Cardiac ketone body metabolism.

The ketone bodies, d-β-hydroxybutyrate and acetoacetate, are soluble 4-carbon compounds derived principally from fatty acids, that can be metabolised by many oxidative tissues, including heart, in carbohydrate-depleted conditions as glucose-sparing energy substrates. They also have important signalling functions, acting through G-protein coupled receptors and histone deacetylases to regulate metabolism and gene expression including that associated with anti-oxidant activity. Their concentration, and hence availability, increases in diabetes mellitus and heart failure. Whilst known to be substrates for ATP production, especially in starvation, their role(s) in the heart, and in heart disease, is uncertain. Recent evidence, reviewed here, indicates that increased ketone body metabolism is a feature of heart failure, and is accompanied by other changes in substrate selection. Whether the change in myocardial ketone body metabolism is adaptive or maladaptive is unknown, but it offers the possibility of using exogenous ketones to treat the failing heart.

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Déclaration de conflit d'intérêts

Declaration of competing interest The intellectual property, and patents covering the uses of ketone bodies and esters are owned by BTG Ltd., the University of Oxford, the NIH and TdeltaS Ltd. Should royalties ever accrue from these patents, Professor Kieran Clarke as named inventor may receive a share of royalties as determined by the terms of the University of Oxford. KC is director of TdeltaS, a spin out company of the University of Oxford, aiming to develop and commercialise products based on the KE.