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2016 ; 9
(ä): 122
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gab.com Text
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Tumor Metabolism, the Ketogenic Diet and ?-Hydroxybutyrate: Novel Approaches to
Adjuvant Brain Tumor Therapy
#MMPMID27899882
Woolf EC
; Syed N
; Scheck AC
Front Mol Neurosci
2016[]; 9
(ä): 122
PMID27899882
show ga
Malignant brain tumors are devastating despite aggressive treatments such as
surgical resection, chemotherapy and radiation therapy. The average life
expectancy of patients with newly diagnosed glioblastoma is approximately ~18
months. It is clear that increased survival of brain tumor patients requires the
design of new therapeutic modalities, especially those that enhance currently
available treatments and/or limit tumor growth. One novel therapeutic arena is
the metabolic dysregulation that results in an increased need for glucose in
tumor cells. This phenomenon suggests that a reduction in tumor growth could be
achieved by decreasing glucose availability, which can be accomplished through
pharmacological means or through the use of a high-fat, low-carbohydrate
ketogenic diet (KD). The KD, as the name implies, also provides increased blood
ketones to support the energy needs of normal tissues. Preclinical work from a
number of laboratories has shown that the KD does indeed reduce tumor growth in
vivo. In addition, the KD has been shown to reduce angiogenesis, inflammation,
peri-tumoral edema, migration and invasion. Furthermore, this diet can enhance
the activity of radiation and chemotherapy in a mouse model of glioma, thus
increasing survival. Additional studies in vitro have indicated that increasing
ketones such as ?-hydroxybutyrate (?HB) in the absence of glucose reduction can
also inhibit cell growth and potentiate the effects of chemotherapy and
radiation. Thus, while we are only beginning to understand the pluripotent
mechanisms through which the KD affects tumor growth and response to conventional
therapies, the emerging data provide strong support for the use of a KD in the
treatment of malignant gliomas. This has led to a limited number of clinical
trials investigating the use of a KD in patients with primary and recurrent
glioma.