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(Circulation. 2007;115:909-917.)
© 2007 American Heart Association, Inc.

Molecular Cardiology

Insulin-Resistant Heart Exhibits a Mitochondrial Biogenic Response Driven by the Peroxisome Proliferator-Activated Receptor-/PGC-1 Gene Regulatory Pathway

Jennifer G. Duncan, MD; Juliet L. Fong, BA; Denis M. Medeiros, PhD; Brian N. Finck, PhD; Daniel P. Kelly, MD

From the Center for Cardiovascular Research (J.G.D., J.L.F., B.N.F., D.P.K.), Departments of Medicine (J.L.F., B.N.F., D.P.K.), Pediatrics (J.G.D., D.P.K.), and Molecular Biology and Pharmacology (D.P.K.), Washington University School of Medicine, St. Louis, Mo; and Department of Human Nutrition (D.M.M.), Kansas State University, Manhattan.

Correspondence to Daniel P. Kelly, MD, Center for Cardiovascular Research, Washington University School of Medicine, 660 S Euclid Ave, Campus Box 8086, St. Louis, MO 63110. E-mail dkelly{at}im.wustl.edu

Received August 31, 2006; accepted December 7, 2006.

Background— Obesity and diabetes mellitus are complex metabolic problems of pandemic proportion, contributing to significant cardiovascular mortality. Recent studies have shown altered mitochondrial function in the hearts of diabetic animals. We hypothesized that regulatory events involved in the control of mitochondrial function are activated in the prediabetic, insulin-resistant stage.

Methods and Results— Morphometric analyses demonstrated that cardiac myocyte mitochondrial volume density was increased in insulin-resistant uncoupling protein-diptheria toxin A (UCP-DTA) transgenic mice, a murine model of metabolic syndrome, compared with littermate controls. Mitochondrial DNA content and expression of genes involved in multiple mitochondrial pathways were also increased in insulin-resistant UCP-DTA hearts. The nuclear receptor, peroxisome proliferator-activated receptor- (PPAR), is known to activate metabolic genes in the diabetic heart. Therefore, we evaluated the role of PPAR in the observed mitochondrial biogenesis response in the insulin-resistant heart. Insulin-resistant UCP-DTA mice crossed into a PPAR-null background did not exhibit evidence of mitochondrial biogenesis or induction of mitochondrial gene expression. Conversely, transgenic mice with cardiac-specific overexpression of PPAR exhibited signatures of cardiac mitochondrial biogenesis. A screen for candidate mediators of the PPAR-driven mitochondrial biogenic response revealed that expression of PPAR coactivator-1 (PGC-1), a known regulator of mitochondrial biogenesis, was activated in wild-type UCP-DTA mice but not in PPAR-deficient UCP-DTA mice.

Conclusions— These results demonstrate that mitochondrial biogenesis occurs early in the development of diabetic cardiac dysfunction through a transcriptional regulatory circuit that involves activation of PGC-1 gene expression by the fatty acid–activated nuclear receptor PPAR.

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