Despite intensive research and constant medical progress,
sepsis remains one of the most urgent unmet medical needs of today. Most studies have been focused on the inflammatory component of the disease; however, recent advances support the notion that
sepsis is accompanied by extensive metabolic perturbations. During times of limited caloric intake and high energy needs, the liver acts as the central metabolic hub in which PPARα is crucial to coordinate the breakdown of
fatty acids. The role of hepatic PPARα in
liver dysfunction during
sepsis has hardly been explored. We demonstrate that
sepsis leads to a
starvation response that is hindered by the rapid decline of hepatic PPARα levels, causing excess
free fatty acids, leading to lipotoxicity, and
glycerol. In addition, treatment of mice with the PPARα agonist
pemafibrate protects against bacterial
sepsis by improving hepatic PPARα function, reducing lipotoxicity and tissue damage. Since lipolysis is also increased in
sepsis patients and
pemafibrate protects after the onset of
sepsis, these findings may point toward new therapeutic leads in
sepsis.