Metformin as a Metabolic Reprogramming Interface in Host-Pathogen and Bone Microenvironment Crosstalk: A Dual-Target Strategy Against Antimicrobial Resistance and Osteoporotic Bone Loss
Abstract
Metabolic dysregulation is increasingly recognized as a central feature linking chronic infection, immune dysfunction, and skeletal deterioration; however, these processes are most often investigated in isolation, limiting the development of integrative mechanistic frameworks. In this review, we propose the Metabolic Reprogramming Interface Model (MRIM) as a systems-level, hypothesis-generating construct that conceptualizes metabolism as a shared regulatory axis bridging host-pathogen interactions and bone microenvironment remodeling. Importantly, MRIM is not presented as a unified or experimentally validated disease model, but rather as a structured framework designed to organize and critically evaluate emerging multidisciplinary evidence. At the molecular level, metformin, a widely used metabolic modulator, has been shown to influence mitochondrial bioenergetics, AMP-activated protein kinase (AMPK) signaling, redox balance, and autophagic pathways, all of which are independently implicated in microbial persistence, immune cell function, and skeletal homeostasis. Within MRIM, these observations are integrated to hypothesize that metabolic perturbation may coordinately influence infection dynamics, inflammatory responses, and bone turnover. Nevertheless, most of the supporting evidence remains indirect, arising from in vitro studies, animal models, and observational clinical datasets, thereby limiting causal inference. To address this, the framework explicitly distinguishes…
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