Metformin-an adjunct antineoplastic therapy-divergently modulates tumor metabolism and proliferation, interfering with early response prediction by 18F-FDG PET imaging

Peiman Habibollahi, Nynke S. Van Den Berg, Darshini Kuruppu, Massimo Loda, Umar Mahmood

Research output: Contribution to journalReview articlepeer-review

22 Scopus citations


Over the last several years, epidemiologic data have suggested that the antidiabetes drug metformin (MET), an adenosine monophosphate-activated protein kinase (AMPK) activator, improves progression-free survival of patients with multiple cancers; more than 30 clinical trials are under way to confirm this finding. We postulated that the role of AMPK as a central cellular energy sensor would result in opposite effects on glucose uptake and proliferation, suggesting different roles for 18F-FDG and 3′-deoxy-3′- 18F-fluorothymidine (18F-FLT) in assessing its effectiveness as an antineoplastic agent. Methods: Colon cancer cell lines HT29 (human) and MC26 (murine) were treated for 24 or 72 h with a range of MET concentrations (0-10 mM). Western blotting was used to study the activation of AMPK after MET treatment. Glucose uptake and cell proliferation were measured by cell retention studies with either 18F-FDG or 18F-FLT. EdU (ethynyl deoxyuridine, a thymidine analog) and annexin-propidium iodide flow cytometry was performed to determine cell cycle S-phase and apoptotic changes. In vivo 18F-FDG and 18F-FLT PET images were acquired before and 24 h after MET treatment of HT29 tumor-bearing mice. Results: After 24 h of MET incubation, phosphorylated AMPK levels increased severalfold in both cell lines, whereas total AMPK levels remained unchanged. In cell retention studies, 18F-FDG uptake increased but 18F-FLT retention decreased significantly in both cell lines. The numbers of HT29 and MC26 cells in the S phase decreased 36%and 33%, respectively, after MET therapy. Apoptosis increased 10.5-fold and 5.8-fold in HT29 and MC26 cells, respectively, after 72 h of incubation with MET. PET imaging revealed increased 18F-FDG uptake (mean ± SEM standardized uptake values were 0.71 ± 0.03 before and 1.29 ± 0.11 after MET therapy) (P < 0.05) and decreased 18FFLT uptake (mean ± SEM standardized uptake values were 1.18 ± 0.05 before and 0.89 ± 0.01 after MET therapy) (P < 0.05) in HT29 tumor-bearing mice. Conclusion: MET, through activation of the AMPK pathway, produces a dose-dependent increase in tumor glucose uptake while decreasing cell proliferation in human and murine colon cancer cells. Thus, changes in 18F-FDG uptake after MET treatment may be misleading. 18F-FLT imaging is a promising alternative that correlates with the tumor response.

Original languageEnglish (US)
Pages (from-to)252-258
Number of pages7
JournalJournal of Nuclear Medicine
Issue number2
StatePublished - Feb 2013
Externally publishedYes


  • AMPK
  • Metformin
  • Proliferation imaging
  • Tumor metabolic imaging

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging


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