Pyruvate dehydrogenase complex (PDC) is a complex of three enzymes that converts pyruvate into acetyl-CoA by a process called pyruvate decarboxylation. Acetyl-CoA may then be used in the citric acid cycle to carry out cellular respiration, and this complex links the glycolysis metabolic pathway to the citric acid cycle. Pyruvate decarboxylation is also known as the "pyruvate dehydrogenase reaction" because it also involves the oxidation of pyruvate. The levels of pyruvate dehydrogenase enzymes play a major role in regulating the rate of carbohydrate metabolism and are strongly stimulated by the evolutionarily ancient hormone insulin. The PDC is opposed by the activity of pyruvate dehydrogenase kinase, and this mechanism plays a pivotal role in regulating rates of carbohydrate and lipid metabolism in many physiological states across taxa, including feeding, starvation, diabetes mellitus, hyperthyroidism, and hibernation.
The multienzyme complex is structurally and functionally related to the oxoglutarate dehydrogenase complex (OGDC), the 2-oxoadipate dehydrogenase complex (OADHC) and the branched-chain oxo-acid dehydrogenase complex (BCKDC), all of which are members of the 2-oxoacid dehydrogenase complex family. A role for insulin in the regulation of glucose homeostasis, pyruvate dehydrogenase levels, and the generation of AMP-activated protein kinase (AMPK) in the electron transport chain has been evolutionarily conserved across species. A shift in substrate utilization can be induced by conditions such as eating or fasting, and the oxidation of either glucose or fatty acids tends to suppress the use of the other substrate (a phenomenon known as the Randle cycle). The intake of macronutrients stimulates the secretion and release of insulin and other chemical messengers such as glucagon-like peptide 1 (GLP-1), which act to regulate glucose levels, insulin sensitivity, satiety, and fat balance in the body. In the postprandial period, insulin is produced by the pancreas and serves to activate carbohydrate metabolism and stimulate glucose disposal in order to meet metabolic demands and prevent glucotoxicity. When insulin is unable to efficiently stimulate glucose utilization, the body's tissues become resistant to its hypoglycemic effects, promoting the development of a state of insulin resistance over time. This can happen because of chronic exposure to hyperinsulinemia due to poor diet, sedentary lifestyle, obesity, and other potentially modifiable risk factors. The phenomenon is similar to leptin resistance and can potentially lead to many deleterious health effects stemming from chronically elevated insulin levels, such as excessive fat storage and de novo synthesis, hepatic and peripheral insulin resistance, nonalcoholic fatty liver disease] (NAFLD), hypertension and dyslipidemia, and decreased resting energy expenditure (REE) caused by impaired diet-induced thermogenesis.
