Regulation of fat metabolism in skeletal muscle.

Regulation of carbohydrate and fat utilization by skeletal muscle at rest and during exercise has been the subject of investigation since the early 1960s when Randle et al. proposed the so-called glucose-fatty acid cycle to explain the reciprocal relationship between carbohydrate and fat metabolism. The suggested mechanisms were based on the premise that an increase in fatty acid (FA) availability would result in increased fat metabolism and inhibition of carbohydrate metabolism. Briefly, accumulation of acetyl-CoA would result in inhibition of pyruvate dehydrogenase (PDH), accumulation of citrate would inhibit phosphofructokinase (PFK), and accumulation of glucose-6-phosphate (G6P) would reduce hexokinase (HK) activity. Ultimately, this would inhibit carbohydrate metabolism with increasing availability and oxidation of FA. Although there is some evidence for the existence of the glucose-FA cycle at rest and during low-intensity exercise, it cannot explain substrate use at moderate to high exercise intensities. More recently, evidence has accumulated that increases in glycolytic flux may decrease fat metabolism. Potential sites of regulation are the transport of FA into the sarcoplasma, lipolysis of intramuscular triacylglycerol (IMTG) by hormone-sensitive lipase (HSL), and transport of FA across the mitochondrial membrane. There are several potential regulators of fat oxidation: first, malonyl-CoA concentration, which is formed from acetyl-CoA, catalyzed by the enzyme acetyl-CoA carboxylase (ACC), which in turn will inhibit carnitine palmitoyl transferase I (CPT I). Another possible mechanism is accumulation of acetyl-CoA that will result in acetylation of the carnitine pool, reducing the free carnitine concentration. This could theoretically reduce FA transport into the mitochondria. There is also some recent evidence that CPT I is inhibited by small reductions in pH that might be observed during exercise at high intensities. It is also possible that FA entry into the sarcolemma is regulated by translocation of FAT/CD36 in a similar manner to glucose transport by GLUT-4. Studies suggest that the regulatory mechanisms may be different at rest and during exercise and may change as the exercise intensity increases. Regulation of skeletal muscle fat metabolism is clearly multifactorial, and different mechanisms may dominate in different conditions.