Abstract
Metformin is a widely used drug in patients with type 2 diabetes mellitus. Metformin inhibits hepatic gluconeogenesis and increases glucose utilization in peripheral tissues. In recent years, several studies have shown that metformin is a potential therapeutic agent against cancer, alone or combined with other anticancer treatments. Metformin mainly activates the AMPK complex and regulates intracellular energy status, inhibiting the mitochondrial respiratory chain complex I and reducing the production of reactive oxygen species. Other anticancer targets of metformin are specific transcription factors inhibiting cell proliferation, promoting apoptosis and reducing drug resistance. In addition, metformin modulates tumor cells' response to anticancer treatments, favoring the activity of T cells. In diabetic patients, metformin reduces the occurrence of cancer and improves the prognosis and efficacy of anticancer treatments. In this review, we provided a comprehensive perspective of metformin as an anticancer drug.
Graphical Abstract
[http://dx.doi.org/10.1016/j.diabres.2012.11.008] [PMID: 23333041]
[http://dx.doi.org/10.1056/NEJM199602293340906] [PMID: 8569826]
[http://dx.doi.org/10.3132/dvdr.2008.027] [PMID: 18777488]
[http://dx.doi.org/10.1172/jci.insight.93936] [PMID: 30518693]
[http://dx.doi.org/10.1038/s41591-018-0159-7] [PMID: 30150719]
[http://dx.doi.org/10.1038/nature15766] [PMID: 26633628]
[http://dx.doi.org/10.2337/dc08-2175] [PMID: 19564453]
[http://dx.doi.org/10.1038/nrendo.2013.256] [PMID: 24393785]
[http://dx.doi.org/10.1155/2016/4847812] [PMID: 27761470]
[http://dx.doi.org/10.1038/nature13270] [PMID: 24847880]
[http://dx.doi.org/10.1152/jappl.2001.91.3.1073]
[http://dx.doi.org/10.1038/nature09571] [PMID: 21124450]
[http://dx.doi.org/10.1038/nature11808] [PMID: 23292513]
[http://dx.doi.org/10.1126/science.1120781] [PMID: 16308421]
[http://dx.doi.org/10.1172/JCI40671] [PMID: 20577053]
[http://dx.doi.org/10.1016/j.cmet.2016.12.009] [PMID: 28089566]
[http://dx.doi.org/10.1016/j.cell.2009.03.016] [PMID: 19450513]
[http://dx.doi.org/10.1016/0005-2728(69)90077-2] [PMID: 4304727]
[http://dx.doi.org/10.1074/jbc.275.1.223] [PMID: 10617608]
[http://dx.doi.org/10.1042/bj3480607] [PMID: 10839993]
[http://dx.doi.org/10.1111/j.2042-7158.1991.tb03507.x] [PMID: 1681061]
[http://dx.doi.org/10.1042/BJ20140620] [PMID: 25017630]
[http://dx.doi.org/10.1007/s10863-006-9003-8] [PMID: 16732470]
[http://dx.doi.org/10.1016/j.redox.2017.08.018] [PMID: 28942196]
[http://dx.doi.org/10.3389/fendo.2018.00753] [PMID: 30619086]
[http://dx.doi.org/10.1007/s00125-017-4372-6] [PMID: 28776080]
[http://dx.doi.org/10.1038/s41467-019-08839-1] [PMID: 30796225]
[http://dx.doi.org/10.3389/fendo.2019.00294] [PMID: 31133988]
[http://dx.doi.org/10.1038/nm.3372] [PMID: 24185692]
[http://dx.doi.org/10.2337/db11-0961] [PMID: 22492524]
[http://dx.doi.org/10.1016/S0005-2728(98)00029-2] [PMID: 9593904]
[http://dx.doi.org/10.1016/j.cmet.2014.09.013] [PMID: 25448702]
[http://dx.doi.org/10.1002/cpt.567] [PMID: 27859023]
[http://dx.doi.org/10.1007/s00125-016-3992-6] [PMID: 27216492]
[http://dx.doi.org/10.1210/jc.2017-01091] [PMID: 28938439]
[http://dx.doi.org/10.1158/1940-6207.CAPR-10-0157] [PMID: 20947488]
[http://dx.doi.org/10.3892/ol.2017.7412] [PMID: 29422962]
[http://dx.doi.org/10.1016/j.cell.2017.02.004] [PMID: 28283069]
[http://dx.doi.org/10.1126/science.123.3191.309] [PMID: 13298683]
[http://dx.doi.org/10.1016/j.ccr.2012.02.014] [PMID: 22439925]
[http://dx.doi.org/10.1038/s41586-018-0350-5] [PMID: 30022161]
[http://dx.doi.org/10.1038/nature09586] [PMID: 21057493]
[http://dx.doi.org/10.1016/j.celrep.2013.12.031] [PMID: 24412366]
[http://dx.doi.org/10.1038/nature10066] [PMID: 21490601]
[http://dx.doi.org/10.1016/j.molcel.2011.04.005] [PMID: 21514197]
[http://dx.doi.org/10.1158/1078-0432.CCR-06-2082] [PMID: 17289868]
[http://dx.doi.org/10.1016/j.redox.2014.12.003] [PMID: 25590798]
[http://dx.doi.org/10.1002/iub.61] [PMID: 18465793]
[http://dx.doi.org/10.2741/1667] [PMID: 15769673]
[http://dx.doi.org/10.1074/jbc.M310341200] [PMID: 14625276]
[http://dx.doi.org/10.1042/BJ20040885] [PMID: 15175014]
[http://dx.doi.org/10.2337/diabetes.54.7.2179] [PMID: 15983220]
[http://dx.doi.org/10.1074/jbc.M106417200] [PMID: 11527970]
[http://dx.doi.org/10.1016/j.bbrc.2006.11.118] [PMID: 17161377]
[http://dx.doi.org/10.1002/ijc.26049] [PMID: 21469139]
[http://dx.doi.org/10.1515/hsz-2017-0271] [PMID: 29272251]
[http://dx.doi.org/10.1093/carcin/bgt231] [PMID: 23803693]
[http://dx.doi.org/10.1158/1940-6207.CAPR-17-0407] [PMID: 29545399]
[http://dx.doi.org/10.1158/0008-5472.1007.65.3] [PMID: 15705902]
[http://dx.doi.org/10.1038/sj.onc.1211024] [PMID: 18212742]
[http://dx.doi.org/10.1111/j.1476-5381.2010.01101.x] [PMID: 21054339]
[http://dx.doi.org/10.1016/j.ccr.2012.07.024] [PMID: 22975374]
[http://dx.doi.org/10.1016/j.ccr.2012.08.001] [PMID: 22975375]
[http://dx.doi.org/10.1517/14728222.2014.914173] [PMID: 24793594]
[http://dx.doi.org/10.1038/nri2888] [PMID: 21233853]
[http://dx.doi.org/10.1016/j.immuni.2014.12.030] [PMID: 25607458]
[http://dx.doi.org/10.1016/j.immuni.2016.08.009] [PMID: 27653602]
[http://dx.doi.org/10.1016/j.molcel.2018.07.030] [PMID: 30118680]
[http://dx.doi.org/10.1038/nature08097] [PMID: 19494812]
[http://dx.doi.org/10.1073/pnas.1417636112] [PMID: 25624476]
[http://dx.doi.org/10.1016/j.jhep.2018.11.034] [PMID: 30572006]
[http://dx.doi.org/10.3389/fphar.2017.00561] [PMID: 28878676]
[http://dx.doi.org/10.18632/oncotarget.5541] [PMID: 26497364]
[http://dx.doi.org/10.1111/cas.14615] [PMID: 32794612]
[http://dx.doi.org/10.1016/j.intimp.2022.108889] [PMID: 35679661]
[http://dx.doi.org/10.3389/fonc.2018.00436] [PMID: 30364350]
[http://dx.doi.org/10.3389/fimmu.2021.581799] [PMID: 33953705]
[http://dx.doi.org/10.1016/j.jhep.2022.03.010] [PMID: 35378172]
[http://dx.doi.org/10.18632/oncotarget.25380] [PMID: 29899823]
[http://dx.doi.org/10.3389/fimmu.2020.581728] [PMID: 33488583]
[http://dx.doi.org/10.1177/1758834016687482] [PMID: 28491145]
[http://dx.doi.org/10.1038/s42255-020-00280-9] [PMID: 32958939]
[http://dx.doi.org/10.1172/JCI123360] [PMID: 30395540]
[http://dx.doi.org/10.1016/j.tips.2020.01.003] [PMID: 32033771]
[http://dx.doi.org/10.1007/s00262-011-1062-y] [PMID: 21681370]
[http://dx.doi.org/10.18926/AMO/54514] [PMID: 27549683]
[http://dx.doi.org/10.2174/1389450118666170613081730] [PMID: 28606032]
[http://dx.doi.org/10.3390/ijms22095016] [PMID: 34065108]
[http://dx.doi.org/10.3390/ijms22020867] [PMID: 33467127]
[http://dx.doi.org/10.1016/j.ejphar.2021.174605] [PMID: 34757071]
[http://dx.doi.org/10.1007/s12079-021-00648-w] [PMID: 34611852]
[http://dx.doi.org/10.1016/j.bcp.2019.113787] [PMID: 31884044]
[http://dx.doi.org/10.1136/jitc-2021-002614] [PMID: 34815353]
[http://dx.doi.org/10.3390/ijms17081298] [PMID: 27517917]
[http://dx.doi.org/10.3892/etm.2016.3143] [PMID: 27168791]
[http://dx.doi.org/10.3892/ol.2021.12876] [PMID: 34257723]
[http://dx.doi.org/10.1002/2211-5463.13314] [PMID: 34644456]
[http://dx.doi.org/10.1186/s13058-019-1204-2] [PMID: 31640742]
[http://dx.doi.org/10.1016/j.lfs.2018.07.046] [PMID: 30053447]
[http://dx.doi.org/10.1093/cdn/nzaa131] [PMID: 32908958]
[http://dx.doi.org/10.1016/j.mce.2020.110803] [PMID: 32251713]
[http://dx.doi.org/10.1074/jbc.M114.592576] [PMID: 25143389]
[http://dx.doi.org/10.18632/oncotarget.10671] [PMID: 28881582]
[http://dx.doi.org/10.2147/OTT.S99770] [PMID: 27274280]
[http://dx.doi.org/10.1097/CAD.0000000000000870] [PMID: 31815765]
[http://dx.doi.org/10.4081/oncol.2021.514] [PMID: 33747367]
[http://dx.doi.org/10.1136/jitc-2021-002773] [PMID: 34230113]
[http://dx.doi.org/10.1002/jcp.25318] [PMID: 26791139]
[http://dx.doi.org/10.1038/pcan.2015.35] [PMID: 26215782]
[http://dx.doi.org/10.1093/abbs/gmx106] [PMID: 29342230]
[http://dx.doi.org/10.1158/1078-0432.CCR-18-0420] [PMID: 30012567]
[http://dx.doi.org/10.7150/ijbs.33787] [PMID: 31892847]
[http://dx.doi.org/10.1002/jbt.22662] [PMID: 33147367]
[http://dx.doi.org/10.1158/1940-6207.CAPR-13-0424] [PMID: 24985407]
[http://dx.doi.org/10.2147/CMAR.S200059] [PMID: 31114366]
[http://dx.doi.org/10.1016/j.numecd.2020.05.010] [PMID: 32753274]
[http://dx.doi.org/10.1002/cam4.2025] [PMID: 30968600]
[http://dx.doi.org/10.1038/pcan.2014.20] [PMID: 24861559]
[http://dx.doi.org/10.1089/thy.2019.0851] [PMID: 32791889]
[http://dx.doi.org/10.7150/jca.19750] [PMID: 28900491]
[http://dx.doi.org/10.1007/s10549-012-2170-x] [PMID: 22847511]
[http://dx.doi.org/10.1007/s12032-013-0590-z] [PMID: 23636908]
[http://dx.doi.org/10.1634/theoncologist.2015-0096] [PMID: 26446233]
[http://dx.doi.org/10.1007/s10549-015-3307-5] [PMID: 25682077]
[http://dx.doi.org/10.1007/s10549-015-3519-8] [PMID: 26293146]
[http://dx.doi.org/10.1016/j.ygyno.2016.10.011] [PMID: 27745917]
[http://dx.doi.org/10.1002/cncr.28853] [PMID: 24917306]
[http://dx.doi.org/10.1016/j.ygyno.2014.06.014] [PMID: 24972190]
[http://dx.doi.org/10.1158/0008-5472.CAN-17-2460] [PMID: 29374065]
[http://dx.doi.org/10.18632/oncotarget.10934] [PMID: 27486978]
[http://dx.doi.org/10.1155/2017/5063239] [PMID: 28271076]
[http://dx.doi.org/10.1177/2050312119865114] [PMID: 31360518]
[http://dx.doi.org/10.1158/1078-0432.CCR-13-1787] [PMID: 24141625]
[http://dx.doi.org/10.1038/s41416-020-01208-6] [PMID: 33398062]
[http://dx.doi.org/10.1007/s00384-020-03765-x] [PMID: 32968891]
[http://dx.doi.org/10.1158/1940-6207.CAPR-10-0186] [PMID: 20810669]
[http://dx.doi.org/10.1016/S1470-2045(15)00565-3] [PMID: 26947328]
[http://dx.doi.org/10.1158/1078-0432.CCR-11-2994] [PMID: 22465831]
[http://dx.doi.org/10.1158/1078-0432.CCR-20-0113] [PMID: 32646922]
[http://dx.doi.org/10.1097/COC.0000000000000239] [PMID: 26558876]
[http://dx.doi.org/10.1158/2326-6066.CIR-16-0103] [PMID: 27941003]
[http://dx.doi.org/10.1186/s40425-018-0375-1] [PMID: 29966520]
[http://dx.doi.org/10.1186/s12885-022-09245-5] [PMID: 35189835]
[http://dx.doi.org/10.1007/s00262-021-03116-x] [PMID: 34837101]
[PMID: 31106005]
[http://dx.doi.org/10.1007/s13402-019-00446-y] [PMID: 31001733]
[http://dx.doi.org/10.1016/j.clgc.2016.06.017] [PMID: 27460432]
[http://dx.doi.org/10.1158/1940-6207.CAPR-10-0055] [PMID: 20810672]
[http://dx.doi.org/10.1038/onc.2010.483] [PMID: 21102522]
[http://dx.doi.org/10.1007/s11892-017-0829-8] [PMID: 28116648]
[http://dx.doi.org/10.1007/s13318-014-0213-x] [PMID: 24969688]
[http://dx.doi.org/10.1001/jamaoncol.2019.2553] [PMID: 31486833]
[http://dx.doi.org/10.1158/1078-0432.CCR-19-0437] [PMID: 31413010]
[http://dx.doi.org/10.1001/jamaoncol.2021.7015] [PMID: 35024769]
[http://dx.doi.org/10.1016/j.jtho.2019.07.020] [PMID: 31398539]
[http://dx.doi.org/10.1210/er.2003-0036] [PMID: 15583022]
[http://dx.doi.org/10.1073/pnas.92.17.7921] [PMID: 7644514]
[http://dx.doi.org/10.3390/jcm7040069] [PMID: 29621178]
[http://dx.doi.org/10.1038/79216] [PMID: 10973253]
[http://dx.doi.org/10.1016/j.brainres.2009.07.034] [PMID: 19631630]
[http://dx.doi.org/10.2337/diabetes.51.3.875] [PMID: 11872696]
[http://dx.doi.org/10.1007/s11033-012-2042-9] [PMID: 23054005]