Title: Metformin: Experimental and Clinical Evidence for a Potential Role in Emphysema Treatment.

Authors: Polverino, Francesca; Wu, Tianshi David; Rojas-Quintero, Joselyn; Wang, Xiaoyun; Mayo, Jonathan; Tomchaney, Michael; Tram, Judy; Packard, Samuel; Zhang, Duo; Cleveland, Kristan H; Cordoba-Lanus, Elizabeth; Owen, Caroline A; Fawzy, Ashraf; Kinney, Greg L; Hersh, Craig P; Hansel, Nadia N; Doubleday, Kevin; Sauler, Maor; Tesfaigzi, Yohannes; Ledford, Julie G; Casanova, Ciro; Zmijewski, Jaroslaw; Konhilas, John; Langlais, Paul R; Schnellmann, Rick; Rahman, Irfan; McCormack, Meredith; Celli, Bartolome

Published In Am J Respir Crit Care Med, (2021 Sep 15)

Abstract: Rationale: Cigarette smoke (CS) inhalation triggers oxidative stress and inflammation, leading to accelerated lung aging, apoptosis, and emphysema, as well as systemic pathologies. Metformin is beneficial for protecting against aging-related diseases. Objectives: We sought to investigate whether metformin may ameliorate CS-induced pathologies of emphysematous chronic obstructive pulmonary disease (COPD). Methods: Mice were exposed chronically to CS and fed metformin-enriched chow for the second half of exposure. Lung, kidney, and muscle pathologies, lung proteostasis, endoplasmic reticulum (ER) stress, mitochondrial function, and mediators of metformin effects in vivo and/or in vitro were studied. We evaluated the association of metformin use with indices of emphysema progression over 5 years of follow-up among the COPDGene (Genetic Epidemiology of COPD) study participants. The association of metformin use with the percentage of emphysema and adjusted lung density was estimated by using a linear mixed model. Measurements and Main Results: Metformin protected against CS-induced pulmonary inflammation and airspace enlargement; small airway remodeling, glomerular shrinkage, oxidative stress, apoptosis, telomere damage, aging, dysmetabolism in vivo and in vitro; and ER stress. The AMPK (AMP-activated protein kinase) pathway was central to metformin's protective action. Within COPDGene, participants receiving metformin compared with those not receiving it had a slower progression of emphysema (-0.92%; 95% confidence interval [CI], -1.7% to -0.14%; P = 0.02) and a slower adjusted lung density decrease (2.2 g/L; 95% CI, 0.43 to 4.0 g/L; P = 0.01). Conclusions: Metformin protected against CS-induced lung, renal, and muscle injury; mitochondrial dysfunction; and unfolded protein responses and ER stress in mice. In humans, metformin use was associated with lesser emphysema progression over time. Our results provide a rationale for clinical trials testing the efficacy of metformin in limiting emphysema progression and its systemic consequences.

PubMed ID: 34033525

MeSH Terms: No MeSH terms associated with this publication