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Incretin therapy has emerged as one of the most popular medications for type 2 diabetes. We have previously reported that the dipeptidyl peptidase-4 (DPP-4) inhibitor linagliptin attenuates neointima formation after vascular injury in non-diabetic mice. In the present study, we examined whether combined treatment with linagliptin and the sodium glucose cotransporter 2 (SGLT2) inhibitor empagliflozin attenuates neointima formation in diabetic mice after vascular injury. Diabetic db/db mice were treated with 3 mg/kg/day linagliptin and/or 30 mg/kg/day empagliflozin from 5 to 10 weeks of age. Body weight was significantly decreased by empagliflozin and the combined treatment. Blood glucose levels and glucose tolerance test results were significantly improved by empagliflozin and the combined treatment, but not by linagliptin. An insulin tolerance test suggested that linagliptin and empagliflozin did not improve insulin sensitivity. In a model of guidewire-induced femoral artery injury in diabetic mice, neointima formation was significantly decreased in mice subjected to combined treatment. In an in vitro assay using rat aortic smooth muscle cells (RASMC), 100, 500, or 1000 nM empagliflozin significantly decreased the RASMC number in a dose-dependent manner. A further significant reduction in RASMC proliferation was observed after combined treatment with 10 nM linagliptin and 100 nM empagliflozin. These data suggest that combined treatment with the DPP-4 inhibitor linagliptin and SGLT2 inhibitor empagliflozin attenuates neointima formation after vascular injury in diabetic mice in vivo and smooth muscle cell proliferation in vitro. Keywords: DPP-4I, SGLT2I, Neointima formation, VSMC proliferation

Fibrodysplasia ossificans progressiva (FOP) is a rare autosomal dominant congenital disorder characterized by progressive heterotopic ossification in muscle tissues. A constitutively activated mutation of a bone morphogenetic protein (BMP) receptor, ALK2, has been identified in patients with FOP. We report here that four structurally related compounds, lucilactaene, hydroxylucilactaene, NG-391 and NG-393, produced by fungal strain Fusarium sp. B88, inhibit BMP signaling in vitro. Alkaline phosphatase activity, a marker enzyme of osteoblastic differentiation, was decreased in C2C12 myoblasts stably expressing mutant ALK2 by treatment with those compounds with IC50 values of 5.7, 6.8, 6.9 and 6.1 μM, respectively. Furthermore, NG-391 and NG-393 inhibited BMP-specific luciferase reporter activity, which is directly regulated by transcription factor Smads, with IC50 values of 1.4 and 2.1 μM, respectively. These findings suggest that these fungal metabolites may provide a new direction in the development of FOP therapeutics.