Manipulation of glycolysis in malignant tumors: fantasy or therapy?

After Warburg stated his hypothesis on tumor cell metabolism about 80 years ago, the field of carbohydrate metabolism of cancer cells and solid tumors is experiencing a boom for the past few years. Numerous studies have been focused on the characteristics of cancer metabolism and its accessibility to novel therapeutic interventions. Malignant transformation is associated with an increase in glycolytic flux, mainly caused by an upregulation of numerous glycolysis-related genes in the majority of human cancers. As a consequence of these alterations, tumor cells are producing lactate at higher levels compared to non-malignant tissue, even in the presence of oxygen, a phenomenon termed "aerobic glycolysis" or "Warburg effect". A correlation between alterations in glycolytic pathways and therapy resistance in tumors is partially due to radical scavenger properties of specific metabolites which may decrease therapy-induced radical formation. Glycolytic activity and glycolysis-linked metabolic milieu are often variable between individual tumors resulting in variations in treatment response and aggressiveness. The peculiarities of tumor cell metabolism can be utilized for cancer diagnostics, such as metabolic imaging techniques and metabolic tumor markers. An emerging field of research is the manipulation of tumor cell metabolism for therapeutic purposes; respective studies include approaches of glycolysis inhibition or forcing mitochondrial respiration, respectively, based on biochemical and molecular principles. Up to now, such approach could eliminate tumors in patients without side effects when applied as single drug. Nevertheless, several agents that manipulate tumor metabolism may become a supportive therapy in combination with established cancer treatments.