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Emerging studies have recently shown the potential importance of ketone bodies in cardio-metabolic health. However, techniques to determine myocardial ketone body utilization  in vivo  are lacking. In this work, we developed a novel method to assess myocardial ketone body utilization  in vivo  using hyperpolarized [3- 13 C]acetoacetate and investigated the alterations in myocardial ketone body metabolism in diabetic rats. Within a minute upon injection of [3- 13 C]acetoacetate, the production of [5- 13 C]glutamate and [1- 13 C] acetylcarnitine can be observed real time  in vivo . In diabetic rats, the production of [5- 13 C]glutamate was elevated compared to controls, while [1- 13 C]acetylcarnitine was not different. This suggests an increase in ketone body utilization in the diabetic heart, with the produced acetyl-CoA channelled into the tricarboxylic acid cycle. This observation was corroborated by an increase activity of succinyl-CoA:3-ketoacid-CoA transferase (SCOT) activity, the rate-limiting enzyme of ketone body utilization, in the diabetic heart. The increased ketone body oxidation in the diabetic hearts correlated with cardiac hypertrophy and dysfunction, suggesting a potential coupling between ketone body metabolism and cardiac function. Hyperpolarized [3- 13 C]acetoacetate is a new probe with potential for non-invasive and real time monitoring of myocardial ketone body oxidation  in vivo , which offers a powerful tool to follow disease progression or therapeutic interventions.

A new hyperpolarized 13C ketone body probe reveals an increase in acetoacetate utilization in the diabetic rat heart