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Diabetologia
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Diabetologia
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Dapagliflozin reduces thrombin generation and platelet activation: implications for cardiovascular risk reduction in type 2 diabetes mellitus

Authors: Christina Kohlmorgen; Stephen Gerfer; Kathrin Feldmann; Sören Twarock; Sonja Hartwig; Stefan Lehr; Meike Klier; +12 Authors

Dapagliflozin reduces thrombin generation and platelet activation: implications for cardiovascular risk reduction in type 2 diabetes mellitus

Abstract

Abstract Aims/hypothesis People with diabetes have an increased cardiovascular risk with an accelerated development of atherosclerosis and an elevated mortality rate after myocardial infarction. Therefore, cardioprotective effects of glucose-lowering therapies are of major importance for the pharmacotherapy of individuals with type 2 diabetes. For sodium–glucose cotransporter 2 inhibitors (SGLT2is), in addition to a reduction in blood glucose, beneficial effects on atherosclerosis, obesity, renal function and blood pressure have been observed. Recent results showed a reduced risk of worsening heart failure and cardiovascular deaths under dapagliflozin treatment irrespective of the diabetic state. However, the underlying mechanisms are yet unknown. Platelets are known drivers of atherosclerosis and atherothrombosis and disturbed platelet activation has also been suggested to occur in type 2 diabetes. Therefore, the present study investigates the impact of the SGLT2i dapagliflozin on the interplay between platelets and inflammation in atherogenesis. Methods Male, 8-week-old LDL-receptor-deficient (Ldlr−/−) mice received a high-fat, high-sucrose diabetogenic diet supplemented without (control) or with dapagliflozin (5 mg/kg body weight per day) for two time periods: 8 and 25 weeks. In a first translational approach, eight healthy volunteers received 10 mg dapagliflozin/day for 4 weeks. Results Dapagliflozin treatment ameliorated atherosclerotic lesion development, reduced circulating platelet–leucocyte aggregates (glycoprotein [GP]Ib+CD45+: 29.40 ± 5.94 vs 17.00 ± 5.69 cells, p < 0.01; GPIb+lymphocyte antigen 6 complex, locus G+ (Ly6G): 8.00 ± 2.45 vs 4.33 ± 1.75 cells, p < 0.05) and decreased aortic macrophage infiltration (1.31 ± 0.62 vs 0.70 ± 0.58 ×103 cells/aorta, p < 0.01). Deeper analysis revealed that dapagliflozin decreased activated CD62P-positive platelets in Ldlr−/− mice fed a diabetogenic diet (3.78 ± 1.20% vs 2.83 ± 1.06%, p < 0.01) without affecting bleeding time (85.29 ± 37.27 vs 89.25 ± 16.26 s, p = 0.78). While blood glucose was only moderately affected, dapagliflozin further reduced endogenous thrombin generation (581.4 ± 194.6 nmol/l × min) × 10−9 thrombin vs 254.1 ± 106.4 (nmol/l × min) × 10−9 thrombin), thereby decreasing one of the most important platelet activators. We observed a direct inhibitory effect of dapagliflozin on isolated platelets. In addition, dapagliflozin increased HDL-cholesterol levels. Importantly, higher HDL-cholesterol levels (1.70 ± 0.58 vs 3.15 ± 1.67 mmol/l, p < 0.01) likely contribute to dapagliflozin-mediated inhibition of platelet activation and thrombin generation. Accordingly, in line with the results in mice, treatment with dapagliflozin lowered CD62P-positive platelet counts in humans after stimulation by collagen-related peptide (CRP; 88.13 ± 5.37% of platelets vs 77.59 ± 10.70%, p < 0.05) or thrombin receptor activator peptide-6 (TRAP-6; 44.23 ± 15.54% vs 28.96 ± 11.41%, p < 0.01) without affecting haemostasis. Conclusions/interpretation We demonstrate that dapagliflozin-mediated atheroprotection in mice is driven by elevated HDL-cholesterol and ameliorated thrombin–platelet-mediated inflammation without interfering with haemostasis. This glucose-independent mechanism likely contributes to dapagliflozin’s beneficial cardiovascular risk profile. Graphical abstract

Country
Germany
Keywords

Adult, Blood Glucose, Blood Platelets, Male, Thrombin/metabolism [MeSH] ; Benzhydryl Compounds/therapeutic use [MeSH] ; Blood Platelets/metabolism [MeSH] ; HDL-cholesterol ; Sodium-Glucose Transporter 2 Inhibitors/therapeutic use [MeSH] ; Heart failure ; Mice, Inbred C57BL [MeSH] ; P-Selectin/metabolism [MeSH] ; Flow Cytometry [MeSH] ; P-Selectin (CD62P) ; Atherosclerosis ; Diabetes Mellitus, Type 2/drug therapy [MeSH] ; Platelet Activation/drug effects [MeSH] ; Sodium–glucose cotransporter 2 (SGLT2) inhibitors ; Coronary Artery Disease/prevention ; Male [MeSH] ; Risk Reduction Behavior [MeSH] ; Healthy Volunteers [MeSH] ; Platelets ; Coronary Artery Disease/metabolism [MeSH] ; Cardiovascular Diseases/metabolism [MeSH] ; Female [MeSH] ; Adult [MeSH] ; Humans [MeSH] ; Dapagliflozin ; Middle Aged [MeSH] ; Platelet Count [MeSH] ; Cardiovascular Diseases/prevention ; Animals [MeSH] ; Cardiovascular ; Immunohistochemistry [MeSH] ; Article ; Glucosides/therapeutic use [MeSH] ; Cholesterol, HDL/blood [MeSH] ; Blood Glucose/metabolism [MeSH] ; Diabetes Mellitus, Type 2/metabolism [MeSH] ; Thrombin ; Blood Platelets/drug effects [MeSH] ; Real-Time Polymerase Chain Reaction [MeSH], Coronary Artery Disease, Article, Glucosides, Animals, Humans, Benzhydryl Compounds, Cholesterol, HDL, Middle Aged, Flow Cytometry, Platelet Activation, Immunohistochemistry, Healthy Volunteers, Mice, Inbred C57BL, P-Selectin, Diabetes Mellitus, Type 2, Cardiovascular Diseases, Female

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selected citations
These citations are derived from selected sources.
This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Citations provided by BIP!
popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Influence provided by BIP!
impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
BIP!Impulse provided by BIP!
38
Top 10%
Top 10%
Top 10%
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