Autophagy has long been associated with longevity and it is well established that autophagy reverts and prevents vascular deterioration associated with aging and cardiovascular diseases. Currently, our understanding of how autophagy benefits the vasculature is centered on the premise that reduced autophagy leads to the accumulation of cellular debris resulting in inflammation and oxidative stress, which are then reversed by reconstitution or upregulation of autophagic activity. Evolutionarily, autophagy also functions to mobilize endogenous nutrients in response to starvation. Therefore, we hypothesized that the biosynthesis of the most physiologically abundant ketone body, β-hydroxybutyrate (βHB), would be autophagy dependent, and exert vasodilatory effects via its canonical receptor, Gpr109a. We have revealed for the first time that the biosynthesis of βHB can be impaired by preventing autophagy. Subsequently, βHB caused potent vasodilation via potassium-channels, but not Gpr109a. Finally, we observed that chronic consumption of a high salt diet negatively regulates both βHB biosynthesis and hepatic autophagy, and that reconstitution of βHB bioavailability prevents high salt diet-induced endothelial dysfunction. In summary, this work offers an alternative mechanism to the anti-inflammatory and anti-oxidative stress hypothesis of autophagy-dependent vasculoprotection. Furthermore, it reveals a direct mechanism, by which ketogenic interventions (e.g., intermittent fasting) improve vascular health.
