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SGLT2 inhibition reverses metabolic and inflammatory kidney signatures in youth with type 1 diabetes

ABSTRACT: Sodium-glucose cotransporter-2 (SGLT2) inhibitors slow progression of diabetic kidney disease, but their intrarenal mechanisms remain unclear, particularly in patients with type 1 diabetes (T1D). In a prespecified ancillary study within the placebo-controlled ATTEMPT trial of dapagliflozin in youth with T1D and well-preserved kidney function (N=98), we integrated sequential kidney biopsies, multiparametric kidney MRI, and proteomics. Single-cell RNA-seq of N=16 baseline and N=11 16-week follow-up biopsies (N=27; 214,415 cells) revealed a coordinated network of metabolic, fibrotic, and inflammatory transcriptional changes across nephron, vascular, and immune compartments. These gene shifts paralleled attenuation of hyperfiltration and improvement in glycemic control (HbA1c and time-in-range), implicating 594 transcripts. MRI indicated a reversal of the medullary hyperoxia characteristic of T1D with dapagliflozin. Urine proteomic profiles echoed the transcriptomic patterns. Together, these multimodal data point to metabolic reprogramming, reduced inflammation, and improved oxygen handling as convergent mechanisms of SGLT2-mediated kidney protection. ClinicalTrials.gov: NCT04333823.

ORGANISM(S): Homo sapiens

PROVIDER: GSE316742 | GEO | 2026/03/12

REPOSITORIES: GEO

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Project description:Purpose:Renal injury with the loss of podocyte was characteristic pathology of diabetic nephropathy (DN) and correlated with increased albuminuria. Many studies have found the nephroprotective effect of the novel inhibitors of sodium-glucose cotransporter 2 (SGLT2-is), like Dapagliflozin, delaying the progression of DN. However, the underlying mechanisms of SGLT2 associated with podocyte injury are still not fully elucidated. Methods: Through mRNA sequencing, streptozotocin-induced and Dapagliflozin-intraperitoneal injection mice models were established to explore potential mechanism between Dapagliflozin and renal phenotype. And all changes referring this observed pathway were proven repeatedly in podocyte. Results: Here, we generated the streptozotocin-induced DN models and found the accumulation of nephrotoxin and pathological lesions of the kidney, including interstitial inflammatory infiltration, mesangial expansion and glomerular sclerosis, while low expression of SGLT2 mitigated these injuries in Dapagliflozin-treated mice. Moreover, mRNA expression profile in these treated models determined the significance of insulin-like growth factor-1 receptor (IGF1R)/PI3K regulatory axis in glomerular injury. Particularly, SGLT2-is inhibited the increase of mesenchymal marker, α-SMA and the decrease of podocyte marker, nephrin at the gene or protein level. KEGG analysis also showed the enrichment of phosphatidylinositol signaling system and TGF-β/smad pathway. In parallel, the protein level of IGF1R, phosphorylated PI3K, and α-SMA were increased in high-glucose stimulated human podocyte, and reduced in Dapagliflozin (50nM and 100nM) or OSI-906 (inhibitor of IGF1R, 60nM) used groups. Notably, combination of the two inhibitors produced an accumulative effect in the protection of podocyte integrity. Mechanistically, IGF1 or IGF2 could bind to IGF1 receptors to mediate the epithelial-mesenchymal transition (EMT) of diabetic podocyte in response to the upregulation of SGLT2. Indeed, we enrolled the urine and plasma samples from a cohort consisting of 13 healthy people, and a cohort of 19 patients with DN using SGLT2-inhibitors (n=9) or not (n=10). Compared with pure DN patients, Elisa results suggested an increased circulation and excretion level of IGF1/2 in SGLT2-is used DN cohort. Conclusions: Taken together, our study reported the key role of SGLT2/IGF1R/PI3K signaling in regulating podocyte EMT. Modulating the IGF1R expression may provide a novel idea for DN therapy.

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SGLT2 inhibition reverses metabolic and inflammatory kidney signatures in youth with type 1 diabetes

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