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Cancer as a Metabolic Disease


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Table of Contents

Forword xiii Preface xv 1. Images of Cancer 1 How Cancer is Viewed 2 References 13 2. Confusion Surrounds the Origin of Cancer 15 The Oncogenic Paradox 18 Hallmarks of Cancer 18 Reassessment 26 References 27 3. Cancer Models 31 Problems with Some Cancer Models 31 Animal Charges as a Major Impediment to Cancer Research 38 Problems with Tumor Histological Classification 39 Personal Perspective on Cancer 44 References 45 4. Energetics of Normal Cells and Cancer Cells 47 Metabolic Homeostasis 47 The Constancy of the G ATP 54 ATP Production in Normal Cells and Tumor Cells 55 Energy Production Through Glucose Fermentation 57 Glutaminolysis with or without Lactate Production 61 Transamination Reactions 64 TCA Cycle, Substrate-Level Phosphorylation 66 Cholesterol Synthesis and Hypoxia 67 Summary 67 References 68 5. Respiratory Dysfunction in Cancer Cells 73 Normal Mitochondria 74 Morphological Defects in Tumor Cell Mitochondria 77 Proteomic Abnormalities in Tumor Cell Mitochondria 79 Lipidomic Abnormalities in Tumor Cell Mitochondria 81 Cardiolipin: A Mitochondrial-Specific Lipid 83 Cardiolipin and Abnormal Energy Metabolism in Tumor Cells 85 Complicating Influence of the In Vitro Growth Environment on Cardiolipin Composition and Energy Metabolism 92 Mitochondrial Uncoupling and Cancer 97 Cancer Cell Heat Production and Uncoupled Mitochondria 98 Personal Perspective 99 Summary 100 References 101 6. The Warburg Dispute 107 Sidney Weinhouse?s Criticisms of the Warburg Theory 108 Alan Aisenberg?s Criticisms of the Warburg Theory 110 Sidney Colowick?s Assessment of the Aisenberg Monograph 113 Apples and Oranges 114 References 116 7. Is Respiration Normal in Cancer Cells? 119 Pseudo-Respiration 119 How Strong is the Scientific Evidence Showing that Tumor Cells can Produce Energy Through OxPhos? 124 OxPhos Origin of ATP in Cancer Cells Reevaluated 124 What About OxPhos Expression in Other Tumors? 127 The Pedersen Review on Tumor Mitochondria and the Bioenergetics of Cancer Cells 128 References 129 8. Is Mitochondrial Glutamine Fermentation a Missing Link in the Metabolic Theory of Cancer? 133 Amino Acid Fermentation can Maintain Cellular Energy Homeostasis During Anoxia 133 Evidence Suggesting that Metastatic Mouse Cells Derive Energy from Glutamine Fermentation 134 Fermentation Energy Pathways can Drive Cancer Cell Viability Under Hypoxia 138 Competing Explanations for the Metabolic Origin of Cancer 141 Chapter Summary 143 References 143 9. Genes, Respiration, Viruses, and Cancer 145 Does Cancer have a Genetic Origin? 145 Respiratory Insufficiency as the Origin of Cancer 150 Germline Mutations, Damaged Respiration, and Cancer 154 Somatic Mutations and Cancer 158 Revisiting the Oncogene Theory 160 Mitochondrial Mutations and the Absence or Presence of Cancer 163 Viral Infection, Damaged Respiration, and the Origin of Cancer 165 Summary 168 References 168 10. Respiratory Insufficiency, the Retrograde Response, and the Origin of Cancer 177 The Retrograde (RTG) Response: An Epigenetic System Responsible for Nuclear Genomic Stability 177 Inflammation Injures Cellular Respiration 181 Hypoxia-Inducible Factor (HIF) Stability is Required for the Origin of Cancer 182 Mitochondria and the Mutator Phenotype 183 Calcium Homeostasis, Aneuploidy, and Mitochondrial Dysfunction 186 Mitochondrial Dysfunction and Loss of Heterozygosity (LOH) 187 Tissue Inflammation, Damaged Respiration, and Cancer 188 References 189 11. Mitochondria: The Ultimate Tumor Suppressor 195 Mitochondrial Suppression of Tumorigenicity 195 Normal Mitochondria Suppress Tumorigenesis in Cybrids 196 Evidence from rho0 Cells 198 Normal Mitochondria Suppress Tumorigenesis In Vivo 199 Normal Mouse Cytoplasm Suppresses Tumorigenic Phenotypes 200 Enhanced Differentiation and Suppressed Tumorigenicity in the Liver Microenvironment 202 Summary of Nuclear-Cytoplasmic Transfer Experiments 203 References 204 12. Abnormalities in Growth Control, Telomerase Activity, Apoptosis, and Angiogenesis Linked to Mitochondrial Dysfunction 207 Growth Signaling Abnormalities and Limitless Replicative Potential 208 Linking Telomerase Activity to Cellular Energy and Cancer 209 Evasion of Programmed Cell Death (Apoptosis) 209 Sustained Vascularity (Angiogenesis) 210 References 211 13. Metastasis 215 Metastasis Overview 215 Cellular Origin of Metastasis 217 Macrophages and Metastasis 221 Carcinoma of Unknown Primary Origin 232 Many Metastatic Cancers Express Multiple Macrophage Properties 233 Linking Metastasis to Mitochondrial Dysfunction 233 Revisiting the ?Seed and Soil? Hypothesis of Metastasis 235 Revisiting the Mesenchymal Epithelial Transition (MET) 236 Genetic Heterogeneity in Cancer Metastases 237 Transmissible Metastatic Cancers 240 The Absence of Metastases in Crown-Gall Plant Tumors 240 Chapter Summary 241 References 241 14. Mitochondrial Respiratory Dysfunction and the Extrachromosomal Origin of Cancer 253 Connecting the Links 254 Addressing the Oncogenic Paradox 255 Is Cancer Many Diseases or a Singular Disease of Energy Metabolism? 258 References 258 15. Nothing in Cancer Biology Makes Sense Except in the Light of Evolution 261 Revisiting Growth Advantage of Tumor Cells, Mutations, and Evolution 262 Tumor Cell Fitness in Light of the Evolutionary Theory of Rick Potts 269 Cancer Development and Lamarckian Inheritance 271 Can Teleology Explain Cancer? 272 References 272 16. Cancer Treatment Strategies 277 Current Status of Cancer Treatment 277 The ?Standard of Care? for Glioblastoma Management 280 References 285 17. Metabolic Management of Cancer 291 Is it Dietary Content or Dietary Composition that Primarily Reduces Tumor Growth? 292 Dietary Energy Reduction and Therapeutic Fasting in Rodents and Humans 294 Ketogenic Diets 295 Glucagon and Insulin 297 Basal Metabolic Rate 298 Ketones and Glucose 298 Metabolic Management of Brain Cancer Using the KD 299 Glucose Accelerates Tumor Growth! 301 Glucose Regulates Blood Levels of Insulin and Insulin-Like Growth Factor 1 302 Dietary Energy Reduction is Antiangiogenic 302 Dietary Energy Reduction Targets Abnormal Tumor Vessels 307 Dietary Energy Reduction is Proapoptotic 309 Dietary Energy Reduction is Anti-Inflammatory 310 Targeting Energy Metabolism in Advanced Cancer 314 Differential Response of Normal Cells and Tumor Cells to Energy Stress 316 Dietary Energy Reduction is Anti-Invasive in Experimental Glioblastoma 318 Influence of Growth Site and Host on Tumor Progression 322 Implications of Dietary Energy Reduction for Anticancer Therapeutics 324 Targeting Glucose 325 Metformin 326 Synergistic Interaction of the Restricted Ketogenic Diet (KD-R) and 2-Deoxyglucose (2-DG) 327 Can Synergy Occur with the KD-R and Hyperbaric Oxygen Therapy? 331 Targeting Glutamine 333 Glutamine Targeting Inhibits Systemic Metastasis 334 Targeting Phagocytosis 339 Targeting the Microenvironment 340 Dietary Energy Reduction as a Mitochondrial Enhancement Therapy (MET) 341 Summary 341 References 341 18. Patient Implementation of Metabolic Therapies for Cancer Management 355 Introduction 355 Guidelines for Implementing the Restricted Ketogenic Diet as a Treatment Strategy for Cancer 356 Complicating Issues for Implementing the KD-R as a Treatment Strategy for Cancer 366 Radiation and Chemotherapy is a Standard Treatment for Many Malignant Cancers 366 Compliance 367 Cancer as a Genetic Disease 367 Mechanism of Action? 368 Cachexia 368 Summary 369 References 370 19. Cancer Prevention 375 Cell Phones and Cancer 376 Alzheimer?s Disease and Cancer Risk 377 Ketone Metabolism Reduces Cancer Risk 378 Mitochondrial Enhancement Therapy 379 Therapeutic Fasting and Cancer Prevention 379 Autophagy and Autolytic Cannibalism: A Thermodynamic Approach to Cancer Prevention 381 Cancer Prevention by Following Restricted Ketogenic Diet 382 References 384 20. Case Studies and Personal Experiences in Using the Ketogenic Diet for Cancer Management 387 Effects of a Ketogenic Diet on Tumor Metabolism and Nutritional Status in Pediatric Oncology Patients: Comments from Dr. Linda Nebeling 387 Raffi?s Story: Comments from Miriam Kalamian 389 Biological Plausibility that Cancer is a Metabolic Disease Dependent for Growth on Glucose and Glutamine: Comments from Dr. Bomar Herrin 395 Using the Restricted Ketogenic Diet for Brain Cancer Management: Comments from Neuro-Oncologist, Dr. Kraig Moore 397 The Ketogenic Diet for Brain Cancer Management: Comments from Beth Zupec-Kania 400 Summary 402 References 403 21. Conclusions 405 Major Conclusions 407 References 408 Index 409

About the Author

THOMAS N. SEYFRIED, PhD, has taught and conductedresearch in the fields of neurogenetics, neurochemistry, and cancerfor more than twenty-five years at Yale University and BostonCollege. He has published more than 150 scientific articles andbook chapters and is on the editorial boards of Nutrition &Metabolism, Journal of Lipid Research, Neurochemical Research,and ASN Neuro.


This book offers a refreshing perspective for anyonewanting to get a comprehensive background on the newer emerginginterest in targeting cancer metabolism for therapy. (Doody s, 11 January 2013) For the first time, an entire issue is being devoted to areview article based on a recent medical book. This is a departurefrom our usual format, but I think you will agree that this topicwarrants the detailed treatment we have given it ...This bookshould be required reading for all scientifically literate peoplewho are involved in the cancer problem. (Advancesin Cancer Treatment, 1 October 2012)

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