Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance · 2025
Multiparametric cardiac magnetic resonance identifies macrophage nitric oxide synthase 2-mediated benefits of preventive sodium-glucose cotransporter 2 inhibition in a mouse model of metabolic heart disease.
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Bresticker Julia E, Pavelec Caitlin M, Skacel Thomas P, Echols John T, Roy R Jack, Bradley Leigh A, Macal Edgar H, French Brent A, Marette André, Kramer Christopher M, Isakson Brant E, Patel Amit R, Wolf Matthew J, Epstein Frederick H
Аннотация
BACKGROUND: Sodium-glucose cotransporter 2 (SGLT2) inhibitors improve metabolic and cardiovascular outcomes, but the mechanisms remain incompletely understood. We utilized cardiovascular magnetic resonance (CMR) and complementary methods to investigate whether preventive SGLT2 inhibitor administration attenuates the development of metabolic heart disease in a high-fat, high-sucrose diet (HFHSD) mouse model.
METHODS: Male wild-type (WT) C57BL/6 J mice were fed an HFHSD for 18 weeks to induce obesity, coronary microvascular disease, and diastolic dysfunction. WT mice treated preventively with an SGLT2 inhibitor, empagliflozin (EMPA), were compared to untreated WT mice, and mice fed either an HFHSD or standard chow diet with myeloid cell-specific knockout of the Nos2 gene (Nos2LysMCre) were compared to floxed controls (Nos2fl/fl). CMR assessed epicardial adipose tissue (EAT) volume, fatty acid composition (FAC), proton density fat fraction (PDFF), and T1, and myocardial perfusion, and strain. EAT FAC, PDFF, and T1 were quantified using an inversion-recovery multi-echo gradient-echo sequence and a multi-resonance triglyceride model. EAT volume was quantified using cine images. Myocardial perfusion reserve (MPR) and strain were measured using arterial spin labeling, and displacement encoding with stimulated echoes (DENSE), respectively. Histology and flow cytometry assessed EAT remodeling and macrophage polarization.
RESULTS: EMPA treatment reduced EAT volume (0.36±0.18 µL/g vs 0.61±0.25 µL/g, p<0.01) and saturated fatty acid fraction (38.81 [32.83-47.71]% vs 48.06 [43.82-52.65]%, p<0.05), increased EAT T1 (0.799 [0.764-0.859] s vs 0.755 [0.678-0.772] s, p<0.05), and decreased EAT NOS2+ macrophages (34.74 [21.38-42.098]% vs 46.36 [38.08-61.30]%, p<0.05) compared to controls. EMPA improved diastolic strain rate (2.96 [2.61-3.99] s-1 vs 1.68 [1.21-2.80] s-1, p<0.01) and adenosine MPR (2.00±0.54 vs 1.37±0.40, p<0.01) compared to controls. Myeloid cell NOS2 knockout mice fed an HFHSD exhibited improved adenosine MPR (1.90±0.47 vs 1.39±0.38, p<0.01) compared to floxed controls.
CONCLUSIONS: In this obesity-related metabolic heart disease model, EMPA treatment prevents cardiometabolic dysfunction by improving EAT quantity and quality, coronary microvascular function, and diastolic function. These benefits are mediated in part through macrophage NOS2.
METHODS: Male wild-type (WT) C57BL/6 J mice were fed an HFHSD for 18 weeks to induce obesity, coronary microvascular disease, and diastolic dysfunction. WT mice treated preventively with an SGLT2 inhibitor, empagliflozin (EMPA), were compared to untreated WT mice, and mice fed either an HFHSD or standard chow diet with myeloid cell-specific knockout of the Nos2 gene (Nos2LysMCre) were compared to floxed controls (Nos2fl/fl). CMR assessed epicardial adipose tissue (EAT) volume, fatty acid composition (FAC), proton density fat fraction (PDFF), and T1, and myocardial perfusion, and strain. EAT FAC, PDFF, and T1 were quantified using an inversion-recovery multi-echo gradient-echo sequence and a multi-resonance triglyceride model. EAT volume was quantified using cine images. Myocardial perfusion reserve (MPR) and strain were measured using arterial spin labeling, and displacement encoding with stimulated echoes (DENSE), respectively. Histology and flow cytometry assessed EAT remodeling and macrophage polarization.
RESULTS: EMPA treatment reduced EAT volume (0.36±0.18 µL/g vs 0.61±0.25 µL/g, p<0.01) and saturated fatty acid fraction (38.81 [32.83-47.71]% vs 48.06 [43.82-52.65]%, p<0.05), increased EAT T1 (0.799 [0.764-0.859] s vs 0.755 [0.678-0.772] s, p<0.05), and decreased EAT NOS2+ macrophages (34.74 [21.38-42.098]% vs 46.36 [38.08-61.30]%, p<0.05) compared to controls. EMPA improved diastolic strain rate (2.96 [2.61-3.99] s-1 vs 1.68 [1.21-2.80] s-1, p<0.01) and adenosine MPR (2.00±0.54 vs 1.37±0.40, p<0.01) compared to controls. Myeloid cell NOS2 knockout mice fed an HFHSD exhibited improved adenosine MPR (1.90±0.47 vs 1.39±0.38, p<0.01) compared to floxed controls.
CONCLUSIONS: In this obesity-related metabolic heart disease model, EMPA treatment prevents cardiometabolic dysfunction by improving EAT quantity and quality, coronary microvascular function, and diastolic function. These benefits are mediated in part through macrophage NOS2.