Kinetic and physical approaches have been employed to investigate the binding of acetoacetyl-CoA to hydroxyinethylglutaryl-CoA synthase. The enzyme has an apparent K, for acetoacetyl-CoA (0.35 pM) which is more than an order of magnitude lower than the Ki (6 -10 pM) measured for substrate inhibition by this metabolite.Hepatic acetoacetyl-CoA concentration, as measured by a sensitive and highly specific radioactive assay appears to be in the 1 -10 pM range; the concentration decreases during diabetic ketoacidosis. Total hepatic activity of hydroxymethylglutaryl-CoA synthase and levels of mitochondrial enzyme protein, determined by radioimmunoassay, are not appreciably different in livers from control or ketoacidotic animals.In contrast to the decrease in hepatic acetoacetyl-CoA concentration observed during ketoacidosis, myocardial acetoacetyl-CoA levels are increased by at least tenfold when compared to controls. Elevated acetoacetyl-CoA levels may serve to inhibit fatty acid utilization by the heart. Thus, a consideration of the multiple interactions of acetoacetyl-CoA with the enzymes involved in ketone body production and utilization may be useful in evaluating the metabolic significance of this intermediate.The regulation of hepatic ketogenesis has been the subject of considerable research effort [I -31 but the complete elucidation of the details concerning the identity and relative significance of potential control points for ketogenesis remains obscure. Recently, control of hepatic fatty acid oxidation and, consequently of ketogenesis, has been postulated to reside at the carnitine acyltransferase reaction with the relative activity at this site determining the proportion of fatty acids undergoing oxidation and esterification in the liver [4,5]. The increased flux of fatty acyl-CoA into ketone body production could result in several secondary control points being important in regulation of ketogenesis. For example, the recent report of McKean et al. [6] suggests that acetoacetyl-CoA levels may modulate activity of acyl-CoA dehydrogenase. In addition, acetoacetyl-CoA thiolase [7, 101 have been postulated to be rate-limiting in ketogenesis.Evaluation of the role of HoMeGlt-CoA cycle enzymes in regulation of ketogenesis is difficult due to the lack of a detailed Abbrcviutions. HoMeGlt, 3-hydroxy-3-methylglutaryl; Hepes, 4-(2-hydroxyethy1)-I-piperazineethanesulfonic acid.