Journal
KOREAN CIRCULATION JOURNAL
Volume 50, Issue 5, Pages 443-457Publisher
KOREAN SOC CARDIOLOGY
DOI: 10.4070/kcj.2019.0296
Keywords
Atherosclerosis; Sodium-glucose transporter-2; Sodium-glucose transporter 2 inhibitors; Macrophages
Categories
Funding
- Korean Society of Cardiology [201601-01]
- Yonsei University College of Medicine [6-2016-0082]
- Korea Health Industry Development Institute (KHIDI) - Ministry of Health & Welfare, Republic of Korea [HI15C1277]
- Cardiovascular Research Center (Seoul, Korea)
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Background and Objectives: We sought to investigate an anti-atherosclerotic and antiinflammatory effect of sodium-glucose cotransporter-2 (SGLT-2) inhibitors in normoglycemic atherosclerotic rabbit model. Methods: Male New Zealand white rabbits (n=26) were fed with a 1% high-cholesterol diet for 7 weeks followed by normal diet for 2 weeks. After balloon catheter injury, the rabbits were administered with the Dapagliflozin (1mg/kg/day) or control-medium for 8 weeks (n=13 for each group). All lesions were assessed with angiography, optical coherence tomography (OCT), and histological assessment. Results: Atheroma burden (38.51 +/- 3.16% vs. 21.91 +/- 1.22%, p<0.01) and lipid accumulation (18.90 +/- 3.63% vs. 10.20 +/- 2.03%, p=0.047) was significantly decreased by SGLT-2 inhibitor treatment. The SGLT-2 inhibitor group showed lower macrophage infiltration (20.23 +/- 1.89% vs. 12.72 +/- 1.95%, p=0.01) as well as tumor necrosis factor (TNF)-alpha expression (31.17 +/- 4.40% vs. 19.47 +/- 2.10%, p=0.025). Relative area of inducible nitric oxide synthase' macrophages was tended to be lower in the SGLT-2 inhibitor-treated group (1.00 +/- 0.16% vs. 0.71 +/- 0.10%, p=0.13), while relative proportion of Arg1(+) macrophage was markedly increased (1.00 +/- 0.27% vs. 2.43 +/- 0.64%, p=0.04). As a result, progression of atherosclerosis was markedly attenuated in SGLT-2 inhibitor treated group (OCT area stenosis, 32.13 +/- 1.20% vs. 22.77 +/- 0.88%, p<0.01). Mechanistically, SGLT-2 treatment mitigated the inflammatory responses in macrophage. Especially, Toll-like receptor 4/nuclear factor-kappa B signaling pathway, and their downstream effectors such as interleukin-6 and TNF-alpha were markedly suppressed by SGLT-2 inhibitor treatment. Conclusions: These results together suggest that SGLT-2 inhibitor exerts an antiatherosclerotic effect through favorable modulation of inflammatory response as well as macrophage characteristics in non-diabetic situation.
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