Metformin redistributes the intracellular oxygen. Metformin inhibits oxygen consumption and ATP production by inhibiting mitochondrial complex I. Subsequently, intracellular oxygen redistribution supplies oxygen for prolyl hydroxylase, which promotes the degradation of HIF-1α in the proteasome. ATP depletion caused by mitochondrial inhibition activates AMPK, which is a downstream signaling pathway of mitochondrial respiratory chain [21].
