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Glucose inhibits cardiac muscle maturation through nucleotide biosynthesis
Open accessAbstract
The heart switches its energy substrate from glucose to fatty acids at birth, and maternal hyperglycemia is associated with congenital heart disease. However, little is known about how blood glucose impacts heart formation. Using a chemically defined human pluripotent stem-cell-derived cardiomyocyte differentiation system, we found that high glucose inhibits the maturation of cardiomyocytes at genetic, structural, metabolic, electrophysiological, and biomechanical levels by promoting nucleotide biosynthesis through the pentose phosphate pathway. Blood glucose level in embryos is stable in utero during normal pregnancy, but glucose uptake by fetal cardiac tissue is drastically reduced in late gestational stages. In a murine model of diabetic pregnancy, fetal hearts showed cardiomyopathy with increased mitotic activity and decreased maturity. These data suggest that high glucose suppresses cardiac maturation, providing a possible mechanistic basis for congenital heart disease in diabetic pregnancy.
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![Figure 4. The pentose phosphate pathway inhibits cardiac maturation. (A) Heatmap presentation of the metabolomics analysis of hESC-CMs cultured in the presence or absence of glucose. Note the decrease in the metabolites in purine metabolism, pyrimidine metabolism and the pentose phosphate pathway (PPP) in glucose-deprived conditions (n = 3, each). GlcA, glucuronic acid; R5P, ribose 5-phosphate; Rib, ribose; PRPP, phosphoribosyl pyrophosphate; S7P, sedoheptulose-7-phosphate. See also Figure 4—figure supplement 2. (B) ATP levels of hESC-CMs in 25 mM glucose medium (G25) and glucose-depleted medium (G0) (n = 3, mean ± SD, p = n .s. by t-test.) (C) Experimental regimen for chemical inhibition of glucose metabolic pathways. hESC-CMs are cultured in the medium containing four different glucose levels and different chemical inhibitors. See also Figure 4—figure supplement 3. (D) Relative mRNA expression of TNNT2 and NKX2-5 in different concentrations of glucose and 2-DG, a competitive inhibitor of glucose. 2-DG restored cardiac maturation in the presence of glucose. (E–H) Relative mRNA expression of TNNT2 in 0–25 mM glucose and with different chemical inhibitors of the glucose metabolic pathways: 0–10 μM 3PO (3-(3-pyridinyl)−1-(4-pyridinyl)−2-propen-1-one, a phosphofructokinase [PFK] inhibitor) (E); 0–5 mM sodium oxamate (NaOX; a lactate dehydrogenase [LDH] inhibitor) (F); 0–5 μM 6AN (6-aminonicotinamide, a glucose 6-phosphate dehydrogenase [G6PD] inhibitor) (G); and 0–50 μM DHEA (dehydroepiandrosterone, a G6PD inhibitor) (H). (n = 3, each. mean ± SD; p-value by one-way ANOVA.) See also Figure 4—figure supplement 4.](/paper-figures/8a82179d1fdf4b50bd5fb261f8ca2d7b/glucose-inhibits-cardiac-muscle-maturation-through-nucleotide-biosynthesis-figure-4.jpg)







![Figure 6. Developmental time course of cardiac glucose uptake measured by 18F-FDG accumulation. The radioactivity of the entire heart was measured by γ-counter after tail vein i.v. (fetus) or i.p. (neonates) injections. Values were normalized to heart weight and total body signal (heart values/[heart weight * total body values]). Note a drastic decrease in glucose uptake during late gestational and neonatal stages (n = 6, each; p<0.0001 by one-way ANOVA test.)](/paper-figures/8d24209d1d4e465c9005c2dc3d9ee5dd/glucose-inhibits-cardiac-muscle-maturation-through-nucleotide-biosynthesis-figure-6.jpg)



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“Using a model of STZ-induced insulin-deficient diabetes during pregnancy, Nakano et al. demonstrated that hyperglycemia promotes the proliferation of fetal offspring cardiomyocytes while maturation was inhibited [117].”
From Recent Experimental Studies of Maternal Obesity, Diabetes during Pregnancy and the Developmental Origins of Cardiovascular Disease (2022) · cites this paper as [117]
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“Using a model of STZ-induced insulin-deficient diabetes during pregnancy, Nakano et al. demonstrated that hyperglycemia promotes the proliferation of fetal offspring cardiomyocytes while maturation was inhibited [117].”
From Recent Experimental Studies of Maternal Obesity, Diabetes during Pregnancy and the Developmental Origins of Cardiovascular Disease (2022) · cites this paper as [117]
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Functional Cardiomyocytes Derived From Human Induced Pluripotent Stem Cells
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Congenital Heart Disease in Adults
Brickner, M. E., Hillis, L. D., & Lange, R. A. (2000) · New England Journal of Medicine · doi:10.1056/nejm200001273420407 · Cited by 765
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Metadata
- Authors
- Nakano, H., Minami, I., Braas, D., Pappoe, H., Wu, X., Sagadevan, A., Vergnes, L., Fu, K., Morselli, M., Dunham, C., Ding, X., Stieg, A. Z., Gimzewski, J. K., Pellegrini, M., Clark, P. M., Reue, K., Lusis, A. J., Ribalet, B., Kurdistani, S. K., Christofk, H., Nakatsuji, N., & Nakano, A.
- Affiliations
- University of California, Los Angeles (US)
- Kyoto University (JP)
- California NanoSystems Institute (US)
- Corresponding author
- Nakano, Haruko
- ORCID
- Venue
- eLife
- Publisher
- eLife Sciences Publications, Ltd
- Published
- 2017-12-12
- Volume
- 6
- ISSN
- 2050-084X (ISSN-L)
- PMC
- PMC5726851
- OpenAlex
- W2774527609
- Cited by
- 195
- References
- 54
- Citations by year
- 2026: 13 · 2025: 17 · 2024: 26 · 2023: 28 · 2022: 37 · 2021: 36 · 2020: 16 · 2019: 15 · 2018: 7
- FWCI
- 4.25
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- eLife (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- eScholarship (California Digital Library) (submittedVersion)
- eScholarship (California Digital Library) (submittedVersion, cc-by)
- Funders
- Oppenheimer Foundation
- University of California, Los Angeles (Center for Duchenne Muscular Dystrophy, Pilot and Feasibility Seed Grant program)
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (P30AR057230)
- National Center for Research Resources (Grant S10RR026744)
- National Institutes of Health (DK094311, CA178415, HL126051, HL124503)
- Hunan University (Chinese Scholarship Council of Chemistry and Chemical Engineering)
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Congenital heart defects research
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Pluripotent Stem Cells Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Pancreatic function and diabetes
- Keywords
- high glucose, cardiomyocyte maturation, nucleotide synthesis, pentose phosphate pathway, diabetes in pregnancy, maternal hyperglycemia, congenital heart disease, cardiomyopathy, pluripotent stem cell-derived cardiomyocytes, fetal heart development
- MeSH terms
- Animals, Cell Differentiation, Female, Glucose, Humans, Mice, Inbred C57BL, Myocardium, Nucleotides, Pentose Phosphate Pathway, Pregnancy, Sweetening Agents, Gene Expression Profiling, Muscle Development, Myocytes, Cardiac, Mice, Embryonic Stem Cells
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