Sodium-glucose co-transporter 2 Inhibitors Act Independently of SGLT2 to Confer Benefit for Heart Failure with Reduced Ejection Fraction in Mice.
Justin H BergerTimothy R MatsuuraCaitlyn E BowmanRenee TaingJiten PatelLing LaiTeresa C LeoneJeffrey D ReaganSaptarsi M HaldarZoltan AranyDaniel P KellyPublished in: bioRxiv : the preprint server for biology (2024)
Sodium-glucose co-transporter 2 inhibitors (SGLT2i) are novel, potent heart failure medications with an unknown mechanism of action. We sought to determine if the beneficial actions of SGLT2i in heart failure were on- or off-target, and related to metabolic reprogramming, including increased lipolysis and ketogenesis. The phenotype of mice treated with empagliflozin and genetically engineered mice constitutively lacking SGLT2 mirrored metabolic changes seen in human clinical trials (including reduced blood glucose, increased ketogenesis, and profound glucosuria). In a mouse heart failure model, SGLT2i treatment, but not generalized SGLT2 knockout, resulted in improved systolic function and reduced pathologic cardiac remodeling. SGLT2i treatment of the SGLT2 knockout mice sustained the cardiac benefits, demonstrating an off-target role for these drugs. This benefit is independent of metabolic changes, including ketosis. The mechanism of action and target of SGLT2i in HF remain elusive.
Keyphrases
- heart failure
- left ventricular
- blood glucose
- clinical trial
- acute heart failure
- endothelial cells
- blood pressure
- cardiac resynchronization therapy
- high fat diet induced
- randomized controlled trial
- squamous cell carcinoma
- metabolic syndrome
- neoadjuvant chemotherapy
- skeletal muscle
- rectal cancer
- combination therapy
- weight loss
- phase ii
- pluripotent stem cells