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. 2017 Feb 23:14:19.
doi: 10.1186/s12986-017-0178-2. eCollection 2017.

Press-pulse: a novel therapeutic strategy for the metabolic management of cancer

Thomas N Seyfried  1 , George Yu  2 , Joseph C Maroon  3 , Dominic P D'Agostino  4
Affiliations

Press-pulse: a novel therapeutic strategy for the metabolic management of cancer

Thomas N Seyfried et al. Nutr Metab (Lond). .

Abstract

Background: A shift from respiration to fermentation is a common metabolic hallmark of cancer cells. As a result, glucose and glutamine become the prime fuels for driving the dysregulated growth of tumors. The simultaneous occurrence of "Press-Pulse" disturbances was considered the mechanism responsible for reduction of organic populations during prior evolutionary epochs. Press disturbances produce chronic stress, while pulse disturbances produce acute stress on populations. It was only when both disturbances coincide that population reduction occurred.

Methods: This general concept can be applied to the management of cancer by creating chronic metabolic stresses on tumor cell energy metabolism (press disturbance) that are coupled to a series of acute metabolic stressors that restrict glucose and glutamine availability while also stimulating cancer-specific oxidative stress (pulse disturbances). The elevation of non-fermentable ketone bodies protect normal cells from energy stress while further enhancing energy stress in tumor cells that lack the metabolic flexibility to use ketones as an efficient energy source. Mitochondrial abnormalities and genetic mutations make tumor cells vulnerable metabolic stress.

Results: The press-pulse therapeutic strategy for cancer management is illustrated with calorie restricted ketogenic diets (KD-R) used together with drugs and procedures that create both chronic and intermittent acute stress on tumor cell energy metabolism, while protecting and enhancing the energy metabolism of normal cells.

Conclusions: Optimization of dosing, timing, and scheduling of the press-pulse therapeutic strategy will facilitate the eradication of tumor cells with minimal patient toxicity. This therapeutic strategy can be used as a framework for the design of clinical trials for the non-toxic management of most cancers.

Keywords: Cancer metabolism; Diet; Glucose; Glutamine; Glutaminolysis; Hyperbaric oxygen; KETONE bodies; Mitochondria; Warburg effect.

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Figures

Fig. 1
Fig. 1
_targeting Glucose and Glutamine for the Metabolic Management of Cancer. Cancer cells are largely dependent on glucose and glutamine for survival and growth. Energy through fermentation metabolism (substrate level phosphorylations, SLP) in glycolysis and the tricarboxylic acid cycle (TCA) will compensate for reduced energy through oxidative phosphorylation (OxPhos) that occurs in tumor cells. The yellow ovals indicate the three source of cellular ATP production. Glucose carbons can be used for both the glycolytic and pentose phosphate (PPP) pathways to supply ATP and precursors for lipid and nucleotide synthesis, as well as for glutathione production. Glutamine provides its amide nitrogen for ammonia and nucleotide synthesis. The glutamine-derived glutamate provides anapleurotic carbons to the TCA cycle through α-KG for protein synthesis while also providing ATP through TCA cycle SLP. TCA cycle substrate level phosphorylation through the succinate thiokinase reaction can generate significant cellular ATP under hypoxia especially in tumor cells with defective respiration [78]. The glutamine-derived glutamate is also used for glutathione production that protects tumor cells from oxidative stress. Glucose and glutamine _targeting will thus make cancer cells vulnerable to oxidative stress therapies. The simultaneous _targeting of glucose and glutamine through the press-pulse therapeutic strategy will starve tumor cells of energy production while blocking their ability to synthesize proteins, lipids, and nucleotides. Glucose and glutamine can also be generated internally through the lysosomal digestion of phagocytosed glycoconjugates and proteins (see text). An elevation of non-fermentable ketone bodies through, calorie restriction, ketogenic diets, or supplementation will provide normal cells with an alternative energy source to glucose while also protecting them from oxidative stress. Ghost mitochondria are those containing little or no inner mitochondrial membranes (cristae), which are essential for normal OxPhos function [67, 282, 283]
Fig. 2
Fig. 2
Illustration of the Press-Pulse Therapeutic Strategy for Cancer Management. The “Press-Pulse” therapeutic strategy considers cancer as a singular systemic disease regardless of the specific tissue or organ system containing invasive or metastatic tumor cells. This strategy is designed to _target the glucose and glutamine dependency of tumor cells, while enhancing the metabolic efficiency in normal cells. Press therapies are designed to reduce systemic glucose availability while elevating blood levels of ketone bodies, which tumor cells cannot effectively use for energy generation. This approach pits the metabolic demands of normal cells against those of the mutated tumor cells, which are less capable than normal cells in adapting to metabolic stress from nutrient deprivation. Ketone body supplements could further reduce glucose levels while enhancing the respiratory energy metabolism in normal cells. Stress management techniques together with exercise could further stress tumor cell metabolism while improving general health. The press therapies would be designed to work synergistically with acute pulse therapies to further _target glucose and glutamine metabolism. HBOT will work together with the press therapies to selectively increase oxidative stress in tumor cells. The spacing between the various pulse therapies is designed to stress tumor cell metabolism while minimizing toxicity to normal body cells. This therapeutic strategy will _target the fermentation metabolism common to most tumor cells, thus gradually degrading tumor burden. The progressive color change in the Vitruvian man drawing from red (diseased with darker red spots indicative of metastatic lesions), to yellow (reduced metastasis), to green (resolution) symbolizes a gradual metabolic management and resolution of cancer. The pill symbol is indicative of glycolysis _targeting that could be delivered orally. The Rx symbol is indicative of glutamine _targeting that could be delivered intravenously. Pulse therapies would terminate with evidence of management or resolution while press therapies could continue under modification or adjustment (arrow). Optimization of dosing, timing, and scheduling of the press-pulse therapeutic strategy will facilitate the eradication of tumor cells with minimal patient toxicity. This therapeutic strategy can be used as a framework for the design of clinical trials for the majority of cancers. HBOT, hyperbaric oxygen therapy; KD-R, calorie restricted ketogenic diet
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