Metformin: Candidate host-directed therapy for tuberculosis in diabetes and non-diabetes patients

Tuberculosis (Edinb). 2016 Dec;101S:S69-S72. doi: 10.1016/j.tube.2016.09.008. Epub 2016 Sep 28.

Abstract

Despite major advances in tuberculosis (TB) control, TB continues to be a leading cause of death worldwide. The discovery of new anti-TB treatment drugs and regimens that target drug-sensitive and drug-resistant TB are being complemented with a search for adjunct host-directed therapies that synergize for Mycobacterium tuberculosis (Mtb) elimination. The goal of host-directed therapies is to boost immune mechanisms that diminish excess inflammation to reduce lung tissue damage and limit Mtb growth. Metformin is the most commonly-used medication for type 2 diabetes, and a candidate for host-directed therapy for TB. Preliminary data suggests metformin may be beneficial for TB control by reducing the deleterious inflammation associated with immune pathology and enhancing the anti-mycobacterial activity of immune cells. In this review I summarize current findings, knowledge gaps and the potential benefits as well as points of caution for using metformin as adjunct therapy for TB in patients with and without type 2 diabetes.

Keywords: Diabetes; Host-directed therapy; Immunometabolism; Inflammation; Metformin; Tuberculosis.

Publication types

  • Review
  • Research Support, N.I.H., Extramural

MeSH terms

  • Antitubercular Agents / adverse effects
  • Antitubercular Agents / therapeutic use*
  • Diabetes Mellitus, Type 2 / diagnosis
  • Diabetes Mellitus, Type 2 / drug therapy*
  • Diabetes Mellitus, Type 2 / immunology
  • Host-Pathogen Interactions
  • Humans
  • Hypoglycemic Agents / adverse effects
  • Hypoglycemic Agents / therapeutic use*
  • Immunologic Factors / adverse effects
  • Immunologic Factors / therapeutic use*
  • Metformin / adverse effects
  • Metformin / therapeutic use*
  • Mycobacterium tuberculosis / drug effects*
  • Mycobacterium tuberculosis / immunology
  • Mycobacterium tuberculosis / pathogenicity
  • Risk Factors
  • Treatment Outcome
  • Tuberculosis / diagnosis
  • Tuberculosis / drug therapy*
  • Tuberculosis / immunology
  • Tuberculosis / microbiology

Substances

  • Antitubercular Agents
  • Hypoglycemic Agents
  • Immunologic Factors
  • Metformin