Sotagliflozin ameliorated left atrial enlargement and significantly reduced the magnitude of arrhythmic spontaneous Ca2+ release events in a rat model of metabolic syndrome-related HFpEF.
Does sotagliflozin improve left atrial remodeling and cellular arrhythmogenesis in a rat model of HFpEF?
In a rat model of HFpEF, dual SGLT-1 and SGLT-2 inhibition with sotagliflozin ameliorated left atrial remodeling and improved cellular arrhythmogenesis.
Abstract Background Sodium–glucose linked transporter type 2 (SGLT-2) inhibition has been shown to reduce cardiovascular mortality in heart failure independently of glycemic control and prevents the onset of atrial arrhythmias, a common co-morbidity in heart failure with preserved ejection fraction (HFpEF). The mechanism behind these effects is not fully understood, and it remains unclear if they could be further enhanced by additional SGLT-1 inhibition. We investigated the effects of chronic treatment with the dual SGLT-1 electrically stimulated, caffeine-induced) and spontaneous Ca 2+ release were recorded by ratiometric microscopy using Ca 2+ -sensitive fluorescent dyes (Fura-2) during various experimental protocols. Mitochondrial structure (dye: Mitotracker), Ca 2+ buffer capacity (dye: Rhod-2), mitochondrial depolarization (dye: TMRE) and production of reactive oxygen species (dye: H2DCF) were visualized by confocal microscopy. Statistical analysis was performed with 2-way analysis of variance followed by post-hoc Bonferroni and student’s t-test, as applicable. Results Sotagliflozin ameliorated LA enlargement in HFpEF in-vivo. In-vitro , LA cardiomyocytes in HFpEF showed an increased incidence and amplitude of arrhythmic spontaneous Ca 2+ release events (SCaEs). Sotagliflozin significantly reduced the magnitude of SCaEs, while their frequency was unaffected. Sotagliflozin lowered diastolic Ca 2+ of CaT at baseline and in response to glucose influx, possibly related to a ~ 50% increase of sodium sodium–calcium exchanger (NCX) forward-mode activity. Sotagliflozin prevented mitochondrial swelling and enhanced mitochondrial Ca 2+ buffer capacity in HFpEF. Sotagliflozin improved mitochondrial fission and reactive oxygen species (ROS) production during glucose starvation and averted Ca 2+ accumulation upon glycolytic inhibition. Conclusion The SGLT-1&2 inhibitor sotagliflozin ameliorated LA remodeling in metabolic HFpEF. It also improved distinct features of Ca 2+ -mediated cellular arrhythmogenesis in-vitro (i.e. magnitude of SCaEs, mitochondrial Ca 2+ buffer capacity, diastolic Ca 2+ accumulation, NCX activity). The safety and efficacy of combined SGLT-1&2 inhibition for the treatment and/or prevention of atrial cardiomyopathy associated arrhythmias should be further evaluated in clinical trials.
Bode et al. (Thu,) conducted a other in Heart failure with preserved ejection fraction (HFpEF). Sotagliflozin vs. Vehicle was evaluated on Left atrial enlargement and magnitude of spontaneous Ca2+ release events (SCaEs). Sotagliflozin ameliorated left atrial enlargement and significantly reduced the magnitude of arrhythmic spontaneous Ca2+ release events in a rat model of metabolic syndrome-related HFpEF.