6827 Pharmacological PPARα Activation In Combination With Ketogenic Nutrition Aggravated Muscle Weakness By Metabolic Failure In Septic Mice

Abstract Disclosure: C. Lauwers: None. M.P. Casaer: None. W. Vankrunkelsven: None. S. Derde: None. I. Derese: None. S. Vander Perre: None. P. Vermeersch: None. G.H. Van Den Berghe: None. L. Langouche: None. Introduction: In septic mice, infusion of ketone bodies (beta-hydroxybutyrate (BHB)) attenuated muscle weakness, a debilitating complication of critical illness. Interestingly, in critically ill children, fasting-induced ketosis also improved outcomes, but in adults ketosis upon fasting was impaired, likely due to suppression of PPARα, a key transcriptional regulator of ketogenesis. In septic mice, pharmacological induction of PPARα by pemafibrate (PF) alone, however, was ineffective in promoting ketosis. Therefore, we here hypothesized that PPARα activation by PF combined with ketogenic nutrition can more effectively induce ketosis and hereby reduce muscle weakness in sepsis. Methods: In a fluid-resuscitated and antibiotic-treated mouse model of prolonged (5 days) sepsis (male C57BL/6J), the impact of PF (1mg/kg/d) combined with 4 types of parenteral nutrition (PN) was studied. Mice were either allocated to PF + total PN (composed of glucose, long-chain triglycerides (LCTs) and amino acids) (TPN, n = 18), PF + TPN with an extra LCT emulsion (TPN + LCTs, n = 18), PF + a pure low dose LCT emulsion (Low LCT, n = 16) or PF + a pure high dose LCT emulsion (High LCT n = 18). Healthy control mice on standard chow served as a reference (HC, n=19). After 5 days of sepsis, ex vivo muscle force (aurora scientific®), plasma BHB and lipids (TG, FFA, LDL- and HDL-cholesterol; commercial assays), and liver gene expression levels were measured. Metabolomics of muscle tissue was assessed by LC-MS and plasma acylcarnitines by LC-MS-MS. Results: Liver PPARα gene expression was higher in all PF-treated mice than in HCs. Compared to HCs, specific muscle force was reduced in all septic mice, but mostly so in both PF + LCT groups (PF + Low LCT: 10.7%, PF + High LCT: 25.0%, PF+TPN + LCTs: 44.6%, PF+TPN: 58.4% of HC: 124.7 mN/mm²; p = 0.0001). PF + TPN + LCTs did not induce ketosis, whereas BHB plasma levels increased 95-fold in the PF + High LCT and 10-fold in the PF + Low LCT group (p < 0.0001 vs. other groups). Glycemia was lower in both PF + LCT groups relative to the other septic mice (PF + Low LCT: 52 mg/dl; PF + High LCT: 80 mg/dl; PF + TPN + LCTs: 108 mg/dl; PF + TPN: 102 mg/dl; p < 0.0001). Compared to the PF + TPN group, plasma lipids and long-chain acylcarnitines were increased in all other septic mice with the highest levels in the PF + High LCT group. Muscular glycolytic intermediates and ATP levels were depleted in both PF + LCT groups in comparison with all other septic mice and HCs. Conclusion: In septic mice, PF-induced PPARα activation combined with TPN, irrespective of the amount of LCTs, was unable to induce ketosis and did not attenuate muscle weakness. By contrast, PF-induced PPARα activation in combination with pure LCTs resulted in ketosis, but aggravated rather than improved muscle weakness, irrespective of the dose. In these groups, metabolic analyses suggested a bioenergetic failure of muscle fibers with an accumulation of plasma lipids. Presentation: 6/1/2024