Heart failure with reduced ejection fraction (HFrEF) is characterized not only by reduced left ventricular ejection fraction (EF) but is also combined with symptoms such as dyspnea, fatigue, and edema. Several pharmacological interventions have been established. However, a treatment targeting a novel pathophysiological mechanism is still needed. Evidence indicating that inhibition of pyruvate dehydrogenase kinase 4 (PDK4) may be cardioprotective has been accumulating. Thus, we focused on vitamin K3 and used its framework as a new PDK4 inhibitor skeleton to synthesize new PDK4 inhibitors that show higher activity than the existing PDK4 inhibitor, dichloroacetic acid, and tested their cardioprotective effects on a mouse heart failure model. Among these inhibitors, PDK4 inhibitor 8 improved EF the most, even though it did not reverse cardiac fibrosis or wall thickness. This novel, potent PDK4 inhibitor may improve EF of failing hearts by regulating bioenergetics via activation of the tricarboxylic acid cycle.
射血分数降低型心力衰竭(HFrEF)的特点不仅是左心室射血分数(EF)降低,而且还伴有呼吸困难、疲劳和水肿等症状。目前已确立了几种药物干预方法。然而,针对新的病理生理机制的治疗方法仍有待开发。越来越多的证据表明,抑制丙酮酸脱氢酶激酶 4(PDK4)可能具有保护心脏的作用。因此,我们关注维生素 K3,并利用其框架作为新的 PDK4 抑制剂骨架,合成了比现有 PDK4 抑制剂二氯乙酸活性更高的新 PDK4 抑制剂,并在小鼠心衰模型上测试了它们的心脏保护作用。在这些抑制剂中,PDK4 抑制剂 8 对 EF 的改善最大,尽管它不能逆转心脏纤维化或心壁厚度。这种新型、强效的 PDK4 抑制剂可能通过激活三羧酸循环来调节生物能,从而改善衰竭心脏的 EF。