Sodium-glucose co-transporter inhibitors(SGLTis)are the latest class of anti-hyper-glycemic agents.In addition to inhibiting the absorption of glucose by the kidney causing glycosuria,these drugs also demonstrate card...Sodium-glucose co-transporter inhibitors(SGLTis)are the latest class of anti-hyper-glycemic agents.In addition to inhibiting the absorption of glucose by the kidney causing glycosuria,these drugs also demonstrate cardio-renal benefits in diabetic subjects.miR-30 family,one of the most abundant microRNAs in the heart,has recently been linked to a setting of cardiovascular diseases and has been proposed as novel biomarkers in kidney dysfunctions as well;their expression is consistently dysregulated in a variety of cardio-renal dysfunctions.The mechanistic involvement and the potential interplay between miR-30 and SGLT2i effects have yet to be thoroughly elucidated.Recent research has stressed the relevance of this clus-ter of microRNAs as modulators of several pathological processes in the heart and kidneys,raising the possibility of these small ncRNAs playing a central role in various cardiovascular complications,notably,endothelial dysfunction and pathological remodeling.Here,we review current evidence supporting the pleiotropic effects of SGLT2is in cardiovascular and renal out-comes and investigate the link and the coordinated implication of the miR-30 family in endo-thelial dysfunction and cardiac remodeling.We also discuss the emerging role of circulating miR-30 as non-invasive biomarkers and attractive therapeutic targets for cardiovascular dis-eases and kidney diseases.Clinical evidence,as well as metabolic,cellular,and molecular as-pects,arecomprehensively covered.展开更多
Recently added to the therapeutic arsenal against chronic heart failure as a first intention drug,the antidiabetic drug-class sodium-glucose cotransporter-2 inhibitors(SGLT2i)showed efficacy in decreasing overall mort...Recently added to the therapeutic arsenal against chronic heart failure as a first intention drug,the antidiabetic drug-class sodium-glucose cotransporter-2 inhibitors(SGLT2i)showed efficacy in decreasing overall mortality,hospitalization,and sudden death in patients of this very population,in whom chronic or acute ischemia count among the first cause.Remarkably,this benefit was observed independently from diabetic status,and benefited both preserved and altered ventricular ejection fraction.This feature,observed in several large randomized controlled trials,suggests additional effects from SGLT2i beyond isolated glycemia control.Indeed,both in-vitro and animal models suggest that inhibiting the Na+/H+exchanger(NHE)may be key to preventing ischemia/reperfusion injuries,and by extension may hold a similar role in ischemic damage control and ischemic preconditioning.Yet,several other mechanisms may be explored which may help better target those who may benefit most from SGLT2i molecules.Because of a large therapeutic margin with few adverse events,ease of prescription and potential pharmacological efficacity,SGLT2i could be candidate for wider indications.In this review,we aim to summarize all evidence which link SGLT2i and ischemia/reperfusion injuries modulation,by first listing known mechanisms,including metabolic switch,prevention of lethal arrythmias and others,which portend the latter,and second,hypothesize how the former may interact with these mechanisms.展开更多
Sodium-glucose cotransporter 2(SGLT2)inhibitors reduce cardiovascular mortality in patients with diabetes mellitus but the protective mechanism remains elusive.Here we demonstrated that the SGLT2 inhibitor,Empaglifloz...Sodium-glucose cotransporter 2(SGLT2)inhibitors reduce cardiovascular mortality in patients with diabetes mellitus but the protective mechanism remains elusive.Here we demonstrated that the SGLT2 inhibitor,Empagliflozin(EMPA),suppresses cardiomyocytes autosis(autophagic cell death)to confer cardioprotective effects.Using myocardial infarction(Ml)mouse models with and without diabetes mellitus,EMPA treatment significantly reduced infarct size,and myocardial fibrosis,thereby leading to improved cardiac function and survival.In the context of ischemia and nutritional glucose deprivation where autosis is already highly stimulated,EMPA directly inhibits the activity of the Na^(+)/H^(+)exchanger 1(NHE1)in the cardiomyocytes to regulate excessive autophagy.Knockdown of NHE1 significantly rescued glucose deprivation-induced autosis.In contrast,overexpression of NHE1 aggravated the cardiomyocytes death in response to starvation,which was effectively rescued by EMPA treatment.Furthermore,in vitro and in vivo analysis of NHE1 and Beclin 1 knockout mice validated that EMPA s cardioprotective effects are at least in part through downregulation of autophagic flux.These findings provide new insights for drug development,specifically targeting NHE1 and autosis for ventricular remodeling and heart failure after Ml in both diabetic and non-diabetic patients.展开更多
目的 探讨ADAMTSL3(Adisintegrin-like and metalloprotease domain with thrombospondin type I motifs-like-3)在大鼠糖尿病肾病心肌纤维化中的作用机制和SGLT-2抑制剂(Sodium-glucose co-transporter 2)的应用效果。方法 SPF级雄性Wi...目的 探讨ADAMTSL3(Adisintegrin-like and metalloprotease domain with thrombospondin type I motifs-like-3)在大鼠糖尿病肾病心肌纤维化中的作用机制和SGLT-2抑制剂(Sodium-glucose co-transporter 2)的应用效果。方法 SPF级雄性Wistar大鼠28只经高脂高糖饲料喂养联合腹腔注射链脲佐菌素(SMZ)50 mg/kg进行糖尿病肾病造模,造模成功后分为模型组和治疗组,另设正常对照组大鼠,治疗组给予SGLT-2抑制剂(卡格列净10 mg/kg)灌胃。3组大鼠进行心脏B超动态分析心脏结构改变。对大鼠心肌组织进行病理染色、qRT-PCR、Western Blot检测ADAMTSL3基因表达水平,同时观察使用SGLT-2抑制剂后大鼠心肌的病理改变。结果 与正常对照组相比,模型组在左心室重量(LVM)、左心室收缩末壁厚度(LVPWs)、左心室短轴缩短率(LVFS%)、左射血分数(LVEF%)上的差异均有统计学意义(P<0.05)。与模型组相比,治疗组大鼠糖尿病肾病诱导心肌组织纤维化相对面积降低,以及在大鼠心肌纤维化中的Ⅰ型胶原蛋白(CollagenⅠ)、纤维连接蛋白(Fibronectin)表达降低(P<0.05)。与正常对照组相比,模型组大鼠心肌组织的ADAMTSL3蛋白表达显著增加;与模型组相比,治疗组大鼠心肌组织的ADAMTSL3蛋白表达显著降低(P<0.05)。与正常对照组相比,模型组中衰老标志物p-p53、p21、p16表达水平升高;与模型组相比,治疗组p-p53、p16表达水平均降低,差异有统计学意义(P<0.05)。结论 ADAMTSL3表达与纤维化相关,因此ADAMTSL3参与促进糖尿病肾病大鼠心肌纤维化,SGLT-2抑制剂治疗可逆转其心肌纤维化病变。展开更多
基金funded by the OCP Foundation and UM6P University.
文摘Sodium-glucose co-transporter inhibitors(SGLTis)are the latest class of anti-hyper-glycemic agents.In addition to inhibiting the absorption of glucose by the kidney causing glycosuria,these drugs also demonstrate cardio-renal benefits in diabetic subjects.miR-30 family,one of the most abundant microRNAs in the heart,has recently been linked to a setting of cardiovascular diseases and has been proposed as novel biomarkers in kidney dysfunctions as well;their expression is consistently dysregulated in a variety of cardio-renal dysfunctions.The mechanistic involvement and the potential interplay between miR-30 and SGLT2i effects have yet to be thoroughly elucidated.Recent research has stressed the relevance of this clus-ter of microRNAs as modulators of several pathological processes in the heart and kidneys,raising the possibility of these small ncRNAs playing a central role in various cardiovascular complications,notably,endothelial dysfunction and pathological remodeling.Here,we review current evidence supporting the pleiotropic effects of SGLT2is in cardiovascular and renal out-comes and investigate the link and the coordinated implication of the miR-30 family in endo-thelial dysfunction and cardiac remodeling.We also discuss the emerging role of circulating miR-30 as non-invasive biomarkers and attractive therapeutic targets for cardiovascular dis-eases and kidney diseases.Clinical evidence,as well as metabolic,cellular,and molecular as-pects,arecomprehensively covered.
文摘Recently added to the therapeutic arsenal against chronic heart failure as a first intention drug,the antidiabetic drug-class sodium-glucose cotransporter-2 inhibitors(SGLT2i)showed efficacy in decreasing overall mortality,hospitalization,and sudden death in patients of this very population,in whom chronic or acute ischemia count among the first cause.Remarkably,this benefit was observed independently from diabetic status,and benefited both preserved and altered ventricular ejection fraction.This feature,observed in several large randomized controlled trials,suggests additional effects from SGLT2i beyond isolated glycemia control.Indeed,both in-vitro and animal models suggest that inhibiting the Na+/H+exchanger(NHE)may be key to preventing ischemia/reperfusion injuries,and by extension may hold a similar role in ischemic damage control and ischemic preconditioning.Yet,several other mechanisms may be explored which may help better target those who may benefit most from SGLT2i molecules.Because of a large therapeutic margin with few adverse events,ease of prescription and potential pharmacological efficacity,SGLT2i could be candidate for wider indications.In this review,we aim to summarize all evidence which link SGLT2i and ischemia/reperfusion injuries modulation,by first listing known mechanisms,including metabolic switch,prevention of lethal arrythmias and others,which portend the latter,and second,hypothesize how the former may interact with these mechanisms.
基金Y Xiang received support from the National Key Research and Development Program of China(2017YFC1700402)National Outstanding Youth Science Fund Project of National Natural Science Foundation of China(81822048 and 81770256)Fund of Shanghai Pudong New Area(PDZY-2018-0603).
文摘Sodium-glucose cotransporter 2(SGLT2)inhibitors reduce cardiovascular mortality in patients with diabetes mellitus but the protective mechanism remains elusive.Here we demonstrated that the SGLT2 inhibitor,Empagliflozin(EMPA),suppresses cardiomyocytes autosis(autophagic cell death)to confer cardioprotective effects.Using myocardial infarction(Ml)mouse models with and without diabetes mellitus,EMPA treatment significantly reduced infarct size,and myocardial fibrosis,thereby leading to improved cardiac function and survival.In the context of ischemia and nutritional glucose deprivation where autosis is already highly stimulated,EMPA directly inhibits the activity of the Na^(+)/H^(+)exchanger 1(NHE1)in the cardiomyocytes to regulate excessive autophagy.Knockdown of NHE1 significantly rescued glucose deprivation-induced autosis.In contrast,overexpression of NHE1 aggravated the cardiomyocytes death in response to starvation,which was effectively rescued by EMPA treatment.Furthermore,in vitro and in vivo analysis of NHE1 and Beclin 1 knockout mice validated that EMPA s cardioprotective effects are at least in part through downregulation of autophagic flux.These findings provide new insights for drug development,specifically targeting NHE1 and autosis for ventricular remodeling and heart failure after Ml in both diabetic and non-diabetic patients.
文摘目的 探讨ADAMTSL3(Adisintegrin-like and metalloprotease domain with thrombospondin type I motifs-like-3)在大鼠糖尿病肾病心肌纤维化中的作用机制和SGLT-2抑制剂(Sodium-glucose co-transporter 2)的应用效果。方法 SPF级雄性Wistar大鼠28只经高脂高糖饲料喂养联合腹腔注射链脲佐菌素(SMZ)50 mg/kg进行糖尿病肾病造模,造模成功后分为模型组和治疗组,另设正常对照组大鼠,治疗组给予SGLT-2抑制剂(卡格列净10 mg/kg)灌胃。3组大鼠进行心脏B超动态分析心脏结构改变。对大鼠心肌组织进行病理染色、qRT-PCR、Western Blot检测ADAMTSL3基因表达水平,同时观察使用SGLT-2抑制剂后大鼠心肌的病理改变。结果 与正常对照组相比,模型组在左心室重量(LVM)、左心室收缩末壁厚度(LVPWs)、左心室短轴缩短率(LVFS%)、左射血分数(LVEF%)上的差异均有统计学意义(P<0.05)。与模型组相比,治疗组大鼠糖尿病肾病诱导心肌组织纤维化相对面积降低,以及在大鼠心肌纤维化中的Ⅰ型胶原蛋白(CollagenⅠ)、纤维连接蛋白(Fibronectin)表达降低(P<0.05)。与正常对照组相比,模型组大鼠心肌组织的ADAMTSL3蛋白表达显著增加;与模型组相比,治疗组大鼠心肌组织的ADAMTSL3蛋白表达显著降低(P<0.05)。与正常对照组相比,模型组中衰老标志物p-p53、p21、p16表达水平升高;与模型组相比,治疗组p-p53、p16表达水平均降低,差异有统计学意义(P<0.05)。结论 ADAMTSL3表达与纤维化相关,因此ADAMTSL3参与促进糖尿病肾病大鼠心肌纤维化,SGLT-2抑制剂治疗可逆转其心肌纤维化病变。
