Explore the potential mechanisms between ertugliflozin and kidney cancer through bioinformatics analysis and Mendelian randomization study

BACKGROUND: Current research on sodium-glucose cotransporter 2 (SGLT2) inhibitors and kidney cancer is controversial. Recent studies suggest that ertugliflozin increases the overall cancer risk, especially kidney cancer. OBJECTIVE: This study investigated the potential mechanisms between ertugliflozin and kidney cancer through multidimensional data. METHODS: We identified core targets between ertugliflozin and clear cell renal cell carcinoma (ccRCC) through network toxicology. Feature genes were obtained through analysis of the TCGA database, and additional analysis was conducted on SLC5A2. Finally, a two-sample Mendelian randomization (MR) approach (mainly inverse variance weighted) was used to assess the association between feature genes, SGLT2 inhibition, and ccRCC or renal cell carcinoma (RCC). RESULTS: Through network toxicology, 15 core targets between ertugliflozin and ccRCC were identified. Cox regression analysis, ROC curve plotting, and survival analysis were conducted, and then two feature genes, SRC and ESR2, were obtained. Additionally, the expression of SLC5A2 was lower in tumor tissues compared to normal tissues. MR analysis results showed that SRC was not associated with RCC/ccRCC risk, while ESR2 may be associated with a higher risk of ccRCC (P = 0.03). SGLT2 inhibition potentially led to a higher risk of renal cell carcinoma [odds ratio (OR) 3.05; 95% confidence interval 1.03-9.04; P = 0.04]. When using UK Biobank Genome-Wide Association Study data, SGLT2 inhibition was associated with a higher risk of ccRCC (OR 83.70; 95%CI 3.60-1946.03; P < 0.01). Experiments verified that ertugliflozin acted on ESR2 rather than SRC. CONCLUSION: Ertugliflozin may affect kidney cancer by targeting ESR2. SGLT2 inhibition may also be a contributing factor to renal cancer, and further investigation is required.