Ketone bodies (KBs) are crucial energy substrates during states of low carbohydrate availability. However, an aberrant regulation of KB homeostasis can lead to complications such as diabetic ketoacidosis. Exercise and diabetes affect systemic KB homeostasis, but the regulation of KB metabolism is still enigmatic. In our study in mice with either knockout or overexpression of the peroxisome proliferator-activated receptor-g coactivator (PGC)-1a in skeletal muscle, PGC-1a regulated ketolytic gene transcription in muscle. Furthermore, KB homeostasis of these mice was investigated during withholding of food, exercise, and ketogenic diet feeding, and after streptozotocin injection. In response to these ketogenic stimuli, modulation of PGC-1a levels in muscle affected systemic KB homeostasis. Moreover, the data demonstrate that skeletal muscle PGC-1a is necessary for the enhanced ketolytic capacity in response to exercise training and overexpression of PGC-1a in muscle enhances systemic ketolytic capacity and is sufficient to ameliorate diabetic hyperketonemia in mice. In cultured myotubes, the transcription factor estrogen-related receptor-a was a partner of PGC-1a in the regulation of ketolytic gene transcription. These results demonstrate a central role of skeletal muscle PGC-1a in the transcriptional regulation of systemic ketolytic capacity.-Svensson, K., Albert, V., Cardel, B., Salatino, S., Handschin, C. Skeletal muscle PGC-1a modulates systemic ketone body homeostasis and ameliorates diabetic hyperketonemia in mice. FASEB J. 30, 1976FASEB J. 30, -1986FASEB J. 30, (2016 During prolonged starvation, when carbohydrate availability is low, the ketone bodies (KBs) b-hydroxybutyrate (bOHB) and acetoacetate (AcAc) are necessary metabolic fuels that help maintain energy homeostasis (1). KBs are produced in the liver and are subsequently metabolized to acetyl-CoA in extrahepatic organs. Most KB metabolism occurs in the mitochondria and is catalyzed by the enzymes 3-hydroxybutyrate dehydrogenase, type 1 (BDH1), succinyl-CoA:3-ketoacid-coenzyme A transferase 1 (OXCT1), and acetyl-CoA acetyltransferase 1 (ACAT1) (2). Mutations of genes encoding these enzymes are associated with exacerbated ketosis in humans (3). Moreover, knockout of the rate-limiting ketolytic enzyme OXCT1 leads to severe hyperketonemia and lethality in mice (4). Hyperketonemia is a common complication in diabetes that can lead to severe and possibly lethal ketoacidosis (5) and has been attributed in part to impaired peripheral KB oxidation (6). However, relatively little is known about the transcriptional regulation of ketolytic enzymes (7). The peroxisome proliferator-activated receptor g coactivator (PGC)-1a is an essential transcriptional coactivator and has a well-established role in the regulation of mitochondrial metabolic processes such as oxidative phosphorylation and the tricarboxylic acid (TCA) cycle (8). Although these metabolic pathways are crucial for complete oxidation of KBs, it is not known whether PGC-1a directly affects the ...