The heart has high metabolic flexibility in utilizing a variety of substrates for energy production. Reprogramming of cardiac metabolism is recognized as integral to the development of heart failure. In hypertrophied and failing hearts, fatty acid oxidation is reduced and glucose utilization is increased. Recent studies have also identified changes in the catabolism of amino acids and ketone bodies in the failing hearts. Thus, elucidating the functional consequence of the metabolic remodeling could provide mechanistic insights of pathogenesis and therapy of heart failure. While the switch from fatty acids to glucose has been shown ultimately maladaptive for energy supply, the impact of increased glucose reliance on cardiac hypertrophy and remodeling is incompletely understood. Emerging results suggest that changes in glucose and branched chain amino acid metabolism, apart from their contribution to energy production, serve multiple roles in controlling the hypertrophic growth of the heart. A number of studies have evaluated the impact of substrate switch on energy production in the heart by comparing and contrasting the contribution of multiple substrates using bioengineered mouse models. Emerging studies focus on the role of substrate metabolism in signal transduction and biosynthetic function of the cardiomyocytes undergoing hypertrophic growth.
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