Ps-bpb09-5: brown adipose tissue dysfunction promotes metabolic disorder in a failing heart.

Objective: Low body temperature predicts poor clinical outcomes in patients with heart failure, however, underlying mechanisms and pathological implications are largely unknown. Brown adipose tissue (BAT) was initially characterized as a heat generating organ, and studies suggest it has crucial roles for maintaining systemic metabolic health. The purpose of this study was to determine whether alteration of BAT function contributes to development of heart failure. Design and method: We generated two murine heart failure models, thoracic aortic constriction (TAC) and myocardial infarction (MI). We analyzed cardiac function, thermogenic response, and pathological findings in the hearts of these mice. We also performed comprehensive metabolomic analyses in the heart, BAT, and plasma samples from sham- and TAC-operated mice. Results: We found murine models with TAC or MI induced BAT dysfunction, and this led to a significant reduction in body temperature. Chronic activation of adrenergic signaling induced apoptosis in brown adipocytes, and surgical denervation of sympathetic nerves innervating BAT improved thermogenic response and cardiac systolic dysfunction. Gain of BAT function model, generated with BAT implantation into peritoneal cavity, improved thermogenesis and ameliorated cardiac dysfunction in TAC. In contrast, systolic function was reduced in genetically BAT dysfunctional model, and this associated with poor survival rate in this model. Metabolomic analyses showed that BAT dysfunction led to an increase of choline and its downstream metabolite, trimethylamine N-oxide (TMAO) that promoted metabolic dysfunction in the failing heart. TMAO administration resulted in a significant reduction in phosphocreatine or ATP level in cardiac tissues, and this was mediated by the suppression of complex IV activity in mitochondria. Genetic or pharmacological inhibition of TMAO production ameliorated cardiac dysfunction during left ventricular pressure overload. Dilated cardiomyopathy patients had lower body temperature, and this associated with an increase in circulating choline and TMAO level. Conclusions: Alteration of BAT function contributes to the development of heart failure via increased TMAO. Our findings suggest that maintenance of BAT homeostasis and reducing TMAO production could be potential next-generation therapies for heart failure.