The potential hepatoprotective effect of metformin in hepatitis C virus‐infected adolescent patients with beta thalassemia major: Randomised clinical trial

Abstract

Background Iron overload‐induced oxidative stress and transfusion‐acquired hepatitis C virus (HCV) infection are the main reasons of liver damage in beta thalassemia major (β‐TM). Objectives Based on metformin’s hepatic benefits in nondiabetic populations, the study aims to investigate the safety and the potential hepatoprotective effect of metformin in HCV‐infected β‐TM adolescent patients. Methods This was a prospective, randomised, parallel, controlled, open‐label study in which 60 HCV‐infected β‐TM adolescent patients aged 11 to 18 years and receiving no antiviral therapy were selected and randomly assigned to treatment or control group in 1:1 allocation. Both groups were receiving β‐TM standard‐of‐care regimen, whereas metformin (500 mg, twice daily) was added to the treatment group's regimen only. Patients were prospectively followed up for 6 months with assessment of liver biochemical profile, oxidative stress markers, liver fibrosis, clinical symptom improvement and metformin's adverse effects. Results Aspartate aminotransferase serum level decreased significantly over time in the treatment group only (P = .013). However, improvement was not clinically significant and did not attain normality. Change in total antioxidant capacity and malondialdehyde serum levels indicated significantly improved oxidative stress status in the treatment group versus significant deterioration in the control group (P < .001). Fibrosis grade improvement was observed in 14 patients in the treatment group versus one improved case in the control group. Conclusion The use of metformin in HCV‐infected β‐TM adolescent patients as an adjuvant antioxidant hepatoprotective agent is promising and can improve liver damage.

Metformin reduces the risk of developing influenza A virus related cardiovascular disease

“…Recently, it was reported that metformin was significantly associated with a decrease in mortality in obese or type 2 diabetic women hospitalized for COVID-19 [ 20 ]. As described above, several studies have reported that metformin can reduce the risk of infectious diseases and complications in DM patients, but studies on non-DM patients are insufficient [ [20] , [21] , [22] ]. In this study, the antiviral and immunomodulatory effects of metformin were investigated in non-DM conditions through in vitro and in vivo studies.…”

Insights into the Management of Chronic Hepatitis in Children—From Oxidative Stress to Antioxidant Therapy

“…Under normal conditions, lactate is metabolized in the liver and kidney after it is produced in the peripheral tissues. If HCV infection occurs, it mainly influences the mitochondrial respiratory chain complex genes, which leads to the activation of anaerobic processes and lactate and ROS accumulation [4,32]. This virus causes the destruction of the hepatocyte through multiple mechanisms, mainly by counteracting the activity of cellular defense factors.…”

“…In hepatitis C virus-infected adolescents with beta thalassemia major, Mona S Abdel et al [32] reported a significant decrease in aspartate aminotransferase (AST), as well as an improvement in total antioxidant capacity and serum levels of malondialdehyde in the group treated with metformin, but without significant clinical improvement in the patients' condition.…”