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      Metabolic dysregulation and emerging therapeutical targets for hepatocellular carcinoma

      review-article
      a , a , a , a , b , c , a , d , e , , a ,
      Acta Pharmaceutica Sinica. B
      Elsevier
      Metabolic dysregulation, Hepatocellular carcinoma, Glycolysis, Tricarboxylic acid cycle, Pentose phosphate pathway, Fatty acid β-oxidation, Glutamine metabolism, Cancer therapy, 1,3-BPG, 1,3-bisphosphoglycerate, 2-DG, 2-deoxy-d-glucose, 3-BrPA, 3-bromopyruvic acid, ACC, acetyl-CoA carboxylase, ACLY, adenosine triphosphate (ATP) citrate lyase, ACS, acyl-CoA synthease, AKT, protein kinase B, AML, acute myeloblastic leukemia, AMPK, adenosine mono-phosphate-activated protein kinase, ASS1, argininosuccinate synthase 1, ATGL, adipose triacylglycerol lipase, CANA, canagliflozin, CPT, carnitine palmitoyl-transferase, CYP4, cytochrome P450s (CYPs) 4 family, DNL, de novo lipogenesis, EMT, epithelial-to-mesenchymal transition, ER, endoplasmic reticulum, ERK, extracellular-signal regulated kinase, FABP1, fatty acid binding protein 1, FASN, fatty acid synthase, FBP1, fructose-1,6-bisphosphatase 1, FFA, free fatty acid, G6PD, glucose-6-phosphate dehydrogenase, GAPDH, glyceraldehyde-3-phosphate dehydrogenase, GLS1, renal-type glutaminase, GLS2, liver-type glutaminase, GLUT1, glucose transporter 1, GOT1, glutamate oxaloacetate transaminase 1, HCC, hepatocellular carcinoma, HIF-1α, hypoxia-inducible factor-1 alpha, HK, hexokinase, HMGCR, 3-hydroxy-3-methylglutaryl-CoA reductase, HSCs, hepatic stellate cells, IDH2, isocitrate dehydrogenase 2, LCAD, long-chain acyl-CoA dehydrogenase, LDH, lactate dehydrogenase, LPL, lipid lipase, LXR, liver X receptor, MAFLD, metabolic associated fatty liver disease, MAGL, monoacyglycerol lipase, MCAD, medium-chain acyl-CoA dehydrogenase, MEs, malic enzymes, mIDH, mutant IDH, MMP9, matrix metallopeptidase 9, mTOR, mammalian target of rapamycin, NADPH, nicotinamide adenine nucleotide phosphate, NAFLD, non-alcoholic fatty liver disease, NASH, non-alcoholic steatohepatitis, OTC, ornithine transcarbamylase, PCK1, phosphoenolpyruvate carboxykinase 1, PFK1, phosphofructokinase 1, PGAM1, phosphoglycerate mutase 1, PGK1, phosphoglycerate kinase 1, PI3K, phosphoinositide 3-kinase, PKM2, pyruvate kinase M2, PPARα, peroxisome proliferator-activated receptor alpha, PPP, pentose phosphate pathway, ROS, reactive oxygen species, SCD1, stearoyl-CoA-desaturase 1, SGLT2, sodium-glucose cotransporter 2, SLC1A5/ASCT2, solute carrier family 1 member 5/alanine serine cysteine preferring transporter 2 , SLC7A5/LAT1, solute carrier family 7 member 5/L-type amino acid transporter 1, SREBP1, sterol regulatory element-binding protein 1, TAGs, triacylglycerols, TCA cycle, tricarboxylic acid cycle, TKIs, tyrosine kinase inhibitors, TKT, transketolase, VEGFR, vascular endothelial growth factor receptor, WD-fed MC4R-KO, Western diet (WD)-fed melanocortin 4 receptor-deficient (MC4R-KO), WNT, wingless-type MMTV integration site family

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          Abstract

          Hepatocellular carcinoma (HCC) is an aggressive human cancer with increasing incidence worldwide. Multiple efforts have been made to explore pharmaceutical therapies to treat HCC, such as targeted tyrosine kinase inhibitors, immune based therapies and combination of chemotherapy. However, limitations exist in current strategies including chemoresistance for instance. Tumor initiation and progression is driven by reprogramming of metabolism, in particular during HCC development. Recently, metabolic associated fatty liver disease (MAFLD), a reappraisal of new nomenclature for non-alcoholic fatty liver disease (NAFLD), indicates growing appreciation of metabolism in the pathogenesis of liver disease, including HCC, thereby suggesting new strategies by targeting abnormal metabolism for HCC treatment. In this review, we introduce directions by highlighting the metabolic targets in glucose, fatty acid, amino acid and glutamine metabolism, which are suitable for HCC pharmaceutical intervention. We also summarize and discuss current pharmaceutical agents and studies targeting deregulated metabolism during HCC treatment. Furthermore, opportunities and challenges in the discovery and development of HCC therapy targeting metabolism are discussed.

          Graphical abstract

          Metabolic dysregulation is emphasized in the pathogenesis of hepatocellular carcinoma (HCC), thus agents or chemicals are developed as potentials to treat HCC by targeting deregulated metabolism.

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          Most cited references225

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          Cancer statistics in China, 2015.

          With increasing incidence and mortality, cancer is the leading cause of death in China and is a major public health problem. Because of China's massive population (1.37 billion), previous national incidence and mortality estimates have been limited to small samples of the population using data from the 1990s or based on a specific year. With high-quality data from an additional number of population-based registries now available through the National Central Cancer Registry of China, the authors analyzed data from 72 local, population-based cancer registries (2009-2011), representing 6.5% of the population, to estimate the number of new cases and cancer deaths for 2015. Data from 22 registries were used for trend analyses (2000-2011). The results indicated that an estimated 4292,000 new cancer cases and 2814,000 cancer deaths would occur in China in 2015, with lung cancer being the most common incident cancer and the leading cause of cancer death. Stomach, esophageal, and liver cancers were also commonly diagnosed and were identified as leading causes of cancer death. Residents of rural areas had significantly higher age-standardized (Segi population) incidence and mortality rates for all cancers combined than urban residents (213.6 per 100,000 vs 191.5 per 100,000 for incidence; 149.0 per 100,000 vs 109.5 per 100,000 for mortality, respectively). For all cancers combined, the incidence rates were stable during 2000 through 2011 for males (+0.2% per year; P = .1), whereas they increased significantly (+2.2% per year; P < .05) among females. In contrast, the mortality rates since 2006 have decreased significantly for both males (-1.4% per year; P < .05) and females (-1.1% per year; P < .05). Many of the estimated cancer cases and deaths can be prevented through reducing the prevalence of risk factors, while increasing the effectiveness of clinical care delivery, particularly for those living in rural areas and in disadvantaged populations.
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            Understanding the Warburg effect: the metabolic requirements of cell proliferation.

            In contrast to normal differentiated cells, which rely primarily on mitochondrial oxidative phosphorylation to generate the energy needed for cellular processes, most cancer cells instead rely on aerobic glycolysis, a phenomenon termed "the Warburg effect." Aerobic glycolysis is an inefficient way to generate adenosine 5'-triphosphate (ATP), however, and the advantage it confers to cancer cells has been unclear. Here we propose that the metabolism of cancer cells, and indeed all proliferating cells, is adapted to facilitate the uptake and incorporation of nutrients into the biomass (e.g., nucleotides, amino acids, and lipids) needed to produce a new cell. Supporting this idea are recent studies showing that (i) several signaling pathways implicated in cell proliferation also regulate metabolic pathways that incorporate nutrients into biomass; and that (ii) certain cancer-associated mutations enable cancer cells to acquire and metabolize nutrients in a manner conducive to proliferation rather than efficient ATP production. A better understanding of the mechanistic links between cellular metabolism and growth control may ultimately lead to better treatments for human cancer.
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              Atezolizumab plus Bevacizumab in Unresectable Hepatocellular Carcinoma

              The combination of atezolizumab and bevacizumab showed encouraging antitumor activity and safety in a phase 1b trial involving patients with unresectable hepatocellular carcinoma.
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                Author and article information

                Contributors
                Journal
                Acta Pharm Sin B
                Acta Pharm Sin B
                Acta Pharmaceutica Sinica. B
                Elsevier
                2211-3835
                2211-3843
                25 September 2021
                February 2022
                25 September 2021
                : 12
                : 2
                : 558-580
                Affiliations
                [a ]Department of Pharmacology, School of Pharmacy, China Pharmaceutical University, Nanjing 210009, China
                [b ]Research Center of Biotechnology, School of Life Science and Technology, China Pharmaceutical University, Nanjing 210009, China
                [c ]Jiangsu Key Laboratory of Drug Screening, China Pharmaceutical University, Nanjing 210009, China
                [d ]State Key Laboratory of Natural Medicines, China Pharmaceutical University, Nanjing 210009, China
                [e ]Key Laboratory of Drug Metabolism and Pharmacokinetics, China Pharmaceutical University, Nanjing 210009, China
                Author notes
                Article
                S2211-3835(21)00361-0
                10.1016/j.apsb.2021.09.019
                8897153
                35256934
                e708531a-6c99-48c4-8c68-506a9b388d30
                © 2022 Chinese Pharmaceutical Association and Institute of Materia Medica, Chinese Academy of Medical Sciences. Production and hosting by Elsevier B.V.

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 8 April 2021
                : 31 August 2021
                : 1 September 2021
                Categories
                Review

                metabolic dysregulation,hepatocellular carcinoma,glycolysis,tricarboxylic acid cycle,pentose phosphate pathway,fatty acid β-oxidation,glutamine metabolism,cancer therapy,1,3-bpg, 1,3-bisphosphoglycerate,2-dg, 2-deoxy-d-glucose,3-brpa, 3-bromopyruvic acid,acc, acetyl-coa carboxylase,acly, adenosine triphosphate (atp) citrate lyase,acs, acyl-coa synthease,akt, protein kinase b,aml, acute myeloblastic leukemia,ampk, adenosine mono-phosphate-activated protein kinase,ass1, argininosuccinate synthase 1,atgl, adipose triacylglycerol lipase,cana, canagliflozin,cpt, carnitine palmitoyl-transferase,cyp4, cytochrome p450s (cyps) 4 family,dnl, de novo lipogenesis,emt, epithelial-to-mesenchymal transition,er, endoplasmic reticulum,erk, extracellular-signal regulated kinase,fabp1, fatty acid binding protein 1,fasn, fatty acid synthase,fbp1, fructose-1,6-bisphosphatase 1,ffa, free fatty acid,g6pd, glucose-6-phosphate dehydrogenase,gapdh, glyceraldehyde-3-phosphate dehydrogenase,gls1, renal-type glutaminase,gls2, liver-type glutaminase,glut1, glucose transporter 1,got1, glutamate oxaloacetate transaminase 1,hcc, hepatocellular carcinoma,hif-1α, hypoxia-inducible factor-1 alpha,hk, hexokinase,hmgcr, 3-hydroxy-3-methylglutaryl-coa reductase,hscs, hepatic stellate cells,idh2, isocitrate dehydrogenase 2,lcad, long-chain acyl-coa dehydrogenase,ldh, lactate dehydrogenase,lpl, lipid lipase,lxr, liver x receptor,mafld, metabolic associated fatty liver disease,magl, monoacyglycerol lipase,mcad, medium-chain acyl-coa dehydrogenase,mes, malic enzymes,midh, mutant idh,mmp9, matrix metallopeptidase 9,mtor, mammalian target of rapamycin,nadph, nicotinamide adenine nucleotide phosphate,nafld, non-alcoholic fatty liver disease,nash, non-alcoholic steatohepatitis,otc, ornithine transcarbamylase,pck1, phosphoenolpyruvate carboxykinase 1,pfk1, phosphofructokinase 1,pgam1, phosphoglycerate mutase 1,pgk1, phosphoglycerate kinase 1,pi3k, phosphoinositide 3-kinase,pkm2, pyruvate kinase m2,pparα, peroxisome proliferator-activated receptor alpha,ppp, pentose phosphate pathway,ros, reactive oxygen species,scd1, stearoyl-coa-desaturase 1,sglt2, sodium-glucose cotransporter 2,slc1a5/asct2, solute carrier family 1 member 5/alanine serine cysteine preferring transporter 2,slc7a5/lat1, solute carrier family 7 member 5/l-type amino acid transporter 1,srebp1, sterol regulatory element-binding protein 1,tags, triacylglycerols,tca cycle, tricarboxylic acid cycle,tkis, tyrosine kinase inhibitors,tkt, transketolase,vegfr, vascular endothelial growth factor receptor,wd-fed mc4r-ko, western diet (wd)-fed melanocortin 4 receptor-deficient (mc4r-ko),wnt, wingless-type mmtv integration site family
                metabolic dysregulation, hepatocellular carcinoma, glycolysis, tricarboxylic acid cycle, pentose phosphate pathway, fatty acid β-oxidation, glutamine metabolism, cancer therapy, 1,3-bpg, 1,3-bisphosphoglycerate, 2-dg, 2-deoxy-d-glucose, 3-brpa, 3-bromopyruvic acid, acc, acetyl-coa carboxylase, acly, adenosine triphosphate (atp) citrate lyase, acs, acyl-coa synthease, akt, protein kinase b, aml, acute myeloblastic leukemia, ampk, adenosine mono-phosphate-activated protein kinase, ass1, argininosuccinate synthase 1, atgl, adipose triacylglycerol lipase, cana, canagliflozin, cpt, carnitine palmitoyl-transferase, cyp4, cytochrome p450s (cyps) 4 family, dnl, de novo lipogenesis, emt, epithelial-to-mesenchymal transition, er, endoplasmic reticulum, erk, extracellular-signal regulated kinase, fabp1, fatty acid binding protein 1, fasn, fatty acid synthase, fbp1, fructose-1,6-bisphosphatase 1, ffa, free fatty acid, g6pd, glucose-6-phosphate dehydrogenase, gapdh, glyceraldehyde-3-phosphate dehydrogenase, gls1, renal-type glutaminase, gls2, liver-type glutaminase, glut1, glucose transporter 1, got1, glutamate oxaloacetate transaminase 1, hcc, hepatocellular carcinoma, hif-1α, hypoxia-inducible factor-1 alpha, hk, hexokinase, hmgcr, 3-hydroxy-3-methylglutaryl-coa reductase, hscs, hepatic stellate cells, idh2, isocitrate dehydrogenase 2, lcad, long-chain acyl-coa dehydrogenase, ldh, lactate dehydrogenase, lpl, lipid lipase, lxr, liver x receptor, mafld, metabolic associated fatty liver disease, magl, monoacyglycerol lipase, mcad, medium-chain acyl-coa dehydrogenase, mes, malic enzymes, midh, mutant idh, mmp9, matrix metallopeptidase 9, mtor, mammalian target of rapamycin, nadph, nicotinamide adenine nucleotide phosphate, nafld, non-alcoholic fatty liver disease, nash, non-alcoholic steatohepatitis, otc, ornithine transcarbamylase, pck1, phosphoenolpyruvate carboxykinase 1, pfk1, phosphofructokinase 1, pgam1, phosphoglycerate mutase 1, pgk1, phosphoglycerate kinase 1, pi3k, phosphoinositide 3-kinase, pkm2, pyruvate kinase m2, pparα, peroxisome proliferator-activated receptor alpha, ppp, pentose phosphate pathway, ros, reactive oxygen species, scd1, stearoyl-coa-desaturase 1, sglt2, sodium-glucose cotransporter 2, slc1a5/asct2, solute carrier family 1 member 5/alanine serine cysteine preferring transporter 2, slc7a5/lat1, solute carrier family 7 member 5/l-type amino acid transporter 1, srebp1, sterol regulatory element-binding protein 1, tags, triacylglycerols, tca cycle, tricarboxylic acid cycle, tkis, tyrosine kinase inhibitors, tkt, transketolase, vegfr, vascular endothelial growth factor receptor, wd-fed mc4r-ko, western diet (wd)-fed melanocortin 4 receptor-deficient (mc4r-ko), wnt, wingless-type mmtv integration site family

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