title: Metformin: Candidate host-directed therapy for tuberculosis in diabetes and non-diabetes patients.
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.
authors.affiliation: UTHealth Houston, Department of Epidemiology, School of Public Health at Brownsville, 80 Fort Brown, SPH Bldg, Brownsville, TX 78520, USA. Electronic address: blanca.i.restrepo@uth.tmc.edu.
authors.forename: Blanca I
authors.initials: BI
authors.lastname: Restrepo
mesh_terms: D000995:Antitubercular Agents / Q000009:adverse effects / Q000627:therapeutic use*; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology; D054884:Host-Pathogen Interactions; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D007155:Immunologic Factors / Q000009:adverse effects / Q000627:therapeutic use*; D008687:Metformin / Q000009:adverse effects / Q000627:therapeutic use*; D009169:Mycobacterium tuberculosis / Q000187:drug effects* / Q000276:immunology / Q000472:pathogenicity; D012307:Risk Factors; D016896:Treatment Outcome; D014376:Tuberculosis / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology / Q000382:microbiology
chemical_list: D000995:Antitubercular Agents; D007004:Hypoglycemic Agents; D007155:Immunologic Factors; D008687:Metformin
keywords: Diabetes; Host-directed therapy; Immunometabolism; Inflammation; Metformin; Tuberculosis