Sotagliflozin Modulation of SIRT1/Nrf2 and PI3K/AKT Signaling Pathway Ameliorates Experimental Liver Fibrosis in Rats

Background and Purpose: Liver fibrosis poses a major global health burden, contributing substantially to morbidity and mortality worldwide. This study aims to assess the potential novel mechanisms behind the anti-fibrotic effects of sotagliflozin (Sota) in thioacetamide (TAA)-induced liver fibrosis in rats. Experimental Approach: To induce liver fibrosis in rats, 100 mg/kg of TAA was injected intraperitoneally triweekly for 6 weeks. Treated groups were orally administered sotagliflozin (10 and 20 mg/kg) for 4 weeks, concurrent with TAA injections. Key Results: Alongside the histological alterations, the elevation of liver enzymes alanine aminotransferase (ALT) and aspartate aminotransferase (AST), lipid profiles total cholesterol (TC) and triglycerides (TAG), cytokines tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6), apoptotic markers (caspase-3 and Bcl2 associated X protein [Bax] BAX), phosphatidylinositol 3-kinase (PI3K), phosphorylated protein kinase B (p-AKT), and the lipid peroxidation marker malondialdehyde (MDA) indicated liver dysfunction induced by TAA. Furthermore, indicators of liver fibrosis encompassed reduced levels of albumin, antioxidants; glutathione (GSH), superoxide dismutase (SOD), heme oxygenase-1 (HO-1), and nuclear factor erythroid 2-related factor 2 (Nrf2), antiapoptotic protein B-cell lymphoma-2 (BCL2), sirtuin-1 (SIRT1) expression, and histopathological alterations. Conclusion and Implications: This study demonstrated that daily oral treatment with sotagliflozin markedly upregulated antioxidant markers such as SIRT1 and Nrf2, attenuated TNF-α, and reduced apoptotic and fibrogenic markers, thereby protecting against TAA-induced liver fibrosis. This may have occurred through the augmentation of SIRT1/Nrf2 expression, the inhibition of PI3K/AKT, resulting in the suppression of apoptosis and inflammation.