ABSTRACT:We seek to understand the mechanism for the delayed postnatal switch between glycolytic and oxidative metabolism in preterm newborns. Our previous study [Brauner et al. A daptation to extrauterine life depends largely on a switch from glycolytic to oxidative metabolism. Several studies (1-3) demonstrated the recruitment of energy conversion and ATP synthesis in mitochondria during the early postnatal period as well as insufficient maturation of this mechanism in premature newborns (4,5). Results of our previous study (6) on autopsy samples of skeletal muscle, mostly from preterm neonates, suggested impaired postnatal recruitment by nutritional lipids (7,8) of the gene for mitochondrial uncoupling protein 3 (UCP3) in neonates delivered before approximately 26 wk of gestation. UCP3 was shown to uncouple mitochondrial oxidative phosphorylation in vivo (9); it is specifically linked to lipid metabolism (7,10 -14) and possibly also to production of reactive oxygen species (15) in skeletal muscle. Therefore, abnormal postnatal development of UCP3 might have severe metabolic consequences.The reason for the impaired postnatal recruitment of UCP3 in very premature neonates has not been clarified (6). It could reflect activation of its promoter (16) by fatty acids (FA) via a transcription factor, the peroxisome proliferator-activated receptor ␣ (17,18), as well as the control by MyoD, the regulator of differentiation program of muscle cells (19), or the control by thyroid hormones (20) (see also Discussion). AMP-activated protein kinase (AMPK) could also be involved. This enzyme is a sensor of cellular energy stress that, once phosphorylated due to an increase in the cellular AMP/ ATP ratio or other stimulus, activates ATP-producing processes while switching off ATP-consuming metabolic pathways (21). Activation of AMPK in skeletal muscle in response to contraction results in increased glucose uptake (22) and FA oxidation (23). Moreover, activation of AMPK in skeletal muscle by an adenosine analog (5-aminoimidazole-4-carboxamide-1--D-ribofuranoside) increases expression of genes for GLUT4, and for mitochondrial proteins (24), including UCP3 (25)(26)(27)(28)(29). AMPK has also a role in the regulation of the transcription of genes involved in glucose and lipid metabolism in muscle during starvation (30). Importantly, upregulation of AMPK was shown to be responsible for increase of myocardial FA oxidation following birth in the rabbit (31). A homolog of mammalian AMPK, SNF1 protein kinase, is involved in the shift from anaerobic to aerobic metabolism in yeast (32).This report represents an extension of our earlier study on the expression of UCP3 in skeletal muscle in premature