Hypertension affects one billion people and is a principal reversible risk factor for cardiovascular disease. A rare Mendelian syndrome, pseudohypoaldosteronism type II (PHAII), featuring hypertension, hyperkalemia, and metabolic acidosis, has revealed previously unrecognized physiology orchestrating the balance between renal salt reabsorption versus K+ and H+ excretion1. We used exome sequencing to identify mutations in Kelch-like 3 (KLHL3) or Cullin 3 (CUL3) in 41 PHAII kindreds. KLHL3 mutations are either recessive or dominant, while CUL3 mutations are dominant and predominantly de novo. CUL3 and BTB-Kelch proteins such as KLHL3 are components of Cullin/RING E3 ligase complexes (CRLs) that ubiquitinate substrates bound to Kelch propeller domains2–8. Dominant KLHL3 mutations are clustered in short segments within the Kelch propeller and BTB domains implicated in substrate9 and Cullin5 binding, respectively. Diverse CUL3 mutations all result in skipping of exon 9, producing an in-frame deletion. Because dominant KLHL3 and CUL3 mutations both phenocopy recessive loss-of-function KLHL3 mutations, they may abrogate ubiquitination of KLHL3 substrates. Disease features are reversed by thiazide diuretics, which inhibit the Na-Cl cotransporter (NCC) in the distal nephron of the kidney; KLHL3 and CUL3 are expressed in this location, suggesting a mechanistic link between KLHL3/CUL3 mutations, increased Na-Cl reabsorption, and disease pathogenesis. These findings demonstrate the utility of exome sequencing in disease gene identification despite combined complexities of locus heterogeneity, mixed models of transmission, and frequent de novo mutation, and establish a fundamental role for KLHL3/CUL3 in blood pressure, K+, and pH homeostasis.

Brown adipose tissue (BAT) has attracted scientific interest as an antidiabetic tissue owing to its ability to dissipate energy as heat. Despite a plethora of data concerning the role of BAT in glucose metabolism in rodents, the role of BAT (if any) in glucose metabolism in humans remains unclear. To investigate whether BAT activation alters whole-body glucose homeostasis and insulin sensitivity in humans, we studied seven BAT-positive (BAT+) men and five BAT-negative (BAT−) men under thermoneutral conditions and after prolonged (5–8 h) cold exposure (CE). The two groups were similar in age, BMI, and adiposity. CE significantly increased resting energy expenditure, whole-body glucose disposal, plasma glucose oxidation, and insulin sensitivity in the BAT+ group only. These results demonstrate a physiologically significant role of BAT in whole-body energy expenditure, glucose homeostasis, and insulin sensitivity in humans, and support the notion that BAT may function as an antidiabetic tissue in humans.

Since the presence of brown adipose tissue (BAT) was confirmed in adult humans, BAT has become a therapeutic target for obesity and insulin resistance. We examined whether human subcutaneous white adipose tissue (sWAT) can adopt a BAT-like phenotype using a clinical model of prolonged and severe adrenergic stress. sWAT samples were collected from severely burned and healthy individuals. A subset of burn victims were prospectively followed during their acute hospitalization. Browning of sWAT was determined by the presence of multilocular adipocytes, uncoupling protein 1 (UCP1), and increased mitochondrial density and respiratory capacity. Multilocular UCP1-positive adipocytes were found in sWAT samples from burn patients. UCP1 mRNA, mitochondrial density and leak respiratory capacity in sWAT increased after burn trauma. Our data demonstrate that human sWAT can transform from an energy storing to energy dissipating tissue, which opens new research avenues in our quest to prevent and treat obesity and its metabolic complications.

Recent studies suggest that brown adipose tissue (BAT) plays a role in energy and glucose metabolism in humans. However, the physiological significance of human BAT in lipid metabolism remains unknown. We studied 16 overweight/obese men during prolonged, non-shivering cold and thermoneutral conditions using stable isotopic tracer methodologies in conjunction with hyperinsulinemic-euglycemic clamps and BAT and white adipose tissue (WAT) biopsies. BAT volume was significantly associated with increased whole-body lipolysis, triglyceride-free fatty acid (FFA) cycling, FFA oxidation, and adipose tissue insulin sensitivity. Functional analysis of BAT and WAT demonstrated the greater thermogenic capacity of BAT compared to WAT, while molecular analysis revealed a cold-induced upregulation of genes involved in lipid metabolism only in BAT. The accelerated mobilization and oxidation of lipids upon BAT activation supports a putative role for BAT in the regulation of lipid metabolism in humans.

Summary Severe burns incur a profound stress response, which is unrivaled in terms of its magnitude and duration. Recent evidence suggests that the pathophysiological stress response to severe burns persists for several years post injury. Thus, there is a pressing need for novel strategies that mitigate this response and restore normal metabolic function in burn survivors. This is the first installment of a three-part series exploring the stress response to severe burn trauma. In this article we aim to distill the current knowledge pertaining to the stress response to burn trauma, highlighting recent developments and important knowledge gaps that need to be pursued in order to develop novel therapeutic strategies which improve outcomes in burn survivors.

Introduction Loss of mitochondrial competency is associated with several chronic illnesses. Therefore, strategies that maintain or increase mitochondrial function will likely be of benefit in a number of clinical settings. Endurance exercise has long been known to increase mitochondrial function in skeletal muscle. Comparatively little is known regarding the impact of resistance exercise training on skeletal muscle mitochondrial respiratory function. Purpose The purpose of the current study was to determine the impact of chronic resistance training on skeletal muscle mitochondrial respiratory capacity and function. Methods Here, we studied the impact of a 12-week resistance exercise training program on skeletal muscle mitochondrial function in eleven young healthy men. Muscle biopsies were collected before and after the 12-week training program and mitochondrial respiratory capacity determined in permeabilized myofibers by high-resolution respirometry. Results Resistance exercise training increased lean body mass and quadriceps muscle strength by 4 and 15%, respectively (P<0.001). Coupled mitochondria respiration supported by complex I, and complex I and II substrates, increased by 2- and 1.4-fold, respectively (P<0.01). The ratio of coupled complex I supported respiration to maximal respiration increased with resistance exercise training (P<0.05), as did complex I protein abundance (P<0.05), while the substrate control ratio for succinate was reduced after resistance exercise training (P<0.001). Transcripts responsible for proteins critical to electron transfer and NAD+ production increased with training (P<0.05), while transcripts involved in mitochondrial biogenesis were unaltered. Conclusion Collectively, 12-weeks of resistance exercise training resulted in qualitative and quantitative changes in skeletal muscle mitochondrial respiration. This adaptation occurs with modest changes in mitochondrial proteins and transcript expression. Resistance exercise training appears to be a means to augment the respiratory capacity and intrinsic function of skeletal muscle mitochondria.

Mitochondrial health is critical to physiological function, particularly in tissues with high ATP turnover, such as striated muscle. It has been postulated that derangements in skeletal muscle mitochondrial function contribute to impaired physical function in older adults. Here, we determined mitochondrial respiratory capacity and coupling control in skeletal muscle biopsies obtained from young and older adults. Twenty-four young (28 ± 7 yr) and thirty-one older (62 ± 8 yr) adults were studied. Mitochondrial respiration was determined in permeabilized myofibers from the vastus lateralis after the addition of substrates oligomycin and CCCP. Thereafter, mitochondrial coupling control was calculated. Maximal coupled respiration (respiration linked to ATP production) was lower in muscle from older vs. young subjects (P < 0.01), as was maximal uncoupled respiration (P = 0.06). Coupling control in response to the ATP synthase inhibitor oligomycin was lower in older adults (P < 0.05), as was the mitochondria flux control ratio, coupled respiration normalized to maximal uncoupled respiration (P < 0.05). Calculation of respiratory function revealed lower respiration linked to ATP production (P < 0.001) and greater reserve respiration (P < 0.01); i.e., respiratory capacity not used for phosphorylation in muscle from older adults. We conclude that skeletal muscle mitochondrial respiratory capacity and coupling control decline with age. Lower respiratory capacity and coupling efficiency result in a reduced capacity for ATP production in skeletal muscle of older adults.

PURPOSE The purpose of this study was to determine the effects of early outpatient exercise on muscle mass, function, and fractional synthetic rate in severely burned children. METHODS Forty-seven children with ≥40 % total body surface area burn performed 12-weeks standard of care rehabilitation (SOC: N=23) or rehabilitative exercise training (RET: N=24) immediately following hospital discharge. Dual-energy X-ray absorptiometry was used to assess lean body mass (LBM) at discharge, post-treatment, and 12 months post-burn. Muscle function was evaluated with a Biodex Isokinetic Dynamometer and peak aerobic fitness (VO2peak) measured using a modified Bruce treadmill protocol post-treatment. Stable isotope infusion studies were performed in a subset of patients (SOC: N=13; RET: N=11) at discharge and post-treatment to determine mixed-muscle fractional synthetic rate. RESULTS Relative peak torque (RET: 138 ± 9 N · m · kg−1 vs SOC: 106 ± 9 N · m · kg−1) and VO2peak (RET: 32 ± 1 ml · kg−1 · min−1 vs SOC: 28 ± 1 ml · kg−1 · min−1) was greater post-treatment with RET compared to SOC. In addition, RET increased whole-body (9 ± 2%) and leg (17 ± 3%) LBM compared to SOC. Furthermore, the percentage change in whole-body (18 ± 3%) and leg (31 ± 4%) LBM from discharge to 12 months post-burn was greater with RET compared to SOC. Muscle fractional synthetic rate decreased from discharge to post-treatment in both groups (6.9 ± 1.1% · d−1 vs 3.4 ± 0.4% · d−1); however no differences were observed between treatment groups at each time-point. CONCLUSIONS Early outpatient exercise training implemented at hospital discharge represents an effective intervention to improve muscle mass and function following severe burn injury.