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To determine the functional consequence of decreased metabolic gene expression, we investigated cardiac metabolism using Langendorff heart perfusions to quantify substrate utilization in the heart.
Mice with a cardiomyocyte-specific deletion of Hif1α demonstrate a reduction in vascularization, contractility, and high-energy phosphate content that is attributable to the altered expression of genes involved in angiogenesis, calcium handling, and glucose metabolism, indicating a major role for Hif1α in coordinating energy availability and utilization in the heart [180].
In the present study, the authors demonstrate that the R403Q HCM mouse model has diminished cardiac ATP levels and impaired lipid utilization in the heart, assessed by decreased cardiac triglycerides and fatty acid content, and decreased expression of fatty acid translocase (CD36), lipoprotein lipase (LPL), and very low density lipoprotein receptor (VLDLR).
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For example, in case of strong physical exercise the concentration of lactate in human blood may rise to values as high as 19.5 mM (in blood plasma) respectively 7.0 mM (in erythrocyte cytoplasm) [ 34] indicating that the lactate production by the anaerobic skeletal muscle clearly exceeds its rate of re-conversion to glucose in the liver and its utilization rate in the heart muscle.
There are now active research programs to develop therapies to interfere with fatty acid utilization in the failing heart [14], largely based on animal experiments, and it cannot be ruled out that humans are different.
Substrate utilization in the failing heart has been associated with a 'fetal' pattern of metabolic gene expression that results in the preferential use of carbohydrates over free fatty acids (FFAs) for ATP production.
There is some evidence that these alterations in sympatho-adrenal programming also persist through post-natal life, as the offspring of Sprague Dawley rats exposed to hypoxia from pre-natal days 5 20 demonstrate persistent alterations in the levels and utilization of catecholamines in the heart and stellate ganglion at 12 weeks of age [ 72].
We focused next on the glucose and lipid utilization by the heart at E17.5 and P0 stages.
Randle et al. [ 35] have shown that increased plasma FFA concentrations reduce glucose utilization and causes glycogen accumulation in the heart.
The evidence for a shift towards glucose utilization in human heart failure arises from non-invasive monitoring using PET imaging of labelled glucose and palmitic acid moieties.
There is growing awareness of secondary insulin resistance and alterations in myocardial glucose utilization in congestive heart failure.
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