Metformin changes the immune microenvironment of colorectal cancer in patients with type 2 diabetes mellitus
Open Access
- 1 November 2020
- journal article
- research article
- Published by Wiley in Cancer Science
- Vol. 111 (11), 4012-4020
- https://doi.org/10.1111/cas.14615
Abstract
Accumulating evidence suggests that metformin reduces the incidence and mortality of colorectal cancer (CRC). However, underlying mechanisms have not been fully clarified. The aim of this study was to examine the pathological characteristics of resected CRC from patients treated with metformin for type 2 diabetes mellitus (DM). In total, 267 patients with DM underwent curative colectomy for Stage I-III CRC and 53 (19.9%) patients had been treated medically including metformin. Pathological N-stage was significantly lower in metformin-treated patients (P < .05) with prolonged disease-free survival (DFS) (P < .05). Immunohistochemistry showed that the densities of CD3(+) and CD8(+) tumor-infiltrating lymphocytes (TILs) in the invasive front area were significantly higher in 40 patients treated with metformin compared with propensity score matched cases without metformin (P < .05). The density of tertiary lymphoid structures (TLS) in tumor stroma was markedly increased in metformin-treated patients (P < .001). In those tumors, there were more CD68(+) tumor-associated macrophages (TAM) infiltrated (P < .05), while the ratio of CD163(+) M2-phenotype was markedly reduced (P < .001). Stromal fibrosis tended to be suppressed by metformin intake (P = .051). These findings suggested that metformin drastically changes the characteristics of infiltrating immune cells in CRC and reprograms the tumor microenvironment from immunosuppressive to immunocompetent status, which may lead to suppression of microscopic tumor spread and improve the outcomes of patients with CRC and type 2 DM.Funding Information
- Japan Society for the Promotion of Science London (19K09225)
This publication has 53 references indexed in Scilit:
- Diabetes, antihyperglycemic medications and cancer riskCurrent Opinion in Endocrinology, Diabetes and Obesity, 2013
- The Links Between Insulin Resistance, Diabetes, and CancerCurrent Diabetes Reports, 2012
- Metformin Prevents and Reverses Inflammation in a Non-Diabetic Mouse Model of Nonalcoholic SteatohepatitisPLOS ONE, 2012
- Investigating Metformin for Cancer Prevention and Treatment: The End of the BeginningCancer Discovery, 2012
- Cancer Risk in Diabetic Patients Treated with Metformin: A Systematic Review and Meta-analysisPLOS ONE, 2012
- Survival advantage observed with the use of metformin in patients with type II diabetes and colorectal cancerBritish Journal of Cancer, 2012
- The effects of metformin on the survival of colorectal cancer patients with diabetes mellitusInternational Journal of Cancer, 2011
- Metformin and Cancer Risk in Diabetic Patients: A Systematic Review and Meta-analysisCancer Prevention Research, 2010
- Metformin attenuates cardiac fibrosis by inhibiting the TGFβ1–Smad3 signalling pathwayCardiovascular Research, 2010
- Metformin and reduced risk of cancer in diabetic patientsBMJ, 2005