In
liver cirrhosis, hepatic
inflammation and abundant portal-systemic collaterals are indicated for the development of
hepatic encephalopathy.
Sodium-
glucose cotransporter-2 (SGLT-2) inhibitors are a type of anti-diabetic agent which exert pleiotropic and anti-inflammatory effects. Diabetes and chronic
liver disease often coexist, but the influence of SGLT-2 inhibition on
liver cirrhosis and
hepatic encephalopathy remains unknown. This study investigated the effect of SGLT-2 inhibition on cirrhotic rats.
Biliary cirrhosis was induced in Sprague-Dawley rats via common bile duct
ligation. A total of two weeks of treatment with the
SGLT-2 inhibitor,
empagliflozin 30 mg/kg/d, was applied. The motor activities, hemodynamics, biochemistry parameters, plasma levels of
vascular endothelial growth factor (
VEGF), and the severity of portal-systemic collateral shunts were measured. The hepatic histopathology and
protein expressions were examined. We found that
empagliflozin treatment did not affect hemodynamics, liver biochemistry, or
blood glucose levels in cirrhotic rats.
Empagliflozin did not affect hepatic
inflammation and
fibrosis. The
protein expression of factors related to liver injury were not influenced by
empagliflozin. However,
empagliflozin decreased motor activities in cirrhotic rats and increased portal-systemic collateral shunts and
VEGF plasma levels. In summary, SGLT-2 inhibition by
empagliflozin did not ameliorate
portal hypertension and hepatic
inflammation in cirrhotic rats. In contrast, it exacerbated
hepatic encephalopathy, which was evidenced by a decrease in motor activity. A possible mechanism could be an increase of portal-systemic shunts related to
VEGF upregulation. Therefore,
empagliflozin use should be cautious in cirrhotic patients regarding the development of
hepatic encephalopathy. SIGNIFICANCE STATEMENT:
Sodium-
glucose cotransporter-2 inhibition by
empagliflozin did not ameliorate
portal hypertension and hepatic
inflammation in cirrhotic rats. In contrast, it exacerbated
hepatic encephalopathy through increased portal-systemic shunts related to
VEGF up-regulation.