Sharma Nisha, Liu Wenjin, Tsai Xiao-Qing E, Wang Zhou, Outtrim Connor, Tang Anna, Pieper Michael P, Reinhart Glenn A, Huang Yufeng
Department of Internal Medicine, Division of Nephrology & Hypertension, University of Utah Health, Salt Lake City, Utah, United States.
Global Cardio-metabolic Diseases, Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach, Germany.
Am J Physiol Endocrinol Metab. 2025 Mar 1;328(3):E362-E376. doi: 10.1152/ajpendo.00254.2024. Epub 2025 Feb 5.
Diabetic complications are linked to oxidative stress, which hampers the cyclic guanosine monophosphate production by inhibiting nitric oxide/soluble guanylate cyclase (sGC) signaling. This study aimed to determine whether the administration of a novel sGC activator avenciguat alone or in combination with an SGLT2 inhibitor could slow the progression of renal and liver fibrosis in the type 2 diabetic and uninephrectomized mouse model. Experiment groups included normal controls, untreated mice terminated at 12 and 18 wk of age, and mice treated with either one of two doses of avenciguat alone, empagliflozin (Empa) alone, or a combination of both from to of age. Untreated mice exhibited obesity, hyperglycemia, elevated levels of HbA1c and triglycerides (TG), and developed progressive albuminuria, glomerulosclerosis, fatty liver, and liver fibrosis between and of age, accompanied by increased renal and liver production of fibronectin, type-IV collagen, laminin, and increased oxidative stress markers. Avenciguat had no effect on body weight but reduced both blood HbA1c and TG levels, whereas Empa reduced HbA1c but not TG levels as compared with untreated . Both avenciguat and Empa alone effectively slowed the progression of diabetes-associated glomerulosclerosis and liver fibrosis. Importantly, avenciguat, especially at high doses in combination with Empa, further lowered these progression markers compared with baseline measurements. These results suggested that either avenciguat alone or in combination with Empa is therapeutic. Avenciguat in combination with Empa shows promise in halting the progression of diabetic complications. Whether combining an sGC activator with an SGLT2 inhibitor could better control diabetes-associated oxidative stress and NO-cGMP signal deficiency has not yet been explored. Using the type 2 diabetic mouse model, this study underscores the sGC activator avenciguat as a novel therapy for diabetic nephropathy and liver injury beyond sGLT2 inhibitors. It also highlights the need for further investigation into the combined effects of these two treatments in managing diabetic complications.
糖尿病并发症与氧化应激有关,氧化应激通过抑制一氧化氮/可溶性鸟苷酸环化酶(sGC)信号传导来阻碍环磷酸鸟苷的产生。本研究旨在确定新型sGC激活剂阿万西呱单独给药或与钠-葡萄糖协同转运蛋白2(SGLT2)抑制剂联合使用是否能减缓2型糖尿病单侧肾切除小鼠模型中肾和肝纤维化的进展。实验组包括正常对照组、在12周龄和18周龄时处死的未治疗小鼠,以及在8周龄至18周龄期间单独使用两种剂量阿万西呱之一、单独使用恩格列净(Empa)或两者联合治疗的小鼠。未治疗的小鼠表现出肥胖、高血糖、糖化血红蛋白(HbA1c)和甘油三酯(TG)水平升高,并在12周龄至18周龄期间出现进行性蛋白尿、肾小球硬化、脂肪肝和肝纤维化,同时肾和肝中纤连蛋白、IV型胶原、层粘连蛋白的产生增加,氧化应激标志物增多。阿万西呱对体重无影响,但降低了血液中的HbA1c和TG水平,而与未治疗小鼠相比,Empa降低了HbA1c但未降低TG水平。单独使用阿万西呱和Empa均有效减缓了糖尿病相关的肾小球硬化和肝纤维化的进展。重要的是,与基线测量相比,阿万西呱,尤其是高剂量与Empa联合使用时,进一步降低了这些进展标志物。这些结果表明,单独使用阿万西呱或与Empa联合使用具有治疗作用。阿万西呱与Empa联合使用在阻止糖尿病并发症进展方面显示出前景。sGC激活剂与SGLT2抑制剂联合使用是否能更好地控制糖尿病相关的氧化应激和NO-cGMP信号缺陷尚未得到探索。利用2型糖尿病小鼠模型,本研究强调了sGC激活剂阿万西呱作为一种超越SGLT2抑制剂的治疗糖尿病肾病和肝损伤的新疗法。它还强调了进一步研究这两种治疗方法联合治疗糖尿病并发症效果的必要性。