The animal study protocol was approved by the Institutional Ethics Committee of Nanjing Drum Tower Hospital (Approval Number: 2025AE1065, 26 September 2025) and was conducted in accordance with the guidelines outlined in the Guidelines for the Care and Use of Laboratory Animals (8th Edition), published by the National Institutes of Health of the United States.
Animals
Thirty 5-week-old male C57BL/6J mice were used in this study. After 1 week of adaptive feeding, all mice were housed with access to food and water under an alternating 12 h day-night cycle at a temperature of 22°C ± 2°C and humidity of 40%–60%. An HFD combined with low-dose STZ was used to establish the DCM mouse model (Figure 1A). Four weeks after initiation of high-fat diet (HFD; 60% fat, 20% protein, and 20% carbohydrate) feeding, mice were fasted overnight and subsequently administered streptozotocin (STZ; 8 mg/mL dissolved in citrate buffer, pH 4.5) via intraperitoneal injection at a dosage of 35 mg/kg/day for three consecutive days. Control group mice were fed a control diet (10% fat, 20% protein, and 70% carbohydrate) and received equivalent volumes of citrate buffer. Following 15 additional weeks of high-fat diet maintenance, mice meeting both criteria, random blood glucose of ≥13.3 mmol/L and left ventricular ejection fraction (LVEF) of <55%, were defined as successfully established DCM models. These validated DCM mice were numbered and randomly assigned to the DCM and DCM + Lac-Phe groups using a random number table. Approximately half of the mice failed to develop the model; these animals were euthanized in accordance with animal ethics requirements. In brief, mice were divided into three groups: Control, DCM, and DCM + Lac-Phe (n = 10 for each group). All 10 mice per group underwent echocardiography, body weight measurement, and OGTT. Following the 28-day treatment period, hearts were collected for subsequent analyses. There were 10 mice in each group. Of these, three mice per group were used for transcriptome sequencing, three were used for transmission electron microscopy and histological staining, and three were used for protein expression analysis. The remaining mouse in each group was reserved as a backup. After successful establishment of the DCM model, Lac-Phe was dissolved in normal saline to a final concentration of 10 mg/mL. Mice in the DCM + Lac-Phe group received intraperitoneal Lac-Phe at 50 mg/kg/day in an injection volume of 5 mL/kg, once daily for 28 consecutive days. Mice in the Control and DCM groups were administered an equivalent volume of normal saline as vehicle control.

Figure 1. Lac-Phe improves cardiac function and pathological remodeling in mice with diabetic cardiomyopathy. (A) Schematic of the HFD/STZ-induced DCM mouse model and Lac-Phe treatment protocol. (B) Body weights of mice in the Control, DCM, and DCM + Lac-Phe groups during the 4-week treatment period; n = 10 per group. (C) Oral glucose tolerance test (OGTT) in the indicated groups; n = 10 per group. (D) Representative echocardiographic images at 0, 2, and 4 weeks of treatment. (E,F) Quantification of left ventricular ejection fraction (LVEF) (E) and fractional shortening (FS) (F); n = 10 per group. (G) Representative hematoxylin and eosin (H&E)-stained heart sections. Scale bar = 1 mm. (H,I) Representative Masson’s trichrome staining of heart sections (H) and quantification of fibrotic area (I); n = 3 per group. Scale bar = 50 μm. (J,K) Representative wheat germ agglutinin (WGA) staining of heart sections (J) and quantification of relative cardiomyocyte area (K); n = 3 per group. Scale bar = 20 μm. Data are presented as the mean ± standard deviation. P < 0.05, **P < 0.001. Please click here to view a larger version of this figure.
Cardiac function
Following anesthesia with isoflurane inhalation, mice were secured in a supine position on a temperature-controlled platform (37°C). Left ventricular dimensions and mitral valve blood flow velocity during diastole and systole were measured using an echocardiography machine equipped with a 40 MHz transducer, from which LVEF and shortening fraction (FS) were calculated. Three consecutive cardiac cycles were collected from each mouse.
Cell treatment
H9c2 cells were cultured in Dulbecco’s modified Eagle’s medium supplemented with 10% fetal bovine serum and 1% penicillin–streptomycin at 37°C in a humidified atmosphere containing 5% CO₂. Cells were passaged every 2–3 days upon reaching 70%–80% confluence. For experiments, cells were seeded in 10 cm dishes and then divided into three groups: Control, high glucose/palmitic acid (HG/PA), and HG/PA + Lac-Phe. Cells in the HG/PA and HG/PA + Lac-Phe groups were first exposed to 0.25 mM palmitic acid and 50 mM glucose for 24 h. Thereafter, cells in the HG/PA + Lac-Phe group were treated with 10 μg/mL Lac-Phe for an additional 24 h while HG/PA exposure was maintained; cells in the HG/PA group received an equivalent volume of PBS under the same HG/PA conditions. In the p-AMPK inhibition experiments, 10 μM AMPK-IN-3 (dissolved in DMSO) was added simultaneously with Lac-Phe for 24 h, and the corresponding control groups received an equal volume of DMSO. For the atorvastatin experiments, H9c2 cells under HG/PA conditions were treated with 10 μM atorvastatin for 24 h, either alone or in combination with 10 μg/mL Lac-Phe.
Histological staining
After 28 days of Lac-Phe administration, mouse hearts were harvested and immersion-fixed in 4% paraformaldehyde (pH 7.4) for 24 h. Fixed cardiac tissues were paraffin-embedded and sectioned into 6-μm-thick slices. Tissue sections were stained with hematoxylin and eosin, wheat germ agglutinin, and Masson’s trichrome. All staining procedures were performed strictly following the manufacturers’ protocols. Whole-slide imaging was performed at 20× magnification using a high-resolution brightfield microscope equipped with a digital camera system.
Western blot analysis
Protein concentration was determined using the Bradford assay. Tissue lysates were resolved by SDS-PAGE on 10% (w/v) acrylamide gels and electrophoretically transferred to polyvinylidene difluoride membranes. Nonspecific binding sites were blocked with 5% bovine serum albumin for 2 h at room temperature. Membranes were then incubated overnight at 4°C with primary antibodies (diluted 1:1,000), followed by six washes with TBST (5 min each) on a shaker. The membranes were then incubated with horseradish peroxidase-conjugated secondary antibodies (diluted 1:5,000) for 2 h at room temperature, followed by another six washes with TBST (5 min each). Protein bands were visualized using an enhanced chemiluminescence reagent kit. Quantification of western blot results was performed by densitometric analysis using ImageJ software. All antibodies used in this study are listed in the Table of Materials.
Transcriptomics
Total RNA was isolated from cardiac tissue of C57BL/6J mice using TRIzol Reagent and RNeasy mini kits. RNA quality was evaluated using a 2100 bioanalyzer, demonstrating high RNA purity and integrity. RNA-seq libraries were prepared according to the VAHTS Universal V10 RNA-seq Library Prep Kit and sequenced using an Illumina NovaSeq 6000 System (single-read, 150 bp). Differentially expressed genes were identified using DESeq2, with an adjusted P value < 0.05 and an absolute log₂ fold change > 1 considered statistically significant. Gene Ontology (GO) enrichment analysis was conducted on differentially expressed genes, and the significance of enrichment of differentially expressed genes in GO terms was calculated using the hypergeometric distribution algorithm.
Oil Red O staining and LD540 lipid staining
Cardiac tissue was embedded in OCT compound and then cut into 10-μm-thick sections. The frozen sections were equilibrated at room temperature for 30 min and fixed with 4% paraformaldehyde for 10 min. After washing with PBS, the sections were placed in 60% isopropyl alcohol for 15 s and covered with Oil Red O working solution for 30 min. The sections were then treated with 60% isopropyl alcohol for 15 s and washed three times with PBS. For LD540 lipid staining, H9c2 cells were washed with PBS and fixed with 4% paraformaldehyde for 10 min at room temperature. The cells were then incubated with 10 μM LD540 for 30 min at room temperature.
Transmission electron microscopy (TEM)
Fresh mouse heart tissues were cut into 1–2 mm3 pieces, fixed in electron microscope fixative at 4°C for 4 h, then washed with double-distilled water and immersed in ethanol solutions of progressively increasing concentrations. The samples were embedded, sectioned, and then observed under a transmission electron microscope.
Total cholesterol (TC) content
Total cholesterol (TC) levels in serum and H9c2 cell samples were measured using the Amplex Red Cholesterol and Cholesteryl Ester Assay Kit according to the manufacturer’s instructions.
Oral Glucose Tolerance Test (OGTT)
Mice were fasted for 14 h (from 19:00 to 9:00) and gavaged with glucose (20% stock, 2 g/kg). Blood glucose levels were determined using blood collected from the tail vein at 0, 15, 30, 60, and 120 min after gavage.
Cell counting kit-8 (CCK-8) measurement
CCK-8 was used to measure cell viability. H9c2 cells were seeded into 96-well plates at an initial density of 3 × 104 cells/well. After treatment with different concentrations of Lac-Phe under HG/PA conditions for 24 h, 10 μL of the kit reagent was added to 100 μL of culture medium per well, followed by incubation at 37°C for 4 h. The absorbance was measured at 450 nm using a multimode microplate reader to obtain the optical density (OD) value.
Molecular docking
The crystal structures of Lac-Phe and AMPKα1 were downloaded from PubChem26. The molecular docking process was carried out using CB-DOCK227.
Statistical analysis
All echocardiographic measurements, histological staining, and image quantifications were performed by investigators blinded to group assignment. All data analyses were performed using Prism and SPSS 20.0. Each experiment was repeated at least three times, and the data were presented as the mean ± standard deviation. Homogeneity of variance was assessed using Levene’s test. Normality was confirmed by graphical inspection of residuals. Comparisons among multiple groups were conducted using one-way analysis of variance, followed by Tukey's post hoc test for pairwise comparisons. For OGTT data, two-way repeated-measures ANOVA was used, with group as the between-subjects factor and time as the within-subjects factor, followed by Bonferroni's post hoc test. P < 0.05 was considered statistically significant.