Metformin activates a duodenal Ampk-dependent pathway to lower hepatic glucose production in rats

Nat Med. 2015 May;21(5):506-11. doi: 10.1038/nm.3787. Epub 2015 Apr 6.

Abstract

Metformin is a first-line therapeutic option for the treatment of type 2 diabetes, even though its underlying mechanisms of action are relatively unclear. Metformin lowers blood glucose levels by inhibiting hepatic glucose production (HGP), an effect originally postulated to be due to a hepatic AMP-activated protein kinase (AMPK)-dependent mechanism. However, studies have questioned the contribution of hepatic AMPK to the effects of metformin on lowering hyperglycemia, and a gut-brain-liver axis that mediates intestinal nutrient- and hormone-induced lowering of HGP has been identified. Thus, it is possible that metformin affects HGP through this inter-organ crosstalk. Here we show that intraduodenal infusion of metformin for 50 min activated duodenal mucosal Ampk and lowered HGP in a rat 3 d high fat diet (HFD)-induced model of insulin resistance. Inhibition of duodenal Ampk negated the HGP-lowering effect of intraduodenal metformin, and both duodenal glucagon-like peptide-1 receptor (Glp-1r)-protein kinase A (Pka) signaling and a neuronal-mediated gut-brain-liver pathway were required for metformin to lower HGP. Preabsorptive metformin also lowered HGP in rat models of 28 d HFD-induced obesity and insulin resistance and nicotinamide (NA)-streptozotocin (STZ)-HFD-induced type 2 diabetes. In an unclamped setting, inhibition of duodenal Ampk reduced the glucose-lowering effects of a bolus metformin treatment in rat models of diabetes. These findings show that, in rat models of both obesity and diabetes, metformin activates a previously unappreciated duodenal Ampk-dependent pathway to lower HGP and plasma glucose levels.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • AMP-Activated Protein Kinases / metabolism*
  • Animals
  • Blood Glucose / chemistry
  • Diabetes Mellitus, Type 2 / blood
  • Duodenum / drug effects*
  • Gene Expression Regulation, Enzymologic*
  • Glucagon-Like Peptide-1 Receptor
  • Glucose / metabolism*
  • Glucose Clamp Technique
  • HEK293 Cells
  • Humans
  • Insulin
  • Insulin Resistance
  • Liver / enzymology*
  • Male
  • Metformin / administration & dosage
  • Metformin / chemistry*
  • Niacinamide / chemistry
  • Obesity / metabolism
  • Rats
  • Rats, Sprague-Dawley
  • Receptors, Glucagon / metabolism
  • Signal Transduction

Substances

  • Blood Glucose
  • GLP1R protein, human
  • Glp1r protein, rat
  • Glucagon-Like Peptide-1 Receptor
  • Insulin
  • Receptors, Glucagon
  • Niacinamide
  • Metformin
  • AMP-Activated Protein Kinases
  • Glucose