Recent clinical data suggest that individuals with type 2 diabetes (T2D) that receive metformin as a treatment suffer fewer T2D-associated cardiac complications. Quentin et al. set out to determine how metformin acts on the heart by studying rat cardiomyocytes. They focus on endoplasmic reticulum stress signalling (ERSS) pathways, which have previously been shown to be involved in both heart disease and T2D. They find that metformin activates only one of three ERSS pathways – the PERK-ATF4 pathway, leading to induction of CHOP. CHOP is usually proapoptotic, but metformin-treated cardiomyocytes do not activate apoptotic signalling pathways nor undergo apoptosis. The authors propose that future studies of T2D drugs should consider ERSS pathways. Page 259

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