Sodium-glucose co-transporter 2 inhibition as a mitochondrial therapy for atrial fibrillation in patients with diabetes?
While patients with type 2 diabetes mellitus (T2DM) are at increased risk to develop atrial fibrillation (AF), the mechanistic link between T2DM and AF-susceptibility remains unclear. Common co-morbidities of T2DM, particularly hypertension, may drive AF in the setting of T2DM. But direct mechanisms may also explain this relation, at least in part. In this regard, recent evidence suggests that mitochondrial dysfunction drives structural, electrical and contractile remodelling of atrial tissue in patients T2DM. Mitochondrial dysfunction may therefore be the mechanistic link between T2DM and AF and could also serve as a therapeutic target. An elegant series of experiments published in Cardiovascular Diabetology provide compelling new evidence to support this hypothesis. Using a model of high fat diet (HFD) and low-dose streptozotocin (STZ) injection, Shao et al. provide data that demonstrate a direct association between mitochondrial dysfunction and the susceptibility to develop AF. But the authors also demonstrated that the sodium-glucose co-transporter 2 inhibitors (SGLT2i) empagliflozin has the capacity to restore mitochondrial function, ameliorate electrical and structural remodelling and prevent AF. These findings provide a new horizon in which mitochondrial targeted therapies could serve as a new class of antiarrhythmic drugs.
['Yurista|Salva R|SR|', 'Silljé|Herman H W|HHW|', 'Rienstra|Michiel|M|', 'de Boer|Rudolf A|RA|', 'Westenbrink|B Daan|BD|']
D000818:Animals D001281:Atrial Fibrillation D064752:Atrial Remodeling D001559:Benzhydryl Compounds D003921:Diabetes Mellitus, Experimental D003924:Diabetes Mellitus, Type 2 D059305:Diet, High-Fat D005947:Glucose D005960:Glucosides D006801:Humans D008928:Mitochondria D051381:Rats D012964:Sodium D051297:Sodium-Glucose Transporter 2 D013311:Streptozocin
Atrial fibrillation Diabetes Mitochondria Sodium-glucose co-transporter-2 inhibitors