Glioma-initiating cell elimination by metformin activation of FOXO3 via AMPK

Stem Cells Transl Med. 2012 Nov;1(11):811-24. doi: 10.5966/sctm.2012-0058. Epub 2012 Nov 15.

Abstract

Control of the cancer stem/initiating cell population is considered key to realizing the long-term survival of glioblastoma patients. Recently, we demonstrated that FOXO3 activation is sufficient to induce differentiation of glioma-initiating cells having stem-like properties and inhibit their tumor-initiating potential. Here we identified metformin, an antidiabetic agent, as a therapeutic activator of FOXO3. Metformin activated FOXO3 and promoted differentiation of such stem-like glioma-initiating cells into nontumorigenic cells. Furthermore, metformin promoted FOXO3 activation and differentiation via AMP-activated protein kinase (AMPK) activation, which was sensitive to extracellular glucose availability. Importantly, transient, systemic administration of metformin depleted the self-renewing and tumor-initiating cell population within established tumors, inhibited tumor formation by stem-like glioma-initiating cells in the brain, and provided a substantial survival benefit. Our findings demonstrate that targeting glioma-initiating cells via the AMPK-FOXO3 axis is a viable therapeutic strategy against glioblastoma, with metformin being the most clinically relevant drug ever reported for targeting of glioma-initiating cells. Our results also establish a novel, direct link between glucose metabolism and cancer stem/initiating cells.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • AMP-Activated Protein Kinases / metabolism*
  • Animals
  • Blood-Brain Barrier / drug effects
  • Brain Neoplasms / drug therapy*
  • Brain Neoplasms / pathology*
  • Cell Differentiation / drug effects
  • Cell Line, Tumor
  • Forkhead Box Protein O3
  • Forkhead Transcription Factors / metabolism*
  • Glioblastoma / drug therapy
  • Glioblastoma / pathology
  • Glioma / drug therapy*
  • Glioma / pathology*
  • Glucose
  • Humans
  • Metformin / pharmacology*
  • Mice
  • Mice, Inbred BALB C
  • Mice, Nude
  • Neoplastic Stem Cells / drug effects*
  • Neoplastic Stem Cells / physiology*
  • Transplantation, Heterologous

Substances

  • FOXO3 protein, human
  • Forkhead Box Protein O3
  • Forkhead Transcription Factors
  • Metformin
  • AMP-Activated Protein Kinases
  • Glucose