Sodium glucose co-transporter 2 inhibitor empagliflozin prevents endothelial dysfunction induced by oscillatory shear stress

Background: Empagliflozin (EMPA), a sodium-glucose co-transporter 2 inhibitor, exhibits endothelial protective effects under disturbed flow conditions. Oscillatory shear stress (OSS) induces endothelial dysfunction via increased Reactive Oxygen Species (ROS), intracellular CA²⁺, VE-cadherin phosphorylation, and inflammatory activation. We hypothesized that EMPA prevents OSS-induced dysfunction by inhibiting ROS through the NHE1/NCX/CA²⁺ axis or Piezo1.

Methods: Human coronary artery endothelial cells (HCAECs) were pretreated with EMPA and exposed to LSS or OSS. Mechanistic studies included ROS scavenger NAC, calcium chelator BAPTA-AM, NHE1 inhibitor cariporide, NCX inhibitor ORM-10962, and Piezo1 knockdown. ROS, NO bioavailability, and CA²⁺ were measured using live-cell imaging. VE-cadherin and ICAM-1 were evaluated by immunostaining; phosphorylation of VE-cadherin, SFK, ERK1/2, and Piezo1 was assessed by Western blot. Ex vivo en face staining of mouse aortas analyzed EMPA's effect on endothelial SOD1 expression.

Results: EMPA restored OSS-induced increases in ROS, CA²⁺, VE-cadherin phosphorylation, ICAM-1, and monocyte transmigration (all P < 0.05). Piezo1 knockdown or inhibitors of NHE1/NCX reduced ROS, with no additive effect when combined with EMPA, suggesting a shared pathway. NAC restored VE-cadherin but not ICAM-1. EMPA increased endothelial SOD1 expression in aortic arches, confirming the translational relevance of in vitro findings.

Conclusions: EMPA prevents OSS induced ROS generation by the inhibition of the NHE1/NCX/CA²⁺ axis. The suppression of OSS-induced ROS generation by EMPA contributes to improved endothelial barrier function of endothelial cells but has limited effect on the inflammatory response in HCAECs subjected to OSS.