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REVIEW

The Role and Mechanism of Metformin in Inflammatory Diseases

, , & ORCID Icon
Pages 5545-5564 | Received 19 Aug 2023, Accepted 17 Nov 2023, Published online: 23 Nov 2023

Figures & data

Figure 1 Metformin inhibits mTOR both with and without activating AMPK. There are two ways that metformin could inhibit mTORC1 downstream: (1) After AMPK activity is activated, the TSC1/TSC2 complex (which can inhibit the activity of Rheb) is activated, and then the action of mTORC1 activity is inhibited. (2) Metformin inhibited Rag GTPase activity in an AMPK-independent manner, thereby inhibiting mTORC1. mTOR has two complexes, mTORC1 and mTORC2, which have important regulatory effects on inflammation, gene transcription, protein translation, etc.

Abbreviations: AMPK, adenosine monophosphate-activated protein kinase; mTOR, mammalian target of rapamycin; PRAS40, proline-rich Akt substrate 40; TSC, tuberous sclerosis complex; RICTOR, rapamycin-insensitive companion of mTOR; Rheb, ras homolog enriched in the brain; mLST8, mammalian lethal with sec-13 protein 8; Raptor, regulatory associated protein of mTOR; Deptor, DEP domain-containing mTOR-interacting protein; mSIN1, mammalian stress-activated protein kinase (SAPK)-interacting protein 1.
Figure 1 Metformin inhibits mTOR both with and without activating AMPK. There are two ways that metformin could inhibit mTORC1 downstream: (1) After AMPK activity is activated, the TSC1/TSC2 complex (which can inhibit the activity of Rheb) is activated, and then the action of mTORC1 activity is inhibited. (2) Metformin inhibited Rag GTPase activity in an AMPK-independent manner, thereby inhibiting mTORC1. mTOR has two complexes, mTORC1 and mTORC2, which have important regulatory effects on inflammation, gene transcription, protein translation, etc.

Table 1 Effects of Metformin Targeting mTOR on Inflammatory Diseases

Figure 2 Metformin reduces inflammation by regulating the autophagy process. TLR family members activated by PAMPs or DAMPs initiate the innate immune response as a response to infection or injury. Then, it activates NF-kB and further activates the NLRP3 inflammasome. Upon NLRP3 activation, pro-IL1-β and pro-IL18 were cleaved into mature and active IL1-β and IL18. These cytokines are subsequently released, initiating an inflammatory response. Metformin activates AMPK, inhibits mTOR, and activates the ULK complex, thus inducing autophagy and further blocking the activation of NLRP3, inhibiting inflammation. Autophagy involves the formation of autophagosomes, fusion of autophagosomes with lysosomes, and degradation of the autophagy-lysosomes. Metformin could also scavenge mtDNA and mtROS through mitophagy induction via the inhibition of mitochondrial complex I, inhibiting NLRP3 inflammasome activation, thus eventually inhibiting inflammation.

Figure 2 Metformin reduces inflammation by regulating the autophagy process. TLR family members activated by PAMPs or DAMPs initiate the innate immune response as a response to infection or injury. Then, it activates NF-kB and further activates the NLRP3 inflammasome. Upon NLRP3 activation, pro-IL1-β and pro-IL18 were cleaved into mature and active IL1-β and IL18. These cytokines are subsequently released, initiating an inflammatory response. Metformin activates AMPK, inhibits mTOR, and activates the ULK complex, thus inducing autophagy and further blocking the activation of NLRP3, inhibiting inflammation. Autophagy involves the formation of autophagosomes, fusion of autophagosomes with lysosomes, and degradation of the autophagy-lysosomes. Metformin could also scavenge mtDNA and mtROS through mitophagy induction via the inhibition of mitochondrial complex I, inhibiting NLRP3 inflammasome activation, thus eventually inhibiting inflammation.