Кардиоваскулярные эффекты метформина: в центре внимания метаболизм жировой ткани

Настоящий обзор посвящен анализу данных по изучению возможного влияния метформина на эндокринную функцию жировой ткани: синтез и секрецию гормонов адипоцитов – адипокинов (лептина, адипонектина, резистина) – и гастроинтестинальной системы (грелина). Метформин – сахароснижающее лекарственное средство класса бигуанидов, используемое в качестве терапии первой линии для коррекции нарушений углеводного обмена. В настоящее время существенно возрос интерес к плейотропным кардиопротективным и антиатерогенным свойствам метформина. Показаны молекулярные механизмы его влияния на углеводный и липидный обмен в жировой ткани на примере изолированных адипоцитов (in vitro) и в живом организме (in vivo). Ключевым ферментом регуляции в действии метформина является АМФ-активируемая протеинкиназа (AMPK), активация которой блокирует синтез жирных кислот и способствует липолизу и окислению жирных кислот, ингибирует продукцию глюкозы в печени, снижая экспрессию АМФ-стимулированных генов ферментов глюконеогенеза, повышает чувствительность к инсулину, что в конечном итоге потенцирует снижение содержания глюкозы. Вместе с тем недостаточно изучены дозозависимые эффекты метформина, нет данных о его долгосрочном влиянии на метаболизм жировой ткани, что требует пристального внимания к изучению данного вопроса. В целом, метформин не только представляется перспективным препаратом для борьбы с гипергликемией, но и, возможно, способствует коррекции дислипидемии при сахарном диабете 2 типа и снижает сердечно-сосудистые риски, связанные с этим заболеванием.

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