|
1
|
Pruett JE, Romero DG, Yanes Cardozo LL. Obesity-associated cardiometabolic complications in polycystic ovary syndrome: The potential role of sodium-glucose cotransporter-2 inhibitors. Front Endocrinol (Lausanne) 2023; 14:951099. [PMID: 36875461 PMCID: PMC9974663 DOI: 10.3389/fendo.2023.951099] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 01/26/2023] [Indexed: 02/17/2023] Open
Abstract
Polycystic Ovary Syndrome (PCOS) is the most common endocrine disorder in reproductive-age women. PCOS is characterized by androgen excess, oligo/anovulation, and polycystic appearance of the ovaries. Women with PCOS have an increased prevalence of multiple cardiovascular risk factors such as insulin resistance, hypertension, renal injury, and obesity. Unfortunately, there is a lack of effective, evidence-based pharmacotherapeutics to target these cardiometabolic complications. Sodium-glucose cotransporter-2 (SGLT2) inhibitors provide cardiovascular protection in patients with and without type 2 diabetes mellitus. Although the exact mechanisms of how SGLT2 inhibitors confer cardiovascular protection remains unclear, numerous mechanistic hypotheses for this protection include modulation of the renin-angiotensin system and/or the sympathetic nervous system and improvement in mitochondrial function. Data from recent clinical trials and basic research show a potential role for SGLT2 inhibitors in treating obesity-associated cardiometabolic complications in PCOS. This narrative review discusses the mechanisms of the beneficial effect of SGLT2 inhibitors in cardiometabolic diseases in PCOS.
Collapse
Affiliation(s)
- Jacob E. Pruett
- Department of Cell and Molecular Biology, University of Mississippi Medical Center, Jackson, MS, United States
| | - Damian G. Romero
- Department of Cell and Molecular Biology, University of Mississippi Medical Center, Jackson, MS, United States
- Mississippi Center of Excellence in Perinatal Research, University of Mississippi Medical Center, Jackson, MS, United States
- Women’s Health Research Center, University of Mississippi Medical Center, Jackson, MS, United States
- Cardiovascular-Renal Research Center, University of Mississippi Medical Center, Jackson, MS, United States
| | - Licy L. Yanes Cardozo
- Department of Cell and Molecular Biology, University of Mississippi Medical Center, Jackson, MS, United States
- Mississippi Center of Excellence in Perinatal Research, University of Mississippi Medical Center, Jackson, MS, United States
- Women’s Health Research Center, University of Mississippi Medical Center, Jackson, MS, United States
- Cardiovascular-Renal Research Center, University of Mississippi Medical Center, Jackson, MS, United States
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, United States
- *Correspondence: Licy L. Yanes Cardozo,
| |
Collapse
|
|
2
|
Pruett JE, Torres Fernandez ED, Everman SJ, Vinson RM, Davenport K, Logan MK, Ye SA, Romero DG, Yanes Cardozo LL. Impact of SGLT-2 Inhibition on Cardiometabolic Abnormalities in a Rat Model of Polycystic Ovary Syndrome. Int J Mol Sci 2021; 22:2576. [PMID: 33806551 PMCID: PMC7962009 DOI: 10.3390/ijms22052576] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 02/24/2021] [Accepted: 02/26/2021] [Indexed: 12/21/2022] Open
Abstract
Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in reproductive-age women. PCOS is characterized by hyperandrogenism and ovulatory dysfunction. Women with PCOS have a high prevalence of obesity, insulin resistance (IR), increased blood pressure (BP), and activation of the renin angiotensin system (RAS). Effective evidence-based therapeutics to ameliorate the cardiometabolic complications in PCOS are lacking. The sodium-glucose cotransporter-2 (SGLT2) inhibitor Empagliflozin (EMPA) reduces BP and hyperglycemia in type 2 diabetes mellitus. We hypothesized that hyperandrogenemia upregulates renal SGLT2 expression and that EMPA ameliorates cardiometabolic complications in a hyperandrogenemic PCOS model. Four-week-old female Sprague Dawley rats were treated with dihydrotestosterone (DHT) for 90 days, and EMPA was co-administered for the last three weeks. DHT upregulated renal SGLT2, SGLT4, and GLUT2, but downregulated SGLT3 mRNA expression. EMPA decreased DHT-mediated increases in fat mass, plasma leptin, and BP, but failed to decrease plasma insulin, HbA1c, or albuminuria. EMPA decreased DHT-mediated increase in renal angiotensin converting enzyme (ACE), angiotensin converting enzyme 2 (ACE2), and angiotensin II type 1 receptor (AGT1R) mRNA and protein expression. In summary, SGLT2 inhibition proved beneficial in adiposity and BP reduction in a hyperandrogenemic PCOS model; however, additional therapies may be needed to improve IR and renal injury.
Collapse
Affiliation(s)
- Jacob E. Pruett
- Department of Cell and Molecular Biology, University of Mississippi Medical Center, Jackson, MS 39216, USA; (J.E.P.); (E.D.T.F.); (S.J.E.); (R.M.V.); (K.D.); (M.K.L.); (S.A.Y.); (D.G.R.)
| | - Edgar D. Torres Fernandez
- Department of Cell and Molecular Biology, University of Mississippi Medical Center, Jackson, MS 39216, USA; (J.E.P.); (E.D.T.F.); (S.J.E.); (R.M.V.); (K.D.); (M.K.L.); (S.A.Y.); (D.G.R.)
| | - Steven J. Everman
- Department of Cell and Molecular Biology, University of Mississippi Medical Center, Jackson, MS 39216, USA; (J.E.P.); (E.D.T.F.); (S.J.E.); (R.M.V.); (K.D.); (M.K.L.); (S.A.Y.); (D.G.R.)
| | - Ruth M. Vinson
- Department of Cell and Molecular Biology, University of Mississippi Medical Center, Jackson, MS 39216, USA; (J.E.P.); (E.D.T.F.); (S.J.E.); (R.M.V.); (K.D.); (M.K.L.); (S.A.Y.); (D.G.R.)
| | - Kacey Davenport
- Department of Cell and Molecular Biology, University of Mississippi Medical Center, Jackson, MS 39216, USA; (J.E.P.); (E.D.T.F.); (S.J.E.); (R.M.V.); (K.D.); (M.K.L.); (S.A.Y.); (D.G.R.)
| | - Madelyn K. Logan
- Department of Cell and Molecular Biology, University of Mississippi Medical Center, Jackson, MS 39216, USA; (J.E.P.); (E.D.T.F.); (S.J.E.); (R.M.V.); (K.D.); (M.K.L.); (S.A.Y.); (D.G.R.)
| | - Stephanie A. Ye
- Department of Cell and Molecular Biology, University of Mississippi Medical Center, Jackson, MS 39216, USA; (J.E.P.); (E.D.T.F.); (S.J.E.); (R.M.V.); (K.D.); (M.K.L.); (S.A.Y.); (D.G.R.)
| | - Damian G. Romero
- Department of Cell and Molecular Biology, University of Mississippi Medical Center, Jackson, MS 39216, USA; (J.E.P.); (E.D.T.F.); (S.J.E.); (R.M.V.); (K.D.); (M.K.L.); (S.A.Y.); (D.G.R.)
- Mississippi Center of Excellence in Perinatal Research, University of Mississippi Medical Center, Jackson, MS 39216, USA
- Women’s Health Research Center, University of Mississippi Medical Center, Jackson, MS 39216, USA
- Cardio Renal Research Center, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Licy L. Yanes Cardozo
- Department of Cell and Molecular Biology, University of Mississippi Medical Center, Jackson, MS 39216, USA; (J.E.P.); (E.D.T.F.); (S.J.E.); (R.M.V.); (K.D.); (M.K.L.); (S.A.Y.); (D.G.R.)
- Mississippi Center of Excellence in Perinatal Research, University of Mississippi Medical Center, Jackson, MS 39216, USA
- Women’s Health Research Center, University of Mississippi Medical Center, Jackson, MS 39216, USA
- Cardio Renal Research Center, University of Mississippi Medical Center, Jackson, MS 39216, USA
- Division of Endocrinology, Department of Medicine, University of Mississippi Medical Center, Jackson, MS 39216, USA
| |
Collapse
|
|
3
|
Leite APO, Aragão DS, Nogueira MD, Pereira RO, Jara ZP, Fiorino P, Casarini DE, Farah V. Modulation of renin angiotensin system components by high glucose levels in the culture of collecting duct cells. J Cell Physiol 2019; 234:22809-22818. [DOI: 10.1002/jcp.28845] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 04/30/2019] [Accepted: 05/01/2019] [Indexed: 11/11/2022]
Affiliation(s)
- A. P. O. Leite
- Disciplina de Nefrologia, Departamento de Medicina, Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil
- Laboratório de Renal, Cardiovascular e Fisiofarmacologia Metabólica, Centro de Ciência da Saúde e Biologia Universidade Presbiteriana Mackenzie São Paulo Brazil
| | - Danielle S. Aragão
- Disciplina de Nefrologia, Departamento de Medicina, Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil
| | - Marie D. Nogueira
- Disciplina de Nefrologia, Departamento de Medicina, Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil
| | - Renata O. Pereira
- Disciplina de Nefrologia, Departamento de Medicina, Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil
- Laboratório de Renal, Cardiovascular e Fisiofarmacologia Metabólica, Centro de Ciência da Saúde e Biologia Universidade Presbiteriana Mackenzie São Paulo Brazil
| | - Zaira P. Jara
- Disciplina de Nefrologia, Departamento de Medicina, Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil
- Department of Molecular Cardiology Lerner Research Institute—Cleveland Clinic Cleveland Ohio
| | - Patricia Fiorino
- Laboratório de Renal, Cardiovascular e Fisiofarmacologia Metabólica, Centro de Ciência da Saúde e Biologia Universidade Presbiteriana Mackenzie São Paulo Brazil
| | - Dulce E. Casarini
- Disciplina de Nefrologia, Departamento de Medicina, Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil
| | - Vera Farah
- Disciplina de Nefrologia, Departamento de Medicina, Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil
- Laboratório de Renal, Cardiovascular e Fisiofarmacologia Metabólica, Centro de Ciência da Saúde e Biologia Universidade Presbiteriana Mackenzie São Paulo Brazil
| |
Collapse
|
|
4
|
Abstract
Progress in the modification of conventional coronary risk factors and lifestyle behavior has reduced the incidence of atherosclerotic coronary artery disease; nonetheless, it continues to be the leading cause of mortality in the world. This might be attributed to the defective risk stratifying and prevention strategy for coronary artery disease. In the current clinical setting, atherosclerotic coronary artery disease risk is estimated on the basis of identifying and quantifying only traditional risk factors; it does not take into consideration nontraditional risk factors. In addition, most of the prevailing therapies for atherosclerosis are targeted toward traditional risk factors rather than atherosclerosis itself. It is desirable to develop a method that can directly assess the activity of atherogenesis at every moment. Endothelial function is an integrated index of all atherogenic and atheroprotective factors present in an individual including nontraditional factors and heretofore unknown factors, and it is reported to have additional predictive value for future cardiovascular events to traditional risk factors. Moreover, endothelial function has a pivotal role in all phases of atherosclerosis, from initiation to atherothrombotic complication, and is reversible at every phase, indicating that endothelial function-guided therapies might be effective and feasible in cardiovascular practice. Thus, the introduction of endothelial function testing into clinical practice might enable us to innovate individualized cardiovascular medicine. In this review, we summarize the current knowledge on the contribution of endothelial dysfunction to atherogenesis and review the methods that assess endothelial function. Finally, we focus on the effects of major antiatherosclerotic disease therapies on endothelial function and argue the possibility of noninvasive assessment of endothelial function aiming at individualized cardiovascular medicine.
Collapse
|
|
5
|
Li S, Wu Y, Yu G, Xia Q, Xu Y. Angiotensin II receptor blockers improve peripheral endothelial function: a meta-analysis of randomized controlled trials. PLoS One 2014; 9:e90217. [PMID: 24595033 PMCID: PMC3940822 DOI: 10.1371/journal.pone.0090217] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 01/26/2014] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE(S) Several studies have assessed the effect of angiotensin II receptor blockers (ARBs) on peripheral endothelial dysfunction as measured by flow-mediated vasodilatation (FMD), a widely-used indicator for endothelial function. We conducted a meta-analysis to investigate the effect in comparison to placebo or no treatment and other antihypertensives. METHODS MEDLINE, Cochrane library and EMBASE were searched to September 2013 for randomized controlled trials (RCTs) that assessed the effect of ARBs versus placebo or no treatment and other antihypertensives (angiotensin-converting enzyme inhibitors (ACEIs), calcium channel blockers (CCBs), β-blockers, diuretics) by forearm FMD. Furthermore, we also use meta-regression to analyze the relationship between the endothelial function and the duration of ARBs treatments. RESULTS In 11 trials including 590 patients, ARBs (n = 315) significantly improved FMD (1.36%, 95% confidence internal [CI]:1.28 to 1.44) versus placebo or no treatment (n = 275). In 16 trials that included 1028 patients, ARBs (n = 486) had a significant effect (0.59%, 95% CI: 0.25 to 0.94) on FMD when compared with other antihypertensives (n = 542). In 8 trials, ARBs (n = 174) had no significant effect (-0.14%, 95% CI: -0.32 to 0.03) compared with ACEI (n = 173). Compared with others, the benefits of ARBs, respectively, were 1.67% (95% CI: 0.65 to 0.93) in 7 trials with CCBs, 0.79% (95% CI: 0.42 to 1.01) with β-blockers in 3 trials and 0.9% (95% CI: 0.77 to 1.03) with diuretics in 3 trials. Importantly, we found ARBs were less effective in a long time span (95% CI: -1.990 to -0.622) than the first 6 months (95% CI: -0.484 to 0.360). CONCLUSIONS This study shows that ARBs improve peripheral endothelial function and are superior to CCBs, β-blockers and diuretics. However, the effect couldn't be maintained for a long time. In addition, there was no significant difference between ARBs and ACEI.
Collapse
Affiliation(s)
- Shuang Li
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yan Wu
- Department of Ophthalmology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Ge Yu
- Department of Gastroenterology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Qing Xia
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yawei Xu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| |
Collapse
|
|
6
|
Guang C, Jiang B, Phillips RD, Milani F. Inhibition of renin and the (pro)renin receptor system. Blood Press 2012; 21:377-85. [PMID: 22775989 DOI: 10.3109/08037051.2012.698042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Renin is the rate-limiting step of the renin-angiotensin system (RAS) and can induce hypertension and cardiovascular diseases (CVDs) through the over-activated renin-angiotensin-converting enzyme (ACE)-angiotensin (Ang) II-Ang II type 1 receptor (AT(1)R) axis. Prorenin and renin bound to the (pro)renin receptor [(P)RR] not only increase the catalytic conversion of angiotensinogen (AGT) to Ang I, but also upregulate the expression of profibrotic genes. This review will discuss the inhibition of renin and the (P)RR system pharmacologically and nutritionally.
Collapse
Affiliation(s)
- Cuie Guang
- State Key Laboratory of Food Science and Technology, Jiangnan University , 1800 Lihu Avenue, Wuxi, Jiangsu 214122, China.
| | | | | | | |
Collapse
|