Administering the glycolysis inhibitor metformin based on HK2 circadian rhythm improves trastuzumab efficacy. A and B, Western blot analysis of PER1, AMPK, and p-AMPK proteins in TR cells treated with MET with or without AMPK knockdown (A) or MG132 treatment (B). C, NCI-N87TR cells were subcutaneously injected in nude mice under a 12:12 h light/dark cycle with the lights on from ZT0 to ZT12. Mice were treated with PBS, trastuzumab (TRA; 10 mg/kg), metformin (MET; 250 mg/kg), or TRA combined with MET at ZT6 or ZT18. Western blot analysis was performed to detect PER1, HK2, AMPK, and p-AMPK in PBS and MET groups at ZT6 or ZT18. D, Nude mice were killed at 4 hours intervals across the 24 hours light/dark cycle for two consecutive days. qPCR analysis of relative mRNA levels of clock genes BMAL1, CLOCK, PER1, and PER2 in PBS and MET (250 mg/kg) groups are shown (n = 3). E and F, Tumor volumes (E) and weight (F) of nude mice were calculated (n = 5). One-way ANOVA was used to calculate P values. G, Representative IHC images of Ki67, cleaved-caspase-3, PER1, and HK2 performed on serial sections of subcutaneous tumors of xenograft nude mice. Scale bar, 140 µm. Data are graphed as the mean ± SD; *, P < 0.05; ***, P < 0.001; ns, nonsignificant, P > 0.05.