Introduction From Fetal To Fatal

Metabolic adaptation of the heart to environmental stress

Heinrich Taegtmeyer MD, DPhil*

The year 23004 marked the centenary of two important discoveries in the field of metabolism: The discovery of beta-oxidation of fatty acids by Franz Knoop (1904),1 and the discovery of the oxygen dependence for normal pump function of the heart by Hans Winterstein (1904).2 The year 2004 also marked the 50th anniversary of the discovery, by Richard Bing and his colleagues, that the human heart prefers fatty acids for respiration.3

These early studies support the concept that the heart is well designed, both anatomically and biochemically, for uninterrupted, rhythmic aerobic work. Although heart muscle has certain distinctive biochemical characteristics, many of the basic biochemical reaction patterns are similar to those of other tissues. In short, metabolism and function of the heart are inextricably linked (Fig. 1).

In spite of, or perhaps because of the intricate network of metabolic pathways, heart muscle is an efficient converter of energy. The enzymatic catabolism of substrates results in the production of free energy, which is then used for cell work and for various biosynthetic activities including the synthesis of glycogen, triglycerides, proteins, membranes, and enzymes. Here I highlight the many actions of cardiac metabolism in energy transfer, cardiac growth, gene expression, and viability.

Figure 1. The coupling of metabolism and function. H. Taegtmeyer, Circulation 110, 895 (2004).

* University of Texas Houston Medical School, Department of Medicine, Division of Cardiology, 6431 Fannin Street, MSB 1.246, Houston, Texas 77030, e-mail: [email protected]

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