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Section of Cardiovascular Medicine and the Howard Hughes Medical Institute, Yale University School of Medicine, New Haven, Connecticut 06520
Administration of supplemental glucose
and/or insulin is postulated to improve the outcome from myocardial
ischemia by increasing the heart's relative utilization of glucose as
an energy substrate. To examine the degree to which circulating glucose
and insulin levels actually influence myocardial substrate preference
in vivo, we infused conscious, chronically catheterized rats with
D-[1-13C]glucose and compared steady-state
13C enrichment of plasma glucose with that of myocardial
glycolytic ([3-13C]alanine) and oxidative
([4-13C]glutamate) intermediary metabolites. In fasting
rats, [3-13C]alanine-to-[1-13C]glucose and
[4-13C]glutamate-to-[3-13C]alanine ratios
averaged 0.16 ± 0.12 and 0.14 ± 0.03, respectively, indicating that circulating glucose contributed 32% of myocardial glycolytic flux, whereas subsequent flux through pyruvate dehydrogenase contributed 14% of total tricarboxylic acid (TCA) cycle activity. Raising plasma glucose to 11 mmol/l, or insulin to 500 pmol/l, increased these contributions equivalently. At supraphysiological (>6,500 pmol/l) insulin levels, the plasma glucose contribution to
glycolysis increased further, and addition of hyperglycemia made it the
sole glycolytic substrate, yet
[4-13C]glutamate-to-[3-13C]alanine ratios
remained
0.60. Thus plasma levels of glucose and insulin
independently regulate the proportional contribution of exogenous
glucose to myocardial glycolytic and TCA cycle flux in vivo in a
dose-dependent manner. However, even at supraphysiological levels,
nonglucose substrates continue to supply
40% of myocardial TCA cycle flux.
diabetes; glycolysis; insulin
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