NF-κB-mediated metabolic remodelling in the inflamed heart in acute viral myocarditis

Biochim Biophys Acta Mol Basis Dis. 2018 Aug;1864(8):2579-2589. doi: 10.1016/j.bbadis.2018.04.022. Epub 2018 May 3.


Acute viral myocarditis (VM), characterised by leukocyte infiltration and dysfunction of the heart, is an important cause of sudden cardiac death in young adults. Unfortunately, to date, the pathological mechanisms underlying cardiac failure in VM remain incompletely understood. In the current study, we investigated if acute VM leads to cardiac metabolic rewiring and if this process is driven by local inflammation. Transcriptomic analysis of cardiac biopsies from myocarditis patients and a mouse model of VM revealed prominent reductions in the expression of a multitude of genes involved in mitochondrial oxidative energy metabolism. In mice, this coincided with reductions in high-energy phosphate and NAD levels, as determined by Imaging Mass Spectrometry, as well as marked decreases in the activity, protein abundance and mRNA levels of various enzymes and key regulators of cardiac oxidative metabolism. Indicative of fulminant cardiac inflammation, NF-κB signalling and inflammatory cytokine expression were potently induced in the heart during human and mouse VM. In cultured cardiomyocytes, cytokine-mediated NF-κB activation impaired cardiomyocyte oxidative gene expression, likely by interfering with the PGC-1 (peroxisome proliferator-activated receptor (PPAR)-γ co-activator) signalling network, the key regulatory pathway controlling cardiomyocyte oxidative metabolism. In conclusion, we provide evidence that acute VM is associated with extensive cardiac metabolic remodelling and our data support a mechanism whereby cytokines secreted primarily from infiltrating leukocytes activate NF-κB signalling in cardiomyocytes thereby inhibiting the transcriptional activity of the PGC-1 network and consequently modulating myocardial energy metabolism.

Keywords: Inflammation; Metabolic remodelling; Mitochondrial oxidative metabolism; NF-κB; PGC-1; Viral myocarditis.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Disease
  • Animals
  • Coxsackievirus Infections / metabolism*
  • Coxsackievirus Infections / pathology
  • Disease Models, Animal
  • Enterovirus B, Human*
  • Female
  • Gene Expression Profiling*
  • Gene Expression Regulation*
  • Humans
  • Male
  • Mice
  • Muscle Proteins / metabolism*
  • Myocarditis / metabolism*
  • Myocarditis / pathology
  • Myocarditis / virology
  • NF-kappa B / metabolism*
  • PPAR gamma / metabolism
  • Transcription Factors / metabolism


  • Muscle Proteins
  • NF-kappa B
  • PPAR gamma
  • Transcription Factors
  • peroxisome-proliferator-activated receptor-gamma coactivator-1