, New York, NY (P.C.S.); Metabolic Biology Laboratory, Center for Translational Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, PA (K.D.); and Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, New York University School of Medicine, New York, NY (I.J.G.).
| | - Konstantinos Drosatos
- From the Divisions of Cardiology, Friedrich-Schiller-University Jena, Germany, and Columbia University, New York, NY (P.C.S.); Metabolic Biology Laboratory, Center for Translational Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, PA (K.D.); and Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, New York University School of Medicine, New York, NY (I.J.G.)
| | - Ira J Goldberg
- From the Divisions of Cardiology, Friedrich-Schiller-University Jena, Germany, and Columbia University, New York, NY (P.C.S.); Metabolic Biology Laboratory, Center for Translational Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, PA (K.D.); and Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, New York University School of Medicine, New York, NY (I.J.G.)
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12
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Gloschat CR, Koppel AC, Aras KK, Brennan JA, Holzem KM, Efimov IR. Arrhythmogenic and metabolic remodelling of failing human heart. J Physiol 2016; 594:3963-80. [PMID: 27019074 DOI: 10.1113/jp271992] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 03/21/2016] [Indexed: 12/24/2022] Open
Abstract
Heart failure (HF) is a major cause of morbidity and mortality worldwide. The global burden of HF continues to rise, with prevalence rates estimated at 1-2% and incidence approaching 5-10 per 1000 persons annually. The complex pathophysiology of HF impacts virtually all aspects of normal cardiac function - from structure and mechanics to metabolism and electrophysiology - leading to impaired mechanical contraction and sudden cardiac death. Pharmacotherapy and device therapy are the primary methods of treating HF, but neither is able to stop or reverse disease progression. Thus, there is an acute need to translate basic research into improved HF therapy. Animal model investigations are a critical component of HF research. However, the translation from cellular and animal models to the bedside is hampered by significant differences between species and among physiological scales. Our studies over the last 8 years show that hypotheses generated in animal models need to be validated in human in vitro models. Importantly, however, human heart investigations can establish translational platforms for safety and efficacy studies before embarking on costly and risky clinical trials. This review summarizes recent developments in human HF investigations of electrophysiology remodelling, metabolic remodelling, and β-adrenergic remodelling and discusses promising new technologies for HF research.
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Affiliation(s)
- C R Gloschat
- Department of Biomedical Engineering, The George Washington University, Washington, DC, USA
| | - A C Koppel
- Department of Biomedical Engineering, The George Washington University, Washington, DC, USA
| | - K K Aras
- Department of Biomedical Engineering, The George Washington University, Washington, DC, USA
| | - J A Brennan
- Department of Biomedical Engineering, The George Washington University, Washington, DC, USA
| | - K M Holzem
- Department of Biomedical Engineering, The George Washington University, Washington, DC, USA
| | - I R Efimov
- Department of Biomedical Engineering, The George Washington University, Washington, DC, USA
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13
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Wolf P, Winhofer Y, Krssak M, Smajis S, Harreiter J, Kosi-Trebotic L, Fürnsinn C, Anderwald CH, Baumgartner-Parzer S, Trattnig S, Luger A, Krebs M. Suppression of plasma free fatty acids reduces myocardial lipid content and systolic function in type 2 diabetes. Nutr Metab Cardiovasc Dis 2016; 26:387-392. [PMID: 27118107 DOI: 10.1016/j.numecd.2016.03.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Revised: 02/25/2016] [Accepted: 03/10/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND AIM Type 2 diabetes (T2DM) is closely associated with the development of heart failure, which might be related with impaired substrate metabolism and accumulation of myocardial lipids (MYCL). The aim of this study was to investigate the impact of an acute pharmacological inhibition of adipose tissue lipolysis leading to reduced availability of circulating FFA on MYCL and heart function in T2DM. METHODS AND RESULTS 8 patients with T2DM (Age: 56 ± 11; BMI: 28 ± 3.5 kg/m(2); HbA1c: 7.29 ± 0.88%) were investigated on two study days in random order. Following administration of Acipimox or Placebo MYCL and heart function were measured by (1)H-magnetic-resonance-spectroscopy and tomography at baseline, at 2 and at 6 h. Acipimox reduced circulating FFA by -69% (p < 0.001), MYCL by -39 ± 41% (p < 0.001) as well as systolic heart function (Ejection Fraction (EF): -13 ± 8%, p = 0.025; Cardiac Index: -16 ± 15%, p = 0.063 compared to baseline). Changes in plasma FFA concentrations strongly correlated with changes in MYCL (r = 0.707; p = 0.002) and EF (r = 0.651; p = 0.006). Diastolic heart function remained unchanged. CONCLUSIONS Our results indicate, that inhibition of adipose tissue lipolysis is associated with a rapid depletion of MYCL-stores and reduced systolic heart function in T2DM. These changes were comparable to those previously found in insulin sensitive controls. MYCL thus likely serve as a readily available energy source to cope with short-time changes in FFA availability.
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Affiliation(s)
- P Wolf
- Medical University of Vienna, Department of Internal Medicine III, Division of Endocrinology and Metabolism, Vienna, Austria
| | - Y Winhofer
- Medical University of Vienna, Department of Internal Medicine III, Division of Endocrinology and Metabolism, Vienna, Austria.
| | - M Krssak
- Medical University of Vienna, Department of Internal Medicine III, Division of Endocrinology and Metabolism, Vienna, Austria; Medical University of Vienna, Department of Biomedical Imaging and Image-guided Therapy, Centre of Excellence - High Field MR, Vienna, Austria
| | - S Smajis
- Medical University of Vienna, Department of Internal Medicine III, Division of Endocrinology and Metabolism, Vienna, Austria
| | - J Harreiter
- Medical University of Vienna, Department of Internal Medicine III, Division of Endocrinology and Metabolism, Vienna, Austria
| | - L Kosi-Trebotic
- Medical University of Vienna, Department of Internal Medicine III, Division of Endocrinology and Metabolism, Vienna, Austria
| | - C Fürnsinn
- Medical University of Vienna, Department of Internal Medicine III, Division of Endocrinology and Metabolism, Vienna, Austria
| | - C-H Anderwald
- Medical University of Vienna, Department of Internal Medicine III, Division of Endocrinology and Metabolism, Vienna, Austria; Metabolic Unit, Institute of Biomedical Engineering, National Research Council, Padova, Italy; Medical Direction, Specialized Hospital Complex Agathenhof, A-9322 Micheldorf, Austria
| | - S Baumgartner-Parzer
- Medical University of Vienna, Department of Internal Medicine III, Division of Endocrinology and Metabolism, Vienna, Austria
| | - S Trattnig
- Medical University of Vienna, Department of Biomedical Imaging and Image-guided Therapy, Centre of Excellence - High Field MR, Vienna, Austria
| | - A Luger
- Medical University of Vienna, Department of Internal Medicine III, Division of Endocrinology and Metabolism, Vienna, Austria
| | - M Krebs
- Medical University of Vienna, Department of Internal Medicine III, Division of Endocrinology and Metabolism, Vienna, Austria
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14
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Makimura H, Stanley TL, Suresh C, De Sousa-Coelho AL, Frontera WR, Syu S, Braun LR, Looby SE, Feldpausch MN, Torriani M, Lee H, Patti ME, Grinspoon SK. Metabolic Effects of Long-Term Reduction in Free Fatty Acids With Acipimox in Obesity: A Randomized Trial. J Clin Endocrinol Metab 2016; 101:1123-33. [PMID: 26691888 PMCID: PMC4803166 DOI: 10.1210/jc.2015-3696] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
CONTEXT Increased circulating free fatty acids (FFAs) have been proposed to contribute to insulin resistance in obesity. Short-term studies have investigated the effects of acipimox, an inhibitor of hormone-sensitive lipase, on glucose homeostasis, but longer-term studies have not been performed. OBJECTIVE To test the hypothesis that long-term treatment with acipimox would reduce FFA and improve insulin sensitivity among nondiabetic, insulin-resistant, obese subjects. DESIGN, SETTING, PATIENTS, AND INTERVENTION At an academic medical center, 39 obese men and women were randomized to acipimox 250 mg thrice-daily vs identical placebo for 6 months. MAIN OUTCOME MEASURES Plasma lipids, insulin sensitivity, adiponectin, and mitochondrial function via assessment of the rate of post-exercise phosphocreatine recovery on (31)P-magnetic resonance spectroscopy as well as muscle mitochondrial density and relevant muscle gene expression. RESULTS Fasting glucose decreased significantly in acipimox-treated individuals (effect size, -6 mg/dL; P = .02), in parallel with trends for reduced fasting insulin (effect size, -6.8 μU/mL; P = .07) and HOMA-IR (effect size, -1.96; P = .06), and significantly increased adiponectin (effect size, +668 ng/mL; P = .02). Acipimox did not affect insulin-stimulated glucose uptake, as assessed by euglycemic, hyperinsulinemic clamp. Effects on muscle mitochondrial function and density and on relevant gene expression were not seen. CONCLUSION These data shed light on the long-term effects of FFA reduction on insulin sensitivity, other metabolic parameters, and muscle mitochondrial function in obesity. Reduced FFA achieved by acipimox improved fasting measures of glucose homeostasis, lipids, and adiponectin but had no effect on mitochondrial function, mitochondrial density, or muscle insulin sensitivity.
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Affiliation(s)
- Hideo Makimura
- Program in Nutritional Metabolism and Neuroendocrine Unit (H.M., T.L.S., C.S., S.S., L.R.B., S.E.L., M.N.F., S.K.G.), Massachusetts General Hospital, Boston, Massachusetts 02114; Harvard Medical School (H.M., T.L.S., A.L.D.S.-C., L.R.B., S.E.L., M.T., H.L., M.-E.P., S.K.G.), Boston, Massachusetts 02115; Pediatric Endocrine Unit (T.L.S., L.R.B.), Massachusetts General Hospital, Boston, Massachusetts 02114; Research Division (A.L.D.S.-C., M.-E.P.), Joslin Diabetes Center, Boston, Massachusetts 02215; Department of Physical Medicine and Rehabilitation (W.R.F.), Vanderbilt University Medical Center, Nashville, Tennessee 37212; Department of Physical Medicine and Rehabilitation (W.R.F.), Harvard Medical School/Spaulding Rehabilitation Hospital, Boston, Massachusetts 02114; Department of Physiology (W.R.F.), University of Puerto Rico School of Medicine, San Juan, Puerto Rico 00936; Department of Radiology (M.T.), Massachusetts General Hospital, Boston, Massachusetts 02114; and MGH Biostatistics Center (H.L.), Massachusetts General Hospital and Harvard Medical Center, Boston, Massachusetts 02114
| | - Takara L Stanley
- Program in Nutritional Metabolism and Neuroendocrine Unit (H.M., T.L.S., C.S., S.S., L.R.B., S.E.L., M.N.F., S.K.G.), Massachusetts General Hospital, Boston, Massachusetts 02114; Harvard Medical School (H.M., T.L.S., A.L.D.S.-C., L.R.B., S.E.L., M.T., H.L., M.-E.P., S.K.G.), Boston, Massachusetts 02115; Pediatric Endocrine Unit (T.L.S., L.R.B.), Massachusetts General Hospital, Boston, Massachusetts 02114; Research Division (A.L.D.S.-C., M.-E.P.), Joslin Diabetes Center, Boston, Massachusetts 02215; Department of Physical Medicine and Rehabilitation (W.R.F.), Vanderbilt University Medical Center, Nashville, Tennessee 37212; Department of Physical Medicine and Rehabilitation (W.R.F.), Harvard Medical School/Spaulding Rehabilitation Hospital, Boston, Massachusetts 02114; Department of Physiology (W.R.F.), University of Puerto Rico School of Medicine, San Juan, Puerto Rico 00936; Department of Radiology (M.T.), Massachusetts General Hospital, Boston, Massachusetts 02114; and MGH Biostatistics Center (H.L.), Massachusetts General Hospital and Harvard Medical Center, Boston, Massachusetts 02114
| | - Caroline Suresh
- Program in Nutritional Metabolism and Neuroendocrine Unit (H.M., T.L.S., C.S., S.S., L.R.B., S.E.L., M.N.F., S.K.G.), Massachusetts General Hospital, Boston, Massachusetts 02114; Harvard Medical School (H.M., T.L.S., A.L.D.S.-C., L.R.B., S.E.L., M.T., H.L., M.-E.P., S.K.G.), Boston, Massachusetts 02115; Pediatric Endocrine Unit (T.L.S., L.R.B.), Massachusetts General Hospital, Boston, Massachusetts 02114; Research Division (A.L.D.S.-C., M.-E.P.), Joslin Diabetes Center, Boston, Massachusetts 02215; Department of Physical Medicine and Rehabilitation (W.R.F.), Vanderbilt University Medical Center, Nashville, Tennessee 37212; Department of Physical Medicine and Rehabilitation (W.R.F.), Harvard Medical School/Spaulding Rehabilitation Hospital, Boston, Massachusetts 02114; Department of Physiology (W.R.F.), University of Puerto Rico School of Medicine, San Juan, Puerto Rico 00936; Department of Radiology (M.T.), Massachusetts General Hospital, Boston, Massachusetts 02114; and MGH Biostatistics Center (H.L.), Massachusetts General Hospital and Harvard Medical Center, Boston, Massachusetts 02114
| | - Ana Luisa De Sousa-Coelho
- Program in Nutritional Metabolism and Neuroendocrine Unit (H.M., T.L.S., C.S., S.S., L.R.B., S.E.L., M.N.F., S.K.G.), Massachusetts General Hospital, Boston, Massachusetts 02114; Harvard Medical School (H.M., T.L.S., A.L.D.S.-C., L.R.B., S.E.L., M.T., H.L., M.-E.P., S.K.G.), Boston, Massachusetts 02115; Pediatric Endocrine Unit (T.L.S., L.R.B.), Massachusetts General Hospital, Boston, Massachusetts 02114; Research Division (A.L.D.S.-C., M.-E.P.), Joslin Diabetes Center, Boston, Massachusetts 02215; Department of Physical Medicine and Rehabilitation (W.R.F.), Vanderbilt University Medical Center, Nashville, Tennessee 37212; Department of Physical Medicine and Rehabilitation (W.R.F.), Harvard Medical School/Spaulding Rehabilitation Hospital, Boston, Massachusetts 02114; Department of Physiology (W.R.F.), University of Puerto Rico School of Medicine, San Juan, Puerto Rico 00936; Department of Radiology (M.T.), Massachusetts General Hospital, Boston, Massachusetts 02114; and MGH Biostatistics Center (H.L.), Massachusetts General Hospital and Harvard Medical Center, Boston, Massachusetts 02114
| | - Walter R Frontera
- Program in Nutritional Metabolism and Neuroendocrine Unit (H.M., T.L.S., C.S., S.S., L.R.B., S.E.L., M.N.F., S.K.G.), Massachusetts General Hospital, Boston, Massachusetts 02114; Harvard Medical School (H.M., T.L.S., A.L.D.S.-C., L.R.B., S.E.L., M.T., H.L., M.-E.P., S.K.G.), Boston, Massachusetts 02115; Pediatric Endocrine Unit (T.L.S., L.R.B.), Massachusetts General Hospital, Boston, Massachusetts 02114; Research Division (A.L.D.S.-C., M.-E.P.), Joslin Diabetes Center, Boston, Massachusetts 02215; Department of Physical Medicine and Rehabilitation (W.R.F.), Vanderbilt University Medical Center, Nashville, Tennessee 37212; Department of Physical Medicine and Rehabilitation (W.R.F.), Harvard Medical School/Spaulding Rehabilitation Hospital, Boston, Massachusetts 02114; Department of Physiology (W.R.F.), University of Puerto Rico School of Medicine, San Juan, Puerto Rico 00936; Department of Radiology (M.T.), Massachusetts General Hospital, Boston, Massachusetts 02114; and MGH Biostatistics Center (H.L.), Massachusetts General Hospital and Harvard Medical Center, Boston, Massachusetts 02114
| | - Stephanie Syu
- Program in Nutritional Metabolism and Neuroendocrine Unit (H.M., T.L.S., C.S., S.S., L.R.B., S.E.L., M.N.F., S.K.G.), Massachusetts General Hospital, Boston, Massachusetts 02114; Harvard Medical School (H.M., T.L.S., A.L.D.S.-C., L.R.B., S.E.L., M.T., H.L., M.-E.P., S.K.G.), Boston, Massachusetts 02115; Pediatric Endocrine Unit (T.L.S., L.R.B.), Massachusetts General Hospital, Boston, Massachusetts 02114; Research Division (A.L.D.S.-C., M.-E.P.), Joslin Diabetes Center, Boston, Massachusetts 02215; Department of Physical Medicine and Rehabilitation (W.R.F.), Vanderbilt University Medical Center, Nashville, Tennessee 37212; Department of Physical Medicine and Rehabilitation (W.R.F.), Harvard Medical School/Spaulding Rehabilitation Hospital, Boston, Massachusetts 02114; Department of Physiology (W.R.F.), University of Puerto Rico School of Medicine, San Juan, Puerto Rico 00936; Department of Radiology (M.T.), Massachusetts General Hospital, Boston, Massachusetts 02114; and MGH Biostatistics Center (H.L.), Massachusetts General Hospital and Harvard Medical Center, Boston, Massachusetts 02114
| | - Laurie R Braun
- Program in Nutritional Metabolism and Neuroendocrine Unit (H.M., T.L.S., C.S., S.S., L.R.B., S.E.L., M.N.F., S.K.G.), Massachusetts General Hospital, Boston, Massachusetts 02114; Harvard Medical School (H.M., T.L.S., A.L.D.S.-C., L.R.B., S.E.L., M.T., H.L., M.-E.P., S.K.G.), Boston, Massachusetts 02115; Pediatric Endocrine Unit (T.L.S., L.R.B.), Massachusetts General Hospital, Boston, Massachusetts 02114; Research Division (A.L.D.S.-C., M.-E.P.), Joslin Diabetes Center, Boston, Massachusetts 02215; Department of Physical Medicine and Rehabilitation (W.R.F.), Vanderbilt University Medical Center, Nashville, Tennessee 37212; Department of Physical Medicine and Rehabilitation (W.R.F.), Harvard Medical School/Spaulding Rehabilitation Hospital, Boston, Massachusetts 02114; Department of Physiology (W.R.F.), University of Puerto Rico School of Medicine, San Juan, Puerto Rico 00936; Department of Radiology (M.T.), Massachusetts General Hospital, Boston, Massachusetts 02114; and MGH Biostatistics Center (H.L.), Massachusetts General Hospital and Harvard Medical Center, Boston, Massachusetts 02114
| | - Sara E Looby
- Program in Nutritional Metabolism and Neuroendocrine Unit (H.M., T.L.S., C.S., S.S., L.R.B., S.E.L., M.N.F., S.K.G.), Massachusetts General Hospital, Boston, Massachusetts 02114; Harvard Medical School (H.M., T.L.S., A.L.D.S.-C., L.R.B., S.E.L., M.T., H.L., M.-E.P., S.K.G.), Boston, Massachusetts 02115; Pediatric Endocrine Unit (T.L.S., L.R.B.), Massachusetts General Hospital, Boston, Massachusetts 02114; Research Division (A.L.D.S.-C., M.-E.P.), Joslin Diabetes Center, Boston, Massachusetts 02215; Department of Physical Medicine and Rehabilitation (W.R.F.), Vanderbilt University Medical Center, Nashville, Tennessee 37212; Department of Physical Medicine and Rehabilitation (W.R.F.), Harvard Medical School/Spaulding Rehabilitation Hospital, Boston, Massachusetts 02114; Department of Physiology (W.R.F.), University of Puerto Rico School of Medicine, San Juan, Puerto Rico 00936; Department of Radiology (M.T.), Massachusetts General Hospital, Boston, Massachusetts 02114; and MGH Biostatistics Center (H.L.), Massachusetts General Hospital and Harvard Medical Center, Boston, Massachusetts 02114
| | - Meghan N Feldpausch
- Program in Nutritional Metabolism and Neuroendocrine Unit (H.M., T.L.S., C.S., S.S., L.R.B., S.E.L., M.N.F., S.K.G.), Massachusetts General Hospital, Boston, Massachusetts 02114; Harvard Medical School (H.M., T.L.S., A.L.D.S.-C., L.R.B., S.E.L., M.T., H.L., M.-E.P., S.K.G.), Boston, Massachusetts 02115; Pediatric Endocrine Unit (T.L.S., L.R.B.), Massachusetts General Hospital, Boston, Massachusetts 02114; Research Division (A.L.D.S.-C., M.-E.P.), Joslin Diabetes Center, Boston, Massachusetts 02215; Department of Physical Medicine and Rehabilitation (W.R.F.), Vanderbilt University Medical Center, Nashville, Tennessee 37212; Department of Physical Medicine and Rehabilitation (W.R.F.), Harvard Medical School/Spaulding Rehabilitation Hospital, Boston, Massachusetts 02114; Department of Physiology (W.R.F.), University of Puerto Rico School of Medicine, San Juan, Puerto Rico 00936; Department of Radiology (M.T.), Massachusetts General Hospital, Boston, Massachusetts 02114; and MGH Biostatistics Center (H.L.), Massachusetts General Hospital and Harvard Medical Center, Boston, Massachusetts 02114
| | - Martin Torriani
- Program in Nutritional Metabolism and Neuroendocrine Unit (H.M., T.L.S., C.S., S.S., L.R.B., S.E.L., M.N.F., S.K.G.), Massachusetts General Hospital, Boston, Massachusetts 02114; Harvard Medical School (H.M., T.L.S., A.L.D.S.-C., L.R.B., S.E.L., M.T., H.L., M.-E.P., S.K.G.), Boston, Massachusetts 02115; Pediatric Endocrine Unit (T.L.S., L.R.B.), Massachusetts General Hospital, Boston, Massachusetts 02114; Research Division (A.L.D.S.-C., M.-E.P.), Joslin Diabetes Center, Boston, Massachusetts 02215; Department of Physical Medicine and Rehabilitation (W.R.F.), Vanderbilt University Medical Center, Nashville, Tennessee 37212; Department of Physical Medicine and Rehabilitation (W.R.F.), Harvard Medical School/Spaulding Rehabilitation Hospital, Boston, Massachusetts 02114; Department of Physiology (W.R.F.), University of Puerto Rico School of Medicine, San Juan, Puerto Rico 00936; Department of Radiology (M.T.), Massachusetts General Hospital, Boston, Massachusetts 02114; and MGH Biostatistics Center (H.L.), Massachusetts General Hospital and Harvard Medical Center, Boston, Massachusetts 02114
| | - Hang Lee
- Program in Nutritional Metabolism and Neuroendocrine Unit (H.M., T.L.S., C.S., S.S., L.R.B., S.E.L., M.N.F., S.K.G.), Massachusetts General Hospital, Boston, Massachusetts 02114; Harvard Medical School (H.M., T.L.S., A.L.D.S.-C., L.R.B., S.E.L., M.T., H.L., M.-E.P., S.K.G.), Boston, Massachusetts 02115; Pediatric Endocrine Unit (T.L.S., L.R.B.), Massachusetts General Hospital, Boston, Massachusetts 02114; Research Division (A.L.D.S.-C., M.-E.P.), Joslin Diabetes Center, Boston, Massachusetts 02215; Department of Physical Medicine and Rehabilitation (W.R.F.), Vanderbilt University Medical Center, Nashville, Tennessee 37212; Department of Physical Medicine and Rehabilitation (W.R.F.), Harvard Medical School/Spaulding Rehabilitation Hospital, Boston, Massachusetts 02114; Department of Physiology (W.R.F.), University of Puerto Rico School of Medicine, San Juan, Puerto Rico 00936; Department of Radiology (M.T.), Massachusetts General Hospital, Boston, Massachusetts 02114; and MGH Biostatistics Center (H.L.), Massachusetts General Hospital and Harvard Medical Center, Boston, Massachusetts 02114
| | - Mary-Elizabeth Patti
- Program in Nutritional Metabolism and Neuroendocrine Unit (H.M., T.L.S., C.S., S.S., L.R.B., S.E.L., M.N.F., S.K.G.), Massachusetts General Hospital, Boston, Massachusetts 02114; Harvard Medical School (H.M., T.L.S., A.L.D.S.-C., L.R.B., S.E.L., M.T., H.L., M.-E.P., S.K.G.), Boston, Massachusetts 02115; Pediatric Endocrine Unit (T.L.S., L.R.B.), Massachusetts General Hospital, Boston, Massachusetts 02114; Research Division (A.L.D.S.-C., M.-E.P.), Joslin Diabetes Center, Boston, Massachusetts 02215; Department of Physical Medicine and Rehabilitation (W.R.F.), Vanderbilt University Medical Center, Nashville, Tennessee 37212; Department of Physical Medicine and Rehabilitation (W.R.F.), Harvard Medical School/Spaulding Rehabilitation Hospital, Boston, Massachusetts 02114; Department of Physiology (W.R.F.), University of Puerto Rico School of Medicine, San Juan, Puerto Rico 00936; Department of Radiology (M.T.), Massachusetts General Hospital, Boston, Massachusetts 02114; and MGH Biostatistics Center (H.L.), Massachusetts General Hospital and Harvard Medical Center, Boston, Massachusetts 02114
| | - Steven K Grinspoon
- Program in Nutritional Metabolism and Neuroendocrine Unit (H.M., T.L.S., C.S., S.S., L.R.B., S.E.L., M.N.F., S.K.G.), Massachusetts General Hospital, Boston, Massachusetts 02114; Harvard Medical School (H.M., T.L.S., A.L.D.S.-C., L.R.B., S.E.L., M.T., H.L., M.-E.P., S.K.G.), Boston, Massachusetts 02115; Pediatric Endocrine Unit (T.L.S., L.R.B.), Massachusetts General Hospital, Boston, Massachusetts 02114; Research Division (A.L.D.S.-C., M.-E.P.), Joslin Diabetes Center, Boston, Massachusetts 02215; Department of Physical Medicine and Rehabilitation (W.R.F.), Vanderbilt University Medical Center, Nashville, Tennessee 37212; Department of Physical Medicine and Rehabilitation (W.R.F.), Harvard Medical School/Spaulding Rehabilitation Hospital, Boston, Massachusetts 02114; Department of Physiology (W.R.F.), University of Puerto Rico School of Medicine, San Juan, Puerto Rico 00936; Department of Radiology (M.T.), Massachusetts General Hospital, Boston, Massachusetts 02114; and MGH Biostatistics Center (H.L.), Massachusetts General Hospital and Harvard Medical Center, Boston, Massachusetts 02114
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15
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Abstract
An abundance of data has provided insight into the mechanisms underlying the development of left ventricular (LV) hypertrophy and its progression to LV failure. In contrast, there is minimal data on the adaptation of the right ventricle (RV) to pressure and volume overload and the transition to RV failure. This is a critical clinical question, because the RV is uniquely at risk in many patients with repaired or palliated congenital heart disease and in those with pulmonary hypertension. Standard heart failure therapies have failed to improve function or survival in these patients, suggesting a divergence in the molecular mechanisms of RV versus LV failure. Although, on the cellular level, the remodeling responses of the RV and LV to pressure overload are largely similar, there are several key differences: the stressed RV is more susceptible to oxidative stress, has a reduced angiogenic response, and is more likely to activate cell death pathways than the stressed LV. Together, these differences could explain the more rapid progression of the RV to failure versus the LV. This review will highlight known molecular differences between the RV and LV responses to hemodynamic stress, the unique stressors on the RV associated with congenital heart disease, and the need to better understand these molecular mechanisms if we are to develop RV-specific heart failure therapeutics.
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Affiliation(s)
- Sushma Reddy
- From Department of Pediatrics (Cardiology) and the Stanford Cardiovascular Institute, Stanford University, Palo Alto, CA.
| | - Daniel Bernstein
- From Department of Pediatrics (Cardiology) and the Stanford Cardiovascular Institute, Stanford University, Palo Alto, CA
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16
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Winhofer Y, Krššák M, Wolf P, Anderwald CH, Geroldinger A, Heinze G, Baumgartner-Parzer S, Marculescu R, Stulnig T, Wolzt M, Trattnig S, Luger A, Krebs M. Free fatty acid availability is closely related to myocardial lipid storage and cardiac function in hypoglycemia counterregulation. Am J Physiol Endocrinol Metab 2015; 308:E631-40. [PMID: 25670825 DOI: 10.1152/ajpendo.00371.2014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 02/03/2015] [Indexed: 11/22/2022]
Abstract
Hypoglycemia, a major side effect of intensive glucose-lowering therapy, was recently linked to increased cardiovascular risk in patients with diabetes. Whether increased circulating free fatty acids (FFA) owing to catecholamine-induced lipolysis affect myocardial energy metabolism and thus link hypoglycemia to cardiac vulnerability is unclear. Therefore, this study investigated the impact of hypoglycemia counterregulation (± inhibition of lipolysis) on myocardial lipid content (MYCL) and left ventricular function in healthy subjects. Nine healthy men were studied in randomized order: 1) insulin/hypoglycemia test (IHT; ins+/aci-), 2) IHT during inhibition of adipose tissue lipolysis by acipimox (ins+/aci+), 3) normoglycemia with acipimox (ins-/aci+), and 4) normoglycemia with placebo (ins-/aci-). MYCL and cardiac function were assessed by employing magnetic resonance spectroscopy/imaging at baseline and at 2 and 6 h. In response to acute hypoglycemia, plasma FFA (P<0.0001) and ejection fraction (EF; from 63.2±5.5 to 69.6±6.3%, P=0.0001) increased significantly and were tightly correlated with each other (r=0.68, P=0.0002); this response was completely blunted by inhibition of adipose tissue lipolysis. In the presence of normoglycemia, inhibition of lipolysis was associated with a drop in EF (from 59.2±5.5 to 53.9±6.9%,P=0.005) and a significant decrease in plasma FFA, triglycerides, and MYCL (by 48.5%, P=0.0001). The present data indicate that an intact interorgan cross-talk between adipose tissue and the heart is a prerequisite for catecholamine-mediated myocardial contractility and preservation of myocardial lipid stores in response to acute hypoglycemia.
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Affiliation(s)
- Yvonne Winhofer
- Department of Internal Medicine III, Division of Endocrinology and Metabolism, Medical University of Vienna, Vienna, Austria;
| | - Martin Krššák
- Department of Internal Medicine III, Division of Endocrinology and Metabolism, Medical University of Vienna, Vienna, Austria; Centre of Excellence, High-Field MR, Department of Radiodiagnostics, Medical University of Vienna, Vienna, Austria
| | - Peter Wolf
- Department of Internal Medicine III, Division of Endocrinology and Metabolism, Medical University of Vienna, Vienna, Austria
| | - Christian-Heinz Anderwald
- Department of Internal Medicine III, Division of Endocrinology and Metabolism, Medical University of Vienna, Vienna, Austria; Mariahilf Community Pharmacy, Arnoldstein, Austria; Medical Direction, Specialized Hospital Complex Agathenhof, Micheldorf, Austria
| | - Angelika Geroldinger
- Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Georg Heinze
- Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Sabina Baumgartner-Parzer
- Department of Internal Medicine III, Division of Endocrinology and Metabolism, Medical University of Vienna, Vienna, Austria
| | - Rodrig Marculescu
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Thomas Stulnig
- Department of Internal Medicine III, Division of Endocrinology and Metabolism, Medical University of Vienna, Vienna, Austria; Christian Doppler Laboratory for Cardio-Metabolic Immunotherapy, Department of Medicine III, Medical University of Vienna, Vienna, Austria; and
| | - Michael Wolzt
- Department of Internal Medicine III, Division of Endocrinology and Metabolism, Medical University of Vienna, Vienna, Austria; Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Siegfried Trattnig
- Centre of Excellence, High-Field MR, Department of Radiodiagnostics, Medical University of Vienna, Vienna, Austria
| | - Anton Luger
- Department of Internal Medicine III, Division of Endocrinology and Metabolism, Medical University of Vienna, Vienna, Austria
| | - Michael Krebs
- Department of Internal Medicine III, Division of Endocrinology and Metabolism, Medical University of Vienna, Vienna, Austria
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17
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Sulkin MS, Yang F, Holzem KM, Van Leer B, Bugge C, Laughner JI, Green K, Efimov IR. Nanoscale three-dimensional imaging of the human myocyte. J Struct Biol 2014; 188:55-60. [PMID: 25160725 DOI: 10.1016/j.jsb.2014.08.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Revised: 08/08/2014] [Accepted: 08/18/2014] [Indexed: 11/28/2022]
Abstract
The ventricular human myocyte is spatially organized for optimal ATP and Ca(2+) delivery to sarcomeric myosin and ionic pumps during every excitation-contraction cycle. Comprehension of three-dimensional geometry of the tightly packed ultrastructure has been derived from discontinuous two-dimensional images, but has never been precisely reconstructed or analyzed in human myocardium. Using a focused ion beam scanning electron microscope, we created nanoscale resolution serial images to quantify the three-dimensional ultrastructure of a human left ventricular myocyte. Transverse tubules (t-tubule), lipid droplets, A-bands, and mitochondria occupy 1.8, 1.9, 10.8, and 27.9% of the myocyte volume, respectively. The complex t-tubule system has a small tortuosity (1.04±0.01), and is composed of long transverse segments with diameters of 317±24nm and short branches. Our data indicates that lipid droplets located well beneath the sarcolemma are proximal to t-tubules, where 59% (13 of 22) of lipid droplet centroids are within 0.50μm of a t-tubule. This spatial association could have an important implication in the development and treatment of heart failure because it connects two independently known pathophysiological alterations, a substrate switch from fatty acids to glucose and t-tubular derangement.
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Affiliation(s)
- Matthew S Sulkin
- Department of Biomedical Engineering, Washington University in St. Louis, MO, USA
| | - Fei Yang
- Department of Radiation Oncology, School of Medicine, Washington University in St. Louis, MO, USA
| | - Katherine M Holzem
- Department of Biomedical Engineering, Washington University in St. Louis, MO, USA
| | | | | | - Jacob I Laughner
- Department of Biomedical Engineering, Washington University in St. Louis, MO, USA
| | - Karen Green
- Department of Pathology and Immunology, School of Medicine, Washington University in St. Louis, MO, USA
| | - Igor R Efimov
- Department of Biomedical Engineering, Washington University in St. Louis, MO, USA.
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18
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Abstract
The heart consumes huge amounts of energy to fulfil its function as a relentless pump. A highly sophisticated system of energy generation based on flexibility of substrate use and efficient energy production, effective energy sensing and energy transfer ensures function of the healthy heart across a range of physiological situations. In left ventricular hypertrophy and heart failure, these processes become disturbed, leading as will be discussed to impaired cardiac energetic status and to further impairment of cardiac function. These metabolic disturbances form a potential target for therapy.
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19
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Melenovsky V, Kotrc M, Polak J, Pelikanova T, Bendlova B, Cahova M, Malek I, Jarolim P, Kazdova L, Kautzner J. Availability of energetic substrates and exercise performance in heart failure with or without diabetes. Eur J Heart Fail 2014; 14:754-63. [DOI: 10.1093/eurjhf/hfs080] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Vojtech Melenovsky
- Department of Cardiology; Institute of Clinical and Experimental Medicine-IKEM; Prague 4 140 28 Czech Republic
| | - Martin Kotrc
- Department of Cardiology; Institute of Clinical and Experimental Medicine-IKEM; Prague 4 140 28 Czech Republic
| | - Jan Polak
- Department of Cardiology; Institute of Clinical and Experimental Medicine-IKEM; Prague 4 140 28 Czech Republic
- Division of Pulmonary and Critical Care Medicine; The Johns Hopkins University; Baltimore MD USA
| | - Terezie Pelikanova
- Diabetes Center, Institute of Clinical and Experimental Medicine-IKEM; Prague Czech Republic
| | | | - Monika Cahova
- Center for Experimental Medicine, Institute of Clinical and Experimental Medicine-IKEM; Prague Czech Republic
| | - Ivan Malek
- Department of Cardiology; Institute of Clinical and Experimental Medicine-IKEM; Prague 4 140 28 Czech Republic
| | - Petr Jarolim
- Center for Experimental Medicine, Institute of Clinical and Experimental Medicine-IKEM; Prague Czech Republic
| | - Ludmila Kazdova
- Department of Pathology; Brigham and Women's Hospital, Harvard Medical School; Boston MA USA
| | - Josef Kautzner
- Department of Cardiology; Institute of Clinical and Experimental Medicine-IKEM; Prague 4 140 28 Czech Republic
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20
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Kolwicz SC, Purohit S, Tian R. Cardiac metabolism and its interactions with contraction, growth, and survival of cardiomyocytes. Circ Res 2013; 113:603-16. [PMID: 23948585 DOI: 10.1161/circresaha.113.302095] [Citation(s) in RCA: 518] [Impact Index Per Article: 47.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The network for cardiac fuel metabolism contains intricate sets of interacting pathways that result in both ATP-producing and non-ATP-producing end points for each class of energy substrates. The most salient feature of the network is the metabolic flexibility demonstrated in response to various stimuli, including developmental changes and nutritional status. The heart is also capable of remodeling the metabolic pathways in chronic pathophysiological conditions, which results in modulations of myocardial energetics and contractile function. In a quest to understand the complexity of the cardiac metabolic network, pharmacological and genetic tools have been engaged to manipulate cardiac metabolism in a variety of research models. In concert, a host of therapeutic interventions have been tested clinically to target substrate preference, insulin sensitivity, and mitochondrial function. In addition, the contribution of cellular metabolism to growth, survival, and other signaling pathways through the production of metabolic intermediates has been increasingly noted. In this review, we provide an overview of the cardiac metabolic network and highlight alterations observed in cardiac pathologies as well as strategies used as metabolic therapies in heart failure. Lastly, the ability of metabolic derivatives to intersect growth and survival are also discussed.
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Affiliation(s)
- Stephen C Kolwicz
- Mitochondria and Metabolism Center, Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA 98109, USA
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21
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Khan RS, Lin Y, Hu Y, Son NH, Bharadwaj KG, Palacios C, Chokshi A, Ji R, Yu S, Homma S, Schulze PC, Tian R, Goldberg IJ. Rescue of heart lipoprotein lipase-knockout mice confirms a role for triglyceride in optimal heart metabolism and function. Am J Physiol Endocrinol Metab 2013; 305:E1339-47. [PMID: 24085031 PMCID: PMC3882371 DOI: 10.1152/ajpendo.00349.2013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Hearts utilize fatty acids as a primary source of energy. The sources of those lipids include free fatty acids and lipoprotein triglycerides. Deletion of the primary triglyceride-hydrolyzing enzyme lipoprotein lipase (LPL) leads to cardiac dysfunction. Whether heart LPL-knockout (hLPL0) mice are compromised due a deficiency in energetic substrates is unknown. To test whether alternative sources of energy will prevent cardiac dysfunction in hLPL0 mice, two different models were used to supply nonlipid energy. 1) hLPL0 mice were crossed with mice transgenically expressing GLUT1 in cardiomyocytes to increase glucose uptake into the heart; this cross-corrected cardiac dysfunction, reduced cardiac hypertrophy, and increased myocardial ATP. 2) Mice were randomly assigned to a sedentary or training group (swimming) at 3 mo of age, which leads to increased skeletal muscle production of lactate. hLPL0 mice had greater expression of the lactate transporter monocarboxylate transporter-1 (MCT-1) and increased cardiac lactate uptake. Compared with hearts from sedentary hLPL0 mice, hearts from trained hLPL0 mice had adaptive hypertrophy and improved cardiac function. We conclude that defective energy intake and not the reduced uptake of fat-soluble vitamins or cholesterol is responsible for cardiac dysfunction in hLPL0 mice. In addition, our studies suggest that adaptations in cardiac metabolism contribute to the beneficial effects of exercise on the myocardium of patients with heart failure.
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22
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Bayeva M, Sawicki KT, Ardehali H. Taking diabetes to heart--deregulation of myocardial lipid metabolism in diabetic cardiomyopathy. J Am Heart Assoc 2013; 2:e000433. [PMID: 24275630 PMCID: PMC3886738 DOI: 10.1161/jaha.113.000433] [Citation(s) in RCA: 112] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Marina Bayeva
- Feinberg Cardiovascular Research Institute, Northwestern University, Chicago, IL
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23
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Nielsen R, Nørrelund H, Kampmann U, Kim WY, Ringgaard S, Schär M, Møller N, Bøtker HE, Wiggers H. Failing heart of patients with type 2 diabetes mellitus can adapt to extreme short-term increases in circulating lipids and does not display features of acute myocardial lipotoxicity. Circ Heart Fail 2013; 6:845-52. [PMID: 23733915 DOI: 10.1161/circheartfailure.113.000187] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Circulating lipid levels and myocardial lipid content (MyLC) is increased in type 2 diabetes mellitus. This may cause a state of lipotoxicity that compromises left ventricular function and aggravate heart failure. We investigated the relationship among circulating lipid levels, MyLC, and cardiac function together with the acute cardiac effects of high as opposed to low circulating free fatty acid (FFA) and triglyceride levels in patients with type 2 diabetes mellitus and heart failure. METHODS AND RESULTS Eighteen patients underwent 8-hour intralipid/heparin-infusion (high FFA) and hyperinsulinemic-euglycemic clamping (low FFA) in a randomized crossover-designed study. We applied magnetic resonance proton spectroscopy to measure MyLC. Cardiac function was assessed by advanced echocardiography, cardiopulmonary exercise, and MRI. MyLC correlated positively with circulating triglyceride (r=0.47; r(2)=0.22; P=0.003) and FFA (r=0.45; r(2)=0.20; P=0.001) levels and inversely with left ventricular ejection fraction (r=-0.54; r(2)=0.29; P=0.004). Circulating FFA concentrations differed between study arms (0.05 ± 0.04 mmol/L [low FFA] versus 1.04 ± 0.27 mmol/L [high FFA]; P<0.001) and MyLC increased from 0.78 ± 0.59% (low FFA) to 1.16 ± 0.73% (high FFA; P<0.01). Resting left ventricular ejection fraction and global strain did not differ between high and low FFA, whereas resting systolic mitral plane velocity (S'max) was highest during high FFA (3.6±0.8 cm/s [low FFA] versus 3.8±0.7 cm/s [high FFA]; P=0.02). Peak exercise capacity and oxygen consumption did not differ between the study arms, and neither did postexercise measurements of left ventricular ejection fraction, global strain, and S'max. CONCLUSIONS Our findings indicate that the failing heart of patients with type 2 diabetes mellitus can adapt to short-term extreme changes in circulating substrates and does not display features of acute myocardial lipotoxicity. Clinical Trial Registration- URL: http://www.clinicaltrials.gov. Unique identifier: NCT01192373.
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Affiliation(s)
- Roni Nielsen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
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24
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Wende AR, Symons JD, Abel ED. Mechanisms of lipotoxicity in the cardiovascular system. Curr Hypertens Rep 2013; 14:517-31. [PMID: 23054891 DOI: 10.1007/s11906-012-0307-2] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Cardiovascular diseases account for approximately one third of all deaths globally. Obese and diabetic patients have a high likelihood of dying from complications associated with cardiovascular dysfunction. Obesity and diabetes increase circulating lipids that upon tissue uptake, may be stored as triglyceride, or may be metabolized in other pathways, leading to the generation of toxic intermediates. Excess lipid utilization or activation of signaling pathways by lipid metabolites may disrupt cellular homeostasis and contribute to cell death, defining the concept of lipotoxicity. Lipotoxicity occurs in multiple organs, including cardiac and vascular tissues, and a number of specific mechanisms have been proposed to explain lipotoxic tissue injury. In addition, recent data suggests that increased tissue lipids may also be protective in certain contexts. This review will highlight recent progress toward elucidating the relationship between nutrient oversupply, lipotoxicity, and cardiovascular dysfunction. The review will focus in two sections on the vasculature and cardiomyocytes respectively.
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Affiliation(s)
- Adam R Wende
- Program in Molecular Medicine, Division of Endocrinology, Metabolism, and Diabetes, University of Utah School of Medicine, Salt Lake City, 84112, USA
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25
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Nielsen R, Nørrelund H, Kampmann U, Bøtker HE, Møller N, Wiggers H. Effect of acute hyperglycemia on left ventricular contractile function in diabetic patients with and without heart failure: two randomized cross-over studies. PLoS One 2013; 8:e53247. [PMID: 23308171 PMCID: PMC3540097 DOI: 10.1371/journal.pone.0053247] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2012] [Accepted: 11/27/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND It is unknown whether changes in circulating glucose levels due to short-term insulin discontinuation affect left ventricular contractile function in type 2 diabetic patients with (T2D-HF) and without (T2D-nonHF) heart failure. MATERIALS AND METHODS In two randomized cross-over-designed trials, 18 insulin-treated type 2 diabetic patients with (Ejection Fraction (EF) 36 ± 6%, n = 10) (trial 2) and without systolic heart failure (EF 60 ± 3%, n = 8) (trial 1) were subjected to hyper- and normoglycemia for 9-12 hours on two different occasions. Advanced echocardiography, bicycle exercise tests and 6-minute hall walk distance were applied. RESULTS Plasma glucose levels differed between study arms (6.5 ± 0.8 mM vs 14.1 ± 2.6 mM (T2D-HF), 5.8 ± 0.4 mM vs 9.9 ± 2.1 mM (T2D-nonHF), p<0.001). Hyperglycemia was associated with an increase in several parameters: maximal global systolic tissue velocity (Vmax) (p<0.001), maximal mitral annulus velocity (S'max) (p<0.001), strain rate (p = 0.02) and strain (p = 0.05). Indices of increased myocardial systolic contractile function were significant in both T2D-HF (Vmax: 14%, p = 0.02; S'max: 10%, p = 0.04), T2D-nonHF (Vmax: 12%, p<0.01; S'max: 9%, p<0.001) and in post exercise S'max (7%, p = 0.049) during hyperglycemia as opposed to normoglycemia. LVEF did not differ between normo- and hyperglycemia (p = 0.17), and neither did peak exercise capacity nor catecholamine levels. Type 2 diabetic heart failure patients' 6-minute hall walk distance improved by 7% (p = 0.02) during hyperglycemia as compared with normoglycemia. CONCLUSIONS Short-term hyperglycemia by insulin discontinuation is associated with an increase in myocardial systolic contractile function in type 2 diabetic patients with and without heart failure and with a slightly prolonged walking distance in type 2 diabetic heart failure patients. (Clinicaltrials.gov identifier NCT00653510).
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Affiliation(s)
- Roni Nielsen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
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26
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Altin SE, Schulze PC. Metabolism of the right ventricle and the response to hypertrophy and failure. Prog Cardiovasc Dis 2012; 55:229-33. [PMID: 23009918 DOI: 10.1016/j.pcad.2012.07.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Profound transcriptional, translational and energetic derangements develop in the right ventricle (RV) in response to physiologic and pathophysiologic stress. The transition from pressure and volume overload to cardiac hypertrophy and subsequent failure is accompanied by a distinct switch from preferential fatty acid to glucose utilization for ATP generation. The failing RV is characterized by an energy-starved state with insufficient ATP levels. Modern non-invasive imaging using positron emission tomography using specific radioactive tracers allows a detailed spatial and temporal characterization of RV metabolism. While the current role for pharmacologic interventions on RV metabolic abnormalities is unclear, several potentially promising molecular targets have been identified and clinical trials targeting molecular dysfunction in RV hypertrophy and failure have been designed.
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Affiliation(s)
- S Elissa Altin
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York 10032, USA
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27
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Abstract
The heart has both the greatest caloric needs and the most robust oxidation of fatty acids (FAs). Under pathological conditions such as obesity and type 2 diabetes, cardiac uptake and oxidation are not balanced and hearts accumulate lipid potentially leading to cardiac lipotoxicity. We will first review the pathways utilized by the heart to acquire FAs from the circulation and to store triglyceride intracellularly. Then we will describe mouse models in which excess lipid accumulation causes heart dysfunction and experiments performed to alleviate this toxicity. Finally, the known relationships between heart lipid metabolism and dysfunction in humans will be summarized.
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Affiliation(s)
- Ira J Goldberg
- Department of Medicine, Columbia University, New York, NY 10032, USA.
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28
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Abstract
In addition to the typical abnormalities in myocardial structure and function, it is well established that the cardiac metabolism is abnormal in patients with heart failure (HF). Insulin resistance is a common co-morbidity in HF patients and also modulates cardiac metabolism in HF. The notion that an altered myocardial metabolism may contribute to the disease pathogenesis and optimizing it may serve therapeutic purposes underscores the importance of identifying the metabolic characteristics of HF patients. In this paper, the literature on the metabolic changes in human HF is reviewed, and the effects of metabolic modulators on patients with HF are discussed.
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Affiliation(s)
- Helena Tuunanen
- Turku PET Centre, University of Turku, c/o Turku University Hospital, PO Box 52, 20521 Turku, Finland
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29
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Nielsen TT, Støttrup NB, Løfgren B, Bøtker HE. Metabolic fingerprint of ischaemic cardioprotection: importance of the malate-aspartate shuttle. Cardiovasc Res 2011; 91:382-91. [PMID: 21349875 DOI: 10.1093/cvr/cvr051] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
The convergence of cardioprotective intracellular signalling pathways to modulate mitochondrial function as an end-target of cytoprotective stimuli is well described. However, our understanding of whether the complementary changes in mitochondrial energy metabolism are secondary responses or inherent mechanisms of ischaemic cardioprotection remains incomplete. In the heart, the malate-aspartate shuttle (MAS) constitutes the primary metabolic pathway for transfer of reducing equivalents from the cytosol into the mitochondria for oxidation. The flux of MAS is tightly linked to the flux of the tricarboxylic acid cycle and the electron transport chain, partly by the amino acid l-glutamate. In addition, emerging evidence suggests the MAS is an important regulator of cytosolic and mitochondrial calcium homeostasis. In the isolated rat heart, inhibition of MAS during ischaemia and early reperfusion by the aminotransferase inhibitor aminooxyacetate induces infarct limitation, improves haemodynamic responses, and modulates glucose metabolism, analogous to effects observed in classical ischaemic preconditioning. On the basis of these findings, the mechanisms through which MAS preserves mitochondrial function and cell survival are reviewed. We conclude that the available evidence is supportive of a down-regulation of mitochondrial respiration during lethal ischaemia with a gradual 'wake-up' during reperfusion as a pivotal feature of ischaemic cardioprotection. Finally, comments on modulating myocardial energy metabolism by the cardioprotective amino acids glutamate and glutamine are given.
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Affiliation(s)
- Torsten Toftegaard Nielsen
- Department of Cardiology, Skejby Hospital, Aarhus University Hospital, Brendstrupgaardsvej 100, Aarhus N, Denmark.
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30
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Abstract
In the advanced stages of heart failure, many key enzymes involved in myocardial energy substrate metabolism display various degrees of down-regulation. The net effect of the altered metabolic phenotype consists of reduced cardiac fatty oxidation, increased glycolysis and glucose oxidation, and rigidity of the metabolic response to changes in workload. Is this metabolic shift an adaptive mechanism that protects the heart or a maladaptive process that accelerates structural and functional derangement? The question remains open; however, the metabolic remodelling of the failing heart has induced a number of investigators to test the hypothesis that pharmacological modulation of myocardial substrate utilization might prove therapeutically advantageous. The present review addresses the effects of indirect and direct modulators of fatty acid (FA) oxidation, which are the best pharmacological agents available to date for 'metabolic therapy' of failing hearts. Evidence for the efficacy of therapeutic strategies based on modulators of FA metabolism is mixed, pointing to the possibility that the molecular/biochemical alterations induced by these pharmacological agents are more complex than originally thought. Much remains to be understood; however, the beneficial effects of molecules such as perhexiline and trimetazidine in small clinical trials indicate that this promising therapeutic strategy is worthy of further pursuit.
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Affiliation(s)
- Vincenzo Lionetti
- Gruppo Intini-SMA Laboratory of Experimental Cardiology, Scuola Superiore Sant'Anna, Pisa, Italy
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