Pimozide Alleviates Hyperglycemia in Diet-Induced Obesity by Inhibiting Skeletal Muscle Ketone Oxidation

Cell Metab. 2020 May 5;31(5):909-919.e8. doi: 10.1016/j.cmet.2020.03.017. Epub 2020 Apr 9.

Abstract

Perturbations in carbohydrate, lipid, and protein metabolism contribute to obesity-induced type 2 diabetes (T2D), though whether alterations in ketone body metabolism influence T2D pathology is unknown. We report here that activity of the rate-limiting enzyme for ketone body oxidation, succinyl-CoA:3-ketoacid-CoA transferase (SCOT/Oxct1), is increased in muscles of obese mice. We also found that the diphenylbutylpiperidine pimozide, which is approved to suppress tics in individuals with Tourette syndrome, is a SCOT antagonist. Pimozide treatment reversed obesity-induced hyperglycemia in mice, which was phenocopied in mice with muscle-specific Oxct1/SCOT deficiency. These actions were dependent on pyruvate dehydrogenase (PDH/Pdha1) activity, the rate-limiting enzyme of glucose oxidation, as pimozide failed to alleviate hyperglycemia in obese mice with a muscle-specific Pdha1/PDH deficiency. This work defines a fundamental contribution of enhanced ketone body oxidation to the pathology of obesity-induced T2D, while suggesting pharmacological SCOT inhibition as a new class of anti-diabetes therapy.

Keywords: glycemia; insulin resistance; ketone bodies; ketone body oxidation; obesity; pimozide; type 2 diabetes.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Animals
  • Diet / adverse effects
  • Hyperglycemia / chemically induced
  • Hyperglycemia / drug therapy*
  • Hypoglycemic Agents / pharmacology*
  • Ketones / antagonists & inhibitors*
  • Ketones / metabolism
  • Male
  • Mice
  • Muscle, Skeletal / drug effects*
  • Muscle, Skeletal / metabolism
  • Obesity / chemically induced
  • Obesity / drug therapy*
  • Oxidation-Reduction
  • Pimozide / pharmacology*
  • Streptozocin

Substances

  • Hypoglycemic Agents
  • Ketones
  • Pimozide
  • Streptozocin