Le Page Lydia M, Rider Oliver J, Lewis Andrew J, Ball Vicky, Clarke Kieran, Johansson Edvin, Carr Carolyn A, Heather Lisa C, Tyler Damian J
Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, U.K.
Division of Cardiovascular Medicine, University of Oxford, Oxford, U.K.
Diabetes. 2015 Aug;64(8):2735-43. doi: 10.2337/db14-1560. Epub 2015 Mar 20.
Although diabetic cardiomyopathy is widely recognized, there are no specific treatments available. Altered myocardial substrate selection has emerged as a candidate mechanism behind the development of cardiac dysfunction in diabetes. As pyruvate dehydrogenase (PDH) activity appears central to the balance of substrate use, we aimed to investigate the relationship between PDH flux and myocardial function in a rodent model of type 2 diabetes and to explore whether or not increasing PDH flux, with dichloroacetate, would restore the balance of substrate use and improve cardiac function. All animals underwent in vivo hyperpolarized [1-(13)C]pyruvate magnetic resonance spectroscopy and echocardiography to assess cardiac PDH flux and function, respectively. Diabetic animals showed significantly higher blood glucose levels (10.8 ± 0.7 vs. 8.4 ± 0.5 mmol/L), lower PDH flux (0.005 ± 0.001 vs. 0.017 ± 0.002 s(-1)), and significantly impaired diastolic function (transmitral early diastolic peak velocity/early diastolic myocardial velocity ratio [E/E'] 12.2 ± 0.8 vs. 20 ± 2), which are in keeping with early diabetic cardiomyopathy. Twenty-eight days of treatment with dichloroacetate restored PDH flux to normal levels (0.018 ± 0.002 s(-1)), reversed diastolic dysfunction (E/E' 14 ± 1), and normalized blood glucose levels (7.5 ± 0.7 mmol/L). The treatment of diabetes with dichloroacetate therefore restored the balance of myocardial substrate selection, reversed diastolic dysfunction, and normalized blood glucose levels. This suggests that PDH modulation could be a novel therapy for the treatment and/or prevention of diabetic cardiomyopathy.
尽管糖尿病性心肌病已被广泛认识,但目前尚无特效治疗方法。心肌底物选择的改变已成为糖尿病心脏功能障碍发生背后的一种潜在机制。由于丙酮酸脱氢酶(PDH)活性似乎是底物利用平衡的核心,我们旨在研究2型糖尿病啮齿动物模型中PDH通量与心肌功能之间的关系,并探讨用二氯乙酸增加PDH通量是否能恢复底物利用平衡并改善心脏功能。所有动物均接受体内超极化[1-(13)C]丙酮酸磁共振波谱和超声心动图检查,分别评估心脏PDH通量和功能。糖尿病动物的血糖水平显著更高(10.8±0.7 vs. 8.4±0.5 mmol/L),PDH通量更低(0.005±0.001 vs. 0.017±0.002 s-1),舒张功能明显受损(二尖瓣舒张早期峰值速度/舒张早期心肌速度比值[E/E'] 12.2±0.8 vs. 20±2),这些均与早期糖尿病性心肌病相符。用二氯乙酸治疗28天可使PDH通量恢复至正常水平(0.018±0.002 s-1),逆转舒张功能障碍(E/E' 14±1),并使血糖水平正常化(7.5±0.7 mmol/L)。因此,用二氯乙酸治疗糖尿病可恢复心肌底物选择平衡,逆转舒张功能障碍,并使血糖水平正常化。这表明PDH调节可能是治疗和/或预防糖尿病性心肌病的一种新疗法。