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mTORC1 与 SGLT2 抑制剂:治疗糖尿病心肌病的新策略

mTORC1 and SGLT2 Inhibitors-A Therapeutic Perspective for Diabetic Cardiomyopathy.

机构信息

Department of Biochemistry and Molecular Biology, Virginia Commonwealth University, Richmond, VA 23298, USA.

Division of Cardiology, Pauley Heart Center, Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA 23298, USA.

出版信息

Int J Mol Sci. 2023 Oct 11;24(20):15078. doi: 10.3390/ijms242015078.

Abstract

Diabetic cardiomyopathy is a critical diabetes-mediated co-morbidity characterized by cardiac dysfunction and heart failure, without predisposing hypertensive or atherosclerotic conditions. Metabolic insulin resistance, promoting hyperglycemia and hyperlipidemia, is the primary cause of diabetes-related disorders, but ambiguous tissue-specific insulin sensitivity has shed light on the importance of identifying a unified target paradigm for both the glycemic and non-glycemic context of type 2 diabetes (T2D). Several studies have indicated hyperactivation of the mammalian target of rapamycin (mTOR), specifically complex 1 (mTORC1), as a critical mediator of T2D pathophysiology by promoting insulin resistance, hyperlipidemia, inflammation, vasoconstriction, and stress. Moreover, mTORC1 inhibitors like rapamycin and their analogs have shown significant benefits in diabetes and related cardiac dysfunction. Recently, FDA-approved anti-hyperglycemic sodium-glucose co-transporter 2 inhibitors (SGLT2is) have gained therapeutic popularity for T2D and diabetic cardiomyopathy, even acknowledging the absence of SGLT2 channels in the heart. Recent studies have proposed SGLT2-independent drug mechanisms to ascertain their cardioprotective benefits by regulating sodium homeostasis and mimicking energy deprivation. In this review, we systematically discuss the role of mTORC1 as a unified, eminent target to treat T2D-mediated cardiac dysfunction and scrutinize whether SGLT2is can target mTORC1 signaling to benefit patients with diabetic cardiomyopathy. Further studies are warranted to establish the underlying cardioprotective mechanisms of SGLT2is under diabetic conditions, with selective inhibition of cardiac mTORC1 but the concomitant activation of mTORC2 (mTOR complex 2) signaling.

摘要

糖尿病性心肌病是一种严重的糖尿病合并症,其特征为心脏功能障碍和心力衰竭,而没有引起高血压或动脉粥样硬化的情况。代谢性胰岛素抵抗,导致高血糖和高血脂,是糖尿病相关疾病的主要原因,但不明确的组织特异性胰岛素敏感性揭示了确定 2 型糖尿病(T2D)血糖和非血糖环境下的统一目标范例的重要性。几项研究表明,雷帕霉素哺乳动物靶标(mTOR),特别是复合物 1(mTORC1)的过度激活,是 T2D 病理生理学的关键介质,通过促进胰岛素抵抗、高血脂、炎症、血管收缩和应激。此外,mTORC1 抑制剂,如雷帕霉素及其类似物,在糖尿病和相关的心脏功能障碍方面显示出显著的益处。最近,美国食品和药物管理局批准的抗高血糖钠-葡萄糖共转运蛋白 2 抑制剂(SGLT2is)已成为 T2D 和糖尿病性心肌病的治疗热点,即使在心脏中不存在 SGLT2 通道。最近的研究提出了 SGLT2 非依赖性药物机制,通过调节钠稳态和模拟能量剥夺来确定其心脏保护益处。在这篇综述中,我们系统地讨论了 mTORC1 作为治疗 T2D 介导的心脏功能障碍的统一、突出靶点的作用,并探讨了 SGLT2is 是否可以靶向 mTORC1 信号以造福糖尿病性心肌病患者。需要进一步的研究来确定 SGLT2is 在糖尿病条件下的潜在心脏保护机制,选择性抑制心脏 mTORC1,但同时激活 mTORC2(mTOR 复合物 2)信号。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/65e2/10606418/e451041ddd70/ijms-24-15078-g001.jpg

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