Repositioning Candidate Details
| Candidate ID: | R0089 |
| Source ID: | DB00331 |
| Source Type: | approved |
| Compound Type: | small molecule |
| Compound Name: | Metformin |
| Synonyms: | |
| Molecular Formula: | C4H11N5 |
| SMILES: | CN(C)C(=N)NC(N)=N |
| Structure: |
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| DrugBank Description: | Metformin is an antihyperglycemic agent of the _biguanide_ class, used for the management of type II diabetes) [FDA label]. Currently, metformin is the first drug of choice for the management of type II diabetes and is prescribed to at least 120 million people worldwide [A176173]. Metformin is considered an antihyperglycemic drug because it lowers blood glucose concentrations in type II diabetes without causing hypoglycemia. Metformin is commonly described as an _insulin sensitizer_ leading to a decrease in insulin resistance and a clinically significant reduction of plasma fasting insulin levels [A176173]. Another well-known benefit of this drug is modest weight loss. Metformin is the drug of choice for obese type II diabetes patients [A36559]. Metformin was first approved in Canada in 1972 [A36552], followed by 1995 in the USA [FDA label]. This drug is available in regular and extended-release forms [FDA label]. |
| CAS Number: | 657-24-9 |
| Molecular Weight: | 129.1636 |
| DrugBank Indication: | **Metformin tablet** Metformin is indicated as an adjunct to diet and exercise to increase glycemic control in _adults and pediatric patients_ 10 years of age and older diagnosed with type 2 diabetes mellitus [FDA label]. **Metformin extended-release tablet (XR)** The extended-release form is indicated as an adjunct to diet and exercise to improve glycemic control in only _adults_ with type 2 diabetes mellitus. Safety in children has not been determined to this date [FDA label]. |
| DrugBank Pharmacology: | **General effects** Insulin is an important hormone that regulates blood glucose levels [T514]. Type II diabetes is characterized by a decrease in sensitivity to insulin, resulting in eventual elevations in blood glucose when the pancreas can no longer compensate. In patients diagnosed with type 2 diabetes, insulin no longer exerts adequate effects on tissues and cells (called insulin resistance) [T514] and insulin deficiency may also be present [L5753]. Metformin reduces liver (hepatic) production of glucose, decreases the intestinal absorption of glucose, and enhances insulin sensitivity by increasing both peripheral glucose uptake and utilization. In contrast with drugs of the _sulfonylurea_ class, which lead to hyperinsulinemia, the secretion of insulin is unchanged with metformin use [FDA label]. **Effect on fasting plasma glucose (FPG) and Glycosylated hemoglobin (HbA1c)** HbA1c is an important periodic measure of glycemic control that is used to monitor diabetic patients. Fasting plasma glucose is also a useful and important measure of glycemic control. In a 29-week clinical trial of subjects diagnosed with type II diabetes, metformin decreased the fasting plasma glucose levels by an average of 59 mg/dL from baseline, compared to an average increase of 6.3 mg/dL from baseline in subjects taking a placebo [FDA label]. Glycosylated hemoglobin (HbA1c) was decreased by about 1.4% in subjects receiving metformin, and increased by 0.4% in subjects receiving placebo only [FDA label]. |
| DrugBank MoA: | Metformin's mechanisms of action are unique from other classes of oral antihyperglycemic drugs. Metformin decreases blood glucose levels by decreasing hepatic glucose production (gluconeogenesis), decreasing the intestinal absorption of glucose, and increasing insulin sensitivity by increasing peripheral glucose uptake and utilization [FDA label]. It is well established that metformin inhibits mitochondrial complex I activity, and it has since been generally postulated that its potent antidiabetic effects occur through this mechanism [A36534, A36557]. The above processes lead to a decrease in blood glucose, managing type II diabetes and exerting positive effects on glycemic control. After ingestion, the organic cation transporter-1 (OCT1) is responsible for the uptake of metformin into hepatocytes (liver cells). As this drug is positively charged, it accumulates in cells and in the mitochondria because of the membrane potentials across the plasma membrane as well as the mitochondrial inner membrane. Metformin inhibits mitochondrial complex I, preventing the production of mitochondrial ATP leading to increased cytoplasmic ADP:ATP and AMP:ATP ratios [A36534]. These changes activate AMP-activated protein kinase (AMPK), an enzyme that plays an important role in the regulation of glucose metabolism [A176348]. Aside from this mechanism, AMPK can be activated by a lysosomal mechanism involving other activators. Following this process, increases in AMP:ATP ratio also inhibit _fructose-1,6-bisphosphatase_ enzyme, resulting in the inhibition of gluconeogenesis, while also inhibiting _adenylate cyclase_ and decreasing the production of cyclic adenosine monophosphate (cAMP) [A36534], a derivative of ATP used for cell signaling [A176351]. Activated AMPK phosphorylates two isoforms of acetyl-CoA carboxylase enzyme, thereby inhibiting fat synthesis and leading to fat oxidation, reducing hepatic lipid stores and increasing liver sensitivity to insulin [A36534]. In the intestines, metformin increases anaerobic glucose metabolism in enterocytes (intestinal cells), leading to reduced net glucose uptake and increased delivery of lactate to the liver. Recent studies have also implicated the gut as a primary site of action of metformin and suggest that the liver may not be as important for metformin action in patients with type 2 diabetes. Some of the ways metformin may play a role on the intestines is by promoting the metabolism of glucose by increasing glucagon-like peptide I (GLP-1) as well as increasing gut utilization of glucose [A36534]. In addition to the above pathway, the mechanism of action of metformin may be explained by other ways, and its exact mechanism of action has been under extensive study in recent years [A36535, A36554, A36555, A36557]. |
| Targets: | Electron transfer flavoprotein-ubiquinone oxidoreductase, mitochondrial; 5'-AMP-activated protein kinase subunit beta-1; Glycerol-3-phosphate dehydrogenase [NAD(+)], cytoplasmic |
| Inclusion Criteria: |
| Strategy ID | Strategy | Synonyms | Related Targets | Related Drugs | |
|---|---|---|---|---|---|
| S07 | antihypertensive | Anti-fibrosis; Anti-hypertensive; Anti-hypertensive; antihypertensive medications; multidrug combination antihypertensive treatment; empirical addition (or increase in the dose) of an antihypertensive agent of a different class""; Anti-hypertensive; Lifestyle measures; Anti-inflammatory; Improve insulin resistance; Enhance lipid metabolism; Regulating intestinal flora; Anti-hypertensive; Anti-hypertensive; Anti-inflammatory; Anti-fibrosis; Anti-inflammatory; Immunotherapy; Anti-hypertensive; Immunosuppressive treatment; Anti-hypertensive; Anti-hypertensive; Anti-platelet aggregation; other antihypertensive drugs; antihypertensive therapy; Anti-hypertensive; Anti-inflammatory; Anti-hypertensive (standard antihypertensive treatment; intensive antihypertensive treatment); Blood pressure management; Anti-hypertensive; Enhance lipid metabolism; Anti-hypertensive; Enhance lipid metabolism; Anti-platelet aggregation; Improve insulin resistance; Anti-hypertensive; Anti-hypertensive; Anti-oxidative stress; antihypertensives; Lifestyle measures; Anti-hypertensive; Anti-fibrosis; Anti-inflammatory; Anti-hypertensive | ACE; Smad4; PKD1; angiotensin receptor; SGLT2; angiotensin II receptor; mineralocorticoid receptor; ACE | riociguat; sGC stimulators; sGC activators; antihypertensive medications; carvedilol; lercanidipine; enalapril; folic acid; retinoic acid; angiotensin II; antihypertensive drug; Tripterygium Wilfordii Hook F; valsartan; Renin-angiotensin system inhibitors; diuretics; calcium channel blocker; corticosteroid; anti-hypertensive treatment; NSAIDs; naproxen; celecoxib; proton pump inhibitor; non-selective NSAID; selective cyclo-oxygenase-2 inhibitor; renin-angiotensin system blockers; antihypertensive agent; cilnidipine; valsartan; RAAS-is; steroids; immunosuppressors; amiloride; hydrochlorothiazide; berberine; Aliskiren; calcium channel blocker; angiotensin II receptor blocker; ARB; Chlorthalidone; Hydrochlorothiazide; Hsub2/subS; NO; Hsub2/subSxa0; xa0; NO; prednisolone; mizoribine; angiotensin-converting enzyme inhibitors; ACEI; eculizumab; antihypertensive agents; antithrombotics; antianemics; proton pump inhibitors; allopurinol; rilmenidine; long-term benzodiazepines; anticholinergic drugs; hydroxyzine; Qian Yang Yu Yin Granule; RAAS blockers; other antihypertensive drugs; antihypertensives; antihypertensive classes; antihypertensive therapy; melatonin; RAASi; Aliskiren; ARBs; ACEIs; tegafur/gimeracil/oteracil; furosemide; prednisolone; angiotensin receptor blockers; valsartan; antihypertensive drugs; fosinopril; valsartan; Canagliflozin; sodium glucose co-transporter 2 inhibitors; Aspirin; Antihypertensive; Lipid-Lowering Treatment; Sodium-glucose cotransporter 2 inhibitors; angiotensin II receptor blocker; Spironolactone; KBP-5074; captopril; enalaprilate; lisinopril; losartan; valsartan; furosemide; pravastatin; simvastatin; Renin Angiotensin System inhibitors; ACE inhibitors; diuretics; β-blockers; Thiazide diuretics; dihydropyridine calcium-channel blockers; angiotensin-converting enzyme inhibitors; angiotensin receptor blockers; calcium-channel blockers; thiazide-like diuretics; lisinopril; Edarbyclor; azilsartan medoxomil; chlorthalidone; hydrochlorothiazide; aliskiren; ARB; enalapril; non-steroidalanti-inflammatory drugs; antihypertensive treatment; Chlorthalidone; loop diuretics; angiotensin-converting enzyme inhibitor; angiotensin receptor blocker; statin; captopril; tiopronin; active form of dalcetrapib; active metabolite of prasugrel, R-138727; Liuwei Dihuang pills; metformin hydrochloride sustained-release tablets; irbesartan tablets; renin-angiotensin-aldosterone system inhibitor; type 1 angiotensin II receptor blockade; olmesartan; steroid; immunosuppressive agents; enalapril; corticosteroid treatment; Angiotensin-converting-enzyme inhibitors; antihypertensives; GLP-1 receptor analogue; SGLT2-inhibitor; sacubitril/valsartan; valsartan; Sulodexide; liraglutide; enalapril; ACE-I/ARBs; angiotensin-converting enzyme inhibitor/angiotensin II receptor blockers; labetalol; ACEi; ARB; ARBs | Details |
| Target ID | Target Name | GENE | Action | Class | UniProtKB ID | Entry Name | |
|---|---|---|---|---|---|---|---|
| T13 | Renin | REN | INHIBITOR | Target is a single protein chain | P00797 | REN_HUMAN | Details |
| T06 | Sulfonylurea receptor 1 | ABCC8 | Target is a single protein chain | Q09428 | ABCC8_HUMAN | Details | |
| T15 | Steryl-sulfatase | STS | INHIBITOR | Hydrolase | P08842 | STS_HUMAN | Details |
| Diseases ID | DO ID | Disease Name | Definition | Class | |
|---|---|---|---|---|---|
| I02 | 1184 | nephrotic syndrome | "A nephrosis characterized by marked increase in glomerular protein permeability resulting in marked elevation of urine protein levels, hypoalbuminemia, hyperlipidemia, and hypercoagulability." [url:https\://en.wikipedia.org/wiki/Nephrotic_syndrome, url:https\://www.niddk.nih.gov/health-information/kidney-disease/nephrotic-syndrome-adults] | Details |