Tang Li, Wu Yuanyuan, Tian Mi, Sjöström C David, Johansson Ulrika, Peng Xiao-Rong, Smith David M, Huang Yufeng
Division of Nephrology and Hypertension, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah.
Center of Kidney Transplantation, Ningbo Urology and Nephrology Hospital, Ningbo, Zhejiang, China.
Am J Physiol Endocrinol Metab. 2017 Nov 1;313(5):E563-E576. doi: 10.1152/ajpendo.00086.2017. Epub 2017 Aug 15.
Sodium-glucose cotransporter 2 (SGLT2) inhibitors are a new class of antidiabetic oral agents indicating promising effects on cardiovascular and renal end points. However, the renoprotective effects of SGLT2 inhibitors are not fully understood. Also, metabolic effects of SGLT2 inhibition on other organ systems, such as effects on hepatic steatosis, are not fully understood. This study sought to address these questions by treating 18-wk-old uninephrectomized mice with the selective SGLT2 inhibitor dapagliflozin. Untreated mice developed progressive albuminuria, glomerular mesangial matrix expansion, and fatty liver associated with increased renal expression of TGFβ1, PAI-1, type IV collagen and fibronectin, and liver deposition of fibronectin, type I and III collagen, and laminin. Treatment with dapagliflozin (1 mg·kg·day) via gel diet from 18 to 22 wk of age not only reduced blood glucose (371.14 ± 55.02 mg/dl in treated vs. 573.53 ± 21.73 mg/dl in untreated , < 0.05) and Hb A levels (9.47 ± 0.79% in treated vs. 12.1 ± 0.73% in untreated , < 0.05) but also ameliorated the increases in albuminuria and markers of glomerulosclerosis and liver injury seen in untreated mice. Furthermore, both renal expressions of NF-kB p65, MCP-1, Nox4, Nox2, and p47phox and urine TBARS levels and liver productions of myeloperoxidase and reactive oxygen species, the markers of tissue inflammation and oxidative stress, were increased in untreated mice, which were reduced by dapagliflozin administration. These results demonstrate that dapagliflozin not only improves hyperglycemia but also slows the progression of diabetes-associated glomerulosclerosis and liver fibrosis by improving hyperglycemia-induced tissue inflammation and oxidative stress.
钠-葡萄糖协同转运蛋白2(SGLT2)抑制剂是一类新型口服抗糖尿病药物,对心血管和肾脏终点显示出有前景的效果。然而,SGLT2抑制剂的肾脏保护作用尚未完全明确。此外,SGLT2抑制对其他器官系统的代谢影响,如对肝脂肪变性的影响,也尚未完全了解。本研究旨在通过用选择性SGLT2抑制剂达格列净治疗18周龄单侧肾切除的小鼠来解决这些问题。未治疗的小鼠出现进行性蛋白尿、肾小球系膜基质扩张和脂肪肝,伴有肾组织中转化生长因子β1、纤溶酶原激活物抑制剂-1、IV型胶原和纤连蛋白表达增加,以及肝脏中纤连蛋白、I型和III型胶原及层粘连蛋白沉积。在18至22周龄时通过凝胶饮食给予达格列净(1mg·kg·天)治疗,不仅降低了血糖(治疗组为371.14±55.02mg/dl,未治疗组为573.53±21.73mg/dl,P<0.05)和糖化血红蛋白水平(治疗组为9.47±0.79%,未治疗组为12.1±0.73%,P<0.05),还改善了未治疗小鼠中出现的蛋白尿增加以及肾小球硬化和肝损伤标志物的升高。此外,未治疗小鼠肾组织中核因子κB p65、单核细胞趋化蛋白-1、Nox4、Nox2和p47phox的表达以及尿中硫代巴比妥酸反应物水平和肝脏中髓过氧化物酶及活性氧的产生,这些组织炎症和氧化应激的标志物均增加,而达格列净给药可使其降低。这些结果表明,达格列净不仅改善高血糖,还通过改善高血糖诱导的组织炎症和氧化应激来减缓糖尿病相关的肾小球硬化和肝纤维化的进展。