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Comprehensive quantification of fuel use by the failing and nonfailing human heart

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TLDR
A comprehensive and quantitative picture of human cardiac fuel use is provided, using blood from artery, coronary sinus, and femoral vein in 110 patients with or without heart failure to quantify the uptake and release of 277 metabolites.
Abstract
The heart consumes circulating nutrients to fuel lifelong contraction, but a comprehensive mapping of human cardiac fuel use is lacking. We used metabolomics on blood from artery, coronary sinus, and femoral vein in 110 patients with or without heart failure to quantify the uptake and release of 277 metabolites, including all major nutrients, by the human heart and leg. The heart primarily consumed fatty acids and, unexpectedly, little glucose; secreted glutamine and other nitrogen-rich amino acids, indicating active protein breakdown, at a rate ~10 times that of the leg; and released intermediates of the tricarboxylic acid cycle, balancing anaplerosis from amino acid breakdown. Both heart and leg consumed ketones, glutamate, and acetate in direct proportionality to circulating levels, indicating that availability is a key driver for consumption of these substrates. The failing heart consumed more ketones and lactate and had higher rates of proteolysis. These data provide a comprehensive and quantitative picture of human cardiac fuel use.

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Journal ArticleDOI

The intestine is a major contributor to circulating succinate in mice

TL;DR: In this article , the authors investigated the role of the intestine in regulating circulating TCA cycle metabolites and their potential signaling effects on health and disease, and found that the intestine is not a major contributor to circulating succinate.
Journal ArticleDOI

Targeting Myocardial Substrate Metabolism in the Failing Heart: Ready for Prime Time?

TL;DR: The clinical benefits and main therapeutic metabolic approaches include inhibiting fatty acid uptake/fatty acid oxidation, reducing circulating fatty acid levels, increasing glucose oxidation, and augmenting ketone oxidation.
Journal ArticleDOI

Myocardial Metabolomics of Human Heart Failure With Preserved Ejection Fraction

TL;DR: In this paper , the authors used agnostic clustering tools, Kruskal-Wallis test with Dunn test, and machine learning to separate heart failure patients with preserved ejection fraction (HFpEF) versus control.
Journal ArticleDOI

A mitochondrial long-chain fatty acid oxidation defect leads to tRNA uncharging and activation of the integrated stress response in the mouse heart.

TL;DR: The results show that perturbations in amino acid metabolism caused by long-chain FAO deficiency impact on cardiac metabolic signaling, in particular the ISR, and show that the consequences of a FAO defect extend beyond cardiac energy homeostasis and include amino acids metabolism and associated signaling pathways such as the integrated stress response.
Journal ArticleDOI

Ketones and the Heart: Metabolic Principles and Therapeutic Implications

TL;DR: The role of cardiac ketone metabolism in health and disease with an emphasis on the therapeutic potential of ketosis as a treatment for heart failure (HF) is discussed in this article , where the authors present evidence for the benefit and feasibility of therapeutic ketosis in preclinical and clinical studies.
References
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Journal ArticleDOI

DrugBank 5.0: a major update to the DrugBank database for 2018

TL;DR: This year’s update, DrugBank 5.0, represents the most significant upgrade to the database in more than 10 years and significant improvements have been made to the quantity, quality and consistency of drug indications, drug binding data as well as drug-drug and drug-food interactions.
Journal ArticleDOI

The failing heart--an engine out of fuel.

TL;DR: This review describes cardiac energy metabolism, appraises the methods used for its assessment, evaluates the role of impaired energy metabolism in heart failure, and gives options for metabolic therapy.
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