Cited by 319Metabolism, Diabetes, and CancerDiabetes Treatment and ManagementGlycogen Storage Diseases and Myoclonus

Metformin reduces liver glucose production by inhibition of fructose-1-6-bisphosphatase

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Hunter, Roger W., Hughey, Curtis C., Lantier, Louise, Sundelin, Elias I., Peggie, Mark, Zeqiraj, Elton, Sicheri, Frank, Jessen, Niels +2 more·2018·Nature Medicine

Abstract

Metformin is a first-line drug for the treatment of individuals with type 2 diabetes, yet its precise mechanism of action remains unclear. Metformin exerts its antihyperglycemic action primarily through lowering hepatic glucose production (HGP). This suppression is thought to be mediated through inhibition of mitochondrial respiratory complex I, and thus elevation of 5′-adenosine monophosphate (AMP) levels and the activation of AMP-activated protein kinase (AMPK), though this proposition has been challenged given results in mice lacking hepatic AMPK. Here we report that the AMP-inhibited enzyme fructose-1,6-bisphosphatase-1 (FBP1), a rate-controlling enzyme in gluconeogenesis, functions as a major contributor to the therapeutic action of metformin. We identified a point mutation in FBP1 that renders it insensitive to AMP while sparing regulation by fructose-2,6-bisphosphate (F-2,6-P2), and knock-in (KI) of this mutant in mice significantly reduces their response to metformin treatment. We observe this during a metformin tolerance test and in a metformin-euglycemic clamp that we have developed. The antihyperglycemic effect of metformin in high-fat diet–fed diabetic FBP1-KI mice was also significantly blunted compared to wild-type controls. Collectively, we show a new mechanism of action for metformin and provide further evidence that molecular targeting of FBP1 can have antihyperglycemic effects. The antidiabetic action of metformin raises heptocyte intracellular AMP levels, causing allosteric inhibition of fructose-1,6-bisphosphatase and thus reductions in gluconeogenesis.

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  • Metformin suppresses hepatic glucose production via AMP-induced inhibition of fructose-1,6-bisphosphatase-1.

    “metformin’s suppression of hepatic glucose production is shown to be the result of AMP-induced inhibition of fructose-1,6-bisphosphatase-1, a rate-controlling enzyme in gluconeogenesis”

    From Benefits of Metformin in Attenuating the Hallmarks of Aging (2020) · cites this paper as Hunter et al. 2018

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  1. [20]Faupel RP Seitz HJ Tarnowski W Thiemann V Weiss C The problem of tissue sampling from experimental animals with respect to freezing technique, anoxia, stress and narcosis. A new method for sampling rat liver tissue and the physiological values of glycolytic intermediates and related compounds Arch Biochem Biophys 1972 148 509 522 5019872

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Authors
Hunter, R. W., Hughey, C. C., Lantier, L., Sundelin, E. I., Peggie, M., Zeqiraj, E., Sicheri, F., Jessen, N., Wasserman, D. H., & Sakamoto, K.
Affiliations
  • University of Bristol (GB)
  • Vanderbilt University (US)
  • Aarhus University (DK)
  • University of Dundee (GB)
  • Mount Sinai Hospital (CA)
Corresponding author
Sakamoto, Kei
Venue
Nature Medicine
Published
2018-08-27
Volume
24
Issue
9
Pages
1395-1406
ISSN
  • 1078-8956 (ISSN-L)
  • 1546-170X
OpenAlex
W2888330909
Cited by
313
References
86
Citations by year
2026: 25 · 2025: 33 · 2024: 47 · 2023: 53 · 2022: 49 · 2021: 33 · 2020: 43 · 2019: 26 · 2018: 4
FWCI
9.51
Type
journal article
Language
en
Open access
Locations
  • Nature Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • Discovery Research Portal (University of Dundee) (publishedVersion)
  • Explore Bristol Research (publishedVersion, other-oa)
  • White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (acceptedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
  • Bristol Research (University of Bristol) (submittedVersion, other-oa)
Funders
  • Vanderbilt University (DK059637)
  • Wellcome Trust (092381)
  • Novo Nordisk
  • Danmarks Frie Forskningsfond (4183-00384)
  • Novo Nordisk Fonden (NNF13OC0003882, NNF17SA0031230-1)
  • Canadian Institutes of Health Research (143277)
  • National Institute of Diabetes and Digestive and Kidney Diseases (U2CDK059637, U24DK059637, R37DK050277, P30DK058404)
Topics
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Metabolism, Diabetes, and Cancer
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
  • Health Sciences › Medicine › Rheumatology › Glycogen Storage Diseases and Myoclonus
Keywords
metformin, FBP1, hepatic glucose production, gluconeogenesis, AMPK, fructose-2,6-bisphosphate, type 2 diabetes, high-fat diet, euglycemic clamp
MeSH terms
Adenosine Monophosphate, Aminoimidazole Carboxamide, Animals, Base Sequence, Chickens, Disease Models, Animal, Glucose, Fructose-Bisphosphatase, Homeostasis, Humans, Hypoglycemia, Liver, Metformin, Mice, Inbred C57BL, Mutation, Obesity, Prodrugs, Ribonucleotides, Glucose Intolerance

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