Man Liu, Hong Liu, Eunji Kim, Gyeoung-Jin Kang, Mitchell C Neumann, Madeline Johnson, Ruthvika Murikinati, Samuel C Dudley
Sodium-glucose cotransporter 2 (SGLT2) inhibitors have shown protective effects against heart failure with preserved ejection fraction (HFpEF), but SGLT2 is not expressed significantly in the heart. Here, we investigated the mechanism by which the SGLT2 inhibitor dapagliflozin (Dapa) alters HypoMg-associated HFpEF. HypoMg was induced by a low-Mg diet in mice or in a human cardiomyocyte cell line. Three weeks of Dapa treatment prevented HypoMg-induced HFpEF in mice. In RL-14 cardiomyocytes, sodium-hydrogen exchanger 1 (NHE1) overexpression or activation mimicked the cellular effects of HypoMg. Dapa reversed these changes. Dapa prevented cardiac HFpEF by inhibiting cardiomyocyte NHE1 activity and suppressing macrophage activation.