Beyond glucose lowering, SGLT-2 inhibitors demonstrate pleiotropic effects including the following: (1) gradual and sustained volume reduction through physiological diuresis, potentially providing more stable inner ear fluid homeostasis compared to traditional diuretics; (2) anti-inflammatory properties, reducing circulating pro-inflammatory cytokines that may contribute to MD pathogenesis; and (3) microvascular improvements through enhanced endothelial function [14,15]. Here, SLC5A2 is linked to Menkes disease.