Aims/hypothesis Despite recent therapeutic advances, achieving optimal glycaemic control remains a challenge in managing type 2 diabetes. Sodium–glucose cotransporter 2 (SGLT2) inhibitors have emerged as effective treatments by promoting
urinary glucose excretion. However, the full scope of their mechanisms extends beyond glycaemic control. At present, their
immunometabolic effects remain elusive.
Methods To investigate the effects of SGLT2 inhibition or deletion, we compared the metabolic and immune phenotype
between high-fat-diet-fed control mice, mice treated chronically with dapagliflozin, and total-body Slc5a2-knockout mice.
Results SGLT2-null mice exhibited better glucose tolerance and insulin sensitivity (blood glucose during IPGTT AUC
0–90 min 1175 ± 57.4 mmol/l × min, mean ± SEM) compared with control (AUC 0–90 min 1857 ± 117.9 mmol/l × min,
p=0.05) or dapagliflozin-treated mice (AUC 0–90 min 1506 ± 68.72 mmol/l × min, p=0.09), independent of glycosuria and
body weight. Moreover, SGLT2-null mice demonstrated physiological regulation of corticosterone secretion, with lower
morning levels than control mice (p<0.01). Systemic cytokine profiling also unveiled significant alterations in inflamma tory mediators, particularly IL-6. Furthermore, unbiased proteomic analysis demonstrated downregulation of acute-phase
proteins and upregulation of glutathione-related proteins, suggesting a role in the modulation of antioxidant responses.
Conversely, IL-6 treatment increased SGLT2 expression in human kidney HK2 cells, suggesting a role for cytokines in the
effects of hyperglycaemia.
Conclusions/interpretation Collectively, our data elucidate a potential interplay between SGLT2 activity, immune modulation and metabolic homeostasis, as well as a potential feedback loop between SGLT2 expression and cytokine concentration