Increasing carbohydrate oxidation improves contractile reserves and prevents hypertrophy in porcine right heart failure

Nikolaj Bøgh,Esben S S Hansen,Vibeke E Hjortdal,Jakob Lindhardt,Christoffer Laustsen,Robert S Stephenson,Peter Agger,Per M Nielsen,Camilla Omann

doi:10.1038/s41598-020-65098-7

Nikolaj Bøgh, Esben S S Hansen + Show 7 more

Open Access

https://doi.org/10.1038/s41598-020-65098-7

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Abstract

In heart failure, myocardial overload causes vast metabolic changes that impair cardiac energy production and contribute to deterioration of contractile function. However, metabolic therapy is not used in heart failure care. We aimed to investigate the interplay between cardiac function and myocardial carbohydrate metabolism in a large animal heart failure model. Using magnetic resonance spectroscopy with hyperpolarized pyruvate and magnetic resonance imaging at rest and during pharmacological stress, we investigated the in-vivo cardiac pyruvate metabolism and contractility in a porcine model of chronic pulmonary insufficiency causing right ventricular volume overload. To assess if increasing the carbohydrate metabolic reserve improves the contractile reserve, a group of animals were fed dichloroacetate, an activator of pyruvate oxidation. Volume overload caused heart failure with decreased pyruvate dehydrogenase flux and poor ejection fraction reserve. The animals treated with dichloroacetate had a larger contractile response to dobutamine stress than non-treated animals. Further, dichloroacetate prevented myocardial hypertrophy. The in-vivo metabolic data were validated by mitochondrial respirometry, enzyme activity assays and gene expression analyses. Our results show that pyruvate dehydrogenase kinase inhibition improves the contractile reserve and decreases hypertrophy by augmenting carbohydrate metabolism in porcine heart failure. The approach is promising for metabolic heart failure therapy.

Highlights

In heart failure, myocardial overload causes vast metabolic changes that impair cardiac energy production and contribute to deterioration of contractile function
We investigated this matter in a porcine model of right ventricular volume overload (RVO) with magnetic resonance imaging (MRI) and hyperpolarized [1-13C] pyruvate Magnetic resonance spectroscopy (MRS) at rest and under pharmacological stress
We report that pyruvate dehydrogenase kinases (PDKs) inhibition prevents myocardial hypertrophy and improves the biventricular contractile reserve in a pig model of early right heart failure from volume overload

Summary

Introduction

Myocardial overload causes vast metabolic changes that impair cardiac energy production and contribute to deterioration of contractile function. To assess if increasing the carbohydrate metabolic reserve improves the contractile reserve, a group of animals were fed dichloroacetate, an activator of pyruvate oxidation. Our results show that pyruvate dehydrogenase kinase inhibition improves the contractile reserve and decreases hypertrophy by augmenting carbohydrate metabolism in porcine heart failure. We hypothesized that recoupling glycolysis to mitochondrial metabolism with DCA increases the carbohydrate metabolic reserve and preserves the contractile reserve in experimental chronic heart failure. We investigated this matter in a porcine model of right ventricular volume overload (RVO) with MRI and hyperpolarized [1-13C] pyruvate MRS at rest and under pharmacological stress. We supported the in-vivo investigations with in-vitro analyses of gene expression and mitochondrial function

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