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. 2023 Feb 10;24(4):3534. doi: 10.3390/ijms24043534

Figure 1.

Figure 1

The schema illustrates ketone body production and oxidation. Ketone bodies produced in the liver are released via the monocarboxylate transporter (MCT) 1/2 into the circulation and reach extrahepatic tissues, including the heart, where they can be utilized as energy sources. Ketone body oxidation in cardiac tissue involves beta-hydroxybutyrate dehydrogenase 1 (BDH1), bound to the inner mitochondrial membrane (MM), which converts beta-hydroxybutyrate (β-OHB) to acetoacetate. Acetoacetate can then be activated via succinyl-CoA:3-oxoacid-CoA transferase (SCOT) whereby a succinyl CoA is transferred to acetoacetate in order to form acetoacetyl CoA. Acetoacetyl CoA is subsequently cleaved to yield two acetyl CoA molecules which can then be oxidized in the tricarboxylic acid (Krebs) cycle. BDH1 = beta-hydroxybutyrate dehydrogenase; βOHB = beta-hydroxybutyrate; CoA = coenzyme A; CO2 = carbon dioxide; MCT = monocarboxylate transporter; MM = mitochondrial membrane; mThiolase = mitochondrial thiolase; NADH = nicotinamide adenine dinucleotide reduced; SCOT = succinyl-CoA:3-oxoacid-CoA transferase.