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Qiao H, Li Y, Xu B, Lu Z, Zhang J, Meng D, He S, Huang J. Metformin Can Be Safely Used in Patients Exposed to Contrast Media: A Systematic Review and Meta-Analysis. Cardiology 2022; 147:469-478. [PMID: 36202076 PMCID: PMC9808674 DOI: 10.1159/000527384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 08/11/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND There have been few studies published on the use of contrast media (CM) in metformin-treated patients. In this study, we conducted a systematic review and meta-analysis to investigate the relationship between metformin and contrast-induced acute kidney injury (CI-AKI). METHODS A comprehensive search of the Medline, PubMed, Embase, and Web of Science databases for literature on associations between metformin use and CI-AKI incidence was conducted. The pooled odds ratio (OR), or relative risk, as well as the corresponding 95% confidence intervals (CIs), was calculated to assess the relationship between metformin and CI-AKI risk as well as the incidence of lactic acidosis (LA). RESULTS In total, seven studies met our eligibility criteria on associations between metformin use and CI-AKI incidence, comprising 2,325 individuals, with 279 new cases of CI-AKI exposed to CM. The pooled analysis revealed no statistically significant increase in the risk of CI-AKI development in patients who used metformin continuously (random-effects OR: 1.15, 95% CI: 0.70-1.90, p = 0.57). No cases of LA that occurred during CM exposure were reported. CONCLUSION Metformin can be safely used in patients with moderate renal impairment (eGFR ≥ 30 mL/min/1.73 m2) during CM exposure.
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Affiliation(s)
- Hua Qiao
- Department of Cardiology, JinTan First People's Hospital, Changzhou, China
| | - Yimin Li
- Department of Cardiology, Sir Run Run Hospital, Nanjing Medical University, Nanjing, China,*Yimin Li,
| | - Bao Xu
- Department of Cardiology, Northern Jiangsu People's Hospital, Yangzhou, China
| | - Zhiping Lu
- Department of Cardiology, Nanjing Chest Hospital, Nanjing, China
| | - Jing Zhang
- Department of Cardiology, Northern Jiangsu People's Hospital, Yangzhou, China
| | - Danxin Meng
- Department of Cardiology, Nanjing Chest Hospital, Nanjing, China
| | - Shenghu He
- Department of Cardiology, Northern Jiangsu People's Hospital, Yangzhou, China
| | - Jin Huang
- Department of Cardiology, Nanjing Chest Hospital, Nanjing, China
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2
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Metabolic Action of Metformin. Pharmaceuticals (Basel) 2022; 15:ph15070810. [PMID: 35890109 PMCID: PMC9317619 DOI: 10.3390/ph15070810] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 06/14/2022] [Accepted: 06/26/2022] [Indexed: 12/12/2022] Open
Abstract
Metformin, a cheap and safe biguanide derivative, due to its ability to influence metabolism, is widely used as a first-line drug for type 2 diabetes (T2DM) treatment. Therefore, the aim of this review was to present the updated biochemical and molecular effects exerted by the drug. It has been well explored that metformin suppresses hepatic glucose production in both AMPK-independent and AMPK-dependent manners. Substantial scientific evidence also revealed that its action is related to decreased secretion of lipids from intestinal epithelial cells, as well as strengthened oxidation of fatty acids in adipose tissue and muscles. It was recognized that metformin’s supra-therapeutic doses suppress mitochondrial respiration in intestinal epithelial cells, whereas its therapeutic doses elevate cellular respiration in the liver. The drug is also suggested to improve systemic insulin sensitivity as a result of alteration in gut microbiota composition, maintenance of intestinal barrier integrity, and alleviation of low-grade inflammation.
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3
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Wasner HK. Metformin's Mechanism of Action Is Stimulation of the Biosynthesis of the Natural Cyclic AMP Antagonist Prostaglandylinositol Cyclic Phosphate (Cyclic PIP). Int J Mol Sci 2022; 23:ijms23042200. [PMID: 35216316 PMCID: PMC8876105 DOI: 10.3390/ijms23042200] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 02/05/2022] [Accepted: 02/10/2022] [Indexed: 11/16/2022] Open
Abstract
Metformin is the leading drug for treating type 2 diabetics, but the mechanism of action of metformin, despite some suggested mechanisms such as the activation of the AMP-kinase, is largely unknown. Among its many positive effects are the reduction of blood glucose levels, the inhibition of cyclic AMP synthesis, gluconeogenesis and an increase in sensitivity to insulin. Recent studies have described the natural antagonist of cyclic AMP, prostaglandylinositol cyclic phosphate. Synthesis of cyclic PIP is stimulated in all organs by hormones such as insulin and also by drugs such as metformin. Its primary action is to trigger the dephosphorylation of proteins/enzymes, phosphorylated on serine/threonine residues. Cyclic PIP triggers many of the regulations requested by insulin. The parallels between the beneficial effects of metformin and the regulations triggered by cyclic PIP suggest that the mechanism of action of this key drug may well be explained by its stimulation of the synthesis of cyclic PIP.
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Affiliation(s)
- Heinrich K Wasner
- BioReg Biopharm, Technology Innovation Laboratory, University of Illinois at Chicago, 2242 West Harrison St., Ste. 201, Chicago, IL 60612, USA
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Shi YL, Zhang YP, Luo H, Xu F, Gao JM, Shi JS, Gong QH. Trilobatin, a Natural Food Additive, Exerts Anti-Type 2 Diabetes Effect Mediated by Nrf2/ARE and IRS-1/GLUT2 Signaling Pathways. Front Pharmacol 2022; 13:828473. [PMID: 35153796 PMCID: PMC8829035 DOI: 10.3389/fphar.2022.828473] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 01/06/2022] [Indexed: 12/23/2022] Open
Abstract
Oxidative stress and aberrant insulin signaling transduction play vital roles in type 2 diabetes mellitus (T2DM). Our previous research has demonstrated that trilobatin (TLB), derived from the leaves of Lithocarpus Polystachyus (Wall.), exhibits a potent antioxidative profile. In the current study, we investigated the anti-T2DM effect of TLB on KK-Ay diabetic mice and further explored the potential mechanisms. Our results showed that TLB significantly reduced the high fasting blood glucose level and insulin resistance and promoted the tolerances to exogenous glucose and insulin in KK-Ay mice. Moreover, TLB reduced the content of reactive oxygen species; enhanced antioxidant enzymes activities, including serum catalase, glutathione peroxidase, and superoxide dismutase; and regulated the abnormal parameters of lipid metabolism, including triglyceride, high-density lipoprotein-cholesterol, low-density lipoprotein-cholesterol, and free fatty acid, as evidenced by enzyme-linked immunosorbent assay. Additionally, TLB markedly ameliorated the pancreatic islet morphology near normal and increased the insulin expression of the islet. Whereafter, TLB promoted Nrf2 that was translocated from cytoplasm to nucleus. Moreover, it increased the protein expressions of HO-1, NQO-1, and GLUT-2, and phosphorylation levels of Akt and GSK-3βSer 9 and decreased the protein expressions of keap1 and phosphorylation levels of IRS-1Ser 307 and GSK-3βTyr 216. Taken together, our findings reveal that TLB exhibits an anti-T2DM effect in KK-Ay mice by activating the Nrf2/ARE signaling pathway and regulating insulin signaling transduction pathway, and TLB is promising to be developed into a novel candidate for the treatment of T2DM in clinic due to its favorable druggability.
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Affiliation(s)
- Yan-Ling Shi
- Key Laboratory of Basic Pharmacology of Ministry of Education and Joint International Research Laboratory of Ethnomedicine of Ministry of Education, Zunyi Medical University, Zunyi, China.,Key Laboratory of Basic Pharmacology of Guizhou Province, Zunyi Medical University, Zunyi, China
| | - Yue-Ping Zhang
- Key Laboratory of Basic Pharmacology of Ministry of Education and Joint International Research Laboratory of Ethnomedicine of Ministry of Education, Zunyi Medical University, Zunyi, China.,Key Laboratory of Basic Pharmacology of Guizhou Province, Zunyi Medical University, Zunyi, China
| | - Huan Luo
- Key Laboratory of Basic Pharmacology of Ministry of Education and Joint International Research Laboratory of Ethnomedicine of Ministry of Education, Zunyi Medical University, Zunyi, China.,Key Laboratory of Basic Pharmacology of Guizhou Province, Zunyi Medical University, Zunyi, China
| | - Fan Xu
- Spemann Graduate School of Biology and Medicine (SGBM), Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Jian-Mei Gao
- Key Laboratory of Basic Pharmacology of Ministry of Education and Joint International Research Laboratory of Ethnomedicine of Ministry of Education, Zunyi Medical University, Zunyi, China.,Key Laboratory of Basic Pharmacology of Guizhou Province, Zunyi Medical University, Zunyi, China.,Department of Pharmacology, School of Pharmacy, Zunyi Medical University, Zunyi, China
| | - Jing-Shan Shi
- Key Laboratory of Basic Pharmacology of Ministry of Education and Joint International Research Laboratory of Ethnomedicine of Ministry of Education, Zunyi Medical University, Zunyi, China.,Key Laboratory of Basic Pharmacology of Guizhou Province, Zunyi Medical University, Zunyi, China
| | - Qi-Hai Gong
- Key Laboratory of Basic Pharmacology of Ministry of Education and Joint International Research Laboratory of Ethnomedicine of Ministry of Education, Zunyi Medical University, Zunyi, China.,Key Laboratory of Basic Pharmacology of Guizhou Province, Zunyi Medical University, Zunyi, China
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Bastos-Silva VJ, Marinho AH, Bezerra da Silva JB, de Barros Sousa FA, Learsi S, Balikian P, Gomes de Araujo G. Acute metformin administration increases mean power and the early Power phase during a Wingate test in healthy male subjects. Eur J Sport Sci 2021; 22:1065-1072. [PMID: 34003071 DOI: 10.1080/17461391.2021.1930191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The present study tested the hypothesis that acute metformin would increase peak power measured during a Wingate test. Fourteen men (24 ± 6 years; 75.8 ± 10.2 kg; 177 ± 7 cm) participated in four test sessions, conducted in a crossover, counterbalanced, double-blind model. The first and second sessions consisted of anthropometric measurements and one Wingate test per day to assess test-retest reliability. In the last two sessions, the Wingate tests were performed on metformin (500 mg capsule, 1 hour before) or placebo (cellulose capsule, 1 hour before) condition. No differences were found between the placebo and metformin for peak power (1056.8 ± 215.8 W vs. 1095.2 ± 199.3 W, respectively; p = 0.24). Mean power (630.9 ± 87.8 W vs. 613.1 ± 94.8 W, respectively; p=0.01) and total work (18928 ± 2633 kJ vs. 18393 ± 2845 kJ, respectively; p = 0.01) in the metformin condition were higher than the placebo. The power were greater in metformin when compared to the placebo in moments 3 (p = 0.01), 4 (p = 0.01), 5 (p = 0.04), 6 (p = 0.04), 7 (p = 0.02), 8 (p = 0.03) and 9 (p = 0.01) seconds. There were no differences between conditions for the peak lactate (p = 0.08) and the rating of perceived exertion (p = 0.84). Acute metformin administration increased the early power phase and the mean power of a Wingate test.
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Affiliation(s)
- Victor José Bastos-Silva
- Laboratory of Applied Sports Science, Institute of Physical Education and Sports, PPGCS/PPGNUT, Federal University of Alagoas, Maceió, Brazil.,Maurício de Nassau University Center, Maceió, Brazil
| | - Alisson Henrique Marinho
- Laboratory of Applied Sports Science, Institute of Physical Education and Sports, PPGCS/PPGNUT, Federal University of Alagoas, Maceió, Brazil
| | | | - Filipe Antônio de Barros Sousa
- Laboratory of Applied Sports Science, Institute of Physical Education and Sports, PPGCS/PPGNUT, Federal University of Alagoas, Maceió, Brazil
| | - Sara Learsi
- Laboratory of Applied Sports Science, Institute of Physical Education and Sports, PPGCS/PPGNUT, Federal University of Alagoas, Maceió, Brazil
| | - Pedro Balikian
- Laboratory of Applied Sports Science, Institute of Physical Education and Sports, PPGCS/PPGNUT, Federal University of Alagoas, Maceió, Brazil
| | - Gustavo Gomes de Araujo
- Laboratory of Applied Sports Science, Institute of Physical Education and Sports, PPGCS/PPGNUT, Federal University of Alagoas, Maceió, Brazil
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Giaccari A, Solini A, Frontoni S, Del Prato S. Metformin Benefits: Another Example for Alternative Energy Substrate Mechanism? Diabetes Care 2021; 44:647-654. [PMID: 33608326 PMCID: PMC7896249 DOI: 10.2337/dc20-1964] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 12/03/2020] [Indexed: 02/03/2023]
Abstract
Since the UK Prospective Diabetes Study (UKPDS), metformin has been considered the first-line medication for patients with newly diagnosed type 2 diabetes. Though direct evidence from specific trials is still lacking, several studies have suggested that metformin may protect from diabetes- and nondiabetes-related comorbidities, including cardiovascular, renal, neurological, and neoplastic diseases. In the past few decades, several mechanisms of action have been proposed to explain metformin's protective effects, none being final. It is certain, however, that metformin increases lactate production, concentration, and, possibly, oxidation. Once considered a mere waste product of exercising skeletal muscle or anaerobiosis, lactate is now known to act as a major energy shuttle, redistributed from production sites to where it is needed. Through the direct uptake and oxidation of lactate produced elsewhere, all end organs can be rapidly supplied with fundamental energy, skipping glycolysis and its possible byproducts. Increased lactate production (and consequent oxidation) could therefore be considered a positive mechanism of action of metformin, except when, under specific circumstances, metformin and lactate become excessive, increasing the risk of lactic acidosis. We are proposing that, rather than considering metformin-induced lactate production as dangerous, it could be considered a mechanism through which metformin exerts its possible protective effect on the heart, kidneys, and brain and, to some extent, its antineoplastic action.
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Affiliation(s)
- Andrea Giaccari
- Center for Endocrine and Metabolic Diseases, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Anna Solini
- Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, Pisa, Italy
| | - Simona Frontoni
- Unit of Endocrinology, Diabetes and Metabolism, San Giovanni Calibita Fatebenefratelli Hospital, Rome, Italy
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Stefano Del Prato
- Section of Metabolic Diseases and Diabetes, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Matyukhin I, Patschan S, Ritter O, Patschan D. Etiology and Management of Acute Metabolic Acidosis: An Update. Kidney Blood Press Res 2020; 45:523-531. [PMID: 32663831 DOI: 10.1159/000507813] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 04/08/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The etiology of acute metabolic acidosis (aMA) is heterogeneous, and the consequences are potentially life-threatening. The aim of this article was to summarize the causes and management of aMA from a clinician's perspective. SUMMARY We performed a systematic search on PubMed, applying the following search terms: "acute metabolic acidosis," "lactic acidosis," "metformin" AND "acidosis," "unbalanced solutions" AND "acidosis," "bicarbonate" AND "acidosis" AND "outcome," "acute metabolic acidosis" AND "management," and "acute metabolic acidosis" AND "renal replacement therapy (RRT)/dialysis." The literature search did not consider diabetic ketoacidosis at all. Lactic acidosis evolves from various conditions, either with or without systemic hypoxia. The incidence of metformin-associated aMA is actually quite low. Unbalanced electrolyte preparations can induce hyperchloremic aMA. The latter potentially worsens kidney-related outcome parameters. Nevertheless, prospective and controlled data are missing at the moment. Recently, bicarbonate has been shown to improve clinically relevant endpoints in the critically ill, even if higher pH values (>7.3) are targeted. New therapeutics for aMA control are under development, since bicarbonate treatment can induce serious side effects. Key Messages: aMA is a frequent and potentially life-threatening complication of various conditions. Lactic acidosis might occur even in the absence of systemic hypoxia. The incidence of metformin-associated aMA is comparably low. Unbalanced electrolyte solutions induce hyperchloremic aMA, which most likely worsens the renal prognosis of critically ill patients. Bicarbonate, although potentially deleterious due to increased carbon dioxide production with subsequent intracellular acidosis, improves kidney-related endpoints in the critically ill.
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Affiliation(s)
- Igor Matyukhin
- Zentrum Innere Medizin 1, Kardiologie, Angiologie, Nephrologie, Klinikum Brandenburg, Medizinische Hochschule Brandenburg, Brandenburg an der Havel, Germany
| | - Susann Patschan
- Zentrum Innere Medizin 1, Kardiologie, Angiologie, Nephrologie, Klinikum Brandenburg, Medizinische Hochschule Brandenburg, Brandenburg an der Havel, Germany
| | - Oliver Ritter
- Zentrum Innere Medizin 1, Kardiologie, Angiologie, Nephrologie, Klinikum Brandenburg, Medizinische Hochschule Brandenburg, Brandenburg an der Havel, Germany
| | - Daniel Patschan
- Zentrum Innere Medizin 1, Kardiologie, Angiologie, Nephrologie, Klinikum Brandenburg, Medizinische Hochschule Brandenburg, Brandenburg an der Havel, Germany,
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Yang L, Chen F, Gao C, Chen J, Li J, Liu S, Zhang Y, Wang Z, Qian S. Design and synthesis of tricyclic terpenoid derivatives as novel PTP1B inhibitors with improved pharmacological property and in vivo antihyperglycaemic efficacy. J Enzyme Inhib Med Chem 2020; 35:152-164. [PMID: 31742469 PMCID: PMC6882489 DOI: 10.1080/14756366.2019.1690481] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Overexpression of protein tyrosine phosphatase 1B (PTP1B) induces insulin resistance in various basic and clinical research. In our previous work, a synthetic oleanolic acid (OA) derivative C10a with PTP1B inhibitory activity has been reported. However, C10a has some pharmacological defects and cytotoxicity. Herein, a structure-based drug design approach was used based on the structure of C10a to elaborate the smaller tricyclic core. A series of tricyclic derivatives were synthesised and the compounds 15, 28 and 34 exhibited the most PTP1B enzymatic inhibitory potency. In the insulin-resistant human hepatoma HepG2 cells, compound 25 with the moderate PTP1B inhibition and preferable pharmaceutical properties can significantly increase insulin-stimulated glucose uptake and showed the insulin resistance ameliorating effect. Moreover, 25 showed the improved in vivo antihyperglycaemic potential in the nicotinamide–streptozotocin-induced T2D. Our study demonstrated that these tricyclic derivatives with improved molecular architectures and antihyperglycaemic activity could be developed in the treatment of T2D.
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Affiliation(s)
- Lingling Yang
- Department of Pharmaceutical Engineering, College of Food and Bioengineering, Xihua University, Chengdu, China
| | - Feng Chen
- Department of Pharmaceutical Engineering, College of Food and Bioengineering, Xihua University, Chengdu, China
| | - Cheng Gao
- Department of Pharmaceutical Engineering, College of Food and Bioengineering, Xihua University, Chengdu, China
| | - Jiabao Chen
- Department of Pharmaceutical Engineering, College of Food and Bioengineering, Xihua University, Chengdu, China
| | - Junyan Li
- Department of Pharmaceutical Engineering, College of Food and Bioengineering, Xihua University, Chengdu, China
| | - Siyan Liu
- Department of Pharmaceutical Engineering, College of Food and Bioengineering, Xihua University, Chengdu, China
| | - Yuanyuan Zhang
- Department of Chemistry, College of Science, Xihua University, Chengdu, China
| | - Zhouyu Wang
- Department of Chemistry, College of Science, Xihua University, Chengdu, China
| | - Shan Qian
- Department of Pharmaceutical Engineering, College of Food and Bioengineering, Xihua University, Chengdu, China
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