Costing less than one Thai baht per dose, metformin
is cheap Type 2 diabetes drug
that has been gaining recognition as a wonder drug
in recent times because of numerous medical and clinical studies showing its effectives in preventing and treating certain cancers
, infections, even certain neurodegenerative diseases and also immune diseases.
has its distant roots in Medieval folk medicine and has a powerful capacity to reduce body weight, fat mass, circulating glucose and prevent diabetes
altogether in people at elevated risk.
Emerging research on the most widely prescribed Type 2 diabetes drug
in the world arrives as a global obesity
epidemic continues unabated. Obesity
is the leading risk factor for Type 2 diabetes
, a metabolic disorder.
While researchers have found that more than 60 percent of metformin
's ability to control Type 2 diabetes
is derived from lowering body weight, it has taken until now to tease out key molecular mechanisms underlying how the medication does its job.
Dr. Stephen O'Rahilly and colleagues at the University of Cambridge, are in the vanguard of scientists worldwide who have tackled a series of metformin
studies in humans and laboratory animals. The team has shown how the drug
causes weight loss, even among heart patients who don't have diabetes
Besides their work, other scientists are hailing metformin
as a wonder drug
not only because of its effect on Type 2 diabetes
, but because of its emerging prominence in cancer
research and potential influence in the lungs of those diagnosed with tuberculosis.
Dr O'Rahilly, a Professor of Clinical Biochemistry and Medicine told Thailand Medical
was first used as a glucose-lowering drug
in patients with Type 2 diabetes
. In these patients, the weight loss can be quite modest, probably because when you reduce glucose in Type 2 diabetes
, you stop calories being lost in the urine as sugar, and that works against the weight-reducing effects.”
Dr O'Rahilly, who is also director of the Wellcome Trust-MRC Institute of Metabolic Science-Metabolic Research Laboratories further added, "It was only when long-term studies in non-diabetic
participants were undertaken that it became clear that people who actually had good compliance with metformin
lost on average around 6 percent of their body weight and could keep it off for years."
In his latest study published in the journal Nature
, Dr O'Rahilly and his team explained the relationship between metformin
ong> and a key circulating protein, a molecule known as GDF15. The initials stand for growth and differentiation factor 15. The protein is a member of the TGF-β superfamily, a vast group of cell regulatory proteins.
The protein molecule GDF15 carries out a wide range of biological activities and is found in a variety of tissues, regulating apoptosis and cell repair. As it turns out, GDF15 plays a potent role in the presence of metformin toward controlling Type 2 diabetes.
The drug and protein relationship now has been fully elucidated by Dr O'Rahilly and his team, and for the first time, posits the molecular mechanisms underlying the weight loss that occurs among patients on the drug. Metformin works with GDF15 and by itself to induce weight loss and maintain energy balance, the team found.
Dr O'Rahilly added, "Our data does suggest that most, if not all, of the weight loss effects of the metformin require GDF15. However, metformin continues to have some effects in lowering glucose and insulin that are independent of weight loss and independent of GDF15.”
The medical researchers found that "metformin treatment increases the levels of GDF15 quite markedly in all people who take the drug regularly."
Dr O'Rahilly described metformin as the most widely prescribed diabetes medication on the planet. Known generically as metformin, the drug is sold under the brand name Glucophage. Sixty tablets cost about US$4 at prescription drug discounters, such as Walmart, in the United States while in Thailand, a hundred tablets can be bought for as low as 70 baht.
Since its approval by the US FDA in 1995, metformin had been widely prescribed for decades in Europe before it was finally given a green light in a country with more than 30 million Type 2 diabetics. The U.S. additionally has 84.1 million people with pre-diabetes, a condition that can lead to the full-blown disease.
Among various pharma drugs, metformin has a long and storied past. The compound destined to become metformin was first isolated during the Middle Ages from the French lilac, a plant scientifically known as Galega officinalis. Ground flowers and leaves were administered by healers to patients suffering from constant urination, a hallmark of a disorder that later would become known as diabetes. The active ingredient in French lilac, a plant also called goat's rue, was identified hundreds of years later as galegine, which triggered a striking reduction in blood glucose.
Medical scientists were able to exploit folk medicine uses and develop the drug that became metformin in the 1950s. In recent years, in vitro studies by Dr. Lloyd Trotman at Cold Spring Harbor Laboratory in New York have shown metformin to be effective against prostate cancer cells. And in November, scientists in Mexico found that metformin promotes the destruction of Mycobacterium tuberculosis bacteria in the lungs. The drug enhances the activity of antimicrobial peptides known as β-defensins. The peptides are common in lung epithelial tissue and are active against Gram negative and Gram positive bacteria.
Dr O'Rahilly and colleagues, meanwhile, have described the benefits of metformin in both human clinical trials and experiments involving animal models. In both types of investigations, metformin influenced weight loss and GDF15 activity.
For instance, in one of the human clinical trials cited in the Nature paper, the team measured circulating GDF15 and found that after two weeks on metformin, there was approximately a 2.5-fold increase in circulating GDF15. To determine if the increase was sustained, protein levels were measured six, 12 and 18 months. Patients who took metformin wound up losing about 3.5 percent of their body weight. In another trial, patients lost even more.
In certain wild-type mice, oral metformin also increased circulating GDF15. Protein levels additionally rose in the distal intestine and kidneys. Metformin prevented weight gain in response to a high-fat diet in the animals but not in mice lacking GDF15 or its receptor protein, GFRAL. Metformin had effects on both energy intake and energy expenditure that required GDF15, the team found.
Dr O'Rahilly said the research has been reproduced by other teams assuring him and his colleagues that they have demonstrated how metformin lowers body weight.
Dr O’Rahilly added, "The key findings of our work have already been independently replicated by Greg Steinberg at McMaster University. We are indeed undertaking further studies to explore exactly where the GDF15 is coming from and how it is regulated."
Reference: Anthony P. Coll et al. GDF15 mediates the effects of metformin on body weight and energy balance, Nature (2019). DOI: 10.1038/s41586-019-1911-y