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Christian Frezza
MRC Cancer Unit
CANCER METABOLISM,
A HALLMARK OF CANCER
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WHAT IS CANCER?
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WHAT IS CANCER?
Douglas Hanahan, Robert A. Weinberg; The Hallmarks of Cancer
Cell, Volume 100, Issue 1, 7 January 2000, Pages 57–70
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CANCER CELLS NEED ENERGY TO PROLIFERATE
EAT,
SURVIVE,
REPRODUCE
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DYSREGULATED METABOLISM IS A HALLMARK OF CANCER
Douglas Hanahan, Robert A. Weinberg; Hallmarks of Cancer: next generation
Cell, Volume 144, Issue 5, p646–674, 4 March 2011
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CANCER AND METABOLISM: WHEN IT ALL STARTED
Warburg observed the
increased glycolysis in cancer cell
Wassermann hypothesised a
role of deregulated respiration in
cancer cell
Muller observed aberrant
metabolism in urine of cancer
patients
Freund proposed that
blood cancercells
can be killed by reducing
glucose
Otto Warburg
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THE TIMELINE OF CANCER RESEARCH
Warburg observed the
increased glycolysis in cancer cell
Warburg published
“On the origin of cancer cell”
debate between Weinhouse and
Warburg on mitochondria and
cancer
Biochemistry era Genomic era
p53 was identified
Kovacevic observed increased
glutaminolysis in cancer cell
I was born
cMyc was discovered
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CANCER: A GENETIC DISEASE
Mutated genes
Transformation
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debate between Weinhouse and
Warburg on mitochondria and
cancer
I was born
Biochemistry era Genomic era
THE TIMELINE OF CANCER RESEARCH
Warburg observed the
increased glycolysis in cancer cell
Warburg published “On the
origin of cancer cell”
p53 was identified
Mina Bissellconfirmed glucose
consumption in virus-transformed
cells c-Myc was discovered
c-Myc regulates glycolysis
Src/Ras regulate glycolysis
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CANCER AND METABOLISM COME TOGETHER
Mutated genes
Transformation
Metabolism
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I was born
THE TIMELINE OF CANCER RESEARCH
Warburg observed the
increased glycolysis in cancer cell
Warburg published “On the
origin of cancer cell”
Debate between Weinhouse and
Warburg on mitochondria and
cancer
mutations in mitochondrial
proteins SDH and FH are cause of
cancer
p53 was identified
Kovacevic observed increased
glutaminolysis in cancer cell cMyc was
discovered
cMyc regulates glycolysis
Biochemistry era Genomic era
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THE TIMELINE OF CANCER RESEARCH
Warburg observed the
increased glycolysis in cancer cell
Warburg published “On the
origin of cancer cell”
Debate between Weinhouse and
Warburg on mitochondria and
cancer
mutations in mitochondrial
proteins SDH and FH are cause of
cancer
p53 was identified
Kovacevic observed increased
glutaminolysis in cancer cell
accumulation of succinate in SDH mutants stabilizes
HIF
I was born
cMyc was discovered
2HG is produced by mutant IDHs and inhibits DNA and
histone demethylation
PGHDH is amplified in breast cancer
p53 regulates cell metabolism via TIGAR,
PGM, Sco2
cMyc regulates glycolysis
mutations in IDH are found in
glioblastoma 2HG is sufficient to induce
leukemogenesis
Fumarate induces EMT
Genomic eraBiochemistry era Metabolomics era
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CANCER: A METABOLIC DISEASE?
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A SYSTEM VIEW OF CANCER
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CANCER METABOLISM
An historical perspective on
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21% 0 %Oxygen concentration
glucose
pyruvate
CO2
fermentation
respiration
lactate
Pasteur effect
METABOLISM IN THE 19TH CENTURY
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WARBURG EXPERIMENTS
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AEROBIC GLYCOLYSIS IN CANCER CELLS
Normal cell Cancer cell
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THE WARBURG HYPOTHESIS
The prime cause of cancer is the replacement of
the respiration of oxygen…by a fermentation of
sugar…”
Normal cell Cancer cellPhase I
Injury of respiration
Phase II
Aerobic glycolysis
Phase III
De-differentiation
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DISSECTING THE WARBURG HYPOTHESIS
Phase I
Injury of respiration
Phase II
Aerobic glycolysis
Phase III
De-differentiation
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IS RESPIRATION IN CANCER CELLS INJURED?
Sidney Weinhouse
”…there is no evidence…that the respiration in cancer cell is either quantitatively
lowered or fails to lower glycolysis…” Weinhouse, Z. Krebsforsh, 1976
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IS HYPOXIA THE CAUSE OF MITOCHONDRIAL DYSFUNCTION?
…all Warburg’s experiment were performed using well oxygenated tissues
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METABOLIC LANDSCAPE OF CANCER
The Cancer Genome Atlas22 tumour types>8000 patients
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THE METABOLIC LANDSCAPE OF CANCER
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High Survival
Low Survival
Gene Set Enrichment Analysis
Metabolic Pathwayslinked to
patient survival
METABOLISM AND PATIENT OUTCOME
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METABOLISM AND PATIENT OUTCOME
OXPHOS is suppressed in low survival patients
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EVIDENCE FROM IN VIVO EXPERIMENTS
Cell Metabolism Volume 28, Issue 5, (November 2018)
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CAN MITOCHONDRIAL
DYSFUNCTION BE A CANCER DRIVER?
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ONCOGENIC ROLES OF DYSFUNCTIONAL MITOCHONDRIA
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MITOCHONDRIAL DYSFUNCTION CAN BE ONCOGENIC
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MITOCHONDRIAL DYSFUNCTION DRIVES CANCER
Metabolic
dysregulation
Krebs cycle
FH=Fumarate Hydratase
SDH=Succinate Dehydrogenase
IDH=Isocitrate Dehydrogenase
Transformation
FH
SDH IDH
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FH MUTATIONS CAUSE HLRCC
HLRCC
• Benign tumours of the skin and uterus
• Papillary type 2 renal cell carcinoma
kidney
tumour
uterus
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FUMARATE ACCUMULATES IN FH-DEFICIENT CELLS
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FUMARATE: AN ONCOMETABOLITE
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MITOCHONDRIA DYSFUNCTION IN CANCER?
Mitochondrial function is rewired in
cancer cells, in a context-dependent
manner
Mitochondrial dysfunction can activate
oncogenic processes
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THE WARBURG HYPOTHESIS
Phase I
Injury of respiration
Phase II
Aerobic glycolysis
Phase III
De-differentiation
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[18F]flouro-2-deoxyglucose (FDG) Positron Emission Tomography (PET)
AEROBIC GLYCOLYSIS IN CANCER
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FDG-PET SHOWS INCREASE IN GLUCOSE UPTAKE IN CANCER
https://en.wikipedia.org/wiki/Positron_emission_tomography
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IMAGING OF CANCER METABOLISM
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IMAGING OF CANCER METABOLISM
subcutaneously implanted EL4 tumour pH map
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IMAGING CANCER METABOLISM
Mitochondrial potential
Glycolysis
4-[18F]fluorobenzyl-triphenylphosphonium
PET-CT
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IS IT ALL ABOUT ATP?
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Illustration by John DiGianni/Dana-Farber Cancer Institute Department of Communications
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AEROBIC GLYCOLYSIS SUPPORTS PROLIFERATION
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AEROBIC GLYCOLYSIS AND MIGRATION
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OVEREXPRESSION OF GLYCOLYTIC ENZYMES DRIVE CANCER
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IS GLYCOLYSIS UP-REGULATED IN CANCER?
Aerobic glycolysis is a hallmark of cancer
Yet, Aerobic glycolysis is a characteristic of most proliferating cells
Aerobic glycolysis provides building blocks for cancer cell growth
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THE WARBURG HYPOTHESIS
Phase I
Injury of respiration
Phase II
Aerobic glycolysis
Phase III
De-differentiation
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AEROBIC GLYCOLYSIS AND “STEMNESS”
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CANCER STEM CELLS AND PLASTICITY
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SOME COMPLICATIONS….
EMERGING CONCEPTS IN CANCER METABOLISM
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DYSREGULATED METABOLISM: A HALLMARK OF CANCER
Metabolic
dysregulation
Transformation
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DYSREGULATED METABOLISM: A HALLMARK OF CANCER
Metabolic
dysregulation
Transformation
Biosynthesis Energy Redox
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THE METABOLIC HALLMARKS OF CANCER
Cell Metabolism 2016 23, 27-47DOI: (10.1016/j.cmet.2015.12.006)
Copyright © 2016 Elsevier Inc. Terms and Conditions
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INTRINSIC METABOLIC HETEROGENEITY OF CANCER
Cell MetabolismVolume 30, Issue 3, 3 September 2019, Pages 434-446
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TUMOUR MICROENVIRONMENT AFFECTS METABOLISM
Biancur et al, BBA 2018
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CANCER METABOLISM EVOLVES OVER TIME
DeBerardinis and Chandel , Sci Adv 2016
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STARVING CANCER TO DEATH
https://discoverysedge.mayo.edu/2017/09/06/starving-cancer/
Cancer cell
nutrients
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THE FIRST EXAMPLE OF TARGETING CANCER METABOLISM?
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TARGETING CANCER METABOLISM (2010)
2HG
IDH*
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TARGETING CANCER METABOLISM (2018)
2HG
IDH*
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IDH AND GLS INHIBITORS ARE IN CLINIC
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RESISTANCE THROUGH METABOLIC REPROGRAMMING
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CONCLUSIONS
Metabolism of cancer cells is different from that of normal cells
Dysregulated metabolism can drive oncogenic processes
Altered metabolism offers a therapeutic window to target cancer cells
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KEY REFERENCES & LINKS
• O. Warburg, On the origin of cancer cells, Science, 1956
• JS. Flier et al. Elevated levels of glucose transport and transporter messenger RNA
are induced by ras or src oncogenes. Science, 1987
• H. Shim et al. c-Myc transactivation of LDH-A: Implications for tumor
metabolism and growth, PNAS, 1998
• D. Hanahan and RA. Weinberg, Hallmarks of Cancer: next generation, Cell, 2011
• Gaude and Frezza, Tissue-specific and convergent metabolic transformation of
cancer correlates with metastatic potential and patient survival, Nat Comms, 2016
• Pavlova and Thompson, The emerging hallmarks of cancer metabolism, Cell
Metabolism, 2016
• Sanderson et al, Revisiting the Warburg Effect: Some Tumors Hold Their Breath, Cell
Metabolism 2018
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