Updated on 2024/12/14

写真a

 
CHIBA Yumiko
 
Organization
School of Medicine Medical Course Basic Medicine Physiology[Autonomous Function]
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Degree

  • 博士(医学) ( 2016.3   東北大学 )

Research Interests

  • metabolism

  • Physiology

Research Areas

  • Life Science / Cardiology

  • Life Science / Metabolism and endocrinology

  • Life Science / Physiology

Education

  • Tohoku University   Graduate School of Medicine

    - 2016

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Research History

  • Asahikawa Medical College   Assistant Professor

    2021.4

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  • Okayama University   Graduate School of Medicine , Dentistry and Pharmaceutical Sciences Botanical Garden Attached to Graduate School of Medicine , Dentistry and Pharmaceutical Sciences   Researcher

    2016.4 - 2018.10

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  • 岡山大学大学院   医歯薬学総合研究科   研究員

    2016.4 - 2018.10

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Professional Memberships

Papers

  • Stretch-induced reactive oxygen species contribute to the Frank-Starling mechanism. International journal

    Keiko Kaihara, Hiroaki Kai, Yumiko Chiba, Keiji Naruse, Gentaro Iribe

    The Journal of physiology   2023.4

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    Language:English   Publishing type:Research paper (scientific journal)  

    Myocardial stretch physiologically activates NADPH oxidase 2 (NOX2) to increase reactive oxygen species (ROS) production. Although physiological low-level ROS are known to be important as signalling molecules, the role of stretch-induced ROS in the intact myocardium remains unclear. To address this, we investigated the effects of stretch-induced ROS on myocardial cellular contractility and calcium transients in C57BL/6J and NOX2-/- mice. Axial stretch was applied to the isolated cardiomyocytes using a pair of carbon fibres attached to both cell ends to evaluate stretch-induced modulation in the time course of the contraction curve and calcium transient, as well as to evaluate maximum cellular elastance, an index of cellular contractility, which is obtained from the end-systolic force-length relationship. In NOX2-/- mice, the peak calcium transient was not altered by stretch, as that in wild-type mice, but the lack of stretch-induced ROS delayed the rise of calcium transients and reduced contractility. Our mathematical modelling studies suggest that the augmented activation of ryanodine receptors by stretch-induced ROS causes a rapid and large increase in the calcium release flux, resulting in a faster rise in the calcium transient. The slight increase in the magnitude of calcium transients is offset by a decrease in sarcoplasmic reticulum calcium content as a result of ROS-induced calcium leakage, but the faster rise in calcium transients still maintains higher contractility. In conclusion, a physiological role of stretch-induced ROS is to increase contractility to counteract a given preload, that is, it contributes to the Frank-Starling law of the heart. KEY POINTS: Myocardial stretch increases the production of reactive oxygen species by NADPH oxidase 2. We used NADPH oxidase 2 knockout mice to elucidate the physiological role of stretch-induced reactive oxygen species in the heart. We showed that stretch-induced reactive oxygen species modulate the rising phase of calcium transients and increase myocardial contractility. A mathematical model simulation study demonstrated that rapid activation of ryanodine receptors by reactive oxygen species is important for increased contractility. This response is advantageous for the myocardium, which must contract against a given preload.

    DOI: 10.1113/JP284283

    PubMed

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  • Olfactory receptors are expressed in pancreatic β-cells and promote glucose-stimulated insulin secretion. International journal

    Yuichiro Munakata, Tetsuya Yamada, Junta Imai, Kei Takahashi, Sohei Tsukita, Yuta Shirai, Shinjiro Kodama, Yoichiro Asai, Takashi Sugisawa, Yumiko Chiba, Keizo Kaneko, Kenji Uno, Shojiro Sawada, Hiroyasu Hatakeyama, Makoto Kanzaki, Jun-Ichi Miyazaki, Yoshitomo Oka, Hideki Katagiri

    Scientific reports   8 ( 1 )   1499 - 1499   2018.1

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    Language:English   Publishing type:Research paper (scientific journal)  

    Olfactory receptors (ORs) mediate olfactory chemo-sensation in OR neurons. Herein, we have demonstrated that the OR chemo-sensing machinery functions in pancreatic β-cells and modulates insulin secretion. First, we found several OR isoforms, including OLFR15 and OLFR821, to be expressed in pancreatic islets and a β-cell line, MIN6. Immunostaining revealed OLFR15 and OLFR821 to be uniformly expressed in pancreatic β-cells. In addition, mRNAs of Olfr15 and Olfr821 were detected in single MIN6 cells. These results indicate that multiple ORs are simultaneously expressed in individual β-cells. Octanoic acid, which is a medium-chain fatty acid contained in food and reportedly interacts with OLFR15, potentiated glucose-stimulated insulin secretion (GSIS), thereby improving glucose tolerance in vivo. GSIS potentiation by octanoic acid was confirmed in isolated pancreatic islets and MIN6 cells and was blocked by OLFR15 knockdown. While Gα olf expression was not detectable in β-cells, experiments using inhibitors and siRNA revealed that the pathway dependent on phospholipase C-inositol triphosphate, rather than cAMP-protein kinase A, mediates GSIS potentiation via OLFR15. These findings suggest that the OR system in pancreatic β-cells has a chemo-sensor function allowing recognition of environmental substances obtained from food, and potentiates insulin secretion in a cell-autonomous manner, thereby modulating systemic glucose metabolism.

    DOI: 10.1038/s41598-018-19765-5

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  • [Dapagliflozin, a Sodium-Glucose Co-transporter-2 Inhibitor, Acutely Reduces Energy Expenditure in Brown Adipose Tissue via Neural Signals in Mice].

    Yumiko Chiba, Tetsuya Yamada, Hideki Katagiri

    Yakugaku zasshi : Journal of the Pharmaceutical Society of Japan   138 ( 7 )   945 - 954   2018

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    Language:Japanese  

    Selective sodium glucose transporter-2 inhibitor (SGLT2i) treatment promotes urinary glucose excretion, thereby reducing blood glucose as well as body weight. However, only limited body weight reductions are achieved with SGLT2i administration. Hyperphagia is reportedly one of the causes of this limited weight loss. However, the effects of SGLT2i on systemic energy expenditure have not been fully elucidated. We investigated the acute effects of dapagliflozin, an SGLT2i, on systemic energy expenditure in mice. Eighteen hours after dapagliflozin administration, oxygen consumption and brown adipose tissue (BAT) expression of ucp1, a thermogenesis-related gene, were significantly decreased as compared with those after vehicle administration. In addition, dapagliflozin significantly suppressed norepinephrine (NE) turnover in BAT and c-fos expression in the rostral raphe pallidus nucleus (rRPa), which contains the sympathetic premotor neurons responsible for thermogenesis. These findings indicate that the dapagliflozin-mediated acute decrease in energy expenditure involves a reduction in BAT thermogenesis via decreased sympathetic nerve activity from the rRPa. Furthermore, common hepatic branch vagotomy abolished the reductions in ucp1 expression, NE contents in BAT, and c-fos expression in the rRPa. In addition, alterations in hepatic carbohydrate metabolism, such as decreases in glycogen contents and upregulation of phosphoenolpyruvate carboxykinase, occurred prior to the suppression of BAT thermogenesis, e.g., 6 h after dapagliflozin treatment. Collectively, these results suggest that SGLT2i acutely suppresses energy expenditure in BAT via regulation of an interorgan neural network consisting of the common hepatic vagal branch and sympathetic nerves.

    DOI: 10.1248/yakushi.17-00223-3

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    J-GLOBAL

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  • Activation of the Hypoxia Inducible Factor 1α Subunit Pathway in Steatotic Liver Contributes to Formation of Cholesterol Gallstones. International journal

    Yoichiro Asai, Tetsuya Yamada, Sohei Tsukita, Kei Takahashi, Masamitsu Maekawa, Midori Honma, Masanori Ikeda, Keigo Murakami, Yuichiro Munakata, Yuta Shirai, Shinjiro Kodama, Takashi Sugisawa, Yumiko Chiba, Yasuteru Kondo, Keizo Kaneko, Kenji Uno, Shojiro Sawada, Junta Imai, Yasuhiro Nakamura, Hiroaki Yamaguchi, Kozo Tanaka, Hironobu Sasano, Nariyasu Mano, Yoshiyuki Ueno, Tooru Shimosegawa, Hideki Katagiri

    Gastroenterology   152 ( 6 )   1521 - 1535   2017.5

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    Language:English   Publishing type:Research paper (scientific journal)  

    BACKGROUND & AIMS: Hypoxia-inducible factor 1α subunit (HIF1A) is a transcription factor that controls the cellular response to hypoxia and is activated in hepatocytes of patients with nonalcoholic fatty liver disease (NAFLD). NAFLD increases the risk for cholesterol gallstone disease by unclear mechanisms. We studied the relationship between HIF1A and gallstone formation associated with liver steatosis. METHODS: We performed studies with mice with inducible disruption of Hif1a in hepatocytes via a Cre adenoviral vector (inducible hepatocyte-selective HIF1A knockout [iH-HIFKO] mice), and mice without disruption of Hif1a (control mice). Mice were fed a diet rich in cholesterol and cholate for 1 or 2 weeks; gallbladders were collected and the number of gallstones was determined. Livers and biliary tissues were analyzed by histology, quantitative reverse-transcription polymerase chain reaction, immunohistochemistry, and immunoblots. We measured concentrations of bile acid, cholesterol, and phospholipid in bile and rates of bile flow. Primary hepatocytes and cholangiocytes were isolated and analyzed. HIF1A was knocked down in Hepa1-6 cells with small interfering RNAs. Liver biopsy samples from patients with NAFLD, with or without gallstones, were analyzed by quantitative reverse-transcription polymerase chain reaction. RESULTS: Control mice fed a diet rich in cholesterol and cholate developed liver steatosis with hypoxia; levels of HIF1A protein were increased in hepatocytes around central veins and 90% of mice developed cholesterol gallstones. Only 20% of the iH-HIFKO mice developed cholesterol gallstones. In iH-HIFKO mice, the biliary lipid concentration was reduced by 36%, compared with control mice, and bile flow was increased by 35%. We observed increased water secretion from hepatocytes into bile canaliculi to mediate these effects, resulting in suppression of cholelithogenesis. Hepatic expression of aquaporin 8 (AQP8) protein was 1.5-fold higher in iH-HIFKO mice than in control mice. Under hypoxic conditions, cultured hepatocytes increased expression of Hif1a, Hmox1, and Vegfa messenger RNAs (mRNAs), and down-regulated expression of AQP8 mRNA and protein; AQP8 down-regulation was not observed in cells with knockdown of HIF1A. iH-HIFKO mice had reduced inflammation and mucin deposition in the gallbladder compared with control mice. Liver tissues from patients with NAFLD with gallstones had increased levels of HIF1A, HMOX1, and VEGFA mRNAs, compared with livers from patients with NAFLD without gallstones. CONCLUSIONS: In steatotic livers of mice, hypoxia up-regulates expression of HIF1A, which reduces expression of AQP8 and concentrates biliary lipids via suppression of water secretion from hepatocytes. This promotes cholesterol gallstone formation. Livers from patients with NAFLD and gallstones express higher levels of HIF1A than livers from patients with NAFLD without gallstones.

    DOI: 10.1053/j.gastro.2017.01.001

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  • MicroRNAs 106b and 222 Improve Hyperglycemia in a Mouse Model of Insulin-Deficient Diabetes via Pancreatic β-Cell Proliferation. International journal

    Sohei Tsukita, Tetsuya Yamada, Kei Takahashi, Yuichiro Munakata, Shinichiro Hosaka, Hironobu Takahashi, Junhong Gao, Yuta Shirai, Shinjiro Kodama, Yoichiro Asai, Takashi Sugisawa, Yumiko Chiba, Keizo Kaneko, Kenji Uno, Shojiro Sawada, Junta Imai, Hideki Katagiri

    EBioMedicine   15   163 - 172   2017.2

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    Language:English   Publishing type:Research paper (scientific journal)  

    Major symptoms of diabetes mellitus manifest, once pancreatic β-cell numbers have become inadequate. Although natural regeneration of β-cells after injury is very limited, bone marrow (BM) transplantation (BMT) promotes their regeneration through undetermined mechanism(s) involving inter-cellular (BM cell-to-β-cell) crosstalk. We found that two microRNAs (miRNAs) contribute to BMT-induced β-cell regeneration. Screening murine miRNAs in serum exosomes after BMT revealed 42 miRNAs to be increased. Two of these miRNAs (miR-106b-5p and miR-222-3p) were shown to be secreted by BM cells and increased in pancreatic islet cells after BMT. Treatment with the corresponding anti-miRNAs inhibited BMT-induced β-cell regeneration. Furthermore, intravenous administration of the corresponding miRNA mimics promoted post-injury β-cell proliferation through Cip/Kip family down-regulation, thereby ameliorating hyperglycemia in mice with insulin-deficient diabetes. Thus, these identified miRNAs may lead to the development of therapeutic strategies for diabetes.

    DOI: 10.1016/j.ebiom.2016.12.002

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  • Dapagliflozin, a Sodium-Glucose Co-Transporter 2 Inhibitor, Acutely Reduces Energy Expenditure in BAT via Neural Signals in Mice. International journal

    Yumiko Chiba, Tetsuya Yamada, Sohei Tsukita, Kei Takahashi, Yuichiro Munakata, Yuta Shirai, Shinjiro Kodama, Yoichiro Asai, Takashi Sugisawa, Kenji Uno, Shojiro Sawada, Junta Imai, Kazuhiro Nakamura, Hideki Katagiri

    PloS one   11 ( 3 )   e0150756   2016

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    Language:English   Publishing type:Research paper (scientific journal)  

    Selective sodium glucose cotransporter-2 inhibitor (SGLT2i) treatment promotes urinary glucose excretion, thereby reducing blood glucose as well as body weight. However, only limited body weight reductions are achieved with SGLT2i treatment. Hyperphagia is reportedly one of the causes of this limited weight loss. However, the effects of SGLT2i treatment on systemic energy expenditure have not been fully elucidated. Herein, we investigated the acute effects of dapagliflozin, a SGLT2i, on systemic energy expenditure in mice. Eighteen hours after dapagliflozin treatment oxygen consumption and brown adipose tissue (BAT) expression of ucp1, a thermogenesis-related gene, were significantly decreased as compared to those after vehicle treatment. In addition, dapagliflozin significantly suppressed norepinephrine (NE) turnover in BAT and c-fos expression in the rostral raphe pallidus nucleus (rRPa) which contains the sympathetic premotor neurons responsible for thermogenesis. These findings indicate that the dapagliflozin-mediated acute decrease in energy expenditure involves a reduction in BAT thermogenesis via decreased sympathetic nerve activity from the rRPa. Furthermore, common hepatic branch vagotomy abolished the reductions in ucp1 expression and NE contents in BAT and c-fos expression in the rRPa. In addition, alterations in hepatic carbohydrate metabolism, such as decreases in glycogen contents and upregulation of phosphoenolpyruvate carboxykinase, manifested prior to the suppression of BAT thermogenesis, e.g. 6 hours after dapagliflozin treatment. Collectively, these results suggest that SGLT2i treatment acutely suppresses energy expenditure in BAT via regulation of an inter-organ neural network consisting of the common hepatic vagal branch and sympathetic nerves.

    DOI: 10.1371/journal.pone.0150756

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  • Hepatic DEPTOR Expression Improves Systemic Insulin Resistance Reviewed

    Yumiko Chiba, Kenji Uno, Hideki Katagiri

    DIABETES   61   A455 - A455   2012.6

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    Language:English   Publisher:AMER DIABETES ASSOC  

    Web of Science

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MISC

  • 心筋の伸展刺激誘発性ROS産生のメカノトランスダクション

    千葉弓子, 貝原恵子, 入部玄太郎

    日本生体医工学会大会プログラム・抄録集(Web)   63rd   2024

  • SGLT2阻害薬は心臓の機械的負荷由来の酸化ストレスを抑制する

    千葉弓子, 金井秀太, 板倉正道, 入部玄太郎

    日本循環制御医学会総会・学術集会プログラム・抄録集   44th   2023

  • SGLT2 inhibitors suppress myocardial mechanically induced oxidative stress

    千葉弓子, 入部玄太郎

    月刊細胞   55 ( 4 )   2023

  • Dapagliflozin, a Sodium-Glucose Co-transporter-2 Inhibitor, Acutely Reduces Energy Expenditure in Brown Adipose Tissue via Neural Signals in Mice

    千葉弓子, 山田哲也, 片桐秀樹

    YAKUGAKU ZASSHI (Web)   138 ( 7 )   2018

  • 中枢末梢臓器間連関を介したSGLT2阻害薬によるエネルギー代謝調節機構

    山田哲也, 千葉弓子, 片桐秀樹

    日本薬学会年会要旨集(CD-ROM)   137th   2017

  • SGLT2阻害薬投与により個体のエネルギー消費は低下する

    千葉弓子, 山田哲也, 突田壮平, 高橋圭, 宗像佑一郎, 白井勇太, 児玉慎二郎, 浅井洋一郎, 椙澤貴志, 高橋広延, 穂坂真一郎, 片桐秀樹

    糖尿病(Web)   59 ( Suppl )   2016

  • 嗅覚受容体は膵β細胞に発現しグルコース応答性インスリン分泌を促進する

    宗像佑一郎, 山田哲也, 今井淳太, 突田壮平, 高橋圭, 白井勇太, 児玉慎二郎, 浅井洋一郎, 椙澤貴志, 千葉弓子, 高橋広延, 穂坂真一郎, 井泉知仁, 高俊弘, 宇野健司, 澤田正二郎, 畠山裕康, 神崎展, 宮崎純一, 片桐秀樹

    糖尿病(Web)   59 ( Suppl )   2016

  • 肝臓におけるhypoxia-inducible factor1αの活性化はコレステロール胆石形成を促進する

    浅井洋一郎, 山田哲也, 突田壮平, 高橋圭, 前川正充, 本間緑, 宗像佑一郎, 白井勇太, 児玉慎二郎, 椙澤貴志, 千葉弓子, 高橋広延, 穂坂真一郎, 近藤泰輝, 金子慶三, 宇野健司, 澤田正二郎, 今井淳太, 中村保宏, 山口浩明, 岡芳知, 笹野公伸, 眞野成康, 上野義之, 下瀬川徹, 片桐秀樹, 片桐秀樹

    日本生化学会大会(Web)   88th   2015

  • SGLT2阻害薬投与が個体のエネルギー消費に及ぼす影響の解明

    千葉弓子, 山田哲也, 突田壮平, 高橋圭, 宗像佑一郎, 白井勇太, 児玉慎二郎, 浅井洋一郎, 椙澤貴志, 高橋広延, 穂坂真一郎, 片桐秀樹

    高血圧関連疾患モデル学会学術総会抄録集   51st   2015

  • mTOR抑制因子であるDEPTORが糖エネルギー代謝に与える影響の解明

    千葉弓子, 宇野健司, 金子慶三, 澤田正二郎, 長谷川豊, 今井淳太, 山田哲也, 山田哲也, 石垣泰, 岡芳知, 片桐秀樹, 片桐秀樹

    糖尿病   55 ( Supplement 1 )   2012

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Presentations

  • Empagliflozin reduced stretch-induced reactive oxygen species production in mice cardiomyocyte by inhibiting sodium-myoinositol cotransporter 1, SMIT1

    Gentaro IRIBE, Yumiko CHIBA

    The 52nd NAITO conference on Frontier of Physical and Mechanical Biology  2024.10 

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    Event date: 2024.10

    Language:English  

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  • 臓器間ネットワークを介した糖尿病性心筋症発症メカニズム

    千葉弓子, 古部瑛莉子, 田中宏樹, 山本幸司, 入部玄太郎

    第104回 日本生理学会北海道地方会  2024.9 

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    Event date: 2024.9

    Language:Japanese   Presentation type:Oral presentation (general)  

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  • The mechanotransduction of stretch-induced ROS production in cardiomyocyte

    The 63rd Annual Conference of Japanese Society for Medical and Biological Engineering  2024.5 

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    Event date: 2024.5

    Language:Japanese   Presentation type:Poster presentation  

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  • 高脂肪食負荷により心筋細胞の急性伸展誘発性ROS産生は増加する

    千葉弓子, 入部玄太郎

    第101回 日本生理学会大会 

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    Event date: 2024.3

    Language:English   Presentation type:Oral presentation (general)  

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  • Myocardial acute stretch-induced cellular ROS production is enhanced in high fat diet fed mice

    Yumiko CHIBA, Gentaro IRIBE

    The Annual Meeting of The Physiologocal Society of Japan  2024.3 

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    Event date: 2024.3

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  • 高脂肪食負荷マウスでは臓器間ネットワークを介して心筋の機械的負荷誘発性ROS産生を増強する

    千葉弓子, 入部玄太郎

    第103回 日本生理学会北海道地区会 

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    Event date: 2023.9

    Language:Japanese   Presentation type:Oral presentation (general)  

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  • SGLT2阻害薬は心臓の機械的負荷由来の酸化ストレスを抑制する

    千葉弓子, 入部玄太郎

    第44回 日本循環制御医学会 総会・学術集会 

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    Event date: 2023.6 - 2023.7

    Language:Japanese   Presentation type:Oral presentation (general)  

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  • SGLT2阻害薬はSMIT1を介して心筋の急性伸展刺激誘発性ROS産生を抑制する

    千葉弓子, 金井秀太, 板倉正道, 入部玄太郎

    北海道医学大会生理系分科会 

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    Event date: 2022.9

    Language:Japanese   Presentation type:Oral presentation (general)  

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  • Myocardial acute stretch-induced increase in ROS production is mediated by sodium myoinositol cotransporter 1 International conference

    Yumiko Chiba, Shuta Kanai, Masamichi Itakura, Gentaro Iribe

    9th World Congress of Biomechanics 

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    Event date: 2022.7

    Language:English   Presentation type:Oral presentation (general)  

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  • Empagliflozin, a sodium glucose cotransporter 2 inhibitor, reduces acute stretch-induced ROS production in mice ventricular cardiomyocytes

    Shuta Kanai, Masamichi Itakura, Yumiko Chiba, Gentaro Iribe

    第99回 日本生理学会大会 

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    Event date: 2022.3

    Language:Japanese   Presentation type:Oral presentation (general)  

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Research Projects

  • 心臓の生理的ROSシグナリングと心不全の過剰酸化ストレスの関係

    Grant number:22K16125  2022.4 - 2025.3

    日本学術振興会  科学研究費助成事業  若手研究

    千葉 弓子

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    Grant amount:\4,680,000 ( Direct Cost: \3,600,000 、 Indirect Cost:\1,080,000 )

    近年、糖尿病と心機能障害が合併して起こる糖尿病性心筋症が注目されているが、臨床統計学上、糖尿病有病者の心不全発症率は非糖尿病患者の心不全発症率と比べておよそ3倍となっているのに加え、予後も悪い。心不全を発症する原因として高血圧性心疾患や弁膜症のような心筋細胞への慢性的な機械的負荷による酸化ストレスが関与していることが知られている。これらの背景から、高脂肪食を負荷させた肥満・糖尿病モデルマウスであるdiet induced obesity (DIO)マウスの心筋細胞の機械的負荷によって発生する活性酸素種(reactive oxygen species: ROS)を測定したところ、普通食マウス(lean)に比べて増加していることが明らかとなった。
    また、心筋細胞の機械的負荷によるROS産生現象の一連の分子メカニズムを探索したところ、phospholipase (PLC)からtransient receptor potential canonical 3 (TRPC3)へ続く分子シグナリングが関与していることがわかった。
    心筋細胞の機械的負荷によって産生されるROSは、変動する血行動態にただちに対応して心臓の出力を調節するための生理的な制御機構であるが、肥満・糖尿病患者ではこの生理的なROSが過剰に産生されることで病的なROSとなり、心不全などの病態が惹起されるのではないか、と考えている。

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  • Mechanisms of heart failure benefits from SGLT2 inhibitor using a single cardiomyocyte stretch system

    Grant number:21K20886  2021.8 - 2023.3

    Japan Society for the Promotion of Science  Grants-in-Aid for Scientific Research  Grant-in-Aid for Research Activity Start-up

    Chiba Yumiko

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    Grant amount:\3,120,000 ( Direct Cost: \2,400,000 、 Indirect Cost:\720,000 )

    We found empagliflozin (EMPA) significantly suppresses acute stretch-induced ROS production in cardiomyocyte. Since SGLT2 is not expressed in the heart, we hypothesized that SMIT1, a member of the SGLT family, is involved in this phenomenon. We stimulated SMIT1 by administrating myoinositol and found that myoinositol induced ROS production, which is abolished by EMPA. From these results, we conclude that SGLT2 inhibitors suppress acute stretch-induced ROS production by inhibiting SMIT1 activity.

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Teaching Experience

  • 生理学

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  • 生理学

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  • 医学チュートリアル

    Institution:旭川医科大学

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  • 生理学実習

    Institution:旭川医科大学

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  • 機能形態基礎医学Ⅱ

    Institution:旭川医科大学

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