Effectiveness and mechanisms of sodium-dependent glucose transporter 2 inhibitors in type 2 diabetes and heart failure patients

We comment on an article by GrubićRotkvićet al published in the recent issue of the World Journal of Cardiology.We specifically focused on possible factors affecting the therapeutic effectiveness of sodium-dependent glucose transporter inhibitors(SGLT2i)in patients with type 2 diabetes mellitus(T2DM)and their impact on comorbidities.SGLT2i inhibits SGLT2 in the proximal tubules of the kidneys,lowering blood glucose levels by inhibiting glucose reabsorption by the kidneys and causing excess glucose to be excreted in the urine.Previous studies have demonstrated a role of SGLT2i in cardiovascular function in patients with diabetes who take metformin but still have poor glycemic control.In addition,SGLT2i has been shown to be effective in anti-apoptosis,weight loss,and cardiovascular protection.Accordingly,it is feasible to treat patients with T2DM with cardiovascular or renal diseases using SGLT2i.

Sodium-dependent glucose transporter 2 inhibitors effects on myocardial function in patients with type 2 diabetes and asymptomatic heart failure

BACKGROUND Sodium-dependent glucose transporter 2 inhibitors(SGLT2i)have shown efficacy in reducing heart failure(HF)burden in a very heterogeneous groups of patients,raising doubts about some contemporary assumptions of their mechanism of action.We previously published a prospective observational study that evaluated mechanisms of action of SGLT2i in patients with type 2 diabetes who were in HF stages A and B on dual hypoglycemic therapy.Two groups of patients were included in the study:the ones receiving SGLT2i as an add-on agent to metformin and the others on dipeptidyl peptidase-4 inhibitors as an add-on to metformin due to suboptimal glycemic control.AIM To evaluate the outcomes regarding natriuretic peptide,oxidative stress,inflammation,blood pressure,heart rate,cardiac function,and body weight.METHODS The study outcomes were examined by dividing each treatment arm into two subgroups according to baseline parameters of global longitudinal strain(GLS),N-terminal pro-brain natriuretic peptide,myeloperoxidase(MPO),high-sensitivity C-reactive protein(hsCRP),and systolic and diastolic blood pressure.To evaluate the possible predictors of observed changes in the SGLT2i arm during follow-up,a rise in stroke volume index,body mass index(BMI)decrease,and lack of heart rate increase,linear regression analysis was performed.RESULTS There was a greater reduction of MPO,hsCRP,GLS,and blood pressure in the groups with higher baseline values of mentioned parameters irrespective of the therapeutic arm after 6 months of follow-up.Significant independent predictors of heart rate decrease were a reduction in early mitral inflow velocity to early diastolic mitral annular velocity at the interventricular septal annulus ratio and BMI,while the predictor of stroke volume index increase was SGLT2i therapy itself.CONCLUSION SGLT2i affect body composition,reduce cardiac load,improve diastolic/systolic function,and attenuate the sympathetic response.Glycemic control contributes to the improvement of heart function,blood pressure control,oxidative stress,and reduction in inflammation.

Effects of octreotide on glucose transporter type 2expression in obese rat small intestine

AIM： TO investigate the effects of the somatostatin analogue, octreotide, on maltose and sucrase activities and expression of glucose transporter type 2 （GLUT2） in obese rat intestinal mucosa. METHODS： We divided 49 Sprague-Dawley rats into a group of 31 high fat diet-induced obese rats and a group of 18 normal controls. The obese rats were separated into an octreotide treated group 9f 16 rats and an obese group of 15. The intervention （：jroup was injected with octreotide at 40 ±g/kg body weight every 12 h for 8 d. Rat body weight was measured weekly to calculate Lee＇s index. After euthanization, maltase and sucrase activities in the small intestine were measured by activity assays, and the fasting plasma glucose level was measured. The expression of GLUT2 in small intestinal mucosa was analyzed by immunohistochemistry, reverse transcriptase polymerase chain reaction and Western blotting assays. RESULTS： Body weight, Lee＇s index, fasting plasma glucose level, maltase activity in small intestinal mucosa, mucosa and apical GLUT2, GLUT2 mRNA and protein expression levels were all significantly higher in the obese group than in the normal control group （605.61 ± 141.00 vs 378.54 ±111.75, 337.61 ± 10.82 vs 318.73 ± 20.10, 8.60± 1.38 vs 7.33 ± 0.70, 156.01 ± 58.81 vs 50.43 ± 30.49, 390 744.2± 62 469.21 vs 170 546.50 ± 50 646.14, 26 740.18 ±3809.60 vs 354.98± 57.19, 0.26± 0.11 vs 0.07± 0.02, and 2.08 ± 0.59 vs 1.27 ± 0.38, respectively, all P 〈 0.01）. Sucrase activity did not differ between the two groups. Octreotide intervention significantly decreased the body weight and fasting plasma glucose level of obese rats （508.27 ± 94.39 vs 605.61 ± 141.00, 7.58 ± 1.51 vs 8.60±1.38, respectively, all P 〈 0.05）. The intestinal mucosa and apical GLUT2, expression of GLUT2 mRNA and protein were also significantly lower in the octreotide intervention group than in the obese group （269 975.2 ± 53 730.94 vs 390 744.2 ± 62 469.21, 3758.06 ± 364.51 vs 26 740.18 ± 3809.60, 0.08 ± 0.02 vs 0.26 ±0.11, and 1.31 ± 0.27 vs 2.08 ±0.59, respectively, all P 〈 0.01）. CONCLUSION： High fat dietinduced obesity is associated with elevated intestinal maltase activity, GLUT2 expression, and permanent apical GLUT2 in the small intestinal mucosa of rats. Octreotide can inhibit these effects.

Role of sodium-glucose co-transporter-2 inhibitors in the management of nonalcoholic fatty liver disease

Nonalcoholic fatty liver disease (NAFLD) is the most prevalent cause of chronic liver disease worldwide. NAFLD is considerably more frequent in patients with type 2 diabetes mellitus (T2DM) than in the general population and is also more severe histologically in this group. Sodium-glucose co-transporter-2 (SGLT2) inhibitors, the newest class of antidiabetic agents, appear to represent a promising option for the management of NAFLD in patients with T2DM. In a number of studies, treatment with SGLT2 inhibitors resulted in a reduction in hepatic steatosis and in transaminase levels. However, existing studies are small, their follow-up period was short and none evaluated the effects of SGLT2 inhibitors on liver histology. Accordingly, larger studies are needed to verify these preliminary results and define the role of SGLT2 inhibitors in the treatment of NAFLD in patients with T2DM.

Effects of suppressing glucose transporter-1 by an antisense oligodeoxynucleotide on the growth of human hepatocellular carcinoma cells

BACKGROUND:The glucose transporter-1(Glut-1),a key ratelimiting factor in the transport and metabolism of glucose in cancer cells,is over-expressed in many human cancer cells and this overexpression is correlated with poor biological behavior. The increased levels of Glut-1 expression in hepatocellular carcinoma(HCC)cells functionally affect tumorigenicity.This study was undertaken to investigate effects of suppressing Glut-1 by an antisense oligodeoxynucleotide(AS-ODN)on the growth of human hepatocellular carcinoma(HepG-2)cells. METHODS:We used AS-ODN targeting against the Glut-1 gene in a HepG-2 cell line.There were four experimental groups: empty pcDNA3.1 vector(mock transfection),pcDNA3.1-anti-Glut(+),pcDNA3.1-Glut(+),and non-transfected HepG-2 cells. The Glut-1 mRNA expression was detected by RT-PCR and the Glut-1 protein expression by Western blotting after cell culture, and the glucose uptake was detected after glucose stimulation in each group. RESULTS:Compared with non-transfected HepG-2 or Glut-1 pcDNA3.1,a down-regulation of Glut-1 mRNA in HepG-2 cells transfected with anti-Glut-1 pcDNA3.1 was noted(P<0.05).Glut-1 protein in HepG-2 cells transfected with Glut-1 AS-ODN was decreased compared with non-transfected HepG-2,Glut-1 pcDNA3.1,or empty vectors. Glucose uptake by the HepG-2 cells transfected with AS-ODN was decreased at 1 hour after glucose stimulation.CONCLUSIONS:The application of Glut-1 AS-ODN can down-regulate the expression of Glut-1 at mRNA and protein,and inhibit glucose uptake partially in HepG-2 cells.The Glut-1 gene maybe a potential therapeutic target for HCC.

青钱柳多糖调节胰岛和肝脏葡萄糖转运蛋白4转位干预2型糖尿病大鼠的作用机制

目的 观察青钱柳多糖调节胰岛和肝脏葡萄糖转运蛋白4(GLUT4)转位改善2型糖尿病(T2DM)大鼠外周胰岛抵抗的作用。方法 建立T2DM大鼠模型(给予高脂饲料后注射链脲佐菌素35 mg·kg^(-1)),将造模成功的大鼠随机分为模型对照组,青钱柳多糖提取物小、大剂量组(5,10 g·kg^(-1))和盐酸二甲双胍组(0.25 g·kg^(-1)),每组9只,给药8周。测定空腹血糖、血脂变化;苏木精-伊红染色法观察胰岛和肝脏病理形态的改变;免疫组化法观察胰岛磷酸化磷酯酰肌醇3激酶(p-PI3K)、磷酸化丝氨酸苏氨酸蛋白激酶1(p-Akt1)、GLUT4蛋白的表达;免疫荧光观察肝脏和胰岛GLUT4转位。结果 与模型对照组比较,青钱柳多糖提取物小、大剂量组和盐酸二甲双胍组大鼠胰岛和肝脏结构较完整,血糖下降(P<0.05),高密度脂蛋白升高(P<0.05),胰岛p-PI3K、p-Akt1、GLUT4蛋白表达升高(P<0.05),肝脏和胰岛GLUT4转位增强(P<0.05)。结论 青钱柳多糖可调节T2DM大鼠糖脂紊乱,其机制可能是增强胰岛p-PI3K、p-Akt1、GLUT4蛋白的表达,促进肝脏和胰岛GLUT4转位,从而调节外周胰岛抵抗。

达格列净对2型糖尿病非增殖期视网膜病变的影响

目的:探讨达格列净对2型糖尿病非增殖期视网膜病变(non-proliferative diabetic retinopathy,NPDR)的影响。方法:选取2021年10月—2023年6月湖南师范大学附属湘东医院收治的88例2型糖尿病NPDR患者。随机将其分为观察组及对照组,各44例。两组均给予常规降糖治疗,观察组加用达格列净治疗。比较两组治疗前后血糖指标及相关指标。分析血管内皮生长因子(vascular endothelial growth factor,VEGF)与血糖波动指标的相关性。结果:治疗后,两组空腹血糖(fasting blood glucose,FBG)、餐后2 h血糖(2 h postprandial blood glucose,2 h PBG)、糖化血红蛋白(glycosylated hemoglobin,HbA1c)、血糖水平标准差(standard deviation of blood glucose,SDBG)、餐后血糖波动幅度(postprandial glucose excursion,PPGE)、最大血糖波动幅度(large amplitude glycemic excursion,LAGE)均下降,观察组SDBG、PPGE、LAGE均低于对照组,差异有统计学意义(P<0.05)。治疗后,两组VEGF、黄斑中心凹厚度均下降,最佳矫正视力(best-corrected visual acuity,BCVA)升高,观察组VEGF、黄斑中心凹厚度均低于对照组,BCVA高于对照组,差异有统计学意义(P<0.05)。Pearson相关性分析结果显示:VEGF与SDBG、PPGE、LAGE均呈正相关(P<0.05)。结论:达格列净能够改善血糖波动,降低VEGF水平,对2型糖尿病NPDR有保护作用。

SGLT-2抑制剂达格列净治疗早期糖尿病肾病的临床效果和安全性分析

目的分析在早期糖尿病肾病治疗中采用钠-葡萄糖协同转运蛋白2(Sodium-dependent Glucose Transporters 2,SGLT-2)抑制剂达格列净的疗效和安全性。方法选取2022年3月—2023年12月北京市第六医院收治的100例早期糖尿病肾病患者为研究对象,以随机数表法分为研究组和对照组,各50例。给予全部患者常规治疗,研究组加用达格列净治疗,对照组加用二甲双胍治疗,对比两组血糖水平、肾功能和不良反应发生情况。结果治疗后,研究组空腹血糖为(5.16±0.77)mmol/L,餐后2 h血糖为(7.11±1.38)mmol/L,糖化血红蛋白为(5.05±0.73)%,低于对照组,差异有统计学意义(t=4.592、5.020、5.093,P均<0.05)。治疗后,研究组尿白蛋白/肌酐比值、肾小球过滤率优于对照组,差异有统计学意义(P均<0.05)。研究组不良反应发生率低于对照组,差异有统计学意义(P<0.05)。结论在早期糖尿病肾病治疗中采用SGLT-2抑制剂达格列净疗效显著,可以有效降低血糖水平,改善肾功能,降低不良反应发生率。

GLUT1、GLUT2介导的葡萄糖摄取对小鼠牙齿早期发育的影响

目的:探究葡萄糖转运蛋白(glucose transporter,GLUT)1、GLUT2介导的葡萄糖摄取对小鼠牙齿早期发育的影响。方法:收集胚胎13.5 d(embryonic day 0.5,E13.5)、E14.5、E16.5、E18.5和出生后1 d(postnatal day 1,P1)时期的下颌磨牙牙胚、上颌切牙牙胚;实时荧光定量聚合酶链反应(real time-quantitative polymerase chain reaction,RT-qPCR)和Western blot检测牙胚中Glut1、Glut2 mRNA和蛋白水平;免疫组织化学染色检测牙胚中GLUT1、GLUT2、Ki67、糖原水平。将下颌磨牙牙胚在无糖DMEM培养基、高糖且含不同浓度的根皮素(0、0.25、0.5 mmol/L)的DMEM培养基中培养9 d;并对其进行苏木精-伊红(hematoxylin-eosin,HE)染色。结果:(1)在E13.5时期,GLUT1在成釉器中高表达,细胞增殖活跃,糖原在牙板和牙囊中大量沉积;在E14.5、E18.5时期,GLUT1在成釉器中表达逐渐降低,细胞增殖减少,糖原在成釉器和牙乳头中大量沉积;在P1时期,GLUT1在中间层和内釉上皮中表达较多,细胞增殖增多,糖原在牙乳头中少量沉积。在整个牙胚发育阶段,GLUT2表达相对较少。(2)GLUT1在前成釉细胞、前成牙本质细胞中高表达,而在分化后的成釉细胞、成牙本质细胞中表达较少;GLUT2与GLUT1呈现相反的表达趋势。(3)0.5 mmol/L根皮素能够抑制E13.5时期外植体牙胚发育,0.25 mmol/L根皮素不抑制E13.5、E14.5时期外植体牙胚发育,但能够导致牙胚变小,且具有根皮素浓度依赖性。无糖培养基能够抑制E13.5、E14.5时期外植体牙胚发育。结论:GLUT1、GLUT2在牙齿早期发育中的表达受到精确的时空调控,由GLUT1、GLUT2介导的葡萄糖摄取在小鼠牙齿早期发育中发挥重要作用。

SGLT-2抑制剂对2型糖尿病肾病患者的心血管保护作用

目的:探究钠-葡萄糖共转运蛋白2抑制剂(SGLT-2i)治疗2型糖尿病肾病患者的临床疗效及心血管保护作用。方法:选择2018年1月到2021年12月于我院内分泌科、心血管内科住院的2型糖尿病肾病患者376例,按治疗方案的不同分为对照组(177例,采用常规治疗方案)和SGLT-2i组(199例,在常规治疗方案的基础上联合使用SGLT-2i),且两组患者持续治疗1年。对比两组患者治疗12个月后血糖、血压、血脂、尿酸、人体质量指数、肾功能相关指标及主要不良心血管事件的发生情况,并记录药物的不良反应。结果:治疗12个月后,与对照组比较,SGLT-2i组的血压、空腹血糖(FBG)、糖化血红蛋白(HbA1c)、尿微量白蛋白/肌酐(UACR)、肌酐(Cr)、尿素氮(BUN)、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、尿酸(UA)水平均显著降低,估算的肾小球滤过率(eGFR)、高密度脂蛋白胆固醇(HDL-C)、白蛋白(Alb)、丙氨酸氨基转移酶(ALT)水平均显著升高(P<0.05或<0.01)。SGLT-2i组的急性心肌梗死(1.51%比6.21%)、因心力衰竭住院的发生率(2.51%比6.78%)均显著低于对照组,泌尿系感染的发生率(8.54%比1.69%)显著高于对照组(P均<0.05)。结论:SGLT-2i不仅能有效控制血糖,而且还有减轻体重、降低血压、改善血脂、降低尿酸、改善肾脏高滤过、减少尿蛋白的作用以及特有的心血管获益优势,但需注意泌尿系统感染风险。

钠-葡萄糖共转运蛋白2抑制剂对急性心肌梗死合并2型糖尿病患者的安全性及有效性评价

目的:探究钠-葡萄糖共转运蛋白2抑制剂(sodium-glucose co-transporter-2 inhibitor,SGLT2i)对合并2型糖尿病(type 2 diabetes mellitus,T2DM)的急性心肌梗死(acute myocardial infarction,AMI)患者的疗效及安全性。方法:研究纳入2018年1月至2023年1月,在首都医科大学附属北京安贞医院行PCI手术且合并T2DM的AMI患者共2 170例,其中357例患者使用SGLT2i,并根据患者出院带药是否使用SGLT2i分成两组:SGLT2i组和常规降糖组,通过倾向性匹配法进行1:1匹配。本研究主要有效性终点事件为支架术后12个月内心血管不良事件(major adverse cardiovascular events,MACE),包含全因死亡、非致命心肌梗死、或缺血相关血运重建,主要安全终点事件为严重出血事件。结果:通过倾向评分匹配成功357对,两组患者基线特征基本一致,差异无统计学意义。研究平均随访(11.7±1.4)个月。与常规降糖组相比,达格列净组的主要有效性终点事件(HR=0.47,95%CI 0.27~0.81,P=0.006)以及次要终点事件中缺血相关血运重建(HR=0.53,95%CI:0.30~0.93,P=0.026)的发生率较低。两组的主要安全性终点事件(HR=0.72,95%CI:0.29~1.81,P=0.492)、全因死亡(HR=0.49,95%CI:0.23~1.06,P=0.069)和心肌梗死(HR=0.62,95%CI:0.32~1.18,P=0.142)发生率差异未见统计学意义。结论:SGLT2i可以降低合并2型糖尿病的急性心肌梗死患者的MACE、心肌梗死或缺血相关血运重建发生率,同时并不增加安全事件风险。

钠-葡萄糖共转运蛋白2抑制剂对射血分数保留心力衰竭中冠状动脉微血管功能障碍的影响

射血分数保留的心力衰竭(heart failure with preserved ejection fraction,HFp EF)约占心力衰竭的50%,且呈增长趋势。HFp EF的发病机制目前仍不完全清楚,临床上缺乏有效的治疗方法。近年来的研究证据表明,冠状动脉微血管功能障碍在HFp EF的发生发展中发挥关键作用。钠-葡萄糖共转运蛋白2 (sodium-dependent glucose transporters 2,SGLT2)抑制剂显著改善射血分数减低的心力衰竭(heart failure with reduced ejection fraction,HFrEF)患者的临床预后且独立于血糖控制,其已被推荐为HFrEF患者的基础治疗药物。SGLT2抑制剂具有广泛的生物学功能。SGLT2抑制剂通过抑制炎症和氧化应激、减轻胰岛素抵抗、维持内皮功能等作用改善冠状动脉微血管功能。目前,尽管仍缺少足够的循证医学证据,SGLT2抑制剂仍被认为是治疗HFpEF的理想方案。

Free fatty acids receptors 2 and 3 control cell proliferation by regulating cellular glucose uptake

BACKGROUND Colorectal cancer(CRC)is a worldwide problem,which has been associated with changes in diet and lifestyle pattern.As a result of colonic fermentation of dietary fibres,short chain free fatty acids are generated which activate free fatty acid receptors(FFAR)2 and 3.FFAR2 and FFAR3 genes are abundantly expressed in colonic epithelium and play an important role in the metabolic homeostasis of colonic epithelial cells.Earlier studies point to the involvement of FFAR2 in colorectal carcinogenesis.AIM To understand the role of short chain FFARs in CRC.METHODS Transcriptome analysis console software was used to analyse microarray data from CRC patients and cell lines.We employed short-hairpin RNA mediated down regulation of FFAR2 and FFAR3 genes,which was validated using quantitative real time polymerase chain reaction.Assays for glucose uptake and cyclic adenosine monophosphate(cAMP)generation was done along with immunofluorescence studies to study the effects of FFAR2/FFAR3 knockdown.For measuring cell proliferation,we employed real time electrical impedancebased assay available from xCELLigence.RESULTS Microarray data analysis of CRC patient samples showed a significant down regulation of FFAR2 gene expression.This prompted us to study the FFAR2 in CRC.Since,FFAR3 shares significant structural and functional homology with FFAR2,we knocked down both these receptors in CRC cell line HCT 116.These modified cell lines exhibited higher proliferation rate and were found to have increased glucose uptake as well as increased level of glucose transporter 1.Since,FFAR2 and FFAR3 signal through G protein subunit(Gαi),knockdown of these receptors was associated with increased cAMP.Inhibition of protein kinase A(PKA)did not alter the growth and proliferation of these cells indicating a mechanism independent of cAMP/PKA pathway.CONCLUSION Our results suggest role of FFAR2/FFAR3 genes in increased proliferation of colon cancer cells via enhanced glucose uptake and exclude the role of PKA mediated cAMP signalling.Alternate pathways could be involved that would ultimately result in increased cell proliferation as a result of down regulated FFAR2/FFAR3 genes.This study paves the way to understand the mechanism of action of short chain FFARs in CRC.

钠-葡萄糖协同转运蛋白2抑制剂治疗心力衰竭的临床综合评价体系构建与实践

目的:建立钠-葡萄糖协同转运蛋白2(SGLT2)抑制剂治疗心力衰竭的临床综合评价体系,并进行实证评价,旨在为其抗心力衰竭的临床价值提供参考。方法:通过文献分析、专家访谈、安全信号挖掘等手段,结合德尔菲法,根据相关文件及指南,围绕药学特性、安全性、有效性、可及性、经济性和其他属性形成SGLT2抑制剂治疗心力衰竭的综合评价体系,并开展多维度的数据整合与分析研判。结果:构建了一套科学、客观、可量化的SGLT2抑制剂抗心力衰竭的临床综合评价体系。对各维度评价结果加权综合分析后,达格列净得分为83.14分,恩格列净为78.36分,艾托格列净为73.70分,卡格列净为70.18分。结论:基于目前的证据,SGLT2抑制剂各品种在心力衰竭治疗中有不同的优势。该评价体系及实证结果可为SGLT2抑制剂用于心力衰竭的临床治疗提供科学、有效、安全、经济的直观证据。

Decarboxylated osteocalcin,a possible drug for type 2 diabetes,triggers glucose uptake in MG63 cells

BACKGROUND Uncarboxylated osteocalcin(GluOC)has been reported to improve glucose metabolism,prevent type 2 diabetes,and decrease the severity of obesity in mice with type 2 diabetes.GluOC can increase glucose uptake in a variety of cells.Glucose metabolism is the main source of energy for osteoblast proliferation and differentiation.We hypothesized that decarboxylated osteocalcin(dcOC),a kind of GluOC,can increase glucose uptake in MG63 cells(osteoblast-like osteosarcoma cells)and influence their proliferation and differentiation.AIM To investigate the effects of dcOC on glucose uptake in human osteoblast-like osteosarcoma cells and the possible signaling pathways involved.METHODS MG63 cells(human osteoblast-like osteosarcoma cells)were treated with dcOC(0,0.3,3,10,or 30 ng/mL)for 1 and 72 h,and glucose uptake was measured by flow cytometry.The effect of dcOC on cell proliferation was measured with a CCK-8 assay,and alkaline phosphatase(ALP)enzyme activity was measured.PI3K was inhibited with LY294002,and hypoxia-inducible factor 1 alpha(HIF-1α)was silenced with siRNA.Then,GPRC6A(G protein-coupled receptor family C group 6 subtype A),total Akt,phosphorylated Akt,HIF-1α,and glucose transporter 1(GLUT1)levels were measured by Western blot to elucidate the possible pathways by which dcOC modulates glucose uptake.RESULTS The glucose uptake of MG63 cells was significantly increased compared with that of the paired control cells after short-term(1 h)treatment with dcOC at different concentrations(0.3,3,and 10 ng/mL groups,P<0.01;30 ng/mL group,P<0.05).Glucose uptake of MG63 cells was significantly increased compared with that of the paired control cells after long-term(72 h)treatment with dcOC at different concentrations(0.3,3,and 10 ng/mL groups,P<0.01;30 ng/mL group,P<0.05).DcOC triggered Akt phosphorylation in a dose-dependent manner,and the most effective stimulatory concentration of dcOC for short-term(1 h)was 3 ng/mL(P<0.01).LY294002 abolished the dcOC-mediated(1 h)promotion of Akt phosphorylation and glucose uptake without affecting GLUT1 protein expression.Long-term dcOC stimulation triggered Akt phosphorylation and increased the protein levels of HIF-1α,GLUT1,and Runx2 in a dose-dependent manner.Inhibition of HIF-1αwith siRNA abolished the dcOC-mediated glucose uptake and substantially decreased GLUT1 protein expression.DcOC interven-tion promoted cell proliferation in a time-and dose-dependent manner as determined by the CCK-8 assay.Treatment with both 3 ng/mL and 10 ng/mL dcOC affected the ALP activity in MG63 cells after 72 h(P<0.01).CONCLUSION Short-and long-term dcOC treatment can increase glucose uptake and affect proliferation and ALP activity in MG63 cells.This effect may occur through the PI3K/Akt,HIF-1α,and GLUT1 signaling factors.

《2023年欧洲心脏病学会心力衰竭指南》更新解读

《2023欧洲心脏病学会心力衰竭(下称心衰)指南》(下称《2023ESC指南》)更新纳入了自2021版指南之后的众多最新的循证医学证据,包括多项大型随机对照试验和荟萃分析。本次更新内容主要包括慢性心衰、急性心衰及心衰合并症三大方面。慢性心衰方面,钠-葡萄糖共转运蛋白2(SGLT2)抑制剂的出现为射血分数轻度降低的心衰及射血分数保留的心衰治疗带来了重要选择,成为目前唯一被推荐用于治疗全射血分数心衰的药物。急性心衰住院患者出院前及出院后前6周内采取强化策略,早期启动循证药物并快速滴定治疗,以减少心衰再入院和死亡率。对于2型糖尿病和慢性肾脏疾病患者,推荐使用SGLT2抑制剂及醛固酮受体拮抗剂类药物非奈利酮以降低心衰住院或心血管死亡的风险,静脉补铁治疗用于铁缺乏合并心衰患者以改善心衰症状和生活质量。《2023 ESC指南》更新对于心衰防治具有重大的指导性意义。

钠-葡萄糖协同转运蛋白-2抑制剂治疗多囊卵巢综合征的研究进展

多囊卵巢综合征(PCOS)是育龄期女性中常见的内分泌代谢疾病,与胰岛素抵抗、肥胖、高雄激素血症以及心血管疾病风险密切相关。钠-葡萄糖协同转运蛋白-2(SGLT-2)抑制剂作为一类治疗2型糖尿病的药物,近年来在PCOS患者中的应用受到了广泛关注。SGLT-2抑制剂不仅可以改善PCOS患者的胰岛素敏感性、降低脂肪含量,还能降低雄激素水平、调节月经周期,并在降低体质量、体质指数和血压方面表现出显著效果。此外,SGLT-2抑制剂还展现出潜在的心血管保护作用。然而,尽管该药物表现出良好的治疗前景,但仍需要更多的研究来评估其长期安全性和对不同表型PCOS的疗效。

SGLT2i对糖尿病心肌保护作用及机制研究进展

钠-葡萄糖协同转运蛋白-2抑制剂(SGLT2i)是新型的降糖药物,通过其独特的降糖机制来调整患者的血糖。目前的很多研究发现SGLT2i在降低血糖的同时也能使患者的心功能受益,但是目前其作用机制尚未完全明确,本文对其相关机制的研究进展进行综述。

METTL3 regulates glucose transporter expression in placenta exposed to hyperglycemia through the mTOR signaling pathway

Background:Alterations in the placental expression of glucose transporters(GLUTs),the crucial maternal-fetal nutrient transporters,have been found in women with hyperglycemia in pregnancy(HIP).However,there is still uncertainty about the underlying effect of the high-glucose environment on placental GLUTs expression in HIP.Methods:We quantitatively evaluated the activity of mammalian target of rapamycin(mTOR)and expression of GLUTs(GLUT1,GLUT3,and GLUT4)in the placenta of women with normal pregnancies(CTRL,n=12)and pregnant women complicated with poorly controlled type 2 diabetes mellitus(T2DM,n=12)by immunohistochemistry.In addition,BeWo cells were treated with different glucose concentrations to verify the regulation of hyperglycemia.Then,changes in the expression of GLUTs following the activation or suppression of the mTOR pathway were also assessed using MHY1485/rapamycin(RAPA)treatment or small interfering RNA(siRNA)-mediated silencing approaches.Moreover,we further explored the alteration and potential upstream regulatory role of methyltransferase-like 3(METTL3)when exposed to hyperglycemia.Results:mTOR,phosphorylated mTOR(p-mTOR),and GLUT1 protein levels were upregulated in the placenta of women with T2DM compared with those CTRL.In BeWo cells,mTOR activity increased with increasing glucose concentration,and the expression of GLUT1,GLUT3,and GLUT4 as well as GLUT1 cell membrane translocation were upregulated by hyperglycemia to varying degrees.Both the drug-mediated and genetic depletion of mTOR signaling in BeWo cells suppressed GLUTs expression,whereas MHY1485-induced mTOR activation upregulated GLUTs expression.Additionally,high glucose levels upregulated METTL3 expression and nuclear translocation,and decreasing METTL3 levels suppressed GLUTs expression and mTOR activity and vice versa.Furthermore,in METTL3 knockdown BeWo cells,the inhibitory effect on GLUTs expression was eliminated by activating the mTOR signaling pathway using MHY1485.Conclusion:High-glucose environment-induced upregulation of METTL3 in trophoblasts regulates the expression of GLUTs through mTOR signaling,contributing to disordered nutrient transport in women with HIP.

钠-葡萄糖耦联转运体2抑制剂对代谢综合征相关代谢紊乱的作用研究进展

代谢综合征是一组复杂的代谢紊乱症候群,其全球发病率不断升高,严重威胁人类的健康,但临床上尚无特效药。钠-葡萄糖耦联转运体2(SGLT2)抑制剂是一种新型口服降糖药物,它不仅可以通过抑制肾脏近曲小管上皮细胞对葡萄糖的重吸收促进尿糖排泄这种非胰岛素依赖方式降低血糖,还可以通过改善胰岛β细胞功能、降低炎症反应、抑制氧化应激来降低血糖。此外,SGLT2抑制剂还可以通过渗透性利尿、增加脂肪代谢以减轻体重;通过抑制交感神经系统过度激活、改善血管功能等作用降低血压;通过增加三酰甘油降解进而改善血脂;通过促进肾脏及肠道尿酸排泄和减少尿酸合成来降低血尿酸。本文就SGLT2抑制剂对代谢综合征相关代谢紊乱的改善作用及其相关调控机制进行综述。