Impact of Ketone Bodies on Myocardial Glucose and Fatty Acid Metabolism in Healthy Volunteers: A Positron Emission Tomography Study

Background:

Ketone bodies are produced by the liver in conditions of increased fatty acid oxidation, serving as important fuel sources during fasting and starvation. They are metabolized to acetyl-CoA which enters the tricarboxylic acid cycle, enabling ATP production independently of glycolysis and resulting in lower oxygen consumption per mole of produced ATP compared to glucose [ref]. Their primary physiological function appears to be as an alternative protein-sparing source of energy for extrahepatic tissues in times of reduced carbohydrate availability, preventing muscle wasting. The principal ketone bodies in humans are beta-hydroxybutyrate (BHB) and acetoacetate. Increased ketogenesis is a feature common to fasting, starvation and diabetes mellitus. Ketones have been shown to have a number of neuroprotective effects including anticonvulsant activity, improving cognitive function in Alzheimer's disease and decreasing the effects of acute brain injury and ischemic damage [ref], as well as antitumoral effect in gliomas. This has led to the suggestion that ketones could be used therapeutically for a number of diseases though currently the only recognized therapeutic use of ketones is in the form of ketogenic diets for the treatment of epilepsy.

There are limited in vivo studies on the effect of ketones on the heart. It is known that fatty acids are the preferred myocardial fuel substrate and that this shifts to increased use of glucose, and to a lesser extent ketones, in times of acutely increased demand. Interestingly, acute ketone infusion in pigs appears to inhibit myocardial fatty acid oxidation. In vitro studies suggest ketones decrease myocardial glucose uptake and affect myocardial contractility, with either increased or decreased contractility when ketones are the only energy source. This has not been further investigated in vivo. It is therefore unclear to what extent ketones can contribute to myocardial metabolism in conditions of hyperketonemia, and how this affects contractility.

The present project thus proposes to address the issues outlined above, by measuring human cerebral and cardiac uptake of energy substrates, together with functional parameters, using PET imaging and appropriate radiotracers, under experimental hyperketonemia.

Hypotheses: