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Kondo H, Akoumianakis I, Akawi N, Kotanidis C, Antonopoulos A, Carena M, Badi I, Oikonomou E, Reus E, Krasopoulos G, Chuaiphichai S, Shirodaria C, Channon K, Casadei B, Antoniades C. Direct effects of canagliflozin on human myocardial redox signalling: a novel role for SGLT1 inhibition. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Recent clinical trials have demonstrated a role for sodium glucose cotransporter 2 (SGLT2) inhibitors in improving cardiovascular outcomes in heart failure patients, but the underlying mechanisms remain unknown. We investigated the direct effects of canagliflozin, a non-selective SGLT1/SGLT2 inhibitor on myocardial redox signalling in humans.
Methods
Study 1 included 364 patients undergoing cardiac surgery. Human right atrial appendage biopsies, obtained during surgery, were used to quantify the sources of superoxide (O2.-) and the gene expression of inflammation, fibrosis and myocardial stretch markers. In Study 2, myocardial biopsies from 51 patients were used ex vivo to study the direct effects of canagliflozin on O2.- generation and understand its role in controlling the activity of NADPH-oxidases and uncoupled nitric oxide synthase (NOS). Finally, we used differentiated H9C2 and human primary cardiomyocytes (hCM) to further characterise the key regulatory mechanisms (Study 3).
Results
SGLT1 was abundantly expressed in the human myocardial biopsies and hCM whilst SGLT2 was barely detectable. SGLT1 expression levels were positively correlated with basal O2.- production and the expression of natriuretic peptides, proinflammatory cytokines and pro-fibrotic markers in human myocardial biopsies from study 1. Incubation of human myocardium with canagliflozin significantly reduced basal and NADPH-oxidase-derived O2.- via AMP kinase (AMPK)-mediated suppression of GTP-activation and consequent reduction of membrane translocation of Rac1, an NADPH-oxidase subunit. This resulted in reduced oxidation and increased bioavailability of tetrahydrobiopterin, the nitric oxide synthase (NOS) co-factor essential for enzymatic coupling, leading to improved NOS coupling. These findings were replicated in hCM, where canagliflozin was shown to regulate AMP/ATP ratio, which could be upstream of AMPK activation. The effects of canagliflozin were significantly attenuated by knocking-down SGLT1 in hCM. Transcriptional profiling of hCM treated with canagliflozin revealed that canagliflozin had striking effects on myocardial redox signalling, causing suppression of apoptotic and inflammatory pathways in the human heart.
Conclusions
We demonstrate for the first time in humans that canagliflozin suppresses myocardial NADPH-oxidase activity and improves NOS coupling through an SGLT1/AMPK/Rac1-mediated pathway, leading to global anti-inflammatory and anti-apoptotic effects in the human myocardium. These findings provide a mechanistic basis for the beneficial effects of SGLT1/2 inhibitors in patients with heart failure.
Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): 1. British Heart Foundation (FS/16/15/32047 and PG/13/56/30383 to CA, CH/16/1/32013 to KC, and Centre of Research Excellence award RG/13/1/30181), 2. The Japanese Heart Rhythm Society-European Heart Rhythm Association fellowship grant sponsored by Biotronik.
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Affiliation(s)
- H Kondo
- University of Oxford, Oxford, United Kingdom
| | | | - N Akawi
- University of Oxford, Oxford, United Kingdom
| | - C Kotanidis
- University of Oxford, Oxford, United Kingdom
| | | | - M Carena
- University of Oxford, Oxford, United Kingdom
| | - I Badi
- University of Oxford, Oxford, United Kingdom
| | - E Oikonomou
- University of Oxford, Oxford, United Kingdom
| | - E Reus
- University of Oxford, Oxford, United Kingdom
| | | | | | | | - K Channon
- University of Oxford, Oxford, United Kingdom
| | - B Casadei
- University of Oxford, Oxford, United Kingdom
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Kondo H, Akoumianakis I, Akawi N, Cristina M, Herdman L, Badi I, Kotanidis C, Akbar N, Antonopoulos A, Oikonomou E, Chuaiphichai S, Channon K, Antoniades C. P6267Novel direct effects of SGLT2 inhibitor, Canagliflozin, on myocardial redox state in humans. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0866] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Sodium glucose cotransporter 2 (SGLT2) inhibitors are antidiabetic drugs that control plasma glucose levels by inhibiting reabsorption of glucose in kidney. Recent clinical trials have suggested a class effect of SGLT2 inhibitors in preventing hospitalization due to heart failure. However, the underlying mechanism has not been fully elucidated.
Purpose
We investigated the direct effect of the SGLT2 inhibitor, Canagliflozin (Cana), on myocardial redox state in humans.
Methods
The study included 48 patients undergoing cardiac surgery. Fresh myocardial tissues were incubated ex vivo with or without Cana and then used for superoxide quantification and Western immunoblotting. NADPH-oxidases activity was evaluated with NADPH 100μM stimulation, while nitric oxide synthase (NOS) coupling was assessed by using N(ω)-nitro-L-arginine methyl ester (L-NAME, a NOS inhibitor). A human cardiomyocyte (HCM) cell line was also used for in vitro validation of the effects of Cana on myocardium.
Results
Ex vivo incubation of myocardium with Cana significantly reduced baseline (A) and NADPH-oxidase-derived O2·− (B) and improved NOS coupling reflected by positive L-NAME delta O2·− values (C). Regulation of NADPH-oxidases activity by Cana was found to result from reduced GTP-activation (D) and consequent membrane translocation (E) of Rac1, a key subunit of NADPH-oxidases. Cana also reduced tetrahydrobiopterin (BH4) oxidation, increasing its bioavailability (F), which is a key mechanism to improve NOS coupling. Incubation with Cana enhanced phosphorylation of AMPK, and the downstream signalling, ACC (not shown). Additional Compound C, which is inhibitor of AMPK, significantly reversed these effects of Cana (A, B, C, D, E, F). These findings were replicated in HCM (not shown). In line with these, Cana increased the ADP/ATP ratio of cytoplasm in HCM, which could provide an upstream mechanism for AMPK activation.
Conclusions
We demonstrate for the first time in humans, that Cana suppresses myocardial NADPH-oxidases activity and improves NOS coupling through an AMPK-mediated pathway. This could be an underlying mechanism for the cardioprotective effects of SGLT2 inhibitors.
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Affiliation(s)
- H Kondo
- University of Oxford, Oxford, United Kingdom
| | | | - N Akawi
- University of Oxford, Oxford, United Kingdom
| | - M Cristina
- University of Oxford, Oxford, United Kingdom
| | - L Herdman
- University of Oxford, Oxford, United Kingdom
| | - I Badi
- University of Oxford, Oxford, United Kingdom
| | - C Kotanidis
- University of Oxford, Oxford, United Kingdom
| | - N Akbar
- University of Oxford, Oxford, United Kingdom
| | | | - E Oikonomou
- University of Oxford, Oxford, United Kingdom
| | | | - K Channon
- University of Oxford, Oxford, United Kingdom
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Patel J, Chuaiphichai S, Douglas G, Channon KM. P342A new role for RGS-1 in vascular function and blood pressure regulation. Cardiovasc Res 2018. [DOI: 10.1093/cvr/cvy060.255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- J Patel
- University of Oxford, Cardiovascular Medicine, Oxford, United Kingdom
| | - S Chuaiphichai
- University of Oxford, Cardiovascular Medicine, Oxford, United Kingdom
| | - G Douglas
- University of Oxford, Cardiovascular Medicine, Oxford, United Kingdom
| | - K M Channon
- University of Oxford, Cardiovascular Medicine, Oxford, United Kingdom
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Chuaiphichai S, Rashbrook VS, Hale AB, Trelfa L, Mcneill E, Lygate CA, Channon KM, Douglas G. P350Deficiency in endothelial cell tetrahydrobiopterin increases resistance vascular remodelling, blood pressure, and susceptibility to aortic abdominal aneurysm in response to angiotensin II. Cardiovasc Res 2018. [DOI: 10.1093/cvr/cvy060.263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- S Chuaiphichai
- University of Oxford, Cardiovascular Medicine, Oxford, United Kingdom
| | - V S Rashbrook
- University of Oxford, Cardiovascular Medicine, Oxford, United Kingdom
| | - A B Hale
- University of Oxford, Cardiovascular Medicine, Oxford, United Kingdom
| | - L Trelfa
- University of Oxford, Cardiovascular Medicine, Oxford, United Kingdom
| | - E Mcneill
- University of Oxford, Cardiovascular Medicine, Oxford, United Kingdom
| | - C A Lygate
- University of Oxford, Cardiovascular Medicine, Oxford, United Kingdom
| | - K M Channon
- University of Oxford, Cardiovascular Medicine, Oxford, United Kingdom
| | - G Douglas
- University of Oxford, Cardiovascular Medicine, Oxford, United Kingdom
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Tarun A, Psarros C, Sanna F, Herdman L, Akoumianakis I, Antonopoulos A, Sayeed R, Krasopoulos G, Chuaiphichai S, Channon K, Antoniades C. P5388Redox-sensitive regulation of cystathionine gamma-lyase (CSE) and the potential protective role of hydrogen sulfide (H2S) in the human heart. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p5388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Chuaiphichai S, Mcneill E, Douglas G, Crabtree MJ, Bendall JK, Hale AB, Alp NJ, Channon KM. 303A cell-Autonomous role for endothelial GTP cyclohydrolase 1 and tetrahydrobiopterin in blood pressure regulation. Cardiovasc Res 2014. [DOI: 10.1093/cvr/cvu089.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Mitic T, Hadoke PWF, Chuaiphichai S, Man TY, Miller E, Andrew R, Walker BR, Chapman KE, Seckl JR. YIA2 11 -HSD1 deficiency attenuates atherosclerosis in ApoE-/- mice: role of both glucocorticoid and non-glucocorticoid (oxysterol) factors. Heart 2010. [DOI: 10.1136/hrt.2010.205781.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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