Published ahead of print on February 8, 2008, doi:10.1164/rccm.200707-1032OC Am. J. Respir. Crit. Care Med., Volume 177, Number 10, May 2008, 1090-1094 A more recent version of this article appeared on May 15, 2008
Submitted on July 13, 2007 Dichloroacetate Enhances Performance and Reduces Blood Lactate during Maximal Cycle Exercise in COPDLori D Calvert1*,1 Department of Respiratory Medicine, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Institute for Lung Health, Leicester, Leicestershire, United Kingdom, 2 Centre for Integrated Systems Biology and Medicine, School of Biomedical Sciences, University of Nottingham Medical School, Queens Medical Centre, Nottingham, Notts, United Kingdom, 3 Department of Health Sciences, Trent RSDU, Leicester, Leicestershire, United Kingdom * To whom correspondence should be addressed. E-mail: lori.calvert{at}uhl-tr.nhs.uk.
Rationale: Impaired skeletal muscle function contributes to exercise limitation in patients with chronic obstructive pulmonary disease (COPD). This is characterised by reduced mitochondrial adenosine triphosphate (ATP) generation, and greater reliance on non-mitochondrial energy production. Dichloroacetate (DCA) infusion activates muscle pyruvate dehydrogenase complex (PDC) at rest, reducing inertia in mitochondrial energy delivery at the onset of exercise and diminishing anaerobic energy production. Objectives: This study aimed to determine whether DCA infusion enhanced mitochondrial energy delivery during symptom-limited maximal exercise, thereby reducing exercise-induced lactate and ammonia accumulation and, consequently, improving exercise performance in COPD patients. Methods and Measurements: A randomised, double-blind crossover design was used. Eighteen COPD subjects performed maximal cycle exercise after an intravenous infusion of DCA (50mg/kg body mass) or saline (control). Exercise work output was determined, and blood lactate and ammonia concentrations were measured at rest, 1 and 2 minutes of exercise, peak exercise, and 2 minutes post-exercise. Main Results: DCA infusion reduced peak blood lactate concentration by 20% [mean(SE) difference 0.48(0.11)mmol/l, p<0.001] and peak blood ammonia concentration by 15% [mean(SE) difference 14.2(2.9)umol/l, p<0.001] compared with control. Following DCA, peak exercise workload improved significantly by a mean(SE) of 8(1)watts [p<0.001] and peak oxygen consumption by 1.2(0.5)ml/kg/min [p=0.03] compared with control. Conclusion: We have shown that a pharmacological intervention known to activate muscle PDC can reduce blood lactate and ammonia accumulation during exercise and improve maximal exercise performance in COPD subjects. Skeletal muscle PDC activation may be a target for pharmacological intervention in the management of exercise intolerance in COPD. Key words: exercise limitation, COPD, energy metabolism, dichloroacetate, skeletal muscle dysfunction
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