Renal denervation ameliorates cardiac metabolic remodeling in diabetic cardiomyopathy rats by suppressing renal SGLT2 expression

This study aimed to investigate the effects of renal denervation (RDN) on diabetic cardiomyopathy (DCM) and explore the related mechanisms. Male Sprague-Dawley rats were fed high-fat chow and injected with low-dose streptozotocin to establish a DCM model. Six rats served as controls. The surviving rats were divided into three groups: control group, DCM group and DCM + RDN group. RDN surgery was performed in the fifth week. At the end of the experiment, all rats were subjected to F-18-FDG PET/CT and metabolic cage studies. Cardiac function and structure were evaluated by echocardiography and histology. Myocardial substrate metabolism and mitochondrial function were assessed by multiple methods. In the 13th week, the DCM rats exhibited cardiac hypertrophy and interstitial fibrosis accompanied by diastolic dysfunction. RDN ameliorated DCM-induced cardiac dysfunction (E/A ratio: RDN 1.07 +/- 0.18 vs. DCM 0.93 +/- 0.12, P < 0.05; E/E' ratio: RDN 10.74 +/- 2.48 vs. DCM 13.25 +/- 1.99, P < 0.05) and pathological remodeling (collagen volume fraction: RDN 5.05 +/- 2.05% vs. DCM 10.62 +/- 2.68%, P < 0.05). Abnormal myocardial metabolism in DCM rats was characterized by suppressed glucose metabolism and elevated lipid metabolism. RDN increased myocardial glucose uptake and oxidation while reducing the absorption and utilization of fatty acids. Meanwhile, DCM decreased mitochondrial ATP content, depolarized the membrane potential and inhibited the activity of respiratory chain complexes, but RDN attenuated this mitochondrial damage (ATP: RDN 30.98 +/- 7.33 mu mol/gprot vs. DCM 22.89 +/- 5.90 mu mol/gprot, P < 0.05; complexes I, III and IV activity: RDN vs. DCM, P < 0.05). Furthermore, both SGLT2 inhibitor and the combination treatment produced similar effects as RDN alone. Thus, RDN prevented DCM-induced cardiac dysfunction and pathological remodeling, which is related to the improvement of metabolic disorders and mitochondrial dysfunction. Diabetic cardiomyopathy is a serious diabetes-related cardiovascular complication, which is closely related to myocardial metabolic disorders, but there is no specific therapy currently. Renal denervation (RDN), a novel technique to remove renal sympathetic nerves, can reduce the overexpression of renal SGLT2 in diabetic rats, thereby promoting urinary glucose excretion and maintaining systemic glucose homeostasis. On this basis, RDN ameliorated diabetes-induced cardiac metabolic disorders and mitochondrial damages, ultimately preventing diabetes-induced cardiac dysfunction and pathological remodeling.

Automated summary

This study investigated the effects of renal denervation (RDN) on diabetic cardiomyopathy (DCM) in rats and found that RDN ameliorated DCM-induced cardiac dysfunction and pathological remodeling by improving metabolic disorders and mitochondrial dysfunction.