AMP-activated protein kinase (AMPK) is recognized as a master regulator of energy homeostasis. In concert with the
AMPK-kinase LKB1, it has been shown to provide a molecular link between
obesity and postmenopausal
breast cancer via its actions to inhibit
aromatase expression, hence
estrogen production, within the breast. The anti-diabetic
drug metformin is known to increase the activity of AMPK and was therefore hypothesized to inhibit
aromatase expression in primary human breast adipose stromal cells. Results demonstrate that
metformin significantly decreases the
forskolin/
phorbol ester (FSK/PMA)-induced expression of
aromatase at concentrations of 10 and 50 muM. Consistent with the hypothesized actions of
metformin to increase AMPK activity, treatment with 50 muM
metformin results in a significant increase in phosphorylation of AMPK at Thr172. Interestingly,
metformin also causes a significant increase in LKB1
protein expression and promoter activity, thereby providing for the first time an additional mechanism by which
metformin activates AMPK. Furthermore,
metformin inhibits the nuclear translocation of CRTC2, a CREB-coactivator known to increase
aromatase expression which is also a direct downstream target of AMPK. Overall, these results suggest that
metformin would reduce the local production of
estrogens within the breast thereby providing a new key therapeutic tool that could be used in the neoadjuvant and adjuvant settings and conceivably also as a preventative measure in obese women.