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Metformin enhances methylene blue-mediated photodynamic therapy in oral squamous cell carcinoma

Osman MA, Sharaky M, Abdel-Fattah H, Safaan AM

Journal of the Egyptian National Cancer Institute, 2026

Abstract

BACKGROUND: Head and neck squamous cell carcinoma (HNSCC) is the most common malignancy of the head and neck region with relatively low survival rate and response and high resistance to treatment. Tongue and floor of the mouth are the most commonly involved sites. New therapies for oral squamous cell carcinoma (OSCC) treatment are still required. An attractive option for the treatment of OSCC is the use of photodynamic therapy (PDT). Considering metformin's potential to reduce cancer risk and inhibit proliferation, therefore the present study aims to evaluate its ability to potentiate the methylene blue-mediated photodynamic effect against the growth of tongue cancer cells in vitro and the possible molecular mechanisms of action involved.

METHODS: Cytotoxic activity of metformin (MF) and/or Methylene blue (MB)+laser light (L) against the growth of HNO97 tongue cells was determined using the sulforhodamine (SRB) method. Several protein expressions were determined using ELISA kits include mechanistic target of rapamycin (mTOR), AMP-activated protein kinase (AMPK), B-cell lymphoma 2 (Bcl-2), Bcl-2-associated X protein (Bax), and caspase 8.

RESULTS: Laser light at different energy per surface area induced inhibition in the surviving fraction of HNO97 cells, while in presence of MB (10 µg/ml for 4 h.), the surviving fractions showed more inhibition. Addition of MF (1000 µg/ml, for 24 h.) to MB + L induced significant 51 and 89% inhibition of cell survival at energy level of 45…

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