Pathways of Ketone Body Utilization

Mitochondrial pathway The major site of ketone body utilization in peripheral tissues is the mitochondria (Figure 6). Although transporters for ketone bodies have been described on the plasma and inner mitochondrial membranes of some tissues, these do not appear to limit the flux. The initiating enzyme for acetoacetate metabolism is 3-oxoacid-CoA transferase:

Acetoacetate + succinyl-CoA ^ acetoacetyl-CoA

+ succinate

The resulting acetoacetyl-CoA is cleaved to two molecules of acetyl-CoA by acetoacetyl-CoA thio-lase; they are then oxidized in the tricarboxylate cycle.

3-Hydroxybutyrate is converted to acetoacetate by 3-hydroxybutyrate dehydrogenase:



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