Knockout of Na⁺-glucose cotransporter SGLT1 mitigates diabetes-induced upregulation of nitric oxide synthase NOS1 in the macula densa and glomerular hyperfiltration

Abstract

Na+-glucose cotransporter (SGLT)1 mediates glucose reabsorption in late proximal tubules. SGLT1 also mediates macula densa (MD) sensing of an increase in luminal glucose, which increases nitric oxide (NO) synthase 1 (MD-NOS1)-mediated NO formation and potentially glomerular filtratrion rate (GFR). Here, the contribution of SGLT1 was tested by gene knockout (−/−) in type 1 diabetic Akita mice. A low-glucose diet was used to prevent intestinal malabsorption in Sglt1−/− mice and minimize the contribution of intestinal SGLT1. Hyperglycemia was modestly reduced in Sglt1−/− versus littermate wild-type Akita mice (480 vs. 550 mg/dl), associated with reduced diabetes-induced increases in GFR, kidney weight, glomerular size, and albuminuria. Blunted hyperfiltration was confirmed in streptozotocin-induced diabetic Sglt1−/− mice, associated with similar hyperglycemia versus wild-type mice (350 vs. 385 mg/dl). Absence of SGLT1 attenuated upregulation of MD-NOS1 protein expression in diabetic Akita mice and in response to SGLT2 inhibition in nondiabetic mice. During SGLT2 inhibition in Akita mice, Sglt1−/− mice had likewise reduced blood glucose (200 vs. 300 mg/dl), associated with lesser MD-NOS1 expression, GFR, kidney weight, glomerular size, and albuminuria. Absence of Sglt1 in Akita mice increased systolic blood pressure, associated with suppressed renal renin mRNA expression. This may reflect fluid retention due to blunted hyperfiltration. SGLT2 inhibition prevented the blood pressure increase in Sglt1−/− Akita mice, possibly due to additive glucosuric/diuretic effects. The data indicate that SGLT1 contributes to diabetic hyperfiltration and limits diabetic hypertension. Potential mechanisms include its role in glucose-driven upregulation of MD-NOS1 expression. This pathway may increase GFR to maintain volume balance when enhanced MD glucose delivery indicates upstream saturation of SGLTs and thus hyperreabsorption.

Elevated glucose represses lysosomal and mTOR-related genes in renal epithelial cells composed of progenitor CD133+ cells

“…The hRTE cells were shown to express the SLC5A1 sodium coupled glucose transporter located downstream from the SLC5A2 transporter in the late portion of the proximal tubule. In the kidney, this transporter is only responsible for reabsorbing 3% of filtered glucose [ 35 ]. Our study demonstrated that the expression of SLC5A2 in the human kidney cortex is much higher than the expression in cultured hRTE cells.…”

Investigation of efficacy and safety of low-dose sodium glucose transporter 2 inhibitors and differences between two agents, canagliflozin and ipragliflozin, in patients with type 2 diabetes mellitus

“…Whereas, SGLT2is could inhibit SGLT1 as well as SGLT2 (18,19). Recently, several reports demonstrated the inhibition of SGLT1 could have diuretic effects (16,17). Actually, canagliflozin was reported to be more effective for SGLT1 among the available SGLT2is (24).…”

“…Interestingly, it was reported that the inhibition of sodium glucose transporter-1 (SGLT1) led to same diuretic effect as that of SGLT2 (16,17). It was also reported that SGLT2is could inhibit SGLT1 as well as SGLT2, implying differences in potencies of inhibition of SGLT1 among available SGLT2is (18,19).…”

Renal Effects of Sodium-Glucose Co-Transporter Inhibitors

“…47 New studies show knockout of SGLT1 prevents diabetes-induced upregulation of NOS1 in the macula densa and mitigates glomerular hyperfiltration. 48 Absence of SGLT1 also attenuates upregulation of macula densa NOS1 expression in response to SGLT2 inhibition in nondiabetic mice. Furthermore, the effects of SGLT1 and SGLT2 inhibition on diabetic glomerular hyperfiltration were additive.…”