Abstract
Metformin, a synthetic derivative of guanidine, is commonly used as an oral antidiabetic agent and is considered a multi-vector application agent in the treatment of other inflammatory diseases. Recent studies have confirmed the beneficial effect of metformin on immune cells, with special emphasis on immunological mechanisms. Multiple Sclerosis (MS) is an autoimmune disease of the central nervous system (CNS) characterized by various clinical courses. Although the pathophysiology of MS remains unknown, it is most likely a combination of disturbances of the immune system and biochemical pathways with a disruption of blood–brain barrier (BBB), and it is strictly related to injury of intracerebral blood vessels. Metformin has properties which are greatly desirable for MS therapy, including antioxidant, anti-inflammatory or antiplatelet functions. The latest reports relating to the cardiovascular disease confirm an increased risk of ischemic events in MS patients, which are directly associated with a coagulation cascade and an elevated pro-thrombotic platelet function. Hence, this review examines the potential favourable effects of metformin in the course of MS, its role in preventing inflammation and endothelial dysfunction, as well as its potential antiplatelet role.
Highlights
Metformin (1,1-dimethylbiguanide hydrochloride) is a synthetic derivative of guanidine isolated from the extract of the French lilac (Galega officinalis) [1], which possess hypoglycemic activity [2]
The main function of metformin is based on sensitizing cells to insulin and on lowering the serum glucose level as well as on inhibiting the mitochondrial glycerol-3-phosphate dehydrogenase (GPDH) in the liver to suppress the process of gluconeogenesis and intensification of anaerobic glycolysis [35]
We will focus on a survey of the accessible reports regarding the effect of metformin on the immune and haemostasis system with an emphasis on immunological mechanisms associated with the development and preservation of autoimmunity and its virtual suitability in the treatment of autoimmune diseases
Summary
Metformin (1,1-dimethylbiguanide hydrochloride) is a synthetic derivative of guanidine isolated from the extract of the French lilac (Galega officinalis) [1], which possess hypoglycemic activity [2]. Metformin is the first-line drug in the treatment of type 2 diabetes (T2D), especially in patients with obesity [3]. It is soluble in water and nearly insoluble in organic compounds, such as acetone, ether or chloroform [4]. The most dangerous effect associated with metformin administration is the occurrence of lactic acidosis It was observed in about 3 cases per 1,000,000 patients after a long-term treatment [30]. Despite many reports concerning the risk of usage of oral anti-diabetes drugs such as metformin, serious adverse events are predictable and potentially preventable if the prescribing guidelines are respected [33,34]. We will focus on a survey of the accessible reports regarding the effect of metformin on the immune and haemostasis system with an emphasis on immunological mechanisms associated with the development and preservation of autoimmunity and its virtual suitability in the treatment of autoimmune diseases
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