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      The Ketogenic Diet and Hyperbaric Oxygen Therapy Prolong Survival in Mice with Systemic Metastatic Cancer

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          Abstract

          Introduction

          Abnormal cancer metabolism creates a glycolytic-dependency which can be exploited by lowering glucose availability to the tumor. The ketogenic diet (KD) is a low carbohydrate, high fat diet which decreases blood glucose and elevates blood ketones and has been shown to slow cancer progression in animals and humans. Abnormal tumor vasculature creates hypoxic pockets which promote cancer progression and further increase the glycolytic-dependency of cancers. Hyperbaric oxygen therapy (HBO 2T) saturates tumors with oxygen, reversing the cancer promoting effects of tumor hypoxia. Since these non-toxic therapies exploit overlapping metabolic deficiencies of cancer, we tested their combined effects on cancer progression in a natural model of metastatic disease.

          Methods

          We used the firefly luciferase-tagged VM-M3 mouse model of metastatic cancer to compare tumor progression and survival in mice fed standard or KD ad libitum with or without HBO 2T (2.5 ATM absolute, 90 min, 3x/week). Tumor growth was monitored by in vivo bioluminescent imaging.

          Results

          KD alone significantly decreased blood glucose, slowed tumor growth, and increased mean survival time by 56.7% in mice with systemic metastatic cancer. While HBO 2T alone did not influence cancer progression, combining the KD with HBO 2T elicited a significant decrease in blood glucose, tumor growth rate, and 77.9% increase in mean survival time compared to controls.

          Conclusions

          KD and HBO 2T produce significant anti-cancer effects when combined in a natural model of systemic metastatic cancer. Our evidence suggests that these therapies should be further investigated as potential non-toxic treatments or adjuvant therapies to standard care for patients with systemic metastatic disease.

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          Most cited references76

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          On the origin of cancer cells.

          O WARBURG (1956)
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            Tumor hypoxia: causative factors, compensatory mechanisms, and cellular response.

            Hypoxia is a characteristic feature of locally advanced solid tumors resulting from an imbalance between oxygen (O(2)) supply and consumption. Major causative factors of tumor hypoxia are abnormal structure and function of the microvessels supplying the tumor, increased diffusion distances between the nutritive blood vessels and the tumor cells, and reduced O(2) transport capacity of the blood due to the presence of disease- or treatment-related anemia. Tumor hypoxia is a therapeutic concern since it can reduce the effectiveness of radiotherapy, some O(2)-dependent cytotoxic agents, and photodynamic therapy. Tumor hypoxia can also negatively impact therapeutic outcome by inducing changes in the proteome and genome of neoplastic cells that further survival and malignant progression by enabling the cells to overcome nutritive deprivation or to escape their hostile environment. The selection and clonal expansion of these favorably altered cells further aggravate tumor hypoxia and support a vicious circle of increasing hypoxia and malignant progression while concurrently promoting the development of more treatment-resistant disease. This pattern of malignant progression, coupled with the demonstration of a relationship between falling hemoglobin level and worsening tumor oxygenation, highlights the need for effective treatment of anemia as one approach for correcting anemic hypoxia in tumors, and in so doing, possibly improving therapeutic response.
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              Cancer as a metabolic disease

              Emerging evidence indicates that impaired cellular energy metabolism is the defining characteristic of nearly all cancers regardless of cellular or tissue origin. In contrast to normal cells, which derive most of their usable energy from oxidative phosphorylation, most cancer cells become heavily dependent on substrate level phosphorylation to meet energy demands. Evidence is reviewed supporting a general hypothesis that genomic instability and essentially all hallmarks of cancer, including aerobic glycolysis (Warburg effect), can be linked to impaired mitochondrial function and energy metabolism. A view of cancer as primarily a metabolic disease will impact approaches to cancer management and prevention.
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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, USA )
                1932-6203
                2013
                5 June 2013
                : 8
                : 6
                : e65522
                Affiliations
                [1 ]Department of Molecular Pharmacology and Physiology, University of South Florida, Tampa, Florida, United States of America
                [2 ]Department of Biology, Boston College, Chestnut Hill, Massachusetts, United States of America
                China Medical University, Taiwan
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Conceived and designed the experiments: AMP TNS DPD. Performed the experiments: AMP CA DPD. Analyzed the data: AMP TNS DPD. Contributed reagents/materials/analysis tools: TNS DPD. Wrote the paper: AMP TNS DPD.

                Article
                PONE-D-12-40282
                10.1371/journal.pone.0065522
                3673985
                23755243
                f1f2b19f-8ffa-4afe-b269-57553e6e5953
                Copyright @ 2013

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 20 December 2012
                : 2 May 2013
                Page count
                Pages: 9
                Funding
                This work was supported by the Office of Naval Research, ONR grant N000140610105 and ONR-DURIP equipment grant N000140210643 ( http://www.onr.navy.mil/). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Biology
                Anatomy and Physiology
                Physiological Processes
                Energy Metabolism
                Biochemistry
                Lipids
                Lipid Metabolism
                Metabolism
                Carbohydrate Metabolism
                Oxygen Metabolism
                Chemistry
                Organic Chemistry
                Organic Compounds
                Ketones
                Medicine
                Nutrition
                Oncology
                Basic Cancer Research
                Metastasis
                Tumor Physiology
                Cancer Risk Factors
                Nutritional Correlates of Cancer
                Cancer Treatment
                Cancers and Neoplasms

                Uncategorized
                Uncategorized

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