Amelioration of endothelial dysfunction by sodium glucose co-transporter
2 inhibitors: pieces of the puzzle explaining their cardiovascular
protection
Abstract
Sodium glucose co-transporter 2 inhibitors (SGLT-2i’s) significantly
improve cardiovascular outcome in both diabetic and non-diabetic
patients. Preclinical studies suggest that SGLT-2i’s directly affect
endothelial function in a glucose-independent manner. The effects of
SGLT-2i’s include reduction of oxidative stress and inflammatory
reaction in endothelial cells. Furthermore, SGLT2i’s have been shown to
restore endothelial-related vasodilation and to regulate angiogenesis.
The favorable cardiovascular effects of SGLT-2i’s might be mediated via
multiple pathways: 1) by inhibition of the overactive sodium-hydrogen
exchanger; 2) by reduction of nicotinamide adenine dinucleotide
phosphate oxidases expression; 3) by alleviation of mitochondrial
injury; 4) by the suppression of inflammatory-related signaling pathways
(e.g. by affecting nuclear factor kappa beta); 5) by modulation of
glycolysis, as well as 6) by restoring impaired nitric oxide
bioavailability. This review focuses on the most recent progress and
existing gaps in preclinical investigations concerning the direct
effects of SGLT-2i’s on endothelial dysfunction and their underlying
mechanisms.