**3.9 SGLT2 inhibitors**

Sodium-glucose cotransporter-2 (SGLT2) inhibitors are a group of sodiumdepended glucose transporters which are primarily expressed in the proximal tube epithelium of the kidney and are responsible for the majority (over 90%) of filter glucose reabsorption. Inhibitors of the SGLT2 result in the increased urinary excretion of glucose and the subsequent decrease of serum glucose levels. Their use has been shown to achieve weight loss in many people due to the extensive fluid excretion and the reduction of cardiovascular risk [35].

The above effects have shown that treatment with either Canagliflozin, Empagliflozin, or Dapagliflozine reduced hyperglycemia followed by lower levels of liver enzymes and improvement of liver steatosis. It is hypothesized that the weight loss caused by SGLT2 inhibitors was strongly associated with these effects since SGLT2 is not expressed in the liver (**Figure 10**). A large retrospective study showed a comparative advantage in the use of Canagliflozin and Dapagliflozin in the improvement of hepatic level enzymes independently of body weight loss and HbA1C reduction. More studies with histologic evaluation need to be conducted to evaluate the usefulness of these agents in NAFLD/NASH [36, 37].

### **Figure 10.**

*Potential action of SGLT2 in liver and contribution in NAFLD/NASH treatment.*
