Abstract 16641: The SGLT2 Inhibitor Ertugliflozin Induces Oxidative Phosphorylation Gene Expression and Improves Systolic Function Independent of Diabetes in Mice
Background: Inhibitors of sodium glucose linked transporter 2 (SGLT2i) improve heart failure (HF) outcomes in patients independent of diabetes. While animal studies suggest SGLT2i improve cardiac metabolism, the effect of SGLT2i on mitochondrial function in the heart is not known. Our goal was to assess the effects of SGLT2i on mitochondrial function, high energy phosphates and genes encoding mitochondrial proteins in hearts of mice with and without diet-induced diabetes. Methods & Results: Ertugliflozin (Ertu; 0.5 mg/g) was given for 4 months to mice fed a high fat, high sucrose (HFHS) diet that causes diabetic cardiomyopathy or control diet (CD). Mitochondrial function was measured in isolated cardiac mitochondria. Myocardial energetics were assessed by NMR spectroscopy simultaneously with systolic function in isolated beating hearts. Myocardial gene expression was assessed by RNA seq using gene set analysis. HFHS diet caused myocardial hypertrophy and diastolic dysfunction, mitochondrial dysfunction (decreased ATP production, increased reactive oxygen species release) and an impaired energetic response to increased work demand - all of which were prevented by Ertu. Systolic function, as reflected by the rate x pressure product (RPP), was super-normalized to a value 124% of CD hearts at high work demand. In control mice, Ertu had no effect on isolated mitochondria function or high energy phosphates, but similar to HFHS hearts, caused super-normalization of RPP to 125% of CD hearts. Myocardial gene expression analysis revealed oxidative phosphorylation (OXPHOS) as the top scoring gene set that was both down-regulated by HFHS with a normalized enrichment score (NES) of -2.08, and up-regulated by Ertu in HFHS (NES, +3.32 vs HFHS). OXPHOS was the top scoring gene set up-regulated by Ertu a) across all groups while controlling for diet (NES, +3.71) and b) in CD-fed mice only (NES, +3.34). Conclusion: The super-normalization of systolic function and induction of the OXPHOS gene set by Ertu is independent of diabetic status. Pro-metabolic remodeling of the myocardium by Ertu may support increased systolic function and contribute to the beneficial actions of Ertu in states such as HF that are associated with impaired cardiac mitochondrial function.