BCKDK protects against obesity-induced cardiac remodelling and dysfunction by alleviating mitochondrial oxidative...

Impaired branched-chain amino acid (BCAA) catabolism has been implicated in obesity cardiomyopathy (OCM), and systemic inhibition of branched-chain ketoacid dehydrogenase kinase (BCKDK), a key negative regulator of BCAA oxidation, improves cardiac function. However, whether cardiomyocyte-specific manipulation of BCAA catabolism is sufficient to confer cardioprotection remains unknown.

Cardiomyocyte-specific BCKDK knockout and overexpression mouse models were generated and subjected to high-fat diet feeding, followed by echocardiography, transcriptomic, metabolomic, and molecular analyses. The mechanistic findings were further validated using in vitro experiments. Despite reduced myocardial BCAA levels, cardiomyocyte-specific BCKDK deletion unexpectedly exacerbated cardiac dysfunction and ventricular remodelling in OCM. Consistently, cardiac BCKDK expression was reduced in OCM. In contrast, cardiomyocyte-specific BCKDK overexpression improved cardiac function and remodelling, accompanied by a further reduction in myocardial BCAA levels, attenuation of mitochondrial oxidative stress, and suppression of MAPK-driven inflammatory signalling. Mechanistically, BCKDK reprogrammed mitochondrial metabolism to restrain oxidative stress. Moreover, mitochondrial ROS scavenging with MitoTEMPO alleviated mitochondrial dysfunction, and reversed the MAPK activation induced by BCKDK deficiency in vitro.

These findings reveal an unexpected BCAA-independent role of BCKDK in preserving cardiomyocyte mitochondrial function and restraining inflammatory signalling in OCM. Our study identifies cardiomyocyte-intrinsic BCKDK as a potential therapeutic target, while cautioning against overestimating the cardioprotective effects of systemic BCKDK inhibition, which may be driven primarily by extracardiac mechanisms.