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

ObjectiveTuberculosis (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.MethodsTB 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.ResultsEstimation 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.ConclusionMetformin 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.