D-hydroxybutyrate stabilizes hippocampal CA3-CA1 circuit during acute insulin resistance

The brain primarily relies on glycolysis for mitochondrial respiration but switches to alternative fuels such as ketone bodies (KBs) when less glucose is available. Neuronal KB uptake, which does not rely on glucose transporter 4 (GLUT4) or insulin, has shown promising clinical applicability in alleviating the neurological and cognitive effects of disorders with hypometabolic components. However, the specific mechanisms by which such interventions affect neuronal functions are poorly understood. In this study, we pharmacologically blocked GLUT4 to investigate the effects of exogenous KB D-hydroxybutyrate (D-Hb) on mouse brain metabolism during acute insulin resistance (AIR). We found that both AIR and D-Hb had distinct impacts across neuronal compartments: AIR decreased synaptic activity and long-term potentiation (LTP) and impaired axonal conduction, synchronization, and action potential properties, while D-Hb rescued neuronal functions associated with axonal conduction, synchronization, and LTP.