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Potential Off-Label Indication of Metformin for Ischaemic Stroke
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- This review gathers data from both preclinical and clinical trials on the use of metformin in the context of ischaemic stroke, clarifying any contradictory findings and proposing potential solutions. It discusses the pharmacological aspects and antidiabetic mechanisms of metformin as well as its role in the brain and implications for ischaemic stroke. Additionally, the review examines evidence supporting the repurposing of metformin as a preventive intervention for individuals at risk of ischaemic stroke and highlights the challenges in translating preclinical findings into clinical practice for this purpose.
- This review emphasises the potential value of conducting further research and comprehensive clinical evaluations of metformin as a repurposed medication for ischaemic stroke.
abstract
This abstract is available on the publisher's site.
Access this abstract nowThe term 'clinical cemetery' is frequently used to characterize ischaemic stroke, one of the leading causes of mortality and long-term morbidity globally. Over the past two decades, a number of novel therapies have been investigated for ischaemic stroke. However, aside from mechanical thrombectomy, the only FDA-approved prescription for treating ischaemic stroke is tissue plasminogen activator, which has a limited therapeutic period. Although post-stroke rehabilitation therapies are helpful in improving functional recovery, their benefits cannot be yielded promptly. Nowadays, drug repurposing might be an appealing approach to expanding therapeutic options for ischaemic stroke. During the last decade, metformin has been extensively researched as a potential repurposing medicine for ischaemic stroke, with a focus on both preventive and therapeutic approaches. With regard to the idea of repurposing metformin in ischaemic stroke, this review aims to compile the available data from pre-clinical and clinical trials, address and clarify any discrepancies, and offer solutions.
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Repurposing metformin: A potential off-label indication for ischaemic stroke?
Diabetes Obes Metab 2024 Nov 27;[EPub Ahead of Print], TT OoFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Although fraught with linguistic and grammatical errors (where were the editors?), this paper presents a very good review of metformin as a promising therapy for ischaemic stroke. The stated mechanism of action involves the inhibition of complex I of the mitochondrial respiratory chain, which indirectly activates adenosine monophosphate–activated protein kinase. This, in turn, results in a reduction of intestinal glucose absorption, inhibition of hepatic glucose production, and an increase in insulin sensitivity.
Although animal studies have reported mixed results regarding the efficacy of metformin for ischaemic stroke, human studies appear promising. The author provides a comprehensive review of mechanisms of action of metformin in cerebral ischaemia to explain why metformin may be beneficial in managing acute stroke. There is evidence of a reduction in infarct size in human stroke with metformin use, especially when administered early. The article mentions two ongoing clinical trials; it seems likely that metformin would improve outcomes in patients with acute stroke and evidence of diabetes or prediabetes.