Off-target effects of sodium-glucose co-transporter 2 blockers: empagliflozin does not inhibit Na+/H+ exchanger-1 or lower [Na+]i in the heart.

Chung YJ., Park KC., Tokar S., Eykyn TR., Fuller W., Pavlovic D., Swietach P., Shattock MJ.

AIMS: Emipagliflozin (EMPA) is a potent inhibitor of the renal sodium-glucose co-transporter 2 (SGLT2) and an effective treatment for type-2 diabetes. In patients with diabetes and heart failure, EMPA has cardioprotective effects independent of improved glycaemic control, despite SGLT2 not being expressed in the heart. A number of non-canonical mechanisms have been proposed to explain these cardiac effects, most notably an inhibitory action on cardiac Na+/H+ exchanger 1 (NHE1), causing a reduction in intracellular [Na+] ([Na+]i). However, at resting intracellular pH (pHi), NHE1 activity is very low and its pharmacological inhibition is not expected to meaningfully alter steady-state [Na+]i. We re-evaluate this putative EMPA target by measuring cardiac NHE1 activity. METHODS AND RESULTS: The effect of EMPA on NHE1 activity was tested in isolated rat ventricular cardiomyocytes from measurements of pHi recovery following an ammonium pre-pulse manoeuvre, using cSNARF1 fluorescence imaging. Whereas 10 µM cariporide produced near-complete inhibition, there was no evidence for NHE1 inhibition with EMPA treatment (1, 3, 10, or 30 µM). Intracellular acidification by acetate-superfusion evoked NHE1 activity and raised [Na+]i, reported by sodium binding benzofuran isophthalate (SBFI) fluorescence, but EMPA did not ablate this rise. EMPA (10 µM) also had no significant effect on the rate of cytoplasmic [Na+]i rise upon superfusion of Na+-depleted cells with Na+-containing buffers. In Langendorff-perfused mouse, rat and guinea pig hearts, EMPA did not affect [Na+]i at baseline nor pHi recovery following acute acidosis, as measured by 23Na triple quantum filtered NMR and 31P NMR, respectively. CONCLUSIONS: Our findings indicate that cardiac NHE1 activity is not inhibited by EMPA (or other SGLT2i's) and EMPA has no effect on [Na+]i over a wide range of concentrations, including the therapeutic dose. Thus, the beneficial effects of SGLT2i's in failing hearts should not be interpreted in terms of actions on myocardial NHE1 or intracellular [Na+].

DOI

10.1093/cvr/cvaa323

Type

Journal article

Publication Date

2021-12-17T00:00:00+00:00

Volume

117

Pages

2794 - 2806

Total pages

12

Keywords

Heart failure, Intracellular Na, NMR spectroscopy, Na/H exchanger-1, SGLT2 inhibitor, Animals, Benzhydryl Compounds, Glucosides, Guinea Pigs, HCT116 Cells, HEK293 Cells, Humans, Hydrogen-Ion Concentration, In Vitro Techniques, Isolated Heart Preparation, Male, Membrane Potentials, Mice, Myocytes, Cardiac, Rats, Wistar, Sodium, Sodium-Glucose Transporter 2 Inhibitors, Sodium-Hydrogen Exchanger 1, Ventricular Function, Left, Ventricular Pressure, Rats

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