Effect and possible mechanisms of metformin as adjuvant therapy in the management of tuberculosis: A prospective study

Abstract

Objective: Tuberculosis (TB) is a deadly infectious ailment causing mortality and morbidity globally. The study objectives were to investigate the effect and possible mechanisms of metformin as adjuvant therapy in the management of tuberculosis. Methods: TB patients attending HAHC hospital, New Delhi (India) and had T2DM (Type-2 diabetes mellitus) comorbidity were enrolled. Study participants were categorized into metformin non-users and metformin users depending on the presence of metformin in their prescription. Whole blood was used for immunophenotyping of total T-Cells (CD45+CD3+), Helper T-Cells (Th) (CD45+CD3+ CD4+) and Cytotoxic T Cells (Tc) (CD45+CD3+CD8+) through flow cytometry. BD FACS Verse and BD LSR II were used for sample acquisition. Results: Estimation of T-Cells (CD45+CD3+), Helper T-Cells (Th) (CD45+CD3+ CD4+) and Cytotoxic T Cells (Tc) (CD45+CD3+CD8+) levels at 2nd visit showed a larger T-Cells (CD45+CD3+) (p < 0.001), Helper T-Cells (Th) (CD45+CD3+ CD4+) (p = 0.004) and Cytotoxic T Cells (Tc) (CD45+CD3+CD8+) (p = 0.001) in metformin users in comparison with metformin non users. The use of metformin had significant effect on the conversion of sputum smear (p = 0.0318, unpaired t-test) in comparison with metformin non-users. Conclusion: Metformin has potential to develop long-term immunity against TB infection and responsible for its protective impact in TB + T2DM comorbid patients. Metformin therapy improved T cells, Helper T cells and cytotoxic T cells in TB + T2DM comorbid patients and it can be prescribed as an adjuvant antitubercular medication unless contraindicated.

Keywords

• Tuberculosis
• Adjuvant therapy
• Drug repurposing
• Metformin