Abstract
BackgroundICU-acquired weakness is a debilitating consequence of prolonged critical illness that is associated with poor outcome. Recently, premorbid obesity has been shown to protect against such illness-induced muscle wasting and weakness. Here, we hypothesized that this protection was due to increased lipid and ketone availability.MethodsIn a centrally catheterized, fluid-resuscitated, antibiotic-treated mouse model of prolonged sepsis, we compared markers of lipolysis and fatty acid oxidation in lean and obese septic mice (n = 117). Next, we compared markers of muscle wasting and weakness in septic obese wild-type and adipose tissue-specific ATGL knockout (AAKO) mice (n = 73), in lean septic mice receiving either intravenous infusion of lipids or standard parenteral nutrition (PN) (n = 70), and in lean septic mice receiving standard PN supplemented with either the ketone body 3-hydroxybutyrate or isocaloric glucose (n = 49).ResultsObese septic mice had more pronounced lipolysis (p ≤ 0.05), peripheral fatty acid oxidation (p ≤ 0.05), and ketogenesis (p ≤ 0.05) than lean mice. Blocking lipolysis in obese septic mice caused severely reduced muscle mass (32% loss vs. 15% in wild-type, p < 0.001) and specific maximal muscle force (59% loss vs. 0% in wild-type; p < 0.001). In contrast, intravenous infusion of lipids in lean septic mice maintained specific maximal muscle force up to healthy control levels (p = 0.6), whereas this was reduced with 28% in septic mice receiving standard PN (p = 0.006). Muscle mass was evenly reduced with 29% in both lean septic groups (p < 0.001). Lipid administration enhanced fatty acid oxidation (p ≤ 0.05) and ketogenesis (p < 0.001), but caused unfavorable liver steatosis (p = 0.01) and a deranged lipid profile (p ≤ 0.01). Supplementation of standard PN with 3-hydroxybutyrate also attenuated specific maximal muscle force up to healthy control levels (p = 0.1), but loss of muscle mass could not be prevented (25% loss in both septic groups; p < 0.001). Importantly, this intervention improved muscle regeneration markers (p ≤ 0.05) without the unfavorable side effects seen with lipid infusion.ConclusionsObesity-induced muscle protection during sepsis is partly mediated by elevated mobilization and metabolism of endogenous fatty acids. Furthermore, increased availability of ketone bodies, either through ketogenesis or through parenteral infusion, appears to protect against sepsis-induced muscle weakness also in the lean.
Highlights
intensive care unit (ICU)-acquired weakness is a debilitating consequence of prolonged critical illness that is associated with poor outcome
Overweight/obesity enhanced fatty acid mobilization during sepsis In the first study (Table 1), we hypothesized that overweight/obese mice have an altered metabolic response to sepsis compared to the lean mice, with elevated mobilization and metabolism of endogenous fatty acids
The obesity-induced muscle protection during sepsis was partly mediated by elevated mobilization and metabolism of endogenous fatty acids
Summary
ICU-acquired weakness is a debilitating consequence of prolonged critical illness that is associated with poor outcome. Ill patients frequently develop weakness of limb and respiratory muscles Such intensive care unit (ICU)-acquired weakness has a high prevalence and is associated with greater post-ICU impairment, prolonged hospitalization, delayed rehabilitation, and late death [1, 2]. Profound loss of muscle mass and quality characterizes ICU-acquired weakness [4]. Muscle regeneration is severely impaired in prolonged critically ill patients, which hampers rehabilitation [12] Several interventions, such as aggressive sepsis treatment, early mobilization, prevention of hyperglycemia, and withholding early parenteral nutrition (PN), have been shown to partially protect against ICUacquired weakness [4, 9, 13, 14]. To reduce the prevalence of this debilitating condition, additional clinical interventions are still required
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