Obesity as a Possible Risk Factor for Progression from Monoclonal Gammopathy of Undetermined Significance Progression into Multiple Myeloma: Could Myeloma Be Prevented with Metformin Treatment?

Figure 1

Figure modified from [32]. Overview of cellular and tissue mechanisms of metformin on inhibiting plasm cell growth. Metformin inhibits at tissue level: the inflammation caused by increases in circulating levels of leptin, insulin, IGF, IL-6, IL-1, and VGFR, driving by adipocyte differentiation of bone marrow mesenchymal stromal cells (AD-MSCs); and a cellular level inhibits mitochondria complex I, stimulates the adenosine monophosphate-activated protein kinase (AMPK) signaling pathway, and/or inhibits the insulin signaling pathway. ACC, acetyl-CoA carboxylase; EMT, epithelial-mesenchymal transition; IGF, insulin growth factor; IGF-1, insulin-like growth factor-1; IGF-1R, insulin-like growth factor-1 receptor; IR, insulin receptor; IL-1, interleukin 1; IL-6, interleukin-6, OCT1, organic cation transporter 1; VGFR, endothelial growth factor.