Evaluation of Renal Effects of Dapagliflozin in Diabetic Rats With Subacute Exposure
Year 2023,
Volume: 43 Issue: 3, 232 - 242, 01.09.2023
Tugce Boran
,
Bahar Ulus Karaca
,
Ayça Karagöz Köroğlu
,
Feriha Ercan
,
Gül Özhan
Abstract
ABSTRACT
Dapagliflozin (DAPA), a sodium glucose co-transporter 2 (SGLT2) inhibitor, is used for the treatment of type 2 diabetes. Although several studies have demonstrated its protective effects on the kidney, the FDA warns about the risk of DAPA-induced nephrotoxicity. SGLT2 inhibitors may induce oxidative stress and inflammation in the kidney due to their mechanism of action. In the present study, it was aimed to clarify the molecular effects of DAPA on the kidney. Diabetes was induced by single injection of streptozotocin (STZ) (35 mg/kg b.w.) after the rats were fed with high-fat diet for two-weeks. Diabetic rats were administered with DAPA at 10 mg/kg by oral gavage for 28 days. The oxidative stress, inflammation and apoptosis induction potentials of DAPA were evaluated. The morphological changes and apoptosis were investigated by histological examinations. The findings showed that DAPA treatment reduced oxidative parameters and slightly inhibited inflammatory mediator levels. According to the histological examinations, DAPA ameliorated the diabetes-induced changes and apoptosis. As a result, DAPA showed a protective effect on the kidney by alleviating oxidative stress and inhibiting inflammation and apoptosis. However, further studies are needed to determine the long-term effects of DAPA on the kidney in diabetic patients.
Project Number
TDK-2018-31064
References
- 1. FDA, 2014. https://www.accessdata.fda.gov/drugsatfda_docs/label/2014/202293s003lbl.pdf. (accessed 5 January 2020).
- 2. FDA, 2019. https://www.accessdata.fda.gov/drugsatfda_docs/label/2019/209091s002lbl.pdf. (accessed 5 January 2020).
- 3. FDA 2021. https://www.accessdata.fda.gov/drugsatfda_docs/label/2021/202293s024lbl.pdf (accessed 10 June 2020).
- 4. Joe E. 2019. Dapagliflozin approved to reduce risk for heart failure hospitalization in type 2 diabetes. NEJM J Watch 2019. https://www.jwatch.org/fw115953/2019/10/22/dapagliflozin-approved-reduce-risk-heart-failure. (accessed 30 January 2020).
- 5. FDA, 2016. FDA strengthens kidney warnings for diabetes medicines canagliflozin (Invokana, Invokamet) and dapagliflozin (Farxiga, Xigduo XR) | https://www.fda.gov/drugs/fda-drug-safety-podcasts/fda-strengthens-kidney-warnings-diabetes-medicines-canagliflozin-invokana-invokamet-and (accessed January 5, 2020).
- 6. Pleros C, Stamaki E, Papadaki A, Damianakis N, Poulidaki R, Gakiopoolou C, Tzanakis I: Dapagliflozin as a cause of acute tubular necrosis with heavy consequences: a case report. CEN Case Reports, 2018, 7:17–20.
- 7. Lim S, Eckel RH, and Koh KK: Clinical implications of current cardiovascular outcome trials with sodium glucose cotransporter-2 (SGLT2) inhibitors. Atherosclerosis, 2018, 272:33–40.
- 8. Garofalo C, Borrelli S, Liberti ME, Andreucci M, Conte G, Minutolo R, Provenzano M, De Nicola L: SGLT2 inhibitors: nephroprotective efficacy and side effects. Medicina, 2019, 55(6):268.
- 9. Baker ML, and Perazella MA: SGLT2 inhibitor therapy in patients with type-2 diabetes mellitus: is acute kidney injury a concern?. Journal of Nephrolology. 2020, 33:985-994.
- 10. McMurray JJ, Wheeler DC, Stefánsson BV, Jongs N, Postmus D, Correa-Rotter R: DAPA-CKD Trial Committees and Investigators. (2021). Effect of dapagliflozin on clinical outcomes in patients with chronic kidney disease, with and without cardiovascular disease. Circulation, 2021, 143(5):438-448.
- 11. Srinivasan K, Wiswanad B, Asrat L, Kaul CL, Ramarao P: Combination of high-fat diet-fed and low-dose streptozotocin-treated rat: a model for type 2 diabetes and pharmacological screening. Pharmacological Research, 2005, 52:313–320.
- 12. Furman BL: Streptozotocin induced diabetic models in mice and rats. Current Protocols in Pharmacology. 2015, 70: 5-47.
- 13. Livak KJ, Schmittgen TD: Analysis of relative gene expression data using real-time quantitative PCR and the 2-ΔΔCT method. Methods 2001; 25:402–408.
- 14. Hahn K, Ejaz AA, Kanbay M, Lanaspa M, Johnson RJ: Acute kidney injury from SGLT2 inhibitors: Potential mechanisms. Nature Reviews Nephrology 2016, 12:711–712.
- 15. Heerspink HJ, Stefánsson BV, Correa-Rotter R, Chertow GM, Greene T, Hou FF, ... Wheeler DC: Dapagliflozin in patients with chronic kidney disease. New England Journal of Medicine 2010, 383(15):1436-1446.
- 16. Terami, N, Ogawa D, Tachibana H, Hatanaka T, Wada J, Nakatsuka A, Eguchi J, Horiguchi CS, Nishii N, Yamada H, Takei K, Makino H: Long-term treatment with the sodium glucose cotransporter 2 inhibitor, dapagliflozin, ameliorates glucose homeostasis and diabetic nephropathy in db/db mice. PLoS One 2014, 9:e100777.
- 17. Jaikumkao K, Pongchaidecha A, Chueakula N, Tohngnak L, Wanchai K, Chatsudthipong V, Chattipakorn N, Lungkaphin A: Dapagliflozin, a sodium‐glucose co‐transporter‐2 inhibitor, slows the progression of renal complications through the suppression of renal inflammation, endoplasmic reticulum stress and apoptosis in prediabetic rats. Diabetes Obesity and Metabolism 2018, 20:2617–2626.
- 18. Han S, Hagan DL, Taylor JR, Xin L, Meng W, Biller SA, Wetterau JR, Washburn WN, Whaley JM: Dapagliflozin, a selective SGLT2 inhibitor, improves glucose homeostasis in normal and diabetic rats. Diabetes 2008, 57:1723-1729.
- 19. European Medicines Agency (EMA), Committee for Medicinal Products for Human Use (CHMP) Assessment report Forxiga dapagliflozin, n.d. www.ema.europa.eu (accessed February 16, 2020)). https://www.ema.europa.eu/en/medicines/human/EPAR/forxiga
- 20. Reilly TP, Graziano MJ, Janowitz EB, Dorr TE, Fairchild C, Lee F …. Tirmenstein M: Carcinogenicity risk assessment supports the chronic safety of Dapagliflozin, an inhibitor of sodium–glucose co-transporter 2, in the treatment of type 2 diabetes mellitus. Diabetes Therapy 2014, 5:73-96. https://doi.org/10.1007/s13300-014-0053-3
- 21. Qiang G, Yang X, Xuan Q, Shi L, Zhan H, Chen B,… Du G: Salvianolic acid A prevents the pathological progression of hepatic fibrosis in high-fat diet-fed and streptozotocin-induced diabetic rats. The American Journal of Chinese Medicine 2014, 42:1183-1198.
- 22. Guo XX, Wang Y, Wang K, Ji B, Zhou F: Stability of a type 2 diabetes rat model induced by high-fat diet feeding with low-dose streptozotocin injection. Journal of Zhejiang University Science B (Biomedicine & Biotechnology) 2018, 19:559-569.
- 23. Valentovic MA, Alejandro N, Carpenter AB, Brown PI, Ramos K: Streptozotocin (STZ) diabetes enhances benzo (α) pyrene induced renal injury in Sprague Dawley rats. Toxicology Letters 2006, 164:214-220.
- 24. Singh DK, Winocour P, and Farrington K: Oxidative stress in early diabetic nephropathy: Fueling the fire. Nature Reviews Endocrinology 2011, 7:176–184.
- 25. Hosohata K: Role of oxidative stress in drug-induced kidney injury. International Journal of Molecular Sciences 2016, 17(11):1826.
- 26. Babu GRS, Anand T, Ilaiyaraja N, Khanum F, gopalan N: Pelargonidin modulates Keap1/Nrf2 pathway gene expression and ameliorates citrinin-induced oxidative stress in HepG2 cells. Frontiers in Pharmacology 2017, 8:1-20.
- 27. Palsamy P, Subramanian S: Resveratrol protects diabetic kidney by attenuating hyperglycemia-mediated oxidative stress and renal inflammatory cytokines via Nrf2-Keap1 signaling. Biochim Biophys Acta - Molecular Basis of Disease 2011, 1812:719–731.
- 28. Chow F, Nikolic-Paterson DJ, Ozols E, Atkins RC, Rollin BJ, Tesch GH: Monocyte chemoattractant protein-1 promotes the development of diabetic renal injury in streptozotocin-treated mice. Kidney International 2006, 69:73-80.
- 29. Navarro-González JF, and Mora-Fernández C: The role of inflammatory cytokines in diabetic nephropathy. Journal of American Society of Nephrology. 2008, 19:433–442.
- 30. Akcay A. Nguyen Q, Edelstein CL: Mediators of inflammation in acute kidney injury. Mediators of Inflammation 2009, 2009:137072.
31. Patel S, and Santani D: Role of NF-κB in the pathogenesis of diabetes and its associated complications. Pharmacological Reports 2009, 61:595–603.
- 32. Liu Y, and Beyer A, Aebersold R: On the dependency of cellular protein levels on mRNA abundance. Cell. 2016, 165:535–550.
33. Liu T, Zhang L, Joo D, Sun S: NF-κB signaling in inflammation. Signal Transduction and Targeted Therapy 2017, 2:1-9.
- 34. Tang L, Wu Y, Tian M, Sjöström CD, Johansson U, Peng X, Smith DM, Huang Y: Dapagliflozin slows the progression of the renal and liver fibrosis associated with type 2 diabetes. American Journal of Physiology – Endocrinology and Metabolism 2017, 313:563–576.
- 35. Lim AKH, and Tesch GH: Inflammation in diabetic nephropathy. Mediators of Inflammation 2012, 2012: 146154.
- 36. Kaneto H, Nakatani Y, Miyatsuka T, Kawamori D, Matsuoka T, Matsuhisa M, Kajimoto Y, … Hori M: Possible novel therapy for diabetes with cell-permeable JNK-inhibitory peptide. Nature Medicine 2004, 10:1128–1132.
- 37. Servais H, Ortriz A, Devuyst O, Denamur S, Tulkens PM, Mingeot-Leclercq MP: Renal cell apoptosis induced by nephrotoxic drugs: cellular and molecular mechanisms and potential approaches to modulation. Apoptosis. 2008, 13:11-32.
- 38. Verzola D, Gandolfo MT, Ferrario F, Rastaldi MP, Vilaggio B, Gianiorio F, Gianonni M, Rimoldi L, Lauria F, Miji M, Deferrari G, Garibotto G:Apoptosis in the kidneys of patients with type II diabetic nephropathy. Kidney International 2007, 72:1262-1272.
- 39. Li J, Yin S, Dong Y, Fan L, Hu H: P53 activation inhibits ochratoxin A-induced apoptosis in monkey and human kidney epithelial cells via suppression of JNK activation. Biochemical Biophysical Research Communications 2011, 411:458–463.
- 40. Mohamed DI, Khairy E, Saad SS, Habib EK, and Hamouda MA: Potential protective effects of Dapagliflozin in gentamicin induced nephrotoxicity rat model via modulation of apoptosis associated miRNAs. Gene 2019, 707:198-204.
Evaluation of Renal Effects of Dapagliflozin in Diabetic Rats with Subacute Exposure
Year 2023,
Volume: 43 Issue: 3, 232 - 242, 01.09.2023
Tugce Boran
,
Bahar Ulus Karaca
,
Ayça Karagöz Köroğlu
,
Feriha Ercan
,
Gül Özhan
Abstract
ABSTRACT
Dapagliflozin (DAPA), a sodium glucose co-transporter 2 (SGLT2) inhibitor, is used for the treatment of type 2 diabetes. Although several studies have demonstrated its protective effects on the kidney, the FDA warns about the risk of DAPA-induced nephrotoxicity. SGLT2 inhibitors may induce oxidative stress and inflammation in the kidney due to their mechanism of action. In the present study, it was aimed to clarify the molecular effects of DAPA on the kidney. Diabetes was induced by single injection of streptozotocin (STZ) (35 mg/kg b.w.) after the rats were fed with high-fat diet for two-weeks. Diabetic rats were administered with DAPA at 10 mg/kg by oral gavage for 28 days. The oxidative stress, inflammation and apoptosis induction potentials of DAPA were evaluated. The morphological changes and apoptosis were investigated by histological examinations. The findings showed that DAPA treatment reduced oxidative parameters and slightly inhibited inflammatory mediator levels. According to the histological examinations, DAPA ameliorated the diabetes-induced changes and apoptosis. As a result, DAPA showed a protective effect on the kidney by alleviating oxidative stress and inhibiting inflammation and apoptosis. However, further studies are needed to determine the long-term effects of DAPA on the kidney in diabetic patients.
Supporting Institution
Research Fund of Istanbul University
Project Number
TDK-2018-31064
References
- 1. FDA, 2014. https://www.accessdata.fda.gov/drugsatfda_docs/label/2014/202293s003lbl.pdf. (accessed 5 January 2020).
- 2. FDA, 2019. https://www.accessdata.fda.gov/drugsatfda_docs/label/2019/209091s002lbl.pdf. (accessed 5 January 2020).
- 3. FDA 2021. https://www.accessdata.fda.gov/drugsatfda_docs/label/2021/202293s024lbl.pdf (accessed 10 June 2020).
- 4. Joe E. 2019. Dapagliflozin approved to reduce risk for heart failure hospitalization in type 2 diabetes. NEJM J Watch 2019. https://www.jwatch.org/fw115953/2019/10/22/dapagliflozin-approved-reduce-risk-heart-failure. (accessed 30 January 2020).
- 5. FDA, 2016. FDA strengthens kidney warnings for diabetes medicines canagliflozin (Invokana, Invokamet) and dapagliflozin (Farxiga, Xigduo XR) | https://www.fda.gov/drugs/fda-drug-safety-podcasts/fda-strengthens-kidney-warnings-diabetes-medicines-canagliflozin-invokana-invokamet-and (accessed January 5, 2020).
- 6. Pleros C, Stamaki E, Papadaki A, Damianakis N, Poulidaki R, Gakiopoolou C, Tzanakis I: Dapagliflozin as a cause of acute tubular necrosis with heavy consequences: a case report. CEN Case Reports, 2018, 7:17–20.
- 7. Lim S, Eckel RH, and Koh KK: Clinical implications of current cardiovascular outcome trials with sodium glucose cotransporter-2 (SGLT2) inhibitors. Atherosclerosis, 2018, 272:33–40.
- 8. Garofalo C, Borrelli S, Liberti ME, Andreucci M, Conte G, Minutolo R, Provenzano M, De Nicola L: SGLT2 inhibitors: nephroprotective efficacy and side effects. Medicina, 2019, 55(6):268.
- 9. Baker ML, and Perazella MA: SGLT2 inhibitor therapy in patients with type-2 diabetes mellitus: is acute kidney injury a concern?. Journal of Nephrolology. 2020, 33:985-994.
- 10. McMurray JJ, Wheeler DC, Stefánsson BV, Jongs N, Postmus D, Correa-Rotter R: DAPA-CKD Trial Committees and Investigators. (2021). Effect of dapagliflozin on clinical outcomes in patients with chronic kidney disease, with and without cardiovascular disease. Circulation, 2021, 143(5):438-448.
- 11. Srinivasan K, Wiswanad B, Asrat L, Kaul CL, Ramarao P: Combination of high-fat diet-fed and low-dose streptozotocin-treated rat: a model for type 2 diabetes and pharmacological screening. Pharmacological Research, 2005, 52:313–320.
- 12. Furman BL: Streptozotocin induced diabetic models in mice and rats. Current Protocols in Pharmacology. 2015, 70: 5-47.
- 13. Livak KJ, Schmittgen TD: Analysis of relative gene expression data using real-time quantitative PCR and the 2-ΔΔCT method. Methods 2001; 25:402–408.
- 14. Hahn K, Ejaz AA, Kanbay M, Lanaspa M, Johnson RJ: Acute kidney injury from SGLT2 inhibitors: Potential mechanisms. Nature Reviews Nephrology 2016, 12:711–712.
- 15. Heerspink HJ, Stefánsson BV, Correa-Rotter R, Chertow GM, Greene T, Hou FF, ... Wheeler DC: Dapagliflozin in patients with chronic kidney disease. New England Journal of Medicine 2010, 383(15):1436-1446.
- 16. Terami, N, Ogawa D, Tachibana H, Hatanaka T, Wada J, Nakatsuka A, Eguchi J, Horiguchi CS, Nishii N, Yamada H, Takei K, Makino H: Long-term treatment with the sodium glucose cotransporter 2 inhibitor, dapagliflozin, ameliorates glucose homeostasis and diabetic nephropathy in db/db mice. PLoS One 2014, 9:e100777.
- 17. Jaikumkao K, Pongchaidecha A, Chueakula N, Tohngnak L, Wanchai K, Chatsudthipong V, Chattipakorn N, Lungkaphin A: Dapagliflozin, a sodium‐glucose co‐transporter‐2 inhibitor, slows the progression of renal complications through the suppression of renal inflammation, endoplasmic reticulum stress and apoptosis in prediabetic rats. Diabetes Obesity and Metabolism 2018, 20:2617–2626.
- 18. Han S, Hagan DL, Taylor JR, Xin L, Meng W, Biller SA, Wetterau JR, Washburn WN, Whaley JM: Dapagliflozin, a selective SGLT2 inhibitor, improves glucose homeostasis in normal and diabetic rats. Diabetes 2008, 57:1723-1729.
- 19. European Medicines Agency (EMA), Committee for Medicinal Products for Human Use (CHMP) Assessment report Forxiga dapagliflozin, n.d. www.ema.europa.eu (accessed February 16, 2020)). https://www.ema.europa.eu/en/medicines/human/EPAR/forxiga
- 20. Reilly TP, Graziano MJ, Janowitz EB, Dorr TE, Fairchild C, Lee F …. Tirmenstein M: Carcinogenicity risk assessment supports the chronic safety of Dapagliflozin, an inhibitor of sodium–glucose co-transporter 2, in the treatment of type 2 diabetes mellitus. Diabetes Therapy 2014, 5:73-96. https://doi.org/10.1007/s13300-014-0053-3
- 21. Qiang G, Yang X, Xuan Q, Shi L, Zhan H, Chen B,… Du G: Salvianolic acid A prevents the pathological progression of hepatic fibrosis in high-fat diet-fed and streptozotocin-induced diabetic rats. The American Journal of Chinese Medicine 2014, 42:1183-1198.
- 22. Guo XX, Wang Y, Wang K, Ji B, Zhou F: Stability of a type 2 diabetes rat model induced by high-fat diet feeding with low-dose streptozotocin injection. Journal of Zhejiang University Science B (Biomedicine & Biotechnology) 2018, 19:559-569.
- 23. Valentovic MA, Alejandro N, Carpenter AB, Brown PI, Ramos K: Streptozotocin (STZ) diabetes enhances benzo (α) pyrene induced renal injury in Sprague Dawley rats. Toxicology Letters 2006, 164:214-220.
- 24. Singh DK, Winocour P, and Farrington K: Oxidative stress in early diabetic nephropathy: Fueling the fire. Nature Reviews Endocrinology 2011, 7:176–184.
- 25. Hosohata K: Role of oxidative stress in drug-induced kidney injury. International Journal of Molecular Sciences 2016, 17(11):1826.
- 26. Babu GRS, Anand T, Ilaiyaraja N, Khanum F, gopalan N: Pelargonidin modulates Keap1/Nrf2 pathway gene expression and ameliorates citrinin-induced oxidative stress in HepG2 cells. Frontiers in Pharmacology 2017, 8:1-20.
- 27. Palsamy P, Subramanian S: Resveratrol protects diabetic kidney by attenuating hyperglycemia-mediated oxidative stress and renal inflammatory cytokines via Nrf2-Keap1 signaling. Biochim Biophys Acta - Molecular Basis of Disease 2011, 1812:719–731.
- 28. Chow F, Nikolic-Paterson DJ, Ozols E, Atkins RC, Rollin BJ, Tesch GH: Monocyte chemoattractant protein-1 promotes the development of diabetic renal injury in streptozotocin-treated mice. Kidney International 2006, 69:73-80.
- 29. Navarro-González JF, and Mora-Fernández C: The role of inflammatory cytokines in diabetic nephropathy. Journal of American Society of Nephrology. 2008, 19:433–442.
- 30. Akcay A. Nguyen Q, Edelstein CL: Mediators of inflammation in acute kidney injury. Mediators of Inflammation 2009, 2009:137072.
31. Patel S, and Santani D: Role of NF-κB in the pathogenesis of diabetes and its associated complications. Pharmacological Reports 2009, 61:595–603.
- 32. Liu Y, and Beyer A, Aebersold R: On the dependency of cellular protein levels on mRNA abundance. Cell. 2016, 165:535–550.
33. Liu T, Zhang L, Joo D, Sun S: NF-κB signaling in inflammation. Signal Transduction and Targeted Therapy 2017, 2:1-9.
- 34. Tang L, Wu Y, Tian M, Sjöström CD, Johansson U, Peng X, Smith DM, Huang Y: Dapagliflozin slows the progression of the renal and liver fibrosis associated with type 2 diabetes. American Journal of Physiology – Endocrinology and Metabolism 2017, 313:563–576.
- 35. Lim AKH, and Tesch GH: Inflammation in diabetic nephropathy. Mediators of Inflammation 2012, 2012: 146154.
- 36. Kaneto H, Nakatani Y, Miyatsuka T, Kawamori D, Matsuoka T, Matsuhisa M, Kajimoto Y, … Hori M: Possible novel therapy for diabetes with cell-permeable JNK-inhibitory peptide. Nature Medicine 2004, 10:1128–1132.
- 37. Servais H, Ortriz A, Devuyst O, Denamur S, Tulkens PM, Mingeot-Leclercq MP: Renal cell apoptosis induced by nephrotoxic drugs: cellular and molecular mechanisms and potential approaches to modulation. Apoptosis. 2008, 13:11-32.
- 38. Verzola D, Gandolfo MT, Ferrario F, Rastaldi MP, Vilaggio B, Gianiorio F, Gianonni M, Rimoldi L, Lauria F, Miji M, Deferrari G, Garibotto G:Apoptosis in the kidneys of patients with type II diabetic nephropathy. Kidney International 2007, 72:1262-1272.
- 39. Li J, Yin S, Dong Y, Fan L, Hu H: P53 activation inhibits ochratoxin A-induced apoptosis in monkey and human kidney epithelial cells via suppression of JNK activation. Biochemical Biophysical Research Communications 2011, 411:458–463.
- 40. Mohamed DI, Khairy E, Saad SS, Habib EK, and Hamouda MA: Potential protective effects of Dapagliflozin in gentamicin induced nephrotoxicity rat model via modulation of apoptosis associated miRNAs. Gene 2019, 707:198-204.