Dapagliflozin activates AMPK to attenuate cardiac dysfunction and oxidative stress under hypoxia/reoxygenation-caused damage

Abstract

Background: Emerging evidence demonstrated Dapagliflozin (DAPA), an inhibitor of type II sodium-glucose cotransporter-2, prevented various cardiovascular events. However, the detailed mechanisms underlying its cardioprotective properties remained largely unknown. In the present study, we sought to investigate the effects of DAPA on the cardiac ischemia/reperfusion (I/R) injury and study the mechanisms of DAPA-provided cardioprotection.Methods: For in intro studies, cardiac myoblast H9c2 cells were exposed to hypoxia with no-glucose medium for 1 hr than followed a reoxygenation with high-glucose medium for 4 hr. DAPA was treated before hypoxia/reoxygenation (H/R) exposure. For in vivo investigations, I/R was instigated in Sprague-Dawley (SD) rats using ligation of the left anterior descending coronary artery (LAD). DAPA was given daily by gavage for 5 days before I/R induction.Results: Results from in vitro experiments showed that DAPA induced the phosphorylation of adenosine 5'-monophosphate activated protein kinase (AMPK), resulting in the downregulation of phosphorylated protein kinase C (PKC) in the cardiac myoblast H9c2 cells following H/R condition. We demonstrated that DAPA treatment diminished the H/R-elicited oxidative stress via the AMPK/ PKC/ NADPH oxidase (Nox) pathway. In addition, DAPA prevented the H/R-induced abnormality of peroxisome proliferator-activated receptor-gamma coactivator 1-alpha (PGC-1α) expression, mitochondrial membrane potential, and mitochondrial DNA copy number through AMPK/ PKC/ Nox signaling. Besides, DAPA reversed the apoptosis-associated changes, including H/R-suppressed Bcl-2 and H/R-induced expression of phosphorylated p53, Bax cytochrome c, and activated caspase 3 via AMPK/ PKC/ Nox/ PGC-1α signaling. Furthermore, we demonstrated that DAPA improved the I/R-induced cardiac dysfunction by echocardiography and abrogated the I/R-elicited apoptotic cells by terminal deoxynucleotidyl transferase dUTP nick end labeling assay in the myocardium of rats. Also, the administration of DAPA mitigated the production of two myocardial infarction markers, creatine phosphokinase isoenzymes and lactate dehydrogenase.Conclusion: In conclusion, our data suggested that DAPA treatment holds the potential to ameliorate the I/R-elicited oxidative stress and the following cardiac apoptosis via AMPK/ PKC/ Nox/ PGC-1α signaling, which attenuates the cardiac dysfunction caused by I/R injury.