Metformin attenuates adhesion between cancer and endothelial cells in chronic hyperglycemia by recovery of the endothelial glycocalyx barrier

Biochim Biophys Acta Gen Subj. 2020 Apr;1864(4):129533. doi: 10.1016/j.bbagen.2020.129533. Epub 2020 Jan 15.


Background: Epidemiologic studies suggest that diabetes is associated with an increased risk of cancer. Concurrently, clinical trials have shown that metformin, which is a first-line antidiabetic drug, displays anticancer activity. The underlying mechanisms for these effects are, however, still not well recognized.

Methods: Methods based on atomic force microscopy (AFM) were used to directly evaluate the influence of metformin on the nanomechanical and adhesive properties of endothelial and cancer cells in chronic hyperglycemia. AFM single-cell force spectroscopy (SCFS) was used to measure the total adhesion force and the work of detachment between EA.hy926 endothelial cells and A549 lung carcinoma cells. Nanoindentation with a spherical AFM probe provided information about the nanomechanical properties of cells, particularly the length and grafting density of the glycocalyx layer. Fluorescence imaging was used for glycocalyx visualization and monitoring of E-selectin and ICAM-1 expression.

Results: SCFS demonstrated that metformin attenuates adhesive interactions between EA.hy926 endothelial cells and A549 lung carcinoma cells in chronic hyperglycemia. Nanoindentation experiments, confirmed by confocal microscopy imaging, revealed metformin-induced recovery of endothelial glycocalyx length and density. The recovery of endothelial glycocalyx was correlated with a decrease in the surface expression of E-selectin and ICAM-1.

Conclusion: Our results identify metformin-induced endothelial glycocalyx restoration as a key factor responsible for the attenuation of adhesion between EA.hy926 endothelial cells and A549 lung carcinoma cells.

General significance: Metformin-induced glycocalyx restoration and the resulting attenuation of adhesive interactions between the endothelium and cancer cells may account for the antimetastatic properties of this drug.

Keywords: AFM; Cancer cells; Endothelial cells; Glycocalyx; Metformin; Nanoindentation; Single-cell force spectroscopy.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • A549 Cells
  • Adenocarcinoma, Bronchiolo-Alveolar / drug therapy*
  • Adenocarcinoma, Bronchiolo-Alveolar / pathology
  • Antineoplastic Agents / pharmacology*
  • Cell Adhesion / drug effects
  • Cells, Cultured
  • Chronic Disease
  • Endothelial Cells / drug effects*
  • Endothelial Cells / pathology
  • Endothelium / drug effects
  • Endothelium / metabolism
  • Glycocalyx / drug effects
  • Glycocalyx / metabolism
  • Humans
  • Hyperglycemia / drug therapy*
  • Hyperglycemia / pathology
  • Hypoglycemic Agents / pharmacology*
  • Lung Neoplasms / drug therapy*
  • Lung Neoplasms / pathology
  • Metformin / pharmacology*
  • Microscopy, Atomic Force


  • Antineoplastic Agents
  • Hypoglycemic Agents
  • Metformin