Mitochondrial energetic and AKT status mediate metabolic effects and apoptosis of metformin in human leukemic cells

Leukemia. 2013 Nov;27(11):2129-38. doi: 10.1038/leu.2013.107. Epub 2013 Apr 9.


Previous reports demonstrate that metformin, an anti-diabetic drug, can decrease the risk of cancer and inhibit cancer cell growth. However, its mechanism in cancer cells is still unknown. Metformin significantly blocks cell cycle and inhibits cell proliferation and colony formation of leukemic cells. However, the apoptotic response to metformin varies. Furthermore, daily treatment with metformin induces apoptosis and reduces tumor growth in vivo. While metformin induces early and transient activation of AMPK, inhibition of AMPKα1/2 does not abrogate anti-proliferative or pro-apoptotic effects of metformin. Metformin decreases electron transport chain complex I activity, oxygen consumption and mitochondrial ATP synthesis, while stimulating glycolysis for ATP and lactate production, pentose phosphate pathway for purine biosynthesis, fatty acid metabolism, as well as anaplerotic and mitochondrial gene expression. Importantly, leukemic cells with high basal AKT phosphorylation, glucose consumption or glycolysis exhibit a markedly reduced induction of the Pasteur effect in response to metformin and are resistant to metformin-induced apoptosis. Accordingly, glucose starvation or treatment with deoxyglucose or an AKT inhibitor induces sensitivity to metformin. Overall, metformin elicits reprogramming of intermediary metabolism leading to inhibition of cell proliferation in all leukemic cells and apoptosis only in leukemic cells responding to metformin with AKT phosphorylation and a strong Pasteur effect.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • AMP-Activated Protein Kinases / antagonists & inhibitors
  • AMP-Activated Protein Kinases / genetics
  • AMP-Activated Protein Kinases / metabolism
  • Adenosine Triphosphate / metabolism
  • Animals
  • Apoptosis / drug effects*
  • Blotting, Western
  • Cell Proliferation / drug effects
  • Chromatography, Liquid
  • Glucose / metabolism
  • Glycolysis / drug effects
  • Humans
  • Hypoglycemic Agents / pharmacology*
  • Immunoenzyme Techniques
  • Lactic Acid / metabolism
  • Leukemia / drug therapy*
  • Leukemia / metabolism
  • Leukemia / pathology*
  • Metformin / pharmacology*
  • Mice
  • Mice, Nude
  • Mitochondria / drug effects
  • Mitochondria / metabolism*
  • Oxygen Consumption / drug effects
  • Phosphorylation / drug effects
  • Proto-Oncogene Proteins c-akt / metabolism*
  • RNA, Small Interfering / genetics
  • Spectrometry, Mass, Electrospray Ionization
  • Tumor Cells, Cultured
  • Xenograft Model Antitumor Assays


  • Hypoglycemic Agents
  • RNA, Small Interfering
  • Lactic Acid
  • Adenosine Triphosphate
  • Metformin
  • Proto-Oncogene Proteins c-akt
  • AMP-Activated Protein Kinases
  • Glucose