Suggested involvement of ketone bodies in the pathogenesis of the metabolic syndrome.

Untreated brain mitochondria are strong producers of H2O2. High peroxide production (in the presence of glutamate and pyruvate) is strictly succinate-dependent. Importantly, it is inhibited by the ketone body acetoacetate (AcAc) starting at 10 μM (maximal effect at 0.5mM). Butyrate derives from the fermentation of prebiotics, is present physiologically in the colon and is a strong producer of AcAc: indeed butyrate induces in the colon the transcription of mitochondrial 3-hydroxy-3-methyl glutarylCoA (HMGCoA) synthase, a key enzyme in ketone body synthesis. Obesity and insulin resistance were shown to be dependent on increased permeability of the colon epithelium to bacterial lipopolysaccharide (LPS); the process is evident particularly upon ingestion of lipids (a peroxidative event, inhibited by vitamin E) and is likely sensitive to AcAc. The oxidation of butyrate and the production of AcAc in the colon appear to be inhibited by high luminal sulphides and high NH3, a situation that presumably facilitates LPS permeation (on the contrary beta-hydroxy-butyrate oxidation is not inhibited). It is proposed that these damaging events may be opposed by the delivery of ketone bodies directly to the colon.