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Metformin + ketogenic diet is a metabolic combination therapy being investigated by Weill Medical College of Cornell University for the treatment of high-grade gliomas, including glioblastoma. This therapeutic strategy aims to exploit the metabolic vulnerabilities of tumor cells, specifically their reliance on glucose (the Warburg effect). Metformin, an FDA-approved biguanide for type 2 diabetes, works by activating AMP-activated protein kinase (AMPK) and inhibiting mitochondrial complex I, which reduces hepatic gluconeogenesis and improves insulin sensitivity. The ketogenic diet, a high-fat, low-carbohydrate regimen, induces a state of ketosis and further lowers systemic glucose and insulin levels. Together, these interventions are intended to "starve" the tumor cells of their primary energy source and inhibit insulin-mediated growth signaling.
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