Kang Chan Woo, Nam Jung Ho, Oh Ju Hun, Wang Eun Kyung, Lee Soo Hyun, Shin Hye Ju, Kim Ye Bin, Lee Eun Jig, Lim Byung Kook, Fang Sung Soon, Cho Arthur, Ku Cheol Ryong
Endocrinology, Institute of Endocrine Research, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
Department of Internal Medicine, Graduate School of Medical Science, Brain Korea 21 Project, Yonsei University College of Medicine, Seoul, Republic of Korea.
Exp Mol Med. 2025 Aug 6. doi: 10.1038/s12276-025-01518-w.
Metformin is widely used as a first-line therapy for type 2 diabetes mellitus. However, the molecular mechanisms by which it modulates intestinal glucose metabolism remain incompletely defined. Here metformin was orally administered to male C57BL/6 mice, followed by intraperitoneal glucose tolerance testing and fluorine-18 fluorodeoxyglucose tracing to evaluate glucose homeostasis. To investigate changes in intestinal glucose metabolism, IEC6 and Caco-2 cell lines were used for in vitro analysis, with organoid experiments conducted for further validation. qRT-PCR, western blotting, flow cytometry and immunohistochemistry were performed to elucidate the effects of metformin on glucose metabolism pathways. Metformin enhanced glucose uptake and excretion in the distal intestine, particularly in the ileum and colon. Mechanistically, metformin upregulated the expression and membrane localization of glucose transporter 1 (GLUT1) by downregulating thioredoxin-interacting protein (TXNIP) expression. Consistently, intestinal-specific overexpression of TXNIP abolished metformin-induced improvements in glucose tolerance, while pharmacological inhibition of GLUT1 similarly negated metformin's glucose-lowering effects. Our findings identified intestinal glucose excretion, mediated through the intestinal TXNIP-GLUT1 regulatory axis, as a previously unrecognized contributor to metformin's glucoregulatory action. These results highlight a novel intestinal mechanism underlying metformin's efficacy and provide insights for potential therapeutic strategies beyond traditional glucose regulation.
二甲双胍被广泛用作2型糖尿病的一线治疗药物。然而,其调节肠道葡萄糖代谢的分子机制仍未完全明确。在此,对雄性C57BL/6小鼠口服二甲双胍,随后进行腹腔葡萄糖耐量试验和氟-18氟脱氧葡萄糖示踪以评估葡萄糖稳态。为研究肠道葡萄糖代谢的变化,使用IEC6和Caco-2细胞系进行体外分析,并进行类器官实验以进一步验证。采用qRT-PCR、蛋白质免疫印迹、流式细胞术和免疫组织化学来阐明二甲双胍对葡萄糖代谢途径的影响。二甲双胍增强了远端肠道尤其是回肠和结肠的葡萄糖摄取和排泄。机制上,二甲双胍通过下调硫氧还蛋白相互作用蛋白(TXNIP)的表达上调葡萄糖转运蛋白1(GLUT1)的表达和膜定位。同样,肠道特异性过表达TXNIP消除了二甲双胍诱导的葡萄糖耐量改善,而对GLUT1的药理学抑制同样消除了二甲双胍的降糖作用。我们的研究结果确定了通过肠道TXNIP-GLUT1调节轴介导的肠道葡萄糖排泄是二甲双胍葡萄糖调节作用中一个先前未被认识的因素。这些结果突出了二甲双胍疗效背后的一种新的肠道机制,并为超越传统葡萄糖调节的潜在治疗策略提供了见解。
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