1
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Liu S, Ke J, Feng X, Wang Z, Wang X, Yang L, Zhao D. The Effect of Canagliflozin on High-Density Lipoprotein Cholesterol and Angiopoietin-Like Protein 3 in Type 2 Diabetes Mellitus. J Diabetes Res 2024; 2024:2431441. [PMID: 38577301 PMCID: PMC10994702 DOI: 10.1155/2024/2431441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 01/12/2024] [Accepted: 02/28/2024] [Indexed: 04/06/2024] Open
Abstract
Background Diabetes mellitus is often accompanied by dyslipidemia. Sodium-glucose cotransporter-2 (SGLT2) inhibitors, as a novel therapeutic agent for the treatment of type 2 diabetes mellitus (T2DM), have been reported to exert effects on lipid, while the results remain controversial. This study is aimed at exploring the effect of SGLT2 inhibitor canagliflozin on lipid profile. Methods This study was a single-center, open-label, nonrandomized, prospective study. Metformin (500 mg three times per day) or canagliflozin (100 mg, once daily) was administered for 12 weeks. Fasting blood samples were collected before and 12 weeks after treatment. Serum lipid profile levels and angiopoietin-like protein 3 (ANGPTL3) were determined. In animal experiment, C57BL/6 J mice were divided into three groups including control, STZ + HFD, and STZ + HFD + canagliflozin. Lipid profile and plasma ANGPTL3 level were measured after 12 week's treatment. Moreover, the expression of ANGPTL3 was detected in the liver tissues. Results There was a decreased trend in low-density lipoprotein cholesterol (LDL-c) and triglycerides (TG) after canagliflozin treatment, while canagliflozin significantly increased high-density lipoprotein cholesterol (HDL-c) level and decreased plasma ANGPTL3 level. In addition, the expression of ANGPTL3 in liver tissues decreased obviously in diabetic mice with canagliflozin treatment. Conclusions Canagliflozin increases HDL-c level and suppresses ANGPTL3 expression in patients with T2DM and diabetic mice. The reduction of ANGPTL3 may contribute to the increase of HDL-c. However, the specific mechanism needs further research. This trial is registered with ChiCTR1900021231.
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Affiliation(s)
- Simo Liu
- Center for Endocrine Metabolism and Immune Diseases, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Jing Ke
- Center for Endocrine Metabolism and Immune Diseases, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Xiaotong Feng
- Center for Endocrine Metabolism and Immune Diseases, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Zongwei Wang
- Center for Endocrine Metabolism and Immune Diseases, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Xin Wang
- Institute of Medical Genomics, Biomedical Sciences College, Shandong First Medical University, Taian, Shandong, China
| | - Longyan Yang
- Center for Endocrine Metabolism and Immune Diseases, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Dong Zhao
- Center for Endocrine Metabolism and Immune Diseases, Beijing Luhe Hospital, Capital Medical University, Beijing, China
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2
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Yu R, Wang Y, Zhu J, Yang G. H 2S-mediated blockage of protein acetylation and oxidative stress attenuates lipid overload-induced cardiac senescence. Arch Physiol Biochem 2024; 130:96-109. [PMID: 34511001 DOI: 10.1080/13813455.2021.1976209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 08/30/2021] [Indexed: 10/20/2022]
Abstract
Hydrogen sulphide (H2S), a newly identified gasotransmitter, can be endogenously produced by cystathionine gamma-lyase (CSE) in the cardiovascular system. This study investigated the role of the CSE/H2S system on lipid overload-induced lipotoxicity and cardiac senescence. Lipid overload in rat cardiomyocyte cells (H9C2) promoted intracellular accumulation of lipid, oxidative stress, mitochondrial dysfunctions, lipid peroxidation and inhibited cell viability, all of which could be reversed by exogenously applied H2S. Further data revealed that H2S protected H9C2 cells from lipid overload-induced senescence by altering the expressions of lipid metabolism-related genes and inhibiting cellular acetyl-CoA and global protein acetylation. Enhancement of protein acetylation abolished the protective role of H2S on cardiac senescence. In vivo, knockout of the CSE gene strengthened cardiac lipid accumulation, protein acetylation, and cellular ageing in high fat diet-fed mice. Taken together, the CSE/H2S system is capable of maintaining lipid homeostasis and cellular senescence in heart cells under lipid overload.
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Affiliation(s)
- Ruihuan Yu
- School of Biological, Chemical & Forensic Sciences, Laurentian University, Sudbury, Canada
- Cardiovascular and Metabolic Research Unit, Laurentian University, Sudbury, Canada
| | - Yuehong Wang
- School of Biological, Chemical & Forensic Sciences, Laurentian University, Sudbury, Canada
- Cardiovascular and Metabolic Research Unit, Laurentian University, Sudbury, Canada
| | - Jiechun Zhu
- School of Biological, Chemical & Forensic Sciences, Laurentian University, Sudbury, Canada
- Cardiovascular and Metabolic Research Unit, Laurentian University, Sudbury, Canada
| | - Guangdong Yang
- School of Biological, Chemical & Forensic Sciences, Laurentian University, Sudbury, Canada
- Cardiovascular and Metabolic Research Unit, Laurentian University, Sudbury, Canada
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3
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Capece U, Pavanello C, Cinti F, Leccisotti L, Mezza T, Ciccarelli G, Moffa S, Di Giuseppe G, Soldovieri L, Brunetti M, Giordano A, Giaccari A, Calabresi L, Ossoli A. Dapagliflozin-Induced Myocardial Flow Reserve Improvement is not Associated with HDL Ability to Stimulate Endothelial Nitric Oxide Production. Diabetes Ther 2024; 15:257-268. [PMID: 37883003 PMCID: PMC10786750 DOI: 10.1007/s13300-023-01491-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 10/09/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Sodium-glucose cotransporter-2 (SGLT2) inhibitors have shown controversial results in modulating plasma lipids in clinical trials. Most studies found slight increases in high-density lipoprotein (HDL) cholesterol but few have provided evidence on HDL functionality with disappointing results. However, there is broad agreement that these drugs provide cardiovascular protection through several mechanisms. Our group demonstrated that dapagliflozin improves myocardial flow reserve (MFR) in patients with type 2 diabetes (T2D) with coronary artery disease (CAD). The underlying mechanisms are still unknown, although in vitro studies have suggested the involvement of nitric oxide (NO). AIM To investigate changes in HDL-mediated modulation of NO production with dapagliflozin and whether there is an association with MFR. METHODS Sixteen patients with CAD-T2D were enrolled and randomized 1:1 to dapagliflozin or placebo for 4 weeks. Blood samples were collected before and after treatment for each group. The ability of HDL to stimulate NO production in endothelial cells was tested in vitro by incubating human umbilical vein endothelial cells (HUVEC) with apoB-depleted (apoB-D) serum of these patients. The production of NO was assessed by fluorescent assay, and results were expressed as fold versus untreated cells. RESULTS Change in HDL-mediated NO production remained similar in dapagliflozin and placebo group, even after adjustment for confounders. There were no significant correlations between HDL-mediated NO production and MFR either at baseline or after treatment. No changes were found in HDL cholesterol in either group, while low-density lipoprotein cholesterol (LDL cholesterol) significantly decreased compared to baseline only in treatment group (p = 0.043). CONCLUSIONS In patients with T2D-CAD, beneficial effects of dapagliflozin on coronary microcirculation seem to be unrelated to HDL functions. However, HDL capacity to stimulate NO production is not impaired at baseline; thus, the effect of drug treatments would be negligible. To conclude, we can assume that HDL-independent molecular pathways are involved in the improvement of MFR in this population. TRIAL REGISTRATION EudraCT No. 2016-003614-27; ClinicalTrials.gov Identifier: NCT03313752.
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Affiliation(s)
- Umberto Capece
- Dipartimento di Scienze Mediche e Chirurgiche, Centro Malattie Endocrine e Metaboliche, Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
| | - Chiara Pavanello
- Centro Grossi Paoletti, Dipartimento di Scienze Farmacologiche e Biomolecolari, Università degli Studi di Milano, Milan, Italy
| | - Francesca Cinti
- Dipartimento di Scienze Mediche e Chirurgiche, Centro Malattie Endocrine e Metaboliche, Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
| | - Lucia Leccisotti
- Radioterapia Oncologica ed Ematologia, UOC di Medicina Nucleare, Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
| | - Teresa Mezza
- Dipartimento di Scienze Mediche e Chirurgiche, Centro Malattie Endocrine e Metaboliche, Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gea Ciccarelli
- Dipartimento di Scienze Mediche e Chirurgiche, Centro Malattie Endocrine e Metaboliche, Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
| | - Simona Moffa
- Dipartimento di Scienze Mediche e Chirurgiche, Centro Malattie Endocrine e Metaboliche, Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gianfranco Di Giuseppe
- Dipartimento di Scienze Mediche e Chirurgiche, Centro Malattie Endocrine e Metaboliche, Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
| | - Laura Soldovieri
- Dipartimento di Scienze Mediche e Chirurgiche, Centro Malattie Endocrine e Metaboliche, Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
| | - Michela Brunetti
- Dipartimento di Scienze Mediche e Chirurgiche, Centro Malattie Endocrine e Metaboliche, Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alessandro Giordano
- Radioterapia Oncologica ed Ematologia, UOC di Medicina Nucleare, Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
| | - Andrea Giaccari
- Dipartimento di Scienze Mediche e Chirurgiche, Centro Malattie Endocrine e Metaboliche, Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Laura Calabresi
- Centro Grossi Paoletti, Dipartimento di Scienze Farmacologiche e Biomolecolari, Università degli Studi di Milano, Milan, Italy
| | - Alice Ossoli
- Centro Grossi Paoletti, Dipartimento di Scienze Farmacologiche e Biomolecolari, Università degli Studi di Milano, Milan, Italy
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4
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Yildirim V, ter Horst KW, Gilijamse PW, van Harskamp D, Schierbeek H, Jansen H, Schimmel AW, Nieuwdorp M, Groen AK, Serlie MJ, van Riel NA, Dallinga-Thie GM. Bariatric surgery improves postprandial VLDL kinetics and restores insulin-mediated regulation of hepatic VLDL production. JCI Insight 2023; 8:e166905. [PMID: 37432744 PMCID: PMC10543721 DOI: 10.1172/jci.insight.166905] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 07/06/2023] [Indexed: 07/12/2023] Open
Abstract
Dyslipidemia in obesity results from excessive production and impaired clearance of triglyceride-rich (TG-rich) lipoproteins, which are particularly pronounced in the postprandial state. Here, we investigated the impact of Roux-en-Y gastric bypass (RYGB) surgery on postprandial VLDL1 and VLDL2 apoB and TG kinetics and their relationship with insulin-responsiveness indices. Morbidly obese patients without diabetes who were scheduled for RYGB surgery (n = 24) underwent a lipoprotein kinetics study during a mixed-meal test and a hyperinsulinemic-euglycemic clamp study before the surgery and 1 year later. A physiologically based computational model was developed to investigate the impact of RYGB surgery and plasma insulin on postprandial VLDL kinetics. After the surgery, VLDL1 apoB and TG production rates were significantly decreased, whereas VLDL2 apoB and TG production rates remained unchanged. The TG catabolic rate was increased in both VLDL1 and VLDL2 fractions, but only the VLDL2 apoB catabolic rate tended to increase. Furthermore, postsurgery VLDL1 apoB and TG production rates, but not those of VLDL2, were positively correlated with insulin resistance. Insulin-mediated stimulation of peripheral lipoprotein lipolysis was also improved after the surgery. In summary, RYGB resulted in reduced hepatic VLDL1 production that correlated with reduced insulin resistance, elevated VLDL2 clearance, and improved insulin sensitivity in lipoprotein lipolysis pathways.
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Affiliation(s)
- Vehpi Yildirim
- Department of Public and Occupational Health, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- Department of Mathematics, Erzurum Technical University, Erzurum, Turkey
| | | | | | - Dewi van Harskamp
- Department of Experimental and Vascular Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Henk Schierbeek
- Department of Experimental and Vascular Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Hans Jansen
- Department of Experimental and Vascular Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Alinda W.M. Schimmel
- Department of Experimental and Vascular Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Max Nieuwdorp
- Department of Experimental and Vascular Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Albert K. Groen
- Department of Experimental and Vascular Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | | | - Natal A.W. van Riel
- Department of Experimental and Vascular Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Geesje M. Dallinga-Thie
- Department of Experimental and Vascular Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
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5
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Neutral effect of SGLT2 inhibitors on lipoprotein metabolism: From clinical evidence to molecular mechanisms. Pharmacol Res 2023; 188:106667. [PMID: 36657502 DOI: 10.1016/j.phrs.2023.106667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/19/2022] [Accepted: 01/15/2023] [Indexed: 01/18/2023]
Abstract
Sodium-glucose cotransporter-2 inhibitors (SGLT2i) are effective, well-tolerated, and safe glucose-lowering compounds for patients with type 2 diabetes mellitus (T2DM). SGLT2i benefit encompasses protection from heart and kidney failure, independently of the presence of diabetes. In addition, SGLT2i consistently reduce the risk of hospitalization for heart failure and, although with some heterogeneity between specific members of the class, favourably affect the risk of cardiovascular outcomes. The molecular mechanisms underlying the cardiovascular favourable effect are not fully clarified. Studies testing the efficacy of SGLT2i in human cohorts and experimental models of atherosclerotic cardiovascular disease (ASCVD) have reported significant differences in circulating levels and composition of lipoprotein classes. In randomized clinical trials, small but significant increases in low-density lipoprotein cholesterol (LDL-C) levels have been observed, with a still undefined clinical significance; on the other hand, favourable (although modest) effects on high-density lipoprotein cholesterol (HDL-C) and triglycerides have been reported. At the molecular level, glycosuria may promote a starving-like state that ultimately leads to a metabolic improvement through the mobilization of fatty acids from the adipose tissue and their oxidation for the production of ketone bodies. This, however, may also fuel hepatic cholesterol synthesis, thus inhibiting atherogenic lipoprotein uptake from the liver. Long-term studies collecting detailed information on lipid-lowering therapies at baseline and during the trials with SGLT2i, as well as regularly monitoring lipid profiles are warranted to disentangle the potential implications of SGLT2i in modulating lipoprotein-mediated atherosclerotic cardiovascular risk.
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6
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Tricò D, Raggi F, Distaso M, Ferrannini E, Solini A. Effect of empagliflozin on plasma proprotein convertase subtilisin/kexin type 9 (PCSK9) in patients with type 2 diabetes. Diabetes Res Clin Pract 2022; 190:109983. [PMID: 35803317 DOI: 10.1016/j.diabres.2022.109983] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 06/13/2022] [Accepted: 07/04/2022] [Indexed: 02/07/2023]
Abstract
AIM Cardiovascular benefits of sodium-glucose cotrasporter-2 (SGLT2) inhibitors occur despite a modest increase in low-density lipoprotein cholesterol (LDL-c). We tested whether the effects of chronic SGLT2 inhibition on lipid profile composition are mediated by elevation in plasma proprotein convertase subtilisin/kexin type 9 (PCSK9) levels inhibiting LDL clearance. METHODS 78 patients with type 2 diabetes (T2D) received empagliflozin 25 mg/d in an open-label design. At enrollment and after 4-week therapy, fasting blood samples were collected for the measurement of plasma PCSK9, glucose, total and fractional cholesterol, and triglycerides. RESULTS Plasma PCSK9 was not significantly affected by empagliflozin (-10.7 [-24.1, 2.7] ng/mL). The treatment induced a mild increase in high-density lipoprotein cholesterol (+1.7 [0.5, 3.0] mg/dL), without significant LDL-c alterations (+1.0 [-4.1, 6.0] mg/dl). Changes in LDL-c were associated with changes in fasting glucose levels (β = 0.320, p = 0.017), but not with plasma PCSK9 (β = 0.010, p = 0.800), after adjustment for age, sex, baseline LDL-c, and body weight change. CONCLUSION In patients with T2D, chronic SGLT2 inhibition with empagliflozin has no potentially harmful effects on circulating PCSK9 levels. This finding does not support a pathogenetic role of plasma PCSK9 in the mild plasma lipid alterations observed during SGLT2i treatment.
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Affiliation(s)
- Domenico Tricò
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Francesco Raggi
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Mariarosaria Distaso
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Ele Ferrannini
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Anna Solini
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy.
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7
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Herring RA, Shojaee-Moradie F, Stevenage M, Parsons I, Jackson N, Mendis J, Middleton B, Umpleby AM, Fielding BA, Davies M, Russell-Jones DL. The SGLT2 Inhibitor Dapagliflozin Increases the Oxidation of Ingested Fatty Acids to Ketones in Type 2 Diabetes. Diabetes Care 2022; 45:1408-1415. [PMID: 35312749 DOI: 10.2337/dc21-2043] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 02/22/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To investigate the mechanism for increased ketogenesis following treatment with the SGLT2 inhibitor dapagliflozin in people with type 2 diabetes. RESEARCH DESIGN AND METHODS The design was a double-blind, placebo-controlled, crossover study with a 4-week washout period. Participants received dapagliflozin or placebo in random order for 4 weeks. After each treatment, they ingested 30 mL of olive oil containing [U-13C]palmitate to measure ketogenesis, with blood sampling for 480 min. Stable isotopes of glucose and glycerol were infused to measure glucose flux and lipolysis, respectively, at 450-480 min. RESULTS Glucose excretion rate was higher and peripheral glucose uptake lower with dapagliflozin than placebo. Plasma β-hydroxybutyrate (BOHB) concentrations and [13C2]BOHB concentrations were higher and glucose concentrations lower with dapagliflozin than placebo. Nonesterified fatty acids (NEFAs) were higher with dapagliflozin at 300 and 420 min, but lipolysis at 450-480 min was not different. Triacylglycerol at all time points and endogenous glucose production rate at 450-480 min were not different between treatments. CONCLUSIONS The increase in ketone enrichment from the ingested palmitic acid tracer suggests that meal-derived fatty acids contribute to the increase in ketones during treatment with dapagliflozin. The increase in BOHB concentration with dapagliflozin occurred with only minimal changes in plasma NEFA concentration and no change in lipolysis. This finding suggests a metabolic switch to increase ketogenesis within the liver.
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Affiliation(s)
- Roselle A Herring
- Centre for Endocrinology, Diabetes and Research, Royal Surrey NHS Foundation Trust, Guildford, U.K.,Faculty of Health and Medical Sciences, University of Surrey, Guildford, U.K
| | - Fariba Shojaee-Moradie
- Centre for Endocrinology, Diabetes and Research, Royal Surrey NHS Foundation Trust, Guildford, U.K
| | - Mary Stevenage
- Centre for Endocrinology, Diabetes and Research, Royal Surrey NHS Foundation Trust, Guildford, U.K
| | - Iain Parsons
- Centre for Endocrinology, Diabetes and Research, Royal Surrey NHS Foundation Trust, Guildford, U.K
| | - Nicola Jackson
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, U.K
| | - Jeewaka Mendis
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, U.K
| | - Benita Middleton
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, U.K
| | - A Margot Umpleby
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, U.K
| | - Barbara A Fielding
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, U.K
| | - Melanie Davies
- Diabetes Research Centre, University of Leicester, Leicester, U.K.,National Institute for Health Research Leicester Biomedical Research Centre, Leicester, U.K
| | - David L Russell-Jones
- Centre for Endocrinology, Diabetes and Research, Royal Surrey NHS Foundation Trust, Guildford, U.K.,Faculty of Health and Medical Sciences, University of Surrey, Guildford, U.K
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8
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Premji R, Nylen ES, Naser N, Gandhi S, Burman KD, Sen S. Lipid Profile Changes Associated with SGLT-2 Inhibitors and GLP-1 Agonists in Diabetes and Metabolic Syndrome. Metab Syndr Relat Disord 2022; 20:321-328. [PMID: 35452324 DOI: 10.1089/met.2022.0004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
The introduction of sodium glucose transporter-2 inhibitors and glucagon-like peptide-1 receptor agonists in type 2 diabetes mellitus treatment has shown an unexpectedly significant improvement in heart disease outcome trials. Although they have very different modes of action, a portion of the salutary cardiovascular disease improvement may be related to their impact on diabetic dyslipidemia. As discussed in this focused review, the sodium glucose transporter-2 inhibitors as a class show a mild increase in low-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterol levels, while triglycerides (TG) decrease inconsistently. In particular, the rise in LDL appears to be related to the less atherogenic, large buoyant LDL particles. The glucagon-like peptide-1 receptor agonists show more of an impact on weight loss and improvement in the underlying low HDL and high TG dyslipidemia. The effect of sodium glucose transporter-2 inhibitors and glucagon-like peptide 1 receptor agonists when used in combination remains largely unknown. Also unexplored is difference in effect of these medications among various ethnicities and metabolic syndrome.
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Affiliation(s)
- Resmi Premji
- Montage Medical Group, Monterey, California, USA
| | - Eric S Nylen
- Department of Endocrinology, VAMC and George Washington University School of Medicine, Washington, District of Columbia, USA
| | - Nejat Naser
- Department of Endocrinology, VAMC and George Washington University School of Medicine, Washington, District of Columbia, USA
| | - Shruti Gandhi
- Department of Endocrinology, VAMC and George Washington University School of Medicine, Washington, District of Columbia, USA
| | - Kenneth D Burman
- Department of Endocrinology, Georgetown University School of Medicine, Washington Hospital Center, Washington, District of Columbia, USA
| | - Sabyasachi Sen
- Department of Endocrinology, VAMC and George Washington University School of Medicine, Washington, District of Columbia, USA
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9
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Yu J, Zhao H, Qi X, Wei L, Li Z, Li C, Zhang X, Wu H. Dapagliflozin Mediates Plin5/PPARα Signaling Axis to Attenuate Cardiac Hypertrophy. Front Pharmacol 2021; 12:730623. [PMID: 34630108 PMCID: PMC8495133 DOI: 10.3389/fphar.2021.730623] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 09/08/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: The purpose of this study was to investigate the effect of dapagliflozin (DAPA), a sodium-glucose cotransporter 2 inhibitor, on relieving cardiac hypertrophy and its potential molecular mechanism. Methods: Cardiac hypertrophy induced by abdominal aortic constriction (AAC) in mice, dapagliflozin were administered in the drinking water at a dose of 25 mg/kg/d for 12 weeks was observed. Echocardiography was used to detect the changes of cardiac function, including LVEF, LVFS, LVEDd, LVEDs, HR and LV mass. Histological morphological changes were evaluated by Masson trichrome staining and wheat germ agglutinin (WGA) staining. The enrichment of differential genes and signal pathways after treatment was analyzed by gene microarray cardiomyocyte hypertrophy was induced by AngII (2 μM) and the protective effect of dapagliflozin (1 μM) was observed in vitro. The morphological changes of myocardial cells were detected by cTnI immunofluorescence staining. ELISA and qRT-PCR assays were performed to detect the expressions levels of cardiac hypertrophy related molecules. Results: After 12 weeks of treatment, DAPA significantly ameliorated cardiac function and inhibited cardiac hypertrophy in AAC-induced mice. In vitro, DAPA significantly inhibited abnormal hypertrophy in AngII-induced cardiacmyocytes. Both in vivo and in vitro experiments have confirmed that DAPA could mediate the Plin5/PPARα signaling axis to play a protective role in inhibiting cardiac hypertrophy. Conclusion: Dapagliflozin activated the Plin5/PPARα signaling axis and exerts a protective effect against cardiac hypertrophy.
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Affiliation(s)
- Jing Yu
- Department of Physiology and Pathophysiology, Tianjin Medical University, Tianjin, China
| | - Huanhuan Zhao
- Department of Physiology and Pathophysiology, Tianjin Medical University, Tianjin, China
| | - Xin Qi
- Department of Cardiology, Tianjin Union Medical Center, Nankai University Affiliated Hospital, Tianjin, China.,Nankai University School of Medicine, Tianjin, China
| | - Liping Wei
- Department of Cardiology, Tianjin Union Medical Center, Nankai University Affiliated Hospital, Tianjin, China.,Nankai University School of Medicine, Tianjin, China
| | - Zihao Li
- Department of Physiology and Pathophysiology, Tianjin Medical University, Tianjin, China
| | - Chunpeng Li
- Department of Physiology and Pathophysiology, Tianjin Medical University, Tianjin, China
| | - Xiaoying Zhang
- Department of Physiology and Pathophysiology, Tianjin Medical University, Tianjin, China
| | - Hao Wu
- Department of Cardiology, Tianjin Union Medical Center, Nankai University Affiliated Hospital, Tianjin, China.,Nankai University School of Medicine, Tianjin, China
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10
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Abstract
PURPOSE OF REVIEW Sodium-glucose cotransporter 2 (SGLT2) inhibitors are widely used antihyperglycemic drugs that show remarkable cardiorenal protective effects in patients with or without type 2 diabetes. Furthermore, they are effective among patients across a wide range of baseline renal and cardiac function. Numerous mechanisms have been evaluated to understand these remarkable clinical benefits. From an early stage, these agents were noted to affect the plasma lipid profile. Here we review lipid profile alterations attributable to SGLT2 inhibitors and also some mechanisms explored in model systems and human studies. RECENT FINDINGS SGLT2 inhibitors given to patients with diabetes as monotherapy shift substrate utilization from carbohydrates to lipids, and have mild effects on the lipid profile. Increased LDL cholesterol appears to be associated with increased hepatic production and decreased catabolism. Increased HDL cholesterol and decreased triglycerides appear to be associated with improved insulin sensitivity and increased lipolysis. Lipid effects of SGLT2 inhibitors are further modulated by background therapy with other diabetes medications and statins. SUMMARY The minor lipid profile alterations observed in patients treated with SGLT2 inhibitors are offset by the staggering range of beneficial pleiotropic mechanisms that likely explain the marked cardiorenal benefits of these agents.
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Affiliation(s)
- Julieta Lazarte
- Department of Medicine
- Department of Biochemistry
- Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | | | - Robert A Hegele
- Department of Medicine
- Department of Biochemistry
- Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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Bouter KEC, van Bommel EJM, Jansen H, van Harskamp D, Schierbeek H, Ackermans MT, Serlie MJ, Schimmel AWM, Nieuwdorp M, Dallinga‐Thie GM, van Raalte DH. The effect of dapagliflozin on apolipoprotein B and glucose fluxes in patients with type 2 diabetes and well-controlled plasma LDL cholesterol. Diabetes Obes Metab 2020; 22:988-996. [PMID: 32026592 PMCID: PMC7318266 DOI: 10.1111/dom.13990] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 01/10/2020] [Accepted: 01/31/2020] [Indexed: 02/06/2023]
Abstract
AIM To dissect the effects of the sodium-glucose linked transporter 2 inhibitor dapagliflozin on lipid metabolism and assess whether these effects could potentially offset cardiovascular benefit with this drug-class. MATERIALS AND METHODS We assessed the effect of dapagliflozin on lipid metabolism in 11 adults with uncomplicated type 2 diabetes. After 4 weeks of statin wash-out and 4 weeks of rosuvastatin 10 mg treatment, participants were treated with dapagliflozin 10 mg once-daily for 5 weeks. Before and after dapagliflozin, plasma lipids were measured and very low-density lipoprotein (VLDL)-1 and VLDL-2 apolipoprotein (Apo)B fluxes were assessed using (5.5.5-2 H3 )-leucine tracer infusion. In addition, hepatic and peripheral insulin sensitivity as well as insulin-mediated inhibition of peripheral lipolysis were measured during a two-step hyperinsulinemic-euglycaemic clamp using (6,6-2 H2 )-glucose and (1,1,2,3,3-2 H5 )-glycerol tracers. RESULTS Rosuvastatin decreased all plasma lipids significantly: total cholesterol from 4.5 (3.2-6.2) to 3.1 (2.5-3.8) mmol/L, LDL cholesterol from 2.6 (1.7-3.4) to 1.5 (1.1-2.2) mmol/L, HDL cholesterol from 1.34 (0.80-2.02) to 1.19 (0.74-1.89) mmol/L and triglycerides from 0.92 (0.31-3.91) to 0.79 (0.32-2.10) mmol/L. The addition of dapaglifozin to rosuvastatin did not raise either LDL cholesterol or total cholesterol, and only increased HDL cholesterol by 0.08 (-0.03-0.13) mmol/L (P = 0.03). In line with this, dapagliflozin did not affect VLDL-1 or VLDL-2 ApoB fluxes. Fasting endogenous glucose production tended to increase by 0.9 (-3.4-3.1) μmol kg-1 min-1 (P = 0.06), but no effect on hepatic and peripheral insulin sensitivity or on peripheral lipolysis was observed. CONCLUSIONS Dapagliflozin has no effect on plasma LDL-cholesterol levels or VLDL-apoB fluxes in the context of optimal lipid-lowering treatment, which will thus not limit cardiovascular benefit when lipids are adequately controlled.
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Affiliation(s)
- Kristien E. C. Bouter
- Department of Vascular Medicine and Experimental Vascular MedicineAmsterdam University Medical Centersthe Netherlands
| | - Erik J. M. van Bommel
- Diabetes Center, Department of Internal MedicineAmsterdam University Medical Centersthe Netherlands
| | - Hans Jansen
- Department of Vascular Medicine and Experimental Vascular MedicineAmsterdam University Medical Centersthe Netherlands
| | - Dewi van Harskamp
- Department of Clinical Chemistry, Laboratory of EndocrinologyAmsterdam University Medical Centersthe Netherlands
| | - Henk Schierbeek
- Department of Clinical Chemistry, Laboratory of EndocrinologyAmsterdam University Medical Centersthe Netherlands
| | - Mariëtte T. Ackermans
- Department of Clinical Chemistry, Laboratory of EndocrinologyAmsterdam University Medical Centersthe Netherlands
| | - Mireille J. Serlie
- Department of Endocrinology and MetabolismAmsterdam University Medical Centersthe Netherlands
| | - Alinda W. M. Schimmel
- Department of Vascular Medicine and Experimental Vascular MedicineAmsterdam University Medical Centersthe Netherlands
| | - Max Nieuwdorp
- Department of Vascular Medicine and Experimental Vascular MedicineAmsterdam University Medical Centersthe Netherlands
| | - Geesje M. Dallinga‐Thie
- Department of Vascular Medicine and Experimental Vascular MedicineAmsterdam University Medical Centersthe Netherlands
| | - Daniël H. van Raalte
- Department of Vascular Medicine and Experimental Vascular MedicineAmsterdam University Medical Centersthe Netherlands
- Diabetes Center, Department of Internal MedicineAmsterdam University Medical Centersthe Netherlands
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