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Two concurrent mechanisms are responsible for the INa increase produced by dapagliflozin and empagliflozin in healthy and heart failure cardiomyocytes - 22/04/25

Doi : 10.1016/j.biopha.2025.117984 
Josu Rapún a, b, 1, Sara Pérez-Martín a, b, 1, Anabel Cámara-Checa a, b, Gorka San José b, c, Roberto Núñez-Fernández a, b, Teresa Crespo-García a, b, Adam Hoban a, b, Marcos Rubio-Alarcón a, b, Elena Martínez-Blanco d, Juan Tamargo a, b, F. Javier Díez-Guerra d, Begoña López b, c, Ricardo Gómez a, Arantxa González b, c, e, Eva Delpón a, b, , 2 , Ricardo Caballero a, b, 2
a Department of Pharmacology and Toxicology, School of Medicine, Universidad Complutense de Madrid, Instituto de Investigación Gregorio Marañón, Madrid 28040, Spain 
b CIBERCV, Instituto de Salud Carlos III, Spain 
c Program of Cardiovascular Disease, CIMA Universidad de Navarra and IdiSNA, Pamplona 31008, Spain 
d Department of Molecular Biology and Center of Molecular Biology “Severo Ochoa” (UAM-CSIC), Universidad Autónoma de Madrid, Madrid 28049, Spain 
e Department of Pathology, Anatomy and Physiology, Universidad de Navarra, Pamplona 31009, Spain 

Corresponding author at: Department of Pharmacology and Toxicology, School of Medicine, Universidad Complutense de Madrid, Instituto de Investigación Gregorio Marañón, Madrid 28040, Spain Department of Pharmacology and Toxicology, School of Medicine, Universidad Complutense de Madrid, Instituto de Investigación Gregorio Marañón Madrid 28040 Spain

Abstract

Dapagliflozin and empagliflozin exert many cardiovascular protective actions in heart failure (HF) patients. HF-induced electrical remodelling decreases the expression of Nav1.5 channels (encoded by SCN5A ) that generate the cardiac Na + current (I Na ) impairing excitability and promoting arrhythmias. We aimed to mechanistically decipher the peak I Na increase produced by dapagliflozin and empagliflozin in healthy and HF cardiomyocytes. We recorded macroscopic and single-channel currents and action potentials (AP) using the patch-clamp technique and generated a mouse model of HF with reduced ejection fraction by transverse aortic constriction (TAC). Single-channel recordings showed that dapagliflozin and empagliflozin (1 μM) increased the open probability ( P o ) of Nav1.5 channels by augmenting channel re-openings and the number of traces with openings and by doubling the open time constant, respectively. Both drugs increased SCN5A mRNA levels and the membrane expression of Nav1.5 channels. Empagliflozin also enhanced the cytoplasmic mobility of Nav1.5 channels. Molecular modelling and site-directed mutagenesis analysis demonstrated that both drugs bind to a previously unknown site at the Nav1.5 DIII-DIV fenestration. Dapagliflozin and empagliflozin hyperpolarized the resting membrane potential and increased the action potential amplitude in human cardiomyocytes derived from induced pluripotent stem cells. Importantly, in TAC cardiomyocytes dapagliflozin and empagliflozin restored the HF-reduced peak I Na to control levels. Dapagliflozin and empagliflozin bind to a novel site within cardiac Nav1.5 increasing I Na by augmenting the P o and the membrane expression of the channels. We hypothesized that this unique effects could be of interest for the treatment of arrhythmias associated with decreased Nav1.5 channel expression.

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Graphical Abstract




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Highlights

Dapagliflozin and empagliflozin bind to an unidentified site within Nav1.5 channels.
Both drugs increase open probability and membrane expression of these channels.
Heart failure (HF)-induced remodelling decreases Nav1.5 membrane expression.
Both drugs restore Na + current (I Na ) density in cardiomyocytes from HF mice.
I Na restoration may contribute to the cardioprotective effects of these drugs.

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Abbreviations : AADs, AP, APA, APD, BSA, CaMKII, CHO, COS-7, Cq, Dapa, DMEM, EC 50 , E max , Empa, FACS, Please delete this abbreviationFQRS-T, FRAP, FSC, GRASP, HEK293, HF, HFpEF, HFrEF, hiPSC-CM, I CaL , I Kr and I Ks , iNa, I Na , I NaL , I Nav1.5 , LAs, LVEF, MOT, [Na + ] i , nH, PBS, PMSF, P o , ROI, RMP, RT-qPCR, SCD, SGLT2i, SSC, t1/2, TAC, T2DM, τ open,

Keywords : Dapagliflozin, Empagliflozin, Na + current , Patch-clamp, Cardiac


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© 2025  The Authors. Pubblicato da Elsevier Masson SAS. Tutti i diritti riservati.
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