Dose and sex-specificity in Canagliflozin-mediated neuroprotection in aging mice

Canagliflozin (Cana), an SGLT2 inhibitor prescribed for type 2 diabetes, extends median lifespan by 14% in male but not female UM-HET3 mice at 180 ppm, with male-specific neuroprotective effects, despite females accumulating higher drug concentrations in blood and brain. Here, we tested whether reducing the dose to a subclinical level of 60 ppm could provide neuroprotective benefits in females by reducing drug accumulation. Starting treatment at 7 months of age, Cana at 60 ppm improved glucose tolerance in both sexes at 18 months and increased water and food intake, consistent with SGLT2 inhibition, but produced only a transient reduction in fat mass in males after one month on diet, with no sustained effect on body weight in either sex. At 60 ppm, Cana did not improve cognitive function at 18 months or reduce neuroinflammation in males, whereas females showed reduced hippocampal microgliosis and astrogliosis at 24 months. Pharmacokinetic analysis demonstrated that females accumulated 3-to 5-fold higher Cana concentrations than males across brain regions, blood, and liver. Together, these findings demonstrate that neither dose reduction nor greater drug accumulation drives neuroprotective benefit in females, indicating fundamental sex differences in the biological response to SGLT2 inhibition and suggesting that the sex-specific longevity effects of Cana are not simply a matter of dose.